| Dictionary: bovine spongiform encephalopathy |
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An infectious disease in cattle thought to be caused by a prion, a very small abnormal heat-resistant protein with the unusual property of transforming normal protein into more prions, hence the infectious nature of the disease. The abnormal protein accumulates leading to nerve damage in the brain. Spread between species is possible. Cattle can, for example, contract the disease from feed containing meat and bone-meal from sheep infected with scrapie (the sheep form of the disease). Transfer of the disease has not yet been demonstrated with certainty between cow and man, but it is a possibility if infected offal (specifically, nerve, brains, and spinal cord) is eaten, as it was between 1988 and 1992 in the UK. The human form of the disease is sometimes called Creutzfeldt-Jakob disease or CJD, but, at the time of writing, it is still not known whether or not BSE and CJD are the same disease.
| Encyclopedia of Public Health: Bovine Spongiform Encephalopathy |
Few more challenging food safety issues exist today than that of bovine spongiform encephalopathy (BSE) and the human form of the disease, variant Creutzfeldt-Jakob disease (vCJD). While vCJD remains rare at this time, the lack of a screening diagnostic test, uncertainty about the extent of exposure to the agent among humans and animals, the long incubation period, and the resulting devastating and inevitably fatal disease combine to create a situation of extreme difficulty for those responsible for public-policy development. The true extent of the unfolding epidemic is unknown, and since the largest exposures to BSE occurred before the relationship to a human disease was recognized, the full impact on human health may not be known for many years to come. This makes it difficult to determine appropriate actions to take to protect the consumer.
The Epidemic of Bse
BSE appeared as a completely novel disease of cattle in the United Kingdom (UK), the first known case being diagnosed retrospectively in 1985. By 1986, BSE was recognized as a transmissible spongiform encephalopathy (TSE) of cattle and considered to be analogous to scrapie, a disease of sheep that is not known to cause human disease. Regardless, investigations were conducted to determine how it was being transmitted among cattle. These studies determined that protein supplement feeds made with meat and bone meal (MBM) were the most likely source of the disease. MBM is extracted from cattle and sheep carcasses through a long cooking process called rendering. Rendering is an established practice, used since the turn of the twentieth century. Through rendering, any tissue remaining on animal carcasses after removal of principle tissues is converted into a cake-like material that is used in multiple industries, including the production of protein supplements for animal feeding. Recycling of the agent through rendering led to the rapid and diffuse spreading of BSE throughout most of the United Kingdom.
Cattle feed sold in the European market spread the disease further. The first cases outside of the UK appeared in 1989 in the Republic of Ireland. By 1990, two other countries (Portugal and Switzerland) were affected, and France reported its first case in 1992. As of December 2000, eleven European countries outside of the UK had reports of BSE in their national herds (Republic of Ireland, Switzerland, Portugal, France, Belgium, Luxembourg, Netherlands, Liechtenstein; and in 2000, Denmark, Spain, and Germany). Three other countries (Canada, Oman, and Maldives Islands) have reported cases, but only in imported cattle. The UK reported approximately 180,000 cases (as of December 2000), with just over 1,300 BSE cases reported elsewhere.
Bse in Humans
In April 1996, Dr. Robert Will of the United Kingdom Edinburgh CJD Surveillance Unit announced that ten persons had been identified with a novel form of Creutzfeldt-Jakob disease (CJD), and that these cases were sufficiently alike and sufficiently distinguishable from sporadic CJD that they could be considered a new variant of CJD
(vCJD). Surveillance for vCJD is conducted throughout the European Union (EU), and in some non-EU countries including the United States, Canada, and Australia. As of April 4, 2001, the number of vCJD cases reported in the UK was ninety-seven, with three cases reported in France and once in the Republic of Ireland.
Clinically, the illness begins with behavioral changes, but its progression is inevitable and unrelenting. The course is relatively prolonged (two years or more) with both mental and physical deterioration. The patient is eventually left in a vegetative state, unable to speak or move, and death is inevitable, as there is no treatment apart from supportive nursing. The average age of onset is 29 years (cases have ranged from 14 to 74 years of age). Diagnosis is made by magnetic resonance imaging, tonsillar biopsy, and cerebro-spinal fluid testing, and must be confirmed by neuropathology. EEG, used for the diagnosis of sporadic CJD, is not helpful. Brain biopsy is not recommended unless a treatable differential diagnosis is sought.
It is now widely considered that the same agent causes both BSE and vCJD. A number of causes have been proposed—including organophosphates, vaccines, and other novel agents— however, scientific support for these theories has been weak. The route of exposure for humans in unclear, but it seems reasonable to suspect cattle-based food.
Discussion of the potential health impact for humans began early, and by 2001 a wide variety of measures had been implemented, including the removal of animals known to have BSE from the human food chain and the removal during slaughter of known high-risk tissues from animal carcasses regardless of their BSE status (certain tissues of sheep and goats are also removed because of fears raised that sheep and goats may be harboring BSE without developing disease). These tissues included initially the brain, eyes, spinal cord and terminal ileum, but the list was later expanded to include the whole head (excluding tongue), spinal column, thymus, intestine, and dorsal root ganglion. In addition, reflecting current knowledge about the spread of infectivity, animals over certain ages (from 6 to 30 months of age depending on the level of safety required) are not consumed. Also to be considered is the possible contamination of skeletal muscle meat due to certain slaughter techniques that embolize brain tissue throughout the body, or which cause surface contamination of edible parts of the carcass.
Control of Bse
To stop the continued spread of BSE, three principle strategies are used: surveillance, preventing the exposure of ruminants (cattle, sheep, and goats) to feed made from ruminant protein, and slaughter of diseased animals. Because of the long incubation period for BSE (four to five years), cases have continued to be reported after the implementation of these measures. The peak of the epidemic was seen in 1992, at which point the UK was reporting over 30,000 cases of BSE per year.
Cases of BSE reported after the feed ban was implemented are known as "born-after-ban" (BAB) cases, and investigation of them revealed important holes in safety measures. BAB cases appear to be the result of an incomplete application of the feed ban and an incomplete understanding of the importance of even a small amount of contamination—a piece of brain tissue the size of a peppercorn is sufficient to infect a bovine animal. In the UK, feed bans had to be extended (in 1994) to include all mammalian protein in ruminant feeds, with a further extension in 1996 to prevent the use of mammalian MBM in all animal feed. Cross-contamination of tissues in slaughterhouses, feed mills, and other sites also required management. Furthermore, inspection, animal tracing systems, financial incentives, and fines were implemented to ensure that all risk materials were removed from carcasses and that animals with disease were reported and destroyed.
The European Union did not introduce its feed ban legislation (a simple ruminant-to-ruminant feed ban) until 1994, by which point it was too late to prevent the introduction of the disease. When the first human cases of vCJD occurred in 1996, the UK was prohibited from exporting bovine meat, cattle, and bovine-based products. As recently as November 2000, with the recognition of more than expected numbers of cases of BSE, it became clear to the EU that their interventions had been both inadequate and inadequately enforced. Measures to prohibit all animal protein feed to farm animals were to be introduced in the EU within 2001. However, the extent of spread of the epidemic among national herds will not be visible for a number of years.
At the international level, a question exists regarding non-European countries who also imported implicated MBM from the UK and Europe. Few non-EU countries have surveillance system for BSE, yet many nations imported and used implicated MBM, and many also imported live cattle. The risk that the disease has been imported into these countries without the financial capacity to enact the required interventions could result in a new foci of distribution of this devastating disease. International guidelines, such as those promulgated by the Office International des Epizooties, the Food and Agriculture Organization, and the World Health Organization are only partial solutions. It is clear that risk analysis must be conducted in each country in order to assess the risk that BSE was imported and whether the conditions exist for its further propagation.
(SEE ALSO: Transmissible Spongiform Encephalopathy; Veterinary Public Health; Zoonoses)
Bibliography
Brown, P.; Will, R. G.; Bradley, R.; Asher, D. M.; and Detwiler, L. (2000). "Bovine Spongiform Encephalopathy and Variant Creutzfeldt-Jakob Disease: Background, Evolution, and Current Concerns." Emerging Infections Diseases (1).
Knight, R. (1994). "The Relationship between New Variant Creutzfeldt-Jakob Disease and Bovine Spongiform Encephalopathy." Vox Sanguinus 76:203–208.
Scott, M. R.; Will, R.; Ironside, J.; Nguyen, H-O. B.; Tremblay, P.; DeArmond, S. J.; and Prusiner, S. B. "Compelling Transgenetic Evidence for Transmission of Bovine Spongiform Encephalopathy Prions to Humans." Proceedings of the National Academy of Science 96(26):15,137–15,142.
Ward, H. J. T. (2000). "Surveillance of Variant Creutzfeldt-Jakob Disease in the United Kingdom." EuroSurveillance 5(9):90–94.
Wilesmith, J. W.; Wells, G. A. H.; Cranwell, M. P.; and Ryan, J. B. M. (1988). "Bovine Spongiform Encephalopathy: Epidemiological Studies." Veterinary Record 123:638–644.
Will, R. G.; Zeidler, M.; Stewart, G. E.; Macleod, M. A.; Ironside, J. W.; Cousens, S. N. et al. (2000). "Diagnosis of New Variant Creutzfeldt-Jakob Disease." Annals of Neurology 47:575–582.
Web Sites of Interest
For information about BSE reports: http://www.OIE.int.
For WHO consultations and opinions: http://www.who.int/emc/diseases/bse/index.html.
For information concerning EU decisions: http://europa.eu.int/comm/food/index_en.html.
Web site of the CJD Surveillance Unit (with connections to UK ministries and international surveillance systems sites): http://www.cjd.ed.ac.uk/index.htm.
— MAURA N. RICKETTS
| Wikipedia: Bovine spongiform encephalopathy |
Bovine spongiform encephalopathy (BSE), commonly known as mad-cow disease (MCD), is a fatal, neurodegenerative disease in cattle, that causes a spongy degeneration in the brain and spinal cord. BSE has a long incubation period, about 4 years, usually affecting adult cattle at a peak age onset of four to five years, all breeds being equally susceptible.[1] In the United Kingdom, the country worst affected, more than 179,000 cattle have been infected and 4.4 million slaughtered during the eradication programme.[2]
It is believed by most scientists that the disease may be transmitted to human beings who eat the brain or spinal cord of infected carcasses.[3] In humans, it is known as new variant Creutzfeldt-Jakob disease (vCJD or nvCJD), and by October 2009, it had killed 165 people in Britain, and 44 elsewhere[4] with the number expected to rise because of the disease's long incubation period.[5] Between 460,000 and 482,000 BSE-infected animals had entered the human food chain before controls on high-risk offal were introduced in 1989.[6]
A British inquiry into BSE concluded that the epidemic was caused by cattle, who are normally herbivores, being fed the remains of other cattle in the form of meat and bone meal (MBM), which caused the infectious agent to spread.[7][8] The origin of the disease itself remains unknown. The infectious agent is distinctive for the high temperatures at which it remains viable; this contributed to the spread of the disease in Britain, which had reduced the temperatures used during its rendering process.[7] Another contributory factor was the feeding of infected protein supplements to very young calves.[7][9]
Contents |
The infectious agent in BSE is believed to be a specific type of misfolded protein called a prion. Those prion proteins carry the disease between individuals and cause deterioration of the brain. BSE is a type of transmissible spongiform encephalopathy (TSE).[10] TSEs can arise in animals that carry an allele which causes previously normal protein molecules to contort by themselves from an alpha helical arrangement to a beta pleated sheet, which is the disease-causing shape for the particular protein. Transmission can occur when healthy animals come in contact with tainted tissues from others with the disease. In the brain these proteins cause native cellular prion protein to deform into the infectious state, which then goes on to deform further prion protein in an exponential cascade. This results in protein aggregates, which then form dense plaque fibers, leading to the microscopic appearance of "holes" in the brain, degeneration of physical and mental abilities, and ultimately death.
Different hypotheses exist for the origin of prion proteins in cattle. Two leading hypotheses suggest that it may have jumped species from the disease scrapie in sheep, or that it evolved from a spontaneous form of "mad cow disease" that has been seen occasionally in cattle for many centuries.[11] Publius Flavius Vegetius Renatus records cases of a disease with similar characteristics in the 4th and 5th Century AD.[12] The British Government enquiry took the view the cause was not scrapie as had originally been postulated, and was some event in the 1970s that it was not possible to identify.[13]
Findings published in PLoS Pathogens (September 12, 2008) suggest that mad cow disease also is caused by a genetic mutation within a gene called Prion Protein Gene. The research shows, for the first time, that a 10-year-old cow from Alabama with an atypical form of bovine spongiform encephalopathy had the same type of prion protein gene mutation as found in human patients with the genetic form of Creutzfeldt-Jakob disease, also called genetic CJD for short. Besides having a genetic origin, other human forms of prion diseases can be sporadic, as in sporadic CJD, as well as foodborne. That is, they are contracted when people eat products contaminated with mad cow disease. This form of Creutzfeldt-Jakob disease is called variant CJD.[14]
Not all scientists agree that the danger of contracting the disease warrants taking extreme measures. They stress that human infection by mad cow disease has been statistically very small.[citation needed]
Cattle are normally herbivores. In nature, cattle eat grass. In modern industrial cattle-farming, various commercial feeds are used, which may contain ingredients including antibiotics, hormones, pesticides, fertilizers, and protein supplements. The use of meat and bone meal, produced from the ground and cooked left-overs of the slaughtering process as well as from the cadavers of sick and injured animals such as cattle, sheep, or chickens, as a protein supplement in cattle feed was widespread in Europe prior to about 1987.[3] Worldwide, soya bean meal is the primary plant-based protein supplement fed to cattle. However, soya beans do not grow well in Europe, so cattle raisers throughout Europe turned to the less expensive animal by-product feeds as an alternative. A change to the rendering process in the early 1980s may have resulted in a large increase of the infectious agents in the cattle feed. A contributing factor was suggested to have been a change in British laws that allowed a lower temperature sterilization of the protein meal. While other European countries like Germany required said animal byproducts to undergo a high temperature steam boiling process, this requirement had been eased in Britain as a measure to keep prices competitive. Later the British Inquiry dismissed this theory saying "changes in process could not have been solely responsible for the emergence of BSE, and changes in regulation were not a factor at all."[15]
The first animal to fall ill with the disease occurred in 1984 in Britain, lab tests the following year indicated the presence of BSE, it was only in November 1986 that the UK Ministry of Agriculture accepted it had a new disease on its hands.[citation needed] Subsequently, 165 people (up until October 2009) acquired and died of a disease with similar neurological symptoms subsequently called vCJD, or (new) variant Creutzfeldt-Jakob disease.[4] This is a separate disease from 'classical' Creutzfeldt-Jakob disease, which is not related to BSE and has been known about since the early 1900s. Three cases of vCJD occurred in people who had lived in or visited Britain — one each in Ireland, Canada and the United States. There is also some concern about those who work with (and therefore inhale) cattle meat and bone meal, such as horticulturists, who use it as fertilizer. Up to date statistics on all types of CJD are published by the National Creutzfeldt-Jakob Disease Surveillance Unit (NCJDSU) in Edinburgh.
For many of the vCJD patients, direct evidence exists that they had consumed tainted beef, and this is assumed to be the mechanism by which all affected individuals contracted it. Disease incidence also appears to correlate with slaughtering practices that led to the mixture of nervous system tissue with hamburger and other beef. It is estimated that 400,000 cattle infected with BSE entered the human food chain in the 1980s.[citation needed] Although the BSE epizootic was eventually brought under control by culling all suspect cattle populations, people are still being diagnosed with vCJD each year (though the number of new cases currently has dropped to fewer than 5 per year). This is attributed to the long incubation period for prion diseases, which are typically measured in years or decades. As a result the extent of the human vCJD outbreak is still not fully known.
The scientific consensus is that infectious BSE prion material is not destroyed through normal cooking procedures, meaning that contaminated beef foodstuffs prepared "well done" may remain infectious.[16][17]
In 2004 researchers reported evidence of a second contorted shape of prions in a rare minority of diseased cattle. If valid, this would imply a second strain of BSE prion. Very little is known about the shape of disease-causing prions, because their insolubility and tendency to clump thwarts application of the detailed measurement techniques of structural biology. But cruder measures yield a "biochemical signature" by which the newly discovered cattle strain appears different from the familiar one, but similar to the clumped prions in humans with traditional CJD Creutzfeldt-Jakob Disease. The finding of a second strain of BSE prion raises the possibility that transmission of BSE to humans has been underestimated, because some of the individuals diagnosed with spontaneous or "sporadic" CJD may have actually contracted the disease from tainted beef. So far nothing is known about the relative transmissibility of the two disease strains of BSE prion.
Alan Colchester, a professor of neurology at the University of Kent, and Nancy Colchester, writing in the September 3, 2005 issue of the medical journal, The Lancet, proposed a theory that the most likely initial origin of BSE in Britain was the importation from the Indian subcontinent of bone meal which contained CJD infected human remains.[18] The government of India vehemently responded to the research calling it "misleading, highly mischievous; a figment of imagination; absurd," further adding that India maintained constant surveillance and had not had a single case of either BSE or vCJD.[19][20] The authors responded in the January 22, 2006 issue of The Lancet that their theory is unprovable only in the same sense as all other BSE origin theories are and that the theory warrants further investigation.[21]
During the course of the investigation into the BSE epizootic, an enquiry was also made into the activities of the Department of Health and its Medicines Control Agency. On May 7, 1999, in his written statement number 476 to the BSE Inquiry, David Osborne Hagger reported on behalf of the Medicines Control Agency that in a previous enquiry the Agency had been asked to:
"... identify relevant manufacturers and obtain information about the bovine material contained in children’s vaccines, the stocks of these vaccines and how long it would take to switch to other products." It was further reported that the: "... use of bovine insulin in a small group of mainly elderly patients was noted and it was recognised that alternative products for this group were not considered satisfactory." A medicines licensing committee report that same year recommended that: "... no licensing action is required at present in regard to products produced from bovine material or using prepared bovine brain in nutrient media and sourced from outside the United Kingdom, the Channel Isles and the Republic of Ireland provided that the country of origin is known to be free of BSE, has competent veterinary advisers and is known to practise good animal husbandry." In 1990 the British Diabetic Association became concerned regarding the safety of bovine insulin and the government licensing agency assured them that: "... there was no insulin sourced from cattle in the UK or Ireland and that the situation in other countries was being monitored." In 1991 a European Community Commission: "... expressed concerns about the possible transmission of the BSE/scrapie agent to man through use of certain cosmetic treatments." Sources in France reported to the British Medicines Control Agency: "... that there were some licensed surgical sutures derived from French bovine material." Concerns were also raised: "... regarding a possible risk of transmission of the BSE agent in gelatin products."
Soybean meal is cheap and plentiful in the United States. As a result, the use of animal byproduct feeds was never common, as it was in Europe. However, U.S. regulations only partially prohibit the use of animal byproducts in feed. In 1997, regulations prohibited the feeding of mammalian byproducts to ruminants such as cows and goats. However, the byproducts of ruminants can still be legally fed to pets or other livestock such as pigs and poultry such as chickens. In addition, it is legal for ruminants to be fed byproducts from some of these animals.[22] A proposal to end the use of cow blood, restaurant scraps, and poultry litter (fecal matter, feathers)[23] in January 2004 has yet to be implemented,[24] despite the efforts of some advocates[who?] of such a policy, who cite the fact that cows are herbivores, and that blood and fecal matter could potentially carry BSE.
In February 2001, the USGAO reported that the FDA, which is responsible for regulating feed, had not adequately policed the various bans.[25] Compliance with the regulations was shown to be extremely poor before the discovery of the Washington cow, but industry representatives report that compliance is now 100%. Even so, critics call the partial prohibitions insufficient. Indeed, US meat producer Creekstone Farms alleges that the USDA is preventing BSE testing from being conducted.[26]
The USDA has issued recalls of beef supplies that involved introduction of downer cows into the food supply. Westland/Hallmark was found to have used electric shocks to prod downer cows into the slaughtering system in 2007.[27] Possibly due to pressure from large agribusiness, the United States has drastically cut back on the number of cows inspected for BSE.[28]
Japan was the top importer of U.S. beef, buying 240,000 tons valued at $1.4 billion in 2003.[citation needed] After the discovery of the first case of BSE in the U.S. on December 23, 2003, Japan stopped U.S. beef imports in December 2003. In December 2005, Japan once again allowed imports of U.S. beef, but reinstated its ban in mid-January 2006 after a technical violation of the U.S.-Japan beef import agreement: a vertebral column, which should have been removed prior to shipment, was included in a shipment of veal.
Tokyo yielded to U.S. pressure to resume imports, ignoring consumer worries about the safety of U.S. beef, said Japanese consumer groups. Michiko Kamiyama from Food Safety Citizen Watch said about this: "The government has put priority on the political schedule between the two countries, not on food safety or human health."
65 nations implemented full or partial restrictions on importing U.S. beef products because of concerns that U.S. testing lacked sufficient rigor. As a result, exports of U.S. beef declined from 1,300,000 metric tons in 2003, before the first mad cow was detected in the US, to 322,000 metric tons in 2004. This has increased since then to 771,000 metric tons in 2007.[29]
On December 31, 2006, Hematech, a biotechnology company based in Sioux Falls, South Dakota, announced that it had used genetic engineering and cloning technology to produce cattle that lacked a necessary gene for prion production - thus theoretically making them immune to BSE.[30]
| Country | BSE cases | vCJD cases |
|---|---|---|
| Austria | 5 | 0 |
| Belgium | 133[31] | 0 |
| Canada | 15[32] | 1[4] |
| Czech Republic | 28[33] | 0 |
| Denmark | 14[34] | 0 |
| Falkland Islands | 1 | 0 |
| Finland | 1 | 0 |
| France[35] | 900 | 25[4] |
| Germany | 312 | 0 |
| Greece | 1[36] | 0 |
| Hong Kong | 2 | 0 |
| Ireland | 1,353 | 4[4] |
| Israel | 1[37] | 0 |
| Italy | 138[38] | 1[4] |
| Japan | 26 | 1[4] |
| Liechtenstein | 2 | 0 |
| Luxembourg | 2 | 1 |
| Netherlands | 85[39] | 3[4] |
| Oman | 2 | 0 |
| Poland | 21 | 0 |
| Portugal | 875 | 2[4] |
| Saudi Arabia | 1[4] | |
| Slovakia | 15 | 0 |
| Slovenia | 7 | 0 |
| Spain | 412 | 5[4] |
| Sweden | 1 | 0 |
| Switzerland | 453 | 0 |
| Thailand | [40] | 2 |
| United Kingdom | 183,841 | 170[4] |
| United States | 3[32] | 3[4] |
| Total | 188,579 | 214 |
The table[citation needed] to the right summarizes reported cases of BSE and of vCJD by country. BSE is the disease in cattle, while vCJD is the disease in people.
The tests used for detecting BSE vary considerably as do the regulations in various jurisdictions for when, and which cattle, must be tested. For instance, in the EU the cattle tested are older (30 months+), while many cattle are slaughtered earlier than that. At the opposite end of the scale, Japan tests all cattle at the time of slaughter. Tests are also difficult as the altered prion protein has very small levels in blood or urine, and no other signal has been found. Newer tests are faster, more sensitive, and cheaper, so it is possible that future figures may be more comprehensive. Even so, currently the only reliable test is examination of tissues during an autopsy.
It is notable that there are no cases reported in Australia, Brazil, New Zealand and Vanuatu where cattle are mainly fed outside on grass pasture and, mainly in Australia, non-grass feeding is done only as a final finishing process before the animals are processed for meat.
As for vCJD in humans, autopsy tests are not always done and so those figures too are likely to be too low, but probably by a lesser fraction. In the UK anyone with possible vCJD symptoms must be reported to the UK Creutzfeldt-Jakob Disease Surveillance Unit. In the U.S., the CDC has refused to impose a national requirement that physicians and hospitals report cases of the disease. Instead, the agency relies on other methods, including death certificates and urging physicians to send suspicious cases to the National Prion Disease Pathology Surveillance Center (NPDPSC) at Case Western Reserve University in Cleveland, which is funded by the CDC.
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