Modeling cost-effectiveness of risk-based bovine tuberculosis surveillance in Minnesota.

In the United States, slaughter surveillance combined with other measures has effectively maintained a very low prevalence of bovine tuberculosis (bTB). However, bTB continues to be sporadically detected, causing substantial economic burden to the government and cattle producers. To detect the infection earlier and reduce sudden economic losses, additional risk-based surveillance of live animals might be more cost-effective than slaughter surveillance alone to detect and prevent bTB infection. The objective of this study was to evaluate alternative risk-based surveillance strategies targeting high-risk herds to complement slaughter surveillance in a region with very low bTB prevalence. We developed an integrated within- and between-herd bTB transmission model with simulated premises-level cattle movements among beef and dairy herds in Minnesota for 10 years. We constructed ten risk-based surveillance strategies for beef herds and dairy herds, and predicted the epidemiological outcomes and costs for each strategy in combination with slaughter surveillance. Our models showed that slaughter surveillance alone resulted in low risk of between-herd transmission with typically small outbreak sizes, and also cost less compared to alternative risk-based surveillance measures. However, risk-based surveillance strategies could reduce the time to detect infection and the time to reach disease freedom by up to 9 months. At a higher initial prevalence, alternative risk-based surveillance could reduce the number of infected herds and shorten the time to disease freedom by almost 3 years (34-35 months). Our findings suggest that risk-based surveillance could detect infection more quickly and allow affected regions to reach disease freedom faster. If the bTB status of the affected regions changes after an outbreak happens, the reduced time to disease freedom could reduce the economic impact on the affected region.

Optimal surveillance strategies for bovine tuberculosis in a low-prevalence country.

Bovine tuberculosis (bTB) is a chronic disease of cattle that is difficult to control and eradicate in part due to the costly nature of surveillance and poor sensitivity of diagnostic tests. Like many countries, bTB prevalence in Uruguay has gradually declined to low levels due to intensive surveillance and control efforts over the past decades. In low prevalence settings, broad-based surveillance strategies based on routine testing may not be the most cost-effective way for controlling between-farm bTB transmission, while targeted surveillance aimed at high-risk farms may be more efficient for this purpose. To investigate the efficacy of targeted surveillance, we developed an integrated within- and between-farm bTB transmission model utilizing data from Uruguay's comprehensive animal movement database. A genetic algorithm was used to fit uncertain parameter values, such as the animal-level sensitivity of skin testing and slaughter inspection, to observed bTB epidemiological data. Of ten alternative surveillance strategies evaluated, a strategy based on eliminating testing in low-risk farms resulted in a 40% reduction in sampling effort without increasing bTB incidence. These results can inform the design of more cost-effective surveillance programs to detect and control bTB in Uruguay and other countries with low bTB prevalence.

Epidemiological investigation of bovine tuberculosis outbreaks in Uruguay (2011-2013).

Bovine tuberculosis (bTB) is a chronic disease of cattle caused by infection with the Mycobacterium bovis. While bTB prevalence in Uruguay has been low (<11 outbreaks/year) for the past 50 years as a consequence of a national control program, annual incidence increased in 2011 through 2013-15, 26 and 16 infected herds each year, raising concerns from livestock stakeholders and the government. The goal of this study was to assess the spatial dynamics of bTB in Uruguay from 2011 to 2013 and the association between bTB and potential demographic and movement risk factors at the herd level using data provided by the Uruguayan Ministry of Livestock, Agriculture, and Fisheries. Clustering of incident outbreaks was assessed using the Cuzick-Edwards' test and the Bernoulli model of the spatial scan statistic, and a conditional multivariable logistic regression model was used to assess risk factors associated with bTB in a subset of Uruguayan dairy farms. Significant (P<0.05) global clustering was detected in 2012, while high-risk local clusters were detected in southwestern (2011, 2012, 2013), northwestern (2012), and southeastern (2012) Uruguay. Increased risk of bTB in different regions of Uruguay suggests a potential role of animal movements in disease dissemination. Larger herds, higher numbers of animals purchased, and incoming steers to the farm were associated with increased odds of breaking with bTB, in agreement with previous studies but also suggesting other additional sources of risk. These results will contribute to enhanced effectiveness of bTB control programs in Uruguay with the ultimate objective of preventing or mitigating the impact of the disease in the human and animal populations of the country.

Evaluating empirical contact networks as potential transmission pathways for infectious diseases.

Networks are often used to incorporate heterogeneity in contact patterns in mathematical models of pathogen spread. However, few tools exist to evaluate whether potential transmission pathways in a population are adequately represented by an observed contact network. Here, we describe a novel permutation-based approach, the network k-test, to determine whether the pattern of cases within the observed contact network are likely to have resulted from transmission processes in the network, indicating that the network represents potential transmission pathways between nodes. Using simulated data of pathogen spread, we compare the power of this approach to other commonly used analytical methods. We test the robustness of this technique across common sampling constraints, including undetected cases, unobserved individuals and missing interaction data. We also demonstrate the application of this technique in two case studies of livestock and wildlife networks. We show that the power of the k-test to correctly identify the epidemiologic relevance of contact networks is substantially greater than other methods, even when 50% of contact or case data are missing. We further demonstrate that the impact of missing data on network analysis depends on the structure of the network and the type of missing data.

Network analysis of cattle movements in Uruguay: Quantifying heterogeneity for risk-based disease surveillance and control.

Movement of livestock between premises is one of the foremost factors contributing to the spread of infectious diseases of livestock. In part to address this issue, the origin and destination for all cattle movements in Uruguay are registered by law. This information has great potential to be used in assessing the risk of disease spread in the Uruguayan cattle population. Here, we analyze cattle movements from 2008 to 2013 using network analysis in order to understand the flows of animals in the Uruguayan cattle industry and to identify targets for surveillance and control measures. Cattle movements were represented as seasonal and annual networks in which farms represented nodes and nodes were linked based on the frequency and quantity of cattle moved. At the farm level, the distribution of the number of unique farms each farm is connected to through outgoing and incoming movements, as well as the number of animals moved, was highly right-skewed; the majority of farms had few to no contacts, whereas the 10% most highly connected farms accounted for 72-83% of animals moved annually. This extreme level of heterogeneity in movement patterns indicates that some farms may be disproportionately important for pathogen spread. Different production types exhibited characteristic patterns of farm-level connectivity, with some types, such a dairies, showing consistently higher levels of centrality. In addition, the observed networks were characterized by lower levels of connectivity and higher levels of heterogeneity than random networks of the same size and density, both of which have major implications for disease dynamics and control strategies. This represents the first in-depth analysis of farm-level livestock movements within South America, and highlights the importance of collecting livestock movement data in order to understand the vulnerability of livestock trade networks to invasion by infectious diseases.