MBA 560 Healthcare Management

Introduction

• Foot and mouth disease ( Latin name ‘Aphtae’ epizooticae) is also referred to as hoof and mouth disease.

• It is  highly contagious and is caused by Aphthovirus.

• It is mostly common in infants and young children.

• It is characterized by rash in the hands and feet and sores in the mouth.

Signs and Symptoms

Ulcers can appear in the mouth and tongue making it difficult for one to eat and drink

(Davies, 2017)

• Red spots that develop into blisters appear on both the hand and the feet

(Davies, 2017)

Etiology

• The foot and mouth disease belongs to genus Apthovirus, familyPicornaviridae.

• There exists seven serotypes of Foot and Mouth Disease such as SouthernAfrican Territories SAT 1, SAT 2 and 3 and A, O, C. Asia-1.

• Among these serotypes, more than 60 have been explained and newsubtypes continue to emerge spontaneously

• The importance of serotypes is that a vaccine may have to be modified according to the subtype present in a particular location in which the vaccine is to be used.

• The most common type of serotype is O

• The members of this family are non-enveloped icosahedral viruses that have single stranded RNA and are small in size( 25-30nm)

Resistance to physical and chemical action

• Inactivated by PH of >9.0

• Resistance to both physical and chemical actions.

• Inactivated by temperature exceeding 50 degrees and preservation is through freezing and refrigeration

• Exists in the bone marrow and lymph nodes at a neutral PH and cannot survive in the muscle when the PH is <6.0

• The virus is easily affected by environmental changes such as desiccation, sunlight and PH <5

• Can be inactivated by sodium carbonate(4%), citric acid (0.2%), sodium hydroxide (2%), hypochlorite and phenol.

Epidemiology

1. Geographical distribution

• Foot and mouth disease is widespread in South America, Africa, Parts of Europe and the Middle East

• Currently, countries are grouped into three disease states regarding foot and mouth disease

1. FMD free without vaccination
2. FMD free without vaccination
3. FMD free with or without vaccination

b)Host range

• Bovidae (cattle, yaks, domestic buffaloes and zebus)

• sheep, goats, swine.

• Elephants, mice and rats

• Camelidae (camels, vicunas, llamas and dromedaries) have low susceptibility

• All wild ruminants and suidae

Sources of Virus

• Meat and by products with PH>6.0.

• Saliva, faeces, breath, urine, semen and milk

• Incubating and clinically affected animals.

• Carriers especially the cattle and pigs which are mostly infected through inhalation and ingestion respectively.

Transmission

• Animate vectors such as humans

• Inanimate vectors such as implements and vehicles

• Direct or Indirect contact through animal droplets

• Airborne mostly in temperatures of up to 300km by sea and 60km overland

• Artificial Insemination

Clinical Findings

• FMD has an incubation of around 2 to 21 days and an average of 3-8days.

• This incubation period depends on:

1. The strain of the virus
2. susceptibility of the host
3. Infecting dose

• Initial signs of Foot and Mouth Disease include:

1. Anorexia
2. Dullness
3. Fever of 39.4-40.6 degrees celcius
4. Blisters appear on the lips, mouth, tongue followed by the emergence of blisters between the claws and the coronary band.
5. Painful mouth lesion and tongue can result to weight loss in Animals.

Pathogenesis

1. Infection can occur through ingestion and inhalation from infected and their products.

1. Primary replication then occurs in the upper epithelium of the upper alimentary tractor respiratory tract.
2. Primary vesicles develop in an estimated 1 to 4 days in the oral-mucosa or lips.
3. This is followed by pyrexia and viraemia.

• The virus then moves in distant epithelium, having a high replication rate.

• Two days later, the secondary vesicles are formed as a result, the incubation period is an estimated 3 to 8 days.

• Vesicles then emerge in the stratified squamous epithelium. The virus then divides in the stratum spinosun cells leading to hydropic degeneration accompanied by necrosis.

• The virus concentrate in the myocardium of young animals leding to instant death.

Treatment

• It recommended to give treatment with mild disinfectants such as 2% acetic acid,2% caustic soda and 4%soda ash and protective clothing to prevent secondary infection.

• Broad-spectrum antibiotics injections or Sulfadimidin are important to the secondary bacterial infection.

• Flunixin meglumine can cause a good, regular response.

Prevention and control

Sanitary prophylaxis measures include:

• Quarantine

• Disinfection of infected material and premises

• Destruction of susceptible animal products, litter and cadaver

• Slaughter of FMD susceptible, recovered and infected contact animals (Global Epidemiology and Prospects for Control of Foot-and-Mouth Disease, pp.133–148).

Medical prophylaxis includes

• Inactivated virus vaccine that contains an adjuvant.

• Immunity is attained 6 months after two previous vaccinations that are one month apart relying on the antigenic relationship between outbreak strains and a vaccine (Global Epidemiology and Prospects for Control of Foot-and-Mouth Disease, pp.133–148).

Conclusion

• FMD is a serious life threatening disease mostly common among children below the age of five due to low immunity.

• Recently this has been a serious issue in pediatric population due to high morbidly and mortality rates.

• Therefore, more efforts should be geared towards preventing the occurrence of the disease and maximum control of the disease upon its occurrence.

References

Davies, G., 2017. How to spot if your child has hand foot and mouth

disease. cornwalllive. Available at:https://www.cornwalllive.com/news/health/hand-foot-mouth-disease-how-628269 [Accessed September 28, 2018]. Kitching, R.P.,

Global Epidemiology and Prospects for Control of Foot-and-Mouth Disease. Current Topics in Microbiology and Immunology Foot-and-Mouth Disease Virus, pp.133–148.