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InFocus

Updates from BCVA Congress 2021

Delegates welcomed a return to face-to-face discussions at BCVA Congress 2021, with discussions arising about the role of paraprofessionals in the vet-led team and the future of TB management

In opening the BCVA Congress, BCVA President Nikki Hopkins made no apology for the Welshness of the coming three days. In fact, she revelled in the location as a practising Welsh vet and looked forward to the Welsh whisky and Welsh cakes planned for the evening socialising. Very welcome they were too. However, agreeing to go ahead with a face-to-face congress in the time of COVID-19 required a “brave decision”. The 400 registrations and the good trade support give the basic facts of success, but the smiles on the faces of the delegates as they met colleagues over coffee and food in the commercial exhibition was the true indicator of how this congress will be remembered.

Keynote: “From rugby to wellie boots”

The technical aspects were at a high level, as the discussions showed that there were things that had to be said that had not been aired through Zoom. Delegates were stimulated, worried and enthused throughout. Nigel Owens (Welsh former international rugby union referee) encompassed all of these elements in a thought-provoking outline of his many experiences, both as a child growing up in the valleys and as a top-flight international rugby referee. Brought up in a council house, he didn’t speak English until he went to school. He was bullied and this led to truancy; his “alien attraction to men” with the need to hide his emotions led to drinking, eating, obesity, bulimia, the use of steroids and attempted suicide. Located by a police helicopter up a mountain with whisky and a shotgun, he was close to death but he recovered with the help of his family and went on to address his problems and accepted “who he really was”.

Nigel related his fear of the TB test and thanked his vets for their caring approach. He recognises that he can rely on the vet when things are difficult and the attitude of the vet is “hugely appreciated”

Nigel observed that we each need to be happy within ourselves and that what really matters is that you are a “decent human being”. He advises “do not try to be perfect” and “don’t be afraid to make mistakes”. He also highlighted that you should never underestimate the effect that you have on the people around you. As a boy he helped out on the farm of a relative but he was not spawned by a farming family. Knowing that his time as a referee would be limited (he managed 34 years), he needed to plan a transition to the next stage of his life and he became a farmer, with 60 acres and pedigree Hereford cattle. Nigel related his fear of the TB test and thanked his vets for their caring approach. He recognises that he can rely on the vet when things are difficult and the attitude of the vet is “hugely appreciated”. The talk was littered with references to rugby incidents, both amusing and highly reflective. A concluding emphasis was that comments made by friends and acquaintances about sexuality are often not intended to harm but if they appear unacceptable do not be afraid to challenge the meaning of what is said. Young vets may find some of the traditional language on farms to be of a sexual nature and “if you don’t like it, say so”. The applause was long lasting.

The role of paraprofessionals as part of the vet-led team

The UK’s Chief Veterinary Officer (CVO) and the three Chief Veterinary Officers for Wales, Scotland and Northern Ireland made up a panel to discuss the role of paraprofessionals as part of the vet-led team. The opening observation from the floor was that the use of a lay TB tester has had a good impact and that farmers give an honest feedback to the tester rather than to a vet who is reluctant to do TB testing. Another comment was that the experience of the practice was that the approved tuberculin tester scheme was well received on the farm and that confidentiality of the tests was not a problem and was covered within the training. Christianne Glossop, CVO for Wales, indicated that within Wales the administration was looking at the impact on the veterinary surgeon to farmer to practice relationship and the contractual details between practices and lay testers. The veterinary surgeon is accountable for the test findings. A further comment, from the floor, was that an animal health paraprofessional should be employed by a practice and not work independently.

The legal underpinning of paraprofessionals needs a more flexible Veterinary Surgeons Act. Delegates were requested to lobby their MPs to review the Veterinary Surgeons Act

Christine Middlemiss confirmed that there were 74 authorised lay testers in England and 32 in training. The legal underpinning of paraprofessionals needs a more flexible Veterinary Surgeons Act. Delegates were requested to lobby their MPs to review the Veterinary Surgeons Act. With the introduction of the annual animal health and welfare review for every farm, this could be conducted by a veterinary surgeon or be vet-led as current legislation allows vets to delegate tasks. Farmers as animal owners can administer to animals but an animal health paraprofessional will need legislation to do so. It was highlighted by a delegate that a team of paraprofessionals added value to a veterinary practice whereas it would be difficult for a vet to rely on the findings of an independent tech when developing health plans for farmers. A further comment was that a lay tester would enhance practice ability, particularly with the introduction of six-monthly testing for TB. There was concern that the more work passed off to animal health paraprofessionals, the less surveillance activity would take place by vets, specifically with sheep. An overview was that there is a need to census opinion more widely to define the activities of animal health paraprofessionals and to “avoid holes” in veterinary practice care.

An overview was that there is a need to census opinion more widely to define the activities of animal health paraprofessionals and to “avoid holes” in veterinary practice care

Bovine tuberculosis

Whenever you talk to researchers and veterinary surgeons about developments with bovine tuberculosis (TB) and fresh attempts at disease control, the phrase “they won’t let us” soon crops up. When asked who “they” are, the response is vague. It has to be hoped that “they” attended the TB sessions because significant points were made and valuable discussions arose. There was enlightenment about the various interpretations about what sensitivity actually means, but it seems to be accepted that the skin test is 98 to 99 percent specific. In scientific terms, for every hundred animals that test positive, one or two do not actually have the disease. In practical terms, of the 40,000 animals testing positive each year over 400 were culled when they were not infected. To over-cull is thought to be better than under-culling, but for the many farmers involved the restriction to their business, for several months, can be both financially and emotionally difficult.

bTB testing

Prevention and removal of infected animals have to go together to control disease in cattle herds. The first step was knowing which animals are infected and then deciding on the most practical way of preventing and reducing infection

Keith Cutler, veterinary director of CHeCS, discussed the historical context of new ideas about disease with amusing old cartoons, but the message was serious. Cattle that were not identified as TB positive by the routine skin test have been shown to be harbouring infection. The technical differences between the different available tests for TB (eg Bovigam, Enferplex, Idexx and Actiphage) are complex but the real question is what to do with the results of such tests. It was not perhaps intentional but James Hanks, livestock information and animal production specialist, stimulated a discussion, in another session, about the value of disease prevention compared to removal of infected animals. The view was that prevention and removal of infected animals have to go together to control disease in cattle herds. The first step was knowing which animals are infected and then deciding on the most practical way of preventing and reducing infection.

TB targets and transmission

Professor Glyn Hewison, Sêr Cymru research chair in the Centre of Excellence for Bovine Tuberculosis for Wales at Aberystwyth University, confirmed that the control of TB is not on target, as highlighted at the OV Conference. In order to achieve OTF status in Wales, a detection rate of 2 in 1,000 herds has to be achieved for three years. The current figure is 102 per 1,000 herds. Local clusters of infected herds are a problem to be addressed, and within-species transmission of badger to badger and cattle to cattle has been identified. The transmission from badger to cattle is believed to be twice that of cattle to badger.

Vaccination

For badgers, the vaccine, at five times the human dose, is being applied in areas of Wales and the administration of injections after trapping has proved to be practical. The expectation is that some animals will be fully protected, some partially protected and around 10 percent will have no protection at all. Where effective, immunity should last for one to two years.

In cattle, the BCG vaccine will sensitise cattle to the tuberculin test and the DIVA (detecting infected among vaccinated animals) test has a specificity of 100 percent

In cattle, the BCG vaccine will sensitise cattle to the tuberculin test and the DIVA (detecting infected among vaccinated animals) test has a specificity of 100 percent. The term “apparent sensitivity” is being used, as sensitivity is “epidemiology-dependent according to the state of the disease”. Field trials are ongoing, but a figure of 75 percent plus for sensitivity is anticipated. The high specificity gives confidence in the DIVA results. Professor Glyn Hewison stated that the gold standard for the detection of bovine TB is the presence of physical lesions and/or culture of the organism.

The future of TB management

The discussion that followed highlighted the concern of cattle vets that cattle farmers were able to trade cattle when there is a likelihood of infected animals within the herd. It was reiterated that the skin test was for surveillance and not considered accurate in detecting disease in individual animals. In supporting high health status herds, particularly dairy cattle, veterinary surgeons are concerned that the farmer is suffering from “hidden disease”. If the tests that detect hidden infection were able to be applied in herds that are not under restriction, the farmer and the vet could develop a management programme for the cattle with a hint of infection. What are lacking are case histories of how the new technology can be applied in practice and the costs and benefits to the farmer client. Basically, the veterinary practices are seeking freedom to manage the disease of bovine TB in a similar way to other cattle herd diseases. This is a positive approach and veterinary practices being prepared to take responsibility for maintaining the herds of clients free from bovine TB is to be applauded. The mood of the delegates at BCVA Congress 2021 is that they hope that “they” are equally anxious to address deficiencies with the eradication programme.

Richard Gard

LARGE ANIMAL CORRESPONDENT

Following a 16-year apprenticeship with Beecham, Richard established a project management and development consultancy and writes regular contributions for the veterinary press.


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