FAO-OIE-WHO Joint Technical Consultation on Avian Influenza at ...

More documents

Recommendations

Info

<strong>Joint</strong> Writing CommitteeAppendix B: Gaps at the human–animalinterfaceSurveillance1. Enhanced and sustainable epidemiological and virologicalsurveillance in animals and humans (withimproved scope and quality of data collected) forH5N1, H9N2, and H7 viruses as well as otherpotentially zoonotic animal influenza viruses, includingswine influenza viruses (leading to closer estimatesof the global prevalence and distribution of theseviruses).2. Solution to achieve better reporting of potentially zoonoticnon-H5 and H7 subtypes.3. Enhanced surveillance specifically among ducks, othersilent reservoirs of avian influenza, and wild birds toevaluate prevalence and persistence.4. Improved surveillance in human populations potentiallyexposed to animal influenza viruses, including sero-surveillanceand serological studies.5. Increased support of virological surveillance, especiallythe use of screening tests, with confirmatory testing andmore frequent and representative genetic characterization,antigenic characterization, and full genomesequencing of selected strains.Virology1. Phylogenetic information on other potentially zoonoticinfluenza subtypes.2. Understanding the contribution of avian virus reassortmentto host range expansion, virulence, and transmissibility.3. Understanding determinants of fitness, and of the fitnessloss ⁄ gain by reassortment among influenza viruses.4. Efficient and reliable methods for virus isolation fromenvironmental samples, including air.5. Understanding of factors affecting cross-protection ofpoultry and human vaccines.6. Understanding of the effect of vaccination on influenzavirus evolution.Epidemiology1. Expanded and consistent capture of epidemiological dataon human zoonotic influenza infections (including useof standard data collection tools and standard definitions).2. Estimate of the baseline level of potential risk variablesfor populations in general.3. Estimate of the true incidence and numbers exposedfor H5N1 and other potentially zoonotic influenza subtypesin humans (e.g., by systematic review and metaanalysis).4. Valid baseline data, including serosurvey data, forexposure to H5N1 and other potentially zoonoticinfluenza subtypes, including serological investigationof people living near poultry outbreaks, working inhigh risk populations, and in contact with confirmedhuman cases.5. Determination of risk factors for human zoonotic influenzainfections within and among countries, includingvirus, host, and ecological factors (including understandingof risk associated with indirect contact withpoultry and contaminated environments and posed bydifferent avian and mammalian species).6. Further investigations of the link between poultry outbreaksand human cases (especially when no apparentlink exists), including joint investigations and analysisof national ⁄ community level factors contributing torisk.7. Understanding which production and slaughter practicesor procedures have increased risk for humanexposure and infection.8. Analysis of role of case definition (e.g., contact withsick and poultry) in identification of human cases.9. Comparative analysis of the epidemiology of differentzoonotic influenza viruses in humans.10. Expanded knowledge of host range of animal influenzasubtypes and strains.11. Understanding of competition among and within circulatingvirus subtypes.12. Understanding of viral persistence in the environment.13. Availability of rationales for developing practical publichealth measures and messages to optimize impact.Live bird markets1. Understanding of virus prevalence and transmission inLBMs, including impact of market interventions onvirus circulation.2. Understanding LBMs as a risk factor for human disease.Virus transmission ⁄ infectivity ⁄ pathogenesis1. Understanding of receptor structural diversity, distribution,and binding, including virus, host species and individualbinding differences, using new technologies suchas glycan arrays and virus histochemistry, and includinghypothesis testing using virus infectivity studies in variousspecies.2. Understanding of the HA mutations required to changethe binding affinity of H5N1 and other potentially zoonoticanimal influenza viruses to allow the virus to passmore easily to ⁄ among humans, and of selection forcesaffecting binding affinity.3. Understanding of the species barrier, including determinantsof species barriers strength for different viruses.18 ª 2010 <strong>FAO</strong>, <strong>OIE</strong> and <strong>WHO</strong>, Influenza and Other Respiratory Viruses, 4 (Suppl. 1), 1–29
<strong>FAO</strong>-<strong>OIE</strong>-<strong>WHO</strong> <strong>Joint</strong> <strong>Technical</strong> <strong>Consultation</strong> on Avian Influenza at the Human-Animal Interface4. Understanding the transmission ⁄ infectivity ⁄ pathogenesisof human seasonal and potentially zoonotic animalinfluenza viruses in various animal species, as well ashumans, including understanding of viral determinantsof these characteristics and identification of appropriateanimal models for associated research.5. Comparison of characteristics of avian viruses thatremain in the avian reservoir to those that spill over tothe mammalian host.6. Understanding of host-specific factors that affect thepolymerase complex, and therefore replication.7. Understanding homosubtypic and heterosubtypic immunityto human seasonal and potentially zoonotic animalinfluenza viruses and its effect on transmission ⁄ infectivity⁄ pathogenesis and serological responses, includingunderstanding of non-HA gene immunity.8. Better understanding of role of heterogeneity in sheddingand thus transmission from infected hosts.9. Additional assessment of the impacts of virus genotypeon phenotype.Analysis and sharing1. Mechanisms for timely and open sharing of information,viruses, reagents, sequence information, technology, andtools within and among sectors.2. Mechanisms for joint data collection and analysis amongsectors.3. Mechanisms for timely sharing of information frominternational or regional epidemiological and virologicalanalyses back to countries from which the data cameand neighboring countries at risk.4. More complete analysis on available virus isolates (e.g.,genetic, antigenic, and genotypic).5. Better understanding of antiviral resistance, includinghow it is acquired, and its effects on fitness.6. Solutions to maximize use of the available information.7. Expanded use of new technologies (e.g., antigenic cartography)to analyze other virus subtypes.Pandemic potential1. Determination of the pandemic potential of variousinfluenza subtypes and strains, including receptor repertoire,geographical distribution, and human exposure⁄ seroprevalence ⁄ immunity.2. Model to assess human infection ⁄ transmission potentialof viruses.3. Understanding of pathways if virus adaptation tohumans, including investigations using reverse adaptationof human strains.4. System to track mutations and evolution to ensureunderstanding of development of a pandemic strain(retrospectively, if necessary).Behavior change and assessment1. Determination of costs and benefits of household, village,and community poultry management practices,including cultural relevance.2. Behavior change communication that is targeted atstakeholders at each critical point along the chain.3. Risk reduction measures focused at the communitylevel, and implemented by the community.4. Impact assessments for proposed and implemented measures.5. Focus on biosecurity at all levels of the human–animalinterface.Diagnostics1. Standardization ⁄ harmonization of laboratory testing⁄ diagnostic procedures with respect to reference antigensand antisera for human sera, poultry sera, wildbird sera, and reference materials.2. Antigen detection tests that are as sensitive and specificbut not as expensive as RT-PCR.3. Serological tests that show significant difference betweenhomologous and heterologous local strain antigens, anda better understanding of what is the protective HI titer.4. Sensitive and specific serologic tests to identify previoushuman infection with AIVs.5. Updated best-practice assay manuals, implementation ofproficiency testing in laboratories, and training of diagnosticiansand epidemiologists.Optimizing the human health–animal health interface1. Optimized, coordinated surveillance and disease reportingsystem for influenza and other zoonotic diseases.2. <strong>Joint</strong> meta-leadership training and skill development.3. Better understanding of the difference between incentivesand disincentives of animal and public health tocreate win–win situations and build trust and respectbetween sectors.4. Shift from capacity building to capacity effectivenessand sustainability.5. Optimized roles and responsibilities of PPP and Nongovernmentalorganization (NGOs).6. Research and development centers to work holisticallyand ecologically for emerging zoonoses, beginning withH5N1.7. Participation of business communities as effective andequitable players in controlling, responding, and preventingEIDs.8. An integrated collaborative mindset and action plan tobetter understand infectious disease ecology and ensureapplicability for other zoonotic diseases.9. Global agenda for action.ª 2010 <strong>FAO</strong>, <strong>OIE</strong> and <strong>WHO</strong>, Influenza and Other Respiratory Viruses, 4 (Suppl. 1), 1–29 19
Page 1: DOI: 10.1111/j.1750-2659.2009.00114
Page 4: Joint Writing Comm
Page 7 and 8: FAO-OIE</s
Page 17: FAO-OIE</s
Page 29: FAO-OIE</s

FAO-OIE-WHO Joint Technical Consultation on Avian Influenza at ...

Create successful ePaper yourself

Delete template?

Save as template?