Introduction to Group Work 1

1. Introduction to Group Work 1 Quality Assurance Programmes Group C (Singapore, Philippines, Viet Nam, Korea)

2. Current WHO EQAP for detection of influenza A by PCR Strengths? • Laboratories find how they are doing relative to an international standard • Inclusion of inactivated virus considered an improvement • Provides confidence in ability to detect H5, as this is not routinely tested for in samples coming into NIC • Additional care in following SOP has tended to overcome any problems detected from a lower EQAP Weaknesses? • Permits for importation can be time consuming and lead to delays

3. Current WHO EQAP for detection of influenza A by PCR Areas to improve? *Proficiency testing of sub-national labs – a need to include in an EQAP – how can this be managed practically? Can sub-national labs be included? *NICs to be certified by international certification *Clear instructions on how to send back monitoring chips *Question raised regarding whether the test should be harder – laboratories will not routinely achieve 100% but *Quantities of virus to vary more markedly *Moving towards compulsory NIC participation as a tool for them to reach a certain standard.

4. Other programmes: do you participate in the following? List the labs participating in the following programmes Free: • CDC: • Philippines – contacted by CDC, yet to participate • Korea – no other EQAP • RCPA, EQA Institute Pasteur – both used in Pasteur Institute, Viet Nam Strengths and Weaknesses of the above programmes Uncertainty as to how many different programmes to participate in?

5. Scope of EQAP: Needs to be expanded? • Virus culture – Philippines, Singapore, Korea, Vietnam HCM, Vietnam Hanoi, • Antivirals (phenotypic or genotypic) – Philippines, Korea, HCM to set up • Sequencing – Philippines (not extensive as yet), Singapore, Korea, Vietnam HCM & Hanoi • Serology – HI testing in Korea, Philippine, Singapore • Others – microneutralization (Korea, Philippines, Hanoi) • Issues relating to setting up additional NIC EQAP ? - very difficult to send virus for culture. Possibly expensive. Importation issues - sequencing EQAP easier?

6. Preferred features of EQAP? • Number of samples - 10-12 generally considered to be OK • Type of samples - for current EQAP, would dilution series help to identify threshold of detection in each particular NIC - inclusion of virus considered a big bonus (makes it more interesting! Extraction required) - would a mock clinical specimen be useful? Treat as ‘real’ samples and treat as such. - would be interesting to have a type A that was not easily subtyped…… But how to ensure it is not a virus without pandemic potential - turnaround time – should EQAP be treated with a ‘clinical turnaround’ – sample processed as if it were an unknown sample entering the laboratory - inclusion of co-infections? - different diagnostic methods used by different NICs – difficulty in setting an absolute threshold of detection but a titration might be useful

7. Preferred features of EQAP? • Frequency - generally happy with 2x per year - suggestion of one panel to focus on different avian influenza, perhaps including a dilution to check for threshold of sensitivity • Time to reporting - the one month wait – sometimes the lab ‘forgot’ they had done the test by the time the report is received. - should timing of performing the PCR and submitting the results be recorded? This would monitor that EQAP was treated rapidly (would test ability to recognize and respond to novel virus) • Format of reports - received by email. Generally happy with format.