The Outbreak of Foot and Mouth Disease Serotype Sat-2 Infection in Al-Muthanna Province of Iraq

Al-Muthanna province in southern Iraq in March 2023 . Three male Holstein Friesian cows, aged between 1 and 1.5 years and weighing approximately 550 ± 15 kg each, were affected. Clinical examination revealed symptoms, including fever, severe lameness, anorexia, depression, frothy salivation, and vesicular lesions on the mouth and feet. Confirmation of the Sat-2 serotype was achieved through serological testing and genotyping of the virus, conducted by the FMD Institute, Ankara, Türkiye. The Sat-2 serotype was recognized by genotyping the virus and submitting SAT-2 VP1 sequences. The treatments for secondary infection prevention included Ceftifur (2.2 mg/kg) for 5 days, and flunixin meglumine (2.2 mg/kg) for 2 days. The other animals that were not exposed to infected animals were vaccinated against FMD. Rigorous biosecurity measures were implemented, involving thorough disinfection of the environment and quarantine of the infected animals. Direct contact between the farmer and other animals, particularly the sick ones, was completely avoided. After 2 weeks, all infected animals began to eat normally again, and clinical signs disappeared. Notably, other animals on the farm did not exhibit any signs of FMD. Conclusion: In conclusion, the findings of this study underscore the importance of biosecurity measures and vaccination in FMD prevention. Additionally, administering antibiotics and non-steroidal anti-inflammatory drugs for the prevention of secondary infections proves to be crucial.


Introduction
Foot and mouth disease (FMD) is a highly contagious global livestock disease that causes significant losses in livestock production across Asia, the Middle East, and Africa 1 .It is a viral disease that affects more than 70 animal species, including cattle, pigs, sheep, goats, water buffalo, and wild ruminants.It is clinically recognized by lesions in the mouth and feet of ungulates 2 .The causative agent of FMD is the aphthovirus, a genus of the Picornaviridae family 3 .Serologically, seven serotypes have been recognized, including A, O, C, Asia 1, Sat 1, 2, and 3; each serotype contains some subgroups 3,4 .Diagnosis typically involves methods, such as the isolation of the FMD virus, PCR, ELIZA, and sequencing the genome of the virus 5 .Foot and mouth disease is endemic in many countries and causes outbreaks that impact the economy 6 .To effectively eliminate and control FMD, a comprehensive approach is required, including the implementation of vaccination plans and the enforcement of restrictions on animal transportation.It is crucial to recognize that current FMD vaccines must be continuously enhanced to bolster their protective efficacy, given the diverse range of FMD serotypes 7,8 .Foot and mouth disease has been increasing in the majority of Iraq provinces [9][10][11] .According to the World Reference Laboratory website by FAO, FMD serotypes detected in Iraq included A, O, C, Asia 1, Sat-1, and recently Sat-2 12 .It should be noted that SAT 1, SAT 2, and SAT 3 are the only three serotypes found exclusively in Africa 6 .The Sat-2 serotype was described in January 2023 13 for the first time in northern Iraq, and then in February 2023, FMD cases appeared in many provinces in the north, middle, and south of Iraq, however, O serotype was not reported at this time 13 .In mid-March, FMD cases appeared in al-Muthanna, affecting cattle and sheep with severe clinical signs.The current case report aimed to determine the clinical characteristics of a newly identified FMD serotype and develop treatment strategies to treat the infected animals.

Case report
In March 2023, three male Holstein Friesian cows aged 1-1.5 years, with an average weight of 550 ± 15 kg, were observed with clinical signs suggestive of FMD infections at the veterinary hospital of Al-Muthanna province, Iraq.These signs included fever, severe lameness, anorexia, depression, frothy salivation, and vesicular lesions on the mouth and feet (Figures 1 and 2).
Foot and mouth disease cases were identified through examinations and history-taking.The serological and confirmatory tests for the outbreaks occurring in various Iraqi provinces were conducted by the FMD Institute, Ankara, Türkiye.The Sat-2 serotype was identified by genotyping the virus and submitting SAT-2 VP1 sequences.Detailed information on each animal, including age, sex, breed, body condition score, rectal temperature, clinical signs, and treatment were all documented 9 .Pathognomonic clinical symptoms and lesions were used to distinguish FMD from other diseases, such as vesicular stomatitis, bovine viral diarrhea, actinobacillosis, rinderpest, blue tongue, and foot rot 19 .Other animals that were not exposed to infected animals were vaccinated (Vetal, turkeye) against FMD.Biosecurity measures were rigorously adhered to, ensuring that the environment was thoroughly disinfected and the infected animals were placed under quarantine.Additionally, all contact between the farmer and other animals, particularly  the sick animals, was completely severed.After 2 weeks, all infected animals started to eat and clinical signs disappeared.Foot and mouth disease is a viral disease with no specific treatment, so treatment depends on the alleviation of clinical signs and the prevention of secondary infections in infected animals.The treatment plan involved administering Ceftiofur (2.2 mg/kg once daily; Fortis Pharma, Ukraine) IM for 5 days and Flunixin Meglumine (2.2 mg/kg body weight; Uvedco, Jordan) intramuscularly twice a day for 3 days 19,26,27 .For hoof disinfection, 5% copper sulfate salts (Vapco, Jordan) were used as a dipping solution applied after cleaning the area.After 2 weeks, the animals returned to feeding gradually and clinical signs disappeared.

Discussion
Foot-and-mouth disease is prevalent in many developing countries and is considered one of the global diseases that impact the economy of livestock significantly 14 .The Veterinary Directorate in Iraq immediately notified the World Organization for Animal Health about new FMD outbreaks, suggesting the possibility of a new sublineage or the emergence of a local sublineage due to insufficient immunological coverage, based on clinical findings.Subsequently, the SAT-2 serotype was confirmed by gene sequencing and real-time PCR 15 .Test results for samples obtained from Egypt, Ethiopia, Iraq, and Jordan have been announced by the World Reference Laboratory for Foot-and-Mouth Disease (WRLFMD).A total 36 outbreaks of FMD type SAT-2 were documented across the country in January 2023.The FMD Institute, Ankara, Turkey, submitted five FMD-type SAT 2 VP1 sequences in total between February 2 and February 14, 2023.Samples taken from water buffalo and cattle in the Nineveh and Baghdad governorates in December 2022 and January 2023 revealed the emergence of FMD SAT-2 cases.Subsequently, additional cases of FMD SAT-2 were isolated from cattle and water buffalo in six provinces, as reported by the Central Veterinary Laboratories in Baghdad, Iraq 16 .The clinical signs detected in this report are in agreement with the study of Lyons et al. (2015)  17 .
Foot and mouth disease has no specific treatment although clinical and supportive therapy are typically used to limit the complications of infection 18 .Preventive medications are used to treat secondary bacterial infections, such as antibiotics like amoxicillin, sulphonamide, oxytetracycline, ampicillin, cloxacillin, and metronidazole 18,20-22, in combination with Flunixin Meglumine that decrease body temperature in infected cattle 19,21 .Pheniramine maleate has been used in another study 16 to decrease irritation and relief symptoms of stomatitis, sore lip, and mouth, and decrease salivation and mucus secretion 27 .Severe laminitis as a result of FMD vesicles treated with Copper sulfate 5% used as an antiseptic solution 18,23 .Vaccines become less effective as the FMD virus often undergoes ongoing alterations that lead to antigenic diversity and the emergence of new FMDV topotypes and lineages 24,25 .

Conclusion
The obtained results of the study indicated that some animals on the farm did not show any sign of FMD.As indicated, biosecurity measures and vaccination are very important in the prevention of FMD.In addition, treatment with antibiotics and non-steroidal anti-inflammatory drugs for the prevention of secondary infection is highlighted as crucial.Given these findings, further studies are warranted to develop comprehensive prevention strategies for FMD.

Figure 1 .
Figure 1.Foot and mouth disease lesion at the heel bulb of a male Holstein Friesian cow aged 1 year old

Figure 2 .
Figure 2. Burst vesicle in the inner aspect of the lower lip in the mouth of a male Holstein Friesian cow with age 1.5 years old