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The Performance of the Regional Laboratory Network Nairobi, 2-3 June 2015

AFR Measles-Rubella TAG Meeting. The Performance of the Regional Laboratory Network Nairobi, 2-3 June 2015. Outline. Distribution of measles laboratories in AFR Region Performance indicators Measles g enotypes Main Challenges Way forward Question for TAG members.

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The Performance of the Regional Laboratory Network Nairobi, 2-3 June 2015

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  1. AFR Measles-Rubella TAG Meeting The Performance of the Regional Laboratory Network Nairobi, 2-3 June 2015

  2. Outline • Distribution of measleslaboratories in AFR Region • Performance indicators • Measlesgenotypes • Main Challenges • Wayforward • Question for TAG members

  3. Distribution of Measles Rubella Lab. • N=47 labs • One lab/country except NIE (4) & ETH (3) • No lab: EQG, STP, CAV, SEY, MAS • Funding: MR initiative National Lab Sub National Lab Regional Ref. Lab

  4. Distribution of Measles Rubella Lab. Network (cn’t) • Coordination at IST level • 1 labperson: IST ESA • 1 labperson: ISTs CA/WA • Diagnostic capacities • Serology: all labs • Virus isolation/PCR: selectedlabs • Sequencing: 3 RRLs

  5. Standardization: equipments (purchased by WHO), technique, kits, testing algorithm, lab database External quality control system in place Regular trainings (bench work & data management) organized Monitoring of performance indicators Accreditation review & lab director meeting WHO support: kits, basic supplies, funds for operationnal cost Main Lab. Network Activities

  6. Main Lab. Performance Indicators

  7. Timeliness & Completeness in Sharing Database Few labs have met the expected target (>=80%) due to internet connexion challenges, conflicting priority activities, staffing problems

  8. Workload at Laboratory 2014: Drop in number of specimens received at NLs in WA & in number of specimens received at IPCIV RRL (Impact of EVD outbreak) Increase in number of specimens received at NICD RRL (re establishment of testing)

  9. Workload at Laboratory (cn’t) • Few shipmentsperformed by NLs in 2014 vs 2013 • No shipmentperformed by somelabs • Refusalfrom DHL carrier to organizeshipment of bloodspecimen due to on going EVD outbreak in WA

  10. Quality of Specimens Specimens received in good condition in most of the case. 90% minimum target met except for specimen received at NICD lab in 2014)

  11. Suspected case of measles Blood specimen IgM(+) IgM(-) IgM(-/+) Lab. Testing Algorithm Rubella IgM (-) Rubella IgM (+) Rubella IgM (-/+) Measles IgM Rubella IgM Repeat Measles IgM Measles IgM (+) Measles IgM (-) Measles IgM (+/-)

  12. Lab. Testing Algorithm (cn’t) Some labs do not strictly follow algorithm & run simultaneous measles & rubella IgM test to save times

  13. Timeliness in sending out IgM results to EPI/surveillance WA below the 80% expected target in 2013 & 2014 due to shortage of kits (NIE impact)- Long term shortage of kits in 2014 (funding issues) affected most labs

  14. Timeliness in sending out IgM results to EPI/surveillance

  15. Timeliness in sending back IgM Results to NLs • Expectedtargetnot met • By IPCIV RRL in 2013 & 2014 • By NICD RRL in 2014 • IPCIV= RRL for 27 NLs. High number of specimensusuallyreceived (incl. from Nigeria) • Shortage of kits has affectedthisindicator for IPCIV

  16. Supply of Kits • High number of kits purchased in 2014 (twice more) than 20013 • Increasingneedsfromlabs. Reason: outbreak ??? • Unit price for Siemens IgM kit: Measle & rubella (295 Euros each), Supplementary (39 Euros) • Total cost (excluding transport) • 2013: 172 264 Euros • 2014: 337 592 Euros

  17. Proficiency Test & Accreditation status Excellent performance obtained for annual Proficiency Test except 1 lab (not accredited) - Sub optimal documentation & implementation of internal quality control procedures (provisionally accredited),

  18. Measles Genotype Identified: 2005-2014 • Identifiedfromspecimencollectedfromoutbreak & QC • Sequencingperformedlab: NICD,UVRI & CDC • IPCIV: sequencingstarted in 2015 • B3 largelycirculating (In 2014 identified in ZIM,NIE & TOG) B3 B2 D4 D2 D10

  19. Main Challenges • Suboptimal weekly reporting timeliness/completeness • Internet connectivity problems • Competing laboratory activities • High staff turn over in some labs (ETH, MAL, South Sudan) • Inconsistency in management of lab reagent • Stock outs ok kit due to outbreaks • Inaccuracy in estimating the needs & supply of kits with short expiring date • Insufficient/inadequate coordination between lab & surveillance • Continuous collection of blood specimen during measles outbreaks • Missed opportunity to collect specimen for virus isolation/genotyping

  20. Main Challenges (cn’t) • Limited funding to cover lab activities (heavily dependant on WHO) • To purchase kits & sequencing reagents/supplies • To organize trainings • Effect of EVD outbreak • Shipment of QC specimen stopped in several countries, • 2014 lab director meeting cancelled

  21. Way Forward • Integration of additional measles lab: SEY, Mauritius (countries on elimination mode) • Full implementation of sequencing activities at IPCIV RRL • Strengthen collaboration between lab & surveillance • Secure alternative carriers to transport specimens for QC • Reconvene annual lab director meeting • Advocate for additional funding for the lab network - Explore Nigeria willingness to purchase kits

  22. Question For MR TAG Members How can we advocate /mobilize more funds to cover measles laboratory network needs???

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