dr. james kober - swine disease diagnostics and economics considerations
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Swine Disease Diagnostics and Economics Considerations - Dr. James Kober, Swine Veterinary Services of MI, LLC/Partner-4 Star Veterinary Services, LLC, from the 2013 Allen D. Leman Swine Conference, September 14-17, 2013, St. Paul, Minnesota, USA. More presentations at http://www.swinecast.com/2013-leman-swine-conference-materialTRANSCRIPT
DIAGNOSTIC CONSIDERATIONS
LEMEN CONFERENCESEPTEMBER 17, 2013
James A. Kober, DVM, MSDiplomate ABVP-SHM
Swine Veterinary Services of MI, LLC/Partner-4 Star Veterinary Services, LLC
Buried in Bureaucracy
Pythagorean theorem: 24 words The Lord’s prayer: 66 words Archimede’s principle: 67 words The ten commandments: 179 words The Gettysburg address: 286 words The Declaration of Independence: 1300
words Constitution of the United States: 4543 Health care regulations from President
Obama:
Buried in Bureaucracy
Pythagorean theorem: 24 words The Lord’s prayer: 66 words Archimede’s principle: 67 words The ten commandments: 179 words The Gettysburg address: 286 words The Declaration of Independence: 1300
words Constitution of the United States: 4543 Health care regulations from President
Obama: 2,163,744
Diagnostics: Two main directions:
Sick pig testing: tissues, oral fluids, serum
Surveillance testing: oral fluids, serum
Diagnostic expenses
What are the costs? Per case? Per year? What are the benefits? What are you going to do with the
results? How much is the right amount to spend
on diagnostics and/or surveillance?
The decisions on how much to spend will vary significantly from producer to producer.
Back yard/show pig
They want to know why the pig died, regardless of the cost.
Diagnostic costs are spread over a small number of pigs.
This group may ask that you to run more tests than necessary.
“test for everything” Doc Little or no surveillance. Often need the most help, because they
make bad health related decisions. More individual animal care; surgeries.
Small independent producer
Toughest group May wait until problem is well advanced Costs are extremely important as there are
a small number of pigs to spread the costs More important to rely on the veterinarians
practice experience or best judgment. May forego actually sending tissues to the
lab. Treatment is more of a shotgun approach. Surveillance unlikely.
Large independent producer
May or may not have budget More pigs to spread costs over Often conducts surveillance in addition to
“sick pig” diagnostics. Need to know exactly what is at fault so
treatment can be correct and precise. Start answering to administrators who
don’t know production.
Integrator or managed herds
Often have some sort of budget. Most will track “sick pig” diagnostics vs.
surveillance. Will vary if multiplier vs. commercial
herds. Informal survey of colleagues working in
this type of production system:
$0.35-$0.40 per pig marketed (commercial)
Budget determined by type of site, threat of area spread, # samples, frequency of testing; then looked at the system wide level (sow units, boar studs, growing pigs, GDU). Historical costs come into play
New breaks or emerging disease are not restricted by budgets.
Budget includes diagnostics (including surveillance), medicine, and vaccines into one figure. $45.91 per sow per year
@ 28 PW/S/Y=$1.64 per pig weaned. $1.60 pig marketed Total: $3.24 per pig marketed (diagnostics,
surveillance, medicine, vaccine).
Bottom line:
It is very difficult to compare company or system diagnostic budgets. They use vastly different ways to track the diagnostic and surveillance costs.
4 Star submissions
Sick pig cases ISU only 12 months: June 1, 2012-May 31, 2013 308 tissue cases Cost: $56,020 total Average: $182/case.
New options for diagnostics
As farms have become more sparse (rural areas), it may be difficult to pay for a veterinarian to come out to post a pig.
More farms have people who are willing to do this. With some training, they can harvest and send tissues/oral fluids on their own.
It is becoming more common for veterinarians to interpret lab results only.
Rural (Veterinarians)
US Government has 15 definitions of “rural”
11 are used by the USDA The biggest definition of rural is less than
50,000 residents (county) The smallest definition is less than 2,500. This creates problems when someone
applies for a “rural development grant” Source: Michigan Farm Bureau News via
The Washington Post
Leveraging resources
If the veterinarian can’t be there, perhaps a manager, intern, or student can be.
They are not diagnosticians, but can be trained in broad categories.
As they post more pigs, more categories can be added.
Use of a flow chart to categorize is helpful.
Lung Lesions?
Blood in stomach?
Blood in intestines?
All organs stuck together?
“POLYSEROSITIS”
“RESPIRATORY”
“HBS”
“ULCER”
“OTHER”
Death
Perform Necropsy?
“UNKNOWN”
N
Y
N
N
N
N
N
N
Y
Y
Y
Y
Y
Y
Finisher Mortality Classification Flowchart
Locke Karriker, DVM, MS, DACVPMJohn T. Waddell, DVM, MBARevised: October 22, 2006
“ACUTE”Was this a “sudden” death?
“CHRONIC” N Y
Record and continue
A “sudden death” is a pig that is found dead in the home pen with no previous
treatment.
CNS observed before death?
Euthanized?
“BRAINER”
“EUTHANIZED”
Record reason:-“junk”-“downer”-“lame”-“rupture”
C A
E
1
2
3
4
5
6
7
Summer of 2011, large client (6600 sows farrow to finish, multiple sites)
Post weaning death loss too high. Why? Unknown. Two veterinary students from MSU
worked for 10 weeks; posted every post weaning pigs they could find.
(Thanks to Novartis and Pfizer/Zoetis)
W/M flow: total 215 pigs posted. Top 6 reasons are:
Bacterial pneumonia/A. suis-17% Unknown: -16% Polyserositis -16% Causes: H.
parasuis or M. hyorhinis HBS -10% twisted gut Meningitis -7% H. parasuis, Strep
suis, hem. E. coli Vitamin E/Se -7% Total, top 6 -73% Two distinct peaks at 6-8 weeks in and 13-15 weeks
in
Nurs and Finisher: 208 pigs posted. Top 7 reasons: Polyserositis -30%, Unknown -17% Bact pneumonia -14% Vit E/Se -5% Meningitis -5% HBS -4% Rectal prolapse -6.5% Total, 7 reasons -81.5% Three peaks (4-6, 7-9, 10-12 weeks post weaning)
Diagnostic Surveillance
Monitoring the health of the herd. To be sure herds negative for certain
agents remain negative (PRRS primarily). To monitor when stable herds become
unstable. To monitor when unstable herds become
stable. To monitor if exposure to subclinical
agents has taken place (PED, PRRS, ileitis)
Much easier to budget; routine Have a plan if results don’t come out like
you would like. “Monitoring for the sake of doing
something does not justify itself in all but the highest health system” (Hansen, et al).
What to do if results are unfavorable
Load, close, homogenize Vaccinate Weaned pigs to a different site Institute McREBEL Dump isolation to slaughter Wait until shedding is complete Put into sow herd “cause we really need
the gilts, doc”
Early surveillance
SPF slaughter checks 10 pigs quarterly; looking for lesions of
Mycoplasma hyopneumoniae Pass/fail Problems:
If failed, just brought 10 more pigs Some farms raised pigs outdoors specifically for
slaughter checks. Small sample, but most farms were small,
continuous flow, single site farms. Likely would find at least one set of lungs with
lesions if Mycoplasma was present.
More precise monitoring
Specific, routine tests Frequency can be altered to fit exact
agent(s) or likelihood of exposure.
Age Timing Frequency Sample type Test Cost per test # samp/pl/rp # smplgs / yr Seq /smplng Seq cost Cost per sampling Cost per yearSows Baseline Once Serum ELISA $4.00 20 1 0 120 $80.00 $80.00Due to be weaned pigs Baseline Once Serum PCR $25.00 12 1 2 120 $540.00 $540.00Nursery (4 weeks post wean) Baseline Once Oral fluid PCR $25.00 4 1 1 120 $220.00 $220.00Finishing (4 weeks post-place) Baseline Once Oral fluid PCR $25.00 4 1 1 120 $220.00 $220.00Gilts (GDU) Baseline Once Oral fluid PCR $25.00 8 1 1 120 $320.00 $320.00Sows Continuos No Serum ELISA $4.00 0 0 0 120 $0.00 $0.00Due to be weaned pigs Continuos Monthly Serum PCR $25.00 6 12 0.5 120 $210.00 $2,520.00Nursery (4 weeks post wean) Continuos Quarterly Oral fluid PCR $25.00 2 4 0.5 120 $110.00 $440.00Finishing (4 weeks post-place) Continuos Quarterly Oral fluid PCR $25.00 2 4 0.5 120 $110.00 $440.00Gilts (GDU) Continuos Quarterly Oral fluid PCR $25.00 4 4 0.5 120 $160.00 $640.00TOTAL $5,420.00
Program can be modified according to goal of production, status of herds, risk of infection and pig flowThis plan = baseline sampling/testing (20 sows, 60 DTW piglets, 4 ropes in Nursery, 4 in Finishing and 8 in gilt flow) + continous testing (30 DTW, 2 ropes in Nur, 2 in Gfin and 4 in GDU / quarter)
Another new type of surveillance
PRRS area regional control projects Monitor the status of a region instead of a
single farm or site. Can use to monitor active infections vs
stable vs. negative farms Can watch and predict an infection
moving across the area.
Michigan PRRS ARC
110 sites Thoroughly tested 2009, 2011, and 2013. Mapped, dendogram created 2009-all serum; 2011-part serum, part oral fluids;
2013- mostly oral fluids. Plan of action introduced to all producers in the
area. Taught to look for sick pigs. Collect oral fluid samples and submit to laboratory Results to ARC leader; notify producers in the area what
was going on. Goal is to warn area producers if something new is
happening.
Nucleotide Substitution per 100 residues0
19.3
24681012141618
11.11.23_201103837713.4.4_201301282213.3.13_2013009550_113.3.13_2013009550_311.11.30_201103888813.4.3_PP13.2.12_201300601111.9.20_201103031213.3.13_2013009550_212.3.16_12151212.5.1_12224213.3.14_2013010367_213.3.14_2013010367_311.3.16_201100839711.10.25_201103438909.8.18_200902336811.11.17_2011036300_211.11.17_2011036300_311.11.30_201103745109.9.25_D09-048096 09.10.29_D09-053722 09.5.28_D09-026622 11.8.18_201102669909.5.28_D09-026618 11.12.8_11977913.1.2_12681109.6.26_D09-032003 11.8.24_201102730411.9.29_201103145809.8.13_D09-040733 09.7.31_D09-038228_109.7.31_D09-038228_309.7.16_D09-035282 09.8.4_D09-038894_2 RespPRRS 2-5-2 ORF511.11.15_201103618613.3.14_2013010367_109.10.19_D09-05184309.8.4_D09-038894_1 09.8.13_D09-04073209.10.29_D09-053724 09.11.18_D09-05675309.7.31_D09-038228_209.7.1_2009019123_1 09.7.1_2009019123_3 09.7.1_2009019123_209.12.4_2009034224_209.7.1_2009019123_409.7.1_2009019123_5 09.12.4_2009034224_109.5.12_D09-02383009.7.2_D09-032898 09.10.2_D09-049195 09.10.30_D09-053958 09.7.16_D09-035284 09.7.28_D09-037475 13.3.22_2013011055_113.3.22_2013011055_211.11.17_201103756013.4.4_201301289411.11.17_2011036300_1ATP-PRRS 1-4-2 ORF513.2.26_2013007331
Diagnostic lab perspective
Previously used IFA, SN, CF, virus isolation
Now immunohistochemistry, PCR, sequencing
PCR/molecular is now the most requested test at the ISU diagnostic lab.
Very specific and very sensitive
ISU VDL FY 2013Pharmacology 2,750 <1%Bacteriology 180,784 36%Tox/Nutrition 10,167 2%Histology 87,650 17%Virology 5,339 1%Res/Dev 6,115 1%Molecular 210,348 42%
503,153 100%Total # tests done on 55926 submissionsMolecular includes PCR tests, including sequences
Oral fluids and PCR testing has revolutionized the world of diagnostic testing
Can be used for both sick pig diagnostics as well as surveillance.
Oral fluids now allow lay people collect and submit the samples.
2010: 10,000; 2011: 30,000; 2012: 50,000
PCR tests for new agents can be developed quickly (PED)
As of Sept 1, appox. 6000 tests for PED conducted at ISU @ $30 each
100 IHC tests for PED @ $13 each. What about new tests? FAD Other viruses
It’s a New World…
Tissue diagnostics: Lay people posting and submitting Flowchart to guide decisions
Students/interns to post large numbers to make findings significant
Oral fluids easily collectable PCR very sensitive and specific
Surveillance: Combination of oral fluids and serum to precisely
monitor individual herds as needed. Regional projects should help areas deal with disease
instead of individual farms. Diagnostic Labs continue to do a great job improving
existing tests and developing new ones.
Acknowledgments
Lemen Conference organizers. Iowa State Veterinary Diagnostic
Laboratory Rodger Main
BIVM (surveillance spreadsheet) Dr. Karriker and Dr. Waddell Novartis and Zoetis Friends and colleagues who completed
the survey