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1 Avian Influenza Surveillance: A global picture Subhash Morzaria Regional Manager ECTAD-RAP Regional Office for Asia and the Pacific Bangkok THAILAND 1 Overview H5N1 HPAI situation and context Field perspective: review of surveillance activities (Asia and Egypt) Some regional activities Value chain analysis Regional networks (lab and epi) H5N1 virus tracing, molecular epidemiology H1N1 regional initiative Current resources and opportunities for surveillance 2 1

2 Fare clic per 2004 modificare lo stile Animal Source: Health EMPRES-i Service Animal Source: Health EMPRES-i Service 4 2

3 Global H5N1 HPAI situation between Trends in H5N1 HPAI situation in poultry Number of Countries Reported Outbreak Number of Outbreak/Cases (Indonesia NOT included) Declining disease incidence Seasonality peak Jan-March, dip August Increase in outbreaks in 2010 Improved surveillance Declining interest-flu fatigue Increase in number of affected countries in 2010 Re-incursion : Cambodia, Israel, LaoPDR, Myanmar, Nepal, Romania Newly infected : Bhutan (Source: EMPRESi) 6 3

4 Animal - Human Interface Country 1 Bangladesh X 2 Bhutan X 3 Bulgaria X (Source: EMPRESi) Human Animal 4 Cambodia X X 5 Egypt X X 6 P.R. Secondo China livello X X 7 Hong Kong X 8 India Terzo livello X 9 Indonesia X X 10 Israel X 11 Lao PDR X 12 Mongolia X 13 Myanmar Quinto livello X 14 Nepal X 15 Romania X 16 Russia X 17 Vietnam X X Since countries reported outbreaks in animals 15 countries also reported human cases In countries reported outbreaks in animals (11 in Asia) 5 countries also reported human cases 7 Significant global response Fare Range clic of per activities modificare gli stili del testo Secondo Surveillance livello as important part of capacity building Objectives and approaches for surveillance Quinto varies considerably livello depending on areas Bangladesh, Nepal, Cambodia, China, Laos, Myanmar, Vietnam, Indonesia, Egypt 8 4

5 Surveillance objectives Broadly no clear cut strategy, gradual evolution Early detection of clinical disease and response Better understanding of the epidemiology disease patterns, time, locality, species, sectors, environment, live bird markets, cross-border, wild birds, etc Assessing and managing risks to animals and humans Risk modeling Monitoring immunity where vaccination is done Virus isolation for monitoring, genetic/antigenic changes, detection of new viruses (diagnosis, vaccine efficacy, etc) To demonstrate freedom from clinical disease and infection 9 SMS Gateway PDSR Surveillance -summary EGYPT +++ Small holder Commercial Ducks Wild birds COUNTRIES PASSIVE ACTIVE POST VACCINATION BANGLADESH +++ No vaccination Ducks Wildlife MYANMAR +++ Smallholder Commercial Ducks Cross border VIETNAM +++ Smallholder Ducks Postvaccination CHINA +++ Virological Different spp LBM INDONESIA SMS Gateway PDSR + NEPAL +++ Small holder Commercial Wild birds Buffer zone No vaccination +++??? No vaccination

6 12/22/2010 ECTAD Bangladesh 260 Upazillas, Gateway system dello SMS schema Targeted Surveillance in ducks Wild surveillance bird Secondo livello entrenched outbreaks nearly every month since February 2007 out Quinto livello 47 of 64 districts infected Active surveillance commercial farms and backyard holdings nearly 1.7 million birds culled no human cases reported vaccination prohibited 11 ECTAD - RAP Fare clicsmsper modificare lo stile Gateway System phase II Diagram del titolo 87 Additional Vet Surg. Please contact 260 U. Livestock CAHWmodificare Cell No Fare clic per gli stili del testo Officer Please contact CAHW Cell No Web based SMS Server 27 out of 35 outbreaks Through SMS G system 780 Community Animal Health worker (CAHW) Animal Health Service Veterinary investigation Administrator ( Maintaining Server ) 12 ECTAD - RAP 6

7 13 Key del achievements titolo Fare Average clic sample per modificare submission gli time stili del is 3.9 testo days dello after onset schema of disease and for result Secondo availability livello is 1.1 days after receipt of Terzo samples livello 14 7

8 Fare Post clic vaccination per modificare monitoring lo stile The dello current schema vaccine (Re-1) in use is fully protective About 60% vaccinated poultry have had protective antibody titre and chickens showed higher protection percentage than ducks 4.5% and 2.5% of unvaccinated slaughter samples and individual households were found to have H5 AI virus Reasonably high prevalence of circulating H5 virus (in ducks primarily) Quarto combined livellowith less than desired flock-level protective immunity in vaccinated birds in 2009 survey are presumed to be the root cause for HPAI outbreaks in season Mixed infection of H5N1 with NCD virus and also with LPAI virus have been observed (H3N8, and/or H6N8,other H5s which are not N1s) 15 ECTAD China Active surveillance and Social network analysis (SNA) 16 8

9 Virological Surveillance Positives, Poultry Outbreak & Human Cases by Month, Jan Feb CN Poultry Outbreak Human cases No. of Report Quarto livello Quinto 2 livello Jan-08 Feb-08 No. of positive Mar-08 Apr-08 May-08 Jun Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Update on the situation Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb Update del on the titolosituation Fare clic Virological per modificare Samples and Positive samples gli trend from stili 2007 to del 2009 Virological Surveillance Positive by Species Jan Feb 2010 testo # of Virological samples collected # of Positive virological samples , ,000 Ck-48 # of Positive Samples # of Samples Collected ,000 Dk ,000 30Terzo livello 300, , , Quinto 0 Ck-1 Gs-2livello Wb-3 0 Dk-31 Dk-55 Ck-37 Dk-23 Ck-14 Chicken 120 Duck Geese 100 Wildbird Gs-4 0 Gs-1 Gs Jan-Feb 2010 # of Positive samples 18 9

10 12/22/ ECTAD - RAP Risk mapping and modeling of HPAI in China Fig. Predicted distribution of HPAI H5N1 risk according to the bootstrapped logistic regression model based on HPAIV H5N1 risk-based surveillance data. 20 ECTAD - RAP 10

11 12/22/2010 Fare clic modificare Keyper success stories lo stile 21 ECTAD - RAP ECTAD Indonesia Participatory disease surveillance and response (PDSR) Passive surveillance Active surveillance Risk based surveillance High number of outbreaks in poultry for the past three in 31 out of 33 provinces years Quarto livello Endemic on the islands of Java, Sumatra and Sulawesi, and probably Bali, with sporadic outbreaks reported elsewhere. Quinto livello PDSR programme 22 ECTAD - RAP 11

12 Definition of PDSR Fare Participatory clic per disease modificare surveillance gli stili del and testo response Secondo Village HPAI livello surveillance, outbreak control, and poultry disease prevention programme Quarto Operates livello in 331 of 448 (74%) districts in 27 of Quinto 33 provinces livello in Java, Sumatra, Bali, Sulawesi and Kalimantan, Primarily focused on sector 4 poultry 23 HPAI detection del rates titolo (Feb 09 - July 09) Source: FAO Indonesia 24 12

13 Number of HPAI outbreaks/cases Indonesia (Nov 08 -July 09) Fare Source: clic EMPRES-i 300 per modificare gli stili del testo Secondo livello November December January February March Month April May June July 25 Major Outputs Over 2200 active field officers trained in PDSR Creation and support of 33 Local Disease Control Centres in 29 provinces across Java, Sumatra, Kalimantan, Sulawesi, Bali, NTB, and NTT National HPAI information system established linking central and local governments Highly sensitive: HPAI detected over 10,000 times since 2006 Quinto livello Over 5.4 million community members participated in HPAI activities organized by PDSR-trained teams 26 13

14 Disadvantages dello focus on schema community engagement Focused mostly on single sector (sector 4) due to Terzo A modified livello set of tools are required to engage commercial farmers PDSR-based data are still difficult to use for determining standard epidemiological parameters (e.g. prevalence) 27 Key observations Greater awareness and qualitative improvement in surveillance Enhanced surveillance capacity (CAHWs, D/PVOs, samples, labs) Early sample submission and detection Post vaccination serology important in evaluating flock immunity Virological surveillance useful in identifying vaccine failure Increased reporting of other TADs Greater engagement between governments and local communities Increased collaboration between health and animal sectors in HPAI Increased understanding of disease epidemiology Some novel approaches being integrated in the veterinary services 28 14

15 Constraints expensive Sensitivity of early detection still needs to be improved Sustainability issue heavily project dependent and Response capacity is still needs further attention (O/I and case definition) Objectives of surveillance not clearly defined (Egypt) Does not always cover key and relevant sectors More attention to collection of appropriate information and database, national data on poultry sector poor Poor analytical capacity (labs/field lack of connection) 29 Fare clic per Virus modificare tracking lo stile

16 del 2010 titolo Virus Tracking Summary 2010 Clade Fare 2.1clic per modificare Clade gli stili del testo dello Localized schema in Indonesia Clade 2.2 Disappeared from China Terzo Localized livello in South Asia Clade 1 Localized in Cambodia and Quinto S. Viet Nam livello Clade 7, 4, 9 Disappeared from the region Spreading into Viet Nam and Myanmar Also found in Russia, S.Korea, Japan, Mongolia, Nepal, Israel and Romania Clade Localized in Viet Nam and Myanmar Circulating back to China

17 Summary Retrospective analysis of virus movement useful Epidemiological information lacking from many virus isolates More structured approach is required to link farming systems,, value Terzo chains, livello markets and epidemiology With the emergence of pandemic H1N1 (2009) and anthroponotic Quinto livello infection in pigs need for surveillance of influenza viruses in pigs 33 Current Regional Initiatives India-Bangladesh Quarto Lao and China livello Regional poultry value chain mapping in SA and SEA India Nepal Bangladesh-Myanmar India-Myanmar Viet Nam and China Viet Nam and Lao Myanmar and China Integrated approach Value chain, farming systems, socio-economics, disease outbreaks 34 17

18 Networks 35 Regional Laboratory Network for HPAI Diagnosis Established in 2004 Bringing people together Capacity development Virus dello identification/characterization schema Physical facilities Staff Secondo developmentlivello Sharing of samples Submission of samples to reg. ref labs. Sharing of information Epidemiologic information Laboratory Quinto information livello Quality Assurance Standard protocols/reference reagents Proficiency testing

19 Regional Epidemiology Consortium Framework for collaboration Veterinary epi capacity building dello FETPV schema Information Sharing Terzo EMPRESi livello Knowledge generation and utilization Improve understanding of disease dynamics and risk Improve understanding of roles of wildlife Activities planned under regional networks Molecular Fare clic epidemiology per modificare of H5N1 gli (genetics stili del and epi) testo More structured longitudinal surveillance of viruses Defined farming systems and epidemiological situation Better understand factors that drive genetic diversity H1N1 Regional surveillance (TCP ASEAN request) Surveillance in pigs for SIV and ph1n1 Regional training of field workers and laboratory technicians Understanding surveillance and developing sound sampling frames Developing standardized protocols In country training

20 Progress Animal Fare Influenza clic per in modificare Asia, Geelong, gli Australia stili del (2009) testo FAO, PFFLU, AAHL, U of Murdoch, ASEAN member countries Regional workshop on surveillance and Lab diagnosis of National training field workers and laboratory technicians together Regional Guiding Principles for Surveillance and Diagnosis of Animal Influenza in Asia Pig samples (swabs and sera) from Cambodia, Laos and Thailand 39 Current resources Strong grass-roots level capacity to detect HPAI Improving diagnostic capacity at regional, national and sub- national levels Networks Asia Enlarging networks A number Secondo of active livello field projects Greater awareness of EIDs and acceptance of OWOH approach OFFLU Terzo Strategy livello document for surveillance and monitoring of influenzas in animals FAO Quarto Guiding Principles livellofor HPAI on Surveillance and Diagnostic FAO Regional Guiding Principles for Surveillance and diagnosis of animal influenzas in Asia OPPORTUNITY FOR STRATEGIC GLOBAL SURVEILLANCE Funding particularly in Africa

21 Needs laboratories Fare clic per modificare gli stili del testo Strengthened interactions between the field workers and Cross-border and regional surveillance programmeengagement Secondo of livello regional organizations Critical review of surveillance strategies and guidance to countries Quarto (OFFLU??) livello Strengthening of existing platforms 41 Fare clic Acknowledgment per modificare lo stile ECTAD Teams, Leaders/CTAs Brum, Angus, Bandyopadhyay, Martin Kalpravidh, Pawin, Kachen Yilma, Loth, Oberoi, Williams, Yamage, MacLean, Naipospos, Lotfi, McGrane, ECTADRAP FAOHQ Slingenbergh OFFLU Dauphin, Kim, Mouille, Claes National staff of veterinary departments International partners OIE, WHO, AI reference labs, USAID, AusAID, EU, Japan, Sweden, Netherlands, etc