06 June 2014 - Since the emergence of the novel influenza A(H7N9) virus in China in March 2013, the Food and Agriculture Organization of the United Nations (FAO) has been engaged in enhancing the preparedness of countries in Asia and Africa for a potential incursion of the virus. In the framework of these activities, FAO, the African Union's Interafrican Bureau for Animal Resources (AU-IBAR) and the Istituto Zooprofilattico Sperimentale delle Venezie (IZSVe) held an epidemiology and laboratory training workshop in Addis Ababa, Ethiopia, from 26 to 30 May 2014.
Epidemiologists and laboratory specialists from eleven African countries (Cameroon, Côte d’Ivoire, Democratic Republic of Congo, Egypt, Ethiopia, Ghana, Kenya, Nigeria, Senegal, Tanzania, and Zambia), along with experts from FAO, IZSVe and AU-IBAR were present. Participating countries, considered to be at low to moderate risk of influenza A(H7N9) incursion, were selected on the basis of: (i) presence of trade links with China, (ii) presence of a high density of poultry and (iii) history of previous infection with influenza A(H5N1) virus as the main criteria.
The fact that A(H7N9), unlike H5N1, causes no clinical signs in infected poultry complicates early detection of the virus through surveillance. This creates a need for routine risk assessments and effective collaboration between epidemiology units and laboratories for active surveillance. Primary objectives of the workshop were therefore to create opportunities for collaboration and partnership amongst key epidemiologists and laboratory experts at national and regional levels, but also to provide training on conducting: (i) risk analysis (including risk assessment, risk management and risk communication); (ii) value chain analysis; (iii) risk-based surveillance; (iv) virus isolation and characterization; and (v) field sample collection, transport and laboratory analysis.
Participants united for sessions during the first and last days of the training, but trained separately the remaining three days. Joint sessions focused on laboratory-epidemiology collaboration, challenges encountered and ways to resolve them, contingency planning and coordinated joint actions.
The epidemiology training focused on risk analysis and surveillance. Live bird trade and wild bird migration were identified as the most likely routes of introduction of A(H7N9) into African countries, with the risk-level being assessed as ranging from negligible/low to moderate. The importance of value chain analysis was emphasized for the identification of critical control points that can be targeted for the implementation of risk-based surveillance and control measures. Since appropriate communication is essential during the whole risk analysis process, guidance was provided with emphasis on how to improve communication of uncertainty, how to diagnose the public’s fear or outrage and why over-reassurance should be avoided even if tempting. For the laboratory experts, training on the diagnosis of A(H7N9), including appropriate testing protocols and algorithms, was provided at the National Animal Health Diagnostic and Investigation Center (NAHDIC), which is Ethiopia’s veterinary reference laboratory for avian influenza and Newcastle disease and acts as the Eastern Africa Regional Support Laboratory (RSL).
As several countries are engaged in controlling other diseases of major importance, and because the currently assessed risk-level for A(H7N9) introduction is considered negligible to low for most African nations, trainers demonstrated how the presented methodology for risk assessment, risk management, risk communication and risk-based surveillance can be adapted and used for other zoonotic or animal diseases, and how existing surveillance efforts can be utilized to also screen for A(H7N9).
The training was highly appreciated by participants who expressed a keen interest to apply the knowledge and skills learned in their national contexts.