dr. james kober - swine disease diagnostics and economics considerations

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