report on pillar 1 activities - food and agriculture ... and csf (ipa project) to avoid duplication...

40th General Session of the EuFMD • 22-24 April 2013, Rome (Italy)

Report on pillar 1 activities Improving readiness for FMD crisis management by Members Eoin Ryan EuFMD Secretariat


• Capacity building for FMD outbreak investigations: the real-time FMD training programme

• Training in modelling and decision support tools for FMD contingency planning

• Support to the West Balkans and Moldova: training, gap analysis and proposal for future support

• Maintaining confidence in disease freedom in South-East Europe: Development of a risk based surveillance programme for Thrace Region

• Support to World Reference Laboratory for services needed in Europe and

the neighbouring region

• Bringing policy makers and FMD scientists together; the 2012 EuFMD Open Sessions at Jerez, Spain

Summary of pillar 1 activities since 39th General Session


Key achievement: Re-establishment of a cadre of European veterinarians with field experience of FMD outbreak investigations >200 vets from 36 member states trained • Programme started in 2009 in Erzurum, Turkey • 2011-13: training conducted in Nakuru, Kenya

• Trainers: Internationally recognised FMD experts • Trainees: state veterinarians, nominated by their CVOs • Local vets also trained – benefits flow both ways

Real-time training in FMD outbreak investigation

http://www.google.ie/imgres?imgurl=http://today.ttu.edu/wp-content/uploads/2009/04/kenya-map-3.jpg&imgrefurl=http://today.ttu.edu/2009/04/agricultural-educator-receives-fulbright-grant/&usg=__kshiNLj-7Bg-BtAd16IlYA0Xx08=&h=504&w=477&sz=100&hl=en&start=2&zoom=1&tbnid=UIVDRsUK4i015M:&tbnh=130&tbnw=123&ei=jSasTfHrLNSIhQf1oJiiCQ&prev=/images?q=nakuru+kenya+map&um=1&hl=en&sa=N&tbm=isch&um=1&itbs=1


Why do we need real-time training? Continuous risk of incursions into Europe

Clinical recognition is the key to early detection!

Key learning objectives:

1. On-farm outbreak investigation skills - Clinical examination, lesion ageing

- Correct sampling for diagnosis

- Use of clinical findings to support epidemiology

- Create timelines for tracing, prioritisation

2. Biosecurity awareness

3. Identify local risk factors


Real-time means... • Real outbreaks investigated (suspected and

confirmed) • Samples collected, tested and results obtained

within hours • Decision making with limited information • Using all skills and tools available • Investigative skills practiced • Working with uncertainty – how, why, when? • Pressure – and team work Monday: lectures, preparation Tuesday/Wednesday: field work Thursday: feedback, compile report, presentation Friday: wrap up


Field Training


Clinical examinations • Careful examination and lesion ageing • Correct sampling – which samples to take,

how to take them, how to preserve them for transportation

• Recording of findings • Create timeline for disease entry and spread • Biosecurity – practical application of the

principles – risk reduction at every step! • How can these findings support

epidemiological investigations?

• Use of penside tests for rapid diagnosis


Epidemiological investigations

• Identify the key issues to investigate

• What information should be recorded?

• How does disease spread, and how can it be traced?

• How can risk factors be rapidly identified – and what can be done to mitigate the risk?


Rapid Assessment of Local Risk Factors Why? Objective: teach trainees that there are risk factors for FMD spread which can be rapidly identified and used to target control actions. Relevance to decisions on control and surveillance in 3k and 10k zones during outbreaks in Europe What? Collect information on risk factors for local FMD spread, learn how to use this to inform decision-making. How? • Trainees are challenged to decide what information to collect

and why it will be useful. • EpiCollect smartphone app – developed by Imperial College

London, open source software, free to use. • Design questionnaire; input answers, collects GPS location • Data uploaded from smartphones to server; collated data can

then be downloaded as excel file & map • Facilitates rapid assessment of risk factors for local spread • UK used similar approach in 2007 – rapid case control study;

informed targetting of surveillance efforts


Clinical examination of the animal

• Open mouth, look in – check tongue, dental pad, nostrils

• Lift feet, look between digits

• Examine teats of cows/ewes • Take temperature of animal • Step back: look at whole animal • Any other signs? Could it be another disease? Discharge from eyes/nose? • Careful and thorough examination of animal essential! • Write down your findings, and link each sample taken with each animal

examined


Sampling from lesions • Lesion epithelium: richest source of FMDV, sample of

choice for diagnosis

• Samples from at least 5 animals with obvious lesions should be sufficient to confirm a diagnosis

• The most suitable materials are – Vesicular epi, vesicular fluid, heart muscle (myocarditis

cases) – For tissues

• At least 2 cm2 of epithelium from unruptured or freshly ruptured vesicles – fingernail sized amount

• Transport medium - equal amounts of glycerine and 0.04 M phosphate buffer pH 7.2-7.6

– For vesicular fluids (very hard to get!) • Plain, small volume tube


Lesion ageing and timelines Essential for tracing disease spread Lesion ageing: provides an estimate for duration and

weight of virus excretion from infected farm. Look for oldest lesion present; subtract incubation

period of 1-14 days (and “most likely” IP of 2-5 days) to generate window for introduction of infection.

Enables prioritisation of tracings – essential if

many contacts present and limited resources available to trace them.

Example from Kenya:


Real-time training: partnerships with others • EuFMD requested by Australian DAFF to train 80

Australians over 8 courses (funded by DAFF) • Training held in Nepal; four courses completed. • The funds provided by Australia have contributed to

expand EuFMD training services to EuFMD member states, thereby benefitting Europeans as well as Australians and Nepalese

• Vets from USA, NZ and Libya (self-funded) and Senegal (US-Identify project funded) have attended Kenya courses

• Training in field investigations also needed in endemic regions: skills of outbreak investigation, taking correct samples for diagnosis, etc are of critical importance


Key achievement: 16 vets from 8 countries attended workshop on the use of disease spread models & decision support tools for FMD contingency planning. Workshop held in Vienna, October 2012 – very positive feedback Menu of follow-up actions identified

Modelling and decision support tools for member states


Background 39th General Session, 27-28 April 2011

Survey results: • Less than 25% of EuFMD MS have used disease spread models or

resource management tools to inform contingency planning – Data to parameterize/build these models is widely available in most

countries

Recommendations: 6. Member states should consider the use of modeling tools as decision

making aids, while ensuring that the output of such models are clearly understood by decision makers with respect to uncertainty and sensitivity. Member states using such models should engage in comparisons with other states to constructively examine the issues affecting confidence in their use, and that support be given to assist countries to review the suitability of tools for their needs


Actions taken EuFMD Standing Technical committee drafted position paper on how best to address this recommendation (P. Willeberg)

Proposal: a series of workshops at 3 levels: 1. CVO workshop: hold first to determine level of interest, get feedback 2. Vet services-Contingency planners 3. Vet Services – modelers (maybe outside partner or contractor)

CVO workshop:, Denmark, June 2012: Outcome: •Support from CVOs for EuFMD proposal to hold a series of modelling workshops •Preference for a regionally-based format for the workshops •Workshops to focus on policy-making veterinary staff to enable them to interpret, question and commission models (“intelligent customer” training) •CVO Austria kindly offered to host the first workshop in October.


Vienna Modelling Workshop, October 2013 • Austria, Serbia, Croatia, Hungary, Slovakia, Slovenia, Czech

Republic, Malta

• Trainers: modelling expert (Colorado State, USA); vet policy expert working with models & FMD (USDA); vet contingency planning and operations expert (UK, retired)

• Trainees: senior state veterinarians, policy-making level

• Objective: enable trainees to commission and set-up modelling groups; understand the issues; data requirements; types of model; how models can be used for FMD contingency planning

• Facilitated cross-border discussions on contingency planning issues, including benefits of cross-border modelling exercises

• Positive feedback – but issue identified that some trainees felt they would not be able to make use of training due to lack of resources

• Dichotomy: some states very engaged, others less so


Outputs: training provided, laboratory gaps identified and proposal for Balkan FMD emergency preparedness network developed. • Vets from each West Balkan country trained in FMD recognition and outbreak investigation. • Laboratory gap analysis managed by WRL, funded by EuFMD, conducted for West Balkans. • Meeting held with West Balkan CVOs/deputies in Denmark in June 2012: identified key capacity

building needs. • EuFMD has coordinated with other EU-funded capacity building projects in the West Balkans on

rabies and CSF (IPA project) to avoid duplication and identify complementarities. • Laboratory network meeting on rabies & CSF attended at kind invitation of IPA project (self-funded

observer): very positive discussions with West Balkan lab experts re: FMD support.

Proposal for Balkan FMD emergency preparedness network


Key achievement: establishment of a program in Thrace for risk-based surveillance to aid early disease detection and to maintain confidence in disease freedom.

• Risk-based approach to surveillance will allow improved early

detection capacity and increased confidence in disease freedom. • Initial workshop held in Istanbul in September 2012 for three

countries, led by expert consultant.

• Follow-up workshop as side-event to Tripartite Thrace region meeting, Chania, February 2013.

• Surveillance activities to start soon; MoUs circulated, awaiting signature.

Risk based surveillance in Thrace region


Risk-based surveillance: why it is useful • Intuitive principles

1. Old surveillance loses value (value of a survey this month versus same survey one year ago…)

2. Confidence accumulates over time (ongoing surveillance activities)

• How to describe these effects quantitatively?

Probability of freedom: Pr(D- | S-) – Probability that the population is free from disease (at the design prevalence), given that

surveillance found no positive animals – Calculated using Bayes’ Theorem

• Contributing factors

– Surveillance sensitivity • Sample size, design prevalence, test Se, risk-based sampling

– Multiple surveillance activities • e.g. serosurveillance + passive reporting + abattoir

– Accumulation of historical evidence over time – Risk of introduction of disease over time


• Objective is no longer to regain FMD free status

• Provide ongoing evidence of freedom from disease

• Surveillance for early detection of disease incursions

- early detection surveillance must be continuous - design prevalence may be much lower than for demonstrating

disease freedom - high-risk sub-populations can be targeted, if risk factors

understood - risk factors relate to consequence of infection as well as

probability of infection


The effect of a survey with 95% sensitivity conducted every two years when the monthly risk of introduction of infection is 0.05. This frequency of surveillance is inadequate to achieve an ongoing high probability of freedom.

The same 2 yearly surveys, combined with two other ongoing surveillance components, each with a monthly sensitivity of 0.2 (for instance, passive reporting and abattoir surveillance).


Not all surveillance components need high sensitivity… • The same surveillance sensitivity may be achieved using tests of different

sensitivity, by modifying the sample size. • Target surveillance sensitivity of 95% (doing representative sampling from a large

population and using a design prevalence of 0.05):

Test sensitivity Sample size

0.99 60

0.95 62

0.90 66

0.80 74

0.50 119

0.20 299

• Cheap tests of low Se (e.g. clinical examination of abattoir inspections) => same surveillance Se as high Se but expensive lab tests

• Only applicable if enough animals are examined. • The overall cost of the low-Se test approach may be less


Risk-based sampling

Relative Risk Sample size 1.0 62

1.5 45

2.0 37

2.5 32

3.0 28

4.0 24

5.0 22

10.0 17

• More efficient approach to surveillance => able to achieve the same surveillance Se using smaller sample size

• Targets units with a higher risk of being infected • Two factors – the strength of the risk factor used & degree of targeting

95% surveillance Se, test Se 95% & design prevalence of 0.05

Proportion from high risk group

Surveillance sensitivity

0% 29% 10% 34% 20% 39% 30% 43% 40% 47% 50% 51% 60% 54% 70% 57% 80% 60% 90% 63%

100% 66%

RR 2, 20% pop in high-risk group, test Se 95%, design prev 0.05, total sample size = 10


0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1 P(free)

P…


Support to WRL, Pirbright

Key achievement: WRL proficiency test service is offered to all non-EU EuFMD member states and many neighbouring countries, with participation increasing from 2008 to 2012. WRL, Pirbright supported by EuFMD funds of USD150,000 per year for 2011/12, with similar support for 2013 being arranged.


EuFMD Open Session, October 2012 Jerez de la Frontera, Spain

• Key achievement: Bringing together policy makers and scientists at what has become the biggest FMD research meeting in the world

• A unique forum where scientists and policy makers can meet to discuss cutting edge FMD reseach

• Open discussions of how science can inform policy

• Over 220 delegates

• Over 70 oral and 30 poster presentations

• Multiple side-meetings and parallel sessions










Field training issues

Surveillance, preparedness and contingency planning issues

Discussion of the issues

report on pillar 1 activities - food and agriculture ... and csf (ipa project) to avoid duplication...

Documents