Thrushfield, M. 1995. Veterinary Epidemiology.

Blackwell
Science LTD. 2nd ed. ISBN 0-632-04036-X; paperback
ISBN 0-632-04851-4
2 The scope of epidemiology
Many contemporary disease problems can be solved by an populations (e.g., Karstad, 1962). Outbreaks of disease in
investigation of animal populations rather than the human populations were called 'epidemics', in animal
individual. The natural history of infectious diseases can be populations were called 'epizootics', and in avian popula -
understood by studying their distribution in different tions were called 'epornitics', from the Greek opvtθ--
populations. The measurement of the amount of infectious (o rn ith- ) = bird (e.g., Montgomery et al., 1979). Other
and non-infectious disease in a population assists in derivatives, such as 'epidemein' ('to visit a community'),
determining their importance and the efficacy of control give hints of the early association between epidemiology
campaigns. Complex and unknown causes of diseases can be and infections that periodically entered a community, in
elucidated by studying the diseases in various groups of contrast to other diseases which were usually present in the
animals. The effects of diseases on production can be population.
realistically estimated only in relation to decreased The various derivatives can be used in different contexts. A
production in the herd or flock rather than in a single study of a disease that is present only in an animal
animal. The economic impact of disease and of attempts at population, such as Brucella ovis infection of sheep, would
its control similarly are evaluated best in groups of not involve a simultaneous study of disease in humans; the
animals, ranging from the individual farm to the national level. term 'epizootiology' might then be used by some to indicate
The investigation of disease in populations is the basis of that the study was confined to animals other than man.
epidemiology. Many diseases, called zoonoses, may be shared by man and
lower animals. Thus, when studying diseases such as bovine
brucellosis and leptospirosis, both of which are zoonoses,
Definition of epidemiology
mechanisms of transfer of disease between human and
Epidemiology is the study of disease in populations and
non-human populations have to be considered. An
of factors that determine its occurrence; the key word
important factor that determines the occurrence of such
being populations. Veterinary epidemiology additionally
occupationally acquired zoonoses (in veterinarians, abattoir
includes investigation and assessment of other health-related
workers and farmers in these examples) is the amount of
events, notably productivity. All of these investigations
disease in domestic animals. The 'epidemiology' of
involve observing animal populations and making inferences
brucellosis and leptospirosis in dairy farmers is therefore
from the observations.
closely associated with the 'epizootiology' of these diseases
lA literal translation of the word 'epidemiology', based on
in cattle. The semantic differentiation between studies
its Greek roots eπι- (epi-) = u p o n , δ η µo- (demo-) = people, involving human diseases and those concerned with animal
and λo'γo- ( l o g o - ) = discoursing, is 'the study of that which diseases therefore is considered neither warranted nor
is upon the people' or, in modern parlance, 'the study of logical (Dohoo e t a l . , 1994). Throughout this book, the
disease in populations'. Traditionally, ‘epidemiology' related word 'epidemiological' is therefore used to describe any
to studies of human populations, and epizootiology', from investigation relating to disease in a population, whether
the Greek ξwo- (zoo-) = , to the studies of animal (excluding or not the population consists of humans, domestic
human) animals, or wildlife.
 The scope of epidemiology
16

The uses of epidemiology in a group of cattle might be associated with

grazing a particular pasture of `burnt off'
There are five objectives of epidemiology: stubble. Such an occurrence could be
associated with an increase in abrasions of the
I. Determination of the origin of a disease
buccal mucosae which could increase the
whose cause is known;
animals' susceptibility to infection with
2. Investigation and control of a disease
Actinobacillus lignieresi. An increased number of
whose cause is
cases of bone defects in puppies might be due
either unknown or poorly understood;
to local publicity given to the use of vitamin
3. Acquisition of information on the ecology and
supplements, resulting in their administration to
natural
animals that were
history of a disease;
already fed a balanced diet, with consequent
4. Planning and monitoring of disease control
hypervitaminosis D and osteodystrophy (Jubb
programmes;
and Kennedy, 1971). An increase in the
5. Assessment of the economic effects of a
number of lamb carcasses with high ultimate
disease and analysis of the costs and
pH values could be associated with excessive
economic benefits of alternative control
washing of the animals prior to slaughter
programmes.
(Petersen, 1983). These possible explanations
can be verified only by epidemiological
Note: We will identify a 6th use of investigations.
epidemiology, which is, “To provide information to
improve clinical decisions on individual patient case- Investigation and control of a disease whose
management’. cause is either unknown or poorly understood
There are many instances of disease control
based on epidemiological observations before
a cause was identified. Contagious bovine
Determination of the origin of a disease whose
pleuropneumonia was eradicated from the US
cause is known
Many diseases with a known cause can be by an appreciation of the infectious nature of
diagnosed precisely by the signs exhibited by the disease before the causal agent, Mycoplasma
the affected animals, by appropriate mycoides, was isolated (Schwabe, 1984).
laboratory tests and by other clinical Lancisi's slaughter policy to control rinderpest,
procedures such as radiological investigation. mentioned in Chapter 1, was based on the
For instance, the diagnosis of salmonellosis assumption that the disease was infectious,
in a group of calves is relatively even though the causal agent had not been
straightforward (the infection frequently discovered. Edward Jenner's classical
produces distinct clinical signs). However, observations on the protective effects of
determining why an outbreak occurred and cowpox virus against human smallpox
using the correct procedures to prevent infection in the 18th century (Fisk, 1959),
recurrence can be difficult. For example, the before viruses were isolated, laid the
outbreak may have been caused either by the foundations for the global eradication of
purchase of infected animals or by smallpox.
contaminated food. Further investigations are More recently, epidemiological studies in the
required to identify the source of infection. UK suggested that cattle develop bovine
When the food is suspected, the ration may spongiform encephalopathy (BSE) following
consist of several components. Even if a consumption of feedstuffs containing meat and
sample of each component is still available, it bone meal contaminated with a scrapie-like
would be expensive and possibly uneconomic agent (Wilesmith et al., 1988). This was
to submit all of the samples for laboratory sufficient to introduce legislation prohibiting the
examination. Consideration of the risk asso- feeding of ruminant derived protein, although
ciated with the consumption of each the causal agent had not been identified.
component of the ration may narrow the field Although the exact cause of `blood
of investigation to only one or two items. splashing' (eccymoses in muscle) in carcasses
There are many examples of the is still not known, observations have shown
investigation of diseases with known causes that there is a correlation between this
that involve answering the questions `Why defect and electrical stunning by a `head
has an outbreak occurred?' or `Why has the only' method (Blackmore, 1983); and the
number of cases increased?'. For instance, occurrence of this condition can be reduced by
an increased number of actinobacillosis cases adopting a short 'stun-to-stick' interval,
stunning animals with a captive bolt, or using a
 The scope of epidemiology
16

method of electrical stunning that causes

concurrent cardiac dysfunction (Gracey, 1986).
Similarly, there is a strong correlation
between grass sickness and grazing, and the
disease can be almost totally prevented by
stabling horses continuously during spring and
summer, although the cause of the disease is
unknown (Gilmour, 1989).
The cause of squamous cell carcinoma of
the eye in Hereford cattle ('cancer eye') is not
known. Epidemiological studies have shown
that animals with unpigmented eyelids are
much more likely to develop the condition than
those with pigment (Anderson et al., 1957). This
 The uses of epidemiology 17

information can be utilized by cattle breeders associated with leptospirosis in either man or
to select animals with a low susceptibility to domestic stock, then part of a disease control
this neoplasm. programme must involve an ecological study of
Epidemiological studies are also used to rat populations and control of infected rats.
identify causes of disease (many of which are Similarly, in Africa, a herpesvirus that
multifactorial and initially poorly understood) produces infections without signs in
so that the most appropriate disease control wildebeeste is responsible for malignant
techniques can be applied. Thus, the catarrhal fever of cattle (Plowright et al., 1960).
identification of low levels of water intake as an Wildebeeste populations, therefore, must be
important component of the cause of feline investigated when attempting to control the
urolithiasis (Willeberg, 1981) facilitated control disease in cattle.
of this syndrome by dietary modification. An ecosystem's climate also is important
Investigations can also be used to identify because it limits the geographical distribution
characteristics of animals that increase the of infectious agents that are transmitted by
risk of disease. For example, entire bitches arthropods by limiting the distribution of the
with a history of oestrus irregularity and arthropods. For example, the tsetse fly, which
pseudopregnancy are particularly at risk of transmits trypanosomiasis, is restricted to the
developing pyometra (Fidler et al., 1966); this humid parts of Sub-Saharan Africa (Ford,
information is of diagnostic value to the 1971).
clinician, and is of assistance when advising Infectious agents may extend beyond the
owners on breeding policy. ecosystems of their traditional hosts. This has
occurred in bovine tuberculosis in the UK,
where the badger population appears to be an
Acquisition of information on the ecology and alternative host for Mycobacterium tuberculosis
natural history of a disease
(Little et al., 1982; Wilesmith et al., 1982).
An animal that can become infected with an Similarly, in certain areas of New Zealand,
infectious agent is a host of that agent. Hosts wild opossums are infected with this
and agents exist in communities that include bacterium and can therefore be a source of
other organisms, all of which live in particular infection to cattle (Thorns and Morris, 1983).
environments. The aggregate of all facts Purposeful routine observation of such infections
relating to animals and plants is their natural provides valuable information on changes in the
history. Related communities and their amount of disease and relevant ecological
environments are termed ecosystems. The factors and may therefore indicate necessary
study of ecosystems is ecology. changes in control strategies.
A comprehensive understanding of the natural Infectious diseases that are transmitted by
history of infectious agents is possible only insects, ticks and other arthropods, and which
when they are studied in the context of their may be maintained in wildlife, present complex
hosts' ecosystems. Similarly, an improved ecological relationships and even more
knowledge of non-infectious diseases can be complex problems relating to their control.
obtained by studying the ecosystems and the Comprehensive epidemiological studies of
associated physical features with which these diseases help to unravel their life-cycles,
affected animals are related. The geological and can indicate suitable methods of control.
structure of an ecosystem, for example, can
affect the mineral content of plants and
therefore can be an important factor in the Planning and monitoring of disease control
occurrence of mineral deficiencies and programmes
excesses in animals. The institution of a programme to either
The environment of an ecosystem affects the control or eradicate a disease in an animal
survival rate of infectious agents and of their population must be based on a knowledge of
hosts. Thus, infection with the helminth the amount of the disease in that population,
Fasciola hepatica is a serious problem only in the factors associated with its occurrence, the
poorly drained areas, because the parasite facilities required to control the disease, and
spends part of its life-cycle in a snail which the costs and benefits involved. This information
requires moist surroundings. is equally important for a mastitis control
Each of the 200 antigenic types (serovars) of programme on a single dairy farm and for a
Leptospira interrogans is maintained in one or more national brucellosis eradication scheme involv-
species of hosts. Serovar copenhageni, for ing all the herds in a country. The
instance, is maintained primarily in rats epidemiological techniques that are employed
(Babudieri, 1958). Thus, if this serovar is include the routine collection of data on
disease in populations (monitoring and
surveillance) to decide if the various
strategies are being successful.
Surveillance is also required to determine
whether the occurrence of a disease is being
affected by new factors. For example, during
the eradication scheme for bovine
18 The scope of epidemiology

Tuberculosis in New Zealand, opossums became industrial veterinarians, concerned with the
infected in certain areas. New strategies had design of clinical trials, compare disease
to be introduced to control this problem (Julian, rates and response to treatment in groups of
1981). During the foot-and mouth disease animals to which different prophylactic and
epidemic in the UK in 1967 and 1968, therapeutic compounds are administered.
surveillance programmes indicated the
importance of wind-borne virus particles in the
transmission of the disease (Smith and Hugh-
Jones, 1969). This additional knowledge was
relevant to the establishment of areas within
which there was a restriction of animal
movement, thus facilitating eradication of the
disease.

Assessing the economic effects of a disease and of

its control
The cost of the control of disease in the
livestock industry must be balanced against the
economic loss attributable to the disease.
Economic analysis therefore is required. This is
an essential part of most modern planned
animal health programmes. Although it may be
economic to reduce a high level of disease in
a herd or flock, it may be uneconomic to
reduce even further the level of a disease that
is present at only a very low level. If 15 % of
the cows in a herd were affected by mastitis,
productivity would be severely affected and a
control programme would be likely to reap
financial benefit. On the other hand, if less than
I % of the herd were affected, the cost of
further reduction of the disease might not result
in a sufficient increase in productivity to pay for
the control programme.

This introduction to the uses of epidemiology

indicates that the subject is relevant to many
areas of veterinary science. The general
agricultural practitioner is becoming
increasingly concerned with herd health. The
companion animal practitioner is faced with
chronic refractory diseases, such as the
idiopathic dermatoses, which may be
understood better by an investigation of the
factors that are common to all cases. The
state veterinarian cannot perform his routine
duties without reference to disease in the
national animal population. The diagnostic
pathologist investigates the associations
between causes and effects (i.e., lesions); this
approach is epidemiological when inferences
are made from groups of animals. The
veterinarian in abattoirs and meat-processing
plants attempts to reduce the occurrence of
defects and contamination by understanding
and eliminating their causes. Similarly,
18 The scope of epidemiology

Types of epidemiological investigation closely to the ideally designed experiment. For

instance, when BSE occurred in the UK,
There are four approaches to epidemiological outbreaks of the disease on the Channel Islands
investigation that traditionally have been (Jersey
called `types' of epidemiology. These types
are descriptive, analytical, experimental
and theoretical epidemiology.

Descriptive epidemiology
Descriptive epidemiology involves observing
and recording diseases and possible causal
factors. It is usually the first part of an
investigation. The observations are
sometimes partially subjective, but, in common
with observations in other scientific disciplines,
may generate hypotheses that can be tested
more rigorously later. Darwin's theory of
evolution, for example, was derived mainly
from subjective observations, but with slight
modification it has withstood rigorous testing by
plant and animal scientists.

Analytical epidemiology
Analytical epidemiology is the analysis of
observations using suitable diagnostic and
statistical tests.

Experimental epidemiology
The experimental epidemiologist observes and
analyses data from groups of animals from
which he can select, and in which he can alter,
the factors associated with the groups. An
important component of the experimental
approach is the control of the groups.
Experimental epidemiology developed in the
1920s and 1930s, and utilized laboratory
animals whose short lifespans enabled events
to be observed more rapidly than in humans
(see Chapter 18). A notable example is the
work of Topley (1942) who infected colonies of
mice with ectromelia virus and Pasteurella spp. The
effects of varying the rate of exposure of mice
maintained in groups of various sizes provided
insights into the behaviour of human epidemic
diseases such as measles, scarlet fever,
whooping cough and diptheria which followed
similar patterns to the experimental infections
(MRC, 1938). This work demonstrated the
importance of the proportion of susceptible
individuals in the population in determining the
progress of epidemics (see Chapter 8);
hitherto, changes in the virulence of a
microorganism were thought to be the most
important factor affecting epidemic patterns.
Rarely, a `natural' experiment can be
conducted when the naturally occurring disease
or other fortuitous circumstance approximates
 Types of epidemiological investigation 19

and Guernsey), which maintain isolated laboratory results, and the opinions of
populations of cattle, provided an ideal situation experts; examples are the identification of the
in which to study the disease, uncomplicated by cause of coughing in dogs (Roudebush, 1984),
the possibility of transmission by contact with and the diagnosis of bovine mastitis
infected animals (Wilesmith, 1993). This added (Hogeveen et a!., 1993). Expert systems are
credence to the hypothesis that the disease also employed in formulating disease control
was transmitted in contaminated feedstuffs. strategies (e.g., for East coast fever: Gettinby
and Byrom, 1989), predicting animal
Theoretical epidemiology productivity (e.g., reproductive performance in
Theoretical epidemiology consists of the
representation of disease using mathematical dairy herds: McKay e t al., 1988), and
'models' that attempt to simulate natural supporting management decisions (e.g.,
patterns of disease occurrence. decisions on replacing sows: Huirne et al.,
1991).
Epidemiological subdisciplines Genetic epidemiology
Various epidemiological subdisciplines are now Genetic epidemiology is the study of the
recognized. These reflect different areas of cause, distribution and control of disease in
interest, rather than fundamentally different related individuals, and of inherited defects in
techniques. They all apply the four types of populations (Morton, 1982; Roberts, 1985). It
epidemiology described above, and can indicates that the disciplinary boundary
overlap, but their separate identities are between genetics and epidemiology is blurred.
considered by some to be justifiable. Many diseases involve both genetic and non-
genetic factors (see Chapter 5), and genes are
Clinical epidemiology increasingly incriminated in diseases of all
Clinical epidemiology is the use of organ systems ( F i g u r e 1.3). Thus, the
epidemiological principles, methods and findings
geneticist and epidemiologist are both
in the care of individuals, with particular
concerned with interactions between genetic
reference to diagnosis and prognosis (Last,
and non-genetic factors - only the frequently
1988), and therefore brings a numerate
indistinct time of interaction may be used to
approach to traditional clinical medicine,
classify an investigation as genetic or
which has tended to be anecdotal and
epidemiological.
subjective (Grufferman and Kimm, 1984). It is
concerned with the frequency and cause of Molecular epidemiology
disease, the factors that affect prognosis, the New biochemical techniques now enable
validity of diagnostic tests, and the microbiologists and molecular biologists to
effectiveness of therapeutic and preventive study small genetic and antigenic differences
techniques (Fletcher et al., 1988). between viruses and other microorganisms at a
higher level of discrimination than has been
Note: Clinical epidemiology and its application in possible using conventional serological
the practice of Evidence-Based Medicine (EBM) is a techniques. The methods include peptide
subdiscipline of epidemiology that has seen great mapping, nucleic acid 'fingerprinting' and
growth in the last decade such that it is clearly hybridization (Keller and Manak, 1989; Kricka,
becoming one of the major uses for epidemiological 1992), restriction enzyme analysis, monoclonal
methods. Two reading segments will follow on EBM. antibodies (Oxford, 1985; Goldspink and
Gerlach, 1990; Goldspink, 1993) and the
polymerase chain reaction (Belak and Ballagi-
Computational epidemiology Pordany, 1993). For example, nucleotide
Computational epidemiology involves the sequencing of European foot-and-mouth disease
application of computer science to virus has indicated that recent outbreaks of the
disease involved vaccinal strains, suggesting
epidemiological studies (Habtemariam et al.,
that improper inactivation or escape of virus
1988). This includes the representation of
from vaccine production plants may have been
disease by mathematical models (see
responsible for the outbreaks (Beck and
'Quantitative investigations', below) and the
Strohmaier, 1987). Similarly, infections that
use of expert systems. These systems are
hitherto have been difficult to identify are now
commonly applied to disease diagnosis where
readily distinguished using these new molecular
they incorporate a set of rules for solving
techniques; examples are infection
problems, details of clinical signs, lesions,
with Mycobacterium paratuberculosis
 (the cause of
Johne's disease) (Murray et al., 1989) and
latent infection with Aujeszky's disease virus
(Belak et al., 1989). The application of these
new diagnostic techniques constitutes
molecular epidemiology. A general
description of the methods is given by Persing
et al. (1993).
Molecular epidemiology is part of the wider
use of biological markers (Hulka et al.,
1990). These are cellular, biochemical or
molecular alterations that are measurable in
biological media such as tissues, cells or
fluids. They may indicate susceptibility to a
causal factor, or a biological response,
suggesting a sequence of events from
exposure to disease (Perera and Weinstein,
1982). Some have been used by veterinarians
for many years, for
instance, serum magnesium levels as indicators The natural history of disease
of susceptibility to clinical hypocalcaemia
(Whitaker and Kelly, 1982; Van de Braak et The ecology of diseases, including the
distribution, mode of transmission and
al., 1987), serum transaminase levels as
maintenance of infectious diseases, is
markers for liver disease, and antibodies as
indicators of exposure to infectious agents (see
Chapter 17).

Other subdisciplines
Several other epidemiological subdisciplines
have also been defined. Chronic disease
epidemiology is involved with diseases of long
duration (e.g., cancers), many of which are non-
infectious. Environmental epidemiology is
concerned with the relationship between
disease and environmental factors such as
industrial pollution and, in human medicine,
occupational hazards. Domestic animals can
act as monitors of environmental hazards
and can provide early warning of disease in
man (see Chapter 18). Micro-epidemiology is
the study of disease in a small group of
individuals with respect to factors that
influence its occurrence in larger segments of
the population. For example, studies of feline
acquired immunodeficiency syndrome (FAIDS)
in groups of kittens have provided insights
into the widespread human disease, AIDS
(Torres-Anjel and Tshikuka, 1988). Micro-
epidemiology, which frequently uses animal
biological models of disease, therefore is
closely related to comparative epidemiology
(see Chapter 18). In contrast, macro-
epidemiology is the study of national patterns
of disease, and the social, economic and
political factors that influence them (Hueston

Components of epidemiology

and Walker, 1993). Other subdisciplines, such

as nutritional epidemiology (Willett, 1990)
and subclinical epidemiology (Evans, 1987),
can also be identified to reflect particular areas
of interest.
The components of epidemiology are
summarized in Figure 2.1. The first stage in
any investigation is the collection of relevant
data. The main sources of information are
outlined in Chapter 10. Methods of storing,
retrieving and disseminating information are
discussed in Chapter 11. Investigations can be
either qualitative or quantitative or a
combination of these two approaches.
Qualitative investigations
investigated by field observation. Ecological
principles are outlined in Chapter 7. Methods of
transmission and maintenance are described
in Chapter 6, and patterns of disease
occurrence are described in Chapter 8. Field
observations also may reveal information
about factors that may directly or indirectly
cause disease. The various factors that act to
produce disease are described in Chapter 5.

Causal hypothesis testing

If field observations suggest that certain
factors may be causally associated with a
disease, then the association must be
assessed by formulating a causal hypothesis.
Causality (the relating of causes to effects) and
hypothesis formulation are described in
Chapter 3.
Qualitative investigations were the mainstay
of epidemiologists before the Second World
War. These epidemiologists were concerned
largely with the identification of unknown
causes of infectious disease and sources of
infection. Some interesting examples of the
epidemiologist acting as a medical `detective'
are described by Roueche (1991).

Quantitative investigations
Quantitative investigations involve
measurement (e.g., the number of cases of
disease), and therefore expression and analysis
of numerical values. Basic methods of
expressing these values are outlined in
Chapters 4 and 12. The types of measurement
that are encountered in veterinary medicine
are described in Chapter 9. Quantitative
investigations include surveys, monitoring
and surveillance, studies, modelling, and the
biological and economic evaluation of disease
control.
Surveys
A survey is an examination of an aggregate of
units (Kendall and Buckland, 1982). A group of
animals is an example of an aggregate. The
examination usually involves counting
members of the aggregate and characteristics
of the members. In epidemiological surveys,
characteristics might include the presence of
particular diseases, weight, and milk yield.
Surveys can be undertaken on a sample of the
population. Less commonly, a census, which
examines the total animal population, can be
undertaken (e.g., tuberculin testing). A cross-
sectional survey records events occurring at a
particular point in time. A longitudinal survey
records events over a period of time. These
latter events may be recorded prospectively
from the present into the future; or may be a
retrospective record of past events.
22 The scope of epidemiology

A particular type of diagnostic survey is 11.

screening. This is the identification of Monitoring and surveillance can include all of
undiagnosed cases of disease using rapid tests the national herd. Alternatively, a few farms,
or examinations. The aim is to separate abattoirs, veterinary practices or laboratories
individuals that probably have a disease from may be selected; these are then referred to as
those that probably do not. Screening tests are `sentinel' units, because they are designed to
not intended to be definitive; individuals with `keep watch' on a disease. Similarly, horses
positive test results (i.e., that are classified as can be used as sentinels for Venezeulan equine
diseased by the screening test) require further encephalitis virus infection (Dickerman and
investigation for definite diagnosis. Scherer, 1983), and stray dogs as sentinels for
Diagnostic tests, including serological canine parvovirus infection (Gordon and
surveys and screening, are considered in Angrick, 1985), the infections being identified
Chapter 17. The design of surveys in general is serologically. Other species of animals that also
described in Chapter 13.

Monitoring and surveillance

Monitoring is the making of routine
observations on health, productivity and
environmental factors and the recording and
transmission of these observations. Thus,
the regular recording of milk yields is
monitoring, as is the routine recording of
meat inspection findings at abattoirs. The
identity of individual diseased animals usually is
not recorded.
Surveillance is a more intensive form of data
recording than monitoring. Originally,
surveillance was used to describe the tracing
and observation of people who were in contact
with cases of infectious disease. It is now used
in a much wider sense (Langmuir, 1965) to
include all types of disease - infectious and
non-infectious - and involves the collation and
interpretation of data collected during
monitoring programmes, usually with the
recording of the identity of diseased individuals,
with a view to detecting changes in a
population's health. It is normally part of
control programmes for specific diseases.
The recording of tuberculosis lesions at an
abattoir, followed by tracing of infected animals
from the abattoir back to their farms of origin, is
an example of surveillance. The terms
`monitoring' and `surveillance' have previously
been used synonymously, but the distinction
between them is now generally accepted. The
national and international aspects of
surveillance are reviewed by Blajan (1979),
Davies (1980, 1993), Ellis (1980) and Blajan
and Welte (1988), and some animal disease
information systems are described in Chapter
are susceptible to an infectious agent can be
used as sentinels for the infection in the main
animal population. For example, wild birds
can be used to monitor the activity of St Louis
encephalitis virus, providing early information
on the activity of the virus at a time when avian
infection rates are still too low to pose an
immediate threat to man (Lord et al., 1974).
Domestic animals can also be used as sentinels
of human environmental health hazards such as
carcinogens and insecticides; this topic is
discussed in detail in Chapter 18.

Studies
`Study' is a general term that refers to any
type of investigation. However, in
epidemiology, a study usually involves
comparison of groups of animals, for example,
a comparison of the weights of animals that
are fed different diets. Thus, although a survey
generally could be classified as a study, it is
excluded from epidemiological studies
because it involves only description rather
than comparison and the analysis that the
comparison requires. There are four main types
of epidemiological study:
1. experimental
studies; 2. cross-
sectional studies; 3.
case-control studies;
4. cohort studies.
In an experimental study the investigator
has the ability to allocate animals to various
groups, according to factors which the
investigator can randomly assign to animals
(e.g., treatment regimen, preventive tech-
nique); such studies are therefore part of
experimental epidemiology. An important
example is the clinical trial. In a clinical trial,
the investigator assigns animals either to a
group to which a prophylactic or therapeutic
procedure is applied, or to a control group. It is
then possible to evaluate the efficacy of the
procedure by comparing the two groups.
Clinical trials are discussed in Chapter 16.
The other types of study - cross-sectional,
case-control and cohort - are observational.
An observational study is similar to an
experimental study: animals are allocated to
groups with respect to certain characteristics
that they possess (trait, disease, etc.).
However, in observational studies, it is not
possible to assign animals to groups randomly
because the investigator has little control
over the factors that are being studied; the
characteristics are inherent (e.g., sex,
weight or normal diet).
A cross-sectional study investigates
relationships between disease (or other
health-related factors) and
 Is epidemiology a science? 23

hypothesized causal factors in a specified experimental science have their own strengths
population. Animals are categorized according and weaknesses which are discussed in detail
to presence and absence of disease and by Trotter (1930). A major advantage of an
hypothesized causal factors; inferences can observational investigation is that it studies
then be made about associations between the natural occurrence of disease.
disease and the hypothesized causal factors, Experimentation may separate factors
for example, between heart valve incompetence associated with disease from other factors that
(the disease) and breed (the hypothesized may have important interactions with them in
causal factor). natural outbreaks.
A case-control study compares a group of Modelling
diseased animals with a group of healthy Disease dynamics and the effects of different
animals with respect to exposure to control strategies can be represented using
hypothesized causal factors. For example, a mathematical equations. This representation is
group of cats with urolithiasis (the disease) `modelling'. Many modern methods rely heavily
can be compared with a group of cats without on computers. Another type of modelling is
urolithiasis with respect to consumption of dry biological simulation using experimental
cat food (the factor) to determine whether animals (frequently laboratory animals) to
that type of food has an effect on the simulate the pathogenesis of diseases that occur
pathogenesis of the disease. naturally in animals and man. Additionally, the
In a cohort study, a group exposed to spontaneous occurrence of disease in animals
factors is compared with a group not exposed can be studied in the field (e.g., using
to the factors with respect to the development observational studies) to increase understanding of
of a disease. It is then possible to calculate a human diseases. Mathematical modelling is
level of risk of developing the disease in outlined in Chapter 19, and spontaneous
relation to exposure to the hypothesized causal disease models are described in Chapter 18.
factors.
Case-control and cohort studies have often Disease control
been applied in human medicine in which The goal of epidemiology is to improve the
experimental investigations of cause are veterinarian's knowledge so that diseases can
usually unethical. For example, it would not be be controlled effectively, and productivity
possible to investigate the suspected toxicity thereby optimized. This can be fulfilled by
of a drug by intentionally administering the treatment, prevention or eradication. The
drug to a group of people in order to study economic evaluation of disease and its control
possible sideeffects. However, if symptoms of is discussed in Chapter 20. Health schemes are
toxicity have occurred, then a case-control described in Chapter 21. Finally, the principles
study could be used to evaluate the of disease control are outlined in Chapter 22.
association between the symptoms and the drug
The different components of epidemiology
suspected of causing the toxicity. There are
apply the four epidemiological approaches to
fewer ethical restraints on experimental
varying degrees. Surveys and studies, for
investigation in veterinary medicine than in
example, consist of a descriptive and an
human medicine and so experimental
analytical part. Modelling additionally may
investigation of serious conditions is more
include a theoretical approach.
tenable. However, observational studies have a
role in veterinary epidemiology; for example,
when investigating diseases in farm and com-
panion animal populations. The increasing Is epidemiology a science?
concern for animal welfare is making these
techniques even more useful than previously. The interplay between epidemiology and
Basic methods of assessing association other sciences
between disease and hypothesized causal During the first half of the 20th century most
factors in observational studies are described epidemiologists were trained initially as
in Chapters 14 and 15. bacteriologists, reflecting epidemiologists' early
Observational studies form the majority of involvement in the investigation of outbreaks
epidemiological studies. Observational and of infectious disease. The epidemiological
approach is now practised by veterinarians
from many disciplines: the parasitologist
studying the life-cycles and dynamics of
helminth, arthropod and protozoan infections,
the geneticist concerned with an hereditary
defect in a population, and the nutritionalist
investigating a deficiency or toxicity.
Today, members of a variety of other
sciences also take part in epidemiological
studies: statisticans analysing data from
groups of animals, mathematicians modelling
diseases. economists assessing the economic
impact of disease, and ecologists studing the
natural history of
24 The scope of epidemiology

disease. Each of these sciences is concerned inethods of traditional subjects are

with different facets of epidemiology, ranging inadequate, and that an allegedly new field
from the purely descriptive, qualitative can be approached only on its own merits.
approach to the quantitative analytical Trotter (1932) has suggested two
approach. There have been many definitions of considerations when judging the individuality
epidemiology (Lilienfeld, 1978), which reflect of a science: quality and distinction. The
these facets. These definitions vary from the quality of data relating to the science must be
ecological relating only to infectious diseases such that they can be analysed
(`the study of the ecology of infectious scientifically, and methods of analysis must
diseases': Cockburn, 1963), to the be available. The field of natural experience
mathematical, referring only to human that is to be investigated by the science must
populations ('the study of the distribution and also be distinct from those investigated by
dynamics of diseases in human populations': other sciences, to the extent that only the
Sartwell, 1973). However, they all have the methods of the new science will extend
study of populations in common, and so are knowledge in that field.
encompassed by the broad definition that was Since the 1960s, veterinary epidemiology
given at the beginning of this chapter. has fulfilled these two criteria (Davies, 1983).
Many of the techniques used in An example is the field investigation of foot-
epidemiological investigations have been and-mouth disease by Smith and Hugh-Jones
developed in sciences other than (1969), mentioned earlier in this chapter. They
epidemiology; statistical tests for assessing plotted the spread of the disease during the
association and methods of sampling 1967-68 epidemic in the UK and concluded
populations are examples. This raises the that virus particles could be disseminated by
question: is epidemiology a separate science wind. The epidemiological data have been
or merely a way of thinking that applies a refined by laboratory investigation of virus
variety of methods borrowed from other excretion and, with meteorological data, have
sciences? (Terris, 1962). When undertaking a been used to formulate a model to predict
field survey, is the bacteriologist practising dispersion of the virus that is of direct value in
a distinct science called epidemiology, or the planning of disease control campaigns
(Gloster et al., 1981). This work fulfils the two
using statistical sampling methods merely to
criteria of quality and distinction; the quality of
add credence to a bacteriological hypothesis,
the data is such that they can be analysed, and
formulated from experimental results derived
the field of natural experience - spread of
in the laboratory? The difference between a
disease in this case - provides distinctive
science and a method is more than a
knowledge. The results of these investigations
semantic one: `If epidemiology is seen merely and the concomitant increased understanding
as an adjunct to experimental research, it will of disease are possible only because of the
be shackled with the same limitations and amalgamation of the techniques of the different
subject to the same narrow perspectives. It sciences that constitute epidemiology.
will either continue to be an amateur sport - that
of making subjective observations in the field
in order to raise an hypothesis that can be
The relationship between epidemiology and
examined at the laboratory bench - or exist
other diagnostic disciplines
simply to add some respectablity to experimen-
tal findings that on their own are The biological sciences form a hierarchy,
unconvincing' (Davies, 1983). If epidemiology ranging from the study of non-replicating
is a science then it has a separate identity and molecules to nucleic acids, organelles, cells,
is free to develop its own methods. tissues, organs, systems, individuals, groups
The differentiation between science and and, finally, whole communities and
method may not be easy (Himsworth, 1970). ecosystems (Wright, 1959). The various
There will be those who hold the opinion that disciplines in veterinary medicine operate at
a proposed new science is merely a variation different levels in this hierarchy. The histologist
of their own, and there will be those who feel, and physiologist study the structure and
with equal conviction, that the concepts and dynamics of the individual. The clinician and
24 The scope of epidemiology

pathologist are concerned with disease

processes in the individual: the clinician
diagnoses disease using the signs displayed by
the patient; the pathologist interprets lesions to
produce a diagnosis. The epidemiologist
investigates populations, using the frequency
and distribution of disease to produce a
diagnosis. These three diagnostic disciplines,
operating at different levels in the hierarchy,
are complementary (Schwabe et al., 1977).
Epidemiologists, dealing with the higher level,
must have a knowledge of those disciplines
`lower' in the hierarchy - they must be able to
see both the `wood' and the `trees'. This
means that they must adopt a broad rather
than a specialist approach, avoiding the
dangers of the specialist; dangers that have
been described (somewhat cynically) by Konrad
Lorenz (1977) in his book on the natural
history of human knowledge:
 Is epidemiology a science? 25
21
statisticians can be consulted if necessary; the epidemiologist
should know when to seek their advice.
The ensuing chapters describe epidemiological con-
` T he specialist comes to know more and more cepts, principles and techniques. They also include material
from other sciences, such as statistics, immunology,
about less and less, until finally he knows every thing economics and computer science, that is relevant to the
about a mere nothing. There is a serious danger practice of contemporary veterinary epidemiology.
that the specialist, forced to compete with his
colleagues in acquiring more and more specialised
Further reading
knowledge, will become more and more ignorant about
other branches of knowledge, until he is utterly Davies, G. (1983) Development of veterinary epidemiology.

incapable of forming any judgement on the role and Veterinary Record, 112, 51-53
importance of his own sphere within the context of Ferris, D.H. (1967) Epizootiology. Advances in
human knowledge as a whole.'
Veterinary Science, 11, 261-320. (An
early description of veterinary
Thus, the major attributes required to become a competent epidemiology)
veterinary epidemiologist are a natural curiosity, a logical Riemann, H. (1982) Launching the new international journal
approach, a general interest in and knowledge of veterinary 'Preventive Veterinary Medicine'. Preventive Veterinary
medicine, and a capability for lateral thinking. In spite of Medicine, 1, 1-4
Thrusfield, M. (1992) Quantitative approaches to veterinary
the preceding remarks on specialists, a special interest and
expertise in a particular sphere of veterinary science may,
epidemiology. In: The Royal Veterinary College
Bicentenary Symposium Series: The
however, be useful in some investigations; for example, a
Advancement of Veterinary Science, London
knowledge of economics when undertaking an evaluation of
199/. Volume 1: Veterinary Medicine Beyond
the economic effects of disease.
2000.
Epidemiology is becoming more quantitative than
Ed. Michell, A.R., pp. 121-142. Commonwealth Agricultural
previously. A basic knowledge of statistics is therefore
Bureaux, Farnham Royal
required. However, many problems can be solved

without the use of complex statistical methods, and