Following the Progressive Control Pathway Melissa McLaws ADED Rounds Sept 2015 Presentation Outline Background EuFMD Foot and Mouth Disease FMD FMD in W Eurasia Progressive Control Pathway PCPFMD ID: 1045133
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1. Surveillance and Control of Foot and Mouth Disease: Following the Progressive Control PathwayMelissa McLawsADED Rounds Sept 2015
2. Presentation OutlineBackgroundEuFMDFoot and Mouth Disease (FMD)FMD in W. EurasiaProgressive Control Pathway (PCP-FMD)Principles, StagesApplication in W. EurasiaOther applicationsLessons learned
3. Key MessagesFMD is challenging to controlNeed multi-disciplinary approach including economists, sociologistsPCP is a framework to facilitate this approachUseful for other diseasescomplementary to OIE tool for evaluation of Performance of the Veterinary Services (PVS)
4. AcknowledgementsEuFMD: Keith Sumption, Chris Bartels, Jenny Maud, Fabrizio Rosso, Eoin Ryan, Kees van Maanen, Carsten Potzsch, Gunel IsmayilovaFAO/OIE FMD working group: G Ferrari, S Metwally, J Domenech, J Pinto, N Leboucq, L Weber-VintzelVeterinary Services: Georgia, Iran, Israel, Palestine, Turkey and other W. Eurasia countriesEUFMD Commission member statesEC (DG-SANCO –Trust Fund; Alf Füssel)FAO World Reference Laboratory (WRL) Pirbright (D Paton, D King)Supporting centres: EUFMD Secretariat staff (N Rumich, C Carraz, I DAlessandro, E Tomat )FAO Ankara
5. Introduction to EuFMDEuFMD is a Commission of the Food and Agriculture Organisation of the UN (FAO) (established 1954)Established to support member countries (37) in the European region to prevent and/or control FMDActions coordinated through DG SANTE of the European Commission
6. AETIOLOGYFamily: PicornaviridaeGenus: AphthovirusSeven serotypesMultiple strainsInactivated by heat, and low/high pH Moderate/low environmental persistenceCan survive in animal productsAOAsia1CSAT2SAT3SAT1What is FMD?Slide from David Paton
7. Cloven hoofed animals are susceptible:Cattle, sheep/goat, PigsBuffalo, Deer, ...Acute vesicular diseaseClinical signs: milk drop, salivation, lamenessSAT1What is FMD?Clinical presentation
8. Highly contagious because...Wide host rangeHigh morbidity but low mortalityVirus shedding before clinical signsHigh viral shedding, low infective doseSubclinical infections (sheep)Pigs shed very high quantities of virusWhat is FMD?
9. GEOGRAPHIC DISTRIBUTIONAsia – serotypes O, A, Asia1Africa – serotypes O, A, SAT1, SAT2, SAT3Different regions – specific strains
10. FMD in “free” countries
11. FMD IMPACTS IN “FREE” COUNTRIESFMD free countriesUK 20016.5 million animals slaughteredGBP 3.1 billion direct costsGBP 3.6 billion indirect costs(Anderson Enquiry, 2002)Korea 2010-11Three incursions (2 serotypes)3.5 million animals culled12 million animals vaccinatedTotal costs in $billions (~ $ 3 billion for farmer compensation costs alone)
12. Incursions between 1992 and 2003FMD INCURSIONS TO ‘FREE’ AREASOutbreaks in officially free countries/zones 2004-2014CountryYearArgentina2006BotswanamultipleBrazil2005/6Bulgaria2011Japan2010KoreamultipleNamibiamultipleParaguay2012Sth Africa2011UK2007
13. FMD in endemic countriesOccurs commonlyClinical signs can be much less severe than in naive populationOften complex: multiple serotypes and strains
14. FMD in endemic countriesReview of published serosurveillance results http://www.slideshare.net/ILRI/serosurveillance-fmd
15. FMD IMPACTS IN ENDEMIC COUNTRIESDirect production losses:Reduced milk yield, growth rates, loss of draft power, some deathsIndirect losses:Cost of controlTrade restrictionsEstimate: annual global impact of FMD in terms of production losses and vaccination costs alone are in the region of 5 billion US dollars (Rushton, J et al, 2012) .
16. FMD in West EurasiaDiverse region: 14 countries including ex-USSR, Turkey, Iraq, Iran, Pakistan, Afghanistan3 serotypes circulating (O, A, Asia 1)Movement of viruses from East to West
17. XXXXXXXXXWest EurasiaSimplified summary and conjectured routesO/ME-SA/PanAsia-2A/ASIA/Iran-05Asia-1O/SEA/Mya-98O/ME-SA/PanAsiaA/ASIA/Sea-97SAT2O/ME-SA/Ind2001??A: 2013Spectrum of vaccines required to cover different threatsO/ME-SA/PanAsia-2 (2010-12)A/ASIA/Iran-05 (2012)Slide from Don King: WRL
18. FMD in West EurasiaSource: 2015 W. Eurasia Roadmap meeting
19. Outbreaks in Turkey: 2001-2012
20. FMD in Iran: Jan 2013-Feb 20151381 outbreaks reported between April 2014- March 2015Source: Darab Abdolahi from Iran Vet Organisation
21. Control in endemic countriesVaccinationMovement controlBiosecuritySurveillance and monitoring
22. Challenges for controlHighly contagiousVaccine immunity: Short-lived No cross-protection between serotypes and variable between strains within serotypesLack of resourcesIncentives often missingAt national and individual levels
23. The Progressive Control Pathway for Foot and Mouth Disease (PCP-FMD)Joint FAO-EuFMD-OIE tool, in use since 2008Framework to progressively increase the level of FMD controlKey tool of FAO-OIE FMD Global Strategy
24. The Progressive Control Pathway for Foot and Mouth Disease (PCP-FMD)5 StagesEach with well-defined outcomes which may be achieved through a variety of activities (NON-prescriptive approach)Risk analysis principlesMake best use of limited resources
25. The Progressive Control Pathway for Foot and Mouth Disease (PCP-FMD)Regional roadmap meetings held regularlyRegional coordination and info exchangePCP progress assessed, peer review Assessment of what Stage a country (or zone) is in is evidence based and transparent
26. West and South Eurasia RoadmapSAARC RoadmapS. Africa RoadmapE. Africa RoadmapPCP based projects supporting the Hemispheric Plan for Eradication - PHEFACountries in the SEACFMD2020Roadmap
27. Stage 1 : Gain understanding of epidemiology and develop risk-based approach to reduce FMD impactPCP-FMD Stages
28. Stage 1 : Gain understanding of epidemiology and develop risk-based approach to reduce FMD impactForeseen activities/outcomes:Estimate FMD incidenceIdentify circulating strainsRisk assessment along value chainSocio-economic impact assessmentFMD strain identificationDevelop risk-based FMD control strategyRequired to progress to stage 2PCP-FMD Stages
29. Template: Risk-Based Strategic Plan for FMD ControlIncludes all relevant issues in one document to enable an integrated approach (socio-econ, risk hotspots, monitoring etc)Available at:http://www.fao.org/ag/againfo/commissions/eufmd/commissions/eufmd-home/progressive-control-pathway-pcp/en/Six chaptersPCP-FMD Stages
30. Stage 2 : Implement risk based control measures such that the FMD impact is reducedOngoing risk assessment PLUS risk managementMonitoring system essential to:Demonstrate reduction in FMD impactMonitor implementation....and prove that reduced impact is related to the control measuresTo progress to Stage 3:A revised, more aggressive control strategy that has the aim of eliminating FMD from at least a zone of the countryPCP-FMD Stages
31. Stage 3: Progressive reduction in incidence, followed by elimination of FMD virus circulationRapid detection and response for ALL outbreaks Needs stakeholder engagement to ensure rapid detection and response (incl compliance with movement controls)NB: Once a country has entered the GF-TADs–supported PCP-Stage 3 and has decided it wants to continue along the pathway to Stage 4 and beyond, implicating the intention to eradicate FMD virus from the domestic animal population, it may ask for formal OIE-endorsement of its national FMD eradication programmePCP-FMD Stages
32. PCP Stage 4 Focus“To maintain ‘zero tolerance’ of FMD within the country or zone and eventually achieve OIE recognition of FMD-free with vaccination”PCP-FMD Stages
33. PCP Stage 5 Focus“To maintain ‘zero tolerance’ of FMD within the country or zone and eventually achieve OIE recognition of FMD-free without vaccination”PCP-FMD Stages
34. PCP in W. EurasiaFirst applied here- Roadmap meeting in Shiraz, Iran in 2008
35. QomEffective control HERE can prevent spread downstreamUnderstanding animal movement patterns can be critical for planning effective FMD control Stage 1 examples: Value chain mapping in Iran
36. Movements of pig and pig meat in Armenia (mapped by workshop participants)Putting together national info to get a regional pictureStage 1 examples: Value chain mapping in TCC
37. Corrected for known risk factorsUncorrectedCan be useful to target control Baseline for comparison after interventions introducedUsing NSP-ELISA to identify FMD prevalence Stage 1 examples: Baseline serosurvey in IranPreventive Veterinary Medicine 2015 May 1;119(3-4):114-22.
38. Risk-based FMD Control Strategy Development
39. PCP Stage 1 –developing national strategy- with national ownership
40. Stage 2: focus on monitoringFMD virus is injected in the tongue of a cow to test for the potency of the vaccineImplementationImpact
41. Stage 2: focus on monitoringStrong need and demand for training, especially in epidemiology
42. Stage 3 and beyondNeed for improved contingency planningKazakhstan: zone free-without-vaccinationTurkish Thrace recognised as free-with- vaccinationOngoing collaboration with Warwick University to develop a disease spread model for Turkey‘communities’ identified through network analysis (from Peter Dawson)
43. Regional coordination through W. Eurasia Roadmap meetingsReported Vaccination coverage: 2014Vaccination schedulesW. Eurasia database: vaccination and outbreaks
44. Lessons learned from implementing PCPFocus on fundamentals:difference between ‘disease’ (clinical effect) and ‘infection’ (virus)establish vaccine quality assuranceManagement issues are important: planning, prioritising, monitoringinter-departmental FMD task forcetrying to reach out to field level: district, local vets, farmer associations, NGOs.
45. Lessons learned from implementing PCPPCP-FMD is about changing mindsets: Support decision makers to make changesTo embed this mindset in organisations with relatively high turn-over of staffHow to make best use of our limited resourcesInfrastructure to collect, validate, analyse data is often not in place Difficulty to change from monitoring on inputs (administrative, often in place) to outcomes
46. Lessons learned from implementing PCPFMD as a pilot: Applicable for control of other diseases as wellSimilar frameworks now developed for rabies, PPR
47. Stepwise Approach towards Rabies Eliminationhttp://caninerabiesblueprint.org
48. Global control and eradication of peste des petits ruminants Investing in veterinary systems, food security and poverty alleviationStagewise Approach for PPR
49. Thank you for listening!Questions?