An observational study was carried out, using data collected from four areas in the Irish midlands, between 1989 and 2004, to critically evaluate the long-term effects of proactive badger culling and to provide insights into reactive badger culling tuberculosis (TB) prevalence in cattle. Confirmed cattle herd TB incidence is the outcome measure used throughout. Relative to reactive culling, proactive badger culling was associated with a decrease in incidence in each of the 16 years of observation, which encompassed periods of both intensive and less-intensive badger removal. By 2004, we observed a decrease of 22% [95% confidence interval (CI) 15-29, P<0.001] in the entire proactive and 37% (95% CI 25-47, P<0.001), in the inner proactive removal areas. The size of the decrease increased with time (P=0.055). There was a decrease (constant over time) of at least 14% (95% CI 76-97, P=0.013) in incidence in the inner compared to the outer control area (herds < or = 2 km, >2 km, from proactive removal area boundaries, respectively). Incidence in the outer proactive removal area (herds < 1.6 km from the proactive removal boundary) was similar to the inner control area (P=0.890). Incidence in the outer control area and total control area, compared to a neighbouring area some distance away, increased over the course of the study. Differences with the total control area were not statistically significant but the outer control area was 11% higher than the neighbouring area by 2004 (borderline significance P=0.057).
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