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International framework to mitigate
the risk of infectious diseases
DVM, PhD, OKAMOTO Karoku
Professor of Veterinary Public Health, Kagoshima University
Classification of Zoonoses
Direct zoonoses
Metazoonoses
Cyclozoonosis
Saprozoonoses
The World Organisation for Animal Health (OIE)
In 1920, rinderpest occurred unexpectedly in Belgium, as a
result of zebus, originating from India and destined for Brazil,
transiting via the port of Antwerp.
Rinderpest is a disease of
cloven-hoofed animals and the
most lethal plague known in cattle.
The disease recurred throughout
history, often accompanying wars
and military campaigns. They hit
Europe especially hard in the 18th
century. An outbreak in the 1890s killed 80 to 90 percent of all cattle in
Southern Africa.
The concept that international cooperation is essential for
prevention of infectious diseases such as rinderpest was
advocated by international society of veterinary medicine.
Despite the inevitable slowness of the negotiations
undertaken through diplomatic channels, 28 States obtained
an agreement for establishing OIE on 25 January 1924.
The OIE's priority missions are as follows:
● Transparency of the animal disease situation worldwide
Collect, analyse and disseminate veterinary information
● Encourage international solidarity in the control of animal
diseases
● Promotion of veterinary services
● Food safety and animal welfare
●
World Assembly of Delegates
Council
Director General
Specialist Commissions
Regional Commissions
Headquarters
Collaborating Centres
Reference Laboratories
Ad hoc Groups
Working Groups
Regional Representations
Africa
Ameicas
Asia and Oceania
Europe
Middle East
Terrestrial Animal Health Code(2010)
Volume 1. General provisions
Section 1. Animal disease diagnosis, surveillance and notification
Section 2. Risk analysis
Section 3. Quality of veterinary services
Section 4. General recommendations: Disease prevention and control
Section 5. Trade measures, import/export procedures and veterinary
certification
Section 6. Veterinary public health
Section 7. Animal welfare
Volume 2. Recommendations applicable to OIE Listed diseases and
other diseases of importance to international trade
Section 8. Multiple species: Anthrax, Foot and mouth disease, Rabies, --Section 9. Apidae: Acarapisosis of honey bees, --Section 10. Aves: Avian influenza, Avian tuberculosis, Newcastle disease, --Section 11. Bovidae: Bovine tuberculosis, Bovine spongiform encephalopathy, --Section 12. Equidae: Equine encephalomyelitis, Equine infectious anaemia. --Section 13. Lagomorpha: Rabbit haemorrhagic disease, --Section 14. Ovidae and capridae: Scrapie, Sheep pox and goat pox, --Section 15. Suidae: Porcine brucellosis, Classical swine fever, ---
World economic
crisis
the spread of high tariffs, import
quotas, discriminatory practices
and foreign exchange restrictions
World
war
April 10 1947, the International Conference was held to
negotiate tariff reductions and finalize the text of a General
Agreement on Tariffs and Trade (GATT).
<GATT Rounds> → → → <Uruguay Round - 1986-1994> the most
substantial trade liberalization agreement in agricultural products in the
history of trade negotiations.
THE GENERAL AGREEMENT ON TARIFFS AND TRADE (GATT)
Article XX General Exceptions
Subject to the requirement that such measures are not applied in a
manner which would constitute a means of arbitrary or unjustifiable
discrimination between countries where the same conditions prevail, or
a disguised restriction on international trade, nothing in this Agreement
shall be construed to prevent the adoption or enforcement by any
contracting party of measures:
(b) necessary to protect human, animal or plant life or health;
The quarantine in order to prevent malignant infectious diseases is not
restricted by the principle of trade liberalization agreement.
Article 20 of GATT allows governments to act on trade in
order to protect human, animal or plant life or health,
provided they do not discriminate or use this as disguised
protectionism. A separate agreement on food safety and
animal and plant health standards(SPS) sets out the basic
rules.
Agreement on the Application of Sanitary and Phytosanitary Measures
It allows countries to set their own standards. But it also
says regulations must be based on science.
Member countries are encouraged to use international
standards, guidelines and recommendations where they
exist. When they do, they are unlikely to be challenged
legally in a WTO dispute.
Understanding the WTO
The World Trade Organization(WTO) was born in 1995. The
bulk of the WTO's current work comes from the 1986-94
negotiations called the Uruguay Round and earlier
negotiations GATT.
OIE is recognised as a reference organisation for
animal health by the World Trade Organization(WTO)
Export
Sanitary level of a country
B
Country A
Equivalent
Non Tariff Barrier !
Appeal to WTO
Not equivalent
E
International
standards
Not equivalent
C
D
Equivalent
Relationship between sanitary measures and
bilateral trade in the free trading system of WTO
For example: foot and mouth disease(FMD)
In 2011, OIE has a total of 178 Member Countries and
Territories which are marked off five FMD status blow.
65 Countries and Territories.
FMD free where vaccination
is Not practised
Many of them are in the countries
of Europe and the Americas.
FMD free zone where
vaccination is Not practised
10 Countries and Territories
FMD free where vaccination
is practised
One Country
FMD free zone where
vaccination is practised
FMD is endemic
Six Countries have several zones
within their borders.
Japan and Korea were FMD free
where vaccination is Not practised
until the outbreaks in 2010.
As globalization has progressed, FMD
outbreaks not only affect the epidemic
countries but also can pose a threat all
over the world.
In order to eradicate FMD,
international organizations and
developed countries are helping
developing countries.
FAO, OIE: The Progressive Control Pathway For FMD control (PCP-FMD)
OIE has been collaborating with Food and Agriculture Organization(FAO)
OIE/FAO Network of Expertise on Animal Influenza(OFFLU)
Animal influenzas threaten animal health and welfare,
agricultural productivity, food security, and the livelihoods of
farmers in some of the world’s poorest countries. Both H5N1
HPAI and pandemic H1N1 2009 have also highlighted the
potential for animal origin influenza viruses to evolve into
global public health threats.
To ensure that the impact and risks for animals and
humans are kept at a minimum, it is vital that the animal
health sector takes the lead in monitoring influenzas in
animals and in sharing this information with the international
community.
Waterbird posess all
typs of H, but other
Waterbird (Anatidae)
H1～H16
(α2-3)
α2-3
animals infect with
difinitive types.
On rare occasions, surpass the “species barrier”
Swine
α2-3、α2-6
Poultry
α2-3
Horse
α2-3
H1、H3
(α2-3、α2-6)
H5、H7
(α2-3)
H3、H7
(α2-3)
H5N1
Human
α2-6
α2-6、α2-3
α2-3 receptor
localized on
alveolar cell
H1、H2、H3
(α2-6)
The flu usually prevalent only
within the same species.
Animal
αreceptor
H type of virus
(Affinity to αreceptor)
Shape and thickness of arrows show
the frequency of infection.
FAO
EMPRES
PB2
PB1
PA
HA
NP
NA
MP
NS
Emergence of pandemic H1N1 2009
Human
H3N2
Swine
H1N1
Double
H3N2
97-98
×
Triple
H3N2
Poultry
H?N?
98
×
⇒
⇒
×
In North America, regional virus repeatedly infect mutually between man and pig.
Eurasia
Swine H1N1
Swine
H1N1
Triple
H1N2
2000 -
09
⇒
PB2
PB1
PA
HA
NP
NA
MP
NS
Triple
H1N1
×
⇒
Pandemic
H1N1 2009
Novel H1N1 Confirmed and Probable Case Rate in
the United States, By Age Group
Novel H1N1 U.S. Deaths, By Age Group
From April 15 to July 24
2009, USA reported 43,771
confirmed and probable
cases of novel influenza A
(H1N1) infection. Of these
cases, 5,011 people were
hospitalized and 302 people
died.
The information analyzed by
CDC supports the conclusion
that novel H1N1 flu has
caused greater disease
burden on people younger
than 25 years of age than
older people.
High incidence of young
generation and significantly
higher fatality rate than
seasonal influenza
strengthened vigilance
worldwide.
2009 H1N1 Early Outbreak and Characteristics
Percentage of Visits for Influenza-like Illness
Reported by the U.S. Surveillance Network
FluView USA
the national
baseline
Number of InfluenzaAssociated Pediatric Deaths
by Week of Death
On April 28, WHO
pulled up flu alert level
from "3" to "4", and to
"5" on the next day,
declaring “Pandemic”
on Jun 12.
People afraid of the
flu pandemic out of
season in summer.
Without mutation
through the epidemic,
the fatality rate is equal
or less than those of
seasonal flu.
WHO announced that
the H1N1 influenza
virus has moved into
the post-pandemic
period. However,
localized outbreaks of
various magnitudes
are likely to continue.
Another threat of flu
Avian influenza viruses do not normally infect
humans. However, there have been instances of
certain highly pathogenic strains causing severe
respiratory disease in humans. In most cases, the
people infected had been in close contact with
infected poultry or with objects contaminated by
their faeces.
Nevertheless, there is concern that the virus
could mutate to become more easily
transmissible between humans, raising the
possibility of an influenza pandemic.
H5N1 (Hong Kong, 1997)
Highly pathogenic H5N1 poultry outbreaks
18 confirmed human cases, 6 deaths
• Median age: 9.5 years (range 1 1-60 yrs.); 11 pneumonia
cases
• Case-control study: Risk factor: exposure to live poultry
the week before illness (OR = 4.5, p = 0.045)
• 10% H5N1 antibody seroprevalence in poultry workers
• No evidence for efficient human-to to-human transmission:
Wet Market:
No Pandemic
• 1.5 million poultry culled,
markets disinfected
• Poultry imports temporarily
stopped from China
• Surveillance: farms, markets,
border
• Poultry segregated, monthly
market “rest days”
Live bird
market
Dead
birds
Number of Patients with Avian H5N1
%
A fatal
human case of avian influenza
H5N1 infection occurred in China in
Nov 2003, and the disease expanded
to South East Asia, in 2005 to world
wide. Since then, 552 persons have
120120.0
100100.0
Fatality
rate
been infected and 322 died
(Fatality rate is about 60%).
8080.0
6060.0
4040.0
Alive
2020.0
Death
0 0.0
2003
2004
2005
2006
2007
2008
2009
2010
2011
2003 2004 2005 2006 2007 2008 2009 2010 2011
50
: Viet Nam
: Indonesia
: Egypt
: China
45
40
35
30
25
20
HPAI H5Ni first attacked Viet Num,
followed Indonesia. In 2006, 45 out of 55
patients died. Although the vaccines
already had been developed, Indonesia
did not available them.
Indonesia government rejected
the entrance of supporting parties
to obtain new strain of flu virus in
2006. Developed countries stocked
huge amount of H5NI vaccine, but
many developing countries could
never perchase them.
15
10
5
0
2003
2004
2005
2006
2007
2008
2009
2010
2011
Number of death in major epidemic countries
Why the spread of H5N1 viruses
among humans is limited?
The epithelial cells in the
upper respiratory tract of
humans mainly possess
sialic acid linked to galactose
by α 2,6 linkages (SA α
2,6Gal).
However, many cells in the
respiratory bronchioles
and alveoli possess SA α
2,3Gal, which is preferentially
recognized by avian viruses.
These facts are consistent
with the observation that
H5N1 viruses can be directly
transmitted from birds to
No sneeze !
humans and cause serious
Influenza virus
lower respiratory tract
receptors in human.
damage in humans.
Virus, 56, 85-90, 2006.
Nasal mucosa
Bronchioli respiratorii
Alveolar cell
Most human cases of H5N1 avian influenza have
occurred in rural or periurban areas where many
households keep small domestic poultry flocks.
However, defeathering or butchering of dead wild
birds, especially waterfowl, is particularly hazardous in
areas where Avian influenza A/H5N1 virus has been
reported or is likely to occur, such as along migratory
routes. The public should be advised to report, and
avoid contact with, wild birds found dead.
FAO developed a wet market communication pilot
project.
Wet Market
Wild aquatic birds are considered the natural reservoir of all low
pathogenic viruses(LPAI). Wild birds have probably carried influenza
viruses, with no apparent harm, for centuries. A considerable
circumstantial evidence suggests that migratory birds can introduce low
pathogenic H5 and H7 viruses to poultry flocks. In some cases these
viruses may then mutate in poultry to the highly pathogenic form.
Unfortunately, the role of migratory birds in the spread of high
pathogenic virus (HPAI) was not fully understood.
Apr 2005, wild birds began dying at Qinghai Lake in China, where
Avian Influenza Surveillance of Wild Birds
numerous migratory
birds congregated.
Altogether, 6,345
birds from different
species died in the
coming weeks. This
was the first reported
instance of any HPAI
causing mass deaths
in wild birds. This
event triggered
world-wide
spreading of H5N1.
WHO strategic action plan for pandemic influenza
November 2005, a meeting on avian influenza and human pandemic influenza
was jointly convened by WHO, FAO, OIE, and the World Bank. The meeting
agreed with two general principles and five Strategic actions.
(1) preventing the emergence of a pandemic virus or, should this prove
impossible, delaying the initial international spread of a pandemic
(2) preparing all countries to cope with a pandemic in ways that reduce
morbidity and mortality and also mitigate economic and social disruption.
Strategic action
1 Reduce human exposure to the H5N1 virus
2 Strengthen the early warning system
3 Intensify rapid containment operations
4 Build capacity to cope with a pandemic
5 Coordinate global scientific research and development
The plan aims to achieve two over-arching objectives:
1. to exploit all feasible opportunities to prevent the H5N1 virus from
developing the ability to ignite a pandemic and, should this effort fail,
2. to ensure that measures are in place to mitigate the high levels of
morbidity and mortality and social and economic disruption that can be
expected during the next pandemic.
Country-Level Financing and Support Framework
Integrated Country Program
Government Resources
Domestic Private Resources
Existing External Financing and Technical Assistance
Potential Additional Support
Grants
Grants
Bilateral Financing
and Technical
Assistance
Possible
World Bankadministered
Trust Fund
Loans,
limited
grants
Multilateral Assistance
(International Bank for
Reconstruction and
Development/Infocomm
Development Authority)
Technical
Assistance,
etc
Regional
Organisation
FAO,
OIE, WHO
and their joint
programs
The World Bank, December 5, 2005: PROGRAM FRAMEWORK DOCUMENT FOR PROPOSED
LOANS/CREDITS/GRANTS IN THE AMOUNT OF US$500 MILLION EQUIVALENT FOR A GLOBAL PROGRAM
FOR AVIAN INFLUENZA CONTROL AND HUMAN PANDEMIC PREPAREDNESS AND RESPONSE
WHO Interim Protocol: Rapid operations to contain the initial
emergence of pandemic influenza
The draft of interim protocol to achieve the strategic action plan for pandemic
influenza was proposed on May 2006, and updated October 2007.
Pandemic
A/H5N1
Avian A/H5N1
Fatality rate=60%
Seasonal Flu
A/H1N1
A/H3N2
Index Cluster
Efficiently
transmissible
human-to-human
Reassortment in humans
Containment Zone: The geographical area and
population which contains the Index Cluster and
where extensive interventions are applied
Buffer Zone: The geographical area and population
around the Containment Zone where active and
complete surveillance is applied.
Containment and Buffer Zones for Rapid Containment
The epithelial cells in the upper respiratory tract of swine
possess SA α2,6Gal and SA α2,3Gal. So, human flu virus
and avian flu virus can infect swine. Reassortment of both
types in swine may emerge novel pandemic virus with very
high fatality rate and transmissibility.
Although the control of these transmissions might be hard,
Pandemic H1N1 2009
we should win this battle.
extended very rapidly
throughout the world, but
the lethality was low. Novel
Pandemic A/H5N1 could be
Avian Virus
Human Virus
second coming of the 1919
Spanish Flu.
Pandemic
A/H5N1
Avian H5N1
Reassortment
in swine
Efficiently
transmissible
human-to-human
OIE Disease timelines: Highly pathogenic avian influenza
2005
2006
2007 2008
2009
2010
Viet Nam
Indonesia
Egypt
China
Thailand
Cambodia
Turkey
Azerbaijan
: There is no information available on this disease
: Never reported
: Disease not reported during this report period
: Disease suspected but not confirmed
: Confirmed infection but no clinical disease
: Confirmed clinical infection
: Confirmed infection but limited to certain zones
Global Framework for Transboundary Animal
Diseases (GF-TADs)
May 2004
Transboundary Animal Diseases(TADs) may be defined as
those epidemic diseases which are highly contagious or
transmissible and have the potential for very rapid spread,
irrespective of national borders, causing serious socioeconomic and possibly public health consequences.
The GF-TADs is a joint initiative of FAO and OIE which
combines the strengths of both organisations in the fight
against TADs world wide. It is composed of a global
component at the OIE and FAO Headquarters level and of
regional and sub-regional components. The ultimate aim of
the Programme is to control and eradicate the most
significant animal diseases including those transmissible to
humans.
The GF-TADs programme will be developed
along four main thrusts:
(1) A regionally led mechanism, to operationally
address and implement action against priority
diseases as agreed by relevant stakeholders;
(2) The development of Regional and Global
Early Warning Systems for major animal diseases;
(3) The enabling and application of research on
TADs causing agents at the molecular and
ecological levels for more effective strategic
disease management and control; and,
(4) The completion of the Global Rinderpest
Eradication Programme set for achieving global
declaration of freedom by the year 2010.
Contributing to One World, One Health
A Strategic Framework for
Reducing Risks of Infectious
Diseases at the Animal-HumanEcosystems Interface
14 October 2008
Contents
1. Introduction: HPAI and beyond
2. Achievements and lessons learned from HPAI and their
relevance to Emerging infectious diseases(EID)
3. Emerging and existing infectious diseases and their
impacts
4. The Strategic Framework
5. Specific objectives and outputs
6. Cross-cutting issues to be addressed This principle may
7. Institutional issues
be called “OWOH”
8. Financing the framework
or “One Health”.
Executive summary
Humanity faces many challenges that require global
solutions. One of these challenges is the spread of infectious
diseases that emerge (or re-emerge) from the interfaces
between animals and humans and the ecosystems in which
they live. This is a result of several trends, including the
exponential growth in human and livestock populations,
rapid urbanization, rapidly changing farming systems, closer
integration between livestock and wildlife, forest
encroachment, changes in ecosystems and globalization of
trade in animal and animal products.
OWOH
Reclamation
Forest
with
wildlife
Human living area
Various pathogens
existing among the
wildlife could infect
livestock and people.
The objective of the Framework is to establish how
best to diminish the risk and minimize the global
impact of epidemics and pandemics due to EID, by
enhancing disease intelligence, surveillance and
emergency response systems at national, regional
and international levels, and by supporting them
through strong and stable public and animal health
services and effective national communication
strategies. National authorities play a key role in
devising, financing and implementing these
interventions. Successful implementation will
contribute significantly to the overall goal of
improving public health, food safety and security,
and the livelihoods of poor farming communities, as
well as protecting the health of ecosystems. OWOH
There are five strategic elements to this work:
• Building robust and well-governed public and animal
health systems compliant with the WHO International Health
Regulations (IHR 2005) and OIE international standards,
through the pursuit of long-term interventions
• Preventing regional and international crises by controlling
disease outbreaks through improved national and
international emergency response capabilities
• Better addressing the concerns of the poor by shifting the
focus from developed to developing economies, from
potential to actual disease problems, and through a focus on
the drivers of a broader range of locally important diseases
• Promoting wide-ranging collaboration across sectors and
disciplines
OWOH
• Developing rational and targeted disease control
programmes through the conduct of strategic research.
Based on these considerations, the following six specific
objectives have been identified as areas for possible priority
emphasis by national authorities:
• Develop international, regional and national capacity in
surveillance, making use of international standards, tools
and monitoring processes
• Ensure adequate international, regional and national
capacity in public and animal health - including
communication strategies - to prevent, detect and respond to
disease outbreaks
• Ensure functioning national emergency response capacity,
as well as a global rapid response support capacity
• Promote inter-agency and cross-sectoral collaboration and
partnership
• Control HPAI and other existing and potentially re-merging
infectious diseases
OWOH
• Conduct strategic research.
The FAO-OIE-WHO Collaboration: A Tripartite Concept Note
Sharing responsibilities and coordinating global activities to address
health risks at the animal-human-ecosystems interfaces. April 2010
VISION
A world capable of preventing, detecting,
containing, eliminating, and responding to animal
and public health risks attributable to zoonoses
and animal diseases with an impact on food
security through multi-sectoral cooperation and
strong partnerships.
Joint efforts should be engaged at regional and
national levels to obtain deeper and sustainable
political support for integrated prevention of
diseases and the effect of high impact pathogens
of medical and veterinary importance.
CONSTITUTION OF THE WORLD HEALTH ORGANIZATION
----The enjoyment of the highest attainable standard of health
is one of the fundamental rights of every human being
without distinction of race, religion, political belief,
economic or social condition.
The health of all peoples is fundamental to the attainment
of peace and security and is dependent upon the fullest cooperation of individuals and States.
The achievement of any States in the promotion and
protection of health is of value to all.
Unequal development in different countries in the
promotion of health and control of disease, especially
communicable disease, is a common danger.
----
Thank you for your
attention
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