Appendix 5

“New tools and challenges for progressive control” Open Session of the EuFMD Research Group, Vienna (Austria) 29 September - 1 October 2010

[1] Prepared by:

Sumption K (1) , BenYoussef, A (1), Potzch, C (1), McLaws, M (1) , Ferrari G (2) and

Lubroth J (2) ,

(1) European Commission for the Control of Foot-and-Mouth Disease (EuFMD), FAO, Rome, Italy, (2) EMPRES Animal Health, AGAH, FAO, Rome, Italy

Regional Roadmaps and the Progressive Control Pathway

(PCP): - lessons learnt in promoting monitoring and risk based

FMD management in endemic regions of Eurasia

Stages 0-3

= infected countries/zones

Risk not controlled Continuous FMDV circulation

Critical risk points identified, strategy being developed

Critical points addressed incidence

Approaching freedom Outbreaks < once / year

Officially free with vaccination No circulation / containment zones only

0

1

2

3

4

Officially free without vaccination No circulation / containment zones only 5

The challenge

To initiate monitoring of FMD in all

countries considered endemic

To support countries interested to

develop (or improve) their FMD

risk management

To enable countries to compare

their FMD risk management

progress

To create a system that fairly

rewards progress in reducing risk

→→PCP-FMD

Progressive

Control Pathway

for FMD

Global Control through Regional Roadmaps for each

of the seven virus pools

a recommendation of the 2008 Open Session of the

EuFMD research group

7 virus pools recognised by the OIE/FAO FMD lab

network

differ in FMDV antigenic types/required vaccines, risk factors

and control capacities, requires tailored approach

FAO follow-up has been to develop the PCP approach –

first applied at the Shiraz Regional Workshop in

November 08

Virus pools and Regional Roadmaps

SEVEN FMDV virus pools - common strains/ risk

Regional Roadmaps exist - for South-East Asia (SEAFMD

campaign) and South America

NEW - West Eurasia Roadmap -since 2008

African Roadmaps (3) developed 2009

Gaps – South Asia (Pool 2), implementation (Africa)

1

2 3

5

4

6

7

The Progressive Control Pathway PCP)

for FMD control

developed by FAO in 2008

pathway leading from “”endemic”” towards “free status””

applied in West Eurasia, and for developing Roadmap for

Africa ;

enables assessment of country progress

within a Region

between Regions

self-assessment at National level

provide progress indicators for donors/investment

under study by OIE as a major tool in a Global Approach

(FAO/OIE)

2010 Session – brings PCP practitioners and methods

developers together - considers uptake of refinements into

PCP practice

Sessions to come –

PCP in Practice 1: Lessons from application, relevance to free regions (5 speakers)

PCP in practice 2: Methodologies – monitoring, identification of intervention points (6

papers)

Lab services needed for each stage:

Diagnostics session (E. Brocchi, K van Maanen)

Epidemiology Sessions: relevant to control strategy development (PCP Stage 1-2)

Vaccine development, control, vaccination campaign monitoring:

Relevant to improving PCP Stage 2 (monitoring programmes for control and eradication)

FAO Consultative Group (expert) meeting on the PCP: next week (4-6th October)

OIE Scientific Commission - considering the PCP criteria and may set up recognition

process for national control strategies that aim at eradication (PCP Stage 3)

Appendix 5

“New tools and challenges for progressive control” Open Session of the EuFMD Research Group, Vienna (Austria) 29 September - 1 October 2010

Conclusions

• The Progressive Control Pathway (PCP) for FMD is a FMD risk based

management approach which has wide applicability at national to

regional scale;

• More technical work is needed :

– On Stage 1, to improve identification of critical risk control points, and socio-economic aspects of strategy optimisation;

– On Stage 2 , to include both “”disease control”” and “”pro-eradication”” as valid management options

– Monitoring vaccination campaigns – what indicators to use?

– define criteria and assessment processes

– identify assessment criteria for quality of national FMD risk management (Stage 2)

– validate the approach in Stage 2 countries

– resolve issues on sharing (sero-) monitoring data (which has regional-global value)

Conclusions/2

Need for more “political work” –

With OIE, on recognition of National FMD Pro-Freedom

Control Strategy (= recognition of PCP Stage 3)

International application in Roadmaps,

Processes for evaluation of country progression

Risk not controlled

Continuous FMDV circulation

Critical risk points identified,

strategy being developed

Critical points addressed

incidence

Approaching freedom

Outbreaks < once / year

Officially free with vaccination No circulation / containment zones only

0

1

2

3

4

Officially free without vaccination No circulation / containment zones only 5

FAO Progressive control pathway

- risk reduction approach

•not a top down prescribed approach: but each MS encouraged to

develop national risk reduction strategies that are supportive to the

regional effort

Stages 0-3

= infected countries/zones

NOT an official status

the common feature of all stages is the

measurement of FMD infection/circulation in the population at

risk

the difference is the level of control of transmission/risk

Wide variation in effectiveness of

national FMD management

Herd immunity Effectiveness of Quarantine of

infected groups Epidemic

potential

High

High

The four PCP Principles

The PCP approach is based on the following principles:

1. active monitoring for FMDV circulation is the basic requirement of a control

program, and therefore common action in all stages

- the monitoring of outcomes (indicators of control), within a national FMD management system,

is required at the higher stages;

2. activities in each PCP stage should be appropriate to the required reduction

in virus circulation and risk of disease to be achieved;

3. activities and their impacts in each stage are measurable, comparable

between countries, and generate information and potential benefits at

national as well as to international stakeholders;

4. the optimisation of use of scarce resources for FMD control through the

targeting of measures to the husbandry systems and critical risk points

where the impact on disease control and/or virus circulation will be greatest;

Stage 0: risk not controlled

Criteria: no systematic FMDV monitoring system in past 12 months

Stage 0: characteristics

when:

level of virus circulation (prevalence in serological studies) has not been

studied in past 12 months;

and/or: outbreaks occur every year

and: the impact of control measures (vaccination, quarantines) on virus

circulation is not studied or measured

Risk not controlled

Continuous FMDV circulation

Appendix 5

“New tools and challenges for progressive control” Open Session of the EuFMD Research Group, Vienna (Austria) 29 September - 1 October 2010

Stage 0:

West Eurasia in 2009

many countries!

whether vaccinating or not

countries that

[deliberately?] do not

report FMD ....and do not

report results of

serological surveys are

automatically in Stage 0

Stage 0 in red

Lessons learnt

Stage 0 Criteria -

clear

Countries do not wish

to remain in Stage O

political incentive to

undertake Stage 1

Stage 1: critical FMD risk points assessed, national

strategy under development

Main criterion: systematic information gathering on FMD circulation

to define possible high risk groups and critical control points

Stage 1: characteristics

when:

level of virus circulation (prevalence - NSP positives) has been studied

in past 12 months, and indicates virus circulation has occurred

the critical risk points associated with the major husbandry/marketing

chains are being identified ;

and:

a strategy is under development to address the CRP

Critical risk points identified,

strategy being developed

Stage 1 – low cost

serological survey to identify incidence and risk groups

identify FMDV strains

identify Critical Control Points (CCP)

identify capacity to control and identify willingness to pay

develop strategy

provides valuable surveillance data for risk assessment

therefore Stage 1 activities of regional value

adm0

adm2 cauc BZ

admin2_baseline08

NSP_prev

0 %

> 0 - 20%

> 20 - 40 %

> 40 - 60 %

> 60 %

not sampled

Regional NSP situation – four country sero-survey Sampling Mid-2008 in 6-24 month animals (true prev.)

Critical control points..........

Appendix 5

“New tools and challenges for progressive control” Open Session of the EuFMD Research Group, Vienna (Austria) 29 September - 1 October 2010

Lessons learnt

• Keep principles simple, easy to communicate

• Ensure sufficient depth

• Analyse production systems at risk/Market chains first?

• Before designing sero-surveys?

• Application Practiced

• (FAO Projects): – 5 Central Asian Countries

– Bhutan (2010)

– Egypt (2010)

• Successes, great improvement in information base - but strategy development?

• What about countries not wishing to progress ? (to implement control)

• Can they remain in Stage 1? -a case for requiring minimum monitoring?

Stage 2: FMD under control, circulation is

progressively reduced

Main criterion: FMD control strategy has been implemented and monitored (repeated sero-surveys)

Stage 2: characteristics when:

each new outbreak(s) is investigated and potential sources identified

level of virus circulation (prevalence in serological studies) has been studied repeatedly for at least 24 months, and evidence of FMDV exposure found in each survey

the risk associated with the major husbandry/marketing chains identified, and strategies implemented for each ;

and: the impact of control measures (vaccination, quarantines, measures at borders) on virus circulation is being measured

Critical points addressed

incidence

Stage 2: can be high cost

usually involves vaccination

but does not prescribe national mass vaccination

expected that some countries will choose not to effectively

implement Stage 2

lack of economic incentives and finance

importance of regional political pressure and support

potential incentives: FMD controlled compartments/commodity

based trade

Vaccination is often not enough.....

very high Ro of virus

high vaccination cover rarely

enough

gaps remain

critical control points need to

be addressed - stop virus

finding gaps

Kevenlik, Turkey: June 4th, 2009

Stage 2: issues

• Should we differentiate between “disease” and “”pro-eradication””

management options?

– Or is this only real difference between what is acceptable (incidence

/trend in critical groups)

• Measuring impact of measures - use of indicators and tolerances (e.g

acceptable levels of vaccination performance)

• Can we –should we –compare key indicators across countries

(harmonisation?: post-vaccination, incidence surveys?)

• Stage 2 Criteria –include expectations of national decision making

processes ?

– Issues include decentralisation of FMD management

• Application : targetting control measures : new, difficult for decision makers

• Need to validate approach -examples include I.R of Iran, Turkey

Stage 3: Approaching freedom; effective prevention and

containment measures

main criterion: FMD outbreaks are exogenous (no continual circulation)

Stage 3: characteristics when:

each new outbreak(s) is shown to originate outside of the country or zone, not originate within;

level of virus circulation (prevalence in serological studies) has been studied repeatedly for at least 24 months, and evidence of FMDV exposure found but being restricted to limited foci or limited time periods;

each cluster of infection or outbreaks have a plausible explanation, through outbreak tracing;

each outbreak or evidence of infection is followed up by immediate measures and post-outbreak surveillance, and review of the impact of control measures (vaccination, quarantines, measures at borders)

Approaching freedom

“FMD Events” < once / year

Appendix 5

“New tools and challenges for progressive control” Open Session of the EuFMD Research Group, Vienna (Austria) 29 September - 1 October 2010

Stage 3:

This is where early warning and response are critical

Surveillance, rather than monitoring – new events require

response

Therefore : - contingency planning is critical

access to vaccine reserves/banks for emergency

Control of incursions requires prevention (border..)

rapid response to risk

ability to regulate animal movement;

example:

several North African countries in response to the type A Iran 05

incursion into Libya in 2009

Stage 3: lessons

Some countries claim to be in Stage 3 (but cannot supply

sero-monitoring evidence - therefore annual assessment

resulted in downgrade)

Possible recognition of this Stage by OIE as a “recognised

control strategy” (aimed at eradication/freedom)

Proving every outbreak/cluster is an incursion – emphasis on

invetigation and molecular typing

Proving short lived circulation; focus on serosurveillance

capacity

Some countries with continual, short lived incursions (cannot

control borders) – really should be Stage 2?

PCP and Roadmaps –application

West Eurasia (Virus Pool 3)

Roadmap -14 countries -developed 2008

1st assessment of progress – October 2009

progress on track to achieve 2020 Vision

Subsaharan Africa (Virus Pools 4-6)

Continental Roadmap - developed January 2009 (Nairobi1

meeting)

composed of three subregional Roadmaps

progress in year 1 mainly to establish FMD Lab networks (part of

information base)

formidable obstacles !

Progress meeting late 2010

West EurAsia Roadmap for FMD Control:

Vision : freedom from clinical disease by 2020

Regional cooperation among

Eurasian countries ...............

for the progressive control of FMD

through public and private

partnerships

leading towards freedom of

clinical disease by 2020 for

regional economic

development, food security,

and poverty alleviation.

Progress in 2009

10 of the 14 countries undertook sero-monitoring program in

2009

TUR, GEO,AZB, ARM, IRAN (pilot areas), PAK, AFG, UZB,

TAJIK, IRAQ

results pending: Syria, Turkenistan

breakthrough - first FMD reported serosurveys in several

countries

high incidence in all (5-10% yearly exposure) except UZB

incentives largely project driven – but no country wants to be

seen as lagging in the Roadmap Annual Progress meeting

Negative progress: two countries “downgraded”” - on lack of

monitoring evidence submitted

Appendix 5

“New tools and challenges for progressive control” Open Session of the EuFMD Research Group, Vienna (Austria) 29 September - 1 October 2010

West EurAsia Roadmap- country Stage position following

the Progress Review of 2009,

and expected progression to 2020

FINAL assessment of country Stage position for 2009, together with the expected progression to 2020. (Chart2)

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Comment

Kazakh

Kyrgyz

new

2009 assessment - no evidence provided of

FMD seromonitoring system therefore Stage 0,

assumed 2, 3 and 5 years to move through to

Tajik new progress to stage 1

Turkmen

Uzbek new progress to stage 1

AFG new progress to stage 1

IRN

PAK new 2009: progress to stage 1. Progress to Stage 2 expected in 2012 at earliest (FAO assessment) based on normal expectation of 3 years in Stage 1 for a large country.

TURK new progress to stage 2

Thrace (TR) new dossier to OIE in 2010

added zones

(TR)

Syrianew

Syria considered to be in Stage 1 in 2009 with

reporting of seromonitoring expected in 2010,

Iraq

Armenia

Azerbaijan

Georgia

pending new

2009 : re-assessed as Stage 1, expect enter

Stage 2 in 2011

West

Eura

sia

by 2020, all at least in Stage 3

PCP criteria and processes

Subject of the FAO Consultative Group meeting in Pirbright,

October 4-6th

criteria – tested in 4 workshops/surveys

surveillance principles developed

require refinement, validation

technical developments

Through application in FAO and other projects in 3 continents

Ideas emerging in this Session

linkage to OIE

Under study; recognition of Stages, link to PVS

criteria for progress could include PVS evaluation and follow-up

2009 2020

Africa Roadmap progression to 2020

– after Nairobi and Algiers Workshops

Agreed timetable for Africa

Countries 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Algeria

Egypt

Libya

Mauritania

Morocco

Tunisia

Benin

Burkina

Faso

Cote

D'Ivoire

Gambia

Ghana

Guinea

Guinea-

Bissau

Liberia

Mali

Niger

Nigeria

Senegal

Sierra

Leone

Togo

Cameroon

Cape Verde

Central

African

Republic

Chad

Congo

(Dem. Rep.

of the)

Congo

(Rep. of the)

Equatorial

Guinea

Gabon

Sao Tome

and Principe

Djibouti

Eritrea

Ethiopia

Kenya

Somalia

Sudan

Tanzania

Burundi

Rwanda

Uganda

Angola ?? 4/5 4/5

Botswana 3z/5 3z/5 3z/5 4/5 4/5 4/5 4/5 4/5 4/5 4/5 4/5 4/5

Comoros

Lesotho 5 5 5 5 5 5 5 5 5 5 5 5

Madagascar

Malawi 4/5

Mauritius

Mayotte

(France)

Mozambique

4/5

Namibia 4z/5 4z/5 4z/5 4z/5 4Z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5

Reunion

(France)

Seychelles

South Africa

4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5 4z/5

Swaziland 4/5

Zambia 4z/5 4z/5 4z/5 4z/5

Zimbabwe 0 0 1 1 1 1 3 3 3 3 3 4z/5

By 2020, there will be sufficient control of FMD in Africa to enable the livestock sector to participate in local, regional, sub-continental, international trade, and contribute to improved food security and livelihoods.  In this regard, obtain by 2010 th

 

Vision statement agreed at the Final Plenary Session, 30th January N Z

Vision statement for North Africa agreed at the OIE General Session, 26th May (Paris) Level 0

Level 1

Level 2

Level 3

Level 4

Level 5

Weste

rn A

fric

aC

entr

al A

fric

aE

ast

Afr

ica

Nort

h A

fric

aS

outh

Afr

ica

Africa Roadmaps

to 2020

Expected PCP

progression,

North,

West/Central,

East and

Southern Africa

(Nairobi Workshop,

Jan 09 and Algiers,

Feb 09)

PCP and global FMD intelligence

• If enough countries implement PCP Stage 1 or above,

– countries in a region can act on the risk

– Global level: improved information for risk assessment based on

incidence and virological threat

– What level of PCP application needed - for sufficient regional

and global “”viral intelligence”” monitoring?

– How many countries per Pool would be enough?

– How often to repeat sero-monitoring? ( if the country does not

intend to progress to control?)

– High potential for PCP take-up to address regional –and

global information gaps

Appendix 5

“New tools and challenges for progressive control” Open Session of the EuFMD Research Group, Vienna (Austria) 29 September - 1 October 2010

Acknowledgements

EUFMD Commission member states

EC (DG-SANCO –Regional workshops)

FAO ( J. Lubroth, G Ferrari, J Pinto)

J. Domenech

OIE (G. Bruckner)

African Union-IBAR (Pan African Workshop)

FAO World Reference Laboratory (WRL) Pirbright (D Paton,

Jef Hammond)

Supporting centres:

EUFMD Secretariat staff (Nadia Rumich)

RAHCs in Nairobi, Bamako, Beirut, Tunis, Gaborone, Nepal