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David Featherstone EPI / IVB WHO/HQ

Global Measles Rubella Laboratory Network: Update. Measles Partners Meeting 23-25 September 2008 Washington. David Featherstone EPI / IVB WHO/HQ. Overview. Why do we need a laboratory network? How is it performing? Challenges and opportunities. Why do we need a laboratory network?.

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David Featherstone EPI / IVB WHO/HQ

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  1. Global Measles Rubella Laboratory Network: Update Measles Partners Meeting 23-25 September 2008 Washington David Featherstone EPI / IVB WHO/HQ

  2. Overview • Why do we need a laboratory network? • How is it performing? • Challenges and opportunities

  3. Why do we need a laboratory network?

  4. Potential measles transmission pathways!

  5. WHO Global Measles and Rubella Laboratory Network: 2001-2007 National Laboratories National Laboratories 172 80 Regional Reference Labs Regional Reference Labs Global Specialised Labs Global Specialised Labs 164 countries = 2001 2007 N= 679 labs 10 Sub-National Labs 31 "NLs" + 331 "SNLs" 124 Sub-National Labs As of July 2008 5

  6. Integrated lab activities (Excluding sub-national Labs)

  7. LabNet Workload: Measles serology samples tested (~80% samples also tested for Rubella in 2007) ~400,000 tests run in 2007 for M & R Data as of June 08

  8. WHO LabNet Quality - Proficiency Test Measles IgM Results 2001-2007 98.8% 98.5% 98% passed 94% passed 90% passed Score 94% passed 96% passed Year of PT Distribution

  9. Capacity building • Training workshops • New labs recently incorporated into LabNet • New staff: constant staff turnover • New techniques • Reference/Specialised Lab staff visit labs • Lab staff visit Reference/Specialist Labs, • Skills • Serology, QA/QC, • Lab Management, • Data Management, • Virus isolation, • Molecular Techniques, Sequencing, • Trouble shooting Lab Workshops 2007-08

  10. Challenge - 1 • Scaling-up molecular surveillance to identify transmission pathways

  11. WHO Vaccine Preventable Disease Lab Network Development of WHO Global genotype database • Password protected SharePoint on-line access • Viruses submitted from 1979 to 2008 • Real-time access Data as of 10 Sept 2008 11

  12. Measles Genotype Detection- WHO LabNet 1979 -2008 No. of viruses submitted 12

  13. Global Measles Virus Genotypes 2007 B3 D4 D5 D6 D8 D9 H1 Key

  14. Global Measles Virus Genotypes 2008 (Sept) D4 D5 D8 D9 H1 Key

  15. During January 1–July 31, 2008, 131 measles cases were reported to CDC from 15 states and the District of Columbia (DC)…. Among the 131 cases, 17 (13%) were importations: three each from Italy and Switzerland; two each from Belgium, India, and Israel; and one each from China, Germany, Pakistan, the Philippines, and Russia….. Nine of the importations were in U.S. residents who had traveled abroad, and eight were in foreign visitors. An additional 99 (76%) of the 131 cases were linked epidemiologically to importations or had virologic evidence of importation….

  16. Challenge - 2 • Developing and validating procedures for non-invasive collection of samples and transportation without cold chain

  17. WER: 25, 2008, 83, 225–232 and MMWR: 2008; 57:657-660 Alternative samples to serum for measles and rubella diagnosis

  18. 100% 75% IgM: Serum/DBS/OF Virus detection: OF 50% Virus detection: DBS 25% Virus culture 60 90 5 7 28 -3 1 21 35 14 Incubation 7-18 days * WER: 25, 2008, 83, 225–232 and MMWR: 2008; 57:657-660 Schematic of wild type measles virus infection* Patients positive 3 -1 Day of illness** (-3 to 5 days) Fever (0 to 5 days) DBS=Dried Blood Spot OF = Oral fluid sample Virus detection = RT-PCR Rash **Day 0 = first day of rash June 2008

  19. Challenge - 3 • Meeting the programmatic need for increased workload and reduced testing turnaround time

  20. Surveillance Indicators through the Elimination Stages: PAHO 1997 2000 2005

  21. Laboratory Workload in Americas: Specimens Processed and Reporting Timeliness Samples Processed Source:MESS EPI week 52

  22. Recurring costs in maintaining LabNet WHO African Region Consumables other than assays (8%) * Measles & Rubella costs 2006 Computers/IT (1%) Equipment (12%) Assays (78%)

  23. Global number of kits WHO procured per annum

  24. Total Cost of kits WHO procured per annum

  25. Major external partners of VPD LabNet • Polio • CDC, USAID • DIFID • Rotary • UNF • Gov'ts of Netherlands, Finland, Italy • Others • Measles and rubella • CDC • YF • IFFIM • CDC (reagents) • JE • PATH / CVP • CDC (GDD) National Ministries of Health provide infrastructure and staffing costs WHO

  26. Funds Needs

  27. Meeting the Challenge of Limited funding • Validating procedures for transporting samples without refrigeration • Reducing meetings frequency: ~every 2nd year • Integrating training and meetings with other disease programmes • Encouraging countries to take on more costs in their surveillance programme budget • Local production and validation of measles and rubella assays: China, Russian Federation

  28. Conclusions – "The Best Kept Secret" • Serving 164 countries • Timely reliable results • Virus tracking and information sharing • Outbreak detection and control • Challenge -Balancing needs with resources • Meeting challenge - Innovation and "belt-tightening" THANK YOU!! Global public good

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