Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 429-439)




  429. Good morning and thank you for coming to see us on our Committee on "Fighting Infection". For the record, could you identify yourself, and make any opening comment before we start on the questions.

  (Professor Thorns) I am Professor Chris Thorns. I work at the Veterinary Laboratories Agency, which is in effect an executive agency of DEFRA. I am Head of the Bacterial Diseases Department and I also manage the Food and Environmental Safety activities at the Veterinary Laboratories Agency, which covers surveillance and research. I am Visiting Professor at the Bristol Veterinary School.
  (Professor Reilly) I am Professor Bill Reilly. I am first and foremost a veterinary surgeon but I have worked in the Scottish Health Service for the last 25 years at the Scottish Centre for Infection and Environmental Health where I am currently the co-ordinator of the gastro-intestinal and zoonoses section. Other interests of mine that are relevant: I am a member of the Scottish Food Advisory Committee to the Food Standards Agency, I am an Honorary Professor at the Glasgow Veterinary School and an Honorary Fellow of the Edinburgh Medical and Veterinary School, both of which universities are teaching schools.

  430. Have you any opening comments to make before we go into questions?
  (Professor Reilly) My Lord Chairman, the only thing I would like to say is that we welcome this opportunity to develop the inter-professional collaboration that I think is necessary to deal with zoonotic disease.

  431. The first question is: could you briefly describe the organisation of surveillance for infectious disease in animals in England and Scotland? In particular, you might wish to highlight who is responsible for ensuring that diseases are reported and samples are taken and who, if anyone, ensures that the information gained from that is fed back to those responsible for taking action. It is a rather complicated question, but you are used to that, I am sure.
  (Professor Thorns) My Lord Chairman, I will start and Professor Reilly may come in afterwards. First of all, the surveillance of animal diseases in the UK is based on the early detection and reporting of clinical disease through scanning surveillance, in particular through the identification of diseases by private veterinary surgeons who have close links with farmers, and reporting and sending material to the appropriate diagnostic laboratory. This is underpinned by certain targeted surveillance activities based on national and international programmes where you target a particular livestock species or particular type of livestock; for example for bovine tuberculosis, brucellosis, salmonella. Also, one identifies particular areas of risk within the human food chain and targeted surveillance at abattoirs is also taken on board to look at some of the major foodborne zoonoses and pathogens that I am sure we will come on to later. The main funder of this activity in England and Wales is DEFRA; in Scotland it is SEERAD (Scottish Executive Environment and Rural Affairs Department) but also the Food Standards Agency via the Meat Hygiene Service, has an important role to play at the abattoir. We must not forget some of the private producers, especially in the poultry industry, who will fund their own monitoring programmes; for example, of salmonella and certain viral diseases in poultry. Dairy companies also will fund certain activities in relation to salmonella and brucellosis. Who carries out this work? In England and Wales, my organisation, the Veterinary Laboratories Agency, is one of the main stakeholders and players in undertaking the surveillance activities, the diagnosis of organisms, diseases, from material. The Scottish Agricultural College in Scotland performs a similar service but we must not ignore the private veterinary surgeons—and we will come back to these—because they are extremely important in ensuring that the material reaches the diagnostic laboratory and their links with the farmers, especially the livestock farmers, is crucial. The veterinary schools, I think, have realised and are developing their own responsibilities in this area, especially in recent years, with a number of initiatives; they have an important role to play in particular in companion animal work. My organisation, which is a national organisation, for example, does not deal generally with companion animals, or indeed horses; horses are generally dealt with by the Animal Health Trust. Who ensures that these diseases, if identified, are reported and action is taken? There is a series of diseases that are either notifiable or reported. These are based on animal diseases that may cause extreme economic loss if they came into this country—many of them are exotic—and cause severe animal health problems. Many of them are zoonoses. It is the responsibility of the competent veterinary authority, which is generally the veterinary surgeon, the Divisional Veterinary Manager I believe in the State Veterinary Service or the DVM in Scotland. These diseases, if identified, have to be reported to those and then they are reported to the relevant authorities, such as DEFRA and the Department of Health. The Reportable Diseases are generally those that come under the Zoonoses Order, which includes some of those on the notifiable list, but it does include others, such as salmonella. If you isolated salmonella from any material, for most animals, not all animals, we have a duty to report that in the case of England and Wales to the Senior Veterinary Investigation Officer, in my organisation it is the Veterinary Laboratories Agency, and I believe in Scotland it is the DVM. How is this information published? In terms of Great Britain, the VIDA Publication data is data of all clinical disease that is isolated and reported in England, Wales and Scotland. The Zoonoses Report, which started in the last few years, is actually an example of the combined data from public health and from veterinary public health where a lot of the data is published. Nowadays, a lot of this data is put, for example, on to the DEFRA website. This is a relatively new initiative, so a lot of this data is really quite current. What do I see as the current strengths of the system? The first thing to say is that it is national; it covers England, Wales and Scotland. I would like to think, and I believe it is recognised worldwide, that the surveillance system in our country—and Professor Roger Morris from New Zealand recognised this—is an all-encompassing system and that for the identification of new and emerging diseases has proven to be a sensitive way of picking them up. However, it has been recognised that there are gaps and weaknesses in the system. You probably realise there are potentially many different stakeholders in England, Wales and Scotland. I would say they are not fully integrated into the one, co-ordinated unit yet. I think that the prioritisation process is not as transparent as it could be, and we are looking to fit this process into a risk-based framework.

  432. Probably we will come on to that co-ordination later. I wonder if Professor Reilly has any comment to make?
  (Professor Reilly) There are one or two points I would like to add to that. I agree entirely that the system is based on clinical disease within the veterinary field, with the addition of notifiable disease and the unusual category of reportable infections where, when the laboratory makes an isolate, it is required under statute to report that to the state veterinary service. In reality, that only applies to salmonella infections. I think if there is a shortfall in the system and it may well be covered in later questions, it is in identifying those infections that are not causing clinical disease. That is the first point. A second point would be to look specifically at the situation in Scotland. In the late 1960s, when my organisation was established, it was established as a multidisciplinary group and at that time the veterinary laboratories were encouraged to report into the medical system. We have, in addition to the formal veterinary reporting that Professor Thorns has identified, an agreement with the Scottish Agricultural College Veterinary Science Division on the list of zoonotic disease that they will also report to us on the medical side. We have within SCIEH, the Scottish Centre for Infection and Environmental Health, the opportunity to compare animal isolates as well as human isolates of the same pathogen, but it still has the same basic limitation in that it is based on animal pathogens. For example, E coli O157 not being an animal pathogen, it would not normally be picked up by routine surveillance methods; veterinary clinicians will not be looking for this organism. It is important to stress the point that Professor Thorns made about surveys. We have very specific surveys looking at, for example O157, campylobacter or salmonella, which may cause animal disease but, to get an estimate of the prevalence and importance of these pathogens, they need to be specifically looked for and targeted.

  433. Apart from the statutory obligation that you may have to report through the Zoonoses Order, what is the general relationship between the Public Health Laboratory Service and the VLA both officially and on the ground in individual members?
  (Professor Thorns) The relationship between the VLA and the PHLS, and indeed VLA, (PHLS) and (SAC) is excellent, very good, both at the personal level, that is the scientific level, the veterinary surgeon and medical epidemiologist, but also we have recently signed a memorandum of understanding between my organisation and the PHLS, soon to be the Health Protection Agency—and we will come on to that later—which identifies key areas of joint activity with the aim of improving the harmonisation of testing procedures, for example, the sharing of data and the reporting of data where appropriate in joint reports. We hold joint conferences together and so on. I think this is the really good initiative in the last few years that has been taken on board by both organisations. We are determined to develop this further.

Lord Oxburgh

  434. Am I right in assuming that the animals that would be the subject of scanning or surveys are all domesticated animals or do you extend to a range of wild animals, because they may be exceedingly important as well?
  (Professor Reilly) In some situations, there is a range of wild animals that will be examined. For example, the Scottish Agricultural College has a marine mammals unit and we will see a list of pathogens that will be identified from these sources. For example, we had eight or nine isolates of brucella last year from animals and in a brucella-free environment, which we until very recently have been in the UK, and we have recognised that these are marine brucellas and are different from brucella abortis, so it does give us a feel for what is in that sector. There are other wildlife instances, particularly deer, where samples will come through the laboratory. One category of animal which is somewhat in the middle might be game birds where there is, I suppose, intensive farming of game birds but they are still wild. The Scottish Agricultural College does have a unit with a lot of input.

  435. Let me give you an example. We heard from the United States that in fact the first indications of West Nile fever were recognised subsequently from the fact that large numbers of dead crows were found in the fields in the eastern United States and no-one appreciated the significance. Would we be likely to have appreciated the significance of this and done something about it had that happened here?
  (Professor Thorns) At VLA we have a specific wildlife project, which is attached to our endemic diseases surveillance programme, and that is generally organised by species—cattle, sheep, pigs and so on. Within that project, the importance of scanning dead crows or dead magpies or even dead jays—that particular family of birds—has been recognised. I would not say we have targeted surveillance but we have put requests in for material from those individual species, dead crows in particular, to be sent to the VLA for examination. Similarly, I understand with horses which have unidentified encephalitis, for example, there is a provision for examination for the West Nile Fever Virus.

  436. Is the answer: it might have been?
  (Professor Thorns) I think so.
  (Professor Reilly) I would like to add to that. I think there are perhaps some examples in the past where an unusual disease in wildlife has been identified, and one perhaps very similar to crows would be an increase in deaths in waterfowl, which has been identified and investigated and found to be botulism. I think we have a good track record of identifying episodes like that.


  437. Can we go back to collaboration between PHLS and VLA. I gather from you that relationships are very good and there is good collaboration, but if there were to be an outbreak of a food-borne enteric organism, would you automatically be brought in to this via the PHLS and food hygiene and abattoir work and things like that?
  (Professor Thorns) It depends on the situation. If there was a human outbreak, say, of salmonella or Verocytotoxigenic Escherichia Coli (VTEC) or campylobacter for that matter, and through epidemiological investigation they identified a potential animal source and they could trace a source back to a particular farm or particular group of farms, then the VLA would be very much part of the investigation control team and we would be responsible for going to the farm, taking the samples and then exploring if we can identify a link—it might be a microbiological link as well as an epidemiological link—between the outbreak and the farm. We are also very much involved now in developing with them joint methods of testing. I am trying to give you an example: antimicrobial resistance. Although I know your committee is not particularly involved in that, it is quite important that we now have a system whereby we can actually compare isolates coming from animals and isolates coming from humans. One specific example which is of interest is that most recently, because our tests are now harmonised as obviously in humans you do antibiotic testing for slightly different reasons than we do for salmonella, we have looked at a number of salmonella isolates from animals in the UK and compared those with salmonella isolates from cases of human food poisoning. We have looked at antibiotic-resistance patterns. What is very interesting is that, as one would suspect, in some cases there is quite good concordance between resistant patterns, between both sets of strains, but we were rather surprised that in some particular serotypes of salmonella there was almost no comparison between the two sets. Because of our good international links, that is with the VLA and the PHLS—and we work pretty closely especially with our European colleagues—we were able to examine these pathogens with isolates from the European countries, such as France and Germany. What emerged was that some of these human strains that perhaps we would have thought came from UK-produced poultry or animals, actually had identical resistance patterns to strains coming from countries in mainland Europe. This is no conclusive evidence but it suggests that there is a very important role, for example for imported food, imported livestock, and that these sorts of activities between the two organisations I have highlighted are examples of how we take this forward.

Lord Turnberg

  438. Could I pursue this collaborative effect with the PHLS and other organisations? Do you use common operating procedures and methodologies and are your IT systems such that you can get ready access to their information and you can pass on information to them?

  (Professor Thorns) I will start with the standard operating procedures. We are moving towards harmonising our standard operating procedures. There is a UK-wide committee chaired in fact by my Chief Executive, Professor Stephen Edwards, which is looking at the harmonisation of certain key protocols. The first example—and Professor Reilly will know—is the standard protocol for (VTEC) O157 in veterinary and public health laboratories. I gave you the example of antimicrobial resistance. We are working towards examples such as campylobacter but there is a very important point here. With some of what I would call orphan zoonoses where the critical mass of expertise in the UK and elsewhere is very limited, such as anthrax and glanders, the very rare bacterial diseases, actually the way forward would probably be to share this rather than to harmonise protocols. I can give you two examples of that. The first one is brucellosis where in my department actually we do all the confirmation of human brucellosis for the PHLS and they do all the confirmation for botulinum for us. So we are moving forward on that. On the IT side, I am not so competent to answer that question, except that I would say at the moment we are not in a position to interrogate each other's epidemiological databases. I believe there are areas of confidentiality and other things that need to be explored before we take this forward.

  (Professor Reilly) Can I give one example where there is this total collaboration between PHLS and VLA, even though I am speaking from the Scottish perspective because this was a Scottish case. We had the unfortunate fatality in November of a rabies case in a patient in Dundee. The laboratory work for that was carried out by the Veterinary Laboratory Agency because that is where the expertises in rabies lies in the UK. If I can comment on collaboration, I do not particularly want this morning to continue to say "but in Scotland things are different", but there are instances where we are different. The statutory responsibility for managing incidents in Scotland resides with the state veterinary service, whereas the Veterinary Laboratory Agency will have that function in England and Wales. The Scottish Agricultural College which provides the veterinary diagnostic support for Scotland does not have a statutory function. The veterinary laboratory service is different in Scotland than it is in England and Wales. Because of the history of the way collaboration has developed in Scotland over 25 years, we regard not only the laboratory but my colleagues in the state veterinary service as our partners in investigation. In fact, we have a set of guidelines for the investigation and management of zoonotic infections that sets out the roles and responsibilities of each of the partner organisations and lines of communication. I can let the committee have a copy of that if you would be pleased to see it.


  439. I think that would be very helpful.  (Professor Reilly) I think we start from the advantage of being a small population of some five million and we know each other. Maybe I will come on later to talk about local liaison. But the fact that we are professionally known to each other means that there is good day-to-day collaboration between the veterinary laboratory, the Scottish Centre for Infection and (SEERAD) the state veterinary service. I think having a formal set of structures as to how to communicate has helped.

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