towards vaccine selection guidelines for each regional virus pool
TRANSCRIPT
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Towards vaccine selection guidelines for each regional
virus pool
Can vaccine strains tailored to cover the needs of particular regions be identified and provide better, more targeted, regionalised
vaccine recommendations?
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WRLFMD Vaccine recommendations (National & European antigen banks)
O ManisaO BFS or CamposA24 CruzeiroA22 Iraq Asia 1 ShamirSAT 2 Saudi Arabia (or equivalent)
A Argentina 01A Iran 96A Iran 99A EritreaA Iran 87 or A Saudi Arabia 23/86 (or equivalent)A Malaysia 97 (or Thai equivalent such as A/NPT/TAI/86)O Taiwan 97 (pig-adapted strain or Philippine equivalent)SAT 1 South AfricaSAT 2 Zimbabwe
A15 Bangkok related strainA KenyaA87 Argentina related strainSAT 1 KenyaSAT 2 KenyaSAT 3 ZimbabweC Noville Within category: not in order of importance
HIGHPRIORITY
MEDIUMPRIORITY
LOWPRIORITY
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Lanzhou Meeting, China, Sept 15-18
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Regional/National
Reference Centres Reference Laboratories and
Collaborating Centres
Additional
Reference Centres
Intermediate, sporadic
Endemic
FMD-free. Virus present in game parks Free with vaccination
Countries with multiples zones
Source: Annual OIE/FAO FMD Reference Laboratory Network Report, 2007
Pool 1
O, A, Asia 1
Pool 2
O, A, Asia 1
Pool 3
O, A, Asia 1
Pool 6
SAT 1, 2, 3
Pool 4
A, O, SAT 1, 2, 3Pool 5
O, A, SAT 1, 2Pool 7
O, A
Regional Differences in FMDV
FMD-free
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Pool 1: East and South-East Asia
Panel members: China, Thailand, Japan.
Position of watershed:• Main weight of infection in SE Asia• Malaysia and all of Vietnam should be included in the region of Pool 1• Variable vaccine cover
Local and international vaccine seed viruses:• China – O 1999 (equivalent to O Manisa), A 1972 (equivalent to A22 Iraq),
Asia1 2005 (equivalent to Asia1 Shamir). • Thailand – O 189/87 (equivalent to O Manisa), A 118/87 (equivalent to A15
Bangkok and A Malaysia 97), and Asia 1 2005.• Japan – Emergency vaccines such as O Manisa, A Malaysia 97
Priority Vaccines: O Manisa-like, O Cathay-like, A Malaysia 97-like, A22 Iraq-like, Asia1 Shamir-like
Improvement in Priority Setting: Improving communication between countries especially over border areas. Better surveillance in some areas, e.g. Myanmar
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Pool 2: Indian Sub-Continent
Panel members: Russia, India, Belgium.
Position of watershed: Separation of Pools 2 and 3 reflects differences in A types
Vaccine seed viruses – standardised throughout India:• Type A. Genotype VII replaced Genotype VI after co-existence (1999-2003). A
Iran 05 occurs sporadically and not in Genotype VII. IND 40/2000 (Genotype VII) will replace IND 17/1982 (Genotype VI) in the vaccine (Dec 2008)
• Type O. Manisa related O/IND R2 75 replaced by O PanAsia 1 strain (better r1values). O PanAsia 2 may be introduced as vaccine.
• Type Asia 1. IND/ 63/72 still provides good protection though genetically distant. Asia1 Shamir vaccine might protect but there is no field information on use.
Priority Vaccines:• O PanAsia (O Manisa or equivalent for now), A IND 40/2000, Asia 1/IND/ 63/72
– theoretically Asia 1 Shamir.
Improvement in Priority Setting: The criteria for replacing a strain in a vaccine are laboratory and field data on match/efficacy and whether the strain is widespread and persistent in field (more than 1 year).
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Pool 3: EurasiaPanel Members: Russia, India, Belgium.
Position of watershed: Separation of Pools 2 and 3 reflects differences in A types
Russian vaccine seed viruses:• Type A. A22 550/USSR/65 replaced in 90s by A Armenia 98 (A Iran 96 strain)
until 2006/7, and will be replaced by A Iran 2005 (A/Turkey/1 2006) for Transcaucasia. The vaccine for the Far East still contains A22 or a bivalent vaccine with Iran 05.
• Type O. Manisa related O 1618 replaced by O PanAsia 1 strain due to better r1values. In future O PanAsia 2 vaccine might be introduced.
• Type Asia 1. Old Asia 1-48/RUS still protects against currently strains though genetically different.
Other local vaccine seeds: Turkey, IranWRL recommendations for W. Europe
Priority Vaccines:• Could use same type O and Asia 1 vaccine strains in Pools 2 and 3.• The priority vaccines - O PanAsia (O Manisa or equivalent for now), A Iran 05
type (or A22 Iraq for now), various Asia1 strains – theoretically Asia 1 Shamir.
Improvement in Priority Setting: Better surveillance in Central Asian countries and bordering pool 2
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Pool 4-6: AfricaPanl members: South Africa, Botswana, WRL
Position of watersheds:• Kruger National Park in South Africa should be in Pool 6 • Insufficient data on central Africa to define border between Pools 4 and 5.
Vaccine seed viruses:• Strains developed for use elsewhere e.g. O Manisa• Historic strains from e.g. Nigeria, Kenya• SAT strains from BVI and OVI
Priority Vaccines:• Historic strains often not available• Uncertainty over suitability of limited selection available
Improvement in Priority Setting:• Need to survey the FMD vaccine strains available/in production in Africa. • Need a systematic analysis of the viruses circulating and their r1 values with
respect to current vaccines. • Increased demand could stimulate supply • Difficulty in adapting some SAT strains
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Pool 7: South America
Panel members: USA, PANAFTOSA, Argentina
Position of watershed: Agreed
Vaccine seed viruses:• Different matching requirements for prophylactic and emergency
vaccination. • Vaccine strains in current use - O Campos, A24 Cruziero, C3 Indaial and A
2001. • Depending on the countries needs bi-, tri- or tetra-valent vaccines are used.
Priority Vaccines:• As above. • Preferential use of high quality vaccines including broad antigenic strains
over use of multiple strains that give an exact match. • Strong emphasis on batch quality control. • Many countries implement surveillance strategies to evaluate the efficiency
of the vaccination programmes.
Improvement in Priority Setting: some difficulties with field isolate supply
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Conclusions
• Decision makers want impartial advice, but sometimes have difficulty interpreting WRLFMD’s general recommendations – regional advice would be useful, but sometimes conflicts of interest
• Watershed concept useful, but overlaps and uncertainties exist
• Continuing and in places improved surveillance needed
• Variable harmonisation of vaccine strains at national and regional level
• Vaccine matching requirements differ for emergency use and prophylaxis –exact match versus generic broadly reactive strains
• Vaccines held in reserves of FMD-free countries often differ from those used in endemic countries
• More thorough antigenic characterisation of available isolates is required, but not clear if public sector has responsibility to select new vaccines
• Some areas have no tailored vaccine supply and few measures to control suitability – related to low demand and public identification of need versus private supply
• Affordability and quality control of vaccines are separate but very important issues
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Recommendations• Map the watersheds better through enhanced and targeted surveillance
(action check list?)
• Border areas between pools
• Blind spots and neighbouring areas plus Facilitate reporting and sample shipment
• Incentives (vaccine/training) for samples
• Simplify sample submission
• Foster regional projects involving local labs and vet services to study prevalence and virus types
• Establish new regional labs (e.g. W Africa - OIE twinning model)
• Survey vaccine strains more fully – availability, use
• More systematic antigenic matching studies to provide confidence in available strains and to develop new ones
• Improve collaboration and clarify roles between reference laboratories and vaccine producers
• Provide regional advice on vaccine selection in future Ref Lab Network reports
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