David Featherstone EPI / IVB WHO/HQ

David Featherstone

EPI / IVB WHO/HQ

Measles Partners Meeting Measles Partners Meeting

23-25 September 200823-25 September 2008

WashingtonWashington

Global Measles Rubella

Laboratory Network: Update

WHO Vaccine Preventable Disease Lab Network

Overview Overview Overview Overview

Why do we need a laboratory network?

How is it performing?

Challenges and opportunities


Why do we need a laboratory network? Why do we need a laboratory network? Why do we need a laboratory network? Why do we need a laboratory network?

44

Potential measles transmission Potential measles transmission pathways!pathways!

WHO Global Measles and Rubella Laboratory Network: 2001-2007

124 Sub-National L

abs

124 Sub-National L

abs

10 Sub-National 10 Sub-National LabsLabs

164 countries =164 countries = Global Specialised Labs

National Laboratories Regional Reference Labs172

Global Specialised Labs

National Laboratories Regional Reference Labs80

N= 679 labs

+ 331 "SNLs" 31 "NLs"

2007

2001

As of July 2008

5

WHO Vaccine Preventable Disease Lab Network6

0

20

40

60

80

100

120

140

160

180

Measles YF JE Polio

JE

YF

Measles

Polio

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


0

50000

100000

150000

200000

250000

Nu

mb

er o

f sa

mp

les

rece

ived

2004 2005 2006 2007

WPR

SEAR

EUR

EMR

Americas

AFR

Data as of June 08

~400,000 tests run in 2007 for M & R

LabNet Workload: Measles serology samples tested LabNet Workload: Measles serology samples tested

(~80% samples also tested for Rubella in 2007) (~80% samples also tested for Rubella in 2007)


0

20

40

60

80

100

120

140

160

180

No

. o

f L

abs

Par

tici

pat

ing

2001 2002 2003 2004 2005 2006 2007

<90% Not pass

90-95% Pass

100% Pass

Pending

98% passed

94% passed90%

passed

94% passed

96% passed

ScoreScore

98.5% 98.8%

Year of PT DistributionYear of PT Distribution

WHO LabNet Quality - Proficiency Test WHO LabNet Quality - Proficiency Test Measles IgM Results 2001-2007Measles IgM Results 2001-2007


Capacity buildingCapacity 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

AFR EMR EUR SEAR PAHO

Serology 3

1

1 2

Cell culture 1

1PCR

Sequencing

QA/QC 3 1

Lab Workshops 2007-08

1010

Challenge - 1Challenge - 1

Scaling-up molecular surveillance Scaling-up molecular surveillance to identify transmission pathwaysto identify transmission pathways

1111 WHO Vaccine Preventable Disease Lab Network

Development of WHO Development of WHO Global genotype databaseGlobal genotype database

Password protected SharePoint on-line Password protected SharePoint on-line access access

Viruses submitted from 1979 to 2008 Viruses submitted from 1979 to 2008

Real-time access Real-time access Number of

virusesGenotypes Countries WHO

Regions

MeasleMeasles s

28232823 1818 7474 66

RubellaRubella 194194 1111 2121 55

Data as of 10 Sept 2008

11


Measles Genotype Detection- WHO LabNet 1979 -2008

Measles Genotype Detection- WHO LabNet 1979 -2008

No

. o

f vi

ruse

s su

bm

itte

d

0

200

400

600

800

1000

1200

1979 1984 1987 1989 1993 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

H2

H1

G3

G2

E

D9

D8

D7

D6

D5

D4

D3

D2

C2

C1

C

B3-2

B3-1

B3

B2

A

?B2

?

12

Global Measles Virus Genotypes 2007Global Measles Virus Genotypes 2007

Key

D4D4B3B3

D6D6

D9D9D8D8

D5D5

H1H1

Global Measles Virus Genotypes 2008 (Sept)Global Measles Virus Genotypes 2008 (Sept)

Key

D4D4

D8D8

D9D9

H1H1

D5D5

During January 1–July 31, 2008, 131 measles cases werereported to CDC from 15 states and the District of Columbia(DC)….

Among the 131 cases, 17 (13%) were importations: threeeach from Italy and Switzerland; two each from Belgium, India,and Israel; and one each from China, Germany, Pakistan, thePhilippines, 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 importationsor had virologic evidence of importation….

1616


Developing and validating Developing and validating procedures for non-invasive procedures for non-invasive collection of samples and collection of samples and transportation without cold chain transportation without cold chain

1717

Alternative samples to serum Alternative samples to serum for measles and rubella for measles and rubella

diagnosisdiagnosis

WER: 25, 2008, 83, 225–232 and MMWR: 2008; 57:657-660


Schematic of wild type measles virus Schematic of wild type measles virus infection*infection*

Incubation 7-18 days

Pati

en

ts p

osit

ive

Day of illness*

*

-1 3

IgM: Serum/DBS/OF

7 14 28 35 9021 60

Virus culture

-3 1 5

25%

50%

100%

75%

Fever

Rash

**Day 0 = first day of rash

(-3 to 5 days)

(0 to 5 days)

Virus detection: OF

Virus detection:

DBS

DBS=Dried Blood Spot

OF = Oral fluid sample

Virus detection = RT-PCR

* WER: 25, 2008, 83, 225–232 and MMWR: 2008; 57:657-660 June 2008

1919


Meeting the programmatic need Meeting the programmatic need for increased workload and for increased workload and reduced testing turnaround timereduced testing turnaround time

2020

Surveillance Indicators through the Elimination Stages: PAHO

2005

1997

2000

0

10,000

20,000

30,000

40,000

50,000

2003 2004 2005 2006 2007

Source:MESSEPI week 52

Sa

mp

les

Pro

cess

ed

0

20

40

60

80

100

% lab results reported <=4 days

Pe

rce

nta

ge

2003 2004 2005 2006 2007

Laboratory Workload in Americas: Specimens Processed and Reporting Timeliness

Laboratory Workload in Americas: Specimens Processed and Reporting Timeliness


No of Labs

(AFRO)

Approx cost of supplies / year

Approx cost per lab

Polio 16 $800,000 $50,000

Measles Rubella*

38 $548,000 $14,500

YF 23 $40,000 $2,000

Equipment (12%)

Assays (78%)

Computers/IT (1%)

Consumables other than assays (8%)

* Measles & Rubella costs 2006

Recurring costs in maintaining LabNet Recurring costs in maintaining LabNet WHO African RegionWHO African Region


Global number of kits WHO procured per annum

0

200

400

600

800

1,000

1,200

1,400

1,600

2003 2004 2005 2006 2007

Measles kits Rubella kits Supplementary


Total Cost of kits WHO procured per annum

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000

$800,000

2003 2004 2005 2006 2007

Total cost


PolioPolio– CDC, USAID– DIFID – Rotary – UNF – Gov'ts of Netherlands, Finland, Italy – Others

Measles and rubellaMeasles and rubella – CDC

YFYF – IFFIM– CDC (reagents)

JEJE – PATH / CVP– CDC (GDD)

WHO

Major external partners of VPD Major external partners of VPD LabNetLabNet

National Ministries of Health provide infrastructure and staffing costs

Funds

Needs


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

Meeting the Challenge of Limited funding


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!!

Conclusions – "The Best Kept Secret"

Global public good

David Featherstone EPI / IVB WHO/HQ

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