Recent surveillance of influenza in animals and joint risk assessments

Transcription

1 Recent surveillance of influenza in animals and joint risk assessments FAO ECTAD TEAM LAOS, MYANMAR, VIETNAM, RAP, HQ OIE Regional Expert Group Meeting for the Control of Avian Influenza in Asia Sapporo, Japan, 3-5 October 2017

2 SURVEILLANCE H5Nx H7N9 2

3 At-risk countries for H7N9 MMR VN LAO 3

4 At-risk countries for H7N9 Cross-border Poultry Value Chains Source: FAO commissioned cross-border study reports 4

5 c Non GS/GD a c c Mar Apr May Jun Jul Aug Sep

6

7 AVIAN INFLUENZA ACTIVE SURVEILLANCE IN ASIA Regional approach for active surveillance: -Risk-based approach -Comprehensive -Aim for cost-effectiveness 7

8 Comprehensive AI surveillance Objectives 1. Early detect incursion of non endemic viruses (H7N9) 2. Monitor the circulation and evolution of AI viruses (H5Nx) in poultry value chains 3. Monitor effectiveness of control programs including decision making on vaccination strategy 4. Raise awareness among different actors of the poultry valuechain 8

9 Surveillance design Key criteria for area selection: - movement of poultry from a known infected area - geographically close to a known infected area - high poultry density - history of AI outbreaks - results of previous active surveillance rounds - vicinity to wild bird congregation sites or major flyways 9

10 Surveillance design Key criteria for sampling site selection: LBMs - Strong connections to the national market network - Large throughput of poultry - Large number of traders from different origins - Poor biosecurity level Farms, villages or poultry gathering sites with imports from known infected areas Slaughterhouses 10

11 Sampling Design At-risk countries - Surveillance design Country Targeted Area Targeted Sites Lao PDR 7 selected provinces (out of 17) - LBM - Farms - Villages - Checkpoint Myanmar 6 townships in 2 cross-border States + 2 inland sites (Mandalay and Yangon) (out of 15 states/division and 330 townships) Viet Nam 31 provinces (out of 64)** - LBM - LBM, city market - Live poultry collecting point - Poultry processing place * Kachin state in MMR surveillance activities on hold due to insurgency ** beside FAO-supported surveillance in Vietnam, CDC and DAH conduct also AI surveillance activities 11

12 * * * * LAO * * * * MMR VN 12

13 Sampling Design At-risk countries - Surveillance design Country Type of Samples Sampling frequency Lao PDR - Chicken & Duck Oropharyngeal swabs - Environmental swabs - Duck sera Myanmar - Chicken & Duck Oropharyngeal swabs - Environmental swabs - Chicken sera Viet Nam - Chicken & Duck Oropharyngeal swabs - Environmental swabs - 6 times ( 2 weeks interval) - 6 times (1 month interval) - Swabs: Once a month - Sera: Biannual - Baseline surveillance (12 months): Once/month - Enhanced surveillance (6 months): Twice/month 13

14 or environmental samples Regional Bioinformatics

15 Laboratory Testing Algorithm Sample Flu A (M gene) Positive Neg H5, H7 wide, H9 Neg HA subtyping by sequencing H5 + H7 wide + H9 + Neg N1, N6, (N8) H7CN, N9 Neg NA subtyping Positive Positive H5Nx H5N1 H5N6 H5N8 CN H7N9 H7 H9 Hx Full genome sequencing / HA & NA sequencing 15

16 Pen-side PCR (Pockit) vs Lab-based qpcr Test steps In the field Laboratory Step 1: RNA extractio n Step 2: Realtime PCR 2017/10/5 Taco mini $5,000 Pockit plus $1,600 Portable equipment Easy reagent storage (RT to 4C) Simple test procedure Simple result interpretation Compact Simple Cheap Same results $35,000 $40,000 Costly equipment Reagent storage in freezer Requires skilled lab operator in testing and interpretation

17 Active surveillance results Proportion of positive per virus subtype among Flu A positive samples 60.00% Country No of samples Flu A % Lao PDR (Jan 2016-Jan 2017) 7335 indv. samples 2.0% (148/7335) 40.00% 30.00% Myanmar (Feb-Jul 2017) 2468 pools 25.0% (616/2468) 20.00% Vietnam* (Mar-Jul 2017) 3638 pools 30.0% (1093/3638) 10.00% 0.00% H5 N1 N6 N8 H7 H9 Myanmar Vietnam** * Integrated results of DAH/CDC/FAO surveillance activities ** Not all samples were tested for H9

18 Avian Influenza Viruses detected in 2017 in Vietnam Active Surveillance

19 No of positive pools No of positive pools Active surveillance results in Vietnam 70 Detected viruses in Vietnam per sample type H5 N1 N6 H7 H9 80 Timeline of virus detection in Vietnam Chicken Duck Env Mar Apr May Jun Jul H5 N1 N6 H7 H9 19

20 No of positive pools No of positive pools Virological surveillance results in Myanmar Detected viruses in Myanmar per sample type H5 N1 N6 H7 H9 N2 70 Timeline of virus detection in Myanmar Chicken Duck Environment Feb Mar Apr May Jun Jul H5 N1 N6 H7 H9 N2 20

21 JRA 21

22 Sub-regional technical consultation on H7N9 Problem: Lack of routine data sharing Lack of understanding of the other sector (i.e. some HH colleagues were unaware of what a poultry value chain was) Limited capacity for risk assessment (both within and between sectors) April 2014, Myanmar Agreed: Need for Joint Risk Assessment by animal and human health sectors together But How? 22

23 Starting from. 23

24 JRA Objective To jointly assess risks from avian influenza H7N9 and other zoonotic influenza viruses at the human and animal interface JRA TWG teleconference on 19 August 2015.may also be applied to other national priority zoonoses or health concerns at the human-animal interface if needed 24

25 Potential pathways for human infection with an avian influenza virus birds in trading partner country birds in a neighbouring country birds on commercial farms Traders birds in live animal markets birds commercially slaughtered birds in households /villages wild birds human National Border Cross border travel (imported case) Cross border travel (exported case) person in nonneighbouring country person in neighbouring country Infection in a traveller to another country

26 Conceptual Basis for JRA Qualitative assessment can be done even with little information importance of expert knowledge from different sectors and disciplines) Systematic approach to evaluating currently available knowledge Iterative and needs to be updated regularly Evidence-based Multiple stakeholder involvement Separate uni-sectoral risk assessments should be performed in preparation to joint risk assessments 26 26

27 Sectoral risk assessment and JRA Preparatory phase Animal health sector Uni-sectoral assessment JRA Multisectoral Human health sector Joint assessment Uni-sectoral assessment 27

28 Potential pathways for human infection with an avian influenza virus birds in trading partner country birds in a neighbouring country birds on commercial farms Traders birds in live animal markets birds commercially slaughtered birds in households /villages wild birds human National Border Cross border travel (imported case) Cross border travel (exported case) Exposures of interest for JRA person in nonneighbouring country person in neighbouring country Infection in a traveller to another country

29 Steps in the JRA Identify need for multisectoral JRA - Review results of separate human health and animal health RAs, consider findings, & identify gaps - Consider need for information and expertise from both sectors Set up the national process for multisectoral JRA - Establish JRA stakeholder group & lead - Establish JRA technical team Data collection plus iterative assessmen t Define the risk assessment - Define the purpose, scope and objectives - Formulate risk questions Identify and diagram risk pathways Characterise the risk - Compile available information - Estimate likelihood, impact and uncertainty - Provide technical interpretation - Identify data gaps Document the assessment Modify if needed Operationalise outcomes of the risk assessment - Make recommendations - Identify next steps and roles and responsibilities for implementation - Re-evaluate / modify process as needed Risk management and communication

30 Next steps Agree on the draft methodology among tripartite FPs Test tool using table top scenarios with RA experts Conduct pilots in selected countries ( flu season??) Finalize tool, disseminate widely Support countries through trainings as needed To be included in tripartite toolkit being developed based on the 2008 document Zoonotic Diseases: A Guide to Establishing Collaboration between Animal and Human Health Sectors at the Country Level

31 Acknowledgement National animal health authorities (central / field / lab) FAO ECTAD teams Lao PDR Myanmar Vietnam RAP HQ 31