Preventive Veterinary Medicine 121 (2015) 21–29 Contents lists available at ScienceDirect Preventive Veterinary Medicine journal homepage: www.elsevier.com/locate/prevetmed Comparison of output-based approaches used to substantiate bovine tuberculosis free status in Danish cattle herds Alessandro Foddai a,b,∗ , Liza Rosenbaum Nielsen c , Preben Willeberg b,c , Lis Alban a a Risk Analysis Group, Department of Food Safety and Veterinary Issues, Danish Agriculture & Food Council, Axeltorv 3, DK-1609 Copenhagen V, Denmark b Section of Epidemiology, National Veterinary Institute, Technical University of Denmark, Bülowsvej 27, 1870 Frederiksberg C, Denmark c Department of Large Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 1870 Frederiksberg C, Denmark article info Article history: Received 5 April 2015 Received in revised form 13 May 2015 Accepted 20 May 2015 Keywords: Surveillance sensitivity Freedom from disease Stochastic Scenario tree Bovine tuberculosis abstract We compared two published studies based on different output-based surveillance models, which were used for evaluating the performance of two meat inspection systems in cattle and to substantiate freedom from bovine tuberculosis (bTB) in Denmark. The systems were the current meat inspection methods (CMI) vs. the visual-only inspection (VOI). In one study, the surveillance system sensitivity (SSe) was estimated to substantiate the bTB free status. The other study used SSe in the estimation of the probability of freedom (PFree), based on the epidemiological concept of negative predictive value to substantiate the bTB free status. Both studies found that changing from CMI to VOI would markedly decrease the SSe. However, the two studies reported diverging conclusions regarding the effect on the substantiation of Denmark as a bTB free country, if VOI were to be introduced. The objectives of this work were: (a) to investigate the reasons why conclusions based on the two models differed, and (b) to create a hybrid model based on elements from both studies to evaluate the impact of a change from CMI to VOI. The hybrid model was based on the PFree approach to substantiate freedom from bTB and was parametrized with inputs according to the newest available information. The PFree was updated on an annual basis for each of 42 years of test-negative surveillance data (1995–2037), while assuming a low (<1%) annual probability of introduction of bTB into Danish cattle herds. The most important reasons for the difference between the study conclusions were: the approach chosen to substantiate the bTB free status (SSe vs. PFree) and the number of years of surveillance data considered. With the hybrid model, the PFree reached a level >95% after the first year of surveillance and remained ≥96% with both the CMI and VOI systems until the end of the analyzed period. It is appropriate to use the PFree of the surveillance system to substantiate confidence in bTB free status, when test-negative surveil- lance results can be documented over an extended period of time, while maintaining a low probability of introduction of bTB into the cattle population. For Denmark, the probability of introduction of bTB should be kept <1% on an annual basis to sustain the high confidence in freedom over time. The results could be considered when deciding if the CMI can be replaced by VOI in cattle abattoirs of countries for which bTB freedom can be demonstrated. © 2015 Elsevier B.V. All rights reserved. 1. Introduction Bovine tuberculosis (bTB 1 ) is caused by Mycobacterium bovis, which can infect domestic cattle, wild animals, and humans (de la Rua-Domenech, 2006). In Denmark, bTB was considered eradicated ∗ Corresponding author at: Risk Analysis Group, Department of Food Safety and Veterinary Issues, Danish Agriculture & Food Council, Axeltorv 3, DK-1609 Copen- hagen V, Denmark. Tel.: +45 26243099; fax: +45 33394141. E-mail address: afo@lf.dk (A. Foddai). 1 A list of abbreviations is provided in the Appendix. from the cattle population in 1952 as a result of a targeted national eradication effort (Anonymous, 1952). In the European Union (EU), Member States can be classified officially free from bTB (OTF), if <0.1% of the cattle herds in the country are confirmed infected with M. bovis (Council Directive 64/432/EEC; Council Directive 98/46/EC). Denmark obtained the OTF-status in 1980 (Commission Decision 80/984/EEC; Reviriego Gordejo and Vermeersch, 2006). In OTF countries, surveillance systems for bTB primarily consist of meat inspection at the abattoir. The current meat inspec- tion (CMI) procedures include palpation and incision of specific organs and lymph nodes to identify affected animals and herds (Regulation (EC) No 854/2004). In Denmark, only selected groups http://dx.doi.org/10.1016/j.prevetmed.2015.05.005 0167-5877/© 2015 Elsevier B.V. All rights reserved.