242 P. Livingstone and N. Hancox
explained to livestock owners and agreement
reached on how test-positive animals – and
herds as a whole – need to be managed. Manage-
ment options or requirements under a testing
programme will depend on its ultimate purpose,
but can include one or some combination of:
(i) removal of all test-positive animals from the
herd; (ii) separating test-negative animals from
test-positive animals and managing each group
separately; and/or (iii) managing the herd as
one group, but vaccinating young stock with
BCG. Ideally, the young stock would be TB free
prior to being vaccinated.
Any testing programme also needs to be
carried out in the context of appropriate wider
herd and farm management to close off any
infection pathways from livestock trading, move-
ment or contacts with unmanaged sources of
livestock infection. Cattle owners thus need to
understand and accept the purpose of the pro-
gramme and full range of its implications.
15.5 The Bigger Picture: Reducing
Zoonotic Tuberculosis in HumansFor the WHO End TB Strategy targets to be
achieved, then in at least some low to medium–
high GNI countries, the transmission of either
M. bovis or M. tuberculosis from infected livestock
to humans will need to be prevented. This sup-
ports the views for a One Health system involve-
ment as outlined by Olea-Popelka et al. (2016).
This will require a coordinated process, to be
funded by a combination of WHO, United
Nations and other international aid organiza-
tions, supported by resources and where possible
funding from individual programme countries.
It should be based upon the One Health concept
and involve the correct combination of knowl-
edgeable people to ensure the goal of TB reduc-
tion is achieved. A suggested process is outlined
as follows:
- Identify for each low to medium–high GNI
economy country the number of new human
cases of TB and number of human deaths due to
TB in 2016. - Undertake a modelling exercise based on
previous TB annual rates and any proposed
treatments for each country to forecast the
expected annual number of new TB human
cases and TB deaths through to 2035.- Calculate the difference between the sum of
new cases and TB deaths forecast by modelling
for 2025 and 2035, and the number determined
by WHO 2025 and 2035 targets. - If the modelled new cases and deaths fore-
cast for 2025 and 2035 exceed the number
determined by WHO targets, then based on indi-
vidual country new cases and death rates, iden-
tify which countries to prioritize for additional
action to ensure targets are met. - Identify for the selected countries, the epi-
demiological characteristics of new TB cases
and TB deaths. - For countries where rural or peri-urban
location is identified as an important factor in
new human cases or TB deaths, then:
a. Determine at a species level, the myco-
bacteria responsible for the infection, based
on an epidemiologically structured cross-
section of new cases and deaths.
b. Where greater than (a suggested) 10%
of the sample cultured indicates infection
due to M. bovis, then undertake the follow-
ing programme:
i. Communication- Discuss with politicians, gov-
ernment agencies and village
leaders and determine how best to
inform villagers and livestock
owners about the risks associated
with consumption of TB-infected
foodstuffs (raw milk and raw milk
products, blood and undercooked
meat). - Undertake a communication
programme using multimedia
and local leaders to ensure that all
rural and peri-urban inhabitants
are continuously aware of the
dangers of consuming TB-
infected foodstuffs. Recommend
all milk to be boiled or pasteurized
prior to consumption and meat to
be cooked through. - Provide small pasteurizers to
villages where there are relatively
large numbers of livestock being
milked and milk sold widely for
human consumption. Provide
guidance on the use of
- Discuss with politicians, gov-