1. Development and current FMD/PPR situation in the Middle East
OIE Regional Workshop on the OIE procedure for the official recognition of Member Countries disease status and for the endorsement of national official control programme with regard to foot and mouth disease and peste des petits ruminants
Development and current FMD/PPR situation in the Middle East
Ghazi Yehia
5-6 October 2016
Cairo Egypt

2. FMD/PPR Consultative meeting Doha-Qatar 1-3 Dec.2016
Under the auspices of the Global Framework for the Progressive Control of Transboundary Animal Diseases (GF-TADs), FAO and OIE have organized a Foot and Mouth Disease (FMD) and Peste de Petits Ruminants (PPR) control roadmap meeting for the Middle East region, held in Doha, Qatar, from 1 to 3 December 2015 in collaboration with the Ministry of Environment of the State of Qatar.
This meeting had several objectives, namely to combine the FMD roadmap meeting with the first PPR roadmap in order to attain more efficiency and synergy in the control of important TADs in the Region.

3. Objectives
1- to present the Global Control and Eradication Strategy and its tools in a detailed manner as well as the Abidjan conference recommendations;
2- to conduct a first assessment of countries’ situation regarding PPR and the capacity of veterinary services to control it;
3- to identify other small ruminant diseases that could be controlled together with PPR;
4- to establish the Regional Advisory Group (RAG) for PPR; and
5- to use this information to formulate the regional roadmap for the Middle East region and to obtain countries’ agreement to engage in its implementation.

4. PPR

5. INTRODUCTION
The Middle East is mainly endemic and surrounded by PPR endemic areas. This characteristic makes the region prone to risk of PPR introduction both from Africa and Asia, which causes a constant evolution of the PPR epidemiological status.
Due to the complexity and the intensity of animal movement, a regional approach is essential to coordinate control measures in the region.
The Global conference on PPR recommendations have served as guidelines for countries to further progress towards achieving the regional Vision by 2025, and thereby, implementing the FAO/OIE Global Strategy for the control of PPRin the Middle East region.
Countries (Bahrain, Egypt, Irak, Jordan, KSA, Kuwait, Lebanon and UAE) then presented the situation of PPR on their territory.It appeared that PPR is endemic in the region and that most of the countries already implement a massive vaccination, except Egypt (perifocal vaccination), using a live attenuated PPRV vaccine (strain Nigeria 75/1) produced in the region (Egypt, Jordan, KSA) or imported.

6. Middle East characteristics
Small ruminants (SR) population
10% world sheep herd
105 million heads
Iran: 4th sheep herd worldwide
5% world goat herd
55 million heads

7. Middle East characteristics SR geographical distribution
Near
East
20%
Iran
50%
Syria
11%
Iran
50%
4th world
sheep herd
Iraq 5%
Egypt 6%
KSA 8%
Arabian
Peninsula
25%
Yemen 12%

8. Middle East characteristics
28% small ruminants population
in countries with
severe political disturbances
Syria
11%
Iraq 5%
Iran
50%
Egypt 6%
KSA 8%
Yemen 12%

9. Middle East characteristics Crossroads of 3 continents
Asia
Europe
Africa

10. Middle East characteristics
Socio-economics aspects
Small holders mainly in traditional extensive production systems
vulnerable human and animal populations
+++ in countries with severe political disturbances
Impact of major SR diseases
Livestock production
Livelihood of populations
Food security

11. Middle East characteristics
Small ruminants’ regional trade
50 M SR slaughtered yearly for consumption
20-30% of total meat consumption
No regional self-sufficiency
Intense regional trade
14 M heads imported yearly
Seasonal (religious feast)
90% to the 6 GCC countries (KSA: 7.8 M)
from Eastern Africa (Ethiopia, Somalia, Sudan), Middle East (Iran, Syria, Turkey) and Australia
Risks linked to uncontrolled trade (traditional transboundary transhumance, smuggling, refugee populations…).

12. Middle East characteristics
Livestock regional trade

13. PPR in Middle East Prevalence All ME at risk Not present Endemic
(OIE/WAHID)
Not present
Lebanon
1997
Jordan
2000
UAE
2009
Bahrain
2011
Syria
Qatar
Last occurrence
Endemic
Egypt
Iraq
KSA
Yemen
Iran
Last occurrence
Syria
Iraq
Iran
Egypt
All ME
at risk
KSA
Yemen

14. PPR in Middle East Vaccination Ring vaccination Mass vaccination No
Iran
Egypt
Ring
vaccination
Vaccination
Iraq
KSA
Yemen
Mass vaccination
Syria No
vaccination
Syria
Iran
Iraq
Egypt
KSA
Yemen

15. PPRV lineage distribution
PPR in Middle East
PPRV lineage distribution

16. PPR in Middle East Vaccination
Live attenuated PPRV vaccine (strain Nigeria 75/1)
Imported
Produced in Jordan, Egypt, KSA & Iran
Estimation of % vaccinated population at the regional level

17. Component I: PPR control and eradication (stepwise approach)
Description of the PPR Monitoring and Assessment Tool (PMAT), a companion tool of the GSCE designed to monitor its proper implementation and assess progress. This tool is based on five technical elements aiming at:
qualifying countries at the appropriate stage along the step-wise approach for the control and eradication of PPR (assessment tool)
monitoring progress within a given Stage and provide an indicative list of activities to implement in the year to come (annual PPR Roadmap).

18. Countries self assessment
Most of the countries (n=7) considered themselves in Stage 2 and only 2 countries in Stage 1.
The PPR Stages agreed for 2015 will serve as the baseline situation for the roadmap.
NB: Stage 2 countries were encouraged to also fill in Stage 1 questionnaire in order to have a clear understanding of what still needs to be done to fully accomplish Stage 1.

19. Countries self assessment
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Bahrain 2 3 4
RSA
Kuwait
Oman
N.A
Qatar 1
UAE
Iraq
Jordan
Lebanon
Palestine
Syria
Yemen
Egypt

20. Countries self assessment
Country
Self assessment Stage
Already provided
Please provide
Encouraged to provide also
Bahrain 2
Stage 2
Stage 1
Egypt 1
Iraq
Stage 1 (on paper) *
Jordan
Kuwait
Stage 1 + 2
Lebanon
SaudiArabia
Qatar
UAE
Palestine
Yemen
Syria
Oman

21. Component II: RAG Voting Members:
CVOs: Dr. Ibrahim Ahmed Qassim from KSA as chairperson;
Dr Elias Ibrahim from Lebanon
Dr. Kassem al Qahtani (Qatar);
Maha El Batel from Kuwait (Leader for Epidemiology Network)
Ahmed Al Majaly from Jordan (Leader for Laboratory Network);
Non-voting Members:
PPR secretariat and/or Representatives from the GF-TADs PPR WG (FAO and OIE)
FAO Regional Livestock Officer: Markos Tibbo;
OIE regional representative for ME: Ghazi Yehia;
OIE PVS Expert: Hassan Aidaros.
PCP experts:

22. Middle East challenges
Significant SR animal population
Regional trade of livestock from various sources
Uncontrolled livestock movements (nat. and intern.)
Political disturbances
PPR endemic status
Socio-economic impact
Uncoordinated national vaccination policies
Laboratory diagnostic capacity
Regional PPR vaccine production capacities

23. Recommendations To countries
Countries to confirm the importance of regional approach collaboration for the control and eradication of PPR.
To ensure consistency and alignment of their national strategies with the GCES, which serves as the reference document;
To increase the number of animals vaccinated in each country for at least 70%, and make sure that vaccines to be used are of high quality and certified by an FAO/OIE recognized laboratory;
To assess effectiveness of vaccination by post vaccination evaluation (PVE);
To consider requesting an OIE PVS initial evaluation or OIE PVS follow up mission to have an updated understanding of their VS capacity and address the gaps relevant to the PPR Stage they are in;
To commit to the PPR stepwise approach at national level and subsequent regional PPR Roadmap process.

24. Recommendations To the regional organisation: GCC Secretariat
To ensure consistency and alignment of the regional roadmap of countries of the Arabian Peninsula with the GCES which serves as the reference document;
To ensure the mobilisation strategy for the implementation of the GCES in the region;
To explore the possibility to establish a Regional Leading EpiCenter and Lab Centre and the regional laboratory and epidemiology networks within the region for the implementation of the GCES;
To support the development of a regional communication strategy to facilitate the proper involvement of all actors in PPR control and eradication;

25. Foot and Mouth Disease Vision for the Middle East Roadmap
 Regional cooperation among Middle East countries for the progressive control of FMD leading towards freedom of clinical disease by 2025 for
regional economic development,
food security, and
poverty alleviation.

26. INTRODUCTION
The Middle East is mainly endemic and surrounded by FMD endemic areas. This characteristic makes the region prone to risk of FMD introduction both from Africa and Asia, which causes a constant evolution of the FMD epidemiological status.
Due to the complexity and the intensity of animal movement, a regional approach is essential to coordinate control measures in the region. Twenty-two (22) recommendations were agreed during the 2nd FMD Roadmap meeting in Amman/Jordan in These recommendations have served as guidelines for countries and FAO and OIE (under the GF-TADs umbrella) to further progress towards achieving the regional Vision by 2021, and thereby, implementing the FAO/OIE Global Strategy for the control of FMD in the Middle East region.
The Global GF-TADs FMD Working Group was in charge of monitoring the proper implementation of these 2014 recommendations over The global strategy was recognized to be flexible enough to work for all the countries.

27. Circulation of the Virus

28. Country Reports by December 2015
-In the last two years ( ), clinical FMD cases were reported in all countries except Jordan, Kuwait, Lebanon and UAE.
-The number of reported outbreaks varied from few in Bahrain) to hundreds in Saudi Arabia.
-Overall, samples of FMD were taken for further identification through characterization of the virus. Few countries further use the isolated FMD virus for vaccine matching.
-The use of preventive vaccination is applied in most countries. The serotypes most used for vaccination, preventive/control measure, are: O Manisa, O 3039, SAT 2 Eritrea, Asia 1 Shamir, A Iran 05, A Saudi Arabia 95. The proportion of livestock receiving vaccination is related to funding and time-head resources.

29. FMD/PPR consultative meeting Doha-Qatar 1-3 Dec 2015
Country
2014
RAG proposal (plenary presentation + advisory group)
Comments
Bahrain 2 2*
•Vaccination cattle sheep and goats twice a year
•Protocol for importation and quarantine
•Need to perform regular serosurvey and PVM
•Enhance border control
•Outbreaks in 2014 and 2015, samples submitted to Pirbright
Risk Based Strategic Plan submitted within 6 months
Submit questionnaire within 1 month
Egypt
•They prefer to consolidate stage rather than progress
•Socioeconomic studies and value chain analysis in progress
•Risk of under reporting despite awareness efforts
•Mobile lab to improved diagnosis (PCR, ELISA)
•Vaccination coverage need to be improved
•More progress made since 2014
•Request for PVS Follow up
WG to review RBSP within 3 weeks
Iraq
•May design and implement additional sero survey, including a questionnaire to further understand the level of infection in livestock
•‘Control plan’ to be provided
•Control activities in place but not risk-based
•No PVS, but requested
•Difficult security context
WG to facilitate submission of FMD samples to WRL
WG to provide feed-back on RBSP (3 weeks)
Final RBSP to be provided (6 months)

30. Doha Assessment (Cont.)
Jordan 2*
•On-going sero-survey (results March 2016), to be shared
•Motivate clinical reporting by private stakeholders
•First draft of risk-based control strategy; to be updated according to the result of the sero-survey
•Request for PVS Follow up
WG to provide feed-back on RBSP (3 weeks)
Final RBSP to be provided (6 months)
Kuwait 3 3*
•Confident of their reporting system. Incentives.
•NSP and serosurvey in cattle, not in small ruminants
•Share results of serosurvey
•Border control to be improved
•Sheep vaccination should be mandatory (now is voluntary)
•Advice PVS follow up
Submit national control plan and contingency plan within 6 month
Lebanon
•Sero-survey (pre-vaccination to be shared with WG. Follow up with NSP study in young livestock (6-24 months)
•Request for PVS Follow up is already submitted
•Control Strategy is provided
•No vaccination exit strategy because of regional situation

31. Doha Assessment (Cont.)
Qatar 3 3*
•Provide evidence that FMD is not circulating
•Animal identification system is in place
•No Serosurvery, no PVM.
•No sample submission to ref lab. Characterisation of virus relies on results from the region (Imported country)
•Request for a PVS follow up
Risk Based Strategic Plan submitted within 6 months
Submit questionnaires of stages 2 and 3 within 1 month
Saudi Arabia 2*
•Vaccination voluntary. Not sufficient for elimination
•Protocol for importation. Compliance?
•Include socio-economic aspects in the RBSP
•Provide the results of the ongoing serosurvey
•Enhance implementation importing protocol
•Movement restriction within the country is a challenge.
•Cost-benefit analysis being done
Risk Based Strategic Plan submitted within 3 months
Submit stages 1 and 2 questionnaires within 1 month
UAE 2
•National control plan (5 diseases) with an eradication objective; need to be endorsed by government. Non endorsed draft plan to be provided within 1 month.
•FMD in captive animals
•Need for strengthened coordination between local authorities and official VS
•NO data from the private sector on control activities
•Request for PVS Follow up is already submitted
WG to provide feed-back on RBSP (3 weeks)

32. The PCP-FMD Stages of Middle East countries as December 2015
Country
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
Bahrain 1 2 2* 3 4
Egypt
Iraq
Jordan
Palestine1
Kuwait 3* 5
Lebanon
Oman1
Qatar
SaudiArabia
Syria1
UAE
Yemen1 1*

33. New Elements 2016
Majority of countries in the region are qualified in PCP stage 2 with a different level of implementation of the stage related activities. Some of those may require furthering revising their plan for gaining a better understanding of the FMD situation and socio-economic impact.
Technical assistance is needed in formulating such plans.
No country has progressed further along the PCP

34. Conclusion Regional approach:
Regional/sub-regional Epi ME to be established in the region and training workshops on practical epidemiology for progressive control in 2016/17 to be organised by FAO and OIE. The Epi-Network produces a comprehensive review of the epidemiology of FMD in the Middle East, to summarise the findings and lessons learnt in the first 5 years.
A regional leading laboratory/ies to be established to serve the countries per terms of references provided by the FMD WG and as potential future reference centre;
Strengthening at the (sub)regional level the work of the OIE/FAO National Focal Points for Laboratories and National Focal Points for Disease Notification;
Strengthening the existing sub-regional networks (GCC and REMESA were mentioned) and potentially enlarge the scope to other ME countries.

35. Conclusion (Cont.) Vaccine
Review of the vaccination strategies against FMD, covering the range of current programmes in use in the region,
Regional / Sub-regional training workshop(s) organised in vaccination programme development, monitoring and evaluation (recommendation, Amman 2014)
Control of live animal at risk
Promoting the use of the OIE international standards on trade (Animal health certification, zoning & compartimentalization by Veterinary Services);
Missions to evaluate quarantine stations BIPs and importing countries inspectors to be based in the stations
Address by the National Focal Points on Wild Animal Diseases during the training seminars.
Preparedness
That Veterinary Services develop contingency plans for the possible introduction of exotic FMDV from other virus pools, including the risk of spread of serotype SAT2 from infected parts of Sub-Sahara Africa.
Encourage submitting the national control plans to OIE endorsement for stage 3 countries; (recommendation, Amman 2014); 

36. Conclusion Next Meeting : February 2017 in Cairo/Amman
The participants agreed to meet again in early February 2017to reassess the progress of the FMD and PPR Control Roadmaps in the Middle East region.
This event should also be the occasion to organize a meeting of the GF TADS Regional Steering committee for the Middle East.