John R. LaMontagne Memorial Symposium on Pandemic Influenza Research April 4-5, 2005 Institute of Medicine Working Group Two: Controlling Animal Influenza and Decreasing Animal-to- Human Transmission Research Recommendations

Highest Priorities  Immediate term –Epidemiology studies (human and animal) –Reverse genetics  5 yr term –Identify control measures: introduce & assess –Technologies to better regulate animal influenza vaccines  10 yr term –Improve animal vaccines –Develop relevant animal models

Immediate: Epidemiology  Country specific epidemiological studies – both animals and humans –Conduct surveillance in industrial settings, village farms, markets (also captive birds) –Conduct studies to identify risks for humans  Where are humans acquiring infections?  Why don’t these individuals become sick (or infected)  Develop a more accessible serology method; micro-NT necessary (standardization ongoing) –Complement epi studies by evaluating pathogenesis in affected bird species – domestic, captive and wild birds

Immediate: Reverse Genetics  Perform reverse genetic studies to identify avian influenza genes from specific strains with greatest interspecies transfer potential  Caution should be exercised as to the appropriate biosafety level for re-assortant studies to generate a potentially pandemic strain by reverse genetics  Develop methods to assess person to person transmission potential

5-yr: Identify control measures  Identify control strategies optimized for conditions in Developing Countries –Assess creative solutions for smallholders: education, economic incentives, changes in agricultural systems –Perform knowledge, attitude, practice studies  Assess all strata (recreational vs village vs industry)  Assess what interventions are practiced  Leverage local pathways for communication  Leverage public education system to introduce better practices –Perform operational research to assess impact of interventions such as education including baseline surveys

5-yr: Technologies to better regulate animal influenza vaccines  Improve standards of purity, safety & potency of AI vaccines  Research to improve procedures for lot release (potency): what is it and how should it be measured?  Greater regulatory oversight (internationally)  Studies to confirm efficacy of AI vaccines in chickens and also ducks, geese and other minor poultry species  Need effectiveness studies to monitor product  Particularly in Asia if vaccines will be used for AI control  Develop vaccines for domestic ducks and geese

10-yr: Improve Vaccines  Cell culture production  New adjuvant systems  Oils which can be metabolized  Vaccines which reduce transmission (Sterilizing immunity is unachievable)  Mass delivery techniques

10-yr: Animal Models  Develop animal models to predict & understand potential for circulating animal influenza viruses including H5N1 Asian viruses to infect humans and be transmitted from human to human