Open Veterinary Journal, (2025), Vol. 15(5): 1907-1933

Review Article

10.5455/OVJ.2025.v15.i5.6

Current trends and challenges in the management of foot and mouth disease in Saudi Arabia: A review

Mohammed Ali Al-Hammadi

Department of Microbiology, College of Veterinary Medicine, King Faisal University, Hofuf, Saudi Arabia

*Corresponding Author: Mohammed Ali Al-Hammadi. Department of Microbiology, College of Veterinary Medicine, King Faisal University, Hofuf, Saudi Arabia. Email: malhammadi [at] kfu.edu.sa

Submitted: 06/04/2025 Revised: 09/04/2025 Accepted: 17/04/2025 Published: 31/05/2025

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Abstract

This review explores the etiology, transmission, molecular epidemiology, economic impact, diagnostics, control measures, inactivated vaccine challenges, global epidemiological trends, and recommendations for foot-and-mouth disease (FMD), with a focus on Saudi Arabia. The O/ME -SA topotype is the predominant strain in the region, with high genetic similarity (88%–98%) to strains in neighboring countries, highlighting significant cross-border transmission. Despite FMD being an endemic disease, comprehensive molecular epidemiological studies in Saudi Arabia remain limited. FMD caused by the foot and mouth disease virus poses substantial economic burdens and affects various livestock species. Its persistence in Saudi Arabia is due to inadequate vaccination coverage, weak surveillance systems, and logistical challenges. Insufficient outbreak response, vaccine hesitancy, and gaps in public awareness further contribute to disease spread. Transmission occurs through direct animal contact and indirect routes, with the virus surviving in the contaminated environment for up to 14 days, indicating indirect transmission, representing 70% of cases and a key factor in sustaining outbreaks. Diagnosis primarily relies on sandwich enzyme-linked immunosorbent assay and reverse transcription polymerase chain reaction (RT-PCR), with RT-PCR offering higher sensitivity and specificity. Integrating these with advanced techniques like reverse-transcription LAMP, could enhance the rapid detection and response. Control measures include vaccination, surveillance, and movement restrictions, with efforts to improve vaccine thermostability and efficacy. Strengthening disease data collection is essential for monitoring trends and improving vaccine selection. The key recommendations for Saudi Arabia include enhancing vaccine development, improving surveillance systems, conducting vaccine matching studies, and adopting a One Health approach. Collaboration with international organizations, public education, and research into new strategies and technologies is crucial for effective FMD control and prevention.

Keywords: Foot-and-mouth disease, Saudi Arabia, Control measures, Vaccine, Surveillance.

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Introduction

Foot and mouth disease (FMD) is a transboundary animal disease with a global impact that affects both wildlife and livestock. As of 2022, FMD remains endemic in Africa, Asia, and South America, with certain nations still facing significant challenges (Burova et al., 2023).

The persistence of FMD in Africa, Asia, and South America is driven by several interconnected factors. First, the virus’s highly infectious nature, combined with the presence of multiple serotypes and topotypes, makes vaccination efforts particularly challenging. This is evident in regions like East Africa, where vaccine uptake is low due to concerns about the effectiveness of vaccines against the circulating strains (Railey and Marsh, 2019; Hammond et al., 2021). Additionally, wildlife reservoirs and livestock movement dynamics contribute to the virus’s spread, as observed in the epidemiological trends in Uruguay and Africa (Casey et al., 2014; Iriarte et al., 2023a). Furthermore, fragmented control strategies and a lack of regional coordination impede effective management of FMD outbreaks, in contrast to more successful approaches in other continents (Mashinagu et al., 2024). Economic constraints and the impact of FMD on food security further complicate control efforts because the disease greatly reduces livestock productivity and market access (Hammond et al., 2021; Mashinagu et al., 2024). These factors together create a difficult environment for controlling FMD in endemic areas.

FMD primarily spreads from infected to susceptible animals through direct contact, with animal movements between farms being identified as a key transmission route during outbreaks (Yi et al., 2022; Iriarte et al., 2023b). Indirect transmission also plays a significant role, particularly through contaminated equipment and vehicles, which can facilitate the virus’s spread without direct animal contact (Yi et al., 2022). Additionally, although airborne transmission is less common, it is a high-consequence route where the virus can spread rapidly under favorable conditions, complicating control efforts (Brown et al., 2022; Tolawak and Pal, 2022). The movement of infected livestock, especially through markets and highly connected farms, has been shown to greatly contribute to FMD’s spread, underscoring the importance of targeted surveillance and intervention strategies (Iriarte et al., 2023b). Effective control measures must therefore address both direct and indirect transmission routes to reduce the impact of FMD outbreaks (Tolawak and Pal, 2022).

The disease is caused by seven serotypes of the FMD virus, rendering numerous animal species vulnerable to infection (González Gordon et al., 2022). FMD can be transmitted through ingesting contaminated food or inhaling virus particles (Zhu et al., 2023). Risk factors for viral infection include livestock movement, lack of vaccination, and herd size (Brito et al., 2017).

Foot and mouth disease outbreaks cause significant disruptions in international animal product markets, leading to price increases and substantial economic losses. The economic impact is complex, encompassing the direct costs of animal depopulation and the indirect costs of trade restrictions. For example, FMD outbreaks can lead to welfare losses of up to $271 million in Brazil alone, largely due to reduced access to international markets and increased bilateral trade in unaffected regions (de Menezes et al., 2022). In endemic countries, annual economic losses can reach as high as $200 billion, with severe consequences for export capabilities to FMD-free nations (Tewari et al., 2020). Moreover, the choice of control strategies, such as culling or vaccination, affects market dynamics by influencing production levels and consumer behavior, which in turn disrupts price equilibrium in livestock markets (Feng et al., 2017). FMD outbreaks introduce considerable volatility in animal product prices, highlighting the importance of effective disease management strategies to mitigate these economic impacts (Acosta et al., 2020; Kargbo and Bangura, 2024).

The economic consequences of FMD are substantial, as FMD disrupts global livestock and animal product trade (Knight-Jones et al., 2016a). Through spatial and spatiotemporal analyses, high-risk areas and factors contributing to FMD outbreaks were identified. Advances in molecular biology, phylogenetics, vaccine development, and diagnostics have significantly enhanced FMD research and control efforts. However, controlling the disease remains challenging in developing nations, necessitating further research to improve control measures, particularly in endemic regions.

The foot and mouth disease virus (FMDV) uses various molecular strategies to evade host immune responses and establish infection. The key mechanisms underlying the suppression of innate immunity include antigenic variation, receptor switching, and the inhibition of type I interferon (IFN) responses. The non-structural protein 2B of FMDV plays a crucial role by degrading RIG-I and MDA5, essential sensors in the IFN signaling pathway, thereby blocking IFN-β production and enabling viral persistence (Weerawardhana et al., 2022; Kabir et al., 2024b). Additionally, FMDV’s ability to modulate host immune responses is tied to protein–protein interactions that help maintain a virus–host equilibrium (Sarry et al., 2022). Advances in molecular biology, especially nucleic acid sequencing and phylogenetic analysis, have deepened our understanding of FMDV’s genetic diversity and epidemiology, facilitating the development of targeted vaccines and therapies (Scherbakov, 2024). These insights are critical for controlling outbreaks and reducing the economic impact of FMD (Li et al., 2023).

The impact of FMD on the global economy is significant. FMD outbreaks can lead to substantial economic setbacks, necessitating quarantine measures, export restrictions, and sometimes even culling entire livestock populations (Dutta et al., 2022). Developing vesicles in the mouth and other tissues due to the disease results in economic losses and reduced productivity (Lu et al., 2022). The global grazing industry is also affected by FMD, resulting in trade and economic stagnation (Menezes et al., 2022). The disease remains a persistent global threat, resulting in substantial financial consequences due to disruptions in production and constraints on international trade (Sebhatu, 2019). For example, a hypothetical FMD outbreak in Brazil could lead to a welfare loss of 271 million people, highlighting the importance of maintaining herd health in a meat-producing country (Ruiz and Wigdorovitz, 2018). Vaccination plays a crucial role in FMD prevention; however, conventional vaccine production methods have inherent risks and limitations. This has spurred research into the development of more effective vaccines.

Foot and mouth disease is an exceptionally transmissible viral infection that poses a significant financial threat to Saudi Arabia’s agricultural sector. FMD outbreaks can lead to substantial economic losses, export restrictions, and culling of entire livestock populations (Dutta et al., 2022). The importation of live ruminants from regions where FMD is endemic, such as Sudan and the Horn of Africa, heightens the risk of introducing novel FMDV serotypes into Saudi Arabia (Hemida et al., 2018).

Research indicates that a considerable percentage of imported animals may be seropositive for FMD, with 28.3% of sheep and 51.5% of cattle in Saudi Arabia testing positive for FMD antibodies, underscoring the prevalence of the disease among imported livestock (Abd El-Rahim et al., 2016). Additionally, the global shift in FMD management since 2001 has prioritized biosecurity over trade isolation, heightening the risks associated with international live animal trade (Shanafelt and Perrings, 2018). The presence of asymptomatic carriers among imported animals further complicates the situation because these animals can introduce new FMDV serotypes, potentially exacerbating the disease’s spread (Abd El-Rahim et al., 2016). Therefore, effective control strategies, including stringent biosecurity measures and thorough monitoring of animal health, are crucial for mitigating these risks (Shanafelt and Perrings, 2017).

A high morbidity rate characterizes the disease and can cause severe consequences in livestock, including erosion of the buccal mucosa, nose, and feet, fever, loss of appetite, salivation, and vesiculation (Abd El-Rahim et al., 2016). The inadequacy of the FMD vaccines currently used in Saudi Arabia to combat certain circulating strains highlights the need for more effective preventive measures (Mahmoud and Galbat, 2017).

The limited effectiveness of current FMD vaccines in controlling outbreaks in Saudi Arabia is due to several interconnected factors. Vaccine hesitancy, a significant issue in the region, impacts overall vaccination rates and public confidence in vaccine effectiveness. Studies have suggested that concerns about vaccine safety, potential side effects, and misinformation contribute to hesitancy, with parents expressing apprehensions about the harm vaccines might cause (Asraf et al., 2022; Basham et al., 2024; Sulaimani et al., 2024). Additionally, logistical challenges, such as limited access to vaccines and the timing of immunization, particularly in rural areas, further impede successful vaccination campaigns (Basham et al., 2024). The cultural context also influences vaccine uptake, as varying attitudes toward vaccination affect participation (Bahri et al., 2024). Moreover, the emergence of new variants and the virus’s adaptability may surpass the protection offered by current vaccine formulations, highlighting the need for ongoing research and development to improve vaccine effectiveness against FMD in the region (Sheriff et al., 2024). Addressing these challenges through targeted awareness campaigns and better health care access is essential for improving vaccination outcomes.

Preventive measures and widespread immunization of susceptible individuals are crucial for FMD management (Yousef et al., 2012). It is advisable to genotype and understand the epidemiology of various FMDV strains to devise effective control strategies.

Effective strategies for implementing widespread immunization programs against FMD involve a combination of innovative vaccine development, targeted vaccination efforts, and robust diagnostic capabilities. Studies have shown that traditional inactivated vaccines have limitations, such as providing short-term immunity and being unable to differentiate between vaccinated and infected animals (DIVA strategy) (Niedbalski et al., 2019). Novel vaccine platforms, like recombinant DNA vaccines, present promising alternatives by offering cost-effective, long-lasting immunity (Haynie, 2023). Additionally, targeted vaccination strategies that focus on specific regions and species have proven effective in significantly reducing the size and duration of outbreaks while minimizing the number of animals that need to be vaccinated (Capon et al., 2021). Network-based immunization strategies, especially degree immunization, are particularly effective under conditions of incomplete data, suggesting that a flexible approach to vaccination can enhance real-world effectiveness (Rosenblatt et al., 2020). By integrating these strategies, the control of FMD outbreaks can be improved globally.

Therefore, this review provides a comprehensive understanding of FMD in Saudi Arabia, covering its molecular epidemiology, economic impact assessment, diagnostic techniques, control strategies, and global epidemiological patterns. The aim of this study is to thoroughly assess the disease by emphasizing the integration of local and global perspectives.

Etiology and transmission of foot and mouth disease

Several strains of the FMDV have been identified, including O/ME–SA/Ind2001e, O/ME–SA/Cluster-2018, O/ME–SA/PanAsia-2/ANT10, A-Africa topotype Genotype IV, O/ME–SA/2018 cluster, EA-3 lineage Alx-17, ME–SA lineage Sharqaui-72, and Mya98 lineage (Dahiya et al., 2021; El-Bagory et al., 2022; Dahiya et al., 2023; El-Bagoury et al., 2023; Hwang et al., 2023). FMD is caused by the FMDV, classified as a minor positive-sense RNA virus in the Picornaviridae family and the genus Aphthovirus. FMDV consists of seven immunologically distinct serotypes: A, O, C, Asia 1, SAT 1, SAT 2, and SAT 3. Numerous variants of these serotypes are distributed across various global regions (Niedbalski, 2016). The virus has diverse topotypes, including Cathay, Middle East-South Asia, and Southeast Asia, each containing variant genotypes (Shahan, 1962; Li et al., 2012; Rincón Forero, 2012). Animals affected by FMDV develop distinctive lesions, and the virus’s variants pose challenges in vaccine development and disease management (Shahan, 1962; Niedbalski, 2016). Serotypes O and A were most prevalent, with serotype O being the most prevalent (Niedbalski, 2016). Active research has been dedicated to developing vaccines and antivirals to combat this economically debilitating disease (Rincón Forero, 2012).

Foot and mouth disease transmission can occur via direct and indirect contact with contaminated environments and infected animals (Arzt et al., 2018; Li et al., 2020; Brown et al., 2022). Indirect transmission through contaminated environments is crucial for FMDV proliferation (Colenutt et al., 2020). Although transmission through the air is considered a low-probability, high-consequence occurrence (Björnham et al., 2020), aerosolized particles produced by infected animals may contain the virus, which can travel specific distances. Additionally, FMDV carriers, which are characterized by chronic, subclinical infections, can transfer the virus to susceptible animals via oropharyngeal secretions or tissues. These carriers may continue to excrete small amounts of the virus for months to years after infection. Airborne transmission, direct contact, and indirect contact via contaminated environments are the modes of FMD transmission.

Foot-and-mouth disease transmission among susceptible animals occurs through both direct and indirect contact, with each method playing a unique role in disease spread. Direct contact transmission involves the spread of the FMDV through physical interaction between infected and susceptible animals. Research has shown that horizontal transmission is more effective among animals of the same species, with notable transmission between infected pigs and other cloven-hoofed animals, such as cows and goats (Fukai et al., 2020). However, simulation models indicate that direct contact alone may not be sufficient for large-scale outbreaks; combining direct and indirect transmission methods is essential for substantial disease spread (Yi et al., 2021). Indirect transmission occurs in contaminated environments, where FMDV can survive for up to 14 days. Studies have shown that environmental contamination can lead to successful transmission in about 70% of cases, highlighting its potential to maintain outbreaks without direct animal-to-animal contact (Colenutt et al., 2020). The basic reproduction number for environmental transmission is estimated to be 1.65, suggesting that indirect transmission can independently sustain disease spread (Colenutt et al., 2020).

Molecular epidemiology of foot and mouth disease in Saudi Arabia

The molecular epidemiology of FMD in Saudi Arabia reveals significant patterns of virus circulation and genetic diversity. Studies have revealed that FMD is endemic in neighboring regions, with particular serotypes like the O/ME-SA topotype being prevalent across the Middle East and South Asia (Eltahir et al., 2024). Analysis of recent outbreak isolates in the UAE demonstrates high genetic similarity (88%–98%) with strains circulating in Saudi Arabia, suggesting cross-border transmission and highlighting the importance of regional cooperation for effective control (Eltahir et al., 2024). Despite these findings, the lack of comprehensive investigations into FMD outbreaks within Saudi Arabia calls for systematic molecular epidemiological studies to provide better insights into the disease’s spread and to inform more effective animal health management strategies (Aleyiydi et al., 2024). While the focus is primarily on FMD, acknowledging the broader context of infectious diseases in Saudi Arabia is equally critical, as other viral and bacterial pathogens continue to pose substantial public health challenges (Aleyiydi et al., 2024).

The molecular epidemiological approach, which employs nucleic acid sequencing and phylogenetic analysis, has been crucial for understanding the region’s evolution and transmission of FMD (Scherbakov, 2024). FMD has exhibited significant epidemiological patterns in Saudi Arabia, with recurrent outbreaks predominantly affecting cattle, sheep, and goats. Over the past decade, serotype O has been the most commonly identified strain, with outbreaks documented in various years, such as 1994, 2000, and 2010, demonstrating the virus’s persistent presence in the region (Alsayeqh and Fat’hi, 2012). Recent surveillance identified 14 suspected cases during the Hajj season in 2011, highlighting the potential for disease spread during large gatherings (Alsayeqh and Fat’hi, 2012). Moreover, comprehensive epidemiological monitoring of viral diseases, including FMD, is vital for public health strategies in Saudi Arabia (Aleyiydi et al., 2024). Although recent studies have concentrated on bacterial diseases, the necessity for enhanced surveillance of viral diseases like FMD remains crucial, particularly given the underreporting of mild cases (Alakrash et al., 2024; Alhumaid et al., 2024).

The primary genetic distinctions among the circulating strains of FMD in Saudi Arabia include the presence of FMD type A virus of the ASIA topotype and the prevalence of FMDV ME-SA Pan Asia II topotype during type O outbreaks (Abd El Ghany et al., 2018). Specific isolates of the current circulating FMDV type O PanAsia strain exhibit only moderate resemblance to the FMDV type O Manisa strain included in the current vaccine formulation (Yousef et al., 2012). The FMD type A virus strain prevalent in Saudi Arabia is similar to the Iranian A/Iran/2005 strain (Al-Ghafli et al., 2018). Based on these findings, it is recommended that Saudi Arabian dairy farms utilize a tetravalent vaccine comprising type O FMDV PanAsia topotype, type A Iran 2005, Asia1, and Sat2 to prevent FMD. Routine vaccination campaigns could also benefit from a bivalent vaccine containing the type O FMDV PanAsia topotype and type A Iran 2005 (Farman et al., 2019).

The genetic lineage and clonality of the Saudi Arabian strains of FMDV resemble those of global variants. The predominant strain identified in Saudi Arabia was FMDV serotype O, which exhibited similarities to strains detected in the Middle East and Europe (Van Belkum et al., 1997; Alsayeqh and Fat’hi, 2012). This study identified a clonally related lineage among methicillin-resistant Staphylococcus aureus (MRSA) isolates obtained from Saudi Arabian hospitals. This suggests that specific MRSA clones have been disseminated nationwide (Al-Ghafli et al., 2018). It was also discovered that multidrug-resistant Mycobacterium tuberculosis complex (MDR-MTBC) isolates in Saudi Arabia exhibited clonal similarity, indicating the possibility of these strains being established and transmitted across borders (Bachanek-Bankowska et al., 2016). Moreover, the entire genome of FMDV type A virus extracted from cattle in Saudi Arabia is endemic to the Indian subcontinent lineage (Samuel et al., 1997). In summary, the clonality and genetic lineage of the Saudi Arabian strains FMDV, MRSA, and MDR-MTBC are comparable to those of global variants. This suggests that particular strains have become widespread and established throughout the country.

Economic impact of foot and mouth disease

Foot and mouth disease is endemic in the Saudi Arabian region and poses a significant economic burden on the country. Serotypes O, A, and Asia 1 have been reported, with a new lineage of serotype O (O/ME-SA/Ind-2001) identified during an outbreak in Libya and the Saudi Arabia region (Knowles et al., 2016). Outbreaks have resulted in significant losses, such as in sheep farms where abortions and neonatal deaths have occurred (Hamouda et al., 2019).

The genetic characterization of O/ME-SA/Ind-2001 serotype O demonstrates significant distinctions from other serotypes, especially in terms of its mutation rates and antigenic variability, which are crucial considerations for vaccine development. The O/ME-SA/Ind-2001 lineage exhibits high genetic diversity, with recent studies identifying several sublineage, including O/ME-SA/Ind-2001e, which exhibits a 95.7%–96.8% nucleotide similarity with strains from India and Myanmar (Dahiya et al., 2023; Ryoo et al., 2024). In China, the O/ME-SA/Ind-2001 lineage has been associated with 19 outbreaks, with a notable decline in nucleotide identity over time, suggesting rapid evolution (Zhang et al., 2023). Variability in the antigenic sites of the O/ME-SA/Ind-2001e lineage, especially in the VP1 region essential for inducing neutralizing antibodies, presents a risk to the effectiveness of current vaccines, as mutations could result in vaccine escape (Hossain et al., 2023; Zhang et al., 2023). Although the O/ME-SA/Ind-2001e lineage is present, existing vaccines like O INDR2/1975 have shown effectiveness against circulating strains. However, continuous monitoring and possible updates to vaccines are needed to maintain their efficacy (Dahiya et al., 2023). While the O/ME-SA/Ind-2001 lineage poses specific challenges, other serotypes might not display the same degree of genetic variability, potentially allowing for more stable vaccine formulations.

The emergence of the O/ME-SA/Ind-2001 lineage in Libya and Saudi Arabia is closely linked to the regional epidemiology of dengue fever and other mosquito-borne diseases, underscoring the complex interplay between viral transmission dynamics and environmental factors that facilitate outbreaks. In Saudi Arabia, particularly in the Jazan region, there has been a significant increase in dengue cases, with seasonal rains creating optimal breeding conditions for mosquitoes. Between 2015 and 2020, year-round transmission of dengue shifted, marking its establishment as an endemic disease (Alqassim et al., 2024). A 2019 outbreak in Jazan identified an imported DENV-2 variant closely related to strains from Southeast Asia, highlighting the role of global travel in spreading the disease (Dafalla et al., 2023, 2022). The emergence of new variants poses challenges for existing surveillance systems, necessitating continuous monitoring and targeted interventions to prevent outbreaks (Dafalla et al., 2023, 2022). Additionally, effective prevention relies on public knowledge and behavior, yet recent studies have identified gaps in public practices, despite generally good awareness and positive attitudes toward dengue prevention (Hamed, 2024).

The outbreak of the O/ME-SA/Ind-2001 serotype O in Libya has substantial long-term public health implications, particularly concerning livestock health and food security. This outbreak underscores the endemic presence of FMD in the region, highlighting the urgent need for effective mitigation strategies. Epidemiologically, the O/ME-SA/Ind-2001 lineage has been associated with sporadic FMD outbreaks in Libya for almost 50 years, with seroprevalence rates of 19% in large ruminants and 13.5% in small ruminants, indicating widespread viral circulation (Eldaghayes et al., 2017; Eldaghayes et al., 2022). The introduction of this exotic strain has disrupted local livestock production, posing significant threats to food security and economic stability (Casey et al., 2014; Pezzoni et al., 2022). To mitigate the spread of FMD, enhanced surveillance and vaccination programs are crucial, and the development of real-time reverse transcription polymerase chain reaction (RT-PCR) assays can facilitate the rapid detection and differentiation of FMD strains (Casey et al., 2014). Implementing biosecurity measures on farms and educating farmers on disease management practices is also vital to minimizing transmission risks (Eldaghayes et al., 2022). In addition to focusing on controlling the current outbreak, addressing broader issues such as AMR in livestock is essential for developing comprehensive public health strategies in Libya (Elgriw et al., 2023).

The endemic presence of FMD in Saudi Arabia profoundly affects the livestock industry, affecting animal health, productivity, and economic stability. FMD causes significant economic losses by reducing livestock productivity and increasing veterinary costs. Farmers often experience limited market access for infected animals, which lowers their income potential (Eltahir et al., 2024). Because the livestock sector is vital for food security in Saudi Arabia, FMD outbreaks can disrupt supply chains, resulting in food shortages and higher prices (Al-Ghaswyneh, 2022). The high prevalence of FMD necessitates strict biosecurity measures, which can be challenging for farmers, especially those with limited resources (Alnafissa et al., 2024). The knowledge and practices of farmers regarding disease management are crucial; however, many lack sufficient education on FMD prevention and control (Alghafeer et al., 2024). The endemic nature of FMD complicates marketing strategies for livestock products, as consumers may be hesitant to buy from affected regions, putting additional strain on the industry (Al-Ghaswyneh, 2022).

While FMD presents significant challenges, some argue that it also encourages innovation in animal care and management practices, leading farmers to adopt improved feeding strategies and biosecurity measures to reduce risks. This dual aspect highlights the need for comprehensive strategies to address both the immediate impacts of FMD and the long-term resilience of the livestock sector.

The economic impact of FMD is further supported by the detection of FMDV RNA in 5.7% of milk samples, indicating the potential for widespread transmission through dairy products (Armson et al., 2020).

The detection of FMDV RNA in 5.7% of milk samples has critical implications for food safety and quality standards in the dairy industry, emphasizing the urgent need for improved surveillance and preventive measures to reduce the health risks associated with contaminated milk. The presence of FMDV in milk poses potential health risks to consumers, as infected milk can carry the virus, contributing to its spread and endangering public health (Shaban et al., 2022). Additionally, infected milk shows reduced levels of fat, protein, and lactose, leading to a decline in its nutritional quality (Shaban et al., 2022). To address these concerns, enhanced monitoring techniques, such as the use of pooled milk samples for FMDV surveillance, have been shown to be effective, enabling early detection of the virus in dairy herds, even among vaccinated animals (Armson et al., 2020). Furthermore, rapid testing technologies, including innovative platforms like Sector Self-Driving Microfluidics, offer on-site testing capabilities, facilitating the timely identification of contaminated milk products (Wang et al., 2024). The presence of FMDV RNA in milk thus highlights the need for robust surveillance systems and advanced detection methods to ensure public health protection and maintain high dairy quality standards.

Consuming milk contaminated with FMDV RNA presents significant health risks, particularly regarding viral transmission and milk quality. FMDV can be detected in raw milk from infected cattle, pointing to a possible pathway for virus transmission to humans and other animals (Shaban et al., 2022). The presence of FMDV in milk suggests that consuming contaminated dairy products could facilitate the spread of the virus, especially in regions where FMD is endemic (Mishchenko et al., 2022). Additionally, infected milk shows altered physicochemical properties, including reduced levels of fat, protein, and lactose, which diminish its nutritional value (Shaban et al., 2022). High somatic cell counts in FMDV-positive milk further indicate poor quality, raising concerns about consumer health and safety (Shaban et al., 2022). To address these issues, effective surveillance using milk samples can help detect FMDV in herds, thereby aiding disease control efforts (Armson et al., 2020). Enhancing biosecurity measures on farms is also crucial for reducing the risks associated with contaminated milk (Mishchenko et al., 2022). Although the direct health risks to humans from consuming FMDV-contaminated milk are not yet fully understood, the potential for zoonotic transmission and degraded milk quality underscores the need for rigorous monitoring and preventive actions.

In Hail, a seroprevalence of 17.5% was reported in nonvaccinated animals, highlighting the prevalence of the disease (Mahmoud et al., 2021). To address this issue, there is a need to confirm the effectiveness of current animal health interventions and establish a uniform FMD immunization plan. This includes primary immunization at 4 months of age, a booster shot at 5 months, and herd vaccination every 4 months. Continuous disease monitoring across Saudi Arabia is possible because of the establishment of local laboratory facilities, ensuring that vaccination can protect against circulating FMD viruses (Hafez et al., 1993).

A review article on the prevalence of FMD in Asia revealed that FMD is endemic in many Asian countries, including Saudi Arabia (Aslam and Alkheraije, 2023). Serotype O is most prevalent among these countries, with outbreaks occurring in various regions over decades. The disease is directly and indirectly transmitted, with carrier animals contributing to the persistence of the virus (Aslam and Alkheraije, 2023).

The optimal distance between carrier animals and susceptible hosts for the transmission of the FMD virus is influenced by various factors, including carrier transmission dynamics and environmental conditions. Research has shown that although direct contact is a primary transmission route, the proximity of carriers to susceptible populations plays a crucial role. Carrier animals can harbor the FMD virus for prolonged periods, contributing to the disease’s persistence even when transmission rates are low (Guyver-Fletcher et al., 2021). The average duration of the carrier phase and the development of natural immunity significantly impact the likelihood of FMD persisting within a population (Guyver-Fletcher et al., 2021). Additionally, indirect transmission routes, such as contaminated equipment and vehicles, can expand the effective range of virus spread, complicating control efforts (Yi et al., 2022). Information-sharing networks among farms can help mitigate virus transmission by enabling timely quarantines, thus indirectly affecting the optimal distance for managing outbreaks (Yi et al., 2022). In conclusion, while direct contact is vital, the complex interaction of carrier dynamics and environmental factors means that optimal distances for FMD transmission are context-dependent, necessitating comprehensive management strategies to minimize risks.

To effectively minimize trade disruptions during FMDV outbreaks, several rapid response strategies have been identified in recent research. Implementing a 21-day quarantine period for cattle has proven effective in reducing the risk of FMDV introduction into markets, with a low risk of releasing infected cattle during this time (Wongnak et al., 2024). The success of quarantine is further enhanced by effective vaccination because higher immunity levels during this period can further mitigate risks (Wongnak et al., 2024). Prioritizing critical supply movements, such as those involving weaned pigs and vaccination crews, is essential for maintaining business continuity while minimizing disease spread (Patterson et al., 2016). Proactive risk assessments of these movements help in the efficient allocation of resources during an outbreak (Patterson et al., 2016). Additionally, targeting minor, noncentral agents within trade networks can be more effective than focusing solely on major hubs, balancing economic costs with the need to prevent disease spread (Moslonka-Lefebvre et al., 2016). A comprehensive understanding of both economic and epidemiological risks facilitates more informed decision-making in outbreak responses (Moslonka-Lefebvre et al., 2016). Overall, while these strategies are effective, the complexity of livestock operations and the potential economic impact of FMD outbreaks necessitate ongoing adaptation and enhancement of response plans to ensure both animal health and market stability (Bickett-Weddle et al., 2017).

The economic impact of FMD is substantial because trade restrictions are implemented during outbreaks, leading to a loss of earnings via exports. To mitigate these effects, preventive strategies, such as improving disease surveillance, reporting, detection, and quick response, are recommended (Aslam and Alkheraije, 2023).

Diagnostic methods for fmd detection

The sandwich enzyme-linked immunosorbent assay (S-ELISA) and RT-PCR are the most efficacious methodologies employed in Saudi Arabia for the diagnosis of FMD.

The level of concurrence between S-ELISA and RT-PCR in diagnosing FMDV plays a crucial role in effective disease surveillance. Studies have revealed a moderate agreement between these two diagnostic methods, which has important implications for improving surveillance strategies. In one study, S-ELISA identified 63% of the samples as positive, whereas RT-PCR detected 85%, resulting in a Kappa value of 0.303, indicating fair agreement between the methods (Khan et al., 2021). S-ELISA notably missed two positive samples that were confirmed by RT-PCR, suggesting that RT-PCR is more reliable for definitive diagnosis (Khan et al., 2021). Combining S-ELISA and RT-PCR can enhance surveillance effectiveness by ensuring that negative S-ELISA results are followed by RT-PCR testing (Khan et al., 2021). Furthermore, the development of rapid assays, such as RT-LAMP, shows promise for timely FMDV detection, which is particularly critical in endemic regions (Ali et al., 2017). Although S-ELISA serves well for initial screening, RT-PCR is essential for confirming the presence of FMDV, highlighting the need for integrated diagnostic approaches in disease management.

S-ELISA has demonstrated efficacy in detecting serotypes O, A, and Asia-1 of the FMDV, with moderate concurrence with RT-PCR findings (Khateb and Alkhaibari, 2023). In contrast, RT-PCR is an expeditious, astute, and conclusive diagnostic technique for FMD; it can identify the serotype and detect the viral genome (Hwang et al., 2021). Furthermore, the application of non-structural protein (NSP) analysis via 3ABC-ELISA has shown potential in diagnosing FMD in cattle, as evidenced by the high seroprevalence rates observed in both vaccinated and unvaccinated animals (Khan et al., 2021). When used together with serological and molecular techniques for identifying specific FMD serotypes, these methods may aid in the effective diagnosis and control of FMD in Saudi Arabia (Mahmoud and Galbat, 2017; Abd Hatem and Al-Alo, 2022).

Analyzing NSPs is crucial for accurately diagnosing FMD because it enhances the precision and specificity of tests used to differentiate between vaccinated and infected animals, which is essential for effective disease control, especially in endemic regions. NSPs are produced during FMD virus infection, allowing for the development of serological tests that detect antibodies specific to these proteins, thereby distinguishing infected animals from those that have only been vaccinated (King et al., 2015). The presence of NSPs triggers a specific immune response that can be quantitatively measured to improve diagnostic accuracy (King et al., 2015). Furthermore, NSP-based assays reduce cross-reactivity with vaccines, enhancing test specificity and minimizing false-positive results, which are critical for accurate disease management (King et al., 2015). Despite the significant improvements that NSP analysis has brought to FMD diagnostics, challenges remain, such as the need to continuously update testing protocols to accommodate evolving viral strains and the potential for NSP expression to vary among different strains.

The timely and precise identification of FMD is a key imperative for managing outbreaks and executing efficient control strategies. Recent developments in FMD diagnostic technologies include the creation of simple, rapid, and equipment-free isothermal amplification methods, such as LAMP and RPA (Chen et al., 2022). Molecular diagnostic techniques, such as RT-PCR and RT-LAMP, have enhanced sensitivity in detecting nucleic acids associated with FMDV (Wong et al., 2020). Real-time RT-LAMP with assimilating probes has shown high sensitivity, rapidity, and dependability in detecting FMDV serotypes (Lim et al., 2020). Furthermore, for immediate on-site diagnosis of FMDV, lateral flow immunochromatographic test strips have been created, offering accurate results without requiring external instruments (Khan et al., 2021). Multiplex real-time RT-PCR assays have been developed for specific detection and differential serotyping of FMDV serotypes O, A, and Asia 1, demonstrating enhanced detection and serotyping capabilities (Lim et al., 2020). These developments in FMD diagnostic technologies present the potential for the rapid, specific, and dependable detection of FMDV in clinical samples, facilitating the prompt containment of FMD outbreaks.

In Saudi Arabia, recent developments in diagnostic technologies for FMD have incorporated enzyme-linked immunosorbent assay (ELISA) techniques, offering the advantage of prompt and precise diagnosis (Wong et al., 2020).

ELISA-based techniques are essential for diagnosing FMD in both vaccinated and infected animals, offering significant advantages over traditional methods. These techniques, especially those utilizing NSPs, provide high sensitivity and specificity, which are critical for effective disease control. For instance, ELISA methods like the capture antibody ELISA developed with chicken IgY have shown a sensitivity of 100% and a specificity of 98% for detecting FMDV serotype A (Ivani et al., 2024). Similarly, the r3ABC-based ELISA demonstrated a sensitivity of 95.3% and specificity of 96.3%, making it highly effective at distinguishing between infected and vaccinated animals (Zia et al., 2022). Compared with methods such as the virus neutralization test (VNT), which requires high biosafety levels, ELISA techniques are safer and easier to implement (Lee et al., 2022; Sayee et al., 2024). Additionally, ELISA can utilize recombinant proteins, thereby enhancing diagnostic accuracy and enabling large-scale surveillance (Yakovleva and Scherbakov, 2023). Despite their high sensitivity and specificity, ELISA techniques still face challenges, including the potential for false-positive results in some formats.

The sensitivity and specificity of ELISA-based techniques for distinguishing between vaccinated and infected animals with FMD depend on several critical factors, including antigen selection, assay design, and the use of monoclonal antibodies. ELISA tests that utilize NSPs, especially the 3ABC protein, have demonstrated high diagnostic sensitivity (95.3%) and specificity (96.3%) for differentiating between infected and vaccinated animals (Zia et al., 2022). Recombinant NSPs are particularly favored because they improve both specificity and sensitivity, making them ideal for serological monitoring (Yakovleva and Scherbakov, 2023). The design of the assay also plays a significant role in diagnostic accuracy. For example, solid-phase competition ELISA (SPCE), which uses monoclonal antibodies, has a specificity of 99.6% and sensitivity of 86.1%, highlighting the importance of carefully designed assays (Sayee et al., 2024). Additionally, capture antibody ELISA kits developed with chicken IgY antibodies have achieved a sensitivity of 100% and specificity of 98%, demonstrating the effectiveness of innovative assay approaches (Ivani et al., 2024). Commercially available ELISA kits have shown exceptionally high specificity (up to 100%) in various environments, highlighting their reliability for FMD surveillance (Milićević et al., 2024). Despite these advancements, challenges remain in ensuring consistent performance across diverse populations and settings, highlighting the need for ongoing validation and optimization of ELISA techniques.

Extensive reviews have been conducted on these ELISA-based techniques, including sandwich, liquid-phase blocking, and solid-phase competition ELISA, which have proven effective in distinguishing between vaccinated and infected animals (Mahmoud and Galbat, 2017). Due to their exceptional sensitivity in detecting viral nucleic acids, molecular diagnostic techniques, namely RT-LAMP and RT-PCR, are employed for FMD diagnosis (Yousef et al., 2012). Additionally, cost-effective on-site diagnostic tests, including lateral flow immunochromatographic test strips, have been devised, which are simple for untrained personnel to execute (Abdulaziz et al., 2023). Implementing tetravalent and bivalent vaccines containing specific strains of FMDV has been suggested as a preventive measure against FMD in Saudi Arabian dairy farms (Hamdy et al., 2018). These innovative vaccination strategies and diagnostic technologies have significantly reduced FMD incidence in Saudi Arabia.

The advancement of FMD diagnostic technologies on a global scale should prioritize the creation of serotyping and strain-determination assays that are more precise and sensitive (Belsham, 2020; Foglia et al., 2021). Enhanced field diagnostics that can rapidly and readily ascertain serotype and strain are imperative, particularly in regions with limited laboratory capacity and countries devoid of FMDs (Knight-Jones et al., 2016a). Molecular and genetic technologies, including RT-LAMP and sequencing, have demonstrated the potential to augment diagnostic capabilities (Knight-Jones et al., 2016b; Bath et al., 2020). To further develop vaccines, a better understanding of cellular and mucosal immunity is required. Additionally, a high priority is the advancement of enhanced vaccines, such as virus-like particles and recombinant vaccines. Furthermore, advances in molecular biology and phylogenetics are indispensable for advancing FMD research and diagnostics. The overarching objective is to develop straightforward, cost-effective, and precise diagnostic tests to augment FMD control and prevention efforts.

In Saudi Arabia, the investigation and advancement of novel diagnostic technologies for FMD have focused on several promising domains. One area of study focuses on the detection and identification of agents that cause FMD, including the peste des petits ruminants virus and the FMDV (Mahmoud and Galbat, 2017). Another area of investigation is the influence of importing live ruminants from regions where FMD is enzootic on the etiology of FMD in Saudi Arabia (Abd El-Rahim et al., 2016). Furthermore, investigations have been conducted regarding the serological method of analyzing NSP through ELISA to diagnose FMD in both vaccinated and unvaccinated animals (Abd Hatem and Al-Alo, 2022).

The application of RT-LAMP and RT-PCR techniques for diagnosing FMD in Saudi Arabia has significant implications for enhancing disease surveillance and control measures. These molecular diagnostic methods improve the accuracy and speed of FMD detection, which is crucial for timely intervention. Both RTLAMP and RT-PCR have high sensitivity and specificity, enabling the early identification of FMD, which is essential for effectively controlling outbreaks (Aleyiydi et al., 2024). The rapid turnaround time associated with these techniques allows for prompt response actions, thereby reducing the spread of the disease (Solimam et al., 2023).

Implementing these molecular diagnostics bolsters surveillance systems, allowing for more accurate monitoring of FMD prevalence and transmission patterns (Aleyiydi et al., 2024). Integrating such advanced diagnostics into existing surveillance frameworks can enhance public health strategies and optimize the allocation of resources (Alhumaid et al., 2024). Early detection facilitated by RTLAMP and RT-PCR supports targeted vaccination and culling strategies, helping to minimize economic losses in the livestock industry (Ali et al., 2022). Additionally, improved surveillance can provide critical information to policymakers, enabling them to implement proactive measures to prevent potential outbreaks (Alanazi et al., 2020). Despite these advantages, challenges such as the need for skilled personnel and adequate infrastructure to support these advanced diagnostic techniques remain. Addressing these challenges is vital for fully exploiting the benefits of RTLAMP and RT-PCR in managing FMD in Saudi Arabia.

Additionally, the advancement of innovative diagnostic technologies, such as biosensors based on gold nanoparticles, has demonstrated potential for the precise and vigilant detection of FMD (Hamdy et al., 2018). These research and development domains aim to enhance the capacity for FMD detection, prevention, and management in Saudi Arabia.

Control measures and strategies

Current FMD control measures in Saudi Arabia include immunization, surveillance, and movement restriction. Vaccination is a fundamental method for managing FMD and it is employed for both preventive and reactive measures in response to heightened exposure risk (Lyons et al., 2017).

The effectiveness of vaccination against FMD depends on several key factors, including vaccine formulation, vaccination timing, and immune response monitoring. The choice of vaccine formulation is critical; for instance, incorporating adjuvants like Ictyolane 18 oil can significantly boost the immunogenicity of FMD vaccines, leading to a strong and lasting immune response in cattle (Amin et al., 2023). Monovalent vaccines can rapidly induce protective immunity, with some formulations generating neutralizing antibodies as early as 7 days after vaccination (Михалишин et al., 2020).

Timing is also crucial for successful vaccination efforts. Administering vaccines to susceptible animals immediately during outbreaks is essential because vaccinations performed 7–14 days before exposure can significantly reduce virus transmission (Duffy et al., 2020). The scheduling of booster doses is another important factor, as previous studies have demonstrated that administering multiple doses can enhance serological responses (Shaban et al., 2021).

Monitoring and evaluation are integral components of effective vaccination programs. Robust monitoring systems are necessary to assess immune responses and ensure adequate vaccine coverage. Techniques such as SPCE) and VNT are valuable tools for evaluating the efficacy of vaccination (Kang et al., 2018). Despite the critical role vaccination plays in controlling FMD, challenges remain, including ensuring timely vaccine administration and maintaining high vaccination coverage to effectively prevent outbreaks.

The implementation of a national park system by Saudi Arabian authorities regulates the migration of animals across various regions of the country (Abdel Baky et al., 2005). With risk-based control strategies and ongoing monitoring, surveillance is also essential for FMD control ( FAO publication catalog 2023, 2023). Recent studies have emphasized the assessment of vaccines, including the polyvalent FMDV vaccine incorporating the Saudi Arabian drug A-95. This vaccine is effective in reducing the transmission of the virus and alleviating the symptoms of clinical illness (Lyons et al., 2017).

The efficacy of the polyvalent FMDV vaccine, which includes the A Saudi-95 strain, in alleviating clinical symptoms is influenced by several key factors, such as vaccine composition, serotype diversity, and implementation strategies. The precise formulation of a vaccine is crucial because mismatches between vaccine strains and circulating field strains can diminish its effectiveness. This research underscores the importance of high-resolution sequencing to accurately identify component strains and ensure compatibility with local FMDV variants (Forth et al., 2020). Serotype diversity also plays a significant role in vaccine efficacy, as FMDV exhibits considerable variability. Effective vaccines must offer cross-protection against multiple serotypes to avoid vaccine failure in the absence of such protection (Wubshet et al., 2024). Moreover, the success of vaccination efforts depends heavily on well-planned and executed implementation strategies. A meta-analysis revealed that effective vaccination strategies could lower the risk of FMDV infection by approximately 69.3% (Wubshet et al., 2024). In addition to these factors, other challenges, including biosecurity measures and animal movement control, significantly impact the overall success of vaccination campaigns.

Additionally, the Saudi Arabian government has illustrated its dedication to mitigating the economic repercussions of FMD by disclosing that the disease incurred an annual loss of over 629 million USD in 2020 (Aslam and Alkheraije, 2023).

The Saudi Ministry of Agriculture has established vaccination schedules that include routine immunizations for prevalent diseases, such as FMD and Avian Influenza, tailored to the age and health status of livestock (Alharbi et al., 2024). These vaccination campaigns are strategically optimized based on epidemiological data, considering factors like population demographics and disease prevalence, which enhances the effectiveness of disease control measures (Alkhamis and Hosny, 2024). By implementing well-structured vaccination schedules, the incidence of infectious diseases in livestock can be significantly reduced, thereby minimizing the risk of zoonotic transmission to humans (Boubaker, 2023). Studies have shown that optimized vaccination strategies can lead to substantial decreases in morbidity and mortality rates among livestock populations, ultimately benefiting public health (Hobani and Alharbi, 2024). However, challenges remain, including the need to increase public awareness and improve accessibility to vaccines, which can hinder overall vaccination rates and the effectiveness of disease control efforts (Alzamil et al., 2023).

Foot-and-mouth disease in Saudi Arabia is a significant public health concern due to serotypes O, A, and Asia 1. Concerns have been raised regarding the efficacy of vaccination programs implemented in dairy cattle farms, specifically those derived from the region’s prevalent A/ASIA/Iran-05 viral lineage. The effectiveness of routine vaccination utilizing a polyvalent vaccine that incorporates the A Saudi-95 strain was assessed in a recent study, revealing indications of inadequate vaccine-induced immunity. FMD occurrence has decreased in Saudi Arabian large-scale dairy farms that routinely administer vaccines containing the A Saudi-95 strain. However, disease control remains challenging due to several obstacles: antigenic mismatch between vaccines and field viruses, vaccines having a comparatively limited shelf life, and reliance on the cold chain.

The Saudi Arabian government has implemented several risk-based strategies to control the spread of FMD, emphasizing enhanced surveillance, improved public health infrastructure, and the use of technology for effective monitoring. To strengthen surveillance and monitoring, comprehensive systems have been established to track livestock health and detect FMD outbreaks early (Alslamah and Abalkhail, 2022). By utilizing data-driven approaches, including advanced data analytics and modeling, authorities can better understand disease dynamics and implement timely interventions (Alatawi and Gumel, 2024; Mohammad et al., 2024). The government is also focused on bolstering public health infrastructure by investing in health care facilities, particularly hospitals, to manage outbreaks and prevent the spread of infections (Alslamah and Abalkhail, 2022). Training programs for health care workers and veterinarians are being conducted to ensure effective response strategies are in place (Mujalli, 2024). Moreover, integrated approaches involving collaboration between sectors such as agriculture and health further enhance the effectiveness of FMD control measures (Hazazi and Wilson, 2022). Despite these strategies’ promise, challenges like community awareness and resource allocation must be addressed to ensure the long-term success of FMD control efforts in Saudi Arabia.

Ongoing surveillance of the correlation between the vaccine and the viruses encountered in the field will ensure that the vaccines remain effective (Lyons et al., 2017; Aslam and Alkheraije, 2023, 2023).

The accuracy of data-driven surveillance systems in detecting FMD outbreaks is significantly influenced by factors such as data quality, spatiotemporal modeling, and the integration of diverse data sources. Recognizing and addressing these factors is crucial to improving outbreak detection and response. High-quality data collection is essential because underreporting can lead to skewed results. For instance, a study in Thailand demonstrated that using capture-recapture methods enhanced the estimation of outbreak prevalence, underscoring the need for reliable data sources (Sansamur et al., 2021). The quality of data reported by health professionals, including nurses, also impacts surveillance effectiveness, with issues like inconsistent case definitions and the prioritization of patient care over surveillance contributing to potential inaccuracies (Craig et al., 2018).

Spatiotemporal factors are also critical. Integrating mobility patterns into predictive models has been shown to enhance detection accuracy, with research showing that using mobility-informed risk indices helped identify 87% of affected urban areas Zhang et al. (2023). Environmental factors such as temperature and isothermally are crucial to FMD dynamics. For example, a machine learning study in China analyzed these environmental aspects, providing a deeper understanding of outbreak patterns (Li et al., 2024).

Combining various data sources, including local and global datasets like meteorological data and mobility patterns, enables a more detailed understanding of FMD outbreaks. This comprehensive approach can enhance early warning systems and improve response strategies (Moharana et al., 2023; Li et al., 2024). Although these factors significantly enhance surveillance accuracy, challenges remain, particularly in maintaining consistent data collection practices and managing the complexities of disease dynamics across regions.

Integrating ongoing surveillance with vaccination programs significantly enhances the control of FMD in Saudi Arabia. This comprehensive approach not only improves disease monitoring and guides vaccination strategies but ultimately leads to better public health outcomes. Enhanced epidemiological monitoring through continuous surveillance enables real-time tracking of FMD outbreaks, allowing for prompt interventions and the launch of effective vaccination campaigns (Alhumaid et al., 2024). Establishing robust surveillance systems has been vital for assessing the prevalence and spread of FMD, thereby enabling more targeted vaccination efforts (Badur et al., 2021). The effectiveness of vaccination campaigns similar to those conducted for COVID-19 highlights the importance of public health marketing in boosting vaccine uptake (Alhraiwil et al., 2024). By integrating data from both surveillance and vaccination programs, resource allocation can be optimized and vaccination coverage can be improved, mirroring successful strategies used for other infectious disease control efforts in Saudi Arabia (Albogami et al., 2021). Despite the promise of this integrated approach, challenges such as vaccine hesitancy and logistical difficulties in rural areas may hinder its optimal implementation. Overcoming these barriers is crucial for maximizing the effectiveness of FMD control strategies.

Global epidemiological trends

Foot-and-mouth disease is caused by an Aphthovirus belonging to the Picornaviridae family, with seven strains (A, O, C, SAT1, SAT2, SAT3, and Asia1) exhibiting endemic status in various countries across the globe (Kabir et al., 2024a; WOAH - World Organization for Animal Health, 2024). The World Reference Laboratory for FMD summarized the likely pattern of FMD spread in the ‘Old World’ in 2008, indicating that, based on historical experience, the overall risk of FMD for Europe is likely to originate from either Africa or Asia, with Africa posing a lesser risk than Asia (Rweyemamu et al., 2008). FMD is a transboundary animal disease that manifests intermittently in habitually free regions. In 2009, 2010, 2011, and 2013, new serotypes of FMD were identified in Iraq, including FMDV-A ASIA Iran05 BAR-08, FMDV-A ASIA Iran05 AFG-07, FMDV-O ME-SA PanAsia2 ANT-10, FMDV-A Asia 1 Sindh-08, and FMDV-A Asia1 Iran05SIS-10, respectively (Al-Salihi, 2019). The expenses associated with the prevention and control of FMD are predominantly borne by low-income and lower-middle-income nations in Africa and Eurasia, accounting for 75% and 33% of the overall costs, respectively (WOAH - World Organization for Animal Health, 2024; Abd El-Rahim et al., 2016). The World Organization for Animal Health (OIE) has compiled an authoritative roster of FMD-free nations, two officially recognized (WOAH - World Organization for Animal Health, 2024).

The global epidemiology of FMD is evolving because of numerous factors. Modern transportation has facilitated the increased movement of people, animals, and pathogens, while demographic shifts such as urbanization and population growth have also contributed to the spread of FMD (Ullah et al., 2023; Kabir et al., 2024a).

Urbanization and population growth significantly affect the transmission dynamics of FMD in densely populated areas. The interaction between increased human density and the spread of infectious diseases like FMD is complex and multifaceted. Higher population density can facilitate closer contact between livestock and humans, thereby increasing the risk of FMD transmission. Although urban areas are often perceived as less susceptible, they can still pose significant FMD risks due to dense livestock populations (Bessell et al., 2008). Additionally, urban landscapes feature geographical barriers such as roads and rivers, which can influence disease spread by either facilitating or restricting transmission between farms. For example, rivers may act as natural barriers, lowering the chances of disease transmission (Bessell et al., 2008). Urbanization also impacts the movement of humans and animals, potentially accelerating the spread of FMD across regions. Increased mobility in urban settings can exacerbate outbreaks because infected animals or humans travel between densely populated areas (Guo, 2022). On the other hand, while urbanization presents certain risks, it can also lead to enhanced surveillance and control measures due to improved infrastructure and resources, which may help mitigate the impact of FMD outbreaks.

Diverse risk factors for FMD seroprevalence were identified in the northern border region of Pakistan, where it was discovered that seroprevalence was high among sheep, goats, cattle, and buffaloes, among other animal species (Куников and Фомина, 2021). The global epidemiology of FMD is affected by various factors, including regional outbreaks, demographic shifts, and the mobility of animals and pathogens.

Foot and mouth disease has exhibited diverse prevalence and distribution patterns in Saudi Arabia. Between July 1999 and June 2004, five FMD serotype O epidemics and one serotype an outbreak were documented (Abdel Baky et al., 2005).

In Saudi Arabia, the prevalence and impact of serotypes O and A differ significantly, especially concerning health outcomes and blood group distribution. Studies have consistently found that serotype O is the most common blood type among the Saudi population, with frequencies reported as high as 43.6% in the Hail region and 53.1% in control groups from other studies (Farshori et al., 2018; Qanash et al., 2022). In contrast, serotype A appears less frequently but has been linked to specific health conditions. Notably, 31.4% of hypertensive female patients had blood type A, and similar associations have been observed with myocardial infarctions (Farshori et al., 2018). These findings suggest that while serotype O is more widespread and generally associated with favorable health outcomes, serotype A is more frequently linked to higher rates of hypertension and myocardial infarctions, indicating a potential health impact that is less pronounced for serotype O (Farshori et al., 2018). Understanding these differences is crucial because they can influence blood transfusion practices and disease susceptibility, underscoring the need for targeted healthcare strategies that take into account the distribution of blood types within the population (Belali, 2022; Qanash et al., 2022).

FMD is endemic in Asia, including Saudi Arabia, where it is a concern for the livestock industry. Evidence suggests that epidemics of FMD are more prevalent in the winter months, specifically in the northern and southern regions (Abdel Baky et al., 2005). The seroprevalence of FMD in small ruminants in Pakistan, geographically adjacent to Saudi Arabia, is 19.8% (Dubie and Negash, 2021). Research on FMD was conducted by the Department of Veterinary Medicine at the College of Agriculture and Veterinary Medicine, Qassim University, Buraidah, Saudi Arabia (Aslam and Alkheraije, 2023). A study conducted between 1999 and 2004 showed that serotype O was most prevalent in Saudi Arabia, with serotype A exhibiting a single outbreak (Abdel Baky et al., 2005). Strict vaccination programs and restrictions on animal movement have been implemented as control measures in Saudi Arabia during the risk period of FMD in various locales, leading to the effectiveness of these measures and no FMD epidemics from May 2002 to May 2004 (Abdel Baky et al., 2005).

Inadequate vaccination coverage and insufficient disease surveillance contribute to the endemic nature of FMD in Saudi Arabia. The combined effects of vaccine hesitancy, logistical challenges, and surveillance deficiencies create conditions that favor disease persistence. Research has shown a 20.9% prevalence of delays in childhood vaccinations in Riyadh, which is influenced by factors such as parental concerns about vaccine safety and logistical barriers (Basham et al., 2024). Vaccine hesitancy is recognized as a significant public health issue, with experts advocating for awareness campaigns to dispel misconceptions and emphasize the benefits of vaccination (Asraf et al., 2022). Furthermore, vaccination compliance among Hajj pilgrims, which is critical to preventing outbreaks, remains below ideal levels, with significant gaps noted for vaccines against diseases like polio and yellow fever (Alotaibi et al., 2021). The absence of robust surveillance systems further hinders the ability to respond promptly to outbreaks, allowing diseases like FMD to continue to circulate within the population (Hobani and Alharbi, 2024). While these factors exacerbate the persistence of FMD, there is a belief that enhanced public health initiatives and greater community engagement could help overcome these challenges, fostering a stronger culture of vaccination and improving disease monitoring capabilities.

Challenges with inactivated vaccines

Inactivated FMD vaccines are vital for FMD prevention in Saudi Arabia and other countries, but they have significant limitations. The thermostability of these vaccines is concerning, as higher temperatures can reduce their efficacy by causing the FMD virus to dissociate into pentamer subunits (Gao et al., 2021a).

To improve the thermostability of inactivated FMD vaccines, researchers have identified optimal formulations and adjuvant combinations that enhance the stability of viral antigens while preserving their immunogenicity. Studies have demonstrated that a formulation containing 5% trehalose and 5% sucrose, along with stabilizers like arginine and cysteine, significantly improved the stability of the 146S antigen, maintaining 14% stability after 14 months at 4°C Li et al. (2022b). Additionally, a mix of 20% trehalose, 500 mM NaCl, and 3 mM CuSO4 has been found to enhance viral stability and extend the half-life of FMDV inactivation Li et al. (2022a). Recombinant FMDV strains with specific amino acid substitutions, such as Y2098F, have also shown increased thermostability without compromising immunogenicity, indicating their potential for future vaccine development (Gao et al., 2021b). Furthermore, using oil-based adjuvants, like aluminum hydroxide gel mixed with oil, has resulted in a stronger immune response compared with traditional formulations, suggesting a shift toward oil-based adjuvants for enhanced vaccine efficacy (Ayele et al., 2023). Although these advancements hold promise, the ongoing dependence on cold-chain logistics remains a challenge, highlighting the need for further research into formulations that can maintain their effectiveness at higher temperatures.

Additionally, selecting appropriate vaccine strains is challenging because of the lack of cross-protection between serotypes and incomplete protection between some strains within a serotype (Bergmann et al., 2021). Current in vitro methods for assessing vaccine strain protective capacity are inconclusive and do not cover various field scenarios (Kenubih, 2021). Moreover, producing inactivated vaccines requires a costly biosafety facility and an exhaustive purification process to eliminate nonstructural proteins necessary for differentiating infected from vaccinated animals (Haynie, 2023). These challenges underscore the need for alternative FMD prevention strategies in Saudi Arabia and elsewhere. Although inactivated vaccines have been crucial for FMD control, they have limitations. These include limited coverage against emerging variants, the need for booster injections, short-lived immunity, carrier state persistence, cold chain challenges, production and safety concerns, cost and accessibility issues, and vaccine match challenges (Maree et al., 2014; Saeed et al., 2015). Researchers are exploring alternative vaccines like reverse genetics-based vaccines and novel delivery systems to improve efficacy and safety (Saeed et al., 2015). Additionally, diagnostic tools and surveillance systems can enhance monitoring efforts (Maree et al., 2014; Saeed et al., 2015).

Current vaccine development strategies for providing cross-protection against multiple FMD serotypes have increasingly focused on recombinant and multiepitope approaches. These methods aim to enhance immunogenicity and effectiveness against a wide range of viral strains. For instance, a recombinant multi-epitope trivalent vaccine has been developed, which has been shown to elicit strong immune responses against three different FMDV topotypes in pigs, offering sterilizing immunity and sustained protection for up to 6 months (Shao et al., 2024). Additionally, chimeric protein-based vaccines incorporating potential B-cell and T-cell epitopes from various FMDV strains have demonstrated significant protective immunogenicity against serotypes O and A in guinea pigs (Akter et al., 2024).

Machine learning techniques are also being utilized to enhance vaccine design by predicting cross-neutralization potential among serotype O viruses and identifying critical genomic sites that can improve immunization strategies (Makau et al., 2024). Moreover, some well-established vaccine strains, such as those originating from South America, have been found to possess a broad immunogenic spectrum against circulating FMDV lineages, thereby aiding in the effectiveness of vaccination programs (Malirat et al., 2023). Despite the promise of these strategies, achieving complete cross-protection remains a challenge because of the genetic diversity of FMDV strains. Continuous monitoring and adaptive modification of vaccine formulations are crucial for the successful control of FMD outbreaks.

Combining observational and experimental study designs offers a powerful approach to evaluating vaccine efficacy, utilizing the strengths of each method while addressing their respective biases. Observational study designs, such as the test-negative design, are commonly employed to estimate vaccine effectiveness by comparing vaccinated individuals who test positive for a disease to those who test negative, thus controlling for healthcare-seeking behavior and exposure risk (Dean and Amin, 2024). However, these studies are prone to healthy vaccine bias, where healthier individuals are more likely to receive vaccination, potentially leading to an overestimation of vaccine effectiveness if not properly controlled (Høeg et al., 2024). On the other hand, randomized controlled trials (RCTs) provide robust and unbiased data by randomly assigning participants to vaccine or placebo groups, effectively minimizing the biases inherent in observational studies (Fung et al., 2024). Nevertheless, RCTs might not capture the long-term effectiveness of vaccines or fully reflect real-world conditions. To bridge this gap, the use of target trial emulation—emulating hypothetical RCTs using observational data—has emerged as a valuable approach. This method allows researchers to simulate RCT conditions while utilizing existing data, providing insights into the effectiveness of vaccines against different variants and booster responses (Hulme et al., 2023). While this integrated approach enhances the reliability of vaccine efficacy assessments, it also highlights the need to address challenges such as ensuring data quality and effectively managing biases to achieve accurate and comprehensive evaluations.

Innovative solutions to address the challenges of FMD in Saudi Arabia and other regions include genotyping FMDV strains to understand the epidemiology and track movement between regions (Abd El-Rahim et al., 2016). Vaccinating imported sheep flocks with the vaccine used during quarantine can help control FMD, especially when imported from disease-free countries (Mahmoud and Galbat, 2017). Developing a robust health and safety program in the construction sector can minimize the risks of FMD transmission (Qaffas et al., 2021). Additionally, the application of the Internet of Things (IoTs) and big data technologies can predict and detect FMD and other diseases earlier and on a large scale, minimizing risks (Alshemimry, 2016). Integrating hospital information and patient health care details into a central system database can automate patient file management and improve health care service efficiency (Miladi et al., 2021). Alternative approaches to FMD challenges include developing advanced vaccine platforms that stimulate cellular and humoral immune responses (Lee et al., 2020), creating DIVA-compatible vaccines for differentiation between vaccinated and infected animals (Hardham et al., 2020), producing plant-based vaccines for cost-effectiveness (Lee et al., 2020), utilizing DNA and RNA vaccines for rapid production and effectiveness, and developing live attenuated vaccines for safety and efficacy (Lee et al., 2020). Antiviral agents like Tri-Solfen, have shown promise for treating FMD (Outreach, 2021). Improving vaccine delivery methods using nanoparticles or adjuvants aims to enhance immune responses (Lee et al., 2020). These approaches target challenges such as slow induction and short-term maintenance of antibody titers, the need for regular vaccination, and potential adverse effects to improve FMD control and prevention globally.

The optimal size and composition of nanoparticles are crucial for enhancing immune responses to vaccines, and research indicates that both factors significantly influence their immunogenicity and efficacy. Nanoparticles around 170 nm, such as DDAB/PLA NPs, and those approximately 250 nm, like LMSN-M, have shown enhanced immune responses, with the former offering high antigen loading capacity and stability, and the latter improving mucosal immunity through better cellular uptake and retention in lymph nodes (Liu et al., 2024; Yang et al., 2024). Larger nanoparticles, such as those around 250 nm, facilitate improved interaction with immune cells, promoting dendritic cell maturation and subsequent immune activation (Liu et al., 2024). In terms of composition, polysaccharide nanoparticles with high molecular weights have been effective in mRNA vaccine delivery, enhancing immune responses via specific signaling pathways (Wu et al., 2023). Furthermore, nanoparticles coated with hybrid membranes derived from immune cells have demonstrated significant improvements in interactions with dendritic cells, thereby amplifying antitumor immune responses (Yu et al., 2024). In summary, nanoparticles sized between 170 and 250 nm, made from biocompatible materials like polysaccharides or hybrid membranes, are optimal for enhancing vaccine-induced immune responses. However, the complexity of immune interactions necessitates further research to tailor nanoparticle designs for specific vaccine applications.

Tri-Solfen (TS) exhibits promising antiviral properties that can be effectively combined with other therapeutic strategies, such as immunotherapy and gene therapy, to enhance its efficacy against FMD. TS has demonstrated potential viricidal effects because of its low pH, which may help reduce viral loads in lesions caused by FMD, while its formulation—including local anesthetics and antiseptics—not only manages pain but also aids in recovery for infected animals (Lacasta et al., 2021). Combining TS with immunotherapy, specifically pegylated IFNs, could provide immediate antiviral action and extend the therapeutic window, addressing the delay in immune response development postvaccination (Diaz-San Segundo et al., 2021). Furthermore, integrating TS with gene therapy approaches, such as the use of recombinant adenoviruses expressing porcine IFNs and small interfering RNAs, could enhance the overall antiviral response, offering rapid protection during outbreaks when vaccines are not yet fully effective (Kim et al., 2015). Despite its potential, further research is necessary to optimize the integration of TS with immunotherapy and gene therapy to maximize its efficacy against FMD.

Significance of disease-data collection

The Sickle Cell Disease (SCD) registry, established by the Saudi Ministry of Health, exemplifies how routine disease data collection in Saudi Arabia can enhance vaccine-matching studies (Alqurashi et al., 2022). These registries gather real-world data on diseases like SCD, focusing on disease patterns, outcomes, clinical characteristics of patients, and healthcare resource utilization to improve patient care and outcomes (Aslam and Alkheraije, 2023).

Establishing diverse disease registries and surveillance systems is vital for enhancing vaccine safety and efficacy because they can utilize existing health care data and innovative methods to monitor adverse events and bolster public health responses. Combining active and passive surveillance methods provides comprehensive monitoring, with active systems proactively collecting data and passive systems relying on reports from healthcare providers and patients, as exemplified by the Vaccine Adverse Event Reporting System (Amir et al., 2024). The use of electronic health records (EHRs) can further identify vaccine-related risks by leveraging routinely collected healthcare data, although these systems must be carefully designed to minimize biases (Schuemie et al., 2022). Advanced technologies like natural language processing (NLP) can analyze large amounts of online data to detect mentions of adverse events, improving the detection of safety signals (Buttery and Clothier, 2022). Specialized registries, such as the Vaccine Safety Datalink, focus on specific populations, like pregnant individuals, to address unique safety concerns (Gee et al., 2024). Despite the potential benefits, implementing these systems requires addressing the challenges related to data privacy, potential biases, and the need for robust methodologies to ensure accurate and effective vaccine safety monitoring.

The Saudi Arabian health care system can significantly improve vaccine development and distribution by leveraging insights from existing disease registries, which provide valuable data for managing diseases with genetic similarities. For example, registries such as the kidney disease and sickle cell disease registry highlight the importance of real-world data in understanding disease patterns and patient demographics, which can inform vaccine development strategies (Ezzat et al., 2022; Tawhari et al., 2024). The success of the COVID-19 vaccination campaign, which utilized predictive modeling based on control engineering to optimize vaccine distribution by analyzing disease dynamics and vaccination impacts, demonstrates how these approaches can be adapted for other diseases (Boubaker, 2023). Furthermore, the unique public health challenges faced by Saudi Arabia, particularly during mass gatherings, can be addressed by using insights from these registries to tailor vaccination strategies that mitigate associated risks (Alkhamis and Hosny, 2024). However, to fully capitalize on these benefits, challenges such as data integration and resource allocation must be addressed to maximize the potential of these registries in enhancing vaccine strategies across various diseases.

Integrating routine disease data with vaccine data can assess the safety and efficacy of COVID-19 vaccines, especially in Saudi Arabian adults, reducing vaccine hesitancy and promoting mass vaccination (Al-Hanawi et al., 2022; Ezzat et al., 2022). Saudi Arabia’s current passive pharmacovigilance system can conduct near-real-time monitoring of COVID-19 vaccine safety (Albogami et al., 2021). Studies conducted in Saudi Arabia, such as one in Taif City examining predictors of influenza vaccination adherence among patients undergoing in-center dialysis and another in Al-Baha City exploring parents’ knowledge and beliefs regarding COVID-19 vaccination for children, highlight the significance of routine disease data in understanding vaccination outcomes and behaviors (Mohmmed and Ismail, 2022; Almutairi and Atalla, 2023). These data contribute significantly to our understanding of vaccine safety, efficacy, and coverage, thereby aiding health care providers and policymakers in vaccine distribution and implementation decisions.

Data-driven decision-making and surveillance are crucial for FMD control initiatives. Surveillance systems provide valuable data for documenting program progress, evaluating intervention efforts, and achieving interim results (Metwally et al., 2023). Using big data analytics alongside data-driven surveillance allows collecting and analyzing a wide range of data sources to detect and track disease trends (Dórea et al., 2023). This approach ensures that the generated data are suitable for disease surveillance and enables the timely identification of FMD outbreaks. Emerging data sources, such as artificial intelligence, crowdsourcing, technology-enabled physiological measurements, and field experiments, offer advantages over traditional approaches in terms of improved speed and reduced resource requirements (Shausan et al., 2023). By integrating relevant data sources and employing advanced technologies, surveillance systems can provide early indicators and facilitate the prompt detection of FMD. Effective management of FMD outbreaks relies on targeted interventions and control measures that are informed by data-driven decision-making and surveillance information.

Artificial intelligence algorithms greatly improve the accuracy of FMD outbreak detection by harnessing diverse data sources and employing advanced predictive modeling techniques. The integration of AI with mobile health data and the IoT can facilitate real-time surveillance and early warning systems. AI algorithms can analyze extensive datasets, including electronic health records, social media, and mobile health information, to identify potential outbreaks and predict the spread of disease (Chouit et al., 2024; Isiaka et al., 2024). Machine learning models further enhance this capability by assessing demographic data, travel patterns, and environmental factors, thus increasing the precision of outbreak predictions (Olaboye et al., 2024; Siddique et al., 2024). These AI-driven predictive models empower public health authorities to allocate resources effectively and implement timely interventions to improve the efficiency of outbreak control (Anggraini Ningrum et al., 2024; Isiaka et al., 2024). The use of spatiotemporal data, for instance, has been shown to boost prediction accuracy, as demonstrated in studies on diseases like dengue, which provide relevant insights for FMD (Abdulaziz et al., 2023; Anggraini Ningrum et al., 2024). However, while AI offers significant promise in enhancing outbreak detection, challenges such as data privacy concerns, potential algorithmic bias, and the need for robust infrastructure remain critical factors to consider for its successful implementation.

Data-driven decision-making and surveillance are essential for preventing FMD, as recent research has highlighted their significance in forecasting and prioritizing disease control measures. For example, a study on FMD risk classification used cattle transportation data to demonstrate the predictive capability of livestock transportation in identifying FMD outbreaks. This research has contributed to the development of strategies to control and prevent FMD (Moreno et al., 2023). Another investigation emphasized the risk of individual producers’ exposure to FMDs and their ability to react. A Bayesian network model was constructed to guide the allocation of resources for risk-based surveillance, further highlighting the importance of surveillance in FMD control efforts (Manyweathers et al., 2021).

To improve the accuracy of predictive models for FMD outbreak detection, key variables related to cattle transportation data, including network characteristics and environmental factors, can be effectively leveraged. Network centrality measures, such as eigenvector centrality and in-degree, are crucial for identifying high-risk areas, with high in-degree nodes—those receiving many shipments—serving as strong predictors of infection risk, as evidenced by the analysis of Turkey’s cattle transport network (Herrera-Diestra et al., 2022). The structure of livestock transportation patterns also provides valuable insights, with risk-ranking approaches based on these patterns successfully predicting FMD outbreaks, such as the case in Colombia (Moreno et al., 2023). Additionally, environmental factors, particularly meteorological data like annual average temperature and minimum temperature during the coldest month, significantly enhance the predictive capabilities of models by accounting for the environmental conditions that facilitate disease spread (Li et al., 2024). While these variables significantly contribute to improving the accuracy of predictive models, challenges such as limited data availability and the inherent complexities of disease dynamics must be considered to ensure model reliability.

In addition, data-driven decision-making is critical for FMD control. A study conducted in China examined the correlation between air pollutants and the incidence of FMD, emphasizing the importance of instituting control measures based on empirical evidence Li et al. (2022). Moreover, an integrated assessment that analyzed demographic, production, and trade characteristics and mapped surveillance system components underscored the criticality of efficient and effective animal health surveillance systems to prevent adverse economic repercussions caused by animal diseases (Häsler et al., 2014). Recent research has emphasized the significance of data-driven decision-making and surveillance in FMD control initiatives. These methodologies contribute to the well-being and health of animals and advance sustainable food production, public health, and resource utilization (Häsler et al., 2014). As recent studies and practical implementations have highlighted, surveillance and data-driven decision-making are crucial for managing FMD in Saudi Arabia. Integrating surveillance data sources and epidemiological modeling is essential for FMD management, as demonstrated in the paper “Social computing, behavioral-cultural modeling, and prediction” from the seventh International Conference SBP 2014 (Kennedy et al., 2014). Understanding the propagation dynamics and social network structure of infectious diseases like FMD is critical for forecasting disease transmission and developing effective control strategies. For example, the article “Cover Your Cough! Evaluating the Advantages of Implementing Localized Healthy Behavior Interventions to Control Influenza Epidemics in Washington, DC” illustrates the positive impacts of such interventions on disease management (Kennedy et al., 2014).

Surveillance and data-driven decision-making are pivotal in managing FMD outbreaks in Saudi Arabia. The Saudi Food and Drug Administration (SFDA) has established a national surveillance system for FMDs that incorporates real-time disease occurrence and distribution monitoring. The SFDA collaborates with the World Organization for Animal Health (OIE) to coordinate control measures and exchange information. The Saudi Ministry of Environment, Water, and Agriculture (MEWA) has also tried to improve data management and strengthen the national surveillance system. MEWA has implemented a nationwide FMD vaccination initiative grounded in surveillance and data-driven decision-making. In conclusion, surveillance and data-driven decision-making are indispensable for FMD management in Saudi Arabia. By integrating surveillance data feeds and epidemiological modeling, policymakers and researchers can better understand disease dynamics, forecast outbreaks, and implement effective control strategies (Kennedy et al., 2014).

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Conclusion

Based on the existing literature reviewed so far, this review highlights the pivotal role of advanced disease data collection and surveillance systems in optimizing public health outcomes in Saudi Arabia. It emphasizes the transformative impact of disease-specific registries, such as the SCD registry, and the integration of cutting-edge technologies like EHR and NLP. These innovations facilitate a nuanced understanding of disease dynamics, enhance patient care, and refine vaccine strategies to enhance efficacy and safety. By leveraging data-driven approaches, health care providers can proactively identify and manage adverse events, implement timely public health measures, and address vaccine hesitancy, particularly in the context of large-scale events. In animal health, the application of data-driven surveillance, including AI and predictive modeling, has proven indispensable for managing diseases such as FMD, enabling early outbreak detection and efficient resource allocation. Nevertheless, the effective deployment of such systems must overcome data privacy, integration, and potential biases. To fully harness the potential of these surveillance frameworks, continuous investments in infrastructure, enhanced collaboration among health care stakeholders, and active community engagement are imperative. Addressing these challenges will enhance Saudi Arabia’s capacity to respond to emerging health threats, safeguard public health, and contribute to global health security.

Recommendations and future directions

To enhance public health outcomes and improve vaccine safety and efficacy in Saudi Arabia, it is imperative to prioritize the establishment and optimization of comprehensive disease data collection and surveillance systems. Expanding disease registries to encompass a broader spectrum of diseases beyond the current SCD registry is critical for obtaining a thorough understanding of disease dynamics, patient demographics, and health care resource utilization. The integration of advanced technologies, including EHR, AI, and NLP, will significantly enhance the detection of disease outbreaks and vaccine-related adverse events. Furthermore, integrating data from diverse sources, such as hospitals, clinics, and laboratories, will facilitate seamless data sharing and support accurate predictive modeling for vaccine development and distribution.

A balanced approach to surveillance that incorporates both active and passive methods should be adopted. Active surveillance involves systematic data collection, whereas passive surveillance relies on voluntary reporting from health care providers and patients. Investment in public health infrastructure, healthcare professionals’ training, and rigorous data privacy measures is essential to support the effective implementation of these advanced surveillance systems. Collaborative efforts among government agencies, health care providers, academic institutions, and international organizations will foster the exchange of best practices and enhance research capabilities. Public awareness campaigns are necessary to educate the public about the significance of vaccines and disease surveillance, thereby fostering trust and mitigating vaccine hesitancy.

Additionally, tailored surveillance and vaccination strategies should be developed for high-risk groups, including children, the elderly, and individuals with chronic illnesses, with particular emphasis on settings such as mass gatherings. Ongoing research is vital for monitoring the long-term safety and efficacy of vaccines, especially new vaccines introduced in response to emerging health threats. By implementing these recommendations, Saudi Arabia can substantially strengthen its public health surveillance capabilities, optimize vaccine strategies, and ultimately improve health outcomes for its population. Future efforts should focus on continuous improvement, adapting to evolving health challenges, and leveraging technological advancements to sustain a resilient and effective public health system.

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Acknowledgment

I want to express my sincere gratitude to the Deanship of Scientific Research at King Faisal University for their financial support through Project Number (GRANT5873). This support was instrumental in conducting the research and developing the manuscript.

Conflict of interest

The author declares no conflict of interest.

Funding

This work was supported by the Deanship of Scientific Research at King Faisal University (GRANT5873)

Authors’ contribution

All the work was conducted by Mohammed Al-Hammadi.

Data availability

All data are included in the manuscript.

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