The overview was presented through the EMPRES concept paper which had been elaborated by AGAH. This was adopted by the consultation as representing the basic concept for EMPRES. However, the consultation stressed the need for a clear definition of the transboundary animal diseases that the programme should address; the need for a clear mission statement; and a strategy which identifies areas of for strategic activities and those for tactical involvement by EMPRES. These were further elaborated during discussions on early warning and early reaction.
4.1.1 EMPRES-transboundary diseases.
The Experts affirmed their support for the objective of the animal diseases component being confined to transboundary diseases which were defined as:
those that are of significant economic, trade and/or food security importance for a considerable number of countries; which can easily spread to other countries and reach epidemic proportions; and where control/management, including exclusion, requires co-operation between several countries.
The consultation stressed furthermore that EMPRES should be seen to have a clear vision and therefore a statement of the mission of EMPRES was deemed necessary. The following was recommended as suitable:
To promote the effective containment and control of the most serious epidemic livestock diseases as well as newly emerging diseases by progressive elimination on a regional and global basis through-international co-operation involving EARLY WARNING, EARLY/RAPID REACTION, ENABLING RESEARCH and COORDINATION.
220.127.116.11 Early warning -
was identified as all disease initiatives, which predominantly would be based on epidemiological surveillance, that would lead to improved knowledge of the distribution of disease or infection and that might permit the forecasting further evolution of an outbreak.
18.104.22.168 Early reaction-
was identified as all actions that would be targeted at rapid and effective containment leading to elimination of a disease outbreak, thus preventing it from turning into a serious epidemic. This should include contingency planning and emergency preparedness.
22.214.171.124 Enabling Research and Coordination -
the consultation welcomed the identification of research as a prime element of EMPRES and wished to commend the qualification given as Enabling Research to emphasize the collaboration between FAO and scientific centres of excellence in directing research efforts towards problem solving.
The fourth element should be viewed as either coordination of global eradication for an identified animal disease, such as rinderpest, or encouraging regional initiatives for eradication of a given transboundary animal disease.
4.1.3 Disease categories.
The consultation emphasized the need to group transboundary diseases which require EMPRES attention into three categories.
126.96.36.199 Diseases which are of strategic importance to the programme. These were identified as rinderpest, contagious bovine pleuropneumonia and foot-and-mouth disease.
188.8.131.52 Diseases which require tactical attention by EMPRES, the most prominent of which were identified as Rift Valley fever, peste des petits ruminants (PPR), lumpy skin disease and Newcastle disease of poultry.
184.108.40.206 EVOLVING or EMERGING diseases.
The consultation drew the attention of FAO to the recent worsening state of infectious diseases both in animals and man. Thus certain infectious diseases have extended geographically into new territories - e.g. Rift Valley fever into Egypt and West Africa, PPR in Asia, capripox (lumpy skin diseases, goat and sheep pox), African swine fever - certain others appear to have gained in importance either as a result of changes in the farming system or changes in the character of disease or its causative agent - examples include Newcastle disease in rural chickens in Asia and Africa, porcine reproductive and respiratory disease syndrome (PRRS) - while certain others might be classified as truly emerging rather than evolving due to either newly identified aetilogical agents or uncharacterised agents. Examples of the last category include bovine spongiform encephalopathy (BSE), Enterohaemorrhagic E coli (EHEC), Lyme disease, Borna disease, Morbillivirus infection of aquatic animals, Distemper infection of lions, Encephalomyocarditis infection of pigs and game animals, Equine paramyxovirus (morbillivirus?), Orbivirus of kangaroos (blindness), camel respiratory disease in the Horn of Africa. While not all these can be classified as of major economic importance at present and therefore, would not always merit immediate intervention through early reaction or other FAO mechanisms, the consultation felt that the EMPRES Global Early Warning System should have an awareness capability and should be positioned to advise member countries as appropriate.
4.1.4 Suggested Priority rating for EMPRES
The consultation developed the following scoring system for each disease/category against the prime elements of EMPRES in order to indicate a priority rating for EMPRES involvement:
EMPRES PRIORITY DISEASE RATING
|EMPRES Element||Rinderpest||CBPP||FMD||Geograph. ext.(eg. PPR,RVF)||Temporal extension (eg.RVF)||Changing character (eg.Newcastle disease, PRRS)||Uncharacterised aetiology (eg.BSE, Vector-borne)||Human health (eg. RVF, rabies)||Total Score EMPRES ELEMENT|
|Encourage Regional Coordination||5||5||5||2||0||0||0||0||17|
The Expert Consultation was preceded by a Technical Consultation on the ‘World Without Rinderpest’, which was held on 22–24 July at FAO Headquarters. The Technical Consultation, which covered all aspects of the Global Rinderpest Eradication Programme and which made a series of recommendations related to GREP (see Appendix 2), provided the foundation for the deliberations of the Expert Consultation. The Proceedings of the Technical Consultation should be read in conjunction with this report.
Although significant progress has been made towards rinderpest eradication in Africa and India, several problem areas for the disease remain and the potential exists for further epidemic spread through largely susceptible livestock populations. The Expert Consultation was firmly of the view that whilst this potential for virus spread persists, rinderpest constitutes a serious threat to food security and that this fact should be brought to the attention of the World Food Summit to be held at FAO in November 1996.
The main outcome of the Expert Consultation was the development and adoption of a blueprint for global rinderpest by the year 2010 (Appendix 3). This blueprint provides a detailed timetable for eradication of the disease within individual countries and regions which should allow all countries to be verified free of the disease by 2010 or even up to three years earlier. Strict adherence by all countries to the OIE pathway for achieving and verifying freedom from rinderpest virus infection will be critical. The Expert Consultation stressed the important role that EMPRES will have in helping countries to follow the OIE pathway and to finally document and present cases for OIE recognition of rinderpest freedom.
The blueprint also sets out a logical framework for the global rinderpest eradication programme which defines the roles and terms of reference for the GREP Coordination Unit at FAO, Rome and Regional Rinderpest Coordination Units. The Expert Consultation noted that, whilst there is a regional coordination unit in Africa (PARC) and one is about to be established in South Asia (SAREC), there is no regional rinderpest coordination unit to cover the most important regions of West and Central Asia. EMPRES needs to quickly rectify this deficiency.
The Expert Consultation considered that, whilst OIE has developed and adopted a pathway for demonstration of national freedom from rinderpest infection, further work needs to be done on the mechanisms for declaration of regional and global rinderpest freedom. In this context it was considered that the model adopted by WHO for regional declaration of poliomyelitis freedom is worthy of investigation for possible use with rinderpest.
In reviewing the current world situation for PPR, the Expert Consultation noted with concern the major spread of the disease over the last few years through Asia into the Indian Subcontinent. PPR is seen as a significant cause of losses in small ruminants as well as being a complicating factor for rinderpest eradication campaigns. Although a specific PPR vaccine has been developed, it is not yet available for field use. Rinderpest vaccines have been used to protect sheep and goats against PPR in some circumstances.
The epidemiological pattern of PPR appears to be very different from that of rinderpest but requires further study. No country has yet embarked on a large-scale PPR control programme. It was felt that EMPRES should facilitate studies to determine the current epidemiological situation for PPR and to develop appropriate control and eradication strategies for future use.
The Expert Consultation reviewed the global FMD situation. It noted the regions of the world where the disease is absent and those where there are programmes aimed at controlling and eradicating the disease. It further reviewed the regions where the disease is sporadic or endemic and the actions which would be required to promote the control and eradication of the disease.
In the discussion, the following points were highlighted:
the need to control FMD in endemically infected areas to protect cattle in order to promote increased milk production,
the need to increase epidemiological investigations and surveillance in certain strategically important regions of the world so that appropriate disease control strategies can be formulated (these areas include European Turkey, Central Asia, China and Myanmar,
the need to routinely characterise the strains of virus circulating among buffaloes in Southern Africa to ensure that nearby livestock are appropriately vaccinated, and
the need for establishment of a regional FMD reference laboratory in South East Asia and of a system for independently verifying the quality of vaccine used there
The Expert Consultation concluded that:
the glóbal eradication of FMD in the short term (by 2010) is not an achievable goal,
eradication of FMD from the Americas and Europe are probable achievable goals,
eradication of FMD from other regions where the disease sporadic or endemic will require considerable expenditure and deployment of manpower resources and should be viewed as long term goals.
The current world status for CBPP was reviewed. The Expert Consultation expressed concern about the major spread of the disease in Eastern and Southern Africa over the last few years and noted that these and West Africa remain the major problem regions for CBPP. However CBPP also persists in the Iberian Peninsula and the current situation in South Asia needs to be clarified.
Concern was expressed on the inadequacy of currently available vaccines, which either lack immunogenicity or cause unacceptable reactions.
The Expert Consultation was of the opinion that CBPP is amenable to eradication on a regional and global basis and that it should be the next disease in the ‘pipeline’ for consideration for a global eradication programme after rinderpest. However it was felt that this should not be initiated until the successful conclusion of the global rinderpest eradication programme.
Attention was drawn to a number of research needs for CBPP. These included:
Disease - further research into the pathogenesis of the disease, immunity and mechanisms of resistance,
Diagnosis - development of a test to reliably detect subclinical CBPP and of a field diagnostic teat,
Microbiology - study of strain variation and specificity,
Vaccines - development of new safe and potent vaccines that have the correct balance between lack of virulence and immunogenicity. A vaccine that provides single dose protection for more than one year is required. Better methods of potency assessment of vaccines is also needed, and
Chemotherapy - a better definition of its role in CBPP control and eradication programmes.
Rift Valley fever, being a mosquito borne disease, is not eradicable within the foreseeable future, but can be prevented in domestic animals by immunisation. The disease is still confined to Africa but has the potential to spread to other regions.
Outbreaks of RVF are usually explosive, but are generally separated by long inter-epidemic periods. In Southern Africa it is considered that outbreaks are presently impossible to predict, but in Kenya some promising work has been done using satellite remote sensing. It is also likely that some advance warning of spread of RVF into new areas, e.g. along the Nile Valley into Egypt, may be possible.
The Expert Consultation concluded that the main role of EMPRES in respect to RVF should be in providing early warning of possible RVF outbreaks to countries where practicable and in helping countries to be prepared to respond to such outbreaks. A key component of this is access to effective vaccines, either through facilitation of vaccine banks or through contractual arrangements with vaccine manufacturers.
Lumpy skin disease has a complex but poorly understood epidemiology and there is no foreseeable prospect for eradication of the disease. The consultation noted that this disease had spread from its traditional areas of Southern and Eastern Africa to West African countries where it had caused considerable losses in the msuhrooming peri-urban dairy farms. The aetiologically related disease of small ruminants (sheep and goat pox) had also extended geographically in the Middle East in some Central Asia Republics. Prevention can be readily and effectively achieved and this is the only control option in endemic and epidemic situations.
It was considered that EMPRES can assist in promoting research into the epidemiology of this disease and by identifying potential suppliers of high quality LSD vaccine and negotiate with them mechanisms for guaranteed availability of vaccine for emergency use.
The consultation considered that the growing importance of Newcastle disease in village chickens in Asia and Africa warrants this disease to be included in the priority list for EMPRES diseases.
The discussion papers prepared on the subject plus a draft project document and the concept paper on the EMPRES-Global Early Warning System prepared by the EMPRES Group provided background material. The consultation stressed that effective control of epidemic diseases and the present phase of GREP require that a concerted effort be made by EMPRES to promote the concepts of early warning and early reaction at national level. At the same time there is need for a structured global system led by FAO in close collaboration with other international organizations. The consultation stressed the need for EMPRES to develop a series of information packages to member countries and also to the donor community.
The concept papers were adopted as the basis for developing the programme. The consultation emphasized the need for close collaboration with the OIE in developing the EMPRES-GEWS in view of the complementarity between the proposed activities for the EMPRES-GEWS and the information system of OIE. The consultation viewed the proposed EMPRES-GEWS as filling an important gap. However, it was important for EMPRES to move fast into modern disease mapping and computer-based decision support systems in developing GEWS and early reaction systems.
The priority rating of EMPRES activities was discussed in detail and this has been summarized under section 3.1.4 above.