PRACTICAL FIELD SIMULATION EXERCISE - BASIC
TRAINING FORM OF THE PREPAREDNESS AGAINST FOOT
AND MOUTH DISEASE
Formerly: Chief, Animal Health Service, Food and
Agriculture Organization of the United Nations; Czechoslovak and Czech Chief
Epizootiologist; Professor Epizootiology,
a) The key problem of successful control of foot-and-mouth disease (FMD) is to detect in time primary outbreak as well as the secondary ones together with immediate isolation of well identified suspect area! This depends on the competence of all who are involved in FMD-susceptible animal species breeding, production and trade, i.e. who are in the “first anti-FMD front line“. All of them should be properly informed and instructed. The decisive role have the veterinarians who are able to recognize the suspect cases, to apply immediate provisional isolation measures avoiding further spread and to inform without any delay relevant veterinary and government authorities realizing follow-up actions. The task is not to repeat the past errors in detecting and controlling the FMD. There are different forms of the veterinary staff preparedness against FMD. One of them is represented by simulation exercises organized by local, national authorities and international organizations.
b) Relatively easy and cheap-to-prepare theoretical and paper “simulation exercises” as well as simple demonstrations to passive watching and listening participants have low effectiveness and the acquired information can be easy forgotten. Better to call them as “information/demonstration simulation” or “opinion/experience exchange workshops” or “simulation seminars” preparing administrative (“armchair”) anti-FMD solutions. In these cases there is not need to work with animals or even to see them. This form is to some extent also useful but not real effective preparedness for practical activities starting always at the field level. It reminds the theoretical exercises of generals without practical field exercises of the decisive factors in any war – well trained solders !
Examples: The above theoretical
“simulation exercises” have been organized by the European Union, European
Commission for the Control of Foot-and-Mouth Disease (EUFMD), etc. The latest
one took place in Tervuren,
Note: Similar theoretical effect can have simple distribution of special instructive videos, DVDs and films or distributing information materials such as instructive brochures containing the anti-FMD instructions, models of emergency plans, specific forms and questionnaires, legislation documents, specific publications, examples of actions, pictures of the FMD and of similar diseases, etc. for individual studying. The available literature sources on the FMD are the richest of all animal infections !
c) Theoretical “simulation exercises” including only limited number of participants can be replaced by modern and more effective electronic simulation exercises, preparedness trainings or workshops using on-line internet communications. The use of electronic tools can provide information and instructions as well as the chance of discussion through the internet when exploiting the best international FMD specialists and the most suitable audio-video instructive material. This kind of electronic exercise has multiplying effect due to great number of participants.
Example: One of the first electronic workshops was organized by the FAO in 2000 (from 18 September to 27 October) dedicated to land and water problems: “Key questions addressed in the workshop were outlined in an introductory note. Supporting documents included two discussion papers, five background papers and 31 case studies. There were 471 participants (!), 38 of whom made contributions, comments and suggestions for future activities. The interventions were summarized on four occasions as the workshop proceeded. A full documentation of the workshop material was included in a CD”.
d) The preparedness against the extremely dangerous and rapidly spreading disease such as the FMD cannot be based on paper work and bureaucratic formalism or on using non-sense software modelling the extremely complex and dynamic biological process under particular conditions being in all cases different.
Example: The application of
very specific theoretic software called EPIMAN-FMD “for FMD control” developed
in New Zealand and bought also in the European Union contributed to
catastrophic outcome of the United Kingdom 2001 FMD panzootics (e.g. daily
e) The above mentioned theoretical “simulation exercises” strongly underestimate the fact that any effective anti-FMD measures must be based on f i e l d clinical and epizootiological investigations to reach reliable diagnosis confirmed virologically. Without very good knowledge of the local and territorial FMD situation the anti-FMD measures can be applied only by “blind” or “semi-blind” decision-makers “shooting at random”. The results of the field investigations start the anti-FMD measures exploiting in-advance-prepared emergency plans, legislation and instructions as well as other relevant components (used also in the theoretical “simulation exercises”). The field investigation represents the first and decisive step of any effective anti-FMD actions while the measures represent the follow-up second step !
There is not any doubt that also theoretical “FMD simulation exercise” of anti-FMD has its importance, however, if not combined with field investigation training it conduces to very dangerous distraction from the main problem of anti-FMD preparedness. Unfortunately, the theoretical “paper exercise” of managerial/administrative procedures, isolated from field investigations’ training, creates general false impression of anti-FMD “preparedness”.
f) We have to consider very bad experience gained in the recent FMD panzootics. The catastrophic consequences were caused mainly due to absolute absence of practical preparedness of veterinary manpower. Almost all veterinary faculties and postgraduate trainings in the world are preparing the veterinarians mainly for small animal practice – pet animal medicine and food-producing large animal practice is strongly underestimated. The teaching in anti-infection preparedness is too theoretical giving minimum or zero attention to practical skills. Private veterinarians having rich experience of small animals as well public service veterinarians accustomed to work in offices (mainly with the computers) were often not able to investigate clinically the animals of FMD susceptible species due to lacking necessary skills or due to having fear of hard work with large animals or being not willing to work under very difficult and often unhygienic environmental conditions. The majority of these veterinarians were not prepared (unable) to investigate properly all FMD-predilection body areas such as mouth cavity and tongue as well interdigital spaces. Many veterinarians were even not able to catch and fix the animals, mainly when these were not stalled fastened or having free movement on pastures. A lot of the veterinarians were even not able to open the mouth and to pull out the tongue (basic clinical method for FMD investigation !) not only in cattle but also in sheep, goats and pigs, not mentioning the difficult investigation of their young categories.
g) Clinical investigation of suspected and threatened herds represents very hard work, mainly when lacking necessary supporting staff. Therefore, the FMD was frequently not detected in time or ignored or misdiagnosed. The veterinarians were very often not able to correctly identify the focal and perifocal limits and to apply adequate anti-FMD measures due to investigating only very limited number of animals. Due to investigating minimal number of animals there were established incorrect limits of the outbreak and perifocal zones and applied incorrect anti-FMD measures. These zones were usually identified by guesswork either too small or too large. Scientific and the most effective anti-FMD measures can be apllied only when systematically and properly investigating all diseased, suspect and threatened animals. The FMD diagnosis of animals specifically diseased, suspect and threatened cannot be identified from distance. Anti-FMD actions cannot be successful without hard professional work at grass-root level from the very beginning up to the end of the FMD epizootics.
Example: The worse recent experience has been gained
h) The majority of the veterinarians involved in the anti-FMD campaigns were not able to identify the form of the disease, stage of the epizootics, age of pathologic changes (to identify the eldest specific changes, i.e. to can estimate the moment of FMD virus introduction and thus to identify possible source and introduction way and the destination of eventual disease further spreading) and to select the best possible specimen to be collected and sent to laboratory. *)
i) Important indicator of the preparedness to discover in time primary outbreaks of the FMD is the ratio primary/secondary outbreaks: Taiwan in 1977 = 1 : 6,147, UK in 1967/68 = 1 : 2,364; UK in 2001 = 1 : 2,030, Greece in 1994 = 1 : 94, Netherlands in 2001 = 1 : 26; European Union in 1977-1987 average = 1 : 54; Europe in 1991-2000 average = 1 : 10,5. (OIE, FAO, DAVIES). These examples document very late discovery and blockade of the primary outbreaks due to weak or not existing effective anti-epizootic surveillance at field level and due to lack of necessary number of well trained veterinary professionals.
j) Above mentioned examples show enormous difficulties to detect in time introduced diseases in spite of the fact that the FMD belongs among diseases with clinical manifestation more expressed than in the majority of important communicable animal diseases. There are not two identical cases, i.e. every case is different ! The FMD has different forms: from sudden death, peracute, acute, subacute, chronic and subchronic course up to asymptomatic “virus carrier”.
k) The majority of the veterinarians involved in the anti-FMD campaigns were not able to carry out necessary epizootiological investigations to answer the basic questions: what, where, when, why, how, how many ? They were not able to determine: diseased, epizootiologically suspect (contacts), directly threatened and indirectly threatened (each of these epizootiological characteristics requires different diagnostic approach and control measures such as intrafocal isolation and selection for immediate slaughter-destruction animals. They were not able to determine the limits of affected place (outbreak) as well as of perifocal zone and to dictate provisional outbreak isolation measures as well as intrafocal and perifocal provisional emergency measures.
l) Considering the FMD epizootiological situation, intensive long-distance international trade in animals and animal products as well as very bad experience in controlling this extremely dangerous animal disease, it can be stated that the world veterinary staff is not adequately prepared for the FMD emergency ! No any international organization and no any veterinary faculty is organizing particular anti-FMD training programmes through intensive practical field simulation exercises based on clinical and epizootiological investigations of animals. Theoretical/paper preparedness in case of the FMD = no preparedness !
More information see in http://vaclavkouba.byl.cz/emergency.htm.
*) Note: Often in real cases many animals must be examined before sufficient quantity of adequate material suitable for laboratory investigation is collected.
k) The most effective anti-FMD preparation of veterinary manpower is practical field simulation exercise applying the principle “learning by doing”, i.e. training the skills difficult to forget. ¨
Even the Old Romans knew that “Usus magister est optimus” (“Practice makes perfect”).
l) This paper is based on available international simulation exercises’ reports and on author’s national and international experience with FMD control and eradication as responsible epizootiologist and with practical field FMD-simulation exercises as their instructor.
The main objectives of FMD simulation practical field exercise consist in achievement that the participants under emergency situation:
a) will know how and be able to carry out clinical diagnosis after investigating all FMD- predilection body areas of susceptible species animals of different categories (incl. young animals);
b) will know how and be able to carry out epizootiological diagnosis, after considering anamnesis information, results of clinical investigations and investigating local situation, i.e. to identify affected, suspect, contact and threatened animals and their areas/premises, limits of potential outbreak, intrafocal structure and perifocal zone as well as to predict the likely spread;
c) will know how and be able to identify FMD-free animals, herds and areas;
d) will know how and be able to identify and dictate provisional measures to isolate the suspect outbreak and perifocal zone;
e) will know how and be able to find out animal(s) with the best FMD-suspect pathologic changes for sample collection and to pack the suspect tissues and liquids in proper way for sending them to diagnostic laboratory (with respective accompanying documents);
f) will know how and be able to find out animal(s) with the eldest FMD-suspect pathologic changes to can estimate the date of FMD virus introduction and the disease duration (critical period of possible spread outside of suspect area);
g) will know how and be able to trace the origin and introduction way of the FMD as well as eventual spread from the given outbreak (considering movement/transfer of animals, products, equipment and material, movement of persons including vet. practitioners, etc.);
h) will know how and be able to elaborate simple maps (schemes) of the suspect outbreak and perifocal area limits and their epizootiological structure;
i) will know how and be able to carry out biological test on the spot for provisional differentiation of eventual FMD and other vesicular diseases;
j) will know how and be able to identify specific intrafocal initial sanitation (disinfection) measures.
a) The participants (trainees) should be of similar managerial, technical and experience levels. The group should represent a relatively homogenous unit which facilitates the work of the teachers. However, the practical field training is similar for all types of participants who should finish the exercise with necessary practical skill to investigate suspect animals and to identify local epizootiological situation.
b) Due to the fact that any veterinarian, namely working in field practice and slaughterhouses, can be the first in contact with primary FMD outbreak as well as the secondary ones, there is an urgent need that all of them to be properly trained under simulated emergency conditions. They represent the “first front line defence”. A l l veterinarians, i.e. not only of public services but also private veterinarians (not only accredited ones) being in contact with FMD susceptible species animals, should pass this postgraduate practical training programme. Veterinary faculties should include this kind of field practical simulation exercise as a normal component of undergraduate programme for last year students. Also veterinarians – university teachers of veterinary faculties should be trained to be prepared for their eventual involvement in anti-FMD emergency actions in the country.
c) Among the first participants should be leading officers of public veterinary service beginning with Chief Veterinary Officer. They should know how and be able to investigate FMD-suspect animals/herds, to reject or confirm FMD suspicion and to carry out local epizootiological diagnosis. They should know how difficult is to investigate thoroughly the suspect (diseased) herds, outbreak and perifocal areas and what is required for this kind of activity. This knowledge is extremely useful for effective management in case of real FMD control actions at territory or country levels.
d) Number of participants depends on local conditions. The most important is the requirement that the teacher should be able to manage properly the exercise dedicating maximum of time to the participants when investigating animals, herds and surrounding area. His role is namely initial demonstration following by supervision of the participant work and providing necessary consultations.
Example: In my practical FMD simulation field exercises the participants were usually subdivided in four small groups with 4-5 participants. In each group one trainee was selected to be responsible for his group activities, i.e. for assuring the implementation of the particular programme as scheduled. Usually, one participant was investigating and other one was writing down the findings (results) in a simple protocol for follow-up evaluation. Then the role of individual participants and the groups was changed (rotated) in order that everybody passed all components of the training.
a) Successful practical field simulation exercise requires the teachers (trainers or instructors) to be the best possible international specialists for international simulation training and the best possible national specialists for national simulation training, i.e. fully competent in clinical investigation of FMD-susceptible species animals and in field epizootiological investigation of particular diseases. The priority to be given to those having personal practical experience of the FMD and with the management of simulation exercises in the field. Unfortunately, they are not always available (they are not many).
b) International field simulation training should be organized by relevant international organizations for the future national teachers to be well prepared for national practical field simulation exercises. The instructors of these courses to be the best in the world having practical experience with FMD field diagnosis and control. The multiplying effect consists in applying the principle “teaching teachers to teach”.
c) Similarly, at national level should be trained first future teachers to transfer the knowledge and experience to the others using local language considering local conditions.
d) It is recommendable the teacher to be assisted by somebody (at least by one assistant) being responsible for the exercise organization, management and solution of non-professional problems. The teacher should have all necessary conditions to can concentrate his effort on professional programme only.
5. Place and duration
a) The selection of suitable place depends on local availability of FMD-susceptible species animals such as cattle, pigs, sheep or goats and on the agreement with the animal owners and local authorities.
b) For practical FMD field simulation exercise it can be selected any place in livestock husbandry, slaughterhouses or villages according to local conditions The most suitable location is a major farm (herd) or ranch belonging to universities or other education institutions where the animals are kept for teaching purposes. From economic point of view it is usually cheaper to use farms or ranches belonging to state, local government or agriculture cooperatives than to private profit-oriented owner.
c) The animal owners and local authorities in simulated outbreak area and perifocal zone must be informed in advance and agree with this kind of training, i.e. to permit the entrance and investigative work to be carried out by the participants. The animal owner should agree with answering anamnesis questions. The answers should be as much as possible real or simulated (following previous instruction of the teacher).
d) The duration of the exercise depends on the particular programme considering the time needed for all participants to pass all component of the training.
Example: In my practical field simulation exercises the minimum duration was 3 days. One day was dedicated to detailed information on FMD and similar diseases and to exercise introduction, one or more days to the proper individual field work (investigations and measures) and one day to exercise evaluation.
6. Organizational preparation
a) The practical field simulation exercise must be well prepared also materially, i.e. to be available in sufficient quantity: protective clothing, boots, gloves, equipment for animal fixation (lassos, nose leads, hog holders, etc. ), mouth openers, short wooden sticks, specula for mouth investigations, cloth/towels (for fixing the tongue), flashlights with batteries, veterinary thermometers, large and small oesophageal-pharyngeal sample collectors (probang cups), equipment (kit) for specimen collection, packing and transport (surgical scissors, vials, syringes, needles, etc.), brushes for cleaning interdigital cleft of the feet, equipments for cleaning and disinfection (including disinfectants), buckets, communication equipment, instruments for eventual local slaughter, maps (local and territorial), anamnesis questionnaire, forms for findings’ annotation (clinical and epizootiological investigation protocols) and for reporting; writing tools; first aid kit, paper towels, etc.
Note: Using video camera documenting the exercise for its evaluation has proved to be very helpful.
b) The equipment for the restraint of animals, such as races, crushes, pens etc. are necessary to facilitate clinical investigation and collection of sample material.
c) Also in the cases when not all above mentioned materials are available, the practical field FMD-simulation exercise should be performed. Under real emergency it cannot be expected ideal conditions and availability of all above mentioned tools for the investigations. Therefore the participants should be trained for extraordinary situation using improvised simple tools and methods.
d) Very important is the selection of the animals for the exercise. The teacher should visit in advance the place and the herds selecting animal groups of different FMD-susceptible species and their different categories suitable for the exercise. Priority attention should be given to sick animals, animals prepared for culling and animals of lowest value for the owner. It is recommendable the teacher to find out himself the animals with pathologic changes (if any) on FMD-predilection body areas what can be used for FMD differential diagnosis explanation. The participants, without being informed in advance, should try to find these animals themselves investigating all the herd.
e) It is advantageous to have some animals with clinical symptoms similar (naturally or artificially) to vesicular diseases.
Note: Exceptionally, in agreement with animals’ owner, I used chemically provoked artificial changes similar to FMD lesions in some selected animals (e.g. non healthy animals of low value destined for premature culling) in a major herd. The participants were not informed and they must search for them using clinical investigations and find them. The findings served also for differential diagnosis analysis. The lesions similar to FMD were provoked through the inoculation of pure turpentine essence (intradermic about 0.05, maximum 0.1 ml) in the tongue, lips, etc. The changes resembling the vesicles development disappeared under normal conditions during about one week.
f) The interference in current local animal operation and production must be avoided as much as possible. Clinical investigations must be performed very carefully, i.e. without injuring the animals.
g) It is obvious that organizational preparations include also participants’ accommodation, catering and transport.
7) General introduction
a) The exercise should be introduced by detailed information and discussions on FMD situation in the world, region and country, on FMD introduction risk, on FMD characteristics, detailed clinical investigation and diagnostic procedures, on detailed epizootiological investigation and diagnostic procedures, on differential diagnosis comparing FMD with other diseases, on pathologic changes which could be confused with FMD, etc. The use of colour slides, films, videos, etc. is obvious. The use of disease recognition multimedia software is welcome. The attention to be given also to the intrafocal and perifocal measures and to anti-FMD preparedness.
b) All participants should be provided by relevant documents, instructions, brochures (manuals with colour pictures) with detailed description of the FMD and similar diseases, etc. as well as by the forms for anamnesis data recording and by the protocols for clinical and epizootiological investigations.
8) Field exercise introduction
a) Initially the participants should be acquainted with the exercise objectives, methods, location, organization, management, tasks of individual participants and groups, working conditions, forms of evaluation and final examination.
b) The exercise should start with dramatization of hypothetic situation of the suspect occurrence of the FMD to sensitize the participants. The teacher should describe fabricated alarming history of FMD suspicion providing as much as possible details important for the exercise. There are not any limits for the teacher fantasy when respecting logic, disease epizootiology and local conditions. Simulation should be as real as possible.
c) The teacher should describe in details simulated situation (suspicion of FMD outbreak) using simulated information of the animal owner on: the disease occurrence, frequency, losses and duration; size and structure of local animal populations; animal health situation inside of the farm and in the neighbourhood; provisional measures applied, etc.
d) The teacher should explain in details the field activities under simulated conditions, describe in details all exercise objectives (as mentioned above) and the methodology for their reaching. Particular attention to be given to clinical investigation/diagnosis of individual FMD-susceptible animal species and categories, to detailed procedure of epizootiological investigations, to the selection of the most suitable samples and to the methods of packing for sending them to the laboratory. The participants should be instructed also on field biological tests.
e) The teacher should identify places and timing for total and partial activities, explain rotation system of the groups and provide a map or scheme of the area indicating places and time of particular field practical activities (use of notice board).
f) The teacher should inform on the most frequent errors and deficiencies when implementing individual objectives of the exercise.
g) It is recommendable that the participants obtain a list of their tasks, to avoid misunderstandings during the training, and eventually some data on the place, timing and organization of the field exercise.
h) The participants should be instructed how to identify investigated animals, how to note the findings and how to formulate the recommendations for the measures to be applied (for follow-up analysis and evaluation).
i) In other words, the participants should be properly instructed in time to can start practical field exercise without any delay due to a gap in initial instructions (not to waste time allocated for practical field work).
9) Starting practical field simulation exercise
a) Task declaring:
Reject or confirm FMD suspicion, identify the limits of simulated outbreak and perifocal zone and apply provisional anti-FMD measures in and around simulated outbreak area.
b) First step of the exercise on the spot should be immediate simulated isolation of the farm or other place (to be provisionally visibly marked, e.g. by warning placard) with simulated suspect animals following by immediate simulated reporting to relevant local veterinary authorities and by immediate thorough investigation of the suspect animals (without wasting time with paper work that drags away from the key activity).
c) The participants should be divided in smaller groups and indicated on starting time for particular investigations and rotation of the groups. Considering local conditions the grouping and exercise group location and timing should be flexible as much as possible to facilitate to fulfil the exercise tasks. The exercise organization depends on local conditions, number of participants and groups, availability of suitable animals, time and space conditions, supporting staff, communication facilities, etc.
d) Applying the principle of “learning by doing” requires that every participant should clinically investigate (thoroughly all FMD-predilection areas of the body) several animals of all available FMD-susceptible species and their categories and based on epizootiological investigations identify the limits of simulated outbreak and perifocal area and suggest concrete measures (to be later discussed with the teacher). The complicated conditions, faults and difficulties serve also for participants’ learning.
The anamnesis provided by the owners proved to be extremely useful for veterinary specialists investigating the case at the very beginning, i.e. immediately after obtaining the report on the suspicion. The participants should ask animal owner(s) or animal caretaker(s) or other informed person(s) about simulated suspicion, diseased animals, previous and current contacts of animals and persons with outside places, previous introduction and transfer of animals to other places, etc. The answers can be real or prepared in advance based on fabricated situation. The participants should note anamnesis information.
Note: Under real emergency the anamnesis information must be professionally verified..
Detailed anamnesis of selected 31 primary FMD outbreaks are described in K o u b a (1961) publication (PhD thesis). These texts based on real situations represent useful tool for starting FMD simulation exercises, instead of artificial theoretical paper anamnesis.
11) Clinical investigation
a) The clinical investigation is the key method
for implementing the tasks under the paragraphs 2a - 2f facilitating to
identify correctly all anti-FMD measures. The field practical diagnosis is
decisive for any anti-FMD control and eradication programmes, without regard to
management levels. Bad experience with theoretical approach isolated from the
reality causing enormous losses is a warning phenomenon! When replacing the
clinical investigation by only a demonstration for watching participants, the
simulation exercise is losing its sense and effect (= wasting time and money).
Everybody can study the FMD problems (books, legislation, instructions,
internet, etc.) at home, but practical training to get necessary grips cannot
be replace at all. Paper exercise is easier for the organizers but with minimal
or without practical effect in case of real FMD occurrence. The participants of
“paper simulation exercise” having fear
to properly investigate suspected animals were often giving the priority to
solve FMD epizootics in offices without seeing the animals and to use different
mathematical theoretical models. This “armchair approach” has caused enormous
losses during recent panzootics in
More information in http://vaclavkouba.byl.cz/biodisaster.htm
Practical problem solution of real FMD starts in the field and ends in the field !
b) The clinical investigations start with the animals indicated by the simulated anamnesis as being suspect (diseased).
c) Simultaneously, the participants should observe all susceptible animals on the premises by walking among the animals in their normal habitat. Those lying down should be required to get up and move, in order to observe any lameness or weakness. The animals should be observed closely for lacrimation, salivation, nasal discharge, increased respiration, shaking feet and other abnormalities. In dairy cows sudden reduction of milk production must be also considered. Sometimes it is useful to carry out a “feeding test” in order to observe any anorexia. Those animals showing suspicious sign should be restrained and a careful physical examination made before investigating the other ones.
d) Among FMD-predilection body areas to be investigated by all the participants are: mouth cavity (with and without mouth opener and nose lead), i.e. tongue (dorsum up to its root, base and lateral sides), upper and lower lips, gums, hard and soft palate, other oral cavity surface, nostrils, surface of the nose (muzzle, snout of pigs), coronary band, corium of dewclaws in pigs, interdigital spaces, teats and udder of cow, sow, ewe and she-goat. Particularly difficult are the investigations of the mouth cavity of young animals – calves, piglets, lambs and kids. FMD has frequently been ignore or misdiagnosed in small ruminants. In some real FMD cases in small ruminants the lesions are located only at the root of the tongue as small vesicles or shallow erosions, i.e. not easy to discover them. The measurement of animal temperature is obvious.
Caution should be exercised to prevent damage to the mucosal membranes!
e) The most important principle of the practical field simulation exercise is that every participant thoroughly investigates as much as possible animals of all FMD-susceptible species and their basic categories !!! The participants should gain a skill of clinical investigation of animals of FMD-susceptible species and of timely discovery of vesicular disease suspect cases.
Note: In reality the vesicles are not pathognomic for FMD alone, since they are also associated with vesicular stomatitis, vesicular exanthema of swine and swine vesicular disease. Classical vesicular lesions may not be found. When they occur they usually rupture leaving eroded, haemorrhagic, granular mucosal surface of the mouth and nose, as well as the skin, epithelial tissues of the feet and other regions. In swine, sheep and goat the lesions on the tongue are usually small easy to be overlooked. In rare cases lesions of the perineum, vulva or scrotum are seen. Tiger heart (grey, white, or yellowish myocardial lesions) may be found in calves or in sudden death of other categories. FMD has enormous number of clinical and epizootiological forms from peracute deadly course to mild one up to sub-clinical infection and carriers (e.g. in vaccinated animals).
f) Mass clinical investigations (e.g. of hundreds of animals) are usually very laborious, mainly in the herds of free-ranging animals. The difficulties are multiplied by insufficient staff for animal catching and fixing, bad hygienic conditions, etc. The participants should be trained to work also under these conditions to be able to replace missing supporting staff when the emergency will require.
Note: The participants should be trained to investigate the cattle mouth after pulling out the tongue when fixing the head by nose lead and using mouth opener and also without them.
g) Similar demanding clinical investigation is also key method for confirmation that the animal is free of FMD changes what is very important for identification of perifocal and threatened zone limits as well as for animal transfers, national and international trade and slaughterhouse inspection. This methods is also used when deciding about the application of the “stamping out” to be sure that the slaughter of all intrafocal animals will represent the end of the local FMD thanks to the confirmation of FMD-free status in perifocal area and in threatened zone. Without clinical investigation identifying correctly the perifocal limits very often the “stamping out” method didn’t block the FMD spread and the measures becoming “semi-blind” or “blind”. Clinical investigation cannot be replaced by any “paper/armchair” method.
Example: In October 2010 an
international team linked to the EU – TA
for Communication Campaign and Preparation Country Dossier for OIE Declaration
for FMD - presented to
The diagnosis (confirmation) of specific health is often much more difficult than the diagnosis (confirmation) of specific disease !
12) Differential diagnosis
a) It should be taken into consideration that every case of the FMD has different clinical and epizootiological picture including atypical courses (e.g. FMD without typical vesicles) ! There are not two identical cases ! The knowledge of differential diagnosis is of extreme importance.
b) Usually, when investigating herds with major number of animals, it can be found some clinical signs such as excessive salivation, smacking of the lips, traumatic lesions of the mouth, lameness, foot-rot, animal stamping its feet, interdigital space erosion/excoriation, interdigital panaritium, lassitude, pyrexia, anorexia, wounds, burns, abscesses, bovine papular stomatitis, mycotic stomatitis, tongue actinomycosis, pseudovariola, mastitis, reduced lactation, phototoxic dermatitis, pathologic changes caused by chemical irritants and by scalding, etc., These changes can serve for FMD differential diagnosis to be explained by the teacher and eventually for specimen collection.
c) Among internationally notifiable FMD similar diseases belong: vesicular stomatitis, vesicular exanthema of swine, swine vesicular disease, rinderpest, peste des petits ruminants, mucosal disease, IBR/IPV, bovine malignant catarrh, contagious pustular dermatitis in sheep and goats, bluetongue, sheep pox, goat pox, , etc.
d) Late discovery of the FMD caused its further spread and in some cases even by the veterinarians themselves who continued in their work and visited other herds not only in the same village. This is the worse what can happen to veterinary service. Therefore, there is a need to be always very careful, i.e. always to consider first the possibility of FMD suspicion and after rejecting it to continue to finish the case diagnosis. There is much more responsible and acceptable to make mistake in expressing the suspicion of FMD existence, applying provisional isolation measures and alarming the authorities, than vice versa ! The worse is to start with indecisive speculation and theoretical “philosophy” letting the disease to spread instead to apply immediate provisional isolation measures and thus providing necessary time for diagnosis finalization.
Examples of real FMD cases initially falsely diagnosed by field veterinarians as: rachitis, osteomalacia, rumen foreign body, sudden change of feed, toxicosis by seed cakes, constipation, vesicular disease of swine, pneumonia, suspicion of toxicosis, unknown infection disease, postvaccination complications, alimentary intoxicosis, stomatitis mycotica, stomatitis papulosa, bovine malignant catarrh, stachybotryotoxicosis alternans, mucosal disease, panaritium, etc.
e) Sometimes, at the end of the exercise, we slaughtered one diseased calf not suitable for further breading and investigated also its internal organs looking for pathologic changes in gastrointestinal places (mainly rumen pillars) and myocardium.
f) In my exercises usually all work was done by the participants themselves without the help of the farmers or workers who under real emergency not always will be available in necessary number and of relevant competence. The veterinarians themselves should be able to catch and fix the animals. Fixing all animals of major herds and their clinical investigations is physically very demanding work.
13. Epizootiological investigations
a) Epizootiological investigation and diagnosis should answer the questions: what, where, when, why, how, how many?
b) Epizootiological investigation on the spot supported by anamnesis information and clinical investigations should determine (identify):
- animals specifically diseased, clinically suspect, epizootiologically suspect (contacts), directly threatened and indirectly threatened (each of these epizootiological characteristics requires different diagnostic approach and control measures);
- limits of affected place (outbreak) and of perifocal zone;
- form of the disease, stage of the epizootics, age of pathologic changes (to identify the eldest specific changes, i.e. to can estimate the moment of FMD virus introduction and thus to identify possible source and introduction way and the destination of eventual disease further spreading);
- movement of animals and their products inside of simulated suspect place and in the simulated perifocal zone as well as their movement to other places during last critical period;
- animals for intrafocal isolation, animal for immediate slaughter (destruction, deactivation);
- the best possible specimen to be collected and sent to laboratory *);
- provisional outbreak isolation measures as well as intrafocal and perifocal provisional emergency measures;
- employees having FMD-susceptible animals at home (for further investigation and observation);
- burial site and needs for local sanitation, i.e. critical places, disinfectant types, concentration and quantity;
- prognosis of disease development;
- needs for further measures and provision of staff, material, transport, logistic etc.;
- regime of systematic observation and further investigations (surveillance), etc.
c) Perifocal epizootiological analysis is based upon anamnesis, clinical investigation of FMD-susceptible animals and evaluation of disease spread facilitating conditions in surrounding zone of simulated outbreak.
d) Results of local epizootiological investigations represent the basis for any effective anti-FMD measures at all managerial levels.
e) The participants after finishing epizootiological investigations should recommend necessary intrafocal and perifocal concrete measures in written form (including scheme) to fit to simulated situation and local conditions. The recommendations to be presented for comments and for final evaluation of the exercise.
*) Note: In real cases often many animals to be examined before sufficient quantity of adequate material suitable for laboratory investigation is collected.
14) Selection and collection of specimen for laboratory investigation
The exercise should include the selection and collection of suitable specimen, its packing and preparation for shipment to laboratory. Not always are available suitable specimens such as lesions scrapings or epithelial flaps. In any case every participant should be trained in extracting oesophageal-pharyngeal fluid for laboratory investigations using probang method.
15) Field biological test on the spot
The simulations exercise under my responsibility was usually ended by training in biological comparative test on the spot which could be sometime useful before etiological diagnosis is finalized. For the simulated test was usually used simulated inoculation (symbolically or using minimal dosis of sterile physiological solution) into tongues of cattle, sheep or goat, pig and horse. However, laboratory confirmation is always necessary.
Note: Under real conditions the inoculation of susceptible horses, swine and cattle (brought from region distant from the outbreak) with suspect material may be helpful in differentiating one vesicular disease from another. All three of the species are susceptible to vesicular disease; cattle and swine are susceptible to FMD; swine alone respond to swine vesicular disease and vesicular exanthema of swine. Vesicular stomatitis is a disease of horses, cattle and swine.
16) Evaluation of the exercise
a) Final day should be dedicated to detailed critical analysis of the exercise and to concrete evaluation of individual participant work commenting on eventual deficiencies to be corrected. Availability of video pictures facilitates the exercise evaluation.
b) The suggestions for the intrafocal and perifocal measures to be discussed and critically evaluated.
c) The participants should prove their new competence by particular examination.
d) The exercise should finish with certificate handover.
e) The exercise effectivity grade depends on professional background and responsibility of the participants, competence and experience of the teachers, training preparation, organization and management, consistency of the implementation of all tasks, discipline of the participants, local working conditions (mainly on the number of animals of different species and categories for investigation), support of animal owners, etc.
The methodology of FMD simulation practical field exercise can serve also as a model for similar practical field simulation exercises directed to other very dangerous animal diseases.
- GAY GUTIÉRREZ, J. (1984): Ejercicios de simulación y su importancia en el desarrollo y evaluación de los sistemas de emergencia en salud animal. Oficina Regional de la FAO para America Latina y el Caribe, 12 pp.
- FAO/EUFMD (1990): Report on
seminar on emergency action against foot-and-mouth disease (
- FAO/EUFMD (2001). Report on
the Joint EUFMD/EC Workshop on Foot-and-Mouth Disease Simulation Exercise, 5-7
- KOUBA, V. (1961): Analysis of foot-and-mouth disease in
- KOUBA, V. (1965): Foot-and-mouth disease – differential diagnosis I. Veterináøství, XV, 6, 241-244 (in Czech).
- KOUBA, V. (1965): Foot-and-mouth disease – differential diagnosis II. Veterináøství, XV, 10, 442-448 (in Czech).
- KOUBA, V. (1969): Foot-and-mouth disease – differential diagnosis III. Veterináøství, XIX, 6, 255-258 (in Czech).
- KOUBA, V. (1985): Epizootiología general. Edición Pueblo y Educación, La Habana, 870 pp.
- KOUBA, V. (2012): Cursos simulacros prácticos (en el campo) sobre fiebre aftosa. http://vaclavkouba.byl.cz/simulacros.ppt
- PANAFTOSA (1981) : Emergency animal diseases eradication manual for the Caribbean with emphasis on foot-and-mouth disease. PAHO, WHO, Brazil , 82 pp.
- PANAFTOSA (1981): Ejercicio
de un brote de fiebre aftosa. Acuerdo de frontera Argentina-Brasil-Uruguay,
- PANAFTOSA/SENASA (2005): Simulacro de brote de fiebre aftosa, Cusco, Peru, 14-18 Febrero 2005.
More information on the principles of preventive and control/eradication measures applicable on FMD see in http://vaclavkouba.byl.cz/textbook.htm.