Appendix 5

Epidemic events and lessons learnt in the European neighbourhood – 2005-present Keith Sumption

Summary The last two years (2005-present) have seen a dramatic worsening of the epidemic situation in the region, with two major epidemics in Turkey and Iran as a result of incursions of a type A and type O (PanAsia II), threatening FMD free regions of Europe and the Caucasus/Russia. In addition an epidemic of an African type A in Egypt in 2006 threatened Israel, a member country, and heightened risk for the region as a whole. As a consequence, the focus of activities has been on containment of the threats, reducing the resources to undertake other categories of preventive and capacity building activity foreseen in the 4 year Strategic Plan agreed at the 36th Session in 2005. The incursions into Thrace region in 2006 and 2007 have been contained with emergency actions, but result from a number of failures to contain epidemics of exotic strains of FMDV in Iran and in eastern Turkey in the late autumn/winter of each year, with subsequent animal population as a result of mass animal movements pre and post festivals, that occurred under favourable conditions for transmission. The recent type O epidemic if of concern as the epidemic has breached biosecurity and well organised vaccination programmes in each country affected, mimicking the spread 10 years ago of the original PanAsia type O virus. The epidemic in Egypt provided that FMD viruses can circulate in Africa for many years (e.g. 8 years in this example) without knowledge of the reference laboratories, potentially leading to lack of suitable vaccines in European contingency plans. The failure of early warnings has only been partly corrected, and early detection and response are constrained by lack of reporting and capacity to mount serious containment effort around new foci. Reducing the risk of further events will need a consistent and sustained effort to strengthen FMD control at the two most critical borders of Eurasia, specifically the eastern borders of Turkey, and the eastern borders of Iran. Greater effort to monitor virus circulation and risk in other regions is also essential if Europe is to have sufficient early warning to ensure that suitable vaccines are stocked to counter new and emerging FMDV, particularly in west Asia and Africa. Report 1. FMD has not been reported in EUFMD member countries, except for Turkey and Israel, since 2001. However, FMD outbreaks occurred in Turkey within 20 km of the border with Greece and

Bulgaria on four occasions in past year (Feb 06 and Jan and Feb 07) 2. Freedom in European Union countries has been maintained, but was severely threatened from the neighbouring regions by type A and type O regional epidemics in west Asia, with incursions of type A Iran 05 and type O (PanAsia II ) into Iran and Turkey in 2005-6, each resulting in severe, widespread epidemics and which resulted in multiple introductions in Thrace region in 2006 (type A) and 2007 (type A, type O) 3. European reserves of vaccine have been mobilised in 2006 and 2007 in response to the above threat, to re-inforce the buffer zone in European parts of Turkey (Thrakia –Thrace) that is maintained by Turkey, a. for emergency vaccination i. Thrace -Feb 2006, 2.5 million doses A, O, Asia-1 (EU vaccine Bank) ii. Emergency reserve provided of 1 million doses , EC funded, via EUFMD, from vaccine bank of The Netherlands, for cover in period 11/06 to 3/07, including use in Thrace in 2007

b. To support the epidemic control in 2006 i. 1.66 million doses of A/O vaccine, from EU vaccine bank, September 06, ii. 1.5 million doses provided February 07 to support spring vaccination in Thrace and Marmara, 2007. 4. In addition an emergency reserve was created for the Caucasus countries to counter the risk of

A Iran 05 (reserve at FGI-ARRIAH, Russia), in addition the maintenance of the Vaccination

Buffer Zone that separates the epidemic situation in Turkey and Iran, from that in the south

Caucasus. Despite the epidemic situation in Turkey and Iran, no FMD outbreaks were reported in the South Caucasus.

5. The attention to emergency events, plus lack of funding for active collection of FMD strains circulating in risk areas, has hindered progress on risk assessment and early warning in more distant risk regions to Europe. 6. The frequency and severity of these epidemic events is a major reverse of the favourable epidemiologic situation in 2003-4; 7. In addition type A incursion into Egypt presented a high risk situation in early 2006, since

Europe was not prepared: a. the EU vaccine bank was not known to contain a suitable vaccine against this type A, b. experiments (funded by EC) to identify a suitable vaccine involved a 4 month delay to obtain results 8. The origin of the type A Iran 05 epidemic appears to be the circulating pool of type A viruses in the ecosystem of west Asia (Pakistan/Iran/Afghanistan), with countries to the west (Turkey, Caucasus, middle-east being at risk of overspill, and devastating epidemics. 9. The origin of the type O (PanAsia II lineage) appears to be South Asia ( Indian subcontinent), on basis of first detection and later detection in neighbouring countries 10. The time period between the international epidemic (pandemic) waves of PanAsia I and II is circa 10 years. In contrast to events leading up to the European PanAsia epidemic sin 2001, there is so far no evidence of the PanAsia II lineage involving east Asia (China and neighbours) , but this also occurred late in the epidemic spread in the PanAsia I pandemic and more information on the type O strains circulating in China is needed. 11. In the past 10 years, Europe and the immediate neighbouring regions have been affected by

FMD incursions from 5 different FMD ecosystems in Asia and Africa; a. Indian subcontinent (type A in Balkans, 1996) b. East Asia, possibly via intermediate countries (pandemic type O PanAsia I, to north-west Europe in 2001) c. West Asia (type O and Asia-1, type A (A Iran 96, A Iran 99 and A Iran 05 types) d. East Africa (type A in Egypt, 2006) e. The pastoralist belt of the sahel region below the sahara i. SAT2 into Libya in 2003 ii. Type O from West Africa into Algeria, Tunisia and Morocco, 1999 12. The region is therefore at risk from at least three major sources of FMD viruses, and at least 7 vaccine antigens are required for the incursions in the past 10 years, and thus the region is one of the most complex in the world for organisation of vaccine banks and preventive vaccination. 13. Early warning in source regions of antigenic shifts is therefore essential for vaccine bank management and for early response. 14. In 2005 and again in 2006, with type A and O respectively, the summer/autumn epidemics in

Iran were followed by incursions into Turkey, and as a result of the pre and post festival movements of animals, widely disseminated outbreaks occurred, reaching Thrace region in

January 06. The type O and A strains have also been detected in Jordan, and type O in Israel in late 2006, a situation last seen with the panAsia epidemic wave in the late 1990s. 15. Epidemics immediately preceding the main festival period, especially if it occurs in cool winter conditions, carry a high risk of disseminating an outbreak. The festival period again falls in mid winter in 2007, therefore heightened surveillance is needed in September-

November. 16. There was no early warning of the type A epidemic in 2005, which contributed to the scale of the problem in Turkey in 2006, with OIE/EC/FAO only being notified when FMD had reached

Thrace region, 17. As a result of the EUFMD /IVO collaboration, the type O epidemic in 2006 was detected, characterised and early warning was provided of the virus strain and of illegal animal trade risk across the eastern borders of Turkey in December 06. Nevertheless, the type O was detected in January 07, and retrospective analysis suggest multiple possible entry points, with the genotype detected close to borders of Iraq and Syria. 18. The subsequent spread of the type O genotype across Turkey in 2007 indicates a failure a. detect and contain new incursions b. in the herd immunity achieved by the vaccination policy (bi-annual cattle vaccination in Anatolia, no systematic vaccination of sheep) c. to regionalise infection, within Anatolia, and across the bosphorous 19. The above incursions into Turkey and other countries in 2006-7 events indicate that Eurasian borders have increased in permeability in past 2 years, of importance not only for FMD but for other TADs. Conclusions 1. The European region is at risk from at three different and complex regions whose ecosystems of

FMD viruses have high antigenic diversity. 2. The situation in the past two years has been highly unstable compared to previous biennium.

3. Epidemics continue to sweep through partially vaccinated populations in Turkey and Iran, highlighting the need for commitment to animal movement control and biosecurity at all levels. 4. The EU vaccine bank and the EC/FAO agreement on the support to EUFMD has been extremely important in mounting effective and rapid response to FMD emergencies in Turkey. 5. The purchase of vaccine from a national bank operated by a member states has been important in enabling a response when the EU vaccine bank stocks was not sufficient. Recommendations 1. The close functional relationship between the EUFMD Secretariat, DG-SANCO and the World

Reference Laboratory, and FAO structures has proven to be effective in enabling rapid response to crisis situation including delivery and monitoring of emergency vaccination programs.

However the crisis situation have taken resources from preventive actions, and therefore further strengthening of the information and response systems, including communication with member countries is recommended. 2. In response to the increasing movements of infection from Africa to the region, the EUFMD

Commission should continue to support the collection and typing of viruses, and in 2007-8 the priorities should include West African and north-east African regions where there is lack of virus information, and in doing so work through the Regional Animal Health Centres (RAHCs) established by FAO: OIE with the African Union (AU-IBAR) in Bamako and Nairobi, 3. In order to improve the information base for risk assessment, the Commission should also support information gathering on FMD epidemiology in source regions, with priority to areas where suitable vaccines are unknown or unavailable , working through the RAHCs, and through the established Global Early Warning System (GLEWS) operated by FAO/OIE/WHO. 4. The Commission should specifically promote and monitor risk reduction measures which will assist to reduce the FMD risks of trans-border movements of animals and products across the eastern boundaries of Europe, and through improved efficiency of vaccination programs, measures to reduce or mitigate illegal animal movements, early warning and response capacity in the border regions. 5. To these ends the FAO EUFMD Commission, in consultation with OIE and EC, and with the countries involved, invite participation in regular “Multi-partite” meetings for FMD control at the

Eurasian interface (Turkish boundaries), and provide technical assistance to the improve the monitoring and impact of vaccination and other control measures. 6. As a component of a Global Region reduction under GF-TADS, the Commission should assist development of a long term plan (“Roadmap”) for FMD control in the region where Europe and

Asia meet (Europe: West Asia). 7. The position of Iran is of great importance for disease control and therefore the EUFMD

Commission should continue to support the Iranian authorities in their efforts to establish an effective early detection and early warning system for FMD incursions, and to promote effective control. 8. The boundaries of Iran with its eastern neighbours constitute a important potential barrier to westward movement of infections, and therefore FAO, in consultation with OIE and EC, and the

Economic Co-operation organisation (ECO), and with the countries involved should also consider establishing regular multipartite forum on FMD risk reduction across the Central and West Asian borders, to which EUFMD is invited to participate. 9. The feasibility of the long term plan for FMD control in Turkey should be re-evaluated in light of the recent epidemiology, and the possible reasons for failure recognised and addressed early in the planning and implementation process. 10. Given the apparent failure of FMD control against the epidemic type O virus, using an apparently suitable vaccine, the feasibility of achieving the much higher level of herd immunity to effectively drive FMD type O outbreaks to extinction should be re-evalauted. As part of this, other options, including greater emphasis on regionalisation and effective local containment of epidemics, should be considered. 11. Greater emphasis and support to epidemiology and predictive modelling is needed over the next 3 years, for the most affected countries.

Time-line of major epidemic events, 2005-7

Iran Turkey Egypt other July 2005 Start of A Iran 05 epidemic

November 05 First type A outbreak for 6 months. Recognised as A Iran 05 in December 05

January 06

February 06

March 06

April 06

June-July Regional meeting organised by EUFMD to identify vaccine for control of A Iran 05. Thrace: overspill from Anatolian epidemic- 2 isolated ob. Dramatic decline in cases after April, before type A vaccination program starts

Widely distributed cases of FMD type A outbreaks. Entry into Thrace (index case) Continued type A epidemic –widespread (140 outbreaks) Type A outbreaks reported in Thrace. Emergency missions –EUFMD/EC 2.5 million doses vaccine donated by EU-VB. Continued type A epidemic -widespread Mass vaccination campaign in Thrace. No more reported cases in Thrace EUFMD missions for diagnostic support, epidemic control. Homologous vaccine produced in Egypt.

Resurgence of type A epidemic in Anatolia First outbreaks of type A (African origin), wide spread Reported to OIE, samples typed at WRL. Severe, widespread outbreaks.

September 06 Upsurge in outbreaks –type O. (Start of epidemic with new variant)

October 06 Spread of type O, severe nature of cases

November 06 Warning issued about virulence of type O and epidemic situation Warning to Turkey issued on risk of cross border movement of type O 1 million doses vaccine donated EC via EUFMD for emergency reserve for winter risk FAO/OIE Roundtable on FMD control in middle-east –Damascus, discussed regional risk.

Decline in type A in Turkey Early re-vaccination in Thrace. 1.66 million doses vaccine donated by EU for autumn control. Index case of new panAsia type O in Turkey Type A Iran 05 incursion in Jordan

December 06 (?)

January 07

February 07 Meeting of Iranian and Turkish veterinarians to discuss improved FMD control Massive type O epidemic (122 outbreaks) Isolated Type A outbreak Thrace (Edirne)

Type O outbreaks start to decline EU donate 1.5 million doses vaccine for Thrace New outbreak in Thrace (Kirklareli) –type O FMD type O outbreaks in Israel (previously 12/2005) . Northern Iraq: FMD cases observed by FAO consultants, severe mortality in young animals FMD in West Bank (type O), A very high mortality among lambs and kids aged less than two

March 07 Type O outbreak in Thrace (Cannakale, Evrese)

years was observed. FMD type O in wildlife (gazelle, wild boar) in northern Israel, possible transfrontier movements. Outbreaks in domestic animals April Outbreaks continue in Israel

Number FMD outbreaks in Turkey 2005-2007(March)

180 160 140 120 100 80 60 40 20 0 JANUARY-05 MARCH MAY JULY SEPTEMBER NOVEMBER JANUARY-06MARCH MAY JULY SEPTEMBER NOVEMBERJANUARY-07MARCH

Month

TYPE O TYPE A