Global capacities, alert and response Improving laboratory quality to aid the control of dengue...

Global capacities, alert and response

Improving laboratory quality to aid the control of dengue

Meeting of the WHO Collaborating Centres for detection of dengue

Instituto Nacional de Diagnóstico y referencia Epidemiológica (InDRE)

Mexico City31 August – 1 September 2015

Christopher Oxenford

Laboratory Strengthening and Biorisk Management Team

Global Capacities, Alert and response Department

WHO Lyon


WHO - Headquarters

• Global Capacities, Alert and Response Department• Laboratory Strengthening and Biorisk Management

Team

• Support countries to build laboratory capacity including to meet obligations under the IHR(2005)


Spread of vectors

• Other pathogens also spreading– Chikungunya virus

– Zika virus

– West Nile virus

• International travel means pathogens can spread to almost any place in the world within 24 hours


IHR requirement

• The International Health Regulations (2005) are the global framework for reporting and responding to global public health threats. They require countries to have:• Surveillance systems to detect outbreaks and monitor

the spread of disease

• Access to laboratory testing capability to confirm the cause of an outbreak in a timely manner

• The response mechanisms to deal with the outbreak


Laboratory testing

• To detect and monitor outbreaks• Monitor the impact of vaccination and other control

measures

• Needs to be reliable and timely• Ideally a laboratory should have a quality management

system in place

• The right result on the right test done on the right specimen & reported to the right people


Laboratory quality

• The QMS should cover all components of the laboratories' work• pre-analytical, analytical and post-analytical

• technical areas and administration

• Particular tests should not be seen in isolation but as part of a laboratory's overall function


Laboratory quality

• LSB team has prepared a number of tools to help laboratories improve quality• Laboratory assessment tools

• For individual laboratories and also national systems

http://www.who.int/ihr/publications/laboratory_tool/en/

• A quality management system handbook and CD ROM• Reference material for those providing training on QMS

http://www.who.int/ihr/publications/lqms/en/


Laboratory quality

• Laboratory Quality Stepwise Implementation (LQSI) tool• Developed in conjunction with the Royal Tropical Institute (KIT), the

Netherlands

• A practical guide for laboratories seeking to improve quality

• Based on ISO 15189

• The stepwise approach helps laboratories prioritise quality improvement activities

• When all the steps have been completed the laboratory may seek accreditation against ISO 15189

http://www.who.int/ihr/lyon/hls_lqsi/en/


Laboratory quality

• Proficiency testing (PT) a type of external quality assessment, is an important component of a QMS• It allows external monitoring of the laboratory's performance

• Helps identify existing and potential problems

• All errors identified in PT schemes should be followed up and corrective actions taken when necessary

• A number of vertical disease programmes within WHO run PT schemes


Proficiency testing

• Provides a means to understand the capacity and capabilities of laboratories• Panels often include surveys asking how tests are

performed

• Offers a framework to link laboratories informally• To distribute standardized methods and reagents

• To provide educational and other support

• These linkages could be critical during emergency situations


Proficiency testing

• Regional schemes are a means of fostering champions• Can be used to encourage national PT schemes

• LSB supports a number of regional and country-level PT schemes• AFR, EMR, WPR – Pacific islands

• Most cover basic bacteriology (ID & AST)


Proficiency testing

• This year LSB has organized a global PT scheme for MERS-CoV • The recent outbreak in Korea has highlighted the

importance of reliable laboratory testing even for pathogens that seem unlikely threats.

• The largest outbreak to date outside the ME

• 186 cases, 36 deaths


Dengue PT

A regional PT scheme for dengue was established by WPRO in 2013• It covered detection by PCR/ ELISA/ RDT and serology

• It was organized by the NEA Singapore

• 19 laboratories participated

• 15 laboratories scored the maximum, all were satisfactory

http://ojs.wpro.who.int/ojs/index.php/wpsar/article/view/317/503

A second panel was distributed in 2015 (24 labs)• Some laboratories in WHO/SEAR participated

• Chikungunya was added

• Overall performance was not quite as good as in 2013, most errors were in RDT/ELISA testing


Dengue PT

WHO/HQ is looking to expand the programme and make it global• All regional offices have endorsed this approach

• May seek to add specimens with additional arboviruses (? WNV)

• Seek to coordinate with PAHO and RELDA


Dengue PT

• Next steps• Plan a meeting with WHO CCs in other regions to build

on what is already in place without duplication

• Global PT scheme

• Networking activities

• The first round of PT distributed in the second half of 2016

• The input of the major institutions in PAHO will be vital to the success of this initiative


¡Muchas gracias!


Risk of dengue

• Even Europe is at increased risk

Global capacities, alert and response Improving laboratory quality to aid the control of dengue...

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