FMD_Treatment and metaphylaxis_ Prof GM _pptx

Treatment and metaphylactic measure are presented for practicing veterinarian in resource-poor countries

1. Rational treatment of foot-and-mouth disease AND Metaphylactic measures Prof. Dr. Ghulam Muhammad, Imaad Rashid Dr. M. Saqib Department of Clinical Medicine & Surgery, University of Agriculture, Faisalabad

2. Hand, foot and mouth disease (HFMD )………. a disease of human caused by intestinal viruses of Picornaviridae family . ‘ Put one’s foot in one’s mouth ’ (an idiom which means to say something that is really embarrassing) As yet no specific treatment for FMD , as also for other viral diseases.

3. ‘An ounce of prevention is better than a pound of cure’ Treatment is like extinguishing a fire Treatment of FMD – An attempt to ‘ make the best of a bad bargain ’ so to speak Treatment alone does not address the problem of production -------- hence shoot for prevention

4. Therapeutic and metaphylactic measures: Principles of treatment 1 . First do not harm’ ( Primum non nocere ) ……..Hippocratic oath- one of the principal precepts of medical and veterinary ethics ‘ Physician, heal thyself ’ Bible, Luke 4:23 ( King James Version ) ……. Attend to one's own faults, in preference to pointing out the faults of others 2. The Treatment should complement National FMD Control and Eradication Program 3. Treatment should hasten recovery 4. Treatment should prevent/treat complications/ sequelae 5. Affordable by the owners

5. (1) Isolate FMD affected animals and institute strict biosecurity measures Place the unaffected animals in the southern end of the farm as transmission through air is principal way of spread of FMD When a veterinarian visits more than one farm in a day, professional ethics as well as tenets of biosecurity call for taking a shower and changing the clothes and shoes between the two farms. Alternatively , the farmer should be encouraged to construct a change-room with shower arrangements well outside the sheds . The visiting veterinarian should take shower, change clothes and have the gum boots on before moving on to the sheds. An antiseptic solution (4 inches deep) should be placed at the foyer and eve of this change-room . Vets visiting the farm should also resort to use of medicated gurgles (with Listerine R )

6. (1) Isolate FMD affected animals and institute strict biosecurity measures … Nosocomial spread and spread through veterinarians and paraveterinary staff : The use of syringes, thermometers, ropes for restraint and cattle crushes etc. which have been used previously for the treatment of FMD affected animal may potentially transmit the FMD virus to uninfected susceptible animals presented at the same hospital on the given day. Veterinarians and paraveterinary staff have no training related to the handling of cases of training related to the handling of cases of infectious communicable animal diseas es in hospital setting. Owing to the same reasons, they may spread FMD and other infectious diseases during their movement from one farm to another .

7. (1) Isolate FMD affected animals and institute strict biosecurity measures … Assign separate attendants for affected and unaffected animals on the farm Left over feed should burnt Suckling calves should be isolated from their affected dams and vaccinated immediately Put the farm in the quarantine ------ Do not move the animals off the farm in the face of an outbreak Also don’t purchase new animals when an outbreak going on Encourage the owners to get their FMD affected animals treated at home/farm – Bringing affected animals to the hospitals creates the possibility of Nosocomial transmission Use of media for farmers – advisory message

8. (2) Antibiotics and antipyretics ……… sheet anchors of FMD treatment Use plain antibiotics like inj. Penicllin Fort . Do not use antibiotics which act through blocking the protein synthesis (e.g., aminoglycosides, Tetracycline, etc.) Antipyretics like inj. Thampyron ® ( Methampyrone + Caffein + Chlorpheniramine maleate) 25 ml for cows/buffaloes. Offer soft green fodder 2-3 hrs after antipyretics Boil the needle, syringe after injection Disinfect and discard any item used for the treatment of FMD affected animals

9. (3) Minimum handling of FMD affected animals Do not rinse the mouth with Condy’s lotion (1:500-1000 KMNO 4 ) This practice spreads the disease as it contaminates the irrigator, ropes used for restraint, crushes and ground, famer’s body etc. Thus it defeats the objective of FMD contaminant and eradication down the line As such, this practice is like ‘Missing the f orest for the trees’. (4) Put the affected animals on Kaccha ground. (5) Administer oil (500ml) + Yogurt (1/2 kg) + 3 grams of Z inc sulfate daily for 5 days

10. (6) Protect the affected animals against the rigors of weather : In summer ------ fanning, cold water hosing, provision of shade etc. to make the animal feel comfortable In winter ---------- Protect against cold drafts by blanketing etc . (7) Treat the affected animals with Viroxide Super TM ( Quat-Chem , UK; marketed in Pakistan by Doctor’s Dairies, Karachi) - Individual animal : 5g in 5L of drinking water or by drench x 2 days - Mass treatment at the farm : 1kg to 5000 L of drinking water x 2 days

11. (8) Use of FMD serum --- of questionable value (9) Dress the foot lesions with a protective and fly repellent wound dressing e.g. Creosotic 8ml Terebeni 180ml Olive Oil ad O.i . Greig , J.R. (ed.) 1939. Veterinary Materia Medica andTherapeutics . 5 th Ed. Bailliere , Tindall and Cox, London, p:483. OR CuSO 4 -- 2 - 5% solution OR Phenolphthalein ball + simple oil

12. (10) Inj. Vitamin AD3E to speed up recovery Dose 15-20ml daily for 3 days (11 ) Keep the crows at bay by smearing the foot wound with “ Sundhur ” (12 ) Vaccinate the yet unaffected animals using aluminium hydroxide adjuvanted vaccine like Aftovaxpur TM ( Merial ) Experimental work at PAFMDC (Pan American FMD Center) Rio de Janeiro, Brazile has shown that good quality vaccines (of the classical aluminum hydroxide type; as well as oil adjuvanted vaccine) afford a highly protective effect as early as 4 days after vaccination in herds that have been part of the regular vaccination program. An important degree of protection can be obtained with oil based vaccine as early as 7 days after first vaccination ( Sutmoller , 1984) Sutmoller , P., 1984. Field problems associated with control of Foot-and-mouth disease outbreaks. In: Riemann, H.P. and M.J. Burridge (eds.) Proc. International Conference on Impact of Diseases on Livestock Production in the Tropics. May 9-13, 1983. Kissimmee, Florida, USA. Published by Elsevier Science Publishers, Amsterdam. pp : 353-358.

13. 13) Use of thyroxine /Iodine for the treatment of FMD and FMD-associated panting ( Asthma cardicum post apthosum ) in cattle Some animals, particularly cross-bred cattle develop panting as a sequel to foot-and-mouth disease (FMD ). This condition is characterized by continuous fever, depression, panting, dyspnea, ropy salivation, anorexia, and severe drop in milk production etc. The affected animals tires very quickly and start foaming at the mouth even if they walk a short distance in the sun. The body coat is ‘tanned’ with greyish hairs turning slowly dark brown in colour . On auscultation, muffled splashing heart sounds can be detected. The condition does not respond to antibiotics, antipyretics and antiprotozoan (e.g., imidocarb dipropionate ; Inj. Imizole , ICI) and other therapeutic agent etc. (Personal observations, Dr. Ghulam Muhammad). It is caused by the upset of heat regulation center consequent on dysfunction of pituitary, thyroid and adrenal glands Arzt et al ., 2011). Such cases should be treated with subcutaneous administration of 25 tablets (10 microgram each) of Thyroxine Sodium in 20mL distilled water . Four such injections are given at an interval of one week. Thyroxine solution should be prepared fresh each time. A noticeable improvement in panting would occur even after first injection ( Longanathan , 1953). This treatment may also be tried in cases of infertility and other complications/ sequelae of FMD. It is pertinent to mention that fever and hyperthermia lead to suppression of thyroid hormones (Shafer et al ., 1980)

14. 13. Use of thyroxine /Iodine for the treatment of FMD and FMD-associated panting … Another study by an Indian worker ( Sethuraman , 1972) has documented successful treatment of cattle affected with FMD by administration of 20-30mL of Lugol’s iodine orally for 3-6 days or by intravenous administration of Collosol iodine 20mL per day for 3-4 days along with terramycin IM. Collosol iodine consists of a solution in which iodine is present in the form of hydroiodic acid combined with the products of acid hydrolysis of proteins. When Collosol iodine is given parentally, the iodine remains in combination and is slowly released to the tissues which makes its safe even if administered over long periods. Recovery with Lugol’s iodine occurred in seven days whereas with Collosol iodine IV and terramycin IM recovery period was shortened to four days animals showing typical sings of FMD (fever, mouth vesicles and ulcers, hoof lesions and arthritis).

15. 13. Use of thyroxine /Iodine for the treatment of FMD and FMD-associated panting … In Indian subcontinent, cattle with exotic blood (e.g. Holstein-Friesian, Jersey and their Crosses) suffer from hyperthermia during summer season . Chhabra et al . (2008) selected 30 hyperthermic cows with rectal temperature above 105 ₀ F in summer season. These animals had remained unresponsive to treatment with antiprostaglandins (antipyretics), antibiotics and antiprotozoans . Body temperature of the selected animals and their feed and water intake was normal during the early morning hours. Thereafter, their body temperature increased and feed intake decreased as the day progressed. Ten healthy animals were included as the control group. Three daily doses of 2ml of iodized oil, containing 375mg/ml of elemental iodine ( Inj. I Fer H TM ; Carevet Pharma , Ludhiana ), were injected subcutaneously at the brisket region of all the hyperthermic cows . Plasma inorganic iodine (PII) and plasma thyroid hormones ( triiodothyronine i.e. T 3 and thyroxine i.e. T 4 ) were determined. All the animals were kept under the observation in 10 days. Clinically improvement was observed after the administration of subcutaneous iodine. There was a significant improvement in the mean body temperature which was recorded within the normal range in most (27/30) of the treated animal by day 3 of the treatment. Mean rectal temperature of hyperthermic cows was 105.2 ± 0.08 ₀ F.

16. After the treatment with iodine, there was a significant decline (P˂0.01) of mean rectal temperature (102.8± 0.38 ₀ F) on day 3 and mean rectal temperature was 102.3 ± 0.15 ₀ F at day 5 and 102.2±0.14 ₀ F at day 7 of the treatment . Higher intake of iodine led to suppression of TSH (thyroid stimulating hormone) production activity due to decrease in height, size and activity of follicular cells of thyroid gland. The mean plasma inorganic iodine (PII) level of hyperthermic cows was 100.42 ± 13.95 mg/ml and after therapy, mean PII level increased significantly (P˂0.05) to 314.83±60.20mg/ml at day 7. Mean plasma T 3 level of hyperthermic cows (0.91±0.15nmol/l) was non-significantly lower as compared to 1.17±0.10nmol/l in the control group. After the treatment, mean T 3 level increased to 1.26±0.25 nmol /l. On the other hand, the pre-treatment mean T 4 value (35.52±6.51nmol/l) increased significantly (P = 0.09) to 46.47±6.54 nmol /l after the treatment .

17. In the light of these, biochemical and hormonal values, it was hypothesized that subcutaneous administration of iodized oil led to an increase in T 4 levels. Thyroxine , being the inhibitory hormone of thyroid loop, in turn has a negative feedback effect on the secretion of TSH by the thyrotrophic cells of pituitary gland and to some extent, the TRF from hypothalamus and hence the thyroid hormones that were required to increase the BMR (basal metabolic rate) through increase oxygen consumption via its calorigenic effect. This in turn led to a decrease in the body temperature in the hyperthermic cows .

18. Thimbling (overgrown curved hooves) is another important sequelae of FMD Administer 3g of Zinc Sulphate daily for 7 days to prevent this foot problem

19. Literature cited Longanathan , S., 1953. Panting in cattle-A suggested treatment. Ind. Vet. J., 30: 267-268. Sethuraman , V., 1972. Treatment of foot and mouth disease in bovines with ‘ collosol iodine’. Ind. Vet. J., 49(8): 839-841. Chhabra , S., S.S. Randhawa , R. Sharma, and R. Jindal, 2008. Efficacy of parenteral iodine administration on hyperthermia in dairy cows. Indian Vet. J., 85: 1348-1349. Prof. Dr. Ghulam Muhammad, Department of Clinical Medicine and Surgery, University of Agriculture, Faisalabad Arzt , J., N. Juleff , Z. Zhang, and L.L. Roriguez , 2011. The pathogenesis of foot-and-mouth disease I: viral pathways in cattle. Transboundary and Emerging Diseases. 58: 291-304. Shafer, R.B., M.M. Oken , and M.K. Elson, 1980. Effect of fever and hyperthermia on thyroid function. J. Nucl . Med., 21: 1158-1161.

20. The widely touted homeopathic treatments ---- of questionable efficacy Tying it all together (= upshots) 1) Prevention is better than cure 2) Biosecurity--- sine quo non to complement national FMD control/eradication program 3) Minimum handling of FMD affected animals 4) Antibiotics and antipyretics-- the sheet anchors of FMD treatment 5) Thyroxine /Iodine treatment to prevent sequelae /complications

21. “We never think for a minute that we are going to build permanent peace in this world on empty stomach and human misery” Dr. Norman E. Borlaugh ---- Noble Peace Prize Laureate (Father of Green Revolution)