THE GLOBALSTRATEGY FOR PREVENTIONAND CONTROL OFH5N1 HIGHLY PATHOGENIC AVIAN INFLUENZA March2007 Copyrightedma Copyrightedmaterial THE GLOBALSTRATEGY FOR PREVENTIONAND CONTROL OFH5N1 HIGHLY PATHOGENIC AVIAN INFLUENZA March2007 FOODANDAGRICULTUREORGANIZATIONOFTHEUNITEDNATIONS Rome,2007 Copyrightedmaterial Acknowledgements TheFoodandAgricultureOrganizationoftheUnitedNations(FAO)andtheWorldOrganisationfor AnimalHealth(OIE)acknowledgeandaregratefultotheWorldHealthOrganization(WHO)forthe closecollaborationandhelpfuldiscussionsinproducingthisthirdrevisionoftheGlobalStrategy, wzohoenroetbiyccpoortreencttilaylacdadnreasvseirntghtuhmeainssiulelsneosfsparnedveanthiuomnaanndpacnondtermoilcofavianinfluenzaviruseswitha Thedesignationsemployedandthepresentationofmaterialinthisinformationproductdonotimply theexpressionofanyopinionwhatsoeveronthepartoftheFoodandAgricultureOrganizationof theUnitedNationsconcerningthelegalordevelopmentstatusofanycountry,territory,cityorareaor ofitsauthorities,orconcerningthedelimitationofitsfrontiersorboundaries.Thementionofspecific companiesorproductsofmanufacturers,whetherornotthesehavebeenpatented,doesnotimply thatthesehavebeenendorsedorrecommendedbytheFoodandAgricultureOrganizationofthe UnitedNationsinpreferencetoothersofasimilarnaturethatarenotmentioned. ISBN978-92-5-105733-9 Allrightsreserved.Reproductionanddisseminationofmaterialinthisinformationproductfor educationalorothernon-commercialpurposesareauthorizedwithoutanypriorwrittenpermission fthriosmintfhoercmoaptyiroinghptrohdoulcdterfsorprreosvaildeeodrtohtehseorucrocmemiesrfculilaylapcukrnpoowsleesdigsepdrohRiebpirtoedduwcittihoonuotfwmraittetreinalin permissionofthecopyrightholders.Applicationsforsuchpermissionshouldbeaddressedtothe Chief,ElectronicPublishingPolicyandSupportBranch,CommunicationDivision,FAO,Vialedelle TermediCaracalla,00153Rome,[email protected] ©FAO2007 Copyrightedmaterial 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. Copyrightedmaterial 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 Copyrightedmaterial 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 Copyrightedmaterial 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. Copyrightedmaterial 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. Copyrightedmaterial