VS 5-19 D Scrapie Epidemiology Report

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0101. The time required to complete this
information collection is estimated to average 5.5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
Flock ID

OMB APPROVED
0579-0101
EXP DATE XX/XXXX

SCRAPIE EPIDEMIOLOGY REPORT

Owner Name, Address, and Email Address

Flock Location if Different

Premises ID
Telephone
Inspector
Inspection Date

Quarantine Number

Inspector ID

County

Latitude

Longitude

Type of Operation (check all that apply and circle primary activity)

INVENTORY

__________ Breeder (seed stock)
__________ Commercial (breeder)
__________ Club Lamb
__________ Feeder
__________ Dairy
__________ Other ________________________________________

GOATS

0

0

Adult females (≥ 12 mos)
Males (<12 mos)
Females (<12 mos)
Wethers (<12 mos)

Veterinary Practitioner Name
Species

SHEEP

Adult males (≥ 12 mos)

Wethers (≥ 12 mos)

Predominant Breed(s)

TOTAL

1. Number of sheep or goats currently in the flock with clinical signs suggestive of scrapie: sheep:____________ goats:________________
2. Clinical signs suggestive of scrapie observed by the producer or inspector (check all that apply):
(

)

No clinical signs of scrapie

(

)

Excitable, aggressive, or other abnormal behavior

(

)

Incoordination

(

)

Nibbling and licking movements

(
(
(

)
)
)

Weight loss
Intense itching/rubbing with wool loss
Involuntary muscle tremors

(
(
(

)
)
)

Convulsions
Skin abrasions, from rubbing
Other (describe): ________________________________

3. Approximate date when the first clinical signs suggestive of scrapie were seen: ________________
4. Total number of sheep and/or goats that have shown clinical signs suggestive of scrapie in the past 5 years: ___________.
5. Number of adult deaths from all causes over the last year: ____________.
6. Number of rams with official genotype results: _______________; number with unofficial genotype results: _______________.
(Attach copies of genotype records, if available.)
7. Number of ewes with official genotype results: _______________; number with unofficial genotype results: _______________.
(Attach copies of genotype records, if available.)
8. Check the type of records kept:
(

) Record of official ID applied

(

) Sex

(

) Species and breed (or cross), or if breed is unknown, face color (sheep) or type (goats, i.e. meat, dairy, or fiber)

(

) Date of birth or estimated month and year of birth

(

) Contemporary lambing groups

(

) Animal sire and dam Information

(

) Sales information – ID, buyer, date sold

(

) Purchase information – ID, seller, date purchased

(

) Other (describe):_____________________________________________________________________________________

VS Form 5-19D
FEB 2011

Epidemiology

Page 1

9. Description of lambing/kidding facilities:

10. How often is the lambing/kidding area cleaned and disinfected and describe process? If dates of cleaning and disinfection were recorded, attach
copy of disinfection records.

11. Are separate contemporary lambing/kidding groups used?

YES (indicate in inventory which animals are in each group and attach
supporting documentation)
NO

12. Method of disposal of placentas:

13. Method of disposal of dead sheep/goats:

14. Use an attachment to document the following information on each laboratory confirmed case and/or clinically suspicious animal currently in the
flock. Additionally, complete as much information as possible on any clinical suspects that have resided in the flock over the last 5 years.
Official ID and any secondary identification or marks
Sex
Species and breed (or cross), or if breed is unknown, face color (sheep) or type (goats, i.e. meat, milk, or fiber)
Born on farm or purchased
Date of birth or estimated month and year of birth
If purchased, purchase date, flock ID of seller, seller name and address, and a description of the documentation of the purchase.
Genotype, if known (attach documentation)
Date clinical signs noted
Confirmed case or clinical suspect
If confirmed case, date laboratory confirmed; if suspect clinical signs observed
If female: lambing date(s), lambing location(s) and all available information on offspring (current location, sales records, birth date, sex,
official or other ID, identifying marks or characteristics, sire, sire’s genotype if known, etc),
Any additional comments on the animal’s history
15. Use an attachment to document the following information on the offspring of all female scrapie confirmed cases and the animal’s disposition.
Official ID, and any secondary identification or marks
Sex
Species and breed (or cross), or if breed is unknown, face color (sheep) or type (goats, i.e. meat, milk, or fiber)
Date of birth or estimated month and year of birth
Genotype, if known (attach documentation)
Official ID of dam and sire
Genotype of sire, if known (attach documentation)
Disposition (i.e. living on farm, sold, dead or euthanized), and if transferred name and address of new owner
Any additional comments on the animal’s history.
16. Use an attachment to document the following information on all purchased sheep/goats acquired at least 2 yrs before the first positive animal was
diagnosed and up to 5 years before the positive animal was born or acquired unless a source flock has been identified. If a source flock has been
identified (i.e., the infected animal was purchased and under 72 months of age), you can limit this information to the animals acquired from the
source flock.
Official ID and any secondary identification or marks
Sex
Species and breed (or cross), or if breed is unknown, face color (sheep) or type (goats, i.e. meat, milk, or fiber)
Date of birth or estimated month and year of birth
Genotype, if known (attach documentation)
Date of purchase, flock ID of seller, seller name and address, and a description of the documentation of the purchase
Any additional information on the purchase history
VS Form 5-19D
FEB 2011

Epidemiology

Page 2

17. Use an attachment to document the following information on all sheep/goats sold or otherwise disposed of since the positive animal(s) was born or
acquired (Do not include lambs less than 12 months of age sold directly to slaughter).
Official ID and any secondary identification or marks
Sex
Species and breed (or cross), or if breed is unknown, face color (sheep) or type (goats, i.e. meat, milk, or fiber)
Date of birth or estimated month and year of birth
Genotype, if known (attach documentation)
Date of sale, flock ID of buyer, buyer name and address, and a description of the documentation of the sale
Any additional information on the sale history
18. Use an attachment to document the following information on the current flock inventory.
Official ID and any secondary identification or marks
Sex
Species and breed (or cross), or if breed is unknown, face color (sheep) or type (goats, i.e. meat, milk, or fiber)
Born on farm or purchased
Date of birth or estimated month and year of birth
If purchased, purchase date, flock ID of seller, seller name and address, and a description of the documentation of the purchase.
Genotype, if known (attach documentation)
For females, pregnancy status – open, exposed to ram, late gestation and genotype of sire, if known

Investigator Signature

VS Form 5-19D
FEB 2011

Title

Date

Epidemiology

Page 3