Proposed Next Steps for Improving Quality of IB-VPD Surveillance

Ad hoc TAG

Dr. Anne von Gottberg SAGE Session 7: Reinforcing Surveillance

9 November 2011

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Ad Hoc TAG

l  Convened by WHO to provide advise re. improving new vaccines surveillance quality

l  2011 –  2 conf calls: summer –  Most members attended

September surveillance meeting

l  Initial focus on IB-VPD –  Reviewed status, challenges,

limitations –  Discussed matrix

Name Expertise Organization 1 Art Reingold SAGE member SAGE 2 Brad Gessner IB VPD epidemiology AMP 3 Anne Von Gottberg IB VPD laboratory GRL & RRL, NICD, South Africa 4 Anthony Scott IB VPD epi & lab GRL, Kilifi-KEMRI, Kenya 5 Duncan Steele RV epidemiology BMGF 6 Umesh Parashar RV epidemiology CDC 7 Mary Slack IB VPD laboratory GRL, HPA 8 Peter Figueroa SAGE member SAGE 9 Gagandeep Kang RV laboratory RRL, RV 10 Anita Zaidi IB VPD epi and lab Sentinel Site, Pakistan 11 S. Amarzaya Mongolia sentinel

site Sentinel Site,

Mongolia 12 Rana Hajjeh IB VPD Epidemiology and

Laboratory CDC

13 Chris Van Beneden IB VPD Epidemiology CDC 14 Kate O'Brien IB VPD JHSPH 15 Martin Antonio IB VPD lab RRL, MRC, the Gambia

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WHO prioritized recommendations for activities to implement, drawn from Matrix I.  WHO vision and commitment for IB-VPD surveillance

•  Define a clear mission statement - uncertainty amongst partners as to the role of the network: national data, capacity building, data for serotype replacement

•  WHO should signal the need to maintain a high quality surveillance system: Criteria for funding 1.  Presence of surveillance management team in country

l  MoH focal point, sentinel hospital focal point, sentinel hospital laboratory focal point, data manager focal point

2.  Country enrols > 100 suspect meningitis cases / year (countries conducting only Tier 1 surveillance)

3.  Reporting data regularly to WHO 4.  Participating in the global EQA programme 5.  Tier 1 indicators met before support provided for Tier 2 surveillance

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I.  WHO vision and commitment for IB-VPD surveillance, continued

–  WHO should avail itself of modern data collection and sharing processes •  Develop a case-based reporting strategy •  Revise and modernize data collection process

–  Utility of surveillance would be enhanced if simple methodology existed to determine the denominator:

•  Review of hospital admission logs to define catchment area + health care utilization component?

II.  Finance –  Secured funding remains a critical factor

•  Ongoing daily operations •  Stable contracting with GRL, RRLs •  Ensuring implementation of recommendations •  Future development of the networks

WHO prioritized recommendations for activities to implement, drawn from Matrix

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Data Management Lab Epi Location Part time (RO & ISTs) 0 1 + ISTs AFRO

1 part time 1 1 AMRO 1 part time 1 part time 1 part time EMRO 1 part time 1 1 EURO

1 part time in progress 0 1 part time SEARO 1 part time 1 1 part time WPRO 1 part time 1 1 HQ

WHO prioritized recommendations for activities to implement, drawn from Matrix

III.  WHO staffing –  Need for increased staffing for new vaccines surveillance

•  Discussions ongoing with ROs •  For enhanced data management (case-based, modernize data collection

processes), improved laboratory

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IV.  WHO Regional Reference Laboratories (RRLs)

l  RRLs are well poised to continue to provide training and on-site assessments

l  Global EQA programme should be fully utilized to best target laboratories still requiring further support

l  RRL expertise should be used to provide real-time PCR support for sentinel hospital sites via shipment of specimens to the RRLs for testing.

WHO prioritized recommendations for activities to implement, drawn from Matrix

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V.  Global standard operating procedures (SOPs)

l  Draft global SOPs for sentinel sites, including clinical, laboratory, and data management/analysis sections, are useful and should be finalized and distributed

VI.  Sentinel site: training and site assessments

l  Need for strategy to increase regular monitoring and supportive supervision assessments to sentinel sites –  Provision of specific recommendations to improve practices.

l  CSF specimen processing: provision of rapid diagnostic tests - improve detection, encourage physician participation

l  Small working group of RRL and GRL to discuss and prioritize other issues identified on Matrix

WHO prioritized recommendations for activities to implement, drawn from Matrix

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Conclusions

l Ad hoc TAG has offered some expert input

l Additional working group of RRLs, GRLs and others (laboratory working group) between annual meetings

–  Training –  Site visits –  Additional issues identified and define in the matrix

l  Laboratory network gaining from the collaborative experience

–  Additional impetus to highlight the role of laboratories at the country level