Foot-and-mouth disease (FMD) is a highly contagious disease of livestock affecting animal production and trade throughout Asia and Africa. Understanding FMD virus (FMDV) global movements and evolution can help to reconstruct the disease spread between endemic regions and predict the risks of incursion into FMD-free countries. Global expansion of a single FMDV lineage is rare but can result in severe economic consequences. Using extensive sequence data we have reconstructed the global space-time transmission history of the O/ME-SA/Ind-2001 lineage (which normally circulates in the Indian sub-continent) providing evidence of at least 15 independent escapes during 2013–2017 that have led to outbreaks in North Africa, the Middle East, Southeast Asia, the Far East and the FMD-free islands of Mauritius. We demonstrated that sequence heterogeneity of this emerging FMDV lineage is accommodated within two co-evolving divergent sublineages and that recombination by exchange of capsid-coding sequences can impact upon the reconstructed evolutionary histories. Thus, we recommend that only sequences encoding the outer capsid proteins should be used for broad-scale phylogeographical reconstruction. These data emphasise the importance of the Indian subcontinent as a source of FMDV that can spread across large distances and illustrates the impact of FMDV genome recombination on FMDV molecular epidemiology.

Rabies remains a disease of significant zoonotic and economic concern in rabies endemic areas of Bhutan. Rabies outbreaks in livestock threaten the livelihoods of subsistence farming communities and pose a potential public health threat. As a part of identifying approaches to prevent rabies in cattle, a Knowledge, Attitude, and Practice (KAP) survey was conducted among cattle owners in selected rural areas of the southern rabies high-risk zone and low-risk zone in eastern Bhutan. Between March and April 2017, 562 cattle owners (281 in the east and 281 in the south) were interviewed using a questionnaire. Eighty-eight percent of the participants had heard of rabies but only 39% of the participants who had heard of rabies had adequate knowledge about rabies. Multivariable logistic regression analysis showed that residing in the south [OR = 9.25 (95% CI: 6.01–14.53)] and having seen a rabies case [OR = 2.46 (95% CI: 1.6–3.82)] were significantly associated with having adequate knowledge about rabies. Based on our scoring criteria, 65% of the total participants who had heard of rabies had a favorable attitude towards rabies control and prevention programs. The participants residing in the east were two times more likely to have a favourable attitude than their counterparts in the south [OR = 2.08 (95% CI: 1.43–3.05)]. More than 70% of the participants reported engaging in farm activities such as examining the oral cavity of sick cattle and assisting cattle during parturition. Only 25% of the participants reported using personal protective equipment while undertaking these activities. Despite a high level of rabies awareness, we observed that there is a lack of comprehensive knowledge about rabies regarding susceptible hosts, transmission routes, the health outcome of rabies infection in humans, and appropriate health-seeking behaviours. This study highlights the need to strengthen rabies education programs in rural communities to address the knowledge gaps that have been identified.

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Mixing of cattle at grazing areas was identified as a risk factor for FMD. This indicates that spread from infected herds and villages, through close contact, could be an important source of disease for non-infected herds in Bhutan. Therefore, quarantining of early cases in affected herds or villages could reduce the spread of disease within and between villages. This study also highlights the potential role of feeding kitchen waste to cattle as a risk factor for FMD. The findings from this study could be considered for strengthening of the FMD control programme in Bhutan.

A retrospective study on the outbreaks of foot-and-mouth disease (FMD) in Bhutan, between the years 1996 and 2008, based on the data collected through passive surveillance, was undertaken. A total of 230 outbreaks of FMD at sub-district level were recorded in 299 villages located in 19 out of the 20 districts in the country. There were no significant differences between the years (P = 0.998) or months (P = 0.989) on the incidence of FMD. The sub-districts in the north (altitude >1,000 m above mean sea level) had significantly (P = 0.008) higher incidences of outbreaks in winter than in summer. The sub-districts that shared border with India had significantly more outbreaks than those that didn't (P = 0.001). Cattle were the most predominant species affected being involved in all of the outbreaks reported. Serotype O, which constituted 70.6% of the outbreaks typed was the most predominant serotype prevalent in Bhutan followed by A (16.7%), Asia 1 (8.8%), and C (3.9%). Cattle density was significantly positively correlated (P = 0.023) with the incidence of disease. Three waves of outbreaks of epidemic proportions were reported in 1997/1998, 2002/2003, and 2007/2008 due to the PanAsia strain of the O serotype. The study highlights the incursion of the PanAsia strain of the O serotype into the country, possibly, through the transboundary movement of animals and the need for active surveillance of FMD, especially at the border areas. The study also highlights the significance of the O serotype and cattle as the main indicator species in the epidemiology of FMD in Bhutan. The findings from this study can be used as baseline epidemiological data for further research to understand the epidemiology of FMD in Bhutan.

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Highly pathogenic avian influenza A(H5N1), clade 2.3.2.1a, with an H9-like polymerase basic protein 1 gene, isolated in Bhutan in 2012, replicated faster in vitro than its H5N1 parental genotype and was transmitted more efficiently in a chicken model. These properties likely help limit/eradicate outbreaks, combined with strict control measures.