Foot-and-mouth disease (FMD), the most prevalent and, economically, the most important infectious disease of cattle and buffaloes in Pakistan is a major constraint to achieve optimum animal production and limits market opportunities within the country as well as across the borders. FMD is endemic in the country and occurs throughout the year. Infected animals are not culled as there is no compensation policy and FMD control in the country is based on voluntary vaccination by the farmers. An effective surveillance is crucial for the control and prevention of FMD in the country.

Animal Disease surveillance system in Pakistan was under-performing and only a small number of FMD outbreaks (on an average < 20 per year) were being reported. The improved surveillance model recorded 10,166 outbreaks of FMD from different areas of Pakistan between January 2012 and March 2017 (Figure 1). During first few years, the number of reported outbreaks continued to increase and then stabilized at a level. Very few outbreaks of FMD were reported from areas where project staff did not have access due to security concerns and awareness among local farmers and veterinary field staff was limited.
For improving FMD outbreak surveillance, a model was developed and implemented in the field. The surveillance model consisted of the following six components:
1. Awareness of farmers and veterinary field staff;
2. Training of veterinary field staff;
3. Provision of sample collection kits to the trained field staff;
4. Collection and dispatch of tissue samples to the diagnostic laboratories;
5. Handling outbreaks to contain the infection; and
6. Sharing laboratory results with the field staff.

1. Awareness of farmers and veterinary field staff: Posters depicting clinical signs of the diseases and brochures and leaflets for farmers were developed. Posters were displayed in veterinary institutions and other public places highlighting the need to report FMD like symptoms to the nearest Government Veterinarian. Brochures and leaflets were distributed among the farmers and had information on epidemiology and control FMD under livestock farming systems in the country. This printed material also stressed the need to report the outbreak immediately to the veterinarian and how livestock department will help the farmer in control of the outbreak. Farmers’ awareness workshops were also undertaken in all important livestock raising areas of the country. Print and electronic media was also used to create awareness among the farmers wherever possible.
2. Training of veterinary field staff: Pakistan has a good network of veterinary hospitals and dispensaries that are manned by veterinarians and or veterinary assistants. This veterinary field staff is the main player in animal disease surveillance who will normally submit outbreak reports. Training of the field staff in clinical recognition and epidemiology of the disease, disease prevention and outbreak control and sample collection and submission were particularly addressed in this capacity building exercise. Use of ICT particularly reporting outbreak using mobile phones through SMS or call was stressed.
3. Provision of sample collection kits to the trained field staff: At the end of each training, all participants were provided with a sample collection kits. The kit contained small equipment and disposals required for the collection and dispatch of tissue samples in a cool box.
4. Collection and dispatch of tissue samples to the diagnostic laboratories: Trained field staff was encouraged to report all FMD outbreaks using ICT, collect tissue samples from each outbreak and send these to the designated diagnostic laboratories. To cover travel and other related expenses (as no government / project vehicle was provided for sample collection), a fixed amount (Pak Rs. 1000) was paid to the veterinary field staff on submission of tissue samples from each outbreak. This in fact avoided lengthy paper work normally required for re-imbursement from the accounts department. This payment system was later modified and made only when outbreak was found to positive for FMD during lab testing. A novel approach was tested and found to be extremely useful for transport of the tissue samples from the field to the diagnostic labs (See box)

5. Handling outbreaks to contain the infection: Each reported outbreak was also handled by the trained veterinarian to ensure that virus does not spill over to other epidemiological units. Animals showing lesions and fever in the epidemiological unit (village or farm) were isolated and all healthy animals in the epidemiological unit were vaccinated free of cost using 6 PD50 trivalent (serotype O, A and Asia-1) vaccine containing country specific FMD virus vaccine strains. Infected animals were also vaccinated after the healthy animals. All animals in the epidemiological unit were also given booster dose after 3 to 4 weeks of initial vaccination. Sick animals were given treatment and the cost of medicines was borne by the livestock owners.

6. Sharing laboratory results with the field staff: Laboratory results were initially shared with the sender trough SMS initially and then sent a hard copy by mail to the sender, provincial TAD control officer TAD and the project staff. This resulted in providing confidence to the field staff and feeling that their efforts are being recognised.