Exercise Material Only — Not for Distribution EXERCISE

Exercise Material Only - Not for Distribution EXERCISE FICTITIOUS VARIANT EXERCISE

Exercise Material Only - Not for Distribution Introductory Remarks

Exercise Material Only - Not for Distribution Administration and Logistics

Exercise Material Only - Not for Distribution Tabletop Overview • This is a learning exercise, not a test, intended to highlight the dialogue and movement of surveillance information within and amongst internal and external network(s) at all levels. • It also provides visibility beyond the direct impacts of a zoonotic disease on animals, humans and the environment, as to other significant secondary impacts (agri-food industry, trade, environmental considerations etc. ). • During this simulation, you are asked to emulate what you do in similar situations. • The tabletop will last around one and a half hours: ▫ Approach/methodology ▫ Simulation ▫ Lessons learned

Exercise Material Only - Not for Distribution Tabletop Aim • Determine how CORDS can increase the effectiveness of disease surveillance. • Explore the current realities “on the ground” and how this might be improved

Exercise Material Only - Not for Distribution Tabletop Objectives - General • To understand how an emerging zoonotic disease outbreak would be identified by CORDS Networks • To identify how and among whom, information will be shared. • To begin to develop a picture of how the sharing of intelligence might add to the effectiveness of surveillance. • Solicit feedback and input on optimal ways to share and exchange information on a trusted party platform in order to transform information into intelligence. • To identify how CORDS can best contribute by the provision of an IT platform.

Exercise Material Only - Not for Distribution Assumptions and Artificialities • The zoonotic dimension of the exercise (animal to human, human to human etc. ) has been artificially facilitated, and the scenarios do not reflect the complexity of the task to establish such linkages. • Players will assume that any organization not participating in the exercise is responding to the outbreak to the best of their ability, or at full capacity, unless otherwise noted by the facilitator. • Vaccinations, if any carried out, have proven ineffective against this fictitious variant. • Names do not represent true persons.

Exercise Material Only - Not for Distribution Assumptions and Artificialities • Scenario progression has been accelerated. • It is acknowledged that under- reporting for a number of reasons (financial, political etc. ) may occur in real life but this aspect has been minimized. • Locations as well as entities have been emulated where necessary to provide reference points but are by no means to represent any weaknesses real, perceived or interpreted. • The scenario events are not intended to shed discredit on any organization, real or fictitious.

Exercise Material Only - Not for Distribution Player Handbook

Exercise Material Only - Not for Distribution Concept of Play • Exercise players will respond in accordance with the existing procedures, and practices. • Members from a number of the Networks have been assigned to this scenario, while it is acknowledged that a main portion of the scenarios/ injects may focus on a particular Network, contributions and experience from all members will be solicited. • Participants from the various Networks are encouraged to share relevant experience during the discussions and report on the realities of their respective Network.

Exercise Material Only - Not for Distribution Concept of Play • When you receive information whether by means of a scenario update or through an inject, you need to assess for your respective Network: • How, and from whom would I normally have received this information? • How do I know I can trust this information? • Is this information “official” who can I share it with, who do I want to share it with? • Does action need to be taken as a result of this information, by whom? What is my role? • Who else may have intelligence that would be of value? How can I obtain that intelligence?

Exercise Material Only - Not for Distribution Concept of Play • The player, once asked by the facilitator, will present planned actions to all participants and: ▫ emphasize information sources and support requirements by clearly stating the required action and by whom (within and amongst respective networks) ▫ Address any points of clarification from members • At the end of a scenario suite, a short plenary discussion will focus on key overarching thematic questions.

Exercise Material Only - Not for Distribution Background

Exercise Material Only - Not for Distribution FMD v The OIE defines Foot and Mouth Disease (FMD) as: “a highly contagious viral disease of cloven-hooved animals. The morbidity (the number of animals that will get the disease) could be as high as 100%. The virus which causes FMD is an aphthovirus of the family Picornaviridae. ” v Although it is/was thought that FMD is not readily transmissible to humans and is/was not a public health risk, this simulation is likely to explore new territory. v As of early 2014, only a few benign cases of human infections had been documented, and of these cases none required hospitalisation as these were mild in nature.

Exercise Material Only - Not for Distribution FMD v Before the conduct of this exercise, there were seven known immunologically distinct types of FMD viruses, A, O, C, SAT 1, SAT 2, SAT 3, and Asia 1. v “There can be a variety of genotypes within each of these requiring a specific vaccine effective against the circulating viral field strain in the event of an outbreak, to ensure protection”.

Exercise Material Only - Not for Distribution Scenario 1 OUTBREAK CATALYST

Exercise Material Only - Not for Distribution

Exercise Material Only - Not for Distribution SCENARIO HIGHLIGHTS • Mr. Văn’s pig operation is housed in concrete pig sheds with natural ventilation as well as pens and metal cages with natural ventilation panels located in the roofs. The sheds have concrete floors and accommodate the 3000 fatteners that he is raising as well as 275 sows and approximately 2500 piglets • The farm is located in the small village of Kha Ly Ha, located in the Bắc Giang province of Vietnam in the northeastern part of the country, 60 kilometres to the east of Hanoi. • The province has a high pig population density, estimated at around 1000 pigs per hectare. Mr. Văn informed the young help that FMD has been endemic in the region for some time and that the country was not FMD free according to the OIE. • Five young workers on Mr. Văn’s pig farm are being briefed concerning animal care and informed of their daily chores.

EXERCISE SCENARIO-INJECT SHEET Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 1 Today is July 1 st, 2014. As part of the daily chores, on Mr. Van’s farm, Mr. Gong was to cool and clean the pigs and their pens twice a day. He has been performing this task for approximately a week when he suddenly became ill. He displayed a fever of 104, was sweating profusely and his breathing was becoming increasingly difficult. He remained bed ridden and tended by his wife, his mother and two close relatives.

EXERCISE SCENARIO-INJECT SHEET Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Inject 2 Narrative This morning at 0500 hrs, one of the helpers noticed that four pigs were particularly lame, salivating and appeared to have small lesions on their snouts and feet. One pig had died. Mr. Văn asked that the dead pig be buried and that the others be sent to slaughter immediately. Today is July 2 nd, 2014

EXERCISE SCENARIO-INJECT SHEET Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Inject 3 Narrative Mr. Gong has been convulsing, coughing and gasping for air. The village health worker was called upon to tend to his bedside. He was transferred to the Commune Health Station a few kilometres away. Today is July 3 rd, 2014 Later that day, Mr. Gong passed away.

EXERCISE SCENARIO-INJECT SHEET Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Inject 4 Narrative This morning at 0600 hrs, half of Mr. Văn’s pigs were salivating and clearly demonstrated signs of lesions on their snouts and feet. While no pigs were dead, they appeared very weak. Mr. Văn immediately contacted his local field veterinarian Dr. No. The veterinarian arrived at the farm and after observation, proceeded to collect the following samples from the animals: Today is, July 4 th, 2014 • scrapings of foot lesions and placed them in separate buffered glycerine transport medium; • vesicular fluid aspirated with a syringe and placed in separate sterile tubes; • pre-scapular lymph node, tonsil, teat skin, adrenal gland, kidney and thyroid gland; and • blood samples including 10 ml of serum; 10 ml EDTA and 6 air dried smears fixed in 70% alcohol.

EXERCISE SCENARIO-INJECT SHEET Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Inject 5 Narrative Based upon the clinical signs observed, and the consequences associated with a potential case of FMD, the local veterinarian contacted the District Veterinarian. The District Veterinarian coordinated the submission of the samples to the reference laboratory. Mr Van’s farm has been quarantined pending the laboratory results. Today is, July 4 th, 2014 Initial reporting is being carried out.

Exercise Material Only - Not for Distribution PLENARY DISCUSSION - A At the Network level, please provide your views: • How, and from whom would I normally have received this information? • How do I know I can trust this information? • Is this information “official” who can I share it with, who do I want to share it with? • Does action need to be taken as a result of this information, by whom? What is my role? • Who else may have intelligence that would be of value? How can I obtain that intelligence?

Exercise Material Only - Not for Distribution Scenario 2 DOMESTIC CHALLENGE

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 1 Today is July 5 th, 2014 The CORDS Daily Alert reported that another local vet has reportedly taken samples on three farms near Mr. Văn’s farm as dozens of pigs displayed FMD-like symptoms. Similar tests are being ordered in adjoining provinces. 100 pigs from Mr. Văn’s farm have died.

SCANDAL NEWS www. scandalnews. fcom THE WORLD’S MOST DUBIOUS NEWSPAPER July 10 th, 2014 Pigs and Humans – ill! Jean Letannant reported that two large finishing pig farms in the Thai Bin area had been struck by an unknown virus as over 4000 pigs were displaying signs of sluggishness, loss of appetite and disorientation and more than 40 workers and over 200 relatives are said to be sick. As a result of the sudden increase in cases, the Surveillance Section of the District Preventive Medicine Brigade was dispatched to investigate. At the request of the National Institute of Hygiene and Epidemiology, blood samples were collected from all affected.

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 3 Today is July 10 th, 2014 At 0815 hrs, the head of the Reference Laboratory informed the Vietnamese Ministry of Agriculture and Rural Affairs that the samples submitted were diagnosed positive for FMD serotype FV. The following details are known concerning the current outbreak: Outbreak Profile: • Disease type: Confirmed FMD Serotype Fictitious Variant • Number of animals infected: in excess of 50 hogs confirmed • Potential animals affected: 6000

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 3 Cont’d Today is July 10 th, 2014 Location Profile: Location: Kha Ly Ha, located in the Bắc Giang. The community counts twenty farrow-to-finish sow operations of 200 -250 sows. Operations - Current Situation: Farm is quarantined and further local area investigation. Sampling in the Thai Bin area is on-going. OIE and FAO are being notified along with Regional Animal Production and Health Commission for Asia and the Pacific (APHCA), Southeast Asia Coordinating Group for the Control of Foot-and-Mouth Disease Planning: Severe south-westerly winds have been blowing for the past 12 hours. Aerosolised FMD is known to travel up to

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 4 Today is July 10 th, 2014 It has been reported that the newly appointed Deputy Minister of Health for Vietnam, which has heard of MBDS, wants to be briefed on the nature of activities being carried out to address the problem and what Networks and entities are involved. He wants to know what tools the Network has in place and how it intends to use them.

Exercise Material Only - Not for Distribution PLENARY DISCUSSION - B At the Network, please provide your views: • How, and from whom would I normally have received this information? • How do I know I can trust this information? • Is this information “official” who can I share it with, who do I want to share it with? • Does action need to be taken as a result of this information, by whom? What is my role? • Who else may have intelligence that would be of value? How can I obtain that intelligence?

Exercise Material Only - Not for Distribution Scenario 3 OUTBREAK SCOPE EXPANSION

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 1 Today is July 10 th, 2014 Dr. No, the local veterinarian that took blood samples on Mr. Van’s farm on July 4 th, has become violently ill at the Pan Asian Veterinary Conference held in Phnom Penh Cambodia he was admitted to Calmette Hospital. He will be unable to come to the farm for follow-up work, an alternate vet is helping out.

SCANDAL NEWS www. scandalnews. fcom THE WORLD’S MOST DUBIOUS NEWSPAPER July 10 th, 2014 Exported Weanlings - Sick! Jean Letannant Vietnamese weanlings exported to Laos and China arrived at destination in poor health condition today. Having spoken to importers, this reporter was informed that importers were likely to demand reimbursement. Several truckers involved in the transportation were also displaying high fevers. Upon closer inspection, some piglets displayed lesions on the snout and around the feet.

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 3 Today is July 10 th, 2014 Mr Toy, a major assembler (individual specialized in the collection of fattened pigs from farmers and their onward sale to larger assemblers or slaughterhouses) located in Hanoy noted that several pigs are in poor health and notified the Department of Agriculture and Rural Affairs.

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 4 Today is July 11 th, 2014 The Reference Laboratory/Public Health has confirmed that Mr Cong and immediate relatives tested positive for FMD Serotype Fictitious Variant. Other tests results were not available but were forthcoming. In accordance with its Terrestrial Animal Disease notification decision tree, OIE has been informed of the zoonotic potential.

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 5 Today is July 11 th, 2014 Scandal news reported that nobody seems to consider the risks associated with travel, winds or even population density and noted that it was unclear who will be developing disease propagation scenarios and what is the role of surveillance networks?

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 6 Today is July 12 th , 2014 Gone Global? - Scandal News Reported that suspicious illnesses and deaths are being reported in in Thailand, Laos, Cambodia as well as the Kenya, Israel, Canada and France. The reporter suggested that these occurrences were linked to travellers that were in contact with pork or people from the affected region. It was also reported that an additional 100 deaths in the Thai Bin area are suspected to be linked to the Variant. He noted that sources reveal a forthcoming trade ban and movement restriction on all pork from the affected regions.

Exercise Material Only - Not for Distribution PLENARY DISCUSSION - C At the Network level, please provide your views: • How, and from whom would I normally have received this information? • How do I know I can trust this information? • Is this information “official” who can I share it with, who do I want to share it with? • Does action need to be taken as a result of this information, by whom? What is my role? • Who else may have intelligence that would be of value? How can I obtain that intelligence?

Exercise Material Only - Not for Distribution Scenario 4 ACTIONS AND RECOVERY

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 1 Today is July 13 th , 2014 To curtail the spread of this new zoonotic disease, the Head of Animal Health Department under the Ministry of Agriculture and Rural Development ordered the culling of all pigs and a full transportation ban in the two affected areas. Measures to eliminate contaminated manure and carcasses are being assessed but burning will be used as the initial disposal method. He called for increased surveillance and noted the need to better understand the impact on water and the environment. He explained that large amounts of liquid waste are generated due to the volume of water needed to flush the pigs and wash away solid manure. It was measured that about 40 L of water were used per pig per day.

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 2 Today is July 13 th , 2014 A journalist queried whether surveillance encompassed environmental surveillance and wondered if the practice of using pig manure in fish farming created additional risks for humans or could lead to a trade ban on exported farmed shrimp and fish.

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 3 Today is July 14 th , 2014 At the request of the Ministry of Health, a World Health Organization (WHO)/ Global Outbreak Alert and Response Network (GOARN) international team of epidemiologists, case management, infection control experts and laboratory experts will be assisting the Vietnamese health authorities.

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 4 Today is July 14 th, 2014 Scandal News has reported that several cases of FMD Fictitious Variant have been reported in international news, blogs and tweets. The journalist wondered what the surveillance picture can/would reveal, and what linkages exist for the exchange of information and intelligence?

Exercise Material Only - Not for Distribution Scenario/Inje ct # Date/Time Narrative Inject 5 Today is XXXXX Efforts to contain the spread are underway, vaccine development efforts to counter this Fictitious Variant have been initiated. As a Network, you are asked to explain what other protocols/methods need to be instituted to monitor the progress of the outbreak.

Exercise Material Only - Not for Distribution PLENARY DISCUSSION - D At the Network level, please provide your views: • How, and from whom would I normally have received this information? • How do I know I can trust this information? • Is this information “official” who can I share it with, who do I want to share it with? • Does action need to be taken as a result of this information, by whom? What is my role? • Who else may have intelligence that would be of value? How can I obtain that intelligence?

Exercise Material Only - Not for Distribution PLENARY DISCUSSION – Hotwash • What issues and opportunities were identified? • How can an IT platform provided by CORDS help to overcome these? ▫ What would be optimal ways to share and exchange information on a trusted party platform in order to improve early warning? ▫ What tools and processes would be required? ▫ What does this mean for the priorities for CORDS and its networks?