A CC perspective on the three Cs: Collaboration, Communication and Capacity building Anne Kelso

1. 5th WHO National Influenza Centres Meeting, Vientiane, June 2011 A CC perspective on the three Cs: Collaboration, Communication and Capacity building Anne Kelso Director WHO Collaborating Centre for Reference and Research on Influenza

2. Collaboration • Communication • Capacity building (Patrick Reading) • virological surveillance and • isolation of vaccine viruses • research The three Cs

3. Collaboration in virological surveillance and isolation of vaccine viruses

4. Countries that submitted samples to WHO CCs in 2010 US CDC (Atlanta) NIMR (London)VIDRL (Melbourne)NIID (Tokyo)CCDC (Beijing)

5. Collaboration in virological surveillance and isolation of vaccine viruses (1) What CCs need from NICs: What NICs need from CCs:

6. Collaboration in virological surveillance and isolation of vaccine viruses (1) What CCs need from NICs: What NICs need from CCs: • Urgent submission of any novel or unsubtypable viruses • Submission of representative recent circulating viruses to provide a • global picture and contribute to vaccine strain selection by WHO • Any relevant clinical or epidemiological information • Submission of some clinical specimens for isolation of vaccine candidates

7. Collaboration in virological surveillance and isolation of vaccine viruses (1) What CCs need from NICs: What NICs need from CCs: • Urgent submission of any novel or unsubtypable viruses • Submission of representative recent circulating viruses to provide a • global picture and contribute to vaccine strain selection by WHO • Any relevant clinical or epidemiological information • Submission of some clinical specimens for isolation of vaccine candidates • Urgent identification of novel or unsubtypable viruses • Rapid reporting of results for circulating viruses (eg, strains, antiviral • drug resistance) • Availability of vaccines matched to circulating viruses in your country • Anything else?

8. Collaboration in virological surveillance and isolation of vaccine viruses (2) Novel and unsubtypable viruses: • Contact us first: • - email, telephone, fax, smoke signals… (not facebook or twitter!) • We can discuss technical issues, compare primer sequences, etc • We can prepare to receive the viruses • Send us the viruses as soon as possible • Urgent samples go to the front of the queue! • We will contact you about the results as soon as we have them.

9. WHO Consultation for Southern Hemisphere WHO Consultation for Northern Hemisphere Timing of virus submission to CCs: strain selection

10. Collaboration in virological surveillance and isolation of vaccine viruses (3) Representative recent circulating viruses: • Send some viruses as often as you can • They are most useful if they are recent • Send some early in your season as well as later, so we have results in • time for WHO Consultation • Inter-season viruses are also useful • Send us clinical or epidemiological information if you have it. We are testing a new electronic submission form – easier for NICs?

11. Collaboration in virological surveillance and isolation of vaccine viruses (4) Representative recent circulating viruses: • We will report HI and antiviral resistance results as soon as we have them • Reporting time depends on…. • shipping time • delays in customs if we don’t know samples are coming • whether virus needs to be isolated • how easily it grows in MDCK cells • how many other viruses arrive at same time • how urgent • Please tell us if you need more information or explanation of results in • reports.

12. * Samples received in the year following sample date Samples submitted to WHO CC at VIDRL, 2007 – 2010 4044 samples 47 laboratories 20 countries

13. Egg isolate Vaccine candidates Analysis of submitted viruses at WHO CC Antigenic analysis (HI, MN) Isolate HA and NA sequence MDCK cells MDCK isolate Antiviral drug sensitivity (phenotypic, genotypic assays) Clinical specimen PCR Sequence Other testing (eg, human serology) Raise ferret antiserum Eggs Confirm HI & sequence

14. What else do we do with submitted viruses? • Supply HI data to Cambridge University for antigenic cartography • Raise post-infection ferret antisera against interesting viruses • Full genome sequencing; test for reassortment (pyrosequencing) • Follow up viruses showing unusual neuraminidase inhibitor resistance • Analyse reactivity of serum panels from vaccine trials (Australia, • Japan, Europe, US) with recent reference strains • Prepare reagent kits for provision to requesting laboratories • Study pathogenicity, transmission and immunological responses • in ferrets

15. The importance of egg-isolated viruses • Regulators require that influenza vaccine viruses are isolated and • passaged exclusively in hen’s eggs (or primary egg-derived cells). • WHO Collaborating Centres obtain egg isolates as candidate vaccine • strains for provision to vaccine manufacturers (after reasssortment of • type A viruses). • Viruses are adapted growth in eggs by • amniotic passage then growth in the allantoic • cavity.

16. WHO Consultation for Southern Hemisphere WHO Consultation for Northern Hemisphere Timing of virus submission to CCs: vaccine candidates

17. WHO recommendations for seasonal vaccines SH 2010 NH 2010-11 SH 2011 NH 2011-12

18. WHO recommended vaccine viruses from WPR SH 2010 NH 2010-11 SH 2011 NH 2011-12

19. Collaboration in research

20. Emergence and spread of oseltamivir-resistant A(H1N1) influenza viruses in Oceania, South East Asia and South Africa Aeron C. Hurt, Joanne Ernest, Yi-Mo Deng, Pina Iannello, Terry G. Besselaar, Chris Birch, Philippe Buchy, Malinee Chittaganpitch, Shu-Chun Chiu, Dominic Dwyer, Aurélie Guigon, Bruce Harrower, Ip Peng Kei, Tuckweng Kok, Cui Lin, Ken McPhie, Apandi Mohd, Remigio Olveda, Tony Panayotou, William Rawlinson, Lesley Scott, David Smith, Holly D'Souza, Naomi Komadina, Robert Shaw, Anne Kelso and Ian G. Barr Antiviral Research 83(1): 90 – 93 (2009) • Collaboration in research: the goal…. • Collaboration on projects of mutual interest where each party brings • specific expertise and/or resources (viruses, data, techniques etc) • For example: • with authors from Australia, South Africa, Cambodia, Thailand, Taiwan, • New Caledonia, Macao, Singapore, Malaysia, Philippines and New Zealand • If we can help with your research, please let us know.

21. Communication

22. Communication • How can we help each other through communication? • Good human relationships underpin all successful endeavours • Share virological, technical and other information so we can help • each other and do our own work more effectively • Strengthen our collaborative networks. Meet Talk Email Report Browse

23. www.influenzacentre.org

24. Collaboration • Communication • Capacity building (Patrick Reading) • virological surveillance and • isolation of vaccine viruses • research The three Cs

25. Acknowledgements WHO National Influenza Centres and other submitting laboratories WHO Collaborating Centres and others in GISRS Staff of the Melbourne WHO Collaborating Centre: Chantal Baas, Ian Barr, Iwona Buettner, Natalie Caldwell, Louise Carolan, Michelle Chow, Yi-Mo Deng, Joelle Dharmakumara, Chris Durrant, Aeron Hurt, Pina Iannello, Naomi Komadina, Karen Laurie, Leah Leang, Tasoula Mastorakos, Katie O’Bryan, Heidi Peck, Patrick Reading, Rob Shaw, Helen Sjogren The Melbourne WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health and Ageing.