Disease Monitoring Program Research Articles

Efficacy of a novel interstitial lung disease monitoring program in breast cancer patients undergoing treatment with trastuzumab-deruxtecan.

Interstitial lung disease (ILD) is a well described and potentially fatal complication of trastuzumab-deruxtecan (T-DXd). It is currently unknown if specific monitoring is beneficial in the early detection of ILD in these patients. We describe the efficacy and feasibility of a novel ILD monitoring protocol in breast cancer patients treated with T-DXd at our institution. An ILD monitoring protocol developed at our institution included baseline and ongoing monitoring with pulmonary function testing (PFTs) and high-resolution chest computed tomography (HRCT) at pre-specified intervals. Patients with metastatic HER2+ or HER2-low breast cancer treated at Huntsman Cancer Institute who received ≥ 1 cycle of T-DXd between 2020 and 2023 were included (n = 68). Patient outcomes and provider adherence to the protocol were retrospectively evaluated. Providers were classified as "no adherence" if they did not elect to participate in any elements of the recommended protocol or as "some adherence" if they had at least some monitoring per protocol. 10 cases of ILD were identified with an incidence of 12% (3/25) in the no adherence group and 16% (7/43) in the some adherence group. ILD cases in the no adherence group included one grade 2 and two grade 5 cases. The some adherence group included three grade 1 and four grade 2 cases. An ILD monitoring protocol consisting of baseline PFTs and ongoing monitoring with PFTs and HRCT is a feasible approach as evidenced by a majority provider adherence rate. This type of protocol may be effective in preventing severe cases of ILD and identifying grade 1 events that may permit treatment re-challenge.

PREVENTION AND CONTROL OF CHRONIC DISEASES IN VULNERABLE POPULATIONS

Chronic diseases such as diabetes, hypertension and cardiovascular diseases are prevalent in vulnerable populations, who often face difficulties in accessing adequate medical care. Primary care, especially family medicine, plays a central role in the prevention and control of these diseases, as it offers continuous, comprehensive and personalized care, focused on health promotion and the prevention of complications. This model of care is especially effective in communities that face economic, social and cultural barriers, allowing for early intervention and appropriate management of chronic conditions. The aim of this study is to analyze strategies for the prevention and control of chronic diseases in vulnerable populations, with a focus on family medicine. The aim is to identify effective approaches that can be used to improve the quality of life of these populations and reduce the incidence and progression of chronic diseases. The research was carried out through a qualitative literature review, focusing on articles published between 2017 and 2022. The aim was to explore the advances and challenges in the management of chronic diseases, with an emphasis on primary health practices, the impact of social determinants of health, and the role of technologies such as telemedicine in the management of these conditions. By providing continuous and comprehensive care, family medicine uses various strategies to prevent and control chronic diseases. These include regular patient follow-up, early screening for conditions such as hypertension and diabetes, and health education, which guides individuals on healthy behaviors and self-care. In addition, disease monitoring programs and interventions such as modifying eating habits and promoting physical activity have shown positive results in the management of chronic diseases. However, there are still significant challenges, such as the scarcity of resources and the lack of qualified professionals, which limit the effectiveness of these approaches in certain regions and social groups. Overcoming these barriers requires a joint effort between health professionals, managers and public policies. It is concluded that family medicine is a fundamental approach to the control and prevention of chronic diseases, especially in vulnerable populations. The strategies adopted in this model of care, such as continuous monitoring, health education and early intervention, have shown significant results in improving quality of life and reducing complications associated with chronic diseases. However, in order to optimize the results, it is necessary to overcome challenges related to access and the training of professionals, as well as ensuring adequate support for the implementation of public health programs that favour the population in situations of vulnerability. Implementing efficient public policies and expanding access to primary health care are essential to achieving effective control of chronic diseases.

Identification of common spatial and temporal trends in the epidemiology of cattle bovine tuberculosis and human extrapulmonary and drug-resistant tuberculosis in Malawi

BackgroundIdentification of common spatial disease trends between cattle bovine tuberculosis (BTB) and human extrapulmonary tuberculosis (EPTB) and drug-resistant tuberculosis (DRTB) can support integrated disease control and monitoring programmes. We employed the recently developed multivariate disease mapping methods to examine whether the diseases exhibited any spatial correlation. MethodsA retrospective study of cattle BTB and human EPTB and DRTB cases from 2018 to 2022 was conducted. Bivariate shared spatiotemporal components models were fitted to a) cattle BTB and human EPTB and b) cattle BTB and human DRTB at the district level in Malawi, with cattle density, human density and climatic variables as independent variables. ResultsDisease specific spatial effects were higher in the southern half of the country, while the shared spatial effects were more dominant in both the south and western parts of the country. The shared temporal effects showed constant trends, while disease specific temporal effects showed an increasing pattern for cattle BTB and a constant pattern for human EPTB and DRTB. The predicted disease incidence pattern for all forms of TB in the period without data showed a constant pattern over the years. Cattle density was positively associated with cattle BTB (β: 0.022; 95% Credible Interval (CI): 0.004, 0.042). Human density was positively associated with human EPTB (β: 0.005; 95% CI: 0.001, 0.009). ConclusionCattle BTB and human EPTB and DRTB have a common spatial pattern in the west and southern parts of Malawi. Integrated interventions targeting high-density areas for cattle and human may have positive impacts on cattle BTB and human EPTB and DRTB.

Association between work productivity and characteristics of adults with X-linked hypophosphatemia: an analysis of the XLH disease monitoring program.

X-linked hypophosphatemia (XLH) is a rare, genetic, progressive, phosphate-wasting disorder that causes skeletal morbidities, stiffness, pain, and impaired physical function. This study used baseline data from the XLH Disease Monitoring Program to evaluate relationships between work productivity and patient characteristics (demographics, medical history, patient-reported, and functional outcomes) in adults with XLH. Bivariate analysis guided the selection of variables for multivariate analysis after adjustment for multicollinearity and conceptual overlap. The analysis comprised 281 subjects (75.4% female; 80.8% from USA; median age 39.2yr); 53.4% were employed full-time and 31.3% were not employed; 15.3% were receiving disability payments; 47.0% were taking burosumab at study entry. Most employed subjects were working full-time outside the home (69.9%) and in light or sedentary roles (59.6%). In multivariate analyses, patients with fewer orthopedic surgeries (odds ratio [OR] 0.88; 95% confidence interval [CI], 0.81-0.96; p=.002) and better Patient-Reported Outcomes Measurement Information System Physical Function scores (OR 1.08; 95% CI, 1.02-1.15; p=.013) were more likely to be in full-time employment than not employed. Younger patients (OR 0.97; 95% CI, 0.94-0.99; p=.014) and those with fewer orthopedic surgeries (OR 0.83; 95% CI, 0.73-0.95; p=.008) were more likely to be in medium than light or sedentary work. Those with worse WOMAC Pain scores were more likely to be doing heavy/very heavy than light or sedentary activity (OR 1.04; 95% CI, 1.01-1.07; p=.006). Full-time employment levels are low in adults of working age with XLH, and unemployment and disability payment rates are high, suggesting that XLH has a substantial impact on work productivity. Worse physical function and a greater number of orthopedic surgeries are associated with lower work productivity. Worse pain, higher number of orthopedic surgeries, and younger age are associated with heavier work roles; however, causality was not specifically investigated.

Disease characteristics, effectiveness, and safety of vestronidase alfa for the treatment of patients with mucopolysaccharidosis VII in a novel, longitudinal, multicenter disease monitoring program

BackgroundMucopolysaccharidosis VII (MPS VII) is an ultra-rare, autosomal recessive, debilitating, progressive lysosomal storage disease caused by reduced activity of β-glucuronidase (GUS) enzyme. Vestronidase alfa (recombinant human GUS) intravenous enzyme replacement therapy is an approved treatment for patients with MPS VII.MethodsThis disease monitoring program (DMP) is an ongoing, multicenter observational study collecting standardized real-world data from patients with MPS VII (N ≈ 50 planned) treated with vestronidase alfa or any other management approach. Data are monitored and recorded in compliance with Good Clinical Practice guidelines and planned interim analyses of captured data are performed annually. Here we summarize the safety and efficacy outcomes as of 17 November 2022.ResultsAs of the data cutoff date, 35 patients were enrolled: 28 in the Treated Group and seven in the Untreated Group. Mean (SD) age at MPS VII diagnosis was 4.5 (4.0) years (range, 0.0 to 12.4 years), and mean (SD) age at DMP enrollment was 13.9 (11.1) years (range, 1.5 to 50.2 years). Ten patients (29%) had a history of nonimmune hydrops fetalis. In the 23 patients who initiated treatment prior to DMP enrollment, substantial changes in mean excretion from initial baseline to DMP enrollment were observed for the three urinary glycosaminoglycans (uGAGs): dermatan sulfate (DS), -84%; chondroitin sulfate (CS), -55%; heparan sulfate (HS), -42%. Also in this group, mean reduction from initial baseline to months 6, 12, and 24 were maintained for uGAG DS (-84%, -87%, -89%, respectively), CS (-70%, -71%, -76%, respectively), and HS (+ 3%, -32%, and − 41%, respectively). All adverse events (AEs) were consistent with the known vestronidase alfa safety profile. No patients discontinued vestronidase alfa. One patient died.ConclusionsTo date, the DMP has collected invaluable MPS VII disease characteristic data. The benefit-risk profile of vestronidase alfa remains unchanged and favorable for its use in the treatment of pediatric and adult patients with MPS VII. Reductions in DS and CS uGAG demonstrate effectiveness of vestronidase alfa to Month 24. Enrollment is ongoing.

Early results from a long-term disease monitoring program in patients with long-chain fatty acid oxidation disorders

Early results from a long-term disease monitoring program in patients with long-chain fatty acid oxidation disorders

Performance measures and patient/caregiver-reported assessments collected in a longitudinal, multi-center disease monitoring program (DMP) of patients with mucopolysaccharidosis type VII (MPS VII)

Performance measures and patient/caregiver-reported assessments collected in a longitudinal, multi-center disease monitoring program (DMP) of patients with mucopolysaccharidosis type VII (MPS VII)

Vestronidase alfa for the treatment of mucopolysaccharidosis type VII (MPS VII): Updated results from a novel, longitudinal, multi-center disease monitoring program (DMP)

Vestronidase alfa for the treatment of mucopolysaccharidosis type VII (MPS VII): Updated results from a novel, longitudinal, multi-center disease monitoring program (DMP)

DOP07 Monitoring disease activity by intestinal ultrasound predicts biologic treatment persistence in patients with Inflammatory Bowel Disease

Abstract Background Current biomarker-based monitoring strategies have limited efficacy in predicting risk of biologic treatment failure in inflammatory bowel disease (IBD). Endoscopic assessment identifies patients at risk of disease progression but is expensive and poorly accepted by patients. Therefore, we examined how intestinal ultrasound (IUS) performed as part of a monitoring program to predict treatment persistence to biologics in IBD patients. Methods Data were generated as part of a 1-year prospective, observational, cohort study of patients on biologics comparing tight monitoring to a historic cohort (‘Time It´ study). Data used in the present analysis included Harvey Bradshaw index (HBI), simple clinical colitis activity score (SCCAI), CRP, f-calprotectin (FC), IUS, and ileocolonoscopy all done at inclusion. The following definitions were used: Treatment persistence: no need for dose escalation or switching to another biologic or small molecule; IUS transmural remission (TR): bowel wall thickness ≤3mm in all bowel segments and zero color Doppler activity; endoscopic remission (ER): simple endoscopic score (SES)-CD≤2 or Mayo endoscopic score 0; clinical remission (CR): HBI≤4 or SCCAI≤2; FC remission (FCR): FC≤250; CRP remission (CRPR): CRP≤10 mg/L. Chi-square tests and Kaplan-Meier statistics were used to compare baseline measures in treatment persistent and non-persistent patients. Results Of the 91 patients included in 'Time It’, 77 had IUS performed and 69 ileocolonoscopy. Of the 77 patients, 61% were on maintenance treatment at inclusion and 39% were included during induction (Table 1). COVID-19 restrictions were the main reason for missing IUS or endoscopy. As expected, more patients with ER had 1-year treatment persistence (87% vs. 41%; p<0.001). However, patients with IUS TR also had better treatment persistence (78% vs. 38%; p<0.001). CR or FCR were associated with treatment persistence (p<0.05 and p<0.01, respectively), but not CRPR. Combining TR and FCR performed numerically as well as ER (treatment persistence 85% vs. 41%, p=0.002). Survival analysis of TR showed a mean treatment persistence of 318 days vs. 221 days without TR (p<0.001); corresponding treatment persistence data were 327 days vs. 230 days for combined TR and FCR; and 338 days vs. 226 days for ER (both p<0.001; Figure 1). There was no difference in mean treatment persistence between TR and ER (318 vs. 338 days; p=0.36). Conclusion IUS alone or combined with FCR was comparable to endoscopy to identify patients with high biologic treatment persistence. Being a non-invasive, patient friendly, cost-effective modality, IUS monitoring may improve current disease monitoring programs aiming to increase treatment persistence.

Diabetes mellitus early warning and factor analysis using ensemble Bayesian networks with SMOTE-ENN and Boruta

Diabetes mellitus (DM) has become the third chronic non-infectious disease affecting patients after tumor, cardiovascular and cerebrovascular diseases, becoming one of the major public health issues worldwide. Detection of early warning risk factors for DM is key to the prevention of DM, which has been the focus of some previous studies. Therefore, from the perspective of residents' self-management and prevention, this study constructed Bayesian networks (BNs) combining feature screening and multiple resampling techniques for DM monitoring data with a class imbalance in Shanxi Province, China, to detect risk factors in chronic disease monitoring programs and predict the risk of DM. First, univariate analysis and Boruta feature selection algorithm were employed to conduct the preliminary screening of all included risk factors. Then, three resampling techniques, SMOTE, Borderline-SMOTE (BL-SMOTE) and SMOTE-ENN, were adopted to deal with data imbalance. Finally, BNs developed by three algorithms (Tabu, Hill-climbing and MMHC) were constructed using the processed data to find the warning factors that strongly correlate with DM. The results showed that the accuracy of DM classification is significantly improved by the BNs constructed by processed data. In particular, the BNs combined with the SMOTE-ENN resampling improved the most, and the BNs constructed by the Tabu algorithm obtained the best classification performance compared with the hill-climbing and MMHC algorithms. The best-performing joint Boruta-SMOTE-ENN-Tabu model showed that the risk factors of DM included family history, age, central obesity, hyperlipidemia, salt reduction, occupation, heart rate, and BMI.

PCR31 Assessment of Pain, Stiffness, and Physical Functioning Pre and During Burosumab Among Adults with X-Linked Hypophosphatemia: Results from a Multinational, Long-Term, Prospective Outcomes Disease Monitoring Program

Excess FGF23 causes hypophosphatemia, leading to chronic debilitating musculoskeletal impairments in patients with X-linked hypophosphatemia (XLH). Treatments include burosumab, a fully-human monoclonal antibody to FGF23, or the combination of oral phosphate and active vitamin D (Pi/D). XLH symptoms in adults include bone/joint pain, stiffness, and fatigue. Previous research validated the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in adults with XLH. This study assesses burosumab impact on WOMAC among adults from an XLH Disease Monitoring Program (XLH-DMP; NCT03651505).

Vestronidase alfa for the treatment of mucopolysaccharidosis type VII (MPS VII): Updated results from a novel, longitudinal, multicenter Disease Monitoring Program (DMP)

Vestronidase alfa for the treatment of mucopolysaccharidosis type VII (MPS VII): Updated results from a novel, longitudinal, multicenter Disease Monitoring Program (DMP)

P189: Vestronidase alfa for the treatment of mucopolysaccharidosis VII (MPS VII): Updated results from a novel, longitudinal, multicenter disease monitoring program

P189: Vestronidase alfa for the treatment of mucopolysaccharidosis VII (MPS VII): Updated results from a novel, longitudinal, multicenter disease monitoring program

Development and national scale implementation of an open-source electronic laboratory information system (OpenELIS) in Côte d’Ivoire: Sustainability lessons from the first 13 years

PurposeCôte d'Ivoire has a tiered public health laboratory system of 9 reference laboratories, 77 laboratories at regional and general hospitals, and 100 laboratories among 1,486 district health centers. Prior to 2009, nearly all of these laboratories used paper registers and reports to collect and report laboratory data to clinicians and national disease monitoring programs. ProjectSince 2009 the Ministry of Health (MOH) in Côte d'Ivoire has sought to implement a comprehensive set of activities aimed at strengthening the laboratory system. One of these activities is the sustainable development, expansion, and technical support of an open-source electronic laboratory information system (OpenELIS), with the long-term goal of Ivorian technical support and managerial sustainment of the system. This project has addressed the need for a comprehensive, customizable, low- to no-cost, open-source LIS to serve the public health systems with initial attention to HIV clients and later expansion to cover the general population. This descriptive case study presents the first published summary of original work which has been ongoing since 2009 in Côte d’Ivoire to transform the laboratory information management systems and processes nationally. ImpactOpenELIS is now in use at 106 laboratories across Côte d’Ivoire. This article describes the iterative planning, design, and implementation process of OpenELIS in Côte d'Ivoire, and the evolving leadership, ownership, and capacity of the Ivorian MOH in sustaining the system. This original work synthesizes lessons learned from this 13-year experience towards strengthening laboratory information systems in other low resource settings.

OR13-2 Characterizing the Impact of Burosumab on Bone Health in Children with X-Linked Hypophosphatemia: Results from Year 1 of the Disease Monitoring Program

Abstract X-linked hypophosphatemia (XLH) is a rare, heritable disorder wherein excess FGF23 leads to renal phosphate wasting and impaired activation of vitamin D. XLH is characterized by rickets and osteomalacia leading to bone pain, skeletal deformities, and short stature. The XLH Disease Monitoring Program (DMP; NCT03651505) is a prospective, multinational outcomes study of the longitudinal progression of clinical, radiographic, and biochemical features of XLH in children and adults. We assessed the impact of the recombinant human IgG1 monoclonal antibody to FGF23, burosumab, on measures of bone health in children with XLH at Year 1 of the DMP. As of March 2021, 287 children (<18 years) had completed the Year 1 visit. Participants were grouped by when they first received burosumab: Group 1, prior to DMP enrollment (N=68; mean (SD) age 9.5 (3.6) years); Group 2, during the DMP (N=150; 8.7 (5.0) years); Group 3, never, but receiving conventional therapy (N=69; 8.8 (5.3) years). Before receiving burosumab, serum phosphorus levels were below normal; after burosumab initiation, serum phosphorus in Groups 1 and 2 rapidly normalized, with sustained improvements up to 3 years of treatment. Serum phosphorus remained low in Group 3. Before burosumab, serum alkaline phosphatase levels were above normal; with continued burosumab therapy, mean levels gradually declined towards normal and were maintained for up to 4 years. The Radiographic Global Impression of Change (RGI-C) assessed rickets and lower limb deformity from DMP baseline to Year 1, with positive values denoting improvement. Mean (SD) RGI-C rickets global scores were +1.0 (0.9) for Group 1 (n=44), +1.5 (0.7) for Group 2 (n=39), and +0.3 (1.2) for Group 3 (n=3). Lower limb deformity RGI-C scores were +0.3 (0.6) for Group 1 (n=42), +0.4 (0.8) for Group 2 (n=39), and +0.8 (1.1) for Group 3 (n=3). Height Z-score change from DMP baseline at Year 1 was 0.1 (0.3) for Group 1 (n=58), 0.1 (0.4) for Group 2 (n=90), and -0.8 (3.1) for Group 3 (n=18). There were no new safety concerns or reports of hyperphosphatemia. These real-world data affirm that normalization of serum phosphorus is rapid and sustained following burosumab initiation, resulting in improved serum alkaline phosphatase levels which positively impact bone mineralization. Improvements in rickets, growth, and lower limb deformity occur in the first year of burosumab treatment and continue in those who started burosumab prior to entering the DMP. The absence of new safety concerns or reports of hyperphosphatemia up to 4 years after burosumab initiation is also notable. The 10-year DMP study design will provide understanding of long-term effects in these patients with continued burosumab therapy. Presentation: Sunday, June 12, 2022 11:15 a.m. - 11:30 a.m.

Honey Bee Pathogen Prevalence and Interactions within the Marmara Region of Turkey

Simple SummaryThe health of bees is suspected to be low in Turkey due to the lower amounts of bee products that they produce per colony. Regular monitoring of bee diseases in Turkey has been lacking. We sampled bees from 115 colonies across five different locations to determine which pathogens are present and how much of each pathogen was in a bee colony. We found that the Varroa mite is widespread and consistently found in 90% of the bee colonies. We also found that pathogens normally transmitted by this parasite was also present in nearly 100% of the colonies sampled. We therefore concluded that the presence of Varroa mites is central to the decline in bee health and that management practices targeted for this parasite will most likely improve bee health in Turkey. In addition, three bee viruses are interacting with one another that influence the susceptibility to a more deadly variant responsible for colony death. Therefore, these viral interactions should be considered in the future to devise effective ways to improve honey bee health.Beekeeping has yet to reach its full potential in terms of productivity in Turkey where it has a relatively large role in the economy. Poor colony health is suspected to be the reason for this, but comprehensive disease monitoring programs are lacking to support this notion. We sampled a total of 115 colonies across five different apiaries throughout the Marmara region of Turkey and screened for all of the major bee pathogens using PCR and RNA-seq methods. We found that Varroa mites are more prevalent in comparison to Nosema infections. The pathogens ABPV, DWV, KV, and VDV1 are near 100% prevalent and are the most abundant across all locations, which are known to be vectored by the Varroa mite. We therefore suspect that controlling Varroa mites will be key for improving bee health in Turkey moving forward. We also documented significant interactions between DWV, KV, and VDV1, which may explain how the more virulent strain of the virus becomes abundant. ABPV had a positive interaction with VDV1, thereby possibly facilitating this more virulent viral strain, but a negative interaction with Nosema ceranae. Therefore, these complex pathogen interactions should be taken into consideration in the future to improve bee health.

EP166: Vestronidase alfa for the treatment of Mucopolysaccharidosis VII (MPS VII): Updated results from a novel, longitudinal, multicenter disease monitoring program

MPS VII is an ultra-rare, autosomal recessive, debilitating, progressive lysosomal storage disease caused by beta-glucuronidase (GUS) enzyme deficiency. Vestronidase alfa (recombinant human GUS) enzyme replacement therapy is approved in the United States, Europe, and Latin America for the treatment of MPS VII.

Advances in understanding of the natural history, mechanism, extra‐muscular manifestations and treatment of GNE myopathy

AbstractGNE myopathy is an autosomal recessive adult‐onset distal myopathy caused by biallelic variants in the GNE gene, which encodes a protein with two key enzymatic activities in the biosynthesis of sialic acid. In 1981, there was a report of a Japanese family in which muscle biopsies showed rimmed vacuoles in tibialis anterior with relative sparing of the quadriceps muscles. Twenty years later, the causative gene was identified to be GNE. Our group has constructed a mouse model that recapitulates the symptoms of GNE myopathy in patients and demonstrates the therapeutic effects of oral sialic acid supplementation on muscle phenotypes. The first clinical trial of N‐acetylneuraminic acid (NeuAc) was conducted in 2010 at Tohoku University, and several clinical trials are now underway at multiple sites. Patient registries have also been started, including the Japanese Registry of Muscular Dystrophy (Remudy, established in 2012) and the online international GNE Myopathy Disease Monitoring Program (launched in 2014). These registries have allowed collection of comprehensive patient data, including new clinical features suggesting that GNE myopathy is not only a disease of skeletal muscle. In this review, we summarize the history of research on GNE myopathy and discuss the mechanism of the disease and its more recently identified features.

Vestronidase alfa for the treatment of mucopolysaccharidosis type VII (MPS VII): Updated results from a novel, longitudinal, multicenter disease monitoring program (DMP)

Vestronidase alfa for the treatment of mucopolysaccharidosis type VII (MPS VII): Updated results from a novel, longitudinal, multicenter disease monitoring program (DMP)

Overview of Control Programs for Cattle Diseases in Finland

Animal disease control has a long tradition in Finland. The country is free of all EU-regulated cattle diseases of categories A and B. Infectious bovine rhinotracheitis, enzootic bovine leucosis, bovine viral diarrhea, bluetongue, bovine genital campylobacteriosis, and trichomoniasis do not currently exist in the country. The prevalence of paratuberculosis, Mycoplasma bovis, salmonella infection, and Q-fever is low. The geographic location, cold climate, low cattle density, and limited animal imports have contributed to the favorable disease situation. Besides screening for selected regulated diseases, the national disease-monitoring program includes periodic active monitoring of non-regulated diseases, which allows assessment of the need for new control measures. The detection of diseases through efficient passive surveillance also plays an important part in disease monitoring. The Finnish cattle population totals 850,000 animals kept on 9,300 cattle farms, with 62,000 suckler cows in 2,100 herds and 260,000 dairy cows in 6,300 herds. Animal Health ETT, an association owned by the dairy and meat industry, keeps a centralized cattle health care register. Animal Health ETT supervises cattle imports and trade within the country and runs voluntary control programs (CP) for selected diseases. Active cooperation between authorities, the cattle industry, Animal Health ETT, and herd health experts enables the efficient planning and implementation of CPs. CPs have been implemented for cattle diseases such as salmonella, Mycoplasma bovis, ringworm, and Streptococcus agalactiae. The CP for salmonellosis is compulsory and includes all Salmonella serotypes and all cattle types. It has achieved the goal of keeping the salmonella prevalence under 1% of cattle herds. CPs for M. bovis, ringworm, and S. agalactiae are on a voluntary basis and privately funded. The CP for Mycoplasma was designed in collaboration with national experts and has been implemented since 2013. The CP includes observation of clinical signs, nasal swab sampling from calves, and bulk tank milk and clinical mastitis samples for M. bovis. M. bovis-negative herds gradually achieve lower status levels for M. bovis infection. The general challenge facing voluntary CPs is getting farms to join the programs.