in the Middle-East and North Africa

Appe ndi x 16

Report of the 3rd Roundta ble meeting on FMD control in t he Middle -East and North A frica Damascus, Syria, Nove mber 6-7th 2006 Report

Introduction A 3rd F MD Roundtable meeting on FMD C ontrol in Middle-East and North A frica was held in Damascus, Syria, Nov ember 6-7th Nov ember 2006. The mee ting was opened by H.E. Dr Adel Safar, Minister of A griculture and Agrarian Reform, and hosted by Dr Khoury , President of the GF -TADS Regional Steering Committee for the Middle-East . Sev eral countries and international organizations hav e participated in the meeting including Bahrain, Egy pt, Iran, Jordan, Kuwait, Lebanon, O man, Pak istan, Saudi A rabia, Sudan, Sy ria, Turk ey , United A rab Emirates, Yemen, F AO (Rome), O IE (C entral Bureau and Regional), W RL (Pirbright, UK), USDA A PHIS IS C airo A rea O ffice, the Russian F GI-A RRIAH and French Ministry of Agriculture. The v accine production priv ate sector was represented.

The Agenda of the meeting is giv en in Appendix 1, and the list of participants in A ppendix 2 (to add). The Session considered the current risk situation and recent ev ents in F MD epidemiology in the region, the selection of F MD v accines to counter the risk , and the improv ement of performance and standardisation of F MD laboratory diagnosis. Summary F rom the results of the questionnaire surv ey , and from the reports to the meeting, it is clear tha t F MD remains a significant drain on the budgets of the national v eterinary serv ices of MENA countries and on the liv elihoods of liv estock owners across the MENA area. A lmost all countries operate v accination programs in large ruminants, some in a ll ruminant species. These v accination programs utilise v accines from a wide v ariety of sources, including producers based within the region and international suppliers from Europe and India; the lack of standardisation may be a factor affecting control. In 2005-6, the ME has been v ery hard hit by rapid inv asion and impact of two distinct serotype A v iruses, one which emerged in Iran (A Iran 05) in 2005- 6, and an incursion of an A frican ty pe A v irus into Egy pt causing widespread outbreak s in January-July 2006. In Turk ey and Iran, the ty pe A v accines in routine use did not prev ent the new strain from spreading. The A Iran 05 strain continues to circulate in Turk ey and I.R of Iran, and which has been detected in Pak istan and Saudi A rabia in 2006. Ty pe O remains endemic, but the risk of A sia-1 appears diminished with the last reported occurrence in Iran in A ugust 2005. SA T v iruses hav e not been reported in the region since 2003 (SA T-1 in Liby a), but serological ev idence of SA T infection in Sudan was presented. The dynamic situation requires continuous monitoring, not least because first detection of new strain s in the centre of countries rather than at the borders, and because of rapid animal trade mov ements, and also because other antigenic v ariants of serotype A were observ ed in 2005 and may continue to persist in the region and giv e rise to later re-emergence. Further, the proximity and importance of trade with countries in the Horn of A frica, and in west and central A sia, has the potentia l to introduce exotic F MD v iruses from these regions.

The meeting also rev iewed the risk situation, including possible introduction of exotic F MDV, and how selection of v accines against F MDV could be improv ed across the region. It also considered if antigen bank s could play a role to av oid shortage of v accine in emergency situations, and on improv ement and standardisation of diagnostic laboratory performance. Report – by Item of the A genda/Proceedings of the meeting: Item1 Evaluation of FMD status in t he Middle East and North A frica Region (MENA ):

Dr Yehia, OIE Regional Representativ e for the Middle East, summarised the responses to the questionnaire sent to member countries before the meeting, together with information prov ided annually to the O IE. The aim of the surv ey was to prov ide additional information on v accination, diagnostic laboratory usage, and on state of contingency plans. The report is giv en in A ppendix 3. Country Presentations Short presentations were made by on recent F MD experience and current control measures, by representativ es of the v eterinary serv ices or the national v accine producers, from Egypt (giv en by Dr el-Bendary , A ppendix 4), Sudan (giv en by Dr A ziz , A ppendix 5), Yemen (giv en by Dr al-Eriani, A ppendix 6), Syria (giv en by Dr Georgos Mak soud, Appendix 7), Jordan (A ppendix 8), Turk ey (giv en by Fuat Ö zyörük , A ppendix 9), Pak istan (giv en by Dr Usmani, Appendix 10), and Iran (report of the Razi Institute, giv en by Dr Mahrav ani; Appendix 11). The representativ e of the Kingdom of Saudi A rabia (KSA ) gav e a v erbal report. The presentations prov ided much v aluable information and indicated that F MD has occurred the last y ears as new serotypes of F MDV emerged unpredictably in some regional countries and caused serious damages. Their uncontrolled spread represents a high risk of transmission to neighbouring countries

F MD Ty pe A was diagnosed in 2006 in 8-9 gov ernorates in Egy pt this y ear. Genetically , this new seroty pe A differs considerably from the Middle Eastern v iruses and was closely related to F MD v iruses from East A frica.

During 2005 a new F MDV A lineage spread throughout Iran and mov ed westwards into Saudi Arabia and Turk ey (including Thrace). In 2006 it was al so detected in Pak istan. Turk ey has reported an outbreak of FMD v irus serotype (A ) in 2006. The outbreak in Thrace was first detected on 21 January 2006 and confirmed at the beginning of F ebruary 2006. The source of infection is reported to be the introduction of new animals or animal products from Anatolian to European part of the country .

Item 2 Risk situation: Ri sk of FMD evolving from endemic to e pidemi c Global situation and risk of exotic v iruses entering the MENA region O n behalf of the F A O W orld Reference Laboratory (W RL) for F MD, Dr F erris presented a global ov erv iew (A ppendix 12) of the major ev ents in F MD epidemiology , as detected from the sample s submitted to the W RL and to the other laboratories in the OIE/FAO F MD Laboratory Network . O f importance to note is that epidemiology in South A merica has been rela tiv ely stable compared to that in the middle east and in east A sia (C hina and South-East A sia). In A frica, the epidemiological information is scarce and insufficient sample s are receiv ed each y ear to determine major trends, although types A , O and SA T 1, 2 and 3 hav e been detected from outbreak s in the current y ear. In A sia, the circulation of sev eral genetic ty pes of FMDV serotype A sia-1 is a concern, highlighting the fact that at any time multiple v irus strains are simultaneously circulating, and which may be a risk to the Middle East where v accine against A sia-1 i s not used in all countries. Risk situat ion: early warning sy stem in Iran for detection of risk from west and central A sia

The activ ities of the project supported by FAO , EC and the Iranian Veterinary O rganisation (IVO ) to improv e the early warning of F MD v iruses in west and central A sia, which should benefit the middle east by prov iding early information that will assist v accine selection in countries to the west (Turk ey , Iraq, Sy ria,...) was presented by Dr Geiger (FAO ) and Dr O torod (IVO). The former prov ided an ov erv iew of the FAO project (Appendix 13), and the latter illustrated how a k nowledge of the animal populations and F MD incidence was being used to target F MDV surv eillance, in particular aimed at collection of F MDV from animal mixing/mark eting points that could prov ide an efficient mean s to determine if the F MDV ty pes circulating presented a risk to break through the v accines used in the region. Through this approach, a new and v irulent ty pe O strain had been detected which is currently spreading in Iran (A ppendix 14). Item 3 Vaccination: selection and use in t he region The Item was chaired by Dr Khoury . Keith Sumption (FAO ) presented an ov erv iew of k ey issues in v accine selection, highlighting recent problems with F MD control in the region which should prov ide lessons for selection by v eterinary serv ices (Appendix 15). He highlighted the need to predict which F MDV will prov ide the threat of outbreak s in the next 6-12 months, rather than using historic information. The ME region is much more complex than other regions, giv en the threats are from east (A sia-1) as well as south (subSaharan A frica), and possibly in future from South A merica, as well as the regular ty pe O and A strains within the region. In this uncertain situation, high potency v accines are particularly important, as they generally confer a broader protection that low potency v accines, albeit at higher price; this had probably been a major factor in the effectiv e control of F MD in Thrace region of Turk ey in 2006. The purity of FMD v accines is important if countries are intere sted to dev elop export zones or F MD free zones where surv eillance to demonstrate freedom from v irus circulation is needed. The risk of v irus escape, from non-O IE standard v accines, or v accine plants operating without adequate biosecurity , was mentioned; the latter should concern C VO s of countries with production facilitie s since the handling of exotic v irus ty pes could potentially lead to outbreak s of exotic v irus strains to which the region has no immunity . A n ov erv iew of F MD v accine selection in the MENA region, based on the responses to the questionnaire, was giv en by Dr Mustafa Hassan (A ppendix 16). In general, FMD Serotype A is endemic in A fghanistan, Pak istan, Iran and Turk ey while sporadic outbreak s occur in the southern Middle Eastern countries. [Vaccine matching tests rev ealed that the ty pe A v irus responsible for the 2005- 6 epidemic is antigenically different to A Iran 96 and closer to A 22; this new strain has be en designated as A Iran 05. In contrast the ty pe A strain responsible for outbreak s in Egy pt in 2006 is close ly antigenically matched to A Eritrea 98, and not to other ty pe A v accines used frequently in the MENA region such as A Iran 96 or A 22.] F iv e countries in region are k nown to produce FMD vaccine. They are Egypt, Jordan, Turk ey , Iran and Morocco. O thers are mostly importing their needs from external sources known to be recognized international v accine manufacturers. From A frica, countries lik e: South A frica, Botswana, and Keny a (in early day s) are the main sources of F MD v accine. The v accine imported is mainly triv alent (A , O , SAT1 seroty pes) and quadriv alent (A , O , SA T1 and SAT2 seroty pes) and rarely monov alent (A or O seroty pe). W ith few exceptions, v accination strategy is either poorly planned or entirely lack ing in most of countries. Thus a scientifical ly back ed up v accination strategy is needed for the countries of the region. The diagnostic facilities for FMD are not well dev eloped. This justifies why most of the v accine seroty pes imported by the countries are not matching with the local serotypes. F MD contingency plans are not well dev eloped in most countries of the region. A Q &A session on the issues followed, including the questions: Should purchasers check the suppliers’ claims before or after purchase? What lev el of v accine purity is needed in the region? Is it saf e to produce v accine using v iruses from outside of the region?

Priority antigens for use in v accination programs in the MENA region

Dr Sumption introduced this paper. In Europe, a sy stem is in place to guide decision mak ers, usually the C VO , on the choice of F MD antigen to hold in the e mergency reserv es. He suggested that the sy stem could be adapted to prov ide guidance to the decision mak ers in the MENA countries on the

priority antigens to be considered for their programs. The sy stem in Europe involv es the W RL producing a list ev ery 6 months with a full rev iew ev ery 2 y ears; the rev iew involv es discussion with stak eholders and v accine producers, since the stra ins li sted should hav e a number of adv antageous properties including extent of cross-protection to be expected. The draft W RL list for priorities for the MENA region was presented by Dr F erris (Appendix 17). He recommended that each country does it own risk assessment, but in doing so considers the high priority antigens on the list since they represent, according to the v iruses detected internationally in 2005-6, the most appropriate antigens against the most prev alent v iruses. W here countries are affected by outbreak s, then specific adv ice from the W RL should be sought. In discussion, the need to rev iew the li st by experts from the region was highlighted. In particular, Dr O torod (IVO) questioned why A ran 87 was not listed as a priority . Dr Sumption thank ed him for this comment since i t highlighted the v ery high importance of the Reference laboratories such as the W RL receiv ing A Iran 87 isolate s from recent outbreak s to test whether the priority type A v accine strains prov ide sufficient protection. If they do not, this could justify raising A Iran 87 to high priority in the programs for the region. Item 4 Preparing for emergency situations : the potential role of nationa l FMDV vaccine or antigen ba nk s Dr Sumption opened this Item, and brought attention to the problems in the MENA region in the past y ear where commercial suppliers did not hav e stock s for immediate deliv ery to countries affected by the ty pe A epidemics, but the EC was able to deliv er 2.5 million doses of A /O /A sia-1 v accine for emergency v accination in Turk ey from its antigen bank for immediate use. This highlighted the role of bank s to prov ide an immediate response; these bank s were little diff erent from normal tenders, being a contract between a v eterinary serv ice and v accine producer, that would ensure deliv ery of specific v accine within day s of demand from the C VO . Dr v an A arle, (Interv et), presented a paper on this item (A ppendix 18). He highlighted the fact that heptav alent (7 antigen) v accines are used by some countries in the region; through using a antigen bank , sev eral v alencies could be potentially remov ed from the regular programs; in emergencies a monov alent v accine could be rapidly made (5-10 day s) for use in an emergency program. F or most of the MENA countries, antigens bank s could be a way to ensure they hav e access to v accines for emergencies (exotic strains), when the antigen is not needed for the routine prev ention (endemic strains). In addition, the formulation could be made specific to the problem, for example to mak e a high potency to counter a more antigenically div ergent v irus. He also illustra ted the regulatory situation for F MD v accines in Europe which was the most stringent in the world; together with the high purity this leads to a higher price, but also a more guaranteed result.

Item 5 Diagnostic laboratory performance and standardisation This Item was C haired by Dr al-Kuzaei (Bahrain). Dr F erris, W RL presented two talk s (A ppendix 19 and 20) on the subject of harmonising the performance of F MD diagnostic laboratories. Since the OIE prescribed tests for international trade, harmonisation of serology had been important for many y ears since otherwise disputes between countries arose through lack of recognition of laboratory results. Therefore FAO had supported the W RL to organise harmonisation studies (F AO Phase XIX, etc) , which involv ed sending panels of serum to participant laboratories to enable them to assess their own performance. This had become important in recent y ears for labs to reach or retain their accreditation (external quality assurance). In the past y ear, FA O and the W RL had agreed to extend the harmonisation to v irus diagnosis, in particular because many labs now wished to use RT-PC R methods and potentially there may be high v ariation between labs in their ability to detect FMD. This was a prov en problem in the MENA region in 2005-6 since the new ty pe A strains had lead to low reactions in the ELISA tests, therefore diagnostic methods also need to be tuned. The result obtained in 2006 wil l be further discussed be tween F AO and the W RL; the possibility to extend the panel to assist countries wishing to harmonise tests for post-v accination monitoring will be considered.

Ov erall, the results clearly show that labs v ary in their methods and in their results for the same sample s; this could lead to serious problems. C ommercially av ailable test k its tend to be well standardised, but for F MD these are few, and for NSP ELISA the k its v ary significantly in their performance. Discussion followed, which highlighted: - the interest of the C VO s in the region to hav e an inspection of their laboratories by an expert, to dev elop a action plan that would assist to progress towards international standards; - the issue of biosecurity , since v ery few national laboratories in the region are built to required OIE standards for F MD, and there is no separate category or derogation for laboratories in endemic countries to work under lower lev els of biocontainment; - the possibili ty that the new diagnostic methods, which do not require liv e v irus, hav e adv antages by not requiring expensiv e biocontainment - the interest of labs to participate, and the question of whether the C VO should be sent the results before or after the laboratory has had a chance to comment on their own performance

Conclusions:

1- O ne of the major challenges facing v accination against F MD is the prev alence of sev en seroty pes and more than 60 subty pes of F MDV which are quite distinct not enjoy ing common cross reactiv ity . F urthermore, frequent mutation adds to the complexity of v accine selection in endemic regions. 2- It is essentia l to inv est in research effort to develop v accines which will prov ide wide protection against F MDV serotypes and subty pes and thereby reduce complexity and cost of regional FMD control through v accination. 3- F MD v accination is an essential tool in the control and eradication of FMD in the MENA region. 4- F MD v accine producing countries in the region are few. 5- Joint efforts by the local, regional and international communities are needed to strengthen the exi sting v accine production facilitie s to mee t the demand of the region for quality v accine meeting international standards. 6- Monitoring the circulating strains of F MDV (through reference labs) play s an essentia l role in the control of the disea se through v accination, and collected data should be analy zed in a regional reference centre, to improv e of early warning and early control of the disease. 7- The recognition of the most prev alent serotypes in the region is v ery essential. Thus national epidemio-surv eillance campaigns, financially and technically supported by the international community , are needed in all countries. 8- Since the information av ailable on FMD is limited in some areas of the region, training of personnel involv ed in disease inv estiga tion and control should be strengthened. 9- A science based v accination strategy is needed for the countries of the region. 10- Countries, supported by regional and international communities, need to dev elop and regularly update their national F MD contingency plans based on their F MD status. 11- Vaccine quality assurance is badly needed in the region, and establishment of a centre for undertak ing independent trials on v accines should be considered.

T he Recommendations reached are as follows:

Considering that : 1. F MD remains a constant drain on the budget of v eterinary serv ices across the region, and that periodic dev astating epidemics occur that spread rapidly across national and regional borders; 2. liv e animal mov ement, through regulated trade or by illegal mov ement, from regions not free of FMD is a feature of liv estock trading patterns in the region, and contributes to the risk of

F MD entry , and can be expected to continue in the future; 3. west A sia, and East A frica remain potential threats for countries in the eastern and central parts of the MENA region, and that v irus submission to Reference Laboratories from these regions remains inadequate ;

4. lack of information exchange between countries and to the international organisations has contributed to the scale of the ty pe A epidemics experienced in the region in 2005-6. 5. The lack of immediate v accines against the A Iran 05 and A Egy pt 06 v iruses contributed to the scale of the outbreak s. 6. the new serotype A v irus (A Iran 2005) ha s continued to spread in 2006, circulating in Turk ey and I.R. of Iran, and which has been detected in Pak istan and Saudi Arabia in 2006; 7. that further spread of the A Iran 2005 and possibly A Egy pt 2006 v iruses to countries in the

Near-East is l ik ely to occur unless ef fectiv e prev entiv e measures are tak en; 8. the location and risk from other exotic v iruses, should be k ept under rev iew by each country , including the continuous circulation of A sia-1 in south and east A sia; 9. the Ty pe O remains endemic in the Near-East,; 10. the dynamic disease situa tion requires continuous monitoring, not least because of first detection of new strains in the centre of countries rather than at the borders, and because of rapid animal trade mov ements; 11. that F MD v accines can rarely contain all the required antigens to protect against the div ersity of v iruses expected in the region, and that priorities for each species are needed to reduce cost; 12. that antigen bank s are an option for countries to hold sufficient stock s of antigen for immedia te formulation in emergency situations, and which can reduce the need to v accinate against some v irus ty pes; 13. that no country in the region currently maintains an antigen bank , and that only a few countries in the region hav e dev eloped and formalised their contingency planning against

F MD; 14. that there hav e been serious delay s in diagnosis of the new ty pe A v iruses because diagnostic tests were not optimised for the ty pe A infections; 15. that there is a need to build confidence in laboratory capacity in the region for early detection of new strains, and for monitoring of v accination programs and sero-surv eillance; 16. that most MENA countries hav e a national reference laboratory for F MD, but that there is significant v ariation in capacity , in bio-safety , and in standardisation of F MD tests, l eading to lack of confidence in laboratory results, which affects trade prospects; 17. Progress has been made in the v alidation of NSP (non-structural protein) antibody tests for the major species, but that many countries lack the experience in design of surv eillance in potential export or F MD free zones, or following F MD outbreak s,

Recommends that :

Relating to control of FMD in MENA region: 1. The whole of the Middle East and North A frica areas should be considered as one F MD epidemiological region, but with possible subregions reflecting different ecosy stems for circulation of FMDV strains, requiring a set of co-coordinated prev ention, control and eradication programs to be elaborated cov ering the entire region at risk ; 2. Transparency in notification of FMD outbreak s should be strongly implemented within the region to assist an e ffectiv e response and control of F MD; 3. F MD suspected samples to be sent to the international reference laboratories should be accompanied a comprehensiv e epidemiological report, including the geo-reference, to assist early warning and tracing the lik ely pattern of disease spread, 4. Coordinated action across borders and sanitary measures should be strengthened by imposing appropriate quarantine measures on animal mov ements whenev er the disease i s reported; 5. sy stema tic v accination campaigns of ruminants should be encouraged in all areas at risk , especially in border areas, that are designed to reach a population immunity that wil l effectiv ely prev ent F MD spread, using appropriate vaccines that me et international standards; 5. Procurement of v accines should consider the recent F MDV antigenic subtypes in the countries of the region as well as the antigenic relationships to the v irus isolates circulating in neighboring countries;

6. A strategy to achiev e international recognized disease free zones or F MD free country status must be dev eloped in the region, within the framework of the progressiv e control of transboundary animal disease program (GF-TA Ds); 7. in support of the abov e, each country is encouraged to “map” their ruminant liv estock population in the country , and consideration should be giv en to dev eloping a standard format for liv estock population mapping that is applicable across the region, and which will assist each country in planning disease control measures; 8. The countries of the region establish an F MDV network , co-coordinated by the Regional

A nimal Health C enter (RAHC ), to facilitate exchange of information and to respond rapidly to a emergence of any new seroty pe in the region; 9. Member Countries of the Middle East region are urged to dev elop, test and k eep a regularly updated a national foot and mouth disease preparedness plan that will assist the m to ensure a rapid and effectiv e response to new epidemic ev ents;.

Relating to early warning of FMD risk in the MENA region: 1. the information flow to MENA countries on the change in F MD risk should be improv ed, with regular summaries of the situation and alerts with follow ups when major ev ents occur that threaten parts of the region; 2. each country ensures that epidemiologically significant ev ents are detected, acted upon and reported without delay ; early recognition of these ev ents can be helped by using

DEFINITIO NS of abnormal field and laboratory findings, such as increased incidence of F MD, the detection of a new subty pe, or possible break through of F MD in well v accinated herds; 3. when threatening ev ents of regional significance are identified, emergency meetings be rapidly conv ened by the RSC to assess the risk and necessary international response; 4. the Regional Steering Committee of GF -TA DS organise regular roundtable mee tings on F MD prev ention and control, at lea st at y early basis; 5. each country re-assesse s the risk of entry of the prev alent epidemic v iruses in the region, including the A Iran 05 v irus ty pe, and tak es appropriate actions, including v accination, to reduce risk of introduction and spread; 6. increased effort to collect and submit samples for v irus typing is made by countries which hav e an epidemiological importance in the region, particularly Iran (as indicator for west

A sia), Yemen (as an indicator for the Horn of A frica), and Sudan . For the Maghreb countries (North A frica), increased effort is mainly needed in the W est A frican countries to the south of this region. International support from the FAO and/or O IE should be requested to reduce the cost of submission of sample s that are of regional importance.

Relating to i mproved control of epidemic FMD: 7. that each country dev elops and formalises a contingency plan for F MD that addresses the particular problem of entry of an exotic ty pe of F MD v irus to which the regular v accination programs do not protect (see no. 11 abov e); 8. that each importing country that imports liv e animals from countries not free of FMD has in place a contingency plan to address the risk of v irus entry from that region, that will assist to build confidence in animal trade with such countries and reduce restrictions, in full compliance with the O IE Animal Health C ode 9. that each country considers establi shing a national antigen bank to ensure rapid av ailability of potent F MD v accines for use in emergencies;

Relating to priorities for inclusion in vacci nation programs and in a ntige n bank s: 10. each country re-examines its selection of F MD v accines to ensure that the purchased v accines meet or exceed O IE standards and the antigens are appropriate to the international ri sk situation;

11. that the W RL, through the O IE and FAO , is requested to produce a list of priority antigens for inclusion in v accination schedules in the MENA countries on a regular basis; the l ist should be rev iewed by the RSC or a task force nominated by this group, before being made publicly av ailable; 12. that the recommendations of the W RL to the 3rd Roundtable are noted by MENA countries, who should be aware of the elev ated importance of A22 Iraq antigen (to protect against A

Iran 05), and A Eritrea 98 (to protect against the A Egy pt 06); 13. that efforts be made to address gaps in k nowledge of v accines to be used against the circulating v irus ty pes in parts of sub-Saharan A frica which prov ide a source of exotic F MD v iruses to the MENA countries; the international organisations should prov ide support if the countries themselv es are unable to do so; 14. that the RSC or a nominated task force dev elops guidance on the subjects a. harmonisation of v accination in the MENA region to ensure cov erage against the most prev alent (priority ) v iruses; b. v accination of small ruminants;

Relating to i mproving laboratory capacity and harmonisation of FMD laboratory test performance in the region: 15. that member countries ensure that their national laboratories re-assess their methods and reagents to ensure that diagnostic tests are appropriate for detection of the current A (including A Iran 05, A Egypt 06), O , A sia-1 and SAT types expected in the MENA region; 16. that NRLs in the MENA region be encouraged by their national authorities to participate in the international F MD laboratory standardisation exercises organised by FAO through the W RL at

Pirbright; 17. that participants in the Roundtable encourage or organise assessment mi ssions to their NRLs for ev aluation, and which will guide the potential establishment of a regional reference laboratory (RRL); 18. the RSC dev elop guidelines for biosecurity of laboratories that will assist compliance with O IE and are feasible throughout the region;

Relating to epide miological support for planning of FMD preventive and control measures:

19. that the RSC establish an epidemiology adv isory group to assist in response to request from countries for technical support, for example a. in the design of surv eillance programs for establ ishment of export zones in the MENA region b. in the design of sero-monitoring programs post-v accination 20. that the RSC consider nominating one or more centres of expertise in the region to promote the application of modern epidemiological tools and methods to improv e planning of F MD control measures; one such centre could be in Iran, mak ing use of epidemiological capacity of the Iranian Veterinary Organisation and the support receiv ed from the FAO /EC and another one elsewhere in the MENA region, with the help of the international organisations. Location and date of next meeting: A n offer was receiv ed from Jordan to host the next meeting; in approximately one y ear (Nov ember 2007).

Item 6 Endorsement of t he Draft Report Te draft report was read and endorsed by the participants and their comments noted by the rapporteurs. It was agreed that the comments would be incorporated and draft circulated within 10 day s of the close of the meeting.

Closure of the Meeting

Dr Khoury presided ov er the closure of the meeting, and Dr Yehia and Dr Sumption made short statements in closure. Dr Yehia thank ed all the participants for their inputs which had lead to a successful meeting, and the sponsors of the lunches and ev ening ev ents. He thank ed the support staff of the O IE regional representation and of the FAO Headquarters for assistance. A special vote of thank s was made to Dr Khoury and to the Ministry of A griculture and Agrarian reform for the wonderful hospitality and excellent local arrangements. F ollowing the closure, Dr Zakharov (FGI-A RRIA H) made a presentation on their work on FMD v accine production and recent results on v accine potency (Appendix 21). List of A ppendices A ppendix 1 A genda of the 3rd Roundtable A ppendix 2 List of participants A ppendix 3 Surv ey on Foot A nd Mouth Disease Sta tus In The Middle East 2005 – 2006 A ppendix 4 F MD in Egy pt A ppendix 5 Sudan Report A ppendix 6 Epidemiological Situation of F MD in Yemen A ppendix 7 Report of Sy ria A ppendix 8 Report of Jordan A ppendix 9 report of Turk ey A ppendix 10 Report of Pak istan A ppendix 11 Report of the Razi Institute, I.R of Iran A ppendix 12 W RL report on global situation A ppendix 13 EUF MD/EC /IVO project for improv ing F MD surv eillance in Iran and C entral A sia A ppendix 14 Improv ed FMD surv eillance in Iran – Dr O torod, IVO A ppendix 15 Key issue s in v accine selection –Dr Sumption A ppendix 16 F MD v accine selection in the MENA region –Dr Mustafa A ppendix 17 W RL recommendations for F MD v accine and antigen bank s –June 2006 selection A ppendix 18 A ntigen bank s –Dr v an A arle A ppendix 19 W RL/FAO Phase XIX standardisation study –part 1 A ppendix 20 W RL/FAO Phase XIX standardisation study –part 2 A ppendix 21 presentation by FGI-A RRIA H

A ppendix 1 Regional Steering Commit tee for the Middle-East of t he GF-T A DS Meeting on FMD surveillance and control (3rd FMD roundtable)

6-7th November 2006

Damascus, Syria

A genda Sunday, 5th Nove mber. Participants arriv e. Ev ening reception/meal Monday 6th November. Venue: 8. 00 O fficial O pening 8.30 Session Risk assessment session 1. Evaluation of FMD status in the Middle east and North A frica Region (MENA ): F MD information point: what v irus ty pes are currently circulating within the region? W hat v accines are used? C hair: Dr Yehia

Control and Strategy in me mber countries: 10 minute s presentations by 8 inv ited countries on recent experience and current measures: (A lgeria, Egy pt, Sudan, Yemen, KSA , Syria, Iraq and Pak istan) Presentation, discussion and finalisation of summary of regional situation and use of v accine (paper prepared from O IE Secretariat following short questionnaire). 10.30 Break

11.00 Session 2. Risk of FMD evolving from endemic to e pidemi c W hat is the risk of F MD entry into the region? W hat might arriv e next? C hair: Dr Sumption 1: Ov erv iew of the external risk : W RL, Pirbright (Dr Nigel F erris) 2: Risk from west/central A sia: F MD project, Teheran (Dr Geiger, co-presentation with Drs Mahrav ani and O torod) Discussion on risk Discussion on risk reduction

12.30 Lunch break

2. 00 Vaccination: selection and use in t he region C hair: Dr Khoury • Vaccine procurement: the k ey issues. (Dr Sumption, FAO ) • Panel discussion: should purchasers check the suppliers’ claims before or after purchase? W hat lev el of v accine purity is needed in the region? Is it saf e to produce v accine using v iruses from outside of the region?

• Priority v accine antigens for use in the ME and its subregions : discussion on priority list prepared by the W RL-F MD 3.30 Break

4.00 Preparing for emergency situations: A re national bank s of National Vaccine and Antigen Bank s v accine or antigens essential?

C hair: Dr Sumption • Dr Paul v an A arle, Interv et • Panel discussion

Ev ening: reception/dinner offered/hosted by the Syrian Ministry of Agriculture.... T uesday 7th6th November. Venue:

9.0 FMD diagnosis and la boratory activities and performance

C hair: to be elected on day 1 • Improv ing FMD diagnostic test standardisation and harmonisation: The v alue and lessons learnt from the external quality assurance programme for F MD labs supported by FA O (presentation: Dr F erris, W RL) • Panel discussion: FMD laboratory issues including bio-safety

10.30 Break

11.30 Presentation of draft conclusions and recommendations

C hairs: Dr Sumption and Dr Yehia

12.30 C losing C eremony Lunch.

Participants depart. 2-5 pm Meeting of the Steering Committee of the GF -T ADS for the Middle East (me mbers only )

2:00-5:00 pm: Meeting of the Steering Committee of the GF -TA DS for the Middle East (members only )

Plan of activ ities

20:00 D inner offered by O IE/FAO