1.
FMD VACCINATION AND POST-VACCINATION MONITORING
IN AFGHANISTAN: ISSUES AND CHALLENGES
G. Ferrari1; A. Naseri1; A. Torakai1; S. Ullah1; G. Ziay;2 J. Miakhail2; A.
Noori3; Q. Fakhri3; M. Nazemshirazi1
1Food and Agriculture Organization – FAO Afghanistan
2General Directorate for Animal Health and Livestock (Ministry of Agriculture, Irrigation and Livestock – MAIL Afghanistan)
3Dutch Committee for Afghanistan (DCA)

2.
Outline of the presentation
• Background
• FMD vaccination campaign tools
• FMD vaccination campaign outcomes
• Baseline prevalence of FMD
• Risks and Rates
• Post vaccination monitoring
• Conclusion

3.
Background
• Afghanistan is currently qualified in stage 1 of the FMD Progressive Control Pathway
(PCP);
• A national control program is under development to move to stage 2 in 2017;
• Preventive vaccination against FMD (serotypes O, A and Asia1) is one component of
the national program;
• The implementation of the vaccination is supported by the FAO project
OSRO/AFG/402/JPN

4.
Background
• FAO Afghanistan has specific projects to support smallholder dairy farmers’ through
the delivery of integrated dairy services and inputs;
• This process has led to the establishment of 5 provincial Dairy Unions, 24 district
level cooperatives and 77 village level milk producers’ cooperatives;
• The cooperatives have a total membership of 7 961 dairy farmers and are legally
registered within the Ministry of Agriculture Irrigation and Livestock (MAIL);
• Each dairy union runs a milk processing plant (combined capacity of 27 metric
tons/day) and also processes livestock concentrate feed (combined capacity of 100
MT / day) that is sold to farmers.

5.
Background
• Members of the cooperatives delivering milk to the five Dairy Unions are the target for the
FMD preventive vaccination campaign;
• 7 292 small-holder producers (92.1% of registered members) are enrolled in the vaccination
program;
• 327 additional dairy producers were enrolled in Kandahar province. They deliver milk to a
processing plant not part of the Dairy Union system;
• 47 246 cattle estimated to be present at the outset of the campaign;

6.
Background
• FMD vaccination is organized over a one-year period in
two successive campaigns (six-month apart);
• In each campaign two visits (one-month apart) are
supposed to be made by the field operator. The second
visit is to re-vaccinate animals which were found
between 1 and 12 months of age during the first visit
(animals 0-1M are not eligible for vaccination);
• The vaccination is implemented through an agreement
made with a Non-Governmental-Organization (NGO) –
Dutch Committee for Afghanistan (DCA);

7.
Background
• Two main tools are utilized to monitor the
implementation of the campaign;
• Collection of serum samples to establish
baseline prevalence of FMD and to assess
the immune response to vaccine are part of
the routine activities;
• FMD virus largely present in Afghanistan
(from May to 4 October 2016 n. 159 samples
received – 122 Positive [82 type O; 31 type
Asia1; 4 type A; 5 still to be characterized).

8.
FMD vaccination campaign: tools
• A vaccination card is one of the main tools to monitor the progress of the campaign:

9.
FMD vaccination campaign: tools
• According to the proposed schedule and the age at which animals are found during
the first visit of each campaign the number of doses that each individual will receive
over a one-year time is summarized in the below scheme:
– Age-group: from 0 up to 1 M n. of doses: 3
– Age-group: from 1 up to 6 M n. of doses: 4
– Age-group: from 6 up to 12 M n. of doses: 3
– Age-group: more than 12 M n. of doses: 2

10.
FMD vaccination campaign: tools
• Through the vaccination card the following
indicators can be built:
– (i) Proportion of animals vaccinated against the initial
estimated number of animals (OCV);
– (ii) Proportion of animals vaccinated against those
actually found to be present (OCW);
– (iii) the proportion of dropouts (young animals that
failed to receive a booster dose);
– (iv) Average time-distance between the first injection
and the booster dose.

11.
FMD vaccination campaign: tools
• The vaccine registration book is the second tool utilized:

12.
FMD vaccination campaign: tools
• Through the vaccine registration book the following indicators can be built:
– RCV - Overall cumulative rate of consignment to vaccinators from start to end of campaign (for
each batch) = n. doses consigned/n. doses initially loaded
– RMV - Monthly (or some other interval) rate of consignment to vaccinators (for each batch) = n.
of doses consigned at the end of the monitoring period/n. of doses available at the starting of
the monitoring period
– RUV - Cumulative Rate of Utilisation for a selected interval (for each batch) = (n. of doses
consigned in the interval – n. of doses returned in the interval)/(n. of doses consigned in the
interval);
– 1-RUV is the percentage of wastage.

13.
FMD vaccination campaign: outcomes
• The 2016 spring campaign started on 27 May and was concluded on 6 September;
• Tetravalent vaccine O, A (2 subtypes to cover the new G7 strain), Asia1;
• Origin of the vaccine: Turkey
• The number of cattle found to be present was 39 140 (vs 47 246 estimated) and
38 400 were vaccinated (OCV = 81.3% and OCW = 98.1%);
• The rate of dropouts was (6.25%);
• The average number of days between the injection of a first and a booster dose was 27.5
days
• The percentage of doses utilized was 94.94% and conversely the percentage of wastage
5.06%

14.
FMD vaccination campaign: outcomes

15.
Baseline prevalence of FMD
• At the time of first visit a total of 443 serum samples were collected and tested for
the presence of NSP antibodies;
Age-group N. tested Average age NSP pos
Proportion of
NSP positive
0-12 M 163 6.2 M 33 20.2%
12-24 M 132 19.3 M 27 20.4%
>24 M 148 47.2 M 68 45.9%

16.
Baseline prevalence of FMD
• Standardized prevalence (using data from the database of the vaccination cards)
Age-group
Proportion of NSP
positive
Population in
each age-group
Weight
Weighted
prevalence
0-12 M 20.2% 11 781 0.301 6.08%
12-24 M 20.4% 8 120 0.207 4.23%
>24 M 45.9% 19 239 0.491 22.56%
Standardized prevalence (direct method) 32.87%

17.
Risks and Rates
• Age-group specific risks were estimated through the following equation:
𝑅𝑖𝑠𝑘 = 1 −
𝑆 𝑎+1
𝑆 𝑎
where 𝑆 𝑎 is the proportion of susceptible at time a
and
𝑆 𝑎+1 is the proportion of susceptible at time 𝑎 + 1
𝑂𝑣𝑒𝑟𝑎𝑙𝑙 𝑟𝑖𝑠𝑘0−1𝑌 = 1 −
𝑆1𝑌
𝑆 𝑎𝑡 𝑏𝑖𝑟𝑡ℎ
= 1 −
0.7975
1
= 0.2024
𝑂𝑣𝑒𝑟𝑎𝑙𝑙 𝑟𝑖𝑠𝑘1−2𝑌𝑟𝑠 = 1 −
𝑆2𝑌𝑟𝑠
𝑆1𝑌
= 1 −
0.7954
0.7975
= 0.0026
𝑂𝑣𝑒𝑟𝑎𝑙𝑙 𝑟𝑖𝑠𝑘>2𝑌𝑟𝑠 = 1 −
𝑆>2𝑌𝑟𝑠
𝑆2𝑌𝑟𝑠
= 1 −
0.5374
0.7954
= 0.3244
Overall risks over a period of 1 year for the two age-groups 0-1Y and 1-2Yrs.
Overall risk for age-group >2Yrs over a period of 4 years (48M) - [95% of the animals in this age-group were less than 6 years or 72M].

18.
Risks and Rates
• The annual (or pluri-annual) risks were then estimated on a monthly basis through the following:
𝑀𝑜𝑛𝑡ℎ𝑙𝑦 𝑅𝑖𝑠𝑘 = 1 − 𝑆 𝑎
1
𝑎
where
𝑆 𝑎 is the proportion of susceptible at time a (now expressed in months)
𝑅𝑖𝑠𝑘 𝑚𝑜𝑛𝑡ℎ𝑙𝑦 0−12𝑀 = 1 − 0.797512𝑀
1
12
= 0.0187 (𝟏. 𝟖𝟕% 𝒑𝒆𝒓 𝒎𝒐𝒏𝒕𝒉)
𝑅𝑖𝑠𝑘 𝑚𝑜𝑛𝑡ℎ𝑙𝑦 12−24𝑀 = 1 − 0.997312−24𝑀
1
12
= 0.00022 (𝟎. 𝟎𝟐𝟐% 𝒑𝒆𝒓 𝒎𝒐𝒏𝒕𝒉)
𝑅𝑖𝑠𝑘 𝑚𝑜𝑛𝑡ℎ𝑙𝑦 >24𝑀 = 1 − 0.6756>24𝑀
1
48
= 0.00814 (𝟎. 𝟖𝟏𝟒% 𝒑𝒆𝒓 𝒎𝒐𝒏𝒕𝒉)

19.
Risk and Rates
• Finally the monthly incidence rate was estimated through the following:
𝑅𝑖𝑠𝑘 = 1 − 𝑒−𝑟𝑎𝑡𝑒∗𝑡𝑖𝑚𝑒
which re-arranged gives:
−ln(1 − 𝑅𝑖𝑠𝑘)
𝑡𝑖𝑚𝑒
= 𝑅𝑎𝑡𝑒

20.
Risks and Rates
• For the three age-groups the following three estimates of the monthly incidence
rates were obtained:
– Age-group 0-12M 1.885 per 100 animal-months at risk
– Age-group 12-24M 0.0229 per 100 animal-months at risk
– Age-group >24M 0.8169 per 100 animal-months at risk
These estimates were plotted against the expected proportion of NSP positives over time.

21.
Post vaccination monitoring
• Among the 6-12 months age group 140 animals were sampled twice (1 month apart)
to assess the immune response to the vaccine (all those animals were vaccinated for
the first time);
• The source of serum samples to be tested to assess the immune response to vaccine
was twofold: (i) dairy cattle of the dairy union system; (ii) cattle belonging to a re-
settled human population in a previous desert area (assisted by the project).

22.
Post vaccination monitoring
• Out of the 140 animals 31 (22.1%) of them were already NSP positive at the time of first
sampling and thus excluded from further analysis.
• The remaining 109 remained NSP negative 1 month after the first injection and were then
tested also for SP antibodies against type A, O and Asia1 with the following results:
Type %
A 63.3%
O 56.9%
Asia1 83.5%

23.
Conclusion
• The implementation of the activities is coherent with the current framework of Public-Private-Partnership (private
sector as implementer and public sector responsible for monitoring and evaluation);
• The approach proposed to monitor the implementation of the field activities is relatively simple and robust enough to
detect deviations from the targets established at the outset of each vaccination campaign;
• No FMD clinical outbreaks occurred so far in the vaccinated farms/households;
• The serological data presented needs to be further analyzed and confidence intervals estimated taking into account the
complexity of the survey but provides indication that the incidence rates are highest during the first year of life;
• Immune response to one injection maybe is a bit lower than expected;
• Security remains one of the major issues.

24.
Thanks
The FAO project OSRO/AFG/402/JPN is supported by the
Government of Japan