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News & Reports BVA Congress
Thinking differently about surveillance Recent changes to the system of veterinary surveillance in England and Wales were scrutinised in a session at the BVA Congress, with consideration being given to whether the changes posed threats or provided new opportunities. Laura Honey reports Focusing on scanning surveillance in particular, Professor Pfeiffer said that the key was to integrate the different data sources in a way that could produce quality information that could inform action for preventing diseases in animals. When asked by the AHVLA in 2012 to review the surveillance system operating in England and Wales, and to make recommendations for a model for the future delivery of veterinary surveillance, the SAG had initially had to decide what the purpose of the surveillance activity should be, he said. It concluded that it should provide a timely and cost-effective diagnostic service. The group also felt that it was important that the system had the ability to commission further work and research, as well as increase investigative capability, for instance when there was a sudden outbreak of disease, as seen with the recent outbreak of avian influenza. It was also decided that the surveillance system needed to be able to alert other countries, particularly in Europe, to issues it was dealing with. He said that the group had agreed that it was important to maintain veterinary expertise and ensure that there was training available for the different people involved in the surveillance service, allowing the production of quality information. It also felt that there should be practical sharing of information about diseases between the different stakeholders. The SAG had made two main recommendations, Professor Pfeiffer said. The first was that the coverage of the surveillance network should be improved, even though, due to cost cutting, there would be less money available. The group had suggested that options should be explored to encourage more submissions, and to look at the potential for universities, institutions and practitioners to be more actively engaged in that submission system. The second recommendation was that in-depth species-based centres of expertise should be established. He explained that the SAG believed that it was important to establish different tiers of expertise, whereby the most qualified experts would be available in particular locations, as it was recognised that it would not be feasible to have each area of expertise represented in every section of the surveillance system. The changes made to the veterinary surveillance system in England and Wales in light of the recommendations made by
Dirk Pfeiffer: surveillance is one approach to risk management, but it needs to have a clear purpose
the SAG were discussed by Linda Smith, surveillance veterinary lead for the APHA, speaking on behalf of Chris Hadkiss, the APHA’s chief executive, who was unable to attend the congress. Regarding the recommendation to develop species-based centres of expertise, Ms Smith explained that this was something the APHA was working towards, in terms of concentrating expertise within the labs it had. It had also improved the way that its species expert groups functioned, including making sure that those groups undertook more networking and worked more closely with the industry and practitioners to try to improve data collection. ‘Those of you who submit samples by post might perhaps find that it is a bit confusing that you’re in Yorkshire but your samples are going to Bury St Edmunds,’ she said; however, this was simply to try to consolidate expertise across the country and make sure that samples were sent to the relevant experts, rather than the closest laboratory. Discussing attempts to improve the coverage of the surveillance network, Ms Smith referred to the outcome of the recent tendering exercise to procure alternative providers of postmortem examination services (VR, September 6, 2014, vol 175, p 212). She also noted that, having closed a number of laboratories, the APHA had introduced a carcase transport system that would operate for the next three years, with the intention of maintaining throughput to the laboratories. January 10, 2015 | Veterinary Record | 35
t
spending cuts have had a significant impact across many government departments, including Defra. In 2012, a review was conducted of the veterinary surveillance arrangements in England and Wales, which resulted in recommendations for developing a system that was more effective in disease surveillance terms as well as providing better value for the taxpayer. But would reorganisation of the surveillance system reduce its robustness? And if its robustness was reduced, would that be the case forever? These were two of the questions discussed in a session on ‘Surveillance cuts: threats or opportunities for vets?’ at the BVA Congress during the London Vet show on November 21. John Blackwell, the BVA President, who chaired the session, described it as an opportunity to ‘explore the potential impact of the cuts and the reorganisation of our scanning surveillance capacity and consider how we can make sure that vets have guidance and support for difficult cases, and are able to work with the authorities and enable data collection to alert the authorities when novel threats come on the radar and are detected’. Explaining why managing risks, particularly those associated with animals, was important, the first speaker in the session, Dirk Pfeiffer, who chaired the independent Surveillance Advisory Group (SAG) for the AHVLA (now the Animal and Plant Health Agency [APHA]), said that risk management was important for trade, productivity, animal welfare, human health and conservation reasons. A major reason why a country would want to engage in risk management of animal diseases was because of the potential restrictions that could be imposed on its ability to trade livestock products if particular diseases were found within its territory. Surveillance, he said, was one of the ways in which risk management could be tackled. He defined surveillance as ‘the systematic, continuous or repeated, measurement, collection, collation, analysis, interpretation and timely dissemination of animal health and welfare-related data from defined populations, essential for describing health hazard occurrence and to contribute to the planning, implementation, and evaluation of risk mitigation measures’. He said that it was important that there was a clear purpose to the surveillance and that it would be used to inform something.
Downloaded from http://veterinaryrecord.bmj.com/ on July 22, 2015 - Published by group.bmj.com
News & Reports Even before the introduction of the new arrangements, there had been a gradual decline in submissions to the APHA laboratories. It was thought that this might be because practitioners thought that the APHA was ‘not open for business’ or because they ‘didn’t regard postmortem examination as a good way of investing money’. But, she assured the audience, such investment was valuable. In the case of Schmallenberg virus, for example, some of the clinical signs noted had included malaise, diarrhoea and milk drop in dairy cows – signs that were common to many diseases. A great deal of information had been collected from each carcase that had been submitted for postmortem examination and the APHA had been able to determine that it had not seen that particular disease picture before and to conclude that it was caused by the new threat. Highlighting some of the other progress made since the SAG’s report, Ms Smith explained that the APHA had also asked veterinary practitioners about what sort of pathology training they would like to undertake. It had received approximately 400 responses to its questionnaire. ‘We have got quite a lot of data now that indicates what type of training would suit people and, interestingly, we have got quite a high proportion of people responding that were small animal practitioners,’ she said. The APHA had also set up a new unit, the Surveillance Intelligence Unit, made up of the six species expert groups (cattle, small ruminants, poultry, pigs, wildlife, and miscellaneous and exotic farmed species). ‘The intention is that they will concentrate on how we get the new surveillance information out . . . and they are very busy working on creating and generating networks so that they can collect information.’ Looking at the next steps, Ms Smith noted that one of the other recommendations from the SAG was to create a surveillance board and that the APHA was currently working on this. There were also more opportunities for private practitioners to carry out postmortem examinations and so the APHA would be carrying out training with practitioners to enable them to take up those opportunities. Finally, she said that the APHA was also working on a system to allow practitioners who submitted samples to access the results online, rather than having to wait for them to be returned by post. ‘I think genuinely that the changes to surveillance have created opportunities. I don’t think they are threats,’ Ms Smith said in conclusion. There were more opportunities for practitioners to get involved and to have more access to information. When the discussion was opened to the floor, Paula Boyden, from the Dog’s Trust, commented that there appeared to be a ‘worrying lack’ of discussion of surveillance 36 | Veterinary Record | January 10, 2015
Linda Smith – the changes to the surveillance system in England and Wales provide more opportunities for practitioners to get involved
of companion animals. Ms Smith replied that, historically, the forerunner of the APHA had been set up to help promote livestock productivity and so its focus remained very much on farmed agricultural animals. She added that it did occasionally receive cats and dogs, particularly for bovine TB investigation, but that this was not its main focus. James Barnett, an internal medicine consultant from Axiom and Greendale Veterinary Laboratories, noted that there had been talk about private veterinary surgeons and universities getting involved with disease surveillance, but asked what scope there was for engagement with private laboratories. He said that such laboratories were playing an increasing role in providing farm animal diagnostics to private veterinary surgeons and so it was important that the APHA engaged with those laboratories to ensure that it did not miss useful information from them. Ms Smith responded by saying that it was certainly part of the plan and that the APHA intended to work in a collaborative way with private laboratories to share useful information. Alasdair Cook, of the University of Surrey, commented that his university had recently won some of the APHA’s tenders for the provision of postmortem examination services. It had chosen to engage, he said, because there was clearly a need for private veterinary surgeons and universities to become involved in surveillance. The university very much viewed this as an opportunity to engage with private veterinary surgeons. Government, he said, tended to be interested in ‘top-level’ priorities, such as trade, and therefore focused on notifiable diseases. However, it was endemic diseases that caused the main problems. He viewed the changes to the surveillance system as ‘truly an opportunity, but not a risk-free opportunity’. doi: 10.1136/vr.h49
Downloaded from http://veterinaryrecord.bmj.com/ on July 22, 2015 - Published by group.bmj.com
Thinking differently about surveillance
Veterinary Record 2015 176: 35-36
doi: 10.1136/vr.h49 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/176/2/35
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
News & Reports BVA Congress
Thinking differently about surveillance Recent changes to the system of veterinary surveillance in England and Wales were scrutinised in a session at the BVA Congress, with consideration being given to whether the changes posed threats or provided new opportunities. Laura Honey reports Focusing on scanning surveillance in particular, Professor Pfeiffer said that the key was to integrate the different data sources in a way that could produce quality information that could inform action for preventing diseases in animals. When asked by the AHVLA in 2012 to review the surveillance system operating in England and Wales, and to make recommendations for a model for the future delivery of veterinary surveillance, the SAG had initially had to decide what the purpose of the surveillance activity should be, he said. It concluded that it should provide a timely and cost-effective diagnostic service. The group also felt that it was important that the system had the ability to commission further work and research, as well as increase investigative capability, for instance when there was a sudden outbreak of disease, as seen with the recent outbreak of avian influenza. It was also decided that the surveillance system needed to be able to alert other countries, particularly in Europe, to issues it was dealing with. He said that the group had agreed that it was important to maintain veterinary expertise and ensure that there was training available for the different people involved in the surveillance service, allowing the production of quality information. It also felt that there should be practical sharing of information about diseases between the different stakeholders. The SAG had made two main recommendations, Professor Pfeiffer said. The first was that the coverage of the surveillance network should be improved, even though, due to cost cutting, there would be less money available. The group had suggested that options should be explored to encourage more submissions, and to look at the potential for universities, institutions and practitioners to be more actively engaged in that submission system. The second recommendation was that in-depth species-based centres of expertise should be established. He explained that the SAG believed that it was important to establish different tiers of expertise, whereby the most qualified experts would be available in particular locations, as it was recognised that it would not be feasible to have each area of expertise represented in every section of the surveillance system. The changes made to the veterinary surveillance system in England and Wales in light of the recommendations made by
Dirk Pfeiffer: surveillance is one approach to risk management, but it needs to have a clear purpose
the SAG were discussed by Linda Smith, surveillance veterinary lead for the APHA, speaking on behalf of Chris Hadkiss, the APHA’s chief executive, who was unable to attend the congress. Regarding the recommendation to develop species-based centres of expertise, Ms Smith explained that this was something the APHA was working towards, in terms of concentrating expertise within the labs it had. It had also improved the way that its species expert groups functioned, including making sure that those groups undertook more networking and worked more closely with the industry and practitioners to try to improve data collection. ‘Those of you who submit samples by post might perhaps find that it is a bit confusing that you’re in Yorkshire but your samples are going to Bury St Edmunds,’ she said; however, this was simply to try to consolidate expertise across the country and make sure that samples were sent to the relevant experts, rather than the closest laboratory. Discussing attempts to improve the coverage of the surveillance network, Ms Smith referred to the outcome of the recent tendering exercise to procure alternative providers of postmortem examination services (VR, September 6, 2014, vol 175, p 212). She also noted that, having closed a number of laboratories, the APHA had introduced a carcase transport system that would operate for the next three years, with the intention of maintaining throughput to the laboratories. January 10, 2015 | Veterinary Record | 35
t
spending cuts have had a significant impact across many government departments, including Defra. In 2012, a review was conducted of the veterinary surveillance arrangements in England and Wales, which resulted in recommendations for developing a system that was more effective in disease surveillance terms as well as providing better value for the taxpayer. But would reorganisation of the surveillance system reduce its robustness? And if its robustness was reduced, would that be the case forever? These were two of the questions discussed in a session on ‘Surveillance cuts: threats or opportunities for vets?’ at the BVA Congress during the London Vet show on November 21. John Blackwell, the BVA President, who chaired the session, described it as an opportunity to ‘explore the potential impact of the cuts and the reorganisation of our scanning surveillance capacity and consider how we can make sure that vets have guidance and support for difficult cases, and are able to work with the authorities and enable data collection to alert the authorities when novel threats come on the radar and are detected’. Explaining why managing risks, particularly those associated with animals, was important, the first speaker in the session, Dirk Pfeiffer, who chaired the independent Surveillance Advisory Group (SAG) for the AHVLA (now the Animal and Plant Health Agency [APHA]), said that risk management was important for trade, productivity, animal welfare, human health and conservation reasons. A major reason why a country would want to engage in risk management of animal diseases was because of the potential restrictions that could be imposed on its ability to trade livestock products if particular diseases were found within its territory. Surveillance, he said, was one of the ways in which risk management could be tackled. He defined surveillance as ‘the systematic, continuous or repeated, measurement, collection, collation, analysis, interpretation and timely dissemination of animal health and welfare-related data from defined populations, essential for describing health hazard occurrence and to contribute to the planning, implementation, and evaluation of risk mitigation measures’. He said that it was important that there was a clear purpose to the surveillance and that it would be used to inform something.
Downloaded from http://veterinaryrecord.bmj.com/ on July 22, 2015 - Published by group.bmj.com
News & Reports Even before the introduction of the new arrangements, there had been a gradual decline in submissions to the APHA laboratories. It was thought that this might be because practitioners thought that the APHA was ‘not open for business’ or because they ‘didn’t regard postmortem examination as a good way of investing money’. But, she assured the audience, such investment was valuable. In the case of Schmallenberg virus, for example, some of the clinical signs noted had included malaise, diarrhoea and milk drop in dairy cows – signs that were common to many diseases. A great deal of information had been collected from each carcase that had been submitted for postmortem examination and the APHA had been able to determine that it had not seen that particular disease picture before and to conclude that it was caused by the new threat. Highlighting some of the other progress made since the SAG’s report, Ms Smith explained that the APHA had also asked veterinary practitioners about what sort of pathology training they would like to undertake. It had received approximately 400 responses to its questionnaire. ‘We have got quite a lot of data now that indicates what type of training would suit people and, interestingly, we have got quite a high proportion of people responding that were small animal practitioners,’ she said. The APHA had also set up a new unit, the Surveillance Intelligence Unit, made up of the six species expert groups (cattle, small ruminants, poultry, pigs, wildlife, and miscellaneous and exotic farmed species). ‘The intention is that they will concentrate on how we get the new surveillance information out . . . and they are very busy working on creating and generating networks so that they can collect information.’ Looking at the next steps, Ms Smith noted that one of the other recommendations from the SAG was to create a surveillance board and that the APHA was currently working on this. There were also more opportunities for private practitioners to carry out postmortem examinations and so the APHA would be carrying out training with practitioners to enable them to take up those opportunities. Finally, she said that the APHA was also working on a system to allow practitioners who submitted samples to access the results online, rather than having to wait for them to be returned by post. ‘I think genuinely that the changes to surveillance have created opportunities. I don’t think they are threats,’ Ms Smith said in conclusion. There were more opportunities for practitioners to get involved and to have more access to information. When the discussion was opened to the floor, Paula Boyden, from the Dog’s Trust, commented that there appeared to be a ‘worrying lack’ of discussion of surveillance 36 | Veterinary Record | January 10, 2015
Linda Smith – the changes to the surveillance system in England and Wales provide more opportunities for practitioners to get involved
of companion animals. Ms Smith replied that, historically, the forerunner of the APHA had been set up to help promote livestock productivity and so its focus remained very much on farmed agricultural animals. She added that it did occasionally receive cats and dogs, particularly for bovine TB investigation, but that this was not its main focus. James Barnett, an internal medicine consultant from Axiom and Greendale Veterinary Laboratories, noted that there had been talk about private veterinary surgeons and universities getting involved with disease surveillance, but asked what scope there was for engagement with private laboratories. He said that such laboratories were playing an increasing role in providing farm animal diagnostics to private veterinary surgeons and so it was important that the APHA engaged with those laboratories to ensure that it did not miss useful information from them. Ms Smith responded by saying that it was certainly part of the plan and that the APHA intended to work in a collaborative way with private laboratories to share useful information. Alasdair Cook, of the University of Surrey, commented that his university had recently won some of the APHA’s tenders for the provision of postmortem examination services. It had chosen to engage, he said, because there was clearly a need for private veterinary surgeons and universities to become involved in surveillance. The university very much viewed this as an opportunity to engage with private veterinary surgeons. Government, he said, tended to be interested in ‘top-level’ priorities, such as trade, and therefore focused on notifiable diseases. However, it was endemic diseases that caused the main problems. He viewed the changes to the surveillance system as ‘truly an opportunity, but not a risk-free opportunity’. doi: 10.1136/vr.h49
Downloaded from http://veterinaryrecord.bmj.com/ on July 22, 2015 - Published by group.bmj.com
Thinking differently about surveillance
Veterinary Record 2015 176: 35-36
doi: 10.1136/vr.h49 Updated information and services can be found at: http://veterinaryrecord.bmj.com/content/176/2/35
These include:
Email alerting service
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
