VS 4-108 Epidemiologic Investigation of Brucellosis Reactor Herd

(See Notice/Instructions on Reverse)

D

OMB APPROVED 0579-0047
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES

FOR OFFICE USE ONLY
RCS # 34-V5-71

Assigned to Veterinarian:

Code:

Date Assigned:

EPIDEMIOLOGIC INVESTIGATION OF BRUCELLOSIS REACTOR HERD
1. Name of Herd Owner

Date of
Current
Test

2. Street Address

TEST RESULTS (No. of Cattle)
Total

Prior history of Brucellosis
in herd

3 City and State (Include ZIP Code)

Yes
4. County

5. RGE

7. Reason for Test

TWP

SEC

6. Herd No.

No

Negative

Suspect

Reactor

Total No.
Reactors
found

Date Reactors
last found

Other States Involved have been
notified
Yes
No
Date Reviewed

Reviewed by Epidemiologist:

Diagnostic (Abortion, Etc.)

Epid. (Tracebacks
Other
from infected herds,
(specify below)
adjacent herds, sales,
Private sale or show
Livestock Market Reactor
Area Test (Community test in
neighborhood herds, or
heavily infected area or area wide
contact
herds on common
Herd
Certification
Test
recertification tests.)
Brucellosis Ring Test
pasture.)
9. Percentage of Herd Vaccinated
8. Are Clinical Signs of Brucellosis Present? (If yes, describe signs)
for Brucellosis
CV
%
AV
%
C. Animal Clinical Signs
Diff. Breeding No.
Other (Specify)
A. Human
B. Animal
10. Maximum age when calfhood
Abortion No.
Hygromas No.
vaccinated
Yes
Yes
Ret. Placenta No.
Reduced Milk Prod. No.
No
No
Weak Calves No.
Fistulous Withers/Poll Evil (Horses) No.

HERD STATUS

Slaughter Reactor

11. No. of
Herds
Owned or
Managed

Post Movement Retest

12. Location of Herd (Continue on separate page)

13. Date Test Scheduled

14. If all herds are not to be tested, give reason

A.
B.
C.

No.

15. Type of Operation (s)
FeedBeef
lot

Cows
Vac

Dairy

HERD

Cows
Non Vac

16. Cattle Census on Premises (Exclude steers and spayed heifers)
Heifers 1 to 2 years
Bulls
Vac
Non Vac

Heifers under 12 months
Vac
Non Vac

A.
B.
C.
Swine

Goats

Sheep

17. No. Susceptible Species on Premises
Horses
Buffalo
Dogs

Other (Specify species
and no.)

A.

18. Breeding Program this Herd) (Check one in column A.)
B. Dates of Usual Calving Season:

Natural
Art. Insem

TRACEBACK AND
CONTACT INFORMATION

19. Owner’s opinion on source of infection

Yes
No
24. Cattle moved out of herd since
date infection introduced

23. Origins of this herd (All raised, recently
assembled, few purchased additions, many
purchased additions)

27. Reactors were
raised
Yes

Ending
Month

21. Probable source infection (Specify)

22. Date infection
introduced into the herd

25. Reported sales “to slaughter” verified

26. Other sales
verified

Yes

Yes
No
(If yes, complete VS 4-108B)

Assistance needed to
verify slaughter

Yes

No
No
COMPLETE ITEMS 27 AND 28 WHERE APPLICABLE AND COMPLETE VS FORM 4-108A
28. A. Where obtained
B. No. obtained
C. Date obtained
D. Accompanied by Heath Certificate, Blood Test Record, or Permit
No

Livestock Dealer(s)
Yes

Livestock Market(s)

Some
but not
all

None

Direct from farm or ranch

(If no, complete
Item 28.)

(Attach copy of bill of sale, health certification, etc., if possible)
29. LIST NAMES OF SIX NEAREST HERD OWNERS AND COMPLETE VS FORM 4-108C
(2)
(3)

(1)

QUARANTINE AND PERMITS

20. In my opinion this herd is
infected with Brucellosis

Beginning
Month

(4)

(5)

(6)

30. Quarantine and requirements for quarantine release have
been explained to owner
Yes

31. Permit requirements and requirements for Hot “S” Brand on exposed animals
before movement into market channels explained to owner
No

Yes

32. Explained the nature of Brucellosis, discussed a tentative retest schedule, and completed
Herd Plan has been submitted.
35. Supplemental forms completed
VS FORM 4-108A
37. Date quarantine

VS FORM 4-108
APR 2009

Yes

33. Anticipated owner cooperation

Good
Average
No (If no, explain in item 36.)
36. REMARKS (Attach supplemental sheet if necessary. Cite item referred to.)

Poor

No

34. Owner Knows how to
contact you?
Yes

VS FORM 4-108B
VS FORM 4-108C
38. Quarantine No.

Previous editions may be used.

39. Signature of VMO

Code:

40. Date Signed

No

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 0579-0047. The time required to complete this
information collection is estimated to average 4 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.

NOTICE TO HERD OWNERS

Herd owners (Managers or Agents) of herds of brucellosis affected livestock must be advised that
information is given voluntarily to assist in the elimination of brucellosis from the livestock population.
Cooperation of all affected herd owners (Managers or Agents) is needed to complete a thorough
epidemiologic investigation to identify the source of the disease, the method of spread and the possible
dissemination to new herds. The authorities under which the brucellosis program is conducted are
contained in 21 U.S.C. 111, 112, 114, 114a-1, 115, 120, 121, and 134a-f and Title 9, Code of Federal
Regulations, Parts 51 and 78.

INSTRUCTIONS

(For Complete Instructions see VS Memorandum 551.26)
All items are self-explanatory, except as follows:

1.

COMPLETE LEGAL NAME as used on indemnity
papers.

2-3.

COMPLETE MAILING ADDRESS including post office
box number, route number, and ZIP code.

4.

List county in which herd is located.

5.

Geographic location of farm where subject animals are
located – use range, township and section, or longitude
and latitude coordinates or mileage grid indicating
distance north and west from southeast corner of county
– use only one system within a State.

6.

To be completed in office unless herd number is known.

7.

Reason for test:
Slaughter Reactor – MCI reactor disclosed at a
slaughter plant.
Livestock Market Reactor – MCI reactor disclosed at a
livestock market.
Brucellosis Ring Test – Herd Test because of
suspicious milk test.
Diagnostic – Abortion, infertility, etc.

9.

Estimate percentage of animals in herd that were
vaccinated in calfhood or as adults. If calfhood
vaccinated animals are revaccinated as adults,
make a notation of this in remarks (36).

10.

The age of the oldest calf at time of vaccination
should be recorded in months.

11-16.

Report the total number of separate (by UM and R
definition) herds owned and the number of cattle in
each. Prepare a separate 4-108 for each herd
listed and cross-reference all reports (forms).
Specialized operations such as veal raising or dairy
heifers should be included under feedlots (15) and
described under remarks.

18.

If more than one term is applicable in block A, give
the percentage of each. In block B, indicate
beginning and ending month of calving season.

21.

Specify the name of herd owner if known and
probable method of spread (e.g., area spread,
purchased animal, common range, etc).

22.

Estimate from epidemiological information the
probable date that brucellosis was introduced into
the herd.

24.

Include all cattle, other than steers or spayed
heifers, moved for any purpose. This includes dayold calves, cull cows, feeder heifers, etc.

25.

Verify reported sales to slaughter by checking
purchase and sales receipts at markets (or dealer)
and purchase receipts at slaughter plants.

26.

Verify by locating and retesting the animal(s) or by
notifying State of destination.

27.

If any reactors were not raised in the herd, the
response is “NO.”

28.

Give information on the purchase lot(s) (summarize
for each category) from which reactors originated.

29.

List the six nearest herds regardless of distance. If
more than six herds have potential contact, give
details on separate sheets including locations.
Potential contact means epidemiological possibility
of exposure and includes indirect as well as direct
contact.

36.

A narrative statement of your appraisal of the
situation should be attached.

Private sale or show – Cross out nonapplicable item.
Herd Certification Test – Initial or recertification tests.
Post-Movement Retest – Test performed after
purchase for cattle moved under permit and held under
quarantine for retest.
Area Test – (Community test in heavily infected area or
area-wide recertification tests) – Cross out
nonapplicable item.
Epidemiologic – (Tracebacks from infected herd, i.e.,
cattle were sold from this herd into an infected herd;
adjacent or fence contact herds, sales, i.e., cattle were
purchased from an infected herd, neighborhood herds,
or contact herds on common premises). Cross out
nonapplicable categories.
Other – (Specify) – Any tests not covered by the above
categories.
8.

Report number of animals observed by owner or others
showing clinical signs since estimated onset of infection
(see item 22).

VS FORM 4-108 (Reverse)

Privacy Act Notice
Veterinary Services – Brucellosis Information System and Brucellosis Recording and Reporting System
Authority: 21 U.S.C. 111, 112, 114, 114a-1, 115, 120, 121, 125, 134a-134f and title 9, Code of Federal Regulations, part 51 and
part 78.
Purpose and Routine Uses:
Routine uses of records maintained in the system, including categories of users and the purposes of such uses:
1)
2)
3)
4)
5)
6)
7)

Detecting the foci of infection to reduce the rate of spread of infection to new herds;
Evaluating brucellosis program activities of State, Federal, and contractual personnel;
Preparing mailing labels and preaddressed forms to enhance field activities;
Evaluating program effectiveness;
Detecting factors of epidemiologic importance in containing or eliminating foci of infected herds;
Assuring that brucellosis indemnities are promptly and properly paid;
Notification of livestock owners with the animals at high risk of exposure to brucellosis because of livestock movements or
an outbreak of disease or presence of quarantined premises in a community;
8) Referral to the appropriate agency, whether Federal, State, local, or foreign, charged with responsibility of investigating or
prosecuting a violation of law concerning animal disease control and eradication, or of enforcing or implementing a
statute, rule, regulation, or order issued pursuant thereto, of any record within this system when information available
indicates a violation or potential violation of law concerning animal disease control and eradication, whether civil, criminal,
or regulatory in nature, and either arising by general statute or particular program statute, or by rule, regulation, or court
order issued pursuant thereto;
9) Litigation by the Department of Justice when the agency, or any component thereof, or any employee of the agency in his
or her official capacity, or any employee of the agency in his or her individual capacity where the Department of Justice
has agreed to represent the employee, or the United States, where the agency determines that litigation is likely to affect
the agency or any of its components, is a party to litigation or has an interest in such litigation, and the use of such
records by the Department of Justice is deemed by the agency to be relevant and necessary to the litigation; provided,
however, that in each case, the agency determines that disclosure of the records to the Department of Justice is a use of
the information contained in the records that is compatible with the purpose for which the records were collected;
10) Use in a proceeding before a court or adjudicative body before which the agency is authorized to appear, when the
agency, or any component thereof, or any employee of the agency in his or her official capacity, or any employee of the
agency in his or her individual capacity where the agency has agreed to represent the employee, or the United States,
where the agency determines that litigation is likely to affect the agency or any of its components, is a party to litigation
or has an interest in such litigation, and the agency determines that use of such records is relevant and necessary to the
litigation; provided, however, that in each case, the agency determines that disclosure of the records to the court is a use
of the information contained in the records that is compatible with the purpose for which the records were collected; and
11) Response to a request from a congressional office from the record of an individual made at the request of that individual.
To certain Federal and State animal health officials to conduct, analyze, and report on the progress of animal disease
control or surveillance programs.

Disclosure: Furnishing this information is voluntary; however, failure to furnish this information may impede brucellosis
eradication activities.

Form Copy Designation
PART 1-HERD FILE
PART 2-CATTLE DISEASES STAFF,
RIVERDALE, MD (Free Areas only)
PART 3-STATION EPIDEMIOLOGIST
PART 4- STATE OR FEDERAL VETERINARIAN