on organ donation. some blood donation organisations considered relaxing the rules after the covid-19 pandemic and some natural disasters that depleted the blood supply. north america the first reported case in north america was in december 1993 from alberta, canada. another canadian case was reported in may 2003. the first known u.s. occurrence came in december of the same year, but it was later confirmed to be a cow of canadian origin imported to the u.s. the cow was slaughtered on a farm near yakima, washington. the cow was included in the united states department of agriculture's surveillance programme, specifically targeting cattle with bse. canada announced two additional cases of bse from alberta in early 2005. in june 2005, john r. clifford, chief veterinary officer for the united states department of agriculture animal and plant health inspection service, confirmed a fully domestic case of bse in texas. united states the use of animal byproduct feeds was never common, as it was in europe. soybean meal is cheap and plentiful in the united states, and cottonseed meal (1.5 million tons of which are produced in the u.s. every year, none of which is suitable for humans or any other simple-stomach animals) is even cheaper than soybean meal. historically, meat and bone meal, blood meal, and meat scraps have almost always commanded a higher price as a feed additive than oilseed meals in the u.s., so not much incentive existed to use animal products to feed ruminants. however, u.s. regulations only partially prohibited the use of animal byproducts in feed. in 1997, regulations prohibited the feeding of mammalian byproducts to ruminants such as cattle and goats. however, the byproducts of ruminants can still be legally fed to pets or other livestock, including pigs and poultry. in addition, it is legal for ruminants to be fed byproducts from some of these animals. because of this, some authors have suggested that under certain conditions, it is still possible for bse incidence to increase in u.s. cattle. u.s. meat producer creekstone farms alleged in a lawsuit that the usda was preventing the company from testing its slaughtered cattle for bse. the usda has issued recalls of beef supplies that involved introduction of downer cows into the food supply. hallmark/westland meat packing company was found to have used electric shocks to prod downer cows into the slaughtering system in 2007. possibly due to pressure from large agribusiness, the united states has drastically cut back on the number of cows inspected for bse. effect on the us beef industry japan was the top importer of us beef, buying $1.7 billion worth in 2003. after the discovery of the first case of bse in the us on 23 december 2003, japan halted us beef imports. in december 2005, japan once again allowed imports of us beef, but reinstated its ban in january 2006 after a violation of the us-japan beef import agreement: a vertebral column, which should have been removed prior to shipment, was included in a shipment of veal. tokyo yielded to us pressure to resume imports, ignoring consumer worries about the safety of us beef, said japanese consumer groups. michiko kamiyama from food safety citizen watch and yoko tomiyama from consumers union of japan said about this: "the government has put priority on the political schedule between the two countries, not on food safety or human health." sixty-five nations implemented full or partial restrictions on importing us beef products because of concerns that us testing lacked sufficient rigor. as a result, exports of us beef declined from 1,300,000 tonnes (t) in 2003, (before the first mad cow was detected in the us) to 322,000 t in 2004. this has increased since then to 771,000 t in 2007 and to 1,300,000 t by 2017. on 31 december 2006, hematech inc, a biotechnology company based in sioux falls, south dakota, announced it had used genetic engineering and cloning technology to produce cattle that lacked a necessary gene for prion production – thus theoretically making them immune to bse. in april 2012, some south korean retailers ceased importing beef from the united states after a case of bse was reported. indonesia also suspended imports of beef from the us after a dairy cow with mad cow disease was discovered in california. japan with 36 confirmed cases, japan experienced one of the largest number of cases of bse outside europe. it was the only country outside europe and the americas to report non-imported cases. reformation of food safety in light of the bse cases resulted in the establishment of a governmental food safety commission in 2003. europe evolution of the bovine spongiform encephalopathy (bse) epidemic in the uk. cattle are naturally herbivores, eating grasses. in modern industrial cattle-farming, though, various commercial feeds are used, which may contain ingredients including antibiotics, hormones, pesticides, fertilizers, and protein supplements. the use of meat and bone meal, produced from the ground and cooked leftovers of the slaughtering process, as well as from the carcasses of sick and injured animals such as cattle or sheep, as a protein supplement in cattle feed was widespread in europe prior to about 1987. worldwide, soybean meal is the primary plant-based protein supplement fed to cattle. however, soybeans do not grow well in europe, so cattle raisers throughout europe turned to the cheaper animal byproduct feeds as an alternative. the british inquiry dismissed suggestions that changes to processing might have increased the infectious agents in cattle feed, saying, "changes in process could not have been solely responsible for the emergence of bse, and changes in regulation were not a factor at all." (the prion causing bse is not destroyed by food heat treatment.) the first confirmed instance in which an animal fell ill with the disease occurred in 1986 in the united kingdom, and lab tests the following year indicated the presence of bse; by november 1987, the british ministry of agriculture accepted it had a new disease on its hands. subsequently, 177 people (as of june 2014) contracted and died of a disease with similar neurological symptoms subsequently called (new) variant creutzfeldt–jakob disease (vcjd). this is a separate disease from 'classical' creutzfeldt–jakob disease, which is not related to bse and has been known about since the early 1900s. three cases of vcjd occurred in people who had lived in or visited the uk – one each in the republic of ireland, canada, and the us. also, some concern existed about those who work with (and therefore inhale) cattle meat and bone meal, such as horticulturists, who use it as fertilizer. up-to-date statistics on all types of cjd are published by the national creutzfeldt–jakob disease surveillance unit in edinburgh, scotland. for many of the vcjd patients, direct evidence exists that they had consumed tainted beef, and this is assumed to be the mechanism by which all affected individuals contracted it. disease incidence also appears to correlate with slaughtering practices that led to the mixture of nervous system tissue with ground meat (mince) and other beef. an estimated 400,000 cattle infected with bse entered the human food chain in the 1980s. although the bse epizootic was eventually brought under control by culling all suspect cattle populations, people are still being diagnosed with vcjd each year (though the number of new cases currently has dropped to fewer than five per year). this is attributed to the long incubation period for prion diseases, which is typically measured in years or decades. as a result, the full extent of the human vcjd outbreak is still not known. the scientific consensus is that infectious bse prion material is not destroyed through cooking procedures, meaning that even contaminated beef foodstuffs prepared "well done" may remain infectious. alan colchester, a professor of neurology at the university of kent, and nancy colchester, writing in the 3 september 2005 issue of the medical journal the lancet, proposed a theory that the most likely initial origin of bse in the united kingdom was the importation from the indian subcontinent of bone meal which contained cjd-infected human remains. the government of india vehemently responded to the research, calling it "misleading, highly mischievous; a figment of imagination; absurd," further adding that india maintained constant surveillance and had not had a single case of either bse or vcjd. the authors responded in the 22 january 2006 issue of the lancet that their theory is unprovable only in the same sense as all other bse origin theories are and that the theory warrants further investigation. during the course of the investigation into the bse epizootic, an enquiry was also made into the activities of the department of health medicines control agency (mca). on 7 may 1999, david osborne hagger, a retired civil servant who worked in the medicines division of the department of health between 1984 and 1994, produced a written statement to the bse inquiry in which he gave an account of his professional experience of bse. in february 1989, the mca had been asked to "identify relevant manufacturers and obtain information about the bovine material contained in children's vaccines, the stocks of these vaccines and how long it would take to switch to other products." in july, " use of bovine insulin in a small group of mainly elderly patients was noted and it was recognised that alternative products for this group were not considered satisfactory." in september, the bse working party of the committee on the safety of medicines (csm) recommended that "no licensing action is required at present in regard to products produced from bovine material or using prepared bovine brain in nutrient media and sourced from outside the united kingdom, the channel isles and the republic of ireland provided that the country of origin is known to be free of bse, has competent veterinary advisers and is known to practise good animal husbandry." in 1990, the british diabetic association became concerned regarding the safety of bovine insulin. the csm assured them " there was no insulin sourced from cattle in the uk or ireland and that the situation in other countries was being monitored." in 1991, the european commission " concerns about the possible transmission of the bse/scrapie agent to man through use of certain cosmetic treatments." in 1992, sources in france reported to the mca "that bse had now been reported in france and there were some licensed surgical sutures derived from french bovine material." concerns were also raised at a csm meeting "regarding a possible risk of transmission of the bse agent in gelatin products." for this failure, france was heavily criticised internationally. thillier himself queried why there had never been a ban on french beef or basic safety precautions to stop the food chain becoming contaminated, suggesting "perhaps because the french government forgot its role in guaranteeing the safety of food products, and this neglect cost the lives of nine people." the sydney morning herald added, "while blustering french politicians blamed britain for the emergence of the disease – and tried to quarantine the country by banning imports of british beef – they failed to adopt measures to prevent a hidden epidemic at home." in 2016 france confirmed a further case of bse. in october 2015 a case of bse was confirmed at a farm in carmarthenshire in wales. in october 2018, a case of bse was confirmed at a farm in aberdeenshire, scotland, the first such case in scotland in a decade. the case was believed to be an isolated one, but four other animals from the same herd were being culled for precautionary reasons. scottish officials confirmed that the case had been identified as part of routine testing and that the diseased cow had not entered the human food chain. a number of other countries had isolated outbreaks of bse confirmed, including spain, portugal, belgium and germany. the ban on british beef the bse crisis led to the european union (eu) banning exports of british beef with effect from march 1996; the ban lasted for 10 years before it was finally lifted on 1 may 2006 despite attempts in may through september 1996 by british prime minister john major to get the ban lifted. the ban, which led to much controversy in parliament and to the incineration of over one million cattle from at least march 1996, resulted in trade controversies