Diagnostic approach, vaccination and treatment priorities for Lumpy Skin Disease in cattle: lessons from Balkan epidemics to Western Europe re-emergence (2025).

Lumpy skin disease (LSD) remains a high-impact, transboundary infection of cattle driven by capripoxvirus transmission via mechanical vectors, causing morbidity, production losses, and trade disruption. Following the 2015–2017 Balkan epidemics, coordinated high-coverage vaccination campaigns and movement restrictions substantially reduced disease transmission across southeastern Europe. However, the recent re-emergence of LSD in Western Europe in 2025, including outbreaks reported in Italy, France, and Spain, demonstrates that regional elimination remains fragile and requires sustained preparation. This review evaluates the evidence across three practical pillars of outbreak management: diagnostic approach, vaccination strategies, and clinical/therapeutic care. Particular emphasis is placed on vaccination strategies used in field control programs, including mass vaccination, targeted and emergency (ring) vaccination, as well as the comparative performance of homologous live-attenuated Neethling vaccines and heterologous sheep and goatpox vaccines. Emerging inactivated and DIVA-compatible vaccine approaches are also discussed, together with field-level determinants of vaccine effectiveness, such as vaccination coverage, campaign timing, booster policies, cold-chain integrity, and the monitoring of adverse reactions. Based on lessons learned from European epidemics, we propose a phase-based decision-making framework that integrates rapid diagnosis, emergency vaccination, surveillance, and vector management to reduce morbidity and limit onward transmission. Because no licensed LSDV-specific antiviral therapy is currently available, treatment remains primarily supportive. It includes early detection and isolation, anti-inflammatory and antipyretic therapy, hydration and nutritional support, wound and mastitis management, and judicious antimicrobial use for secondary bacterial infections. In addition, we review emerging experimental evidence suggesting that several herbal, conventional, and antiparasitic compounds may represent promising candidates for future therapeutic approaches against LSD. Moreover, the further spread of LSD in Russia and the Middle East has been suggested to be associated with disruptions in vaccine attenuation processes, together with operational constraints affecting compliance and policy implementation in 2025.