The global strategy for prevention and control of H5N1 highly pathogenic avian influenza PDF
Preview The global strategy for prevention and control of H5N1 highly pathogenic avian influenza
THE GLOBALSTRATEGY FOR PREVENTIONAND CONTROL OFH5N1 HIGHLY PATHOGENIC AVIAN INFLUENZA March2007 Copyrightedma Copyrightedmaterial THE GLOBALSTRATEGY FOR PREVENTIONAND CONTROL OFH5N1 HIGHLY PATHOGENIC AVIAN INFLUENZA March2007 FOODANDAGRICULTUREORGANIZATIONOFTHEUNITEDNATIONS Rome,2007 Copyrightedmaterial Acknowledgements TheFoodandAgricultureOrganizationoftheUnitedNations(FAO)andtheWorldOrganisationfor AnimalHealth(OIE)acknowledgeandaregratefultotheWorldHealthOrganization(WHO)forthe closecollaborationandhelpfuldiscussionsinproducingthisthirdrevisionoftheGlobalStrategy, wzohoenroetbiyccpoortreencttilaylacdadnreasvseirntghtuhmeainssiulelsneosfsparnedveanthiuomnaanndpacnondtermoilcofavianinfluenzaviruseswitha Thedesignationsemployedandthepresentationofmaterialinthisinformationproductdonotimply theexpressionofanyopinionwhatsoeveronthepartoftheFoodandAgricultureOrganizationof theUnitedNationsconcerningthelegalordevelopmentstatusofanycountry,territory,cityorareaor ofitsauthorities,orconcerningthedelimitationofitsfrontiersorboundaries.Thementionofspecific companiesorproductsofmanufacturers,whetherornotthesehavebeenpatented,doesnotimply thatthesehavebeenendorsedorrecommendedbytheFoodandAgricultureOrganizationofthe UnitedNationsinpreferencetoothersofasimilarnaturethatarenotmentioned. ISBN978-92-5-105733-9 Allrightsreserved.Reproductionanddisseminationofmaterialinthisinformationproductfor educationalorothernon-commercialpurposesareauthorizedwithoutanypriorwrittenpermission fthriosmintfhoercmoaptyiroinghptrohdoulcdterfsorprreosvaildeeodrtohtehseorucrocmemiesrfculilaylapcukrnpoowsleesdigsepdrohRiebpirtoedduwcittihoonuotfwmraittetreinalin permissionofthecopyrightholders.Applicationsforsuchpermissionshouldbeaddressedtothe Chief,ElectronicPublishingPolicyandSupportBranch,CommunicationDivision,FAO,Vialedelle TermediCaracalla,00153Rome,[email protected] ©FAO2007 Copyrightedmaterial iii Contents Foreword V Abbreviations vii ExecutiveSummary ix Backgroundandrationale 1 THESTRATEGY 3 1-Thevision 3 2.Thepriorities 3 3.Strateqicdomains 4 3.1Theqlobaldomain 5 3.2Theregionaldomain 7 3.3Thenationaldomain 9 ANNEXES Annex1Situationanalysis 19 AllRegionalanalysis 19 At.2Socio-economicimpact 24 Annex2Lessonslearned 27 A2.1Riskfactors 27 A2.2LessonslearnedfromHPAIcontroltoolsandmethods 29 A2.3Lessonslearnedfromreqionalandqlobalcoordination 32 Annex3Partnershipsandimplementation 35 A3.1FAO'sGlobalProqrammeforHPAIPreventionandControl 36 A3.2OlE'sProgramme 36 A3.3Siqmficantmilestonesandexpectedoutputs 38 Thl8 On8 Foreword Sincethecurrentpanzooticofhighlypathogenicavianinfluenza(HPAI)causedbyvirusesof theH5N1sub-typefirstresultedintransboundarydiseaseinlate2003,itsubsequentlyspread fromAsiatoEuropeandbothNorthandWestAfricain2005and2006.Ithascausedhigh mortalitiesinaffectedpoultryflocks,withadditionallossesduetoculling.Farmersandtrad- ershavesufferedlossofincomeasaresultofmarketdisruptioncausedbycontrolactivities andalsomarketshockduetoconsumerconcernsforhumanhealth.ForFAO,OIEandothers concernedwithsecuringthelivelihoodsofdevelopingcountrycommunities,thisissufficient justificationinitselftomountamajorcampaigntopreventfurtherspreadofthedisease,con- tainthediseasewithininfectedareasandprogressivelyworktowardsitseradication. However,itistheconcernforhumanhealth,particularlythethreatofahumaninfluenza pandemic,thathasdrawnworldattentiontoHPAIandstimulateddonorstosupportHPAI controlandpreparednessmeasuresforpandemichumaninfluenzaItisgenerallyaccepted thatthemostimportantelementinaddressingthethreatofhumanpandemicinfluenzaisto controlHPAIinpoultry,thuslimitingopportunitiesforexposureofhumanstothevirusand minimizingthepossibilityfordevelopment,throughadaptivemutationorreassortment,of aviruswiththepotentialtospreadeasilyfromhumantohuman, FollowingpublicationofFAORecommendationsonthePrevention, Controland EradicationofHighlyPathogenicAvianInfluenza(HPAI)inAsiainSeptember2004,the FAO/OIEGlobalStrategyfortheProgressiveControlofHighlyPathogenicAvianInfluenza (HPAI)wasfirstproducedinNovember2005.Sincethen,therehasbeenfurtherspreadof H5N1HPAIandasubstantialriseininternationalsupport,withanotableincreaseinactivi- tiesfundedthroughthegenerosityofalargenumberofdonors,includingnationalgovern- ments,andinternationaldevelopmentbanksanddevelopmentagencies,includingFAO. TheOIE/FAOpublicationEnsuringGoodGovernancetoAddressEmergingandRe-emerg- ingDiseaseThreats-SupportingtheVeterinaryServicesofDevelopingCountriestoMeet OIEInternationalStandardsonQuality(lastupdatedinAugust2006),providesguidelineson limitingthespreadofepizooticdiseases,includingHPAI.Capacity-buildingformedthemain elementforelaborationofstrategiesfortheprogressivecontrolofHPAIinaffectedcountries andpreventionofthedisseminationofthediseasetounaffectedcountries. Althoughthereremainseriousgapsinknowledge,therehasbeenanincreased understandingofthediseaseduringthispanzooticandexperiencewithvariouscontrol approacheshasallowedrefinementofstrategiesattheglobal,regionalandnationallevels. Therevisedglobalstrategypresentedhereisbasedontheexperienceandlessonslearned fromtheinvolvementofFAOandOIEintheglobalcontrolofH5N1HPAIoverthelastthree yearsTherevisedstrategyprovidesthelong-termvisionandgoals,identifiesprioritiesand strategicapproaches,andproposesshort-,medium-andlong-termactionsatnational, regionalandgloballeveltocontrolandultimatelyeradicatethedisease ThisstrategyhasbeendevelopedbyFAOandOIE-incollaborationwithWHOandanum- berofexpertsfromOIE/FAOreferencelaboratories-togiveaclearvisionfortheirapproach andtocommunicatethatvisiontoimplementingpartners,donorsandotherstakeholders. Copyrightedmaterial Abbreviations ASEAN AssociationofSoutheastAsianNations AU-IBAR AfricanUnionInter-AfricanBureauforAnimalResources CMC FAO/OIEAnimalHealthCrisisManagementCentre DPRK DemocraticPeoples'RepublicofKorea ECO EconomicCooperationOrganization ECTAD FAOEmergencyCentreforTransboundaryAnimalDiseases EMPRES-i FAOinformationsystemfortransboundaryanimaldiseases FAO FoodandAgricultureOrganizationoftheUnitedNations GF-TADs FAO/OIEGlobalFrameworkforTransboundaryAnimalDisease Control GLEWS FAO/OIE/WHOGlobalEarlyWarningSystem HongKongSAR HongKongSpecialAutonomousRegionofPRChina HPAI highlypathogenicavianinfluenza H5N1 sub-typeofinfluenzavirus(H5haemagglutmin,N1neuraminidase) LaoPDR LaoPeoples'DemocraticRepublic OFFLU OIE/FAONetworkofExpertiseonAvianInfluenza OIE WorldOrganisationforAnimalHealth PRChina Peoples'RepublicofChina RT-PCR ReverseTranscriptionPolymeraseChamReaction(real-timelaboratory techniquefordetectingviralnucleicacid) PVS OIEPerformance,VisionandStrategy(toolforevaluationofnational veterinarysen/ices) SAARC SouthAsianAssociationforRegionalCooperation TADs transboundaryanimaldiseases UNDP UnitedNationsDevelopmentProgramme UNEP UnitedNationsEnvironmentProgramme UNICEF UnitedNationsChildren'sFund UNSIC UnitedNationsSystemInfluenzaCoordination WAHIS OIEWorldAnimalHealthInformationSystem WHO WorldHealthOrganization Copyrightedmaterial ix Executive Summary TheFAO-OIEGlobalStrategyfortheProgressiveControlofHighlyPathogenicAvian Influenza(HPAI)wasfirstdevelopedbyFAOandOIEincollaborationwithWHOinresponse toarecommendationfromtheFAO/OIERegionalMeetingonAvianInfluenzaControlinAsia (23-25February2005,HoChiMinhCity,VietNam)ThestrategypreparedinNovember 2005wasfocusedpredominantlyoncontrolofthediseaseinEastandSoutheastAsia,Since then,theH5N1HPAIsituationhasevolveddramatically. ThediseasehasspreadwidelyinAsia,CentralandEasternEurope,theNearEastand Africa,culminatinginthecurrentsituationthatisdescribedinAnnex1.AsofDecember 2006,itwasestimatedthatover240millionpoultryhaddiedorbeenculledworldwide duetoH5N1HPAI.Thewidespreadnatureofthedisease,itsmountingsocio-economic impact,theincreasingnumberofhumaninfectionsanddeathsandthepotentialthreatof humanpandemicinfluenzacontinuetounderlinetheneedforaglobalapproachtoH5N1 HPAIpreventionandcontrol.TherevisedGlobalStrategypresentedheretakesintoaccount theaccumulatedexperienceofnational,regionalandglobaleffortstodateandthelessons learnedfromvariouseffortstocontrolthedisease(summarizedinAnnex2). GLOBALPROGRESSINHPAICONTROL SuperficialappraisalindicatesthatHPAIhasspreadsincelate2005toaffectmanymore countries.However,inreality,effortsoverthisperiodhavebeenlargelysuccessfulbothin improvingtheHPAIsituationinpreviouslyinfectedcountriesandincontrollingoreliminating thediseaseinnewlyinfectedcountries. ThesituationhasimprovedgreatlyinChina,whereoutbreaksarenowmostlylimitedto certainareasofthecountryProgressinThailandandVietNam,bothofwhichexperienced ahighincidenceofoutbreaksinpoultryandaccompanyinghumaninfectionshasbeen substantial,withoutbreaksinpoultrynowgreatlyreducedandalmostcompletesuccessin preventinghumandisease.IndonesiahasstruggledtoestablishappropriateHPAIcontrol mechanismsbutsystemsarebeingdeveloped,withsupportfrommanydonors. India,Pakistan,Afghanistan,Myanmar,RepublicofKoreaandJapanhaveallexperienced outbreaksofHPAIthatwereeffectivelycontrolled,althoughinsomecountriesre-introduc- tionofdiseasehasoccurred.MostofthecountriesexperiencingoutbreaksinCentralAsia, EasternEuropeandtheMiddleEastwerealsoabletoeliminatethediseasealthoughagain therehavebeensomerecentfreshoutbreaksofdiseaseintheRussianFederation,Hungary andTurkey.InAfrica,EgyptandNigeriaarebothfacingsubstantialchallengesinachieving effectivecontrolofHPAI;theydeserveparticularinternationalassistance,sincesuchendemi- callyinfectedcountriesrepresentthehighestriskbothforperpetuationofthediseaseand forpossibleemergenceofvirusstrainswithhumaninfluenzapandemicpotential. LESSONSLEARNEDFROMTOOLSANDMETHODSUSEDFORHPAICONTROL Riskfactors Ithasbecomeclearthatcountrieswithwelldevelopedveterinaryservices,withstrongearly Copyrightedmaterial diseasedetectionandresponsecapacities,caneffectivelycontrolandeliminateH5N1HPAI. Countriesthathavehadmostdifficultyinachievingeffectivecontrolarethosewithweak veterinarycapacitiesandthatfacemajorriskfactorssuchashighpoultrypopulationdensi- tieswithpoorbiosecurity,particularlyrelatedtolargesmallholderproductionsectorsand substantialduckpopulations.Internalmovementofpoultry,particularlythroughlivebird marketsandillegalmovementacrossinternationalborders,aremajorcontributorstospread ofthedisease.Migratorywaterfowlhavebeenimplicatedinglobalspreadofthedisease, althoughtheepidemiologicalsignificanceofH5N1virusinfectionofwildbirdsandother species,includingpigsandcats,isnotwellestablished. Diseasesurveillance Ithasbecomeevidentthatmanycountrieslacktheexpertisetodevelopandimplement effectivenationalHPAIsurveillanceplansandtocollectandanalysedata.Theseweak- nesseshavecompromisedeffortstoclearlyunderstandspecificriskfactorsanddisease epidemiology,poultryproductionandmarketingsystems,andtoproperlyassessvaccination programmes.Additionaltechnicalsupportisrequiredtostrengthennationalcapacitiesand suchsupportmustbecomplementedbyfurtherstrengtheningofnetworksforinformation collection,analysisanddisseminationatregionalandgloballevels.Limitedaccesstocom- pensationfundsandinefficientpaymentmechanismsdiscouragefarmersfromreporting suspiciousdiseaseoccurrence. Laboratorycapabilityandcapacity Nationalveterinarydiagnosticlaboratorycapacitiesareoftenpoorlydevelopedand resourced.OIE/FAOreferencelaboratorieshavemadeasignificantcontributioninsupport- ingnationallaboratoriesbutadditionalsupportisneeded,especiallyattheregionallevel. Thereneedstobeimprovedsharingofvirussamplesandsequenceinformationgloballyand thereareopportunitiesfornationalpublichealthandveterinarylaboratoriestocollaborate morestrongly. Containmentofoutbreaks Whilestampingouthasprovedeffectiveforcontainingisolatedoutbreaks,effortsarecom- promisedbyweaknessesinpoultrymovementcontrolandsurveillancearoundoutbreaks. Thereisaninadequateknowledgeandcapacityforsafeandhumanecullinganddisposal ofinfectedpoultry.Astheincidenceofoutbreaksincreases,diseasecontrolauthoritiescan rapidlybecomeoverwhelmedthroughlackofresources. Vaccination VaccinationhasbeenaneffectiveresponseinreducingHPAIincidenceandvirusloadinthe environment,thusminimizingtheriskoffurtherspreadandhumanexposuretoinfection. Planningmustanticipatethereinstallationofclassicalcontrolmeasuressuchasstamping outwhenthenumberofoutbreaksislow.Vaccinationhasprovedveryeffectiveinhigh-risk countrieswherere-introductionofdiseaseislikely,butitmustbeconductedinaccordance withguidelines,involvevaccinesofassuredqualityandbeaccompaniedbyappropriate monitoringofimmuneresponseandinfectionstatusofvaccinatedflocks. Copyrightedmaterial Adjustmentofpoultryproductionandmarketingchains InAsiancountrieswherethediseasehasbeenpresentforalongperiodandwherethe greatestcombinationofriskfactorsarepresent,experienceindicatesthatstampingout ofinfectedflocksprovidesshort-termimprovementsinHPAIstatusbutdoesnotguaran- teelong-termfreedom.Appropriatechangesareneededinpoultrydiseasemanagement practicesonfarmsandtohigh-riskmarketingpracticessuchasuncontrolledmovementof poultrythroughlivebirdmarkets. Communication Communicationservesasafacilitatingmechanismforbuildinganenablingenvironment, throughwhichtheglobalstrategyforthepreventionandcontrolofHPAIcanbesuccess- fullyunderstoodandimplemented.Inaddition,despiterecognitionoftheimportanceof publicawarenessandconsiderableeffortsmadetodate,therehasbeenonlylimitedsuccess inachievingthebehavioralchangesrequiredtocontrolHPAI.Ithasbecomeveryevident thatover-reactionofcommunitiestoHPAIcanhaveanadverseaffectonpoultrymarkets. Balanced,consistentandscientificallysoundmessagesareneededtopromotesafepoultry productionpracticesandappropriateconsumercaution,withoutprecipitatingunduemarket disruptions. MOVINGTOAREVISEDSTRATEGY Experienceandlessonslearnedattheglobal,regionalandnationallevelsincontrolling H5N1HPAIpermitrevisionoftheglobalstrategywithgreaterunderstandingoftheissues thatneedtobeaddressedandthemeansofachievingprogressThestrategyidentifies internationalinitiativesatglobalandregionallevels,andapproachesthatareappropriatefor nationalimplementation,ingeneraltermsbutalsoinlinewiththeHPAIstatusofindividual countries. THEVISION ThestrategyenvisagesaworldwithgreatlyreducedthreatofH5N1virusinfectioninpoul- try,leadingtoreducedpublichealthrisk,securednational,regionalandglobalmarketsand tradeinpoultryandpoultryproducts,andprotectionofanimportantelementoftheliveli- hoodsofpoorfarmingcommunities. THEPRIORITIES Toachievethisvision,threeprioritiesrelatedtocountryHPAIstatusmustbeadoressed concurrently: •Inthesmallnumberofendemicallyinfectedcountries,particularattentionmustbe giventoreducingtheincidenceofHPAI. •Incountriesinwhichsporadicoutbreaksarecurrentlyoccurring,intensiveeffortsto eradicatethediseasemustbesupported;giventhecurrentdiseasesituation,thisis possible. •Incountriesparticularlyatriskofincursionorincountriessufferingsevereconse- quencesasaresultofincursion,HPAIpreparednessandcapacityforearlydetection andresponsemustbeimproved. Copyrightedmaterial
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