AVIS - Foot and Mouth disease

Disease Prevention

Detailed Requirments for Contingency Plans

Detailed requirements for contingency plans in an FMD-free country not practising vaccination

Contents:

Legal Powers
Financial Provisions
Chain of Command
National Disease Control Centres
Local Disease Control Centres
Expert Groups
Personnel, Laboratories, Equipment & Facilities
Operations Manual
Emergency Vaccination
Disease Preparedness and Awareness
Scenarios

1. 1. Each Country shall make provisions to ensure that legal powers necessary for the implementation of the contingency plans are enacted and allow an eradication campaign against foot and mouth disease (FMD) to be rapidly successful.

1. 2. These legal powers shall be clearly understood by all involved with disease control and shall be described in the standing instructions for dealing with disease outbreaks. (Section 8).

1. 3. The legal powers shall provide for inter alia all the necessary aspects to ensure the effective control of an outbreak:

the notification of suspected and confirmed cases,
further actions to be taken in order to determine the diagnosis,
the designation of protection and surveillance zones, perform surveillance within these zones, the control of movements and other restrictions in relation to animals, dairy products, meat and meat products, semen and embryos, provide for emergency animal welfare slaughter,
the destruction of carcases and access to sites to be used for this purpose,
sanitation and other procedures at infected and suspect premises,
the payment of compensation,
the slaughter of infected and contact animals both direct and indirect,
emergency vaccination,
authority to invoke aid and support from the police and other civil organizations in the event of an emergency.

2. 1. Each country shall ensure that it has provision for access to emergency funds and the budgetary powers and financial resources to cover the cost of dealing with all aspects of an FMD epizootic.

The main areas of expenditure are:

the cost of personnel over and above normal running costs,
the cost of capital equipment and consumable items,
the cost of killing livestock, disposal of carcases/contaminated material and zoo-sanitary measures,
the cost of animal welfare measures,
the cost of compensation payments to stockowners,
the cost of emergency vaccination.

2. 2. In order to maintain a state of readiness each country should be adequately prepared for an epizootic. Accordingly, it should in 'peacetime' provide funds to make available all the necessary support facilities/equipment to efficiently manage a major disease outbreak.

An audit of the 'real time alerts' referred to in Section -10 will quickly identify the deficiencies in preparedness and the consequent funding needed to comply.

2. 3. The farming community can be expected to cooperate only if valuation is fair and compensation for killed stock is paid promptly. National authorities should endeavor to ensure that payments of direct losses are made no later than 60 days after the killing of stock.

3. 1. Each country shall establish a chain of command guaranteeing a rapid and effective decision making process for dealing with an FMD epizootic.

3. 2. The crisis organization shall be capable of responding to emergency situations at short notice (within hours).

3. 3. The operational management of an outbreak needs to be carefully considered. To ensure an effective implementation of decisions taken, organisational models shall be drawn up at both national and local level.

3. 4. A central decision making unit (CDU) shall be in charge of the overall direction of control strategies. The composition of the unit will depend on the scale and complexity of the outbreak. The chief veterinary officer (CVO) shall be a member of the Unit.

3. 5. The chain of command shall be clearly understood by all who may be directly or indirectly involved with disease emergencies and shall be clearly described in standing instructions.

4. 1. Each country shall, in the event of an outbreak, be prepared to immediately establish a functional national disease control centre (NDCC). Depending on the national situation and the particular outbreak, the functions of the NDCC may be transferred to the regional centre but only in situations where the tasks of the NDCC are not compromised. The NDCC shall co-ordinate the implementation of all the decisions taken in the central decision making unit (CDU). A coordinator shall be appointed in advance to guarantee the prompt establishment of the centre.

4. 2. To ensure an effective management process and to be optimally prepared, a check list of the people, equipment, facilities and protocols to allow for the prompt establishment of the centre, should be prepared and regularly certified by the coordinator. In addition to the foregoing, the coordinator shall take charge of disease preparedness, contingency planning and the organization of real time alerts .

4. 3. The main task of the NDCC is to direct and monitor the operations of the local disease control centres (Section 5) and its responsibilities include:

defining the actions to be taken and ensuring that the local centres implement them promptly and effectively,
the deployment of staff and other resources to local centres,
the provision of information to the Commission, to other countries and to the national veterinary organisations, national authorities and also the agricultural and trading bodies,
when indicated, they will be responsible for the organization of an emergency vaccination campaign and also the determination of vaccination zones,
liaison with diagnostic laboratories,
liaison with the press and other media,
liaison with the police authorities to ensure specific legal measures i.e., movement controls etc., are being implemented.

4. 4. The NDCC shall have all the necessary staff, facilities and equipment to manage an efficient eradication campaign:

a herd identifier and animal location system preferably computerized,
all suitable means of communication including telephones, fax; facilities for the press are desirable. Additionally, similar communication systems together with a networked computerized information system should be established with the LDCC's the laboratories and other relevant organisations.
maps and other sources of information that can be used in directing control measures,
a common diary shall be maintained to record in chronological order all the events associated with the outbreak,
lists of national and international organizations that will be affected by and must be contacted in the event of a disease outbreak (e.g., A.l. organizations),
lists of staff and other persons who may be called upon immediately to serve at local disease control centres or in expert groups in the event of a disease outbreak. These lists shall record practical experience or training in the control of FMD and abilities to work in more than one community language,
lists of National, International, Expert Laboratories, etc.

4.5 The staffing of NDCCs is dealt with in Section 7.

5. 1. Each country shall have detailed plans and be prepared for the immediate (within 48 hours) establishment of fully functional local disease control centres (LDCC's) in the event of FMD outbreaks.

5. 2. The plans regarding the LDCC's shall provide for: likely locations, organization, staff, accommodation, facilities and equipment, management systems, communication lines as well as information channels.

5. 3. The LDCC's shall be situated within a suitable but safe distance of the primary outbreak(s). The LDCC's may be established at e.g., existing local veterinary offices or laboratories, in temporary buildings or even in mobile accommodations.

5. 4. There shall be clear and effective management of the LDCC's. One individual shall be in charge and he/she shall in turn be directly responsible to the CDU through the LDCC structure. The staff requirement is described in Section 7.

5. 5. The LDCC's shall have staff, facilities and equipment as required and indeed the organization to ensure the prompt implementation of the legislative provisions relating to the epidemiological inquiry, the official surveillance of the zones, tracing, welfare and emergency slaughter, sanitation, emergency vaccination when decided by the CDU and all other policy decisions.

5. 6. The LDCC's shall give special attention to the application of:

strict hygiene rules and the use of disposable material and equipment,
the need for separate shower/dressing rooms for personnel visiting supposedly clean premises as well as for those visiting suspect / infected premises. Also separate facilities for the cleansing and disinfection of equipment used in either 'clean' or suspected / infected herds. Mobile sanitary installations may be used,
the submission of material to diagnostic laboratories,
ensuring personnel engaged in the slaughter, post-mortem and sanitation procedures are provided with totally separate facilities. Each such "subcentre" shall be under the charge of a veterinarian who is directly responsible to the head of the LDCC,
the provision of adequate telephone, fax and computer network communications which is essential. At least one telephone line shall be reserved for communication with the NDCC. Field staff should be equipped with mobile phones,
the provision of 'tools' for effective management of all necessary data. It is recommended that the record systems are computer-based and connected to the NDCC, and net-worked to all necessary databases, the laboratories and other organizations,
a common diary shall be maintained to record in chronological order all the events associated with the outbreak,
there shall be available at all times up to date lists of persons and local organizations in each region who must be contacted and may be involved in the event of an outbreak.

6. 1. Countries shall create a permanently operational expert group to maintain expertise in order to assist the relevant authority in ensuring disease preparedness.

6. 2. The expert group will function in an advisory role and report to the CVO.

6. 3. The staffing of the expert groups is listed in Section 7.

6. 4. The expert group(s) shall possess the required skills and technical knowledge of the clinical signs and the epidemiology of FMD and also the methods of prevention and eradication of an outbreak of the disease. This knowledge shall be kept up to date. Accordingly, education and regular training of the expert groups are essential elements.

6. 5. The expert groups shall have the following responsibilities:

at all times to maintain expertise and assist the relevant authority on preparedness in dealing with disease emergencies,
to advise the CVO and NDCC on and give support to the eradication of FMD.

6. 6. The tasks of the expert groups are as follows:

to give advice on and support to the elaboration of contingency plans, scenarios and the operations manual,
to develop models for collection and analysis of epidemiological information,
to develop tools and models using scientifically based rules and expert knowledge to support the decision making process,
to develop or implement data management systems for managing:
- a) epidemiological information,
- b) geographical and meteorological data,
- c) risk analysis,

assist in organizing the:

a) training of staff on the clinical signs, the epidemiology, the epidemiological inquiry and the control of epizootic diseases,
b) real-time alert exercises,
c) disease awareness campaigns for authorities, farmers and veterinarians.

6. 6. In case of a suspicion of FMD the expert group shall be immediately informed and involved. The expert group shall:

if necessary on the spot, evaluate the clinical picture and the epidemiological situation and give advice regarding the sampling and analyses needed for diagnosing the disease together with the additional actions and measures to be taken.

6. 7. In case of an outbreak the expert group shall be immediately informed and involved. The tasks of the expert groups are then:

to conduct, at least in the index case and if necessary on the spot, an evaluation of the clinical picture and an analysis of the epidemiological inquiry in order to collect the necessary data for determining the origin of the infection, the date of introduction of the infectious agent and the possible spread of the disease,
to report to the CVO and NDCC and give advice on screening, sampling, test procedures, control and the other measures to be applied and the strategy to be implemented,
to follow up and guide the epidemiological inquiry,
to amplify the epidemiological data with geographical, meteorological and other necessary information, to analyse the epidemiological information and to perform, at regular intervals, risk assessments.

7. 1. Each country should ensure that it has the necessary resources to ensure the effective management of an FMD outbreak.

7. 2. Each country should maintain lists of staff available to deal with a disease emergency. The lists (to be held by the coordinator) should identify:

the name and location of the staff members,
qualifications e.g., veterinarians,
practical experience of list A diseases,
language skills,
training undertaken,

7. 1. The staffing of the NDCC should provide for an effective management process. It shall preferably include: the CVO, the coordinator, veterinarians and other administrators trained in the management of disease emergencies, also computer experts etc.

7. 4. The staffing of the LDCC's should be such as to ensure, an effective management of the eradication campaign and the implementation of the decisions taken in the CDU and the NDCC. The personnel resources needed for both administration and field operations must not be underestimated and shall be deployed promptly. Experience suggests a field veterinarian will only manage to deal with five holdings each day. Accordingly, reference to the scenarios, referred to in Section 11, will provide an insight into the numbers of staff available and required at any one time to maintain control.

The LDCC's should have immediately available sufficient trained staff to deal with, at any one time, a best case scenario and up to 10 outbreaks and the consequent surveillance in the protection and surveillance zones associated with each.

The staff shall include:-

administrative personnel trained in the management of disease emergencies at a local level and persons trained in the maintenance of record systems required for FMD control;

veterinarians trained in the diagnosis of FMD, slaughter, zoo-sanitary and other procedures at infected premises, the operation of movement controls and other restrictions,

support staff trained in the tasks of the LDCC i.e., procedures at infected premises and the operation of movement controls etc.

7. 5. Each country shall create an expert group(s) which should consist of: veterinarians with the skills referred to in section 6, laboratory scientists experienced in laboratory tests for FMD, epidemiologists meteorologists trained in the application of stimulation models computer experts.

7. 6. Diagnostic Laboratories: Each country shall ensure that it has available at all times the services of an approved FMD diagnostic laboratory either in its own country or elsewhere.

7. 7. Equipment and Facilities: The NDCC and each LDCC shall have immediate access to equipment and facilities to guarantee the implementation of the control measures, sanitation, burial, rendering capacity etc. Because of infrastructural differences between countries reference shall be made to the different scenarios prepared by the countries to assess those needs. Standing arrangements or protocols should be agreed with public and private contractors to guarantee the immediate availability of this equipment.

8. 1. Each country shall have an up to date operations manual. It shall describe in detail and in a comprehensive and practical way, all the actions, procedures and instructions and control measures in handling either a suspect case or an outbreak of FMD. An up to date copy of the manual shall be kept at each level of the organization. In certain circumstances, i.e., in rendering plants, it may be appropriate to limit or adapt it to meet the needs of specific groups allocated special tasks.

8. 1. In general the manual should describe:

the legal measures,
the organizational arrangements,
the logistics including the hygiene measures,
the emergency vaccination measures,
the arrangements for the release of information to farmers, veterinarians, milk plants and the public.

8. 1. More detailed consideration should be given to:

arrangements for the killing of livestock, the destruction and disposal of carcases,
arrangements for emergency and welfare slaughter during a standstill,
movement control of people, animals, animal product, feed, transport etc. and the use of computers as "tools" to manage these tasks. The overall objective of an effective standstill should not be compromised,
the hygiene rules applicable to a suspect/outbreak location, farm visits etc.,
the prompt deployment of staff and other resources

9. 1. Each country shall have available detailed plans for emergency vaccination.

9. 2. Countries should decide in advance the criteria that would apply before embarking on this strategy.

9. 3. Countries should establish, or have access to staff, facilities, equipment and vaccine to provide for a prompt and effective vaccination programme. Lists should be prepared in advance of personnel who can be called upon.

9. 4. In relation to the handling of vaccine consignments, it is important that the logistical arrangements are clear and unambiguous,

"Cold chain" facilities should be established for the distribution of the vaccine so that it is, at all times, kept under cool temperature conditions e.g., as specified in the European Pharmacopoeia,

responsibility may be assigned to the manufacturer and protocols agreed on the distribution of vaccine to the affected region,

the NDCC should be responsible for distribution within the region to the veterinarians administering the vaccine.

10. 1. Each country shall ensure that staff are regularly trained in procedures for diagnosing and eradicating FMD.

10. 2. National Authorities shall arrange for the regular training of all veterinary and support staff who may be engaged in dealing with FMD outbreaks. Preferably, the training programmes should be led by specialist teams and with the support of staff who have experience of FMD. The training programme should include:

the diagnosis of FMD,
procedures at suspect/infected premises,
procedures at local disease control centres,
procedures at national disease control centres,
procedures and tasks for the expert groups,
the delivery of effective decision making at all levels of the organizations,
tracing exercises, record keeping, and the epidemiological inquiry,
notification and publicity procedures.

10. 1. For a training programme to be effective, 'real-time alert' exercises for FMD should be undertaken at least biennially. These exercises should simulate disease control operations. They should focus on both extensive and intensive production areas, and involve not only holdings where animals of the same species are located but perhaps holdings where animals of all the susceptible species are located. The scenarios referred to in Section 11 should be tested during the training exercises and refined if necessary.

Tools should be available to:

support the operational management of the outbreak,
provide for the rapid tracing of contacts and 'at risk' herds,
simulate the spread of disease between farms,
compare the consequences of different control strategies.

10. 1. An audit of the effectiveness of the 'real time alerts exercises' should be undertaken and a report should be made available.

10. 2. National Authorities rely on stockowners and veterinarians attending farm animals to report the possibility of FMD. Rapid detection and reporting of the index case is essential if an eradication programme is to be successful - this can be achieved by regularly maintaining an awareness of the ongoing risk of FMD outbreaks with both veterinary practitioners and stockowners. Efforts should focus on:

regular refresher courses for veterinarians on FMD,
disease awareness campaigns targeted at stockowners, A.I personnel and perhaps livestock hauliers that would emphasize the risk, the clinical signs, the need for prompt action and finally the availability of compensatory funds.

11. 1. Given that FMD can present itself on different levels: locally, regionally and on a national/international level it is recommended each country shall draw up different scenarios taking into account the specific risk factors and other characteristics of the country such as the animal production systems, infrastructure etc..

11. 2. It is recommended that three or four different scenarios should be described and simulation models might prove helpful in their preparation. Scenarios can be a powerful tool to prepare for an emergency situation; they model the possible course of an outbreak including all the resulting consequences.

scenarios can function as a forecasting instrument bringing to the surface the decisions to be taken in 'what if' situations and all the consequences arising from a particular course of action,

they may assist in detecting the possible weaknesses and the critical points in the system,

they may also be helpful in actual emergencies where access to different scenarios will enable the use of decision trees in the decision process i.e., what will be the available options in a specific situation.

11. 3. Many factors determine the level of spread. However, in a Community where a non-vaccination policy exists, the potential magnitude of an outbreak can be seriously underestimated particularly in intensive animal production areas with associated high levels of animal movements.

Important variables that can influence the course an epidemic can take are:

the moment the infection is diagnosed,
the way the virus has been introduced into the population and how far the virus has been spread in the country,
the character and virulence of the virus, the species infected;
in epidemiological terms, the seriousness of the infection is determined not only by the virulence of the virus and the rate of virus excretion i.e., pigs, but also by the fact that in the more temperate regions of the Community, cows, sheep and goats are for much of the year, held outside while pigs are normally kept indoors,
farm management practices in the region where the infection occurs.