progressive control pathway (pcp) and regional roadmaps ... · no circulation / containment zones...
TRANSCRIPT
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