1. Surveillance, Epidemiology, and Tracing Overview Adapted from the FAD PReP/NAHEMS Guidelines: Surveillance, Epidemiology, and Tracing (2014).

2. Introduction to when and why Definitions for technical terms Organizational structure Overview of Surveillance Plan USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview This Presentation

3. Surveillance, Epidemiology, and Tracing Activities USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview

4. Foreign animal disease (FAD) – Terrestrial or aquatic disease or pest not known to exist in the United States High pathogenicity avian influenza Foot-and-mouth-disease – Preventive measures for introduction Import restrictions Exclusion activities at borders/ports of entry Public education programs USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Introduction

5. FAD investigation – Initiated if an FAD is suspected Foreign Animal Disease Diagnostician Guidance Document 12001 APHIS FAD PReP Manual 4-0 Once an FAD is confirmed – Surveillance, epidemiology, and tracing response components are activated Provide real-time understanding Enable decisions on interventions USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Introduction (cont’d)

6. Surveillance, epidemiology, and tracing techniques are used to: – Detect cases – Understand disease characteristics – Identify risk factors – Provide information for decision-making – Design and implement control measures – Evaluate the effectiveness of the control measures implemented USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Purpose

7. Surveillance – An intensive form of data recording that encompasses gathering, documenting, and analyzing data Epidemiology – The study of the distribution of disease in populations and of factors that determine its occurrence Tracing – Information gathering on recent movements of animals, personnel, vehicles, and fomites to identify potential spread of disease, and source USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Definitions

8. USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Zone/Area Designations Summary of Zone and Area Designations Infected Zone (IZ) Zone that immediately surrounds an infected Premises Buffer Zone (BZ) Zone that immediately surrounds an Infected Zone or Contact Premises Control Area (CA) Consists of an Infected Zone and Buffer Zone Surveillance Zone (SZ) Zone outside and along the border of a Control Area Vaccination Zone (VZ) Emergency Vaccination Zone is classified as either Containment Vaccination Zone (typically inside the control area) or Protection Vaccination Zone (typically outside Control Area). This may be a secondary zone designation

9. Incident Command System (ICS) – Flexible and scalable Number and names of deployed groups will vary – Planning and Operations Sections – Incident Action Plan USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Incident Command System

10. Surveillance and Epidemiology USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview

11. During an FAD outbreak, surveillance plays a key role in: – Identifying the infectious agent – Determining the scope of the outbreak – Assessing the effectiveness of eradication and control efforts – Demonstrating a return to disease free status USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Role of Surveillance

12. Disease description Surveillance objectives Stakeholders and responsible parties Population description Case definitions Data sources Sampling methods Diagnostic tests USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Surveillance Plan Elements

13. Suspect case – Animal showing clinical signs compatible with FAD Presumptive positive case – Animal with clinical signs consistent with FAD and positive test results Confirmed positive case – Agent has been isolated and identified using approved tests USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Case Definitions

14. Data Sources Livestock producers Veterinarians Livestock organizations Disease reporting or notification systems Control programs Sentinel units Post mortem diagnostic specimen collection Wildlife data USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview

15. Considerations for accurate and practical sampling methods: – Sample type – Sample size – Random sampling vs. targeted sampling – Sampling duration and frequency – Sample areas/locations – Availability of diagnostic tests – Pooled testing USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Sampling Methods

16. Types of Specimens Blood or serum Skin or vesicular lesions – Epithelial tissue or vesicular fluid Feces, rectal swabs, cloacal swabs, or genital tract swabs Nasal, oral, or oropharyngeal swabs Nasal discharge, saliva, tears Semen samples Tissues – Tonsil, spleen, kidney, liver, lymph node, lung, brain, etc. Milk Environmental samples USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview

17. Surveillance – Ongoing data collection, analysis, interpretation, and dissemination – Used to determine specific actions for FAD mitigation Field investigation – Used to collect additional information about cases identified via surveillance Disease source, history of disease, etc. USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Core Functions

18. Analytic studies – Utilizes information gleaned from surveillance activities and field investigations – Disease rates and risk factors Evaluation – Effectiveness – Efficacy – Impact of activities USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Core Functions (cont’d)

19. Endemic – Present in a population or geographical area at times Outbreak – Occurrence of more cases of disease than expected in a given area, or a specific group, over a particular time period Pandemic – An outbreak/epidemic that has spread over several countries USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Disease Occurrence

20. A characteristic that is associated with an increase in the occurrence of a particular disease May include: – Age – Species – Location – Contact USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Risk Factors

21. Prevent contact between the FAD agent and susceptible animals – Quarantine, movement controls, biosecurity procedures, target depopulation Stop production of FAD agent by infected or exposed animals – Slaughter or mass depopulation Increase the disease resistance of susceptible animals to the FAD agent – Emergency vaccination USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Epidemiological Principles

22. Generally, disease outbreaks are investigated in three phases: – Descriptive phase – Analytic phase – Intervention phase USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Phases of Investigation

23. Tracing Animal Movements USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview

24. Trace-back – Animals, animal products, fomites, people, vehicles, equipment, and possible vectors that have been moved onto an Infected Premises – Establish the origin of the agent/hazard USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Tracing

25. Trace-forward – Animals, animal products, fomites, people, vehicles, equipment, and possible vectors that have left the Infected Premises USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Tracing (cont’d)

26. A variety of strategies are required to contain, control and/or eradicate an FAD – Biosecurity – Health and safety – Personal protective equipment – Cleaning and disinfection – Quarantine and movement control USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Additional Operational Procedures

27. FAD PReP/NAHEMS Guidelines: Surveillance, Epidemiology, and Tracing, and SOP: Surveillance – http://www.aphis.usda.gov/fadprep http://www.aphis.usda.gov/fadprep Surveillance, Epidemiology, and Tracing web-based training module – http://naherc.sws.iastate.edu/ http://naherc.sws.iastate.edu/ USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview For More Information

28. Authors (CFSPH) Kerry Leedom Larson, DVM, MPH, PhD, DACVPM Glenda Dvorak, DVM, MPH, DACVPM Janice Mogan, DVM Courtney Blake, BA Reviewers (USDA APHIS VS) Dr. R. Alex Thompson Dr. Lowell Anderson Dr. Steve Goff Dr. Fred Bourgeois USDA APHIS and CFSPHFAD PReP/NAHEMS Guidelines: Surveillance, Epi, and Tracing - Overview Guidelines Content

29. Acknowledgments Development of this presentation was by the Center for Food Security and Public Health at Iowa State University through funding from the USDA APHIS Veterinary Services PPT Authors: Patricia Futoma, Veterinary Student; Kerry Leedom Larson, DVM, MPH, PhD, DACVPM Reviewers: Janice Mogan, DVM, Melissa Lang, BS