OIE Headquarters, Paris OIE update on MERS CoV Dr Gounalan Pavade OIE Headquarters, Paris GF-TADs sub regional conference on camel diseases 14 - 16 February 2016 Abu Dhabi, UAE

Notification of MERS CoV in animals MERS CoV in animals is reportable to OIE in accordance with article 1.1.3 of the OIE Terrestrial Animal Health Code Emerging disease with public health impact Notified when positive PCR results or isolation of the virus from animals OIE Member Countries would be obliged to report to the OIE a confirmed case of MERS CoV in animals, as an “emerging disease” in accordance with article 1.1.3 of the OIE Terrestrial Animal Health Code   Following the confirmation of a human MERS CoV in a small farm in Qatar, joint health and veterinary authorities collected animal samples from the patient farm which included 14 camels, 1 sheep, some pigeons and environmental samples (water, soil, animal food and grass). The samples were sent to Netherlands and 3 camels tested positive by PCR OIE has also informed the other Delegates (Kuwait, Jordan, in the region to inform MERS CoV identification in animals is notifiable to OIE

Criteria for listing an emerging animal diseases Emerging disease Means a newly recognised infection resulting from the evolution or change of an existing pathogenic agent, a known infection spreading to a new geographic area or population, or a previously unrecognised pathogenic agent or a disease diagnosed for the first time and which has a significant impact on public health OIE Member Countries would be obliged to report to the OIE a confirmed case of MERS CoV in animals, as an “emerging disease” in accordance with article 1.1.3 of the OIE Terrestrial Animal Health Code   Following the confirmation of a human MERS CoV in a small farm in Qatar, joint health and veterinary authorities collected animal samples from the patient farm which included 14 camels, 1 sheep, some pigeons and environmental samples (water, soil, animal food and grass). The samples were sent to Netherlands and 3 camels tested positive by PCR OIE has also informed the other Delegates (Kuwait, Jordan, in the region to inform MERS CoV identification in animals is notifiable to OIE

Countries notified MERS CoV to OIE Qatar (November 2013, April 2014 and June 2014) Kuwait (June 2014) Oman (May 2014) Iran (October 2014) Saudi Arabia (January 2016)

Question and answers on MERS CoV OIE prepared and posted a Question and Answers document on website Document updated regularly based on latest scientific information Provides information on scientific and general aspects of the disease http://www.oie.int/fileadmin/Home/fr/Media_C enter/docs/pdf/Disease_cards/Q_A_MERS- CoV_EN_update_August_2014_Final.pdf

OIE ad hoc group on MERS CoV In July 2014 OIE convened an ad hoc group on MERS CoV Term epidemiological studies more appropriate than surveillance The objectives of the epidemiological studies should focus on Determine if the MERS CoV present in camels in a country, holding or camel population Assess the risk profile of a country Assess public health risk and management measures Monitor strains and lineages of MERS CoV circulating in camel population

Surveillance for MERS CoV in camels Sample camels of different age groups from different industry sectors Generate data on incubation period, shedding period and risk factors for infection Investigate significant morbidity/ mortality events in camels Studies in wild and domestic animals

Recommendations on further MERS CoV research studies in animals Further develop and validate user-friendly diagnostic tests as fit for purpose (live animals and at slaughter) Comparative epidemiological studies in all countries to determine prevalence, distribution and demographics Experimental and naturally infected studies to characterise the clinical and pathological effects, kinetics of virus shedding and immune response Studies to assess risk factors and potential exposure sources for camel infections and the relationship with human cases

Recommendations on further MERS CoV research studies in animals Studies to investigate and assess the intervention measures to reduce public health risk Conduct genetic analysis of the virus and hosts from different geographical areas Presence, viability and survival of virus in different animal products and the environment Research on immunology and vaccine development

Recommendations on further MERS CoV research studies in animals Identification and evaluation of socioeconomic factors associated with infection Studies to obtain an insight into culturally acceptable risk reduction measures Studies to determine the original animal source of the virus, including wildlife

Need of an OIE Collaborating Centre for Camels Discussion of MERS CoV at Global Conference of the OIE Reference Centres Incheon (2014) The Camel health control is not easy; the type of dominant farming system is extensive, nomadic and performed in remote areas It is necessary to get reliable data on camel health status to improve vet competencies on MERS-CoV and other diseases. Encourage collection of samples and diagnosis essay validation with collaboration of OIE RL The need to set up a network of laboratories for diseases of camels was expressed on this issue and confirmed by OIE Biological Standards Commission Regional networks (Asia, Africa, ME) would be a first step to build a global network for epidemiology and diagnosis of camel diseases Need of an OIE Collaborating Centre for Camels

Establishment of an OIE Reference Centre for MERS CoV OIE received requests from member countries to establish Reference Centre of expertise for MERS CoV A twinning project was launched between OIE reference network of laboratories from Italy (Parent) and the Abu Dhabi Food Control Authority Animal Health Centre for diagnostic and research (Candidate) for camel diseases including MERS CoV

WHO roadmap for global MERS CoV research and product development WHO convened the meeting in Geneva (December 2015) WHO is developing a blueprint for emergency research and development to prevent the impact of infectious disease outbreaks. MERS-CoV is one of the 8 pathogens prioritized in the blueprint OIE participated and shared the recommendations of OIE ad hoc group on MERS CoV research priorities

WHO roadmap for global MERS CoV research and product development Diagnostic tests: Nucleic acid amplification tests (NAATs) are currently the gold standard of MERS-CoV diagnostic platforms Serology - Immunofluorescence, immunochromatography, ELISA, serum neutralisation tests Need for optimization and validation of existing assays and development of next generation diagnostics Need for simple to use commercial tests in fields

WHO roadmap for global MERS CoV research and product development Vaccine development: Three vaccine scenarios - A single dose vaccine during outbreaks (human) Two dose schedule to induce durable protection camel health care workers - Camel vaccine to prevent transmission to humans Dozen vaccine candidates in preclinical development Two vaccines tested in camels - Modified Vaccinia virus Ankara (MVA)

WHO high level mission to Saudi Arabia for MERS-CoV (Jan 2016) February 2016 – 1638 human cases including 587 deaths Saudi Arabia – 1281 human cases (78% of global number) Experts - WHO, OIE, CDC, University of Bonn, Institut Pasteur, University of Hong Kong, Public Health UK, Canada Objectives – Review ongoing MERS situation and implementation of previous mission recommendations Met Deputy Ministers of MoH, MoA and teams, visit human and animal health labs, hospitals, research institutes and camel farm, market, slaughter houses

WHO high level mission to Saudi Arabia for MERS-CoV (Findings and observations) Substantial progress has been made in the country Health Electronic Surveillance Network (HESN) – online system to monitor all suspected and lab cases Improved collaboration between MoH and MoA Field investigations done for human animal interface cases Surveillance done on various animal samples and tested MoH lab operating well for diagnosis of cases MoA lab established facilities for serology and PCR screening and in transition phase to new lab for better facilities Funding for priority public and animal health research on MERS-CoV established

WHO high level mission to Saudi Arabia for MERS-CoV (Recommendations) Focus on preparedness to respond and prevent primary infections in community and future hospital outbreaks Developing a national strategic plan for prevention and control involving all concerned Ministries Identify and nominate a leader to implement the plan Reinforce joint investigations of community acquired infections by joint rapid investigation teams (One health approach) The research programmes should be prioritized that serve public health agenda

Understanding MERS-CoV at animal human interface FAO convened this meeting in January 2016 Inventory of completed, current and planned research activities and field projects compiled Surveillance design, evaluation of diagnostic tests and value chain studies were discussed FAO to undertake field programme to understand the disease dynamics at the human animal interface Scientific network for MERS-CoV as in the model of OFFLU discussed

Conclusions Member Countries report MERS CoV to the OIE Surveillance for MERS-CoV initiated in many camel rearing countries and veterinary laboratories improve capacity and expertise for MERS- CoV Diagnostic tests available but validation needed Vaccine development in preclinical stage and needed more research OIE, FAO and WHO collaborate and provide advice for MERS-CoV international missions and meetings A One Health approach needed to control MERS CoV at the human animal interface

Thank you for your attention Organisation Mondiale de la Santé Animale World Organisation for Animal Health Organización Mundial de Sanidad Animal Thank you for your attention g.pavade@oie.int 12 rue de Prony, 75017 Paris, France - www.oie.int – oie@oie.int