Patient-centered medicine: transforming the clinical method. Second edition

Background: International trade regulations require that countries document their livestock's sanitary status in general and freedom from specific infective agents in detail provided that import restrictions should be applied. The latter is generally achieved by large national serological surveys and risk assessments. The paper describes the basic structure and application of a generic stochastic model for risk-based sample size calculation of consecutive national surveys to document freedom from contagious disease agents in livestock. Methods: In the model, disease spread during the time period between two consecutive surveys was considered, either from undetected infections within the domestic population or from imported infected animals. The @Risk model consists of the domestic spread in-between two national surveys; the infection of domestic herds from animals imported from countries with a sanitary status comparable to Switzerland or lower sanitary status and the summary sheet which summed up the numbers of resulting infected herds of all infection pathways to derive the presurvey prevalence in the domestic population. Thereof the pre-survey probability of freedom from infection and required survey sample sizes were calculated. A scenario for detection of infected herds by general surveillance was included optionally. Results: The model highlights the importance of residual domestic infection spread and characteristics of different import pathways. The sensitivity analysis revealed that number of infected, but undetected domestic herds and the multiplicative between-survey-spread factor were most correlated with the pre-survey probability of freedom from infection and the resulting sample size, respectively. Compared to the deterministic pre-cursor model, the stochastic model was therefore more sensitive to the previous survey's results. Undetected spread of infection in the domestic population between two surveys gained more importance than infection through animals of either import pathway. Conclusion: The model estimated the pre-survey probability of freedom from infection accurately as was shown in the case of infectious bovine rhinotracheitis (IBR). With this model, a generic tool becomes available which can be adapted to changing conditions related to either importing or exporting countries. Published: 18 May 2007 BMC Veterinary Research 2007, 3:10 doi:10.1186/1746-6148-3-10 Received: 3 November 2006 Accepted: 18 May 2007 This article is available from: http://www.biomedcentral.com/1746-6148/3/10 © 2007 Knopf et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.