1. A review of avian influenza control
Dr Keith Hamilton
OIE Headquarters, Paris
Not going into detail about control measures but will give an overview of approach, lessons learned, trends; emphasis on lessons learned.

2. STRATEGY FROM THE BEGINNING: MINIMISE THE THREAT AT THE ANIMAL SOURCE
Early detection and early warning
Rapid and transparent notification is essential
Rapid confirmation of suspects (access to reliable laboratory tests)
AIM has always been to eliminate at the POULTRY source (WHO offer the same message) (although be prepared (contingency plans, vaccine production etc in case of pandemic). NOT WILD BIRDS
Early detection and reporting provides early warning – neighbouring countries can take precautions (i.e. stop imports) and decrease risk of further spread (containment whilst deal with outbreak). Allows rapid response.
Suspect cases should be investigated immediately to confirm or rule out disease- this requires a good reporting network and awareness of what disease may look like. Confirmation requires access to good reliable laboratory. Compensation encourages reporting
Clinical diagnosis of any avian disease (infectious or other) is problematic, especially in areas where people are used to large numbers of deaths from ND etc. THEREFORE LABORATORY diagnosis is essential. Delays getting samples to the lab can be a real problem.
RAPID RESPONSE – disease more amenable to control – delays lead to spiralling costs as disease spreads and becomes harder to control.

3. NOTIFICATION
an infection of poultry caused by any influenza A virus of H5 or H7 subtypes or by any AI virus categorized as HPAI’
HPAI= Any AI virus with IVPI > 1.2 (6wk old chickens) or at least 75% mortality (4-8 wk old chickens) or H5 or H7 subtype with multiple basic amino acids at cleavage site
Notify to OIE:
HPAI in ALL birds (poultry, wild, captive, falcons, pets)
LPNAI (LPAI H5 and H7) in poultry

4. STRATEGY FROM THE BEGINNING: MINIMISE THE THREAT AT THE ANIMAL SOURCE
Rapid response
containment, movements controls, increase biosecurity and humane stamping out followed by disinfection
vaccination when appropriate and if available
Legislation and resources
Strengthen public and private component of Veterinary Services
Rapid response is of course important so that measures can be implemented when disease is most amenable to control and reduce direct losses. Followed by C and D to eliminate virus
A medium to long term strategy to improve response of individual country to disease outbreaks. Investing in global control is a universal benefit.
GLOBAL PUBLIC GOOD i.e outbreak in 1 country is a threat to the whole international community

5. CONSTRAINTS TO CONTROL
Chain of command and decentralization
Weakness of national veterinary services
Weakness of private sector organisation
Lack of compensation mechanisms
Limited ability to control livestock movements
Constraints to implement biosecurity measures
Ministries of health, agriculture and environment should be coordinated. If the relationship is not good can lead to poor communication.
Decentralization can lead to a lack of coordination. For disease control coordination of regions is essential
Weak vet services – means that effective control cannot be implemented so disease can soon get out of control. Infectious disease will exploit any gaps in the system. Equally if private sector is weak i.e. unable to implement effective biosecurity etc
If there is no compensation mechanism – less incentive to report disease; this may be due to a lack of funds or simply a lack of infrastructure to disseminate funds
Lack of compliance with regulations. Difficulties with enforcement i.e. no legislation or no enforcement officers

6. CONSTRAINTS TO CONTROL
Difficulty of implementing vaccination
Poor laboratory diagnostic capacity and capability
HPAI infections may have become established in wild water bird populations (re-infections)
Uncertainty of continued donor support
Knowledge gaps
Many countries have other virulent poultry diseases circulating such as ND. It can be difficult to distingusih some poultry diseases by cliniacl signs indeed the signs may not be due to infectious agent at all. Need lab test for effective disease confirmation and surveillance.
If neighbouring country has it and can’t control it, therat or reintroduction – need to take a regional approach – country borders not necessarily barriers. Risks of spread illegal trade, vehicles, personnel, wild birds/other animals
We can be sure that AI will be around for a few years, therefore need longer term strategy. Most funding is short term so hard to guarantee funding absolutely for longer term projects. This hasn’t been a problem so far. Also issue of how much funding goes to human vs. animal side.
Gaps in knowledge – role of wild birds – there are still many uncertainties as to their actual role, vaccines i.e. need a thermal stable vaccine, current vaccines need to be given to birds individually – useful to have an effective vaccine that could be administered to may birds through water etc. Issues at the human-animal interface such as transmission risk

7. SOME IMPORTANT LESSONS THAT HAVE BEEN LEARNT
Early detection and rapid response have prevented establishment of disease in most of the infected countries
Delayed detection and response have led to entrenched disease
Strong governance and efficient national chain of command are essential
Most countries have been able to jump on the disease quickly and control it. Been easier where veterinary services have been well resourced and organized. Good VS – better surveillance – earlier detection – more effective control. Need to communicate good awareness of signs and have good reporting mechanism for disease suspicion and access to good laboratory tests to confirm disease.
Delayed detection – disease spreads undetected. End up chasing disease.
People need to know who is responsible for what, who to report to. Ensures coordinated response and more effective use of resources with authority making decisions

8. SOME IMPORTANT LESSONS THAT HAVE BEEN LEARNT
Compensation is crucial to encourage transparency and biosecurity measures
Vaccination is a useful complementary tool but used alone and without permanent monitoring it does not eliminate H5N1
Authoritarian policies to change poultry production systems are often inefficient and can be dangerous
To encourage disease reporting and discourage selling of sick/dangerous contact animals. Some countries govt provides compensation to smallholders and industry covers their own insurance/compensation. Compensation needs to be set at the right level so that it is not beneficial to get disease
If it going to be used it needs to be well considered and used as a COMPLEMENTARY CONTROL measure
i.e. unrealistic demands such as banning deep seated cultural practices like ‘live bird’ markets, keeping backyard birds or sports can drive the practices underground, making it even higher risk. Must have control measures that will be accepted. At least knowing that they go on can monitor them.

9. SOME IMPORTANT LESSONS THAT HAVE BEEN LEARNT
Different strategies to control the virus can be efficacious (e.g. Vietnam and Thailand)
Each country should develop the strategy based on their own situation
The role of public and private veterinary networks is crucial
Effective communication is critical
Vietnam and Thailand – both had good results with different strategies – Thailand vaccination was banned/ Vietnam it was used. There’s no one strategy for all. It needs to be tailored to the individual situation depending on culture, resources, vet service, industry structure etc
Private vets and public vets must work together. Private vets must be aware of disease signs, reporting mechanisms to public vets, if there is disease in their area etc etc

10. POSITIVE TRENDS
Less outbreaks in domestic poultry in most newly infected countries
Countries are able to detect and resolve outbreaks quicker
Species other than wild birds and poultry have not yet been involved in the transboundary spread of the virus
Availability of international funds
Tend to be less outbreaks in newly affected countries so indicates that it isn’t spreading as effectively. May be a result of more rapid disease detection (awareness) and better biosecurity
Generally the response to outbreaks, following detection, appears to be better
International funds have been made available.

11. POSITIVE TRENDS Capacity building in veterinary services
Improvement of laboratory infrastructures
Better sharing of strains and data
No human cases without animal outbreaks present
The outbreaks have highlighted the importance of veterinary services in protecting both animal and public health
Funding and support has led to improvement of diagnostic capability/capacity in many countries. Greater access for more countries to laboratory expertise and testing. Long term benefits of this.
More people are sharing viruses and information. This is critical for developing control strategies and for early preparation of human influenza vaccines. Information and viruses are of global public good and should be shared.
There has been no sustained human to human transmission

12. SHORT TERM ACTIONS (animal field)
Prevent further spread of disease amongst poultry
Direct technical assistance to newly and endemic infected countries
Vaccination when appropriate (+ exit strategy)
Compensation mechanisms
Increase communication and awareness
Support preparation of national integrated contingency plans
Missions – important that these are coordinated – hosting missions can take people away form their other tasks
Compensation to encourage reporting and to support smallholders
Communication of risks and awareness of signs, important that these messages get to the right people. Will depend very much on the country i.e. Middle East, religious leaders.
Must have contingency plans that can be a reference. Should contain details of whole control operations, what measures will be used, who and how will they be implemented, who pays for them. Should include details of command chains, resources, compensation, disposal, PPE etc

13. SHORT AND MEDIUM TERM ACTIONS
Need to improve Veterinary Services in developing countries (public and private partners)
The evaluation tool “PVS”
Gap analysis
Preparation of projects (compensation mechanism and animal vaccines stocks)
Implementation
Identify key gaps in knowledge - research initiatives
Need to improve veterinary services in developing countries must account for both the private and public practitioners- both play a crucial role. Private vets may often be the first to come across index case.
PVS – Performance of Veterinary Services – Member country makes a request to OIE for a PVS mission. Team visits country – evaluates the national veterinary services and makes a report. The report is given to the member country. The member country decides whether the information can be shared.
The report can be used to perform a gap analysis – i.e. to identify areas where there is a need for improvement (gaps) for example in diagnostic testing – this can be used to help to attract support/funds from donors.
Good planning is essential, who does what when and all risks identified etc
Then implemented

14. LONGER TERM ACTIONS Permanent lobbying
Follow-up of the Veterinary Services in developing countries (public and private partners)
Capacity building - livestock sectors
Research
Permanent lobbying of donors and governments. Donors for funds and to governments to recognize what a problem this is
Developing country vet services need long term support – problem may recurr and there maybe other problems around the corner. It is acknowledged more and more that a larger percentage of human diseases orginiate in animals. Need sustainable support
Capacity building in livestock sector – biosecurity, education, awareness of signs and risks. Biosecurity has other benefits – other diseases, productivity, less reliance on pharmaceuticals
With a view to the future we have to find better, cheaper and more effective ways to prevent and control disease. We need to look into improving biosecurity in food production systems, we need to look at better vaccines, diagnostics (cheaper, accurate and rapid) and keep these up to date. As diseases evolve the ways we prevent and control them need to evolve with them.

15. AI STATUS Self declared NAI free establishment
NAI free country, zone or compartment
HPNAI free country, zone or compartment
NAI status can be applied to a country, a zone, compartment or establishment and to HPNAI or NAI (both HPNAI and LPNAI).
These are for self declaration of freedom. OIE officially recognises disease freedom for 4 diseases CBPP, BSE, FMD and Rinderpest, not avian influenza.
Difficulties with AI certified freedom – wild birds, extensive small farmers, ducks, LPAI, hard to guarantee.
OIE publish self declared freedom on WAHID

16. COUNTRY, ZONE OR COMPARTMENT FREEDOM
a country, zone or compartment may be considered free from NAI when it has been shown that neither HPNAI nor LPNAI infection has been present in the country, zone or compartment for the past 12 months
Based on surveillance in accordance with Appendix 3.8.9
freedom may be regained after 3 months based on surveillance in accordance with Appendix 3.8.9
and stamping out in the case of HPNAI
‘NAI free’ – evidence that neither LPNAI or HPAI are present based on approved surveillance.
When regaining status must stamp out in case of HPNAI but also must carry out surveillance in accordance with guidelines
Surveillance inc. clinical surveillance (notifiable status, awareness of signs, susceptible spp., concurrent disease, good veterinary services, targeted- markets etc), serological, virological

17. CODE DEFINITION OF FREEDOM
‘a country, zone or compartment may be considered free from HPNAI when it has been shown that HPNAI infection has not been present in the past 12 months’
based on surveillance…it does not meet the criteria for NAI freedom
its LPNAI status may be unknown
but any NAI virus detected is not HPNAI
freedom may be regained 3 months after stamping out, based on surveillance
Self cert. of freedom from HPNAI.
Free from HPNAI but LPNAI status may be uncertain or present (during surveillance LPNAI is isolated).
Clinical surveillance for LPAI may be problematic – may require laboratory surveillance.

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Organisation Mondiale de la Santé Animale
World Organisation for Animal Health
Organización Mundial de Sanidad Animal
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