title: Risk factors for bovine tuberculosis in low incidence regions related to the movements of cattle.
abstract: BACKGROUND
  Bovine tuberculosis (bTB) remains difficult to eradicate from low incidence regions partly due to the imperfect sensitivity and specificity of routine intradermal tuberculin testing. Herds with unconfirmed reactors that are incorrectly classified as bTB-negative may be at risk of spreading disease, while those that are incorrectly classified as bTB-positive may be subject to costly disease eradication measures. This analysis used data from Scotland in the period leading to Officially Tuberculosis Free recognition (1) to investigate the risks associated with the movements of cattle from herds with different bTB risk classifications and (2) to identify herd demographic characteristics that may aid in the interpretation of tuberculin testing results.
  
  
  RESULTS
  From 2002 to 2009, for every herd with confirmed bTB positive cattle identified through routine herd testing, there was an average of 2.8 herds with at least one unconfirmed positive reactor and 18.9 herds with unconfirmed inconclusive reactors. Approximately 75% of confirmed bTB positive herds were detected through cattle with no known movements outside Scotland. At the animal level, cattle that were purchased from Scottish herds with unconfirmed positive reactors and a recent history importing cattle from endemic bTB regions were significantly more likely to react positively on routine intradermal tuberculin tests, while cattle purchased from Scottish herds with unconfirmed inconclusive reactors were significantly more likely to react inconclusively. Case-case comparisons revealed few demographic differences between herds with confirmed positive, unconfirmed positive, and unconfirmed inconclusive reactors, which highlights the difficulty in determining the true disease status of herds with unconfirmed tuberculin reactors. Overall, the risk of identifying reactors through routine surveillance decreased significantly over time, which may be partly attributable to changes in movement testing regulations and the volume of cattle imported from endemic regions.
  
  
  CONCLUSIONS
  Although the most likely source of bTB infections in Scotland was cattle previously imported from endemic regions, we found indirect evidence of transmission within Scottish cattle farms and cannot rule out the possibility of low level transmission between farms. Further investigation is needed to determine whether targeting herds with unconfirmed reactors and a history of importing cattle from high risk regions would benefit control efforts.
authors.affiliation: Epidemiology Group, Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Ashworth Laboratories, Kings Buildings, West Mains Road, Edinburgh EH9 3JT, UK. m.c.gates@sms.ed.ac.uk.
authors.forename: M Carolyn
authors.initials: MC
authors.lastname: Gates
authors.forename: Victoriya V
authors.initials: VV
authors.lastname: Volkova
authors.forename: Mark E J
authors.initials: ME
authors.lastname: Woolhouse
mesh_terms: D000367:Age Factors; D000822:Animal Husbandry / Q000706:statistics & numerical data; D000818:Animals; D002417:Cattle; D016208:Databases, Factual; D060740:Disease Eradication; D005260:Female; D015994:Incidence; D008297:Male; D011159:Population Surveillance; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012680:Sensitivity and Specificity; D014374:Tuberculin Test / Q000592:standards / Q000662:veterinary; D014380:Tuberculosis, Bovine / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006113:United Kingdom / Q000453:epidemiology