An evaluation of Foot-and-Mouth Disease outbreak reporting in mainland South-East Asia from 2000 to 2010.

Foot and Mouth Disease (FMD) is considered to be endemic throughout mainland South-East Asia (SEA). The South-East Asia and China FMD (SEACFMD) campaign is a regional control programme which has been ongoing since 1997. The programme encourages countries to submit reports of outbreaks regularly. This paper evolved from a collaboration with SEACFMD to evaluate 10 years worth of reporting. All publicly available outbreak reports (5237) were extracted from the ASEAN Region Animal Health Information System (ARAHIS) for the period from 2000 to mid 2010. These reports included date, outbreak location (at the province and district level) and serotype (if known) plus information on the outbreak size and affected species. Not all records had complete information on the population at-risk or the number of animals affected. This data was transferred into a spatially enabled database (along with data from other sources) and analysed using R and SaTScan. Outbreak serotype was unknown in 2264 (43%) of reports and some countries had very few laboratory confirmed cases (range <1-86%). Outbreak reports were standardised by number of villages in each province. Outbreak intensity varied however there did not appear to be a consistent pattern, nor was there any seasonal trend in outbreaks. Spatial and spatio-temporal cluster detection methods were applied. These identified significant clusters of disease reports. FMD is endemic across the region but is not uniformly present. ARAHIS reports can be regarded as indicators of disease reporting: there may be reports in which laboratory confirmation has not occurred, and in some cases clinical signs are inconsistent with FMD. This raises questions about the specificity of the data. Advances in decentralised testing techniques offer hope for improved verification of FMD as the cause of disease outbreaks. Advances in molecular typing may provide a substantial leap forward in understanding the circulation of FMD in South East Asia.