Development of a risk assessment methodological framework for potentially pandemic influenza strains (FLURISK)
In our modern and globalised society the interface between animals, humans and zoonotic disease is an increasingly important area for scientific research and surveillance. Zoonotic diseases know no boundary and are able to potentially spread efficiently and quickly through the various international trade and human travel networks. One of the most notorious group of zoonotic pathogens are Influenza A viruses. Historically, avian influenza viruses have been of primary concern within the scientific community as they were responsible for several pandemics in the 20th century and intermittent outbreaks in various countries. With such focus on avian influenza viruses, the scientific community was unprepared in 2009 for the unexpected emergence and worldwide spread of the swine-origin pandemic A(H1N1)pdm09 highlighting gaps in our pandemic preparedness and the importance of taking a broader approach to the problem. The international scientific community in different forums highlighted the need to enhance the capacity of countries/international organisations to identify, in advance and realistically, those animal influenza viruses that are thought to warrant interventions and/or prepare for a potential pandemic situation.
In December 2011 the European Food Safety Authority (EFSA) awarded a grant for the implementation of the FLURISK project which is coordinated by the Istituto Zooprofilattico Sperimentale delle Venezie, Italy. The objective of the project is the development and validation of an influenza risk assessment framework (IRAF) for the ranking of animal influenza A strains in their potential to cross the species barrier and cause human infection. The project consortium consists of recognized human and veterinary medicine European research institutes, reference laboratories and universities such as the Istituto Zooprofilattico Sperimentale delle Venezie (IZSVe), Italy, Animal Health and Veterinary Laboratories Agency (AHVLA), United Kingdom, Royal Veterinary College (RVC), London, United Kingdom, National Institute of Public Health and the Environment (RIVM), Netherlands, Institut Pasteur (IP), France, University of Ghent (UGhent), Belgium) and two external consulting partners, Food and Agriculture Organization of the United Nations (FAO), Rome and the Center of Disease Control (CDC), Atlanta (USA), fostering cross-disciplinary expertise and collaborations. Experts from ECDC, OIE, WHO and OFFLU are also being invited to take part in relevant meetings and activities of the project as external observers and advisors.
The Influenza division of the CDC, which is in the process of developing and validating its own tool to evaluate influenza A viruses with pandemic potential, has shared with the FLURISK consortium the methodology and the key inputs that were necessary to develop their tool. The CDC tool is a simple, additive model based on multi-attribute decision analysis. The model includes elements and sub-elements that address the properties of the virus itself, the attributes of the population, considers both the veterinary and human findings, and integrates both laboratory and field observations. A weight is assigned to each element such that all elements are not considered of equal importance within the model. Difficulties and weaknesses encountered in the process and highlighted by CDC were considered by the FLURISK consortium to design the initial model for the IRAF.
The FLURISK-IRAF applies a quantitative spatial Multi-Criteria Decision Analysis (MCDA) method aimed to answer the following risk question: “What is the relative likelihood of Influenza virus X, Y and Z in animal species A, B, C infecting humans in the current time period?”. As such, the model is not a prediction tool and will not provide a definitive indication of what the next pandemic strain(s) will be. Rather, the project intends to formalise the process of ranking of influenza strains on their potential to move from an animal species and cause human infection. A second aim of the project is to determine where the current virus strains may spread to given trade routes (legal and illegal), bird migration and human travel.
Systematic reviews on evidence of human infections caused by zoonotic influenza virus, intrinsic characteristics of virus and epidemiological risk factors potentially driving a virus jump across animal species, conducted as part of project activities, has contributed to the identification of key parameters and data to be used for the development and validation of the IRAF. Apart from the methodology applied in CDC and FLURISK tools which differ significally, these tools are likely to be complementary since they focus on a different stage of pandemic preparedness. While the FLURISK model focuses on assessing the risk of emergence of a potentially pandemic virus in humans, the CDC tool assesses the probability of a pandemic and its impact.
Both tools are currently still under development and modification but once validated, may contribute to inform surveillance strategies and the planning and implementation of eventual risk mitigation actions.
IZSVe staff in FLURISK
- Ilaria Capua (Scientific Coordinator)
- Marco De Nardi (Project Manager)
- William Dundon (WP-leader)
- Olga Munoz (Researcher)
Name: Marco De Nardi
Position: Project manager
Telephone: +39 049 8084368