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
• 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
Miyazaki, Japan
• Barriers against restarting farming

2010 FMD outbreak in Miyazaki, Japan
Tsuno
Kawa-
Minami
Miyazaki
Takanabe
Shintomi
Fig. Map showing FMD outbreak in Miyazaki

Number of outbreaks (cattle and swine)
Modified from NARO, Japan Vaccination Vaccination Culling of vaccinated Finishing culling of Containment of
started finished animals started all animals vaccinated 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%

Establishment of collaborative framework
for mental health research
Vets wanted mental health experts Mental health experts wanted vets
2012 Jan Psycho-Epidemiologist
Veterinary Epidemiologist (JICA)
(Rakuno Gakuen Univ.)
2011 May Since 2010
2011 Aug
2010 Oct Miyazaki Prefecture
Centre for Mental Health
Affected farmers and Welfare
2010 June Faculty of Medicine,
Miyazaki University
Farmer’s Association
Field vets
Miyazaki Prefecture
Health Centers
Local Health Posts

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
2010: Telephone survey
Follow up
追跡不要 何らかの対応あり
Follow up required
not required
男性（N=646）
Male 80.2% 19.8%
x2=0.45, df=1, p=0.5
女性（N=590）
Female 78.5% 21.5%
2011: Direct visits Follow up
追跡不要 何らかの対応あり
Follow up required
not required
男性（N=302）
Male 85.1% 14.9%
x2=0.91, df=1, p=0.34 Comparison with 2010: x2=3.01, df=1, p=0.08
女性（N=217）
Female 81.6% 18.4%
Comparison with 2010: x2=0.75, df=1, p=0.39

Proportions of mental health high risk farmers
by K6 cut-off
2010: Telephone survey
ローリスクrisk
Not high ハイリスク
High risk
男性（N=646）
Male 96.6% 3.4%
x2=3.48, df=1, p=0.06
女性（N=590）
Female 94.2% 5.8%
2011: Direct visits High risk
ローリスク
Not high risk ハイリスク
男性（N=301）
Male 98.7% 1.3%
Comparison with 2010: x2=2.58, df=1, p=0.11
女性（N=219）
Female 98.6% 1.4%
Comparison with 2010: x2=6.09, df=1, p=0.14

Risk factors for scoring more than Ｋ６ cut-off points
(Farmers in 2010)
Odds ratios (95% CI)
Total studied Kawaminami
Family relationship
5.2 (2.2 - 12.2) 13.1 (2.0 - 86.8) **
problem
Human relationship
5.0 (2.0 - 12.7) 25.9 (3.4 - 197.7) **
problem
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 2011 Apr-Sep
(N=422) (N=335)
Increased Increased
Unchanged
2% (7) 5.4% (18)
8% (34)
Unchanged
25.7% (86)
Decreased
90% (381) Decreased
69% (231)

Proportions of K6 high score (<15 points)
(Local civilians)
ローリスク risk
Not high ハイリスク
High risk
(2011, N=320)
H23(N=320) 86.9% 13.1%
(2010, N=395)
H22 (N=395) 84.8% 15.2%
国民生活基礎調査
National survey
(H19宮崎県、N=8457)
89.4% 10.6%
(2007, Miyazaki, N=8457)
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)
Mental
Announcement of
Dispatch use of vaccine Cull completed
Finding Desperation
Stand by efficient Shift Fatigue Friends
High temp.
Peak of animals started Vanity
culling started
Physical methods Nightmare to be culled calling

Transition of stress: supervisors
Mental
Announcement of
Dispatch use of vaccine Cull completed
Organisation
Unpredictability of vaccination Difference between vaccinated
Concern on
Lack of information teams and non-vaccinated farms on
vets’ health
Fall of local compensation for culling
Physical livestock farming
4
3.5
3
2.5
2
1.5
1
0.5
0
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

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
Farm size
OR=1.01
95%CI (1.003-1.01)
P=0.006
Restart
Owners’ Family
age K6>15
owned farm
OR=0.97 OR=0.07 OR:17.4
95%CI (0.94-0.99) 95%CI (0.01-0.69) 95%CI (1.02-296.8)
P=0.006 P=0.023 P=0.048

Pig farmers
Restart
Total
Farm size mental risk
score
OR=1.01 OR=0.4
95%CI (1.003-1.01) 95%CI (0.18-0.9)
P=0.006 P=0.026

Infected farms Vaccinated farms
Restart Restart
Satisfaction on Satisfaction on
the information Helping culling the information
from at other farms from
Government Government
OR=0.7 OR=3.8 OR=0.3
95%CI (0.5-0.9) 95%CI (0.8-18.1) 95%CI (0.1-0.6)
P=0.02 P=0.09 P<0.001

Overall farmers
Restart of farming
Satisfaction on Satisfaction on
the information the supports
from
K6>15 points
from
Government Government
OR:0.6 OR:0.1 OR:1.3
95％CI(0.5-0.8) 95％CI(0.01-0.6) 95％CI(1.0-1.6)
P<0.001 P=0.02 P=0.03

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