Epidemiological investigation of the first reported outbreak of contagious equine metritis in South Africa

Abstract

This dissertation describes the epidemiological investigation and management of the first outbreak of Contagious Equine Metritis (CEM) reported in South Africa. In addition, the subsequent implementation of a nationwide quantitative polymerase chain reaction (qPCR)- based stallion screening programme and traceback of exposed animals to define the spread of CEM in South Africa is described. The first South African outbreak of CEM caused by the bacterium, Taylorella equigenitalis was reported on the 9th May 2011 to the World Health Organisation for Animal Health (OIE). The outbreak was recognized subsequent to the importation of a young Warmblood stallion from Germany. The outbreak initially appeared confined to a single index property (focus property), an equine breeding facility in Midrand, Gauteng, South Africa with a single confirmed case of transmission involving the index stallion and a Thoroughbred mare. The initial response was rapidly instituted following the suspicion of T. equigenitalis on the index property. This included an inspection of the index property and its records. A riskclassification of in-contact animals allocated them to “high,” “moderate” or “low”-risk categories. The classification was dependent on the temporal relationship of their presence on the index property relative to the period of residence of the index cases. After T. equigenitalis infection was confirmed from both index cases, the breeding facility was placed under state– administered quarantine and all exposed mares and the index cases were transferred to a quarantine facility. The animals were re-tested by genital swabbing for bacterial culture following a standard protocol according to internationally-accepted practice (OIE Terrestrial Manual on Contagious Equine Metritis). Additional duplicate swabs were obtained for real time qPCR. None of the mares were shown to be positive on either bacterial culture or qPCR. All animals were however treated according to an accepted protocol for T. equigenitalis infection (Luddy and Kutzler, 2010, UK Horseracing Betting Levy Board (HBLB) Code of Practice, 2011). All stallions that had been present on the index property and undergone semen collection on the same day as the index stallion were classified as “moderate risk” and were similarlytested. This identified two additional T. equigenitalis-positive stallions, which were confirmed on bacterial culture (World Organization for Health (OIE) Manual of Diagnostic Tests and Vaccines for Terrestrial Animals (Chapter 2.5.1, Contagious Equine Metritis version adopted 20/10/2011) and which were subsequently quarantined and successfully treated. Following recognition of this outbreak, the Department of Agriculture, Forestry and Fisheries (DAFF) in consultation with the Equine Research Centre (ERC) of the Faculty of Veterinary Science at the University of Pretoria promulgated a nationwide qPCR-based screening programme that aimed to establish the prevalence and distribution of T. equigenitalis in South Africa. This required certification of all South African stallions used for breeding either by natural cover or assisted reproductive techniques. The compliance for certification was based on submission of two sets of genital swabs that both tested negative for T. equigenitalis on qPCR-testing. The process was coordinated by a web-based platform (http://wto the prescribed World Organisation for Health (OIE) method (Terrestrial Manual on Contagious Equine Metritis). All stallions apart from one could be linked to the index property. As of 31st October 2013, two additional T. equigenitalis-positive females have been identified, following a traceback of all identified potentially-exposed mares and their offspring that was instituted in September 2012. An “exposed mare” was defined as a mare that had been bred, either by natural breeding or assisted breeding techniques to the index stallion or any other T. equigenitalis-positive stallion. These mares were distributed across five provinces of South Africa at the time the traceback was initiated. During the nationwide traceback, a subpopulation focus was identified when 24 of the 33 resident stallions at the South African Lipizzaner Centre, Midrand, Gauteng tested positive for T. equigenitalis. Six of these stallions had visited the index property for semen collection over the course of several years prior to the arrival of the index stallion. This suggested the possible albeit undetected presence of T. equigenitalis on these premises prior to the arrival of the first reported index case. We strongly suspected that there may have been undetected CEM incursions into South Africa in the past. The index case in this outbreak may either have introduced a new infection or was infected by a pre-existing source of infection subsequent to his arrival. It is hoped that future strain-typing of the isolates from the positive cases identified during this intervention will further clarify this scenario. The use of qPCR-based screening proved to be a highly specific and sensitive method for detecting T. equigenitalis and helped to define the distribution and prevalence of T. equigenitalis in breeding stallions and exposed mares in South Africa. In addition, this method had significant practical advantages with respect to the associated costs, turn-around times and in-the-field application when compared with bacterial culture. The institution of a web-based platform from which the national screening programme was launched and coordinated proved to be indispensable in managing stakeholder access and information availability. To date, 31st October 2013, a total of 39 horses (36 males and 3 females) have been identified as T. equigenitalis-positive and have all subsequently been successfully treated. © Universityww.cemsa.co.za) As of 31st October 2013, an additional 33 carrier stallions have been identified by this screening programme. Of these stallions, 23 have been confirmed on bacteriology according to the prescribed World Organisation for Health (OIE) method (Terrestrial Manual on Contagious Equine Metritis). All stallions apart from one could be linked to the index property. As of 31st October 2013, two additional T. equigenitalis-positive females have been identified, following a traceback of all identified potentially-exposed mares and their offspring that was instituted in September 2012. An “exposed mare” was defined as a mare that had been bred, either by natural breeding or assisted breeding techniques to the index stallion or any other T. equigenitalis-positive stallion. These mares were distributed across five provinces of South Africa at the time the traceback was initiated. During the nationwide traceback, a subpopulation focus was identified when 24 of the 33 resident stallions at the South African Lipizzaner Centre, Midrand, Gauteng tested positive for T. equigenitalis. Six of these stallions had visited the index property for semen collection over the course of several years prior to the arrival of the index stallion. This suggested the possible albeit undetected presence of T. equigenitalis on these premises prior to the arrival of the first reported index case. We strongly suspected that there may have been undetected CEM incursions into South Africa in the past. The index case in this outbreak may either have introduced a new infection or was infected by a pre-existing source of infection subsequent to his arrival. It is hoped that future strain-typing of the isolates from the positive cases identified during this intervention will further clarify this scenario. The use of qPCR-based screening proved to be a highly specific and sensitive method for detecting T. equigenitalis and helped to define the distribution and prevalence of T. equigenitalis in breeding stallions and exposed mares in South Africa. In addition, this method had significant practical advantages with respect to the associated costs, turn-around times and in-the-field application when compared with bacterial culture. The institution of a web-based platform from which the national screening programme was launched and coordinated proved to be indispensable in managing stakeholder access and information availability. To date, 31st October 2013, a total of 39 horses (36 males and 3 females) have been identified as T. equigenitalis-positive and have all subsequently been successfully treated.