Introduction to Population

Medicine and VPH- Year

4
Neil Paton – npaton@rvc.ac.uk
Pathobiology and Population Sciences Dept
October 2022
Year 4
Week 1 Week 4
• Introduction to Food Hygiene • Milk and Dairy Production
• Food Borne Diseases in Humans & Outbreak Investigations • Food Borne Risks by Commodity
• Surveillance and Reporting International Level
Week 2: • Wildlife and Zoonoses lectures 1 & 2
• Investigating Underperformance in Dairy Herd • Wildlife Control Measures
• Underperformance in Pigs • Biosecurity
• The cost of Underperformance in Livestock • Tools for Disease Control
• Endemic Diseases (in Pigs) • Industry Level Risk Management
• Farm Health Planning • Animal Health Economics
• From muscle to meat
• Preslaughter Welfare
• Livestock and Poultry Welfare During Transport Externals
• Who Owns Disease
• Stunning & Slaughter 1 & 2
• Contingency Planning
• Food Safety Management Systems
Week 3
• The Role of veterinarians in the government and food safety
• AM & PM Meat Inspection
• Seafood production and VPH 1+ 2
• Animal by products from meat industry
• Surveillance at the Abattoir
• Food Technology
• Food toxicology and VPH
Type of sessions involved
•
Lectures

• DL and CS attendance
• Designed to help you put theory into practice
• Discussion with peers and facilitators will help you to
integrate knowledge

• CAL Completion
• Clinical/ practical settings
• Increase depth of knowledge

• Lectures, DLs and CALs are all examinable

 Taking a
history- what SIGNS

do you need to What has the

farmer
noticed SIGNALMENT

know?
ICE
Age
Farmer’s Ideas,
Concerns and Stage of
expectations lactation
Species

Start your
Problem List TREATMENT
Has any
NUMBER
AFFECTED
medication Just one animal
been given? or multiples

SEVERITY
PROGRESSION
Is the
Is the problem
animal/group
getting better
eating or
or worse
drinking

RECURRENCE
DURATION
Is this the first
How long has
occurrence in
it been going
this animal / in
on for
the herd
 Clinical Examination

Continue to add to
Temperature
Pulse

your Problem List

BCS
Head/Neck
Musculoskeletal
Skin
Heart

Distance Examination Vaginal

and Lungs
Mentation Rectal

Lumps,
bumps, Breathing
swellings Left Abdomen:
Udder • Rumen
• Reticulum
Neurological Abdominal • Pings
signs Silhouette Right Abdomen
• Colon/Caecum
Stance, Gait • Small Intestines
and
Locomotion
 Logical Problem Solving Approach
Herd / Flock / Group clinical case
Problem List – from history and clinical examination
• Define the Problem: From the information you have so far create your PROBLEM LIST (from history and clinical examination)
• Refine the Problem: Can you create a more focused Problem list? (Remove any unrelated issues, if there are any)
Define the Epidemiology – for the disease/condition, and then refine this list for this case/farm
• Remember that the prevalence of disease is going to affect likelihood of the disease being present on the farm and the
performance of the tests used.
• Key factors that may be involved (Husbandry, Nutrition, Environment, Management, Biosecurity)
• Defined characteristics of the disease such as aetiology (Infectious, Zoonotic, Metabolic, Toxic, Parasitic etc), transmission,
clinical signs, population at risk etc
• Prevalence – UK, Areas within the UK, Farm Type/System
Create a prioritised differential diagnosis list
• Define the differential diagnoses (DDX) Write a list of DDX for this case (relevant to the population under consideration)
• Refine the differential diagnoses (DDX). Prioritise your list and justify why they are in this order
Diagnosis – How can you confirm/reach your diagnosis?
• History Questions: What questions can you ask to rule out some of the differentials?
• Clinical Examination: Do you need to examine more animals? – Can you do an abbreviated examination of a larger number
• Diagnostic tests: Do you need to do any further tests? – (remember the clinical exam is a diagnostic test and maybe the only
test that is appropriate).? Are there diagnostic tests that would help confirm your diagnosis? Are they cost-effective, practical and
necessary? Consider economics, do not fish, you must justify any tests you would do considering cost and practicality (is it a
cow-side test, do we need to wait a day/a week for results?). If request tests be specific – do NOT say PCR – DO say PCR on
what sample for what pathogen on how many samples.
Treatment and Management Plan: Be specific, include appropriate detail
• Decide on a treatment plan for the group– immediate treatment and ongoing treatment (if appropriate)
• Decide on a management plan for the group
 Be specific – what medications (vaccinations, anthelmintics etc) when and for how long, immediate management changes – housing,
feeding, environment etc
Prevention / Control Plan – Consider the whole herd/flock
• How can we prevent this happening in the future – this is relevant whether it is a single animal case or a herd problem.
• Consider both animal level factors and herd level/management factors that may have caused what you have seen.
• Much of the time an individual case will be an iceberg indicator of something that will happen within the wider herd if not dealt
with.
You Are Called Out To a dairy
farm with a cow that aborted…
Problem
• 4 year old Holstein aborted
in the in 2/3 of pregnancy
• Pyrexia
• Inappetence
• …

• Do full clinical examination

• Take complete history of
animal and herd as
possible
(Source: NADIS)
What do you need to know?
•
When was the cow due to calve
•
When it aborted
•
What the cow has been fed on and when
•
Where the cow has been during pregnancy
•
The cow's vaccination status
•
Other clinical signs?

• But also…
• Health status of the farm
• Farm management and animal husbandry
• Did any other cows abort?
Differential diagnosis
Infectious causes
• BVD, Neospora, Salmonella Dublin, leptospirosis…
• Diseases that cause pyrexia (IBR)
• Uncommon: Brucellosis (exotic and notifiable in the UK)

Non-infectious causes
• Contaminated mouldy feed (mycotoxins)
• Genetic defects
• Environmental (high temperature)
• Treatment with abortifacient drugs (prostaglandins)

Different implications for animal and public health!

 What you need to consider…
•
Report to APHA- abortions in cattle are notifiable
(Brucellosis Order)

• Biosecurity measures- isolate the sick animal to

prevent spread to rest of the herd if suspect
infectious cause

• Risk for rest of the herd?

• Is it zoonotic? Consider risk for farm workers and

visitors? (COSHH regulations)
Diagnostic tests
• What diagnostic tests would
you consider?
• Foetus and foetal membranes
• Blood samples
• Feed material- if suspicion of
(Source: https://www6.rennes.inrae.fr/)
mycotoxins

(Source: https://www.nadis.org.uk/)
Treatment options
•
Consider pathogen involved – e.g. Salmonella
Dublin- may require antibiotics if systemic
disease present
•
Consider support care- fluids, anti-
inflammatory drugs

• Eligibility for slaughter- consider food safety

implications
• Zoonotic pathogens
• Presence of drug residues if withdrawal period is not
respected
 Preventive measures
•
Advise farmer on
• Prevention better than cure!
• Vaccination to be considered for abortive pathogens
in the health herd plan
• Quarantine purchased cattle for a minimum of 14
days or maintain a completely 'closed' herd.
• Pay special attention to the health status of bulls.
Purchased bulls can introduce disease and spread it
venereally.
• Ensure farm visitors and their equipment are clean
before they enter the farm.
• Clean and disinfect equipment and vehicles as
necessary
 In conclusion…
•
So don’t just think at the level of the individual
•
Extrapolate to the herd/population level
•
True opportunity to practice preventative veterinary
medicine
•
Think about the animal as part of a food system- “farm
to fork”
•
Take an holistic “One Health” approach- think about the
potential impact to human health too!

From the individual animal to population health =

PMVPH!
But also… “farm to fork” and “One Health”!