Collaborative response to 2010 Foot-and-mouth disease outbreak in Miyazaki, Japan between

veterinary and psychiatry experts

Makita K1,2, Tsutsumi A3, Kadowaki H1, Tsuji A4, Nogami T5, Matsuo Y5, Watari M6, Kim Y6, Ishida Y7

1 Veterinary Epidemiology, Rakuno Gakuen University, Japan

2 International Livestock Research Institute (ILRI), Kenya

3 United Nations University International Institute for Global Health, Malaysia

4 Farmers Association, Miyazaki

5 Miyazaki Prefecture Center for Mental Health and Welfare

6 National Center for Psychiatry and Neurological Research, Japan

7 Miyazaki University, Japan

Overview

Miyazaki, Japan

• FMD outbreak in Miyazaki, Japan in 2010

• How veterinary and mental health teams collaborated

• Mental health status of

– farmers

– local civilians

• Description of psychological stress of

– farmers

– vets

• Barriers against restarting farming

2010 FMD outbreak in Miyazaki, Japan

Tsuno

Kawa- Minami

Takanabe

Shintomi

Fig. Map showing FMD outbreak in Miyazaki

Miyazaki

Number of outbreaks (cattle and swine)

Modified from NARO, Japan Vaccination

started

Vaccination

finished

Culling of vaccinated

animals started

Finishing culling of

all animals vaccinated

Containment of

last case

The numbers of suspect animals, culled and to be culled

x 10,000 animals

New cases and suspects

Culled

To be culled

Vaccination started

Damage caused by 2010 FMD outbreak

• Economic loss

– 1362 farmers, 297,808 animals

– Total economic loss USD 3 billions

• Were the damages limited to economy?

• Restarting of farming

– Farmers resumed 59%

– Planning to resume 9%

– Stopped farming 30%

– Unknown 2%

Miyazaki Prefecture Centre for Mental Health and Welfare Faculty of Medicine, Miyazaki University Miyazaki Prefecture Health Centers Local Health Posts

Veterinary Epidemiologist (Rakuno Gakuen Univ.)

Farmer’s Association Field vets

Affected farmers

Establishment of collaborative framework for mental health research

Psycho-Epidemiologist (JICA)

2010 Oct 2011 Aug

2011 May

2012 Jan

Since 2010

2010 June

Vets wanted mental health experts Mental health experts wanted vets

Methods

• 2010

– First mental health screening • Farmers- telephone screening

• Vets and local population- postal survey

• 2011

– Participatory appraisals • Farmers and local vets

– Second mental health screening • Farmers- direct visits

• Including barriers preventing re-starting of farming

• Vets and local population- postal survey

Measurement of depression Kessler 6 (K6)

• Questions

– During the past 4 weeks, how much of the time did you feel? • …so sad nothing could cheer you up?

• …nervous?

• …restless or fidgety?

• …hopeless?

• …worthless?

– Scoring • All the time (4) – none of the time (0)

• Cut-off: total score 15 points (severe disorder)

• Explanatory variables

– Personal, agricultural, FMD and health associated factors

Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184-9.

Mental health screening for farmers

78.5%

80.2%

21.5%

19.8%

女性（N=590）

男性（N=646）

追跡不要 何らかの対応あり

81.6%

85.1%

18.4%

14.9%

女性（N=217）

男性（N=302）

追跡不要 何らかの対応あり

Male

Male

Female

Female

2011: Direct visits

2010: Telephone survey Follow up not required

Follow up not required

Follow up required

Follow up required

Comparison with 2010: x2=3.01, df=1, p=0.08

Comparison with 2010: x2=0.75, df=1, p=0.39

x2=0.45, df=1, p=0.5

x2=0.91, df=1, p=0.34

Proportions of mental health high risk farmers by K6 cut-off

94.2%

96.6%

5.8%

3.4%

女性（N=590）

男性（N=646）

ローリスク ハイリスク

2010: Telephone survey

2011: Direct visits

98.6%

98.7%

1.4%

1.3%

女性（N=219）

男性（N=301）

ローリスク ハイリスク

Male

Male

Female

Female

High risk

High risk

Not high risk

Not high risk

Comparison with 2010: x2=2.58, df=1, p=0.11

Comparison with 2010: x2=6.09, df=1, p=0.14

x2=3.48, df=1, p=0.06

Risk factors for scoring more than Ｋ６ cut-off points (Farmers in 2010)

Odds ratios (95% CI)

Total studied Kawaminami

Family relationship problem

5.2 (2.2 - 12.2) 13.1 (2.0 - 86.8) **

Human relationship problem

5.0 (2.0 - 12.7) 25.9 (3.4 - 197.7) **

History of illness 2.5 (1.2 - 5.1) 6.9 (1.5 - 11.1) *

**p<0.01, *p<0.05

All the risk factors were existence of the problems before the outbreaks

Economic situations of local civilians - Change of income compared with before the FMD outbreak -

2010 Apr-Sep (N=422)

Unchanged 8% (34)

Increased 2% (7)

Decreased 90% (381)

2011 Apr-Sep (N=335)

Unchanged 25.7% (86)

Increased 5.4% (18)

Decreased 69% (231)

Proportions of K6 high score (<15 points) (Local civilians)

89.4%

84.8%

86.9%

10.6%

15.2%

13.1%

国民生活基礎調査

(H19宮崎県、N=8457)

H22 (N=395)

H23(N=320)

ローリスク ハイリスク High risk Not high risk

National survey

(2007, Miyazaki, N=8457)

(2010, N=395)

(2011, N=320)

Significant increase after the FMD outbreak

(x2=7.76, df=1, p=0.005)

Mental stress for farmers

• From outbreak to infection • Lack of information: geography, type of effective disinfectant

• Stop of veterinary clinical services

• Anxiety against virus infection

• Helplessness of disinfectant due to expanding outbreak

• After infection at the farm • Surprise of remote infections • Anxiety towards inexperienced culling • Long lasting feeding for animals to be culled • Massive deaths of piglets • Voluntary self-confinement

– Inconvenience of daily life

– Effects on children (stay home without going to school, bullying in a class)

Mental health for farmers

• Culling at the infected premises – Searching lands for burial

– Affection towards loved animals

– Pay-for-work organized by Prefecture Government: farmers whose animals were culled aided other farmers

• Vaccination – Co-existence of vaccinating and non-vaccinating zones in a community

– Regret to cull healthy animals

Transition of stress: field vets Mental stress (3.1) > Physical stress (2.0, p<0.001: Wilcoxon matched pair)

Stand by

Mental

Physical

Announcement of use of vaccine

Finding efficient culling methods

Dispatch

Shift started

Fatigue

Nightmare

Desperation

Peak of animals to be culled

High temp.

Cull completed

Vanity Friends started calling

Transition of stress: supervisors Mental

Physical

0

0.5

1

1.5

2

2.5

3

3.5

4

4/20 - 4/25 4/26 - 5/2 5/3 - 5/9 5/10 - 5/16 5/17 - 5/23 5/24 - 5/30 5/31 - 6/6 6/7 - 6/13 6/14 - 6/20 6/21 - 6/28 6/29 - 7/4

Dispatch Announcement of use of vaccine Cull completed

Unpredictability Lack of information

Concern on vets’ health

Organisation of vaccination teams

Difference between vaccinated and non-vaccinated farms on compensation for culling Fall of local

livestock farming

Mental stress for veterinarians during culling

• Contradiction against the motivation as a field vets

• Chaos in a culling team

• Improper hygiene management

• Voluntary confinement in a house including family members during off days

• Gender issue

Barriers preventing restart of farming

• Outcome variable

– Restarting or not

• Explanatory variables

– Personal, agricultural, FMD and health associated factors

• Multiple logistic regression (GLMs)

Beef cattle and dairy farms

Owners’ age

Restart

Family owned farm

K6>15

Farm size

OR=0.97 95%CI (0.94-0.99)

P=0.006

OR=0.07 95%CI (0.01-0.69)

P=0.023

OR:17.4 95%CI (1.02-296.8)

P=0.048

OR=1.01 95%CI (1.003-1.01)

P=0.006

Pig farmers

Restart

Farm size

OR=1.01 95%CI (1.003-1.01)

P=0.006

Total mental risk

score

OR=0.4 95%CI (0.18-0.9)

P=0.026

Vaccinated farms

Restart

Satisfaction on

the information

from

Government

OR=0.3 95%CI (0.1-0.6)

P<0.001

Infected farms

Restart

Satisfaction on

the information

from

Government

Helping culling

at other farms

OR=0.7 95%CI (0.5-0.9)

P=0.02

OR=3.8 95%CI (0.8-18.1)

P=0.09

Overall farmers

Restart of farming

Satisfaction on the supports

from Government

Satisfaction on the information

from Government

K6>15 points

OR:0.6 95％CI(0.5-0.8)

P<0.001

OR:1.3 95％CI(1.0-1.6)

P=0.03

OR:0.1 95％CI(0.01-0.6)

P=0.02

Conclusion

• Importance of trans-disciplinary approach in responding acute animal diseases

• Psychological effects from FMD persisting

• Local civilians are most affected

• Mental stress of local vets and farmers changed dynamically as the outbreak situation changes

• Mental stress is one of the reasons of hesitating restarting

• Keen commercial farmers tend to restart

After the field vets experienced participatory appraisals, they started using PLAs in improving farm management. PLAs showed healing effects among those who participated. Thank you for your attention

We thank Japan Ministry of Health, Labour and Welfare and Rakuno Gakuen University for research funding