pbm surveillance network overview and perspectives

1. PBM Surveillance Network Overview and Perspectives netSPEAR Foundation Meeting 17-19 November, 2003 Nairobi, KENYA WHO AFRO

4. Achievements between 2001 � 2003 (I) 26 countries trained for PBM sentinel site surveillance in June and November 2001 24 countries reporting in 2003 23 countries participating in External Quality Assurance (AFRO-CSR/HQ-Lyons) system for laboratories Intra-country expansion: 2 countries (Uganda and Ghana)

5. Achievements between 2001 � 2003 (II) Monthly profiles and indicators are posted in feedback table (AFRO bulletins) AFRO PBM web page posted Data manager recruited at AFRO 23/26 trained countries are eligible for GAVI/GFCV assistance for new vaccines 5 countries received Hib vaccine, 2001-2002 3 countries approved (2 received) in 2003

7. AFRO PBM S-network Hib Disease Burden and Vaccine Impact Estimation All 24 functioning PBM sites have cultured Hib but.. Hib demonstrated as leading cause of bacterial meningitis at 7/18 PBM sites without Hib vaccine intro Evidence for Hib vaccine impact demonstrated at 1 of 5 sites - Malawi

9. AFRO PBM, Hib Vaccine Preliminary Impact Assessment Uganda: Jan02, little impact (vaccine stock out Jul-Dec03) Kenya: Dec01, no impact (background of low isolation rates) Ghana: Jan02, no impact (low isolation) Rwanda: Jan02, no impact (low isolation) Malawi: Jan02, yes impact (good data)

10. AFRO PBM, Hib Vaccine Preliminary Impact Assessment Hib is the leading cause of meningitis at 7/18 (40%) PBM sites: Benin, Burkina Faso, Burundi, Cameroon, Cote d�Ivoire, Niger and Namibia. 6/24 countries are responsible for nearly 50% of all Hib, Pneumococcal and N. meningitidis cultures against 20% of CSF cultures with results in database Burkina Faso, Cameroon, Mali, Malawi, Niger and Senegal. Only Malawi has introduced vaccine

11. Challenges Financial sustainability of PBM AFRO support to 26 PBM sites spread thin Regional Reference Laboratory layer still under development National support of the referral bacteriology laboratories is often inadequate Wide variation in quality of PBM site surveillance data within the network Weak link between PBM site surveillance data and national EPI planning (for most countries) Only 23/36 VF-eligible countries trained so far

12. Some lessons learnt� Start small and keep things simple Selection of sites crucial to success Keep data manager well motivated Regular (monthly) site meetings vital, especially at the beginning Plan for adequate support to the laboratories Link with EPI managers is critical to local ownership and utilization of data

13. Strengths & Opportunities Awareness of Hib as a VPD has been raised - high institutional and MOH interest Clinical and data/reporting mechanisms are in place and performing well With experience of first 2 years, we aim to focus site support/performance to better meet the needs of national plans for new vaccine introduction Collaboration/Decentralization: netSPEAR East Next generation of new vaccines

15. Pneumococcal Disease

16. Pneumococcal vaccine Pneumococcal conjugate vaccine (7-valent) licensed and introduced in the USA in 2000 Results so far promising (despite stock outs) 9-valent pneumococcal conjugate vaccine trail in Soweto, South Africa in children +/- HIV infection Results published Oct 2003 (NEJM 349;14) 83% and 65% reduction in 1st episode pneumonia due to the 7 serological groups, for HIV -/+ children respectively 25% reduction in x-ray confirmed pneumonia Incidence of invasive penicillin-resistant strains reduced by 67%

17. Pneumococcal vs Hib Disease Hib a �warm-up� for pneumococcal disease? Similar but even more challenging issues. Cost-challenge: Financing and planning for sustainability of even more expensive vaccine Design/selection of appropriate vaccine (more than 90 serotypes!) Recognition: Burden of disease data and advocacy Surveillance: much more difficult for pneumococcal Significant adult disease for pneumo

18. PBM S-Network and Pneumococcal Surveillance Collaboration with netSPEAR Introduction of surveillance using blood cultures (SOP development and training) � strengthening surveillance Data sharing Feedback/Web page development Meetings and workshops Reference laboratory work Site visits and assessments

19. PBM S-Network and Pneumococcal Surveillance CSF isolates from the rest of the network Enhanced pneumococcal surveillance at 5 selected sites (West , Central and Southern Africa) using blood cultures learning from the netSPEAR experience Results from netSPEAR/AFRO collaboration will guide activities elsewhere in the region for pneumococcal surveillance

20. Conclusion A wonderful opportunity to contribute to the control of 2 major VPDs in Africa Many opportunities and challenges: Capacity building at our respective institutions (Lab, data management, clinical practices�) Generation of useful data, for guiding policy Developing (sustainable) surveillance systems Sharing information, problems and solutions�