Giuseppe Ippolito

National Institute for Infectious Diseases “L. Spallanzani”Laboratory of Virology

WHO Collaborating Center for clinical care, diagnosis, response and training on Highly

Infectious Diseases

The EMERGE Joint action

European Network of BSL-4 facilities

Networking activity (EU)

EuroNetP4: 2005- 2007

EuroP4Net: 2008-2010

QUANDIPH: 2011-2014

EMERGE: 2015-2018

EURONET

BSL4 laboratories in Europe

4

Partners

Network of Infectious Viruses

The viral part

of the project

is based on

the

cooperation

of 15 partner

institutes

from 11

European

countries.

National Institute for Infectious Diseases ‘L. Spallanzani’ – Rome, Italy

Robert Koch Institute, Berlin, Germany

Bernhard Nocht Institute for Tropical Medicine – Hamburg, Germany

Philipps Universität – Marburg, Germany

Public Health England, Porton Down, United Kingdom

Swedish Institute for Infectious Disease Control – Solna, Sweden

National Center for Epidemiology, Budapest, Hungary

Institut national de la santé et de la recherche médicale, Laboratoire P4 Jean Mérieux , Lyone, France

BSL 4 laboratories

6

General Objectives

The Joint Action (JA) EMERGE comprises a European network of

about 40 diagnostic laboratories focused on risk group 3 and 4

bacteria and viruses.

The JA contributes to provide an integrated European laboratory

infrastructure and strategy to protect European citizens against

exposure to a panel of globally recognized high threat bacteria and

viruses.

The general objective: ensure efficient response to serious emergent

and re-emergent cross-border events by reinforcing the existing EU

network of BSL 3 and BSL 4 laboratories which are already

active in the field of identification of dangerous bacterial and viral

human pathogens.

7

Selection of agents with cross border potential

- the severity of disease

- the risk of spread in the EU

- the size of the susceptible population

- the gaps present in diagnostics and training

- the presence of other networks potentially involved

8

Agent Weighted Average*

Filoviruses

Ebola Zaire 8.6

Ebola Sudan 8.4

Ebola Cote d’Ivoire 7.4

Ebola Bundibugyo 8.4

Marburg 8.4

Arenaviruses

Lassa 8.6

Junin 9.2

Machupo 8.8

Guanarito 8.6

Sabia 7.6

Lujo 7.0

Bunyaviruses CCHF 11.8

Coronaviruses MERS 8.0

Orthomyxoviruses HPI 12.8

ParamyxovirusesNipah 7.8

Hendra 7.4

OrthopoxvirusesMonkeypox 7.7

Cowpox 8.7

Individual scores attributed to viral agents with cross-border threat by the EMERGE consortium, and their weighted average.

Selection of pathogensScore assigned by SC

Are other Networks involved?

Contact and offer support

Gaps in diagnostic capabilitiesidentified?

NOYES

Start activities

YES

Prioritization of High Consequence Viruses to Improve European Laboratory Preparedness for cross-border health threats. Nisii cC. et al Clin. Microbiol Infec 2016

Selection of pathogens

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Viruses

Molecular assays in general are widely distributed

with highest percentages for

Filoviruses (90.5% for Ebola Zaire and 81% for Marburg),

Mers (90.5%),

CCHF (81%),

Lassa (71.4%),

Cowpox (71.4%)

A slightly lower capability Nipah and Hendra (11/21: 58%).

Update of diagnostic procedures available in each partner laboratory

13

many gaps were highlighted in:

Serology

Mers (33%),

Arenaviruses [Lassa (14.3%)],

Nipah and Hendra (14.3%).

No methods available so far for differentiating Orthopoxviruses.

Antigen detection

Filoviruses (Ebola Zaire) only 3,

Lassa and CCHF only 2 partners

none for New World Arenaviruses, Mers, Paramixoviridae and

Orthopoxviridae.

Update of diagnostic procedures available in each partner laboratory

14

1) Metagenomics approach for known and ‘unknown’ agents detection:

Joint, bacteria and viruses. The main focus of this working group

should be standardization of procedures and collaboration with

COMPARE. (INSERM)

2) RG4 pathogens detection and characterization methods to be

applied in BSL4 such as virus isolation, virus neutralization and

standardization of basic diagnostic techniques and BSL3 laboratories

(including glove box) where BSL4 are not available. (BNI)

3) Antimicrobial susceptibility testing (AST) of highly pathogenic bacteria;

development of standard operational procedures, determination of

break points. The outcomes will be provided to and discussed with

EUCAST. (IMBW)

WP5Working Groups

Workshop at INMI, 14th June 2017

on

“Controversial aspects of RG4 diagnostics:

neutralisation assays and Lassa molecular detection”

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Working Groups: RG4 pathogens detection and characterization

methods

Problems in molecular diagnosis of Lassa fever infection

Altona new diagnostic kit

Neutralization protocols

Activity - 2016

16

Section1:

Guidance for local laboratories for selection, local transport, preservation and transport

of samples from suspected cases and exposed contacts

Specimens

Bed-to-local laboratory transport

Conservation

Handling

Biosafety issue

Stability and viability

Transport

Section2:

Guidance for Laboratory criteria for confirmatory diagnosis, management of confirmed

cases and referral for diagnostic confirmation

Diagnosis and Info to guide decisions for diagnosis

Epidemiology

Route of transmission

Incubation period

Discharge criteria

Critical issues in laboratory management of CCHFV infections: in silico evaluation of relevant molecular assays

To guide laboratorians in

management of CCHFV positive

patients:

•overall view of the main diagnostic

tests available

• in silico evaluation of of molecular

assays for diagnosis of CCHF

•Discharging criteria

•Follow up and management of

contacts