Contribution of the veterinary profession to the Australian animal health surveillance system and opportunities for future contributions.

Animal health surveillance is crucial for early detection of emergency animal diseases and effective responses. However, surveillance systems are complex and rely on the contributions of many animal health stakeholders. Veterinarians are key stakeholders in this system, given their role and skills in investigating, diagnosing, and reporting notifiable diseases. This study investigated the contribution of the veterinary workforce to the Australian animal health surveillance system and opportunities for future involvement. To achieve the aims of the study, an online cross-sectional survey among the veterinary profession was conducted. Descriptive statistics and regression analyses were used to provide an overview and investigate drivers of attitudes and practices of veterinarians in relation to animal health surveillance. A total of 311 usable responses were obtained, with 191 being from veterinarians who worked in private practice in the previous 12 months. Among private practitioners, 58.6% worked with companion animals, 34.0% were mixed practice veterinarians and 7.3% were equine veterinarians. Over half (56.6%) of all participants considered themselves active participants in the local animal disease management system. The level of confidence in understanding the reporting system and knowing and identifying signs of endemic and exotic diseases was moderate among those working in private practice, with companion animal veterinarians reporting the lowest levels of confidence (p < 0.05). Approximately 40% of veterinarians had taken samples for diagnosis for notifiable diseases in the last year, with just over 20% reporting a notifiable disease. Awareness of and participation in training and surveillance programs for animal diseases by veterinarians was low, with those working in private practice having lower levels of both awareness and participation for most programs. In relation to potential future contribution to the surveillance system, over half of participants reported being interested and available to undertake surveillance work on behalf of the government, with those in mixed practice reporting higher levels of interest (69.6%) compared to those in companion (49.5%) and equine practice (30.8%). However, key challenges identified were related to perceived conflict of interest, and tensions between client needs and government agenda, followed by profitability and suitability of the business. This study provides evidence of a significant existing contribution by the veterinary profession to the surveillance system, and the capacity and willingness to increase this contribution. However, there are gaps in awareness, confidence and participation, as well as financial and veterinary-client relationship challenges that should be considered in any future planning to strengthen the Australian surveillance system.

The right strategy for you: Using the preferences of beef farmers to guide biosecurity recommendations for on-farm management of endemic disease.

Effective on-farm biosecurity measures are crucial to the post-border protection of emerging agricultural diseases and are the foundation of endemic disease control. Implementation of on-farm biosecurity measures are contingent on the priorities of individual producers, which can often be neglected for other aspects of the farming enterprise. The on-farm approach to prevention of endemic diseases, like bovine viral diarrhoea virus (BVDV), is inconsistent between farms and it is not realistic to assume that farmers take an entirely normative approach to on-farm decision making. Multi-criteria decision analysis (MCDA) has been used for disease prioritisation and national disease control in human and animal health; however, it is yet to be used as a decision tool for disease control at the farm level. This study used MCDA to determine the most appropriate biosecurity combinations for management of BVDV, based on the preferences of Australian beef producers. Beef producer preferences were obtained from an online survey using indirect collection methods. Point of truth calibration was used to aggregate producer preferences and the performance scores of 23 biosecurity combinations for control of BVDV based on four main criteria: the probability of BVDV introduction, the on-farm impact of BVDV, the off-farm impact of BVDV and the annual input cost of the practice. The MCDA found that biosecurity combinations that included "double-fencing farm boundaries" used in conjunction with "vaccination against BVDV" were most appropriate for management of BVDV in an initially naïve, self-replacing seasonal single-calving beef herd over a 15-year period. Beef producers prioritised practices that preserved the on-farm health of their cattle more than any other criteria, a finding that was persistent regardless of demographic or farming type. Consequently, combinations with "vaccination against BVDV" were consistently ranked higher than those that included "strategic exposure of a persistently infected cow," which is sometimes used by Australian beef producers instead of vaccination. Findings of this study indicate that the benefits of "double-fencing farm boundaries" and "vaccination against BVDV" outweigh the relatively high cost associated with these practices based on the priorities of the Australian beef producer and may be used to demonstrate the benefits of on-farm biosecurity during discussions between livestock veterinarians and beef farmers.

Australian veterinarians' perspectives on the contribution of the veterinary workforce to the Australian animal health surveillance system.

This study investigated the involvement of private veterinarians in surveillance activities and the veterinary workforce's contribution to the Australian animal health surveillance system. The perception that there is overall a decreased engagement by veterinarians in surveillance outcomes at a time when there is increased need for bolstering of surveillance systems was investigated. Three key questions were considered: (1) What is the current contribution of private veterinarians to the Australian surveillance system? (2) What is the veterinary professions capacity to assume a more prominent role in surveillance? (3) What is the interest and ability of the veterinary profession in Australia to undertake this surveillance role now and into the future? Semi-structured telephone interviews were conducted with 17 private veterinarians with data analyzed qualitatively to identify key themes. Results demonstrate that private veterinarians are aware of their responsibilities and are engaged in surveillance activities at both formal and informal levels. The key challenges associated with current and future contributions were related to workload, remuneration, conflicts of interest and clarity over how responsibility for surveillance is shared amongst those involved in the system. The study has demonstrated that even amongst an engaged population, barriers do need to be addressed if private veterinarians are to be tasked with increasing their involvement in animal health surveillance activities.

On-farm evaluation of a predictive model for Australian beef and sheep producers' vulnerability to an outbreak of foot and mouth disease.

To explore Australian sheep and beef producer vulnerability to an emergency animal disease outbreak, Bayesian Network models have been developed, with the ultimate goal of creating risk management tool for outbreak preparedness. These models were developed using multiple stakeholder elicitation including modelling experts, epidemiologists and on-farm stakeholders, including on-farm/survey data. An evaluation of the model's predictive capacity was conducted, using independent, blinded on-farm vulnerability assessments. Nine properties were visited, four each with sheep and beef enterprises, and one mixed enterprise. There were some discrepancies between the model predictions and on-farm assessment in the beef enterprises, with greater disparity with the sheep properties. Discrepancies between the model predictions and on-farm assessments have created opportunities for examination of the data collection process for the model development, the model itself and the on-farm assessment process. Bayesian Network approaches that allow for the inclusion of both continuous and discrete variables may improve the usefulness of these models, avoiding the loss of nuanced data by the need for discretisation of continuous variables, as will the inclusion of input from on-farm stakeholders in model development. Future work includes more data collection to improve the sensitivity of the model predictions, and a deeper, systemic exploration of the factors that may impact Australian producers' vulnerability to an emergency animal disease outbreak.

Identifying scenarios and risk factors for Q fever outbreaks using qualitative analysis of expert opinion.

Q fever is an important zoonotic disease perceived to be an occupational hazard for those working with livestock. Outbreaks involving large numbers of people are uncommon, but the increasing case incidence coupled with changing environmental and industry conditions that promote transmission of Q fever has raised concerns that large and serious outbreaks could become more frequent. The aim of this study was to use expert opinion to better understand how large Q fever outbreaks might occur in an Australian context and to document factors believed to be drivers of disease transmission. Focus groups were conducted with human and animal health professionals across several Australian states. All discussions were recorded, transcribed verbatim and imported into NVIVO for thematic analysis. Four anthropogenic risk factors (disease awareness, industry practices, land use, human behaviour) and three ecological risk factors (physical environment, agent dissemination, animal hosts) emerged from the data. Analysis of expert opinions pointed to the existence of numerous scenarios in which Q fever outbreaks could occur, many of which depict acquisition in the wider community outside of traditional at-risk occupations. This perception of the expansion of Q fever from occupational-acquisition to community-acquisition is driven by greater overarching economic, political and socio-cultural influences that govern the way in which people live and work. Findings from this study highlight that outbreaks are complex phenomena that involve the convergence of diverse elements, not just that of the pathogen and host, but also the physical, political and socioeconomic environments in which they interact. A review of the approaches to prevent and manage Q fever outbreaks will require a multisectorial approach and strengthening of community education, communication and engagement so that all stakeholders become an integrated part of outbreak mitigation and response.

Using a Bayesian Network Predictive Model to Understand Vulnerability of Australian Sheep Producers to a Foot and Mouth Disease Outbreak.

To maintain and strengthen Australia's competitive international advantage in sheep meat and wool markets, the biosecurity systems that support these industries need to be robust and effective. These systems, strengthened by jurisdictional and livestock industry investments, can also be enhanced by a deeper understanding of individual producer risk of exposure to animal diseases and capacity to respond to these risks. This observational study developed a Vulnerability framework, built from current data from Australian sheep producers around behaviors and beliefs that may impact on their likelihood of Exposure and Response Capacity (willingness and ability to respond) to an emergency animal disease (EAD). Using foot and mouth disease (FMD) as a model, a cross-sectional survey gathered information on sheep producers' demographics, and their practices and beliefs around animal health management and biosecurity. Using the Vulnerability framework, a Bayesian Network (BN) model was developed as a first attempt to develop a decision making tool to inform risk based surveillance resource allocation. Populated by the data from 448 completed questionnaires, the BN model was analyzed to investigate relationships between variables and develop producer Vulnerability profiles. Respondents reported high levels of implementation of biosecurity practices that impact the likelihood of exposure to an EAD, such as the use of appropriate animal movement documentation (75.4%) and isolation of incoming stock (64.9%). However, adoption of other practices relating to feral animal control and biosecurity protocols for visitors were limited. Respondents reported a high uptake of Response Capacity practices, including identifying themselves as responsible for observing (94.6%), reporting unusual signs of disease in their animals (91.0%) and daily/weekly inspection of animals (90.0%). The BN analysis identified six Vulnerability typologies, with three levels of Exposure (high, moderate, low) and two levels of Response Capacity (high, low), as described by producer demographics and practices. The most influential Exposure variables on producer Vulnerability included adoption levels of visitor biosecurity and visitor access protocols. Findings from this study can guide decisions around resource allocation to improve Australia's readiness for EAD incursion and strengthen the country's biosecurity system.

Stakeholder mapping in animal health surveillance: A comparative assessment of networks in intensive dairy cattle and extensive sheep production in Australia.

The capacity to rapidly identify and respond to suspicion of animal disease is fundamental to protecting the integrity of the Australian livestock industry. An incursion of a nationally significant endemic, emerging or exotic animal disease could be disruptive and economically damaging for the industry, broader community and national economy. To counter this potential threat, a surveillance system that includes general and targeted activities exists at a jurisdictional and national level. Such a system requires a collaborative effort from all involved to work towards a common goal, reflecting the notion of shared responsibility. As in all systems, the animal health surveillance system can be enhanced or constrained by the relationships of the players involved. This study focusses on two livestock industries, dairy cattle and sheep, exploring the interrelationships between all stakeholders, and their role within the Australian animal health surveillance system. A stakeholder mapping exercise was undertaken, including a depiction of the perceived level of stakeholder interest and influence on producers' animal health surveillance practices and/or the surveillance system. Results from these activities were expanded upon through interviews. The findings reveal complex networks and a system that is, at times, constrained by institutional and individual barriers such as communication between and within stakeholders, and uncertainty about the consequences of reporting a suspected emergency disease. Whilst these challenges have the potential to negatively impact the robustness of the animal disease surveillance system, the study also provides clear evidence of strong and effective relationships amongst many of the key individuals and organisations.

The goat industry in Australia: Using Bayesian network analysis to understand vulnerability to a foot and mouth disease outbreak.

Australia's goat industry is one of the largest goat product exporters in the world, managing both farmed and wild caught animals. To protect and maintain the competitive advantage afforded to the Australian goat industry by the absence of many diseases endemic elsewhere, it is important to identify the vulnerability of producers to livestock disease incursions. This study developed a framework of producer vulnerability built from the beliefs and practices of producers that may impact on their likelihood of exposure and response capacity to an emergency animal disease (EAD), using foot and mouth disease as a model. A cross-sectional questionnaire gathered information on producer/enterprise demographics, animal health management and biosecurity practices, with 107 participating in the study. The biosecurity measures that were most commonly implemented by producers were always using animal movement documentation for purchased stock (74.7 %) and isolating new stock (73.1 %). However, moderate to low uptake of biosecurity protocols related to visitors to the property were reported. Response capacity variables such as checking animals daily (72.0 %) and record keeping (91.7 %) were reported by the majority of respondents, with 40.7 % reporting yearly veterinary inspection of their animals. Using the vulnerability framework, a Bayesian Network model was developed and populated by the survey data, and the relationships between variables were investigated. Six vulnerability profiles were developed, with three levels of exposure (high, moderate, low) and two levels of response capacity (high, low), as described by producer demographics and practices. The most sensitive exposure variables on producer vulnerability included implementation of visitor biosecurity and control of feral animals. Results from this study can inform risk based perspectives and decisions around biosecurity and surveillance resource allocation within the goat industry. The results also highlight opportunities for improving Australia's preparedness for a future EAD incursion by considering producer behaviour and beliefs by applying a vulnerability framework.

Understanding the vulnerability of beef producers in Australia to an FMD outbreak using a Bayesian Network predictive model.

Effective and adaptable biosecurity and surveillance systems are crucial for maintaining and increasing Australia's competitive advantages in international markets, and for the production of high quality, safe animal products. These systems are continuously strengthened by ongoing government and industry investment. However, a better understanding of evolving disease risks and the country's capacity to respond to these risks is needed. This study developed a vulnerability framework based on characteristics and behaviours of livestock producers that impact exposure and response capacity to an emergency animal disease (EAD) outbreak among beef producers in Australia, with a focus on foot and mouth disease (FMD). This framework articulated producer vulnerability typologies to better inform surveillance resource allocation and future research direction. A cross-sectional study of beef producers in Australia was conducted to gather information on producers' demographics, husbandry characteristics, biosecurity and animal health management practices and beliefs, including those specific to FMD risk and response capacity. A Bayesian Network (BN) model was developed from the vulnerability framework, to investigate the complex interrelationships between variables and identify producer typologies. A total of 375 usable responses were obtained from the cross-sectional study. Regarding EAD exposure, producers implemented appropriate biosecurity practices for incoming stock, such as isolation (72.0 %), inspection for disease (88.7 %) and the use of vendor declarations (78.5 %); however, other biosecurity practices were limited, such as restriction of visitor access, visitor biosecurity requirements or feral animal control. In relation to response capacity, a moderate uptake of practices was observed. Whilst daily or weekly visual inspection of animals was reported by most producers (90.1 %), physical inspection was less frequent. Most producers would call a private veterinarian in response to unusual signs of disease in their cattle; however, over 40 % of producers did not cite calling a government veterinarian as a priority action. Most producers believe an FMD outbreak would have extremely serious consequences; however, their level of concern was moderate and their confidence in identifying FMD symptoms was low. The BN analysis identified six vulnerability typologies, with three levels of exposure (high, moderate, low) and two levels of response capacity (high, low), as described by producer demographics and practices. The model identified property size, number of cattle and exposure variables as the most influential to the overall producer vulnerability. Results from this study can inform how to best use current biosecurity and surveillance resources and identify where opportunities exist for improving Australia's preparedness for future EAD incursions.

Animal Health Management Practices Among Smallholder Livestock Producers in Australia and Their Contribution to the Surveillance System.

The risks posed for disease introduction and spread are believed to be higher for smallholder livestock producers than commercial producers. Possible reasons for this is the notion that smallholders do not implement appropriate animal health management practices and are not part of traditional livestock communication networks. These factors contribute to the effectiveness of passive disease surveillance systems. A cross-sectional study, using a postal survey (n = 1,140) and group interviews (28 participants in three groups), was conducted to understand the animal health management and communication practices of smallholders keeping sheep, cattle, pigs, dairy goats and alpacas in Australia. These practices are crucial for an effective passive surveillance system. Findings indicate that there is a need for improvement in animal health management practices, such as contact with veterinarians and attitudes toward reporting. Results also indicate that these practices differ depending on the livestock species kept, with sheep ownership being associated with lower engagement with surveillance activities and smallholders keeping dairy goats and alpacas having in general better practices. Other factors associated with surveillance practices among participant smallholders are gender and years of experience raising livestock. Despite the differences observed, over 80% of all smallholders actively seek information on the health of their livestock, with private veterinarians considered to be a trusted source. Emergency animal diseases are not a priority among smallholders, however they are concerned about the health of their animals. The finding that veterinarians were identified by producers to be the first point of contact in the event of unusual signs of disease, strengthens the argument that private veterinarians play a vital role in improving passive surveillance. Other producers are also a point of contact for animal health advice, with government agencies less likely to be contacted. The effectiveness of on-farm passive surveillance could be enhanced by developing strategies involving both private veterinarians and producers as key stakeholders, which aim to improve awareness of disease and disease reporting responsibilities.

Willingness of veterinarians in Australia to recommend Q fever vaccination in veterinary personnel: Implications for workplace health and safety compliance.

Q fever vaccine uptake among veterinary nurses in Australia is low, suggesting veterinarians are not recommending the vaccination to veterinary personnel. This study aimed to determine the willingness of veterinarians to recommend Q fever vaccination to veterinary personnel and to identify factors influencing Q fever vaccine uptake by veterinary nurses in Australia. An online cross sectional survey targeted veterinarians and veterinary nurses in Australia in 2014. Responses were analysed using multivariable logistic regression. Factors significantly (p<0.05) associated with a willingness to recommend the vaccination, expressed by 35% (95% CI 31-38%) of veterinarians (n = 828), were (1) being very concerned for colleagues regarding Coxiella burnetii (OR 4.73), (2) disagreeing the vaccine is harmful (OR 3.80), (3) high Q fever knowledge (OR 2.27), (4) working within small animal practice (OR 1.67), (5) disagreeing the vaccine is expensive (OR 1.55), and (6) age, with veterinarians under 39 years most likely to recommend vaccination. Of the veterinary nursing cohort who reported a known Q fever vaccination status (n = 688), 29% (95% CI 26-33%) had sought vaccination. This was significantly (p<0.05) associated with (1) agreeing the vaccine is important (OR 8.34), (2) moderate/high Q fever knowledge (OR 5.51), (3) working in Queensland (OR 4.00), (4) working within livestock/mixed animal practice (OR 3.24), (5) disagreeing the vaccine is expensive (OR 1.86), (6) strong reliance on work culture for biosecurity information (OR 2.5), (7) perceiving personal exposure to Coxiella burnetii to be at least low/moderate (OR 2.14), and (8) both agreeing the vaccine is safe and working within a corporate practice structure (OR 4.28). The study identified the need for veterinarians to take greater responsibility for workplace health and safety promotion, and calls for better education of veterinary personnel to raise awareness of the potential for occupational exposure to C. burnetii and improve the perception of the Q fever vaccine as being important, safe and cost-effective.

Q Fever Knowledge, Attitudes and Vaccination Status of Australia's Veterinary Workforce in 2014.

Q fever, caused by Coxiella burnetii, is a serious zoonotic disease in humans with a worldwide distribution. Many species of animals are capable of transmitting C. burnetii, and consequently all veterinary workers are at risk for this disease. An effective Q fever vaccine has been readily available and used in Australia for many years in at-risk groups, and the European Centre for Disease Prevention and Control has recently also called for the use of this vaccine among at-risk groups in Europe. Little is known about attitudes towards this vaccine and vaccine uptake in veterinary workers. This study aimed to determine the Q fever vaccination status of veterinarians and veterinary nurses in Australia and to assess and compare the knowledge and attitudes towards Q fever disease and vaccination of each cohort. An online cross-sectional survey performed in 2014 targeted all veterinarians and veterinary nurses in Australia. Responses from 890 veterinarians and 852 veterinary nurses were obtained. Binary, ordinal and multinomial logistic regression were used to make comparisons between the two cohorts. The results showed that 74% of veterinarians had sought vaccination compared to only 29% of veterinary nurses. Barriers to vaccination among those not vaccinated did not differ between cohorts, and included a lack of perceived risk, financial expense, time constraints, and difficulty in finding a vaccine provider. Poor knowledge and awareness of Q fever disease and vaccination were additional and notable barriers for the veterinary nursing cohort, suggesting veterinary clinics and veterinarians may not be meeting their legal responsibility to educate staff about risks and risk prevention. Further evaluation is needed to identify the drivers behind seeking and recommending vaccination so that recommendations can be made to improve vaccine uptake.