Potential benefits of cattle vaccination as a supplementary control for bovine tuberculosis

Published onlineJournal ArticleResearch Support, Non-U.S. Gov'tVaccination for the control of bovine tuberculosis (bTB) in cattle is not currently used within any international control program, and is illegal within the EU. Candidate vaccines, based upon Mycobacterium bovis bacillus Calmette-Guérin (BCG) all interfere with the action of the tuberculin skin test, which is used to determine if animals, herds and countries are officially bTB-free. New diagnostic tests that Differentiate Infected from Vaccinated Animals (DIVA) offer the potential to introduce vaccination within existing eradication programs. We use within-herd transmission models estimated from historical data from Great Britain (GB) to explore the feasibility of such supplemental use of vaccination. The economic impact of bovine Tuberculosis for farmers is dominated by the costs associated with testing, and associated restrictions on animal movements. Farmers' willingness to adopt vaccination will require vaccination to not only reduce the burden of infection, but also the risk of restrictions being imposed. We find that, under the intensive sequence of testing in GB, it is the specificity of the DIVA test, rather than the sensitivity, that is the greatest barrier to see a herd level benefit of vaccination. The potential negative effects of vaccination could be mitigated through relaxation of testing. However, this could potentially increase the hidden burden of infection within Officially TB Free herds. Using our models, we explore the range of the DIVA test characteristics necessary to see a protective herd level benefit of vaccination. We estimate that a DIVA specificity of at least 99.85% and sensitivity of >40% is required to see a protective benefit of vaccination with no increase in the risk of missed infection. Data from experimentally infected animals suggest that this target specificity could be achieved in vaccinates using a cocktail of three DIVA antigens while maintaining a sensitivity of 73.3% (95%CI: 61.9, 82.9%) relative to post-mortem detection.This study was funded by Defra project SE3127 and uses nationally collected incidence and cattle-movement data sets held by Defra

Potential Benefits of Cattle Vaccination as a Supplementary Control for Bovine Tuberculosis

This is the final published version of the article. It was originally published in PLOS Computational Biology (Conlan AJK, Brooks Pollock E, McKinley TJ, Mitchell AP, Jones GJ, Vordermeier M, Wood JLN, PLoS Computational Biology 2015, 11(2): e1004038. doi:10.1371/journal.pcbi.1004038).\ud \ud ? 2015 Crown Copyright. This is an open-access article distributed under the terms of the free Open Government Licence, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. See: http://www.nationalarchives.gov.uk/doc/o?pen-government-licence/open-government-l?icence.htmVaccination for the control of bovine tuberculosis (bTB) in cattle is not currently used within any international control program, and is illegal within the EU. Candidate vaccines, based upon Mycobacterium bovis bacillus Calmette-Gu?rin (BCG) all interfere with the action of the tuberculin skin test, which is used to determine if animals, herds and countries are officially bTB-free. New diagnostic tests that Differentiate Infected from Vaccinated Animals (DIVA) offer the potential to introduce vaccination within existing eradication programs. We use within-herd transmission models estimated from historical data from Great Britain (GB) to explore the feasibility of such supplemental use of vaccination. The economic impact of bovine Tuberculosis for farmers is dominated by the costs associated with testing, and associated restrictions on animal movements. Farmers? willingness to adopt vaccination will require vaccination to not only reduce the burden of infection, but also the risk of restrictions being imposed. We find that, under the intensive sequence of testing in GB, it is the specificity of the DIVA test, rather than the sensitivity, that is the greatest barrier to see a herd level benefit of vaccination. The potential negative effects of vaccination could be mitigated through relaxation of testing. However, this could potentially increase the hidden burden of infection within Officially TB Free herds. Using our models, we explore the range of the DIVA test characteristics necessary to see a protective herd level benefit of vaccination. We estimate that a DIVA specificity of at least 99.85% and sensitivity of >40% is required to see a protective benefit of vaccination with no increase in the risk of missed infection. Data from experimentally infected animals suggest that this target specificity could be achieved in vaccinates using a cocktail of three DIVA antigens while maintaining a sensitivity of 73.3% (95%CI: 61.9, 82.9%) relative to post-mortem detection.This study was funded by Defra project SE3127 and uses nationally collected incidence and cattle-movement data sets held by Defra. The funders had no role in study design, data analysis, decision to publish, or preparation of the manuscript

The intractable challenge of evaluating cattle vaccination as a control for bovine tuberculosis

Vaccination of cattle against bovine Tuberculosis (bTB) has been a long-term policy objective for countries where disease continues to persist despite costly test-and-slaughter programs. The potential use of vaccination within the European Union has been linked to a need for field evaluation of any prospective vaccine and the impact of vaccination on the rate of transmission of bTB. We calculate that estimation of the direct protection of BCG could be achieved with 100 herds, but over 500 herds would be necessary to demonstrate an economic benefit for farmers whose costs are dominated by testing and associated herd restrictions. However, the low and variable attack rate in GB herds means field trials are unlikely to be able to discern any impact of vaccination on transmission. In contrast, experimental natural transmission studies could provide robust evaluation of both the efficacy and mode of action of vaccination using as few as 200 animals

Evaluating Diagnostic Tests With Near-Perfect Specificity:Use of a Hui-Walter Approach When Designing a Trial of a DIVA Test for Bovine Tuberculosis

Active surveillance of rare infectious diseases requires diagnostic tests to have high specificity, otherwise the false positive results can outnumber the true cases detected, leading to low positive predictive values. Where a positive result can have economic consequences, such as the cull of a bovine Tuberculosis (bTB) positive herd, establishing a high specificity becomes particularly important. When evaluating new diagnostic tests against a “gold standard” reference test with assumed perfect sensitivity and specificity, calculation of sample sizes are commonly done using a normal approximation to the binomial distribution, although this approach can be misleading. As the expected specificity of the evaluated diagnostic test nears 100%, the errors arising from this approximation are appreciable. Alternatively, it is straightforward to calculate the sample size by using more appropriate confidence intervals, while precisely quantifying the effect of sampling variability using the binomial distribution. However, regardless of the approach, if specificity is high the sample size required becomes large, and the gold standard may be prohibitively costly. An alternative to a gold standard test is to use at least two imperfect, conditionally independent tests, and to analyse the results using a variant of the approach initially proposed by Hui and Walter. We show how this method performs for tests with near-perfect specificity; in particular we show that the sample size required to deliver useful bounds on the precision becomes very large for both approaches. We illustrate these concepts using simulation studies carried out to support the design of a trial of a bTB vaccine and a diagnostic that is able to “Differentiate Infected and Vaccinated Animals” (DIVA). Both test characteristics and the efficacy of the bTB vaccine will influence the sample size required for the study. We propose an improved methodology using a two stage approach to evaluating diagnostic tests in low disease prevalence populations. By combining an initial gold standard pilot study with a larger study analyzed using a Hui–Walter approach, the sample size required for each study can be reduced and the precision of the specificity estimate improved, since information from both studies is combined

Expression of the innate immune receptor LILRB5 on monocytes is associated with mycobacteria exposure.

Antigen presenting cells (APC) are critical components of innate immunity and consequently shape the adaptive response. Leukocyte Ig Like Receptors (LILR) are innate immune receptors predominantly expressed on myeloid cells. LILR can influence the antigen presenting phenotype of monocytic cells to determine the nature of T cell responses in infections including Mycobaterium leprae. We therefore investigated the relevance of LILR in the context of Mycobacterium tuberculosis. Real-time PCR studies indicated that the transcriptional profile of the orphan receptor LILRB5 was significantly up-regulated following exposure to mycobacteria. Furthermore, LILRA1 and LILRB5 were able to trigger signalling through direct engagement of mycobacteria using tranfectant cells incorporating a reporter system. We describe for the first time the expression of this receptor on T cells, and highlight the potential relevance to mycobacterial recognition. Furthermore, we demonstrate that crosslinking of this receptor on T cells increases proliferation of cytotoxic, but not helper, T cells

Break-even points for vaccine efficacy under alternative testing scenarios using γ-DIVA test.

<p>We estimate the break-even point for a protective benefit of BCG vaccination at the herd level under three alternative testing scenarios. We model DIVA testing using parameter estimates that optimize DIVA specificity of 99.4% under the constraint of maintaining a DIVA sensitivity comparable to tuberculin testing of 64.4%. We consider four key measures of the epidemiological, and economic, costs associated with bTB testing: <b>A</b> the number of animals condemned as reactors; <b>B</b> the number of tests (tuberculin and DIVA) needed to clear restrictions; <b>C</b> The number of infected animals left in herds after restrictions are lifted (burden of infection missed by testing) <b>D</b> The number of herds that experience a breakdown before the herd clears the singleton challenge. For all panels, solid black lines indicate the median break-even point for the baseline scenario with no vaccination. Dashed lines indicate the 95% quantiles of the baseline scenario. The distribution for each measure is calculated from 100 simulations with parameters drawn from the (approximate) posterior distributions of our estimated model, with each parameter set simulated once for each herd within our representative study population (of 6,601 herds).</p