FOR LIVESTOCK PRIORITY TRANSBOUNDARY DISEASES
1. INTRODUCTION
Early, accurate warning of new outbreaks of epidemic livestock diseases, and particularly the spread of such diseases to new areas, is an essential pre-requisite to the effective containment and control of these diseases.
The EMPRES global early warning system aims to provide national animal health authorities with epidemiological information on the occurrence and spread of its high priority diseases, both on a routine and emergency basis. EMPRES will follow this up by providing advice and other support, where necessary, to enable countries to take appropriate and timely action.
2. BACKGROUND
Early detection, epidemiological analysis and reporting of outbreaks of epidemic diseases is often one of the weakest links in the chain of actions necessary to prevent, control and eradicate these diseases in many countries. At the worst extreme there have been cases where outbreaks of serious epidemic livestock diseases in new areas have not come to the attention of central veterinary authorities for several months. The diseases have thus been allowed to spread unchecked during this period, causing unnecessary production losses and making control and eradication of the disease more difficult and expensive, or maybe impossible. Failure to report new disease occurrences to neighbouring countries and trading partners either directly or through international organisations such as the OIE and FAO have meant that other countries have been unable to take the necessary steps to prevent the introduction of the disease.
Some of the common problems in early warning systems for serious epidemic livestock diseases include:
lack of farmer awareness programs on high threat epidemic livestock diseases and generally inadequate contact between field veterinary staff and farmers
disease reporting systems which are based primarily on passive reporting of outbreaks rather than active disease surveillance
inadequate training of veterinary and para-veterinary staff in the clinical and gross pathological recognition of epidemic diseases which may be either unusual or exotic for the country, the implications of delayed action, and the collection and transportation of appropriate diagnostic specimens
poor coordination of field and laboratory veterinary services
lengthy and over-complicated routine disease reporting chains and failure to institute an emergency reporting system for serious disease outbreaks
failure to establish confirmatory diagnostic capabilities for the target diseases within national laboratories
inadequate liaison with international reference laboratories and failure to send new virus strains from outbreaks to these laboratories on a regular basis for specialised antigenic and epidemiological analysis
lack of an epidemiology unit and expertise to analyse new disease outbreaks, including traceback and traceforward activities
failure to report new disease occurrences to appropriate international organisations, e.g. OIE, within an acceptable time.
lack of contingency planning and other emergency preparedness for epidemic diseases
3. EXISTING INTERNATIONAL DISEASE REPORTING MECHANISMS
The Office International des Epizooties (OIE) is the main international animal health organisation responsible for international disease reporting. there is a well established system for emergency reporting of List A diseases or diseases newly found in a country and a more routine reporting system for other defined diseases.
There are a number of other international disease reporting structures, which operate on a regional or global basis either for specific diseases or of a more general nature. these include ones run by WHO, PAHO, IBAR, European FMD Commission etc.
4. PRINCIPLES TO BE FOLLOWED IN ESTABLISHING THE EMPRES GEWS
4.1 Tightly focused.
It should be tightly focused on the EMPRES priority diseases. these are currently defined as rinderpest, foot and mouth disease, peste des petits ruminants, contagious bovine pleuropneumonia, Rift Valley fever and lumpy skin disease
It should utilise and build on existing national and international disease reporting structures and mechanisms and it should not attempt to impose another formal international disease reporting mechanism upon countries.
With this in mind, FAO should; develop the GEWS in close collaboration with OIE, complement what OIE does, and in no circumstance should the EMPRES GEWS merely duplicate the OIE system.
The EMPRES GEWS should differentiate its product by providing a complete package to countries.
4.2 Accurate and timely.
Training and other programmes should be carried out under the aegis of the EMPRES GEWS to help countries address the various problems that have been cited above in the background section.
In particular, emphasis must be given to helping countries implement active disease surveillance systems. This encompasses fully utilising all potential sources of information on disease incidents; well co-ordinated field and laboratory services; and active disease searching in the field.
This will become even more important during the advanced stages of disease eradication campaigns, e.g. the Global Rinderpest Eradication Programme, when it will become critical to detect remaining pockets of infection in an otherwise susceptible livestock population. In such circumstances it will be necessary to utilise a mix of techniques that includes such things as comprehensive seromonitoring, abattoir monitoring and incentive-aided disease searching.
FAO has a superb network of international contacts in the animal health and related fields and should utilise this to the maximum in obtaining timely information. This includes chief veterinary officers and other animal health officials; international reference laboratories as well as national veterinary laboratories; other international organisations; and FAO regional offices and country representatives.
4.3 Value added
The EMPRES GEWS should develop capabilities that will enable it to undertake comprehensive epidemiological analyses and risk assessments of EMPRES disease outbreaks which will form a solid platform for advising the outbreak country and neighbouring countries and trading partners on the most appropriate prevention and control actions.
The epidemiological analyses may include: antigenic and molecular analysis (nucleotide sequencing) of virus strains at reference laboratories, disease mapping, disease tracing, and consideration of epidemiological factors such as livestock movement patterns, livestock markets, climatic influences, maintenance hosts, immune status of livestock populations, insect vector population dynamics etc.
Initially it is envisaged that the epidemiological analyses will be descriptive, supported by disease mapping.
It should progressively incorporate other techniques such as geographical information systems (GIS), computer disease modelling and expert systems.
4.4 Action oriented
As part of the service provided to back up its GEWS, EMPRES should be prepared to provide advice and assistance to countries on request following early warning of an imminent disease threat.
The EMPRES GEWS must therefore be linked to EMPRES early reaction which could take many forms, e.g. FAO arranged visits by experts, technical co-operation programmes, quarantine advice, contingency plans, disease recognition and diagnostic assistance, vaccine sourcing etc.
In time, it is envisaged that a suite of'off the shelf' assistance packages could be developed.
4.5 Well presented
The EMPRES GEWS information could be promulgated to countries initially by a high-quality quarterly bulletin. This would contain maps of disease distributions and epidemiological analyses. It may also contain other articles and information relevant to EMPRES programmes.
This would be supplemented by emergency disease advice notices and more direct communications with affected and threatened countries as required.
4.6 Accessible
Various methods of promulgating information need to be explored - e.g. e-mail, internet etc.
However, the critical point is that the information must get to the key people who will use the information by the most direct and fastest route.
5. A POTENTIAL PROBLEM
At any one time, FAO EMPRES professional staff are likely to be in possession of information on disease occurrences which has not been officially reported by the animal health authorities in the concerned countries. This information will be from a range of unofficial and official sources and will be of variable reliability. However, from time to time EMPRES may think it important to publicise information, which it considers to be reliable, through its GEWS on new disease occurrences which have not been officially reported internationally by the veterinary authorities in the concerned countries. The information may not have been reported either because it has not come to the attention of the veterinary headquarters or because they do not want the information widely known for trade oŕ other reasons.
Such situations will need to be handled very carefully. It will not only be essential to verify any information before disseminating it internationally through the GEWS, but also to obtain the agreement of the chief veterinary officer for its release. Failure to do so may bring the GEWS to an early end.
This problem ċan only be overcome by a lengthy period of sustained contact and effort with chief veterinary officers and other livestock officials to build up their trust and confidence. EMPRES regional epidemiologists will be very important in this process. FAO training programmes, workshops, technical meetings etc. will also be key elements.
6. CURRENT STRENGTHS AND WEAKNESSES OF FAO IN RESPECT TO DEVELOPING THE EMPRES GEWS
6.1 Strengths:
excellent professional networks
laboratory linkages through reference laboratories and the Joint FAO/IAEA, Vienna
highly trained and experienced veterinarians in FAO AGAH
access to potential consultants, trainers
ability to organise workshops and other training programmes
back-up of FAO regional offices and country representatives
access to specialists and resources in many disciplines at FAO headquarters
capacity for follow-up action to reported disease outbreaks through TCP projects, consultants, trust fund projects etc.
some FAO response actions can be mounted extremely fast and with a minimum of bureaucratic obstacles
6.2 Weaknesses:
inadequate human and financial resources in the Infectious Diseases Group of AGAH to establish a sustainable EMPRES GEWS.
need for disease mapping and GIS expertise, hardware, software, space etc.
animal health presence in FAO regional offices is not strong at present
networking needs to be improved in some regions, e.g. South East Asia, Latin America
7. SUGGESTED ORGANISATION OF THE GEWS
The structure of the EMPRES GEWS should be organised at four levels:
7.1. A nominated liaison person within the animal health headquarters of each country within the early warning network.
These persons would be asked to act as the primary contact point for EMPRES activities (including the GEWS) within their countries. Ideally they would be senior animal health officers, well versed in modern epidemiological techniques and experienced in the planning and implementation of national disease control programmes.
It is envisaged that these EMPRES liaison persons would be provided with training in the concepts and practices of the EMPRES programme. Where appropriate, they may also be provided with communication equipment (e.g. facsimile, e-mail).
7.2 Regional FAO EMPRES-livestock Epidemiologists
These are the pivotal positions in the GEWS. Three, and eventually four, highly experienced epidemiologists should be appointed to cover the following regions: - Africa, Near East and Asia (and Latin America at a later date).
The Regional Epidemiologists would probably best be located at FAO regional offices, so that they may have the full backing of the support services that can be provided in these offices.
The Regional EMPRES Epidemiologists will, in close collaboration with national veterinary administrations and with other animal health professionals and organisations that are operating within regions, assist and advise national veterinary services to achieve the EMPRES objectives described in this document including regional support for GEWS. (See ANNEX V for job descriptions)
7.3 FAO reference laboratories and collaborating Centers
The roles of these institutions are already well defined. They will be important within the GEWS framework for confirmatory diagnoses and characterisation of outbreak strains; molecular epidemiology studies; research and training.
7.4 A central planning and coordination unit for the EMPRES GEWS within the Infectious Diseases Group, AGAH, FAO, Rome
A GEWS Unit should be established in the EMPRES group, within AGAH at FAO headquarters. In order to implement this a full time professional position should be created to manage this function. This would be for a highly qualified veterinary epidemiologist with very considerable experience in the epidemiological study of EMPRES priority diseases and also in modern disease surveillance and animal health information analysis technologies.
It is anticipated that the epidemiologist in charge of the GEWS in headquarters would not only be supported by the Regional Epidemiologists, but would also be supported by visiting scientists brought in for specific purposes, e.g. development of GIS and disease mapping systems. (see ANNEX V for Job description).
This central unit would have the responsibilities for:-
co-ordinating the EMPRES GEWS
coordination of programmes with the EMPRES early reaction unit
supporting the Regional EMPRES Epidemiologists
developing and implementing new systems, such as disease mapping, GIS, disease modelling, risk assessments and expert systems
planning of other research and training programmes
preparation of EMPRES GEWS bulletins and other relevant publications
liaison with other relevant international organisations, e.g. the OIE.
