> ----- Original Message -----
> From: P. Emry <emry@u.washington.edu>
> To: <HistoNet@pathology.swmed.edu>
> Sent: Friday, March 16, 2001 9:03 PM
> Subject: hoof and mouth
>
>
> > I heard an interview on npr yesterday with a woman who's heard was
> > infected and destroyed in Wales.  Made me cry, the description of the
> > cattle and her loss.
> >
> > Does anyone out there know what the disease is and why after so  many
> > years of being around there has not been a successful treatment or
> > inoculation developed?
> >
> > Thanks,
> >
> > Trisha
> >
> >
> >
>


 Dear Trisha,

 Pasted below is an article on Foot and Mouth disease, from the
 British Medical Journal a few weeks ago,

 David


Foot and mouth disease: the human consequences
The health consequences are slight, the economic ones huge



The current major outbreak of foot and mouth disease (FMD) is the latest in
a series of disasters that are putting British agriculture under stress.1
The disease affects all cloven-hoofed animals and is the most contagious of
animal diseases. It is caused by a virus of the family Picornaviridae, genus
Aphthovirus, of which there are seven serotypes (O, A, C, SAT1, SAT2, SAT3,
and Asia1). The current outbreak in the United Kingdom is due to the highly
virulent pan-Asiatic serotype O.1 In animals the disease presents with acute
fever, followed by the development of blisters chiefly in the mouth and on
the feet. Infected animals secrete numerous virus particles before clinical
signs appear.2

Foot and mouth disease is a zoonosis, a disease transmissible to humans, but
it crosses the species barrier with difficulty and with little effect. Given
the high incidence of the disease in animals, both in the past and in more
recent outbreaks worldwide, its occurrence in man is rare3 so experience of
the human infection is limited. The last human case reported in Britain
occurred in 1966, during the last epidemic of foot and mouth disease.4 The
circumstances in which it does occur in humans are not well defined, though
all reported cases have had close contact with infected animals. There is
one report from 1834 of three veterinarians acquiring the disease from
deliberately drinking raw milk from infected cows.5 There is no report of
infection from pasteurised milk, and the Food Standards Agency considers
that foot and mouth disease has no implications for the human food chain.

The type of virus most often isolated in humans is type O followed by type C
and rarely A. The incubation period in humans is 2-6 days. Symptoms have
mostly been mild and self limiting, mainly uncomfortable tingling blisters
on the hands but also fever, sore throat, and blisters on the feet and in
the mouth, including the tongue.3 Patients have usually recovered a week
after the last blister formation. In the unlikely event of human cases in
the current outbreak in Britain they should be reported to the Communicable
Disease Surveillance Centre (0208 200 6868) duty doctor, who can direct
professional inquiries towards expert advice on management and diagnosis.2
Suspected and confirmed human cases must have no contact with susceptible
livestock to avoid transmitting the disease. Person to person spread has not
been reported.

Foot and mouth disease should not be confused with the human disease hand,
foot, and mouth disease. This is an unrelated and usually mild viral
infection, principally of children, caused by different viruses, principally
coxsackie A virus.6

Foot and mouth disease is endemic in many countries, including much of
Africa, Asia, and South America, where its importance relates to the reduced
productivity of livestock, the cost of vaccination, and the restrictions
placed on international trade in live animals and animal products.7 To be
listed among the "FMD free countries where vaccination is not practised" the
Office International des Epizooties, the international regulatory body
concerned with animal infections,8 requires a country to have a record of
regular and prompt animal disease reporting and to supply documented
evidence of an effective system of surveillance. Such a country should also
not import animals vaccinated against foot and mouth disease9 since
serological testing cannot differentiate between infected and vaccinated
animals. A "foot and mouth free zone" may be established in a country in
which parts are infected, separated from the rest by a buffer zone.

As international trade barriers become increasingly subject to scrutiny,
foot and mouth disease remains one of the few remaining constraints to
international trade in live animals and animal products. The occurrence of
even a single case of foot and mouth disease in a previously disease free
country results in an immediate ban on an economically valuable export
trade. The European Commission in 1990-1, after undertaking a cost benefit
analysis, implemented a policy of non-vaccination to increase export
opportunities and to ensure high animal health standards.10 This outbreak
containment policy requires an export ban on all livestock and animal
products from any affected country, along with movement restrictions and the
slaughter and burning of all cloven-hoofed animals that are either infected,
on infected premises, or in contact with infected animals. Until now the
European Union has remained free of foot and mouth disease since an outbreak
in Greece in 1996.

The highest risk to European Union countries is through legal and illegal
imports of infected live animals and contaminated meat or dairy products
from infected countries then being eaten by animals. International
travellers bringing back food from endemic countries could spread the
disease. The foot and mouth disease virus can survive for long periods in a
range of fresh, partially cooked, cured, and smoked meats and in
inadequately pasteurised dairy products. Currently animals and animal
products need to be checked only when they enter the European Union. Once
inside, and with correct documentation, they can be moved around without
restriction. For these reasons other countries have banned the import of
animal products from the UK.

Spread of the virus is facilitated by the development of long distance
animal trading. Dense livestock populations may also enhance local spread in
the vicinity of an outbreak. Awareness of the disease among livestock owners
is crucial, as are the UK's excellent diagnostic facilities. Spread can take
place on the wind and mechanically by the movement of animals, people, and
vehicles that have been contaminated with the virus. Thus the whole British
population has a role in combating the disease. Restriction of non-essential
movement both into and out of affected farms and more widely in the
countryside is important. This is requiring close collaboration between
veterinary, health, and local authorities. If these measures are not
successful, however, the major review of safeguards announced by the
agriculture minister may lead to major changes in animal husbandry in the
UK.11

Henry Prempeh, specialist registrar public health medicine.
Robert Smith, clinical scientist (zoonoses).

(robert.smith@cdsc.wales.nhs.uk)

Berit Müller, epidemiologist.

PHLS Communicable Disease Surveillance Centre, London NW9 5EQ





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1.  Ministry of Agriculture, Fisheries, and Food. Foot and mouth disease -
FAQ [online]. London: MAFF, 2001.
www.maff.gov.uk/animalh/diseases/fmd/qa1.htm. (Accessed 05 March 2001). This
site is being regularly updated during this outbreak.
2.  Foot and mouth disease outbreak- no threat to public health. Commun Dis
Rep CDR Wkly 2001; 11: 1-2.
3.  Bauer K. Foot-and-mouth disease as zoonosis. Arch Virol 1997; 13
(suppl): 95-97[Medline].
4.  Armstrong R, Davie J, Hedger RS. Foot-and-mouth disease in man. BMJ
1967; 4: 529-530[Medline].
5.  Hertwig CA. ?bertragung tierischer Ansteckungsstoffe auf den Menschen.
Med Vet Z 1834;48.
6.  Chin J, ed. Coxsackievirus diseases. In: Control of communicable
diseases manual. 17th ed. Washington, DC: American Public Health
Association, 2000:129-131.
7.  Donaldson AI, Doel TR. Foot-and-mouth disease: the risk for Great
Britain after 1992. Vet Record 1992; 8 Aug;131:114-20.
8.  Kitching RP. Foot and mouth disease: current world situation. Vaccine
1999; 17: 1772-1774[Medline].
9.  Recommendations applicable to specific diseases: Foot and mouth disease
International Animal Health Code - 2000. Paris: Office International des
Epizooties, 2000.
10.  Report from the Commission to the Council on a study carried out by the
Commission on policies currently applied by Member States in the control of
foot-and-mouth disease. Brussels: CEC, 1989.
11.  Minister of Agriculture, Fisheries, and Food. Foot and mouth disease:
thorough review of measures to reduce disease risk [online]. , 2001:3 Mar.
http://www.maff.gov.uk/inf/newsrel/2001/010303a.htm