The global strategy for prevention and control of H5N1 highly pathogenic avian influenza

2007·1.3 MB·English

by  Food and Agriculture Organization of the United Nations

THE GLOBALSTRATEGY FOR
PREVENTIONAND CONTROL
OFH5N1 HIGHLY PATHOGENIC
AVIAN INFLUENZA
March2007
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THE GLOBALSTRATEGY FOR
PREVENTIONAND CONTROL
OFH5N1 HIGHLY PATHOGENIC
AVIAN INFLUENZA
March2007
FOODANDAGRICULTUREORGANIZATIONOFTHEUNITEDNATIONS
Rome,2007
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Acknowledgements
TheFoodandAgricultureOrganizationoftheUnitedNations(FAO)andtheWorldOrganisationfor
AnimalHealth(OIE)acknowledgeandaregratefultotheWorldHealthOrganization(WHO)forthe
closecollaborationandhelpfuldiscussionsinproducingthisthirdrevisionoftheGlobalStrategy,
wzohoenroetbiyccpoortreencttilaylacdadnreasvseirntghtuhmeainssiulelsneosfsparnedveanthiuomnaanndpacnondtermoilcofavianinfluenzaviruseswitha
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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.
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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
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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
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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.
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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.
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