DYNAMICS OF FMDV STRAINS EMERGENCE AND SPREAD WITHIN REGIONS; PROGRESS AND GAPS TO ACHIEVE RAPID THREAT DETECTION
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1 DYNAMICS OF FMDV STRAINS EMERGENCE AND SPREAD WITHIN REGIONS; PROGRESS AND GAPS TO ACHIEVE RAPID THREAT DETECTION Melissa McLaws, Chris Bartels, Nick J. Knowles 2, Mo Salman 4, Keith Sumption 1 New Delhi, February 2012
2 Pool 3: FMD Endemic or multiple Epidemics? Epidemic: higher FMD incidence than usual, unpredicted New epidemic waves emerge every 1-2 years in Eurasia FMD notifications in Pool 3: Number of FMD Notifications per month in Eurasia source: OIE and WRL databases (FMD Bioportal) Jan 1990 Jan 1992 Jan 1994 Jan 1996 Jan 1998 Jan 2000 Jan 2002 Jan 2004 Jan 2006 Jan 2008 Jan 2010 Jan 2012 Date
3 FMD notifications in Pool 3: O Unknown Jan 2010 Jan 1990 Jan 1992 Jan 1994 Jan 1996 Jan 1998 Jan 2000 Jan 2002 Jan 2004 Jan 2006 Jan 2008 Jan 2010 Jan 2012 Jan 1990 Jan 1992 Jan 1994 Jan 1996 Jan 1998 Jan 2000 Jan 2002 Jan 2004 Jan 2006 Jan 2008 Jan 2012 Can we Predict these epidemic events?? and so... Prepare Prevent Number of FMD Notifications per month in Eurasia source: OIE reports and WRL (FMD Bioportal) A Asia 1 3P s Date
4 Recent FMD Events in W. Eurasia Serotypestrain A-Iran-05 (11 sublineages) O-PanAsia-2 (7 sublineages) First detected Asia 1 Late 2008: Pakistan Epidemics 2003: Iran ? Iran, Turkey India , 2010 (Iran 2005) Iran, Turkey ongoing Iran, Turkey Associated Factors Vaccines not protective (A- Iran-96, then A22) -increased animal movement (meat prices) -waning immunity from last O epidemic -decreased protection from vaccine -Shamir vaccine not protective --no natural immunity (previous incursion in 2004)
5 Sub-lineages of A-Iran-05 A-Iran-05 ARD-07 Turkey A-Iran-05 A-Iran-05 EZM-07 A-Iran-05 AFG-07 A-Iran-05 BAR-08 A-Iran-05 FAR-09 Afghanistan 2007, 2010 Iran Pakistan Bahrain 2009 Turkey 2011 Afghanistan 2009 Iran Bahrain 2008 Iran 2009 Iraq 2009 Kuwait 2009 Turkey Lebanon 2009 Libya 2009 Pakistan 2009 Turkey 2009 Iran Afghanistan 2004, 2007 Turkey , 2009 Saudi Arabia 2005 Jordan 2006 Pakistan 2006 A-Iran-05 KSS-09 Turkey A-Iran-05 PAK-09 A-Iran-05 ESF-10 A-Iran-05 HER-10 A-Iran-05 SIS-10 A-Iran-05 QAZ-11 Pakistan 2009 Iran Afghanistan Iran Pakistan 2011 Turkey 2011 Iran 2011 Afghanistan 2010 Pakistan 2010 Iran Iraq 2010 Turkey
6 Sub-lineages of O-PanAsia-2 O-PanAsia-2 TER-08 Turkey 2008 O-PanAsia-2 YAZ-09 Pakistan 2006 Iran O-PanAsia-2 BAL-09 Afghanistan Iran 2010 O-PanAsia-2 Afghanistan 2004, 2007, Azerbaijan 2007 Bahrain 2008 Egypt 2007 Iran Israel Jordan 2006 Kazakhstan 2007 Kuwait 2008 Pakistan Palestinian Auto. Terr Saudi Arabia Turkey United Arab Emirates 2007 O-PanAsia-2 FAR-09 Iran Saudi Arabia 2009 Turkey 2010 O-PanAsia-2 SAN-09 Turkey O-PanAsia-2 PUN-10 Pakistan 2010 Iran O-PanAsia-2 ANT-10 Iraq 2010 Afghanistan Bahrain 2011 Bulgaria South Ossetia 2011 Israel 2011 Kuwait 2011 Libya Pakistan Turkey United Arab Emirates
7 O PanAsia 2: Large surge in outbreaks in Turkey and Iran in w1/09 w13/09 w26/09 w40/09 w1/10 w13/10 Week w26/10 w40/10 w1/11 w13/11 Iran outbreaks Turkey outbreaks
8 FMDV Asia 1 Postulated Spread * Ardahan Aug 2011 Indian lineage Pakistan 2008 lineage Alternative routes Alborz, Qom & Tehran Jan-Feb 2011 Bahrain Feb 2011 Bahrain Apr 2009 Kerman Jan 2011 Faryab Feb-Mar 2011 Kabul Mar 2011 Punjab Dec 2010 Sindh Dec 2008 to May 2011 India km 300 mi Daniel Dalet / d-maps.com * Based on samples and information submitted to the FAO World Reference Laboratory for Foot-and-Mouth Disease
9 How can we reduce the impact of these epidemics? Detection and monitoring of threats Early recognition of events/epidemics Effective and feasible mitigation options Prevention and control
10 Threat Threat (Merriam-Webster): 1 : an expression of an intent to do harm 2 : something that threatens 3 : an indication of something impending In this case, the threat is a situation that increases the chance of an event (in this case, an epidemic)...but the event hasn t happened YET
11 Threat detection Routine monitoring of indicators: Host: Level of immunity Agent: Vaccination-generated Previous infection New strains how know which will cause greatest impact? Increased virulence, infectiousneess Low vaccine matching Environment: Animal movement patterns: related to price differentials, festivals Regional FMD situation...events in neighbouring countries
12 Monitoring: the Host Iran 2010: Proportion of epi-units vaccinated per district Naive animals Waning immunity Population turnover Need to follow over time Correlation of vaccination coverage with immunity?
13 Monitoring: the Agent How identify a priori which strains pose greatest threat? Prone to spread, high virulence Vaccine Matching Results : FMD Pool 3 Based on VNT perfomed at WRL A (Tur 06) Asia-1 (Shamir) O (Manisa) Match No Match
14 Monitoring: the Environment Large scale animal movements price differentials could be indicator Events in neighbouring countries: Regional communication, networks (lab & epi) Prices (in USD per kilo) for live cattle and beef (young male animals) Country Live Meat Turkey Iran Georgia Armenia ,4 Azerbaijan 4 4,5 6,2 6,5
15 Threat detection in practice: 2010 WRL Report Notably, an Asia 1 epidemic may be due in EurAsia, since cases are occurring in Pakistan, whilst other countries including Iran and Turkey with high levels of circulating O and A viruses will by now have a low population immunity to this serotype (last seen in 2004). Increased imports and movements of live cattle and small ruminants into and through the Middle East from Africa and through new trade routes may also increase the risk of African strains being introduced.
16 What should the response to threats be?? Will depend on: Sensitivity, specificity and predictive value of alert system...how likely is an event and How serious would that event be?? May include: Vaccine development Expensive, takes time Increased biosecurity Especially effective when threat is time-limited (eg festivals) Enhanced surveillance...facilitate early event detection Communication, enhance awareness: locally & regionally
17 Event recognition Early detection to facilitate early response Detection is National responsibility Routine monitoring & surveillance essential... Real-time Must define what is normal to recognize what is not normal Need high quality data over time 100 Turkey: : 1613 outbreaks : 181 outbreaks wy All outbreaks Serotype O Serotype A Untyped
18 Event recognition: Define criteria to trigger further investigation Increased number of cases reported Could be automatic algorithm Requires good reporting system for suspect cases FMD in Iran Oct 2010-Dec 2011: Clinical reports and serotypes by month Lab-confirmed samples per serotype Number of outbreak reports O A Asia Clinical outbreak reports
19 Event recognition: Define criteria to trigger further investigation Unusual clinical presentation Higher mortality Age of affected animals FMD in vaccinated animals
20 Event recognition: Define criteria to trigger further investigation Criteria: are a screening test: High sensitivity (detect all events), There will be false alarms Therefore they are signal for further investigation Response to Event: Minimize spread/impact: biosecurity, movement controls, vaccination
21 Progress & Gaps Progress: Regional coordination & communication: lab networks: getting more results, faster Regional Roadmaps FMD remains sensitive issue Data for surveillance (TurkVet, Iran Gis-vet) Gaps: A lot of data is collected...but analysis and applying information to improve strategies is not yet routine More coordination between field, lab, epidemiologists Need to improve information flow about samples (so lab knows clinical picture, and field knows results in timely manner)
22 Monitoring - is a key principle of the PCP Implement Control strategy to eliminate circulation Maintain zero circulation and incursions Maintain zero circulation; withdraw w vaccination Confirm FMD free Early detection & response to incursions Surveillance Objectives change with progression 1 Implement risk-based control Monitor implementation & impact of the control program Identify risk and control options Monitor FMD epidemics and & risk as needed to develop risk-based control program Objective Assessment of Progress of PCP for FMD
23 Summary 1 FMD in endemic areas is actually characterized by epidemic waves that sweep across regions Precipitated by certain conditions ( threat ) related to host-agent-environment These conditions should be monitored to detect when threat-level is increased...(colour coded alert?) Multiple Indicators should be developed and should consider host, agent and environment factors When threat detected: an appropriate response must be implemented...contingency plan
24 Summary 2 Event detection is different from threat detection because indicates early stages of epidemic already started Constant monitoring and surveillance, data analysis is critical...need to combine lab and field data Sensitivity, specificity & predictive value key attributes for both threat and event detection Early detection for early response...contingency planning, practical & effective mitigation options urgently needed
25 Acknowledgements Sequencing (Jemma Wadsworth) Defra grant SE2939 Iranian Veterinary Organization colleagues SAP Institute and GDFC: Turkey Syed Jamal, Pakistan Thank you!
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