Laboratory Integration in Influenza Surveillance

Dr Geethani Wickramasinghe NIC- Sri Lanka

Introduction

Sri Lanka is a developing country with limited resources

There was no organized continuous influenza surveillance until recent past (2007)

Initially, only outbreak surveillance 1998 - Inf A H3N2 Sydney 5/97

Influenza surveillance was initiated under AI preparedness plan of GISN

Focal point- Epidemiology unit of MoH

National influenza network

ILI surveillance 2005 - started from Western province

in Childrens hospital (LRH), Colombo 2007 - Extended to sentinel sites, 20

sites to include all the provinces

SARI surveillance 3 sites (LRH, GH/Matara, TH

Peradeniya) -2010

Network of labs -1 NIC & 2 provincial (Southern & Central)

Training programmes were conducted by the Epi – Lab team in these sites. ICN were trained in collection of samples & proper transport. Introduced case definitions

At the start VTM & swabs were prepared by the NIC & distributed to these sites. Now commercial swabs & media are used

Each site – 30 specimens / month to NIC

Laboratory methods Initially - DFT & Virus isolation Rapid tests were not used Later molecular techniques

Conventional PCR initially rt Rt PCR introduced in 2009

2010 - Changed testing protocols All specimens - PCR Positives – virus isolation SARI samples - PCR & DFT for all respiratory viruses

Participated in WHO EQA programmes since 2007 – 9 panels -now 100% performance

Laboratory Accreditation by CDC in 2010

FundsWHO, WB, CDC - Equipments, Reagents Tsunami Funds/pasteur institute -

Training programmes

District Week Ending

Sentinel Hospital Date of Report

Definition of ILI : Person with the Fever of Rapid onset (over 380 C) . cough and sore throat , in the absence of another

diagnosis

Date (Day,

week)

Number of New Visits

Total < 1 year 1 – 4 years 5-9 years 10-14 years 15-49 years 50-64 years Over 65

Total Visit # ILI Total Visit # ILI Total Visit # ILI Total Visit # ILI Total Visit # ILI Total Visit # ILI Total Visit # ILI Total Visit # ILI

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Total for Week

Population

Incidence

Rate (per

100,000)

ICN Signature

Weekly Data Collection Form for Cases of Influenza- Like Illness (ILI)

Weekly Data Collection Form for Severe Acute Respiratory Infection (SARI) Hospitalizations

District Week Ending

Sentinel Hospital Date of Report

Surveillance of Severe Acute Respiratory Infection (SARI)

Date (Day, week) Number of New Visits

Total < 1 year 1 – 4 years 5-9 years 10-14 years 15-49 years 50-64 years Over 65

Total hospitalized

# SARI Total hospitalized

# SARI Total hospitalized

# SARI Total hospitalized

# SARI Total hospitalized

# SARI Total hospitalized

# SARI Total hospitalized

# SARI Total hospitalized

# SARI

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Total for

Week

Population

Incidence Rate

(per 100,000)

ICN Signature

Dissemination of information

Data reporting – by telephone, fax & emails weekly / monthly print reports

To the Epidemiology unit & MoH During the pandemic - daily reports Weekly data to Flunet Monthly technical committee meetings - human/animal surveillance, Epid unit, Health Education

Bureau for communication, control activities

During the pandemic - guideline preparation & management protocols, control & preventive

strategies - by the technical committee

Dissemination of data

Hospital performance published monthly in WER and Unit Website & presented at the monthly AI/PI technical committee meeting

Also presented quarterly for the Quarterly Review Meeting of Epidemiologists & published in Quarterly Epidemiological Bulletin

Data Compilation and Feed back

National level feedback

Weekly Epidemiological Report (WER)

Quarterly Epidemiological Bulletin

www.epid.gov.lk

ILI surveillance in SL - 2005- 2009

ILI Surveillance – Samples Received from sentinel sites - 2010

0

50

100

150

200

250

NIC/MRI

Virus activity in Sri Lanka from 2005 - 2008

0

200

400

600

800

1000

1200

JAN MAR MAY JUL SEP NOV

2006

2007

2008

2009

2010

Rain fall pattern from 2006 - 2010

PA(H1N1) cases from June 2009–May 2011

Age Distribution of Confirmed cases & deaths in 2009 & 2010

NIC/MRI

Liaison with reference laboratories

Sharing of Influenza viruses with ref labs WHO CC – Melbourne, Ausralia & Hong Kong

University Inf sub types & un-typed viruses - 2-3/year, World

Courier- Global funds

Benefits - Confidence - Sub typing of untypable viruses - Anti-viral susceptibility monitoring - Gene sequencing

Problems

Inadequate collection of specimens from some sentinel sites

Difficulty in transport of specimens from distance sites

Poor performance of sub-national laboratories

Initiation of anti-viral susceptibility monitoring & sequencing studies by the NIC

Control activities

Health Education

School closure

Vaccine recommendations 2010 - Introduced mono-valent Pandemic

influenza vaccine

2011 – Seasonal vaccine was registered for the first time in SL depending on the Inf surveillance data

Future Improvement of sub-national laboratories

Improvement of routine surveillance activities

Disease burden studies

Initiation of drug resistance monitoring

Collaborative research with animal surveillance center – VRI

Gene sequencing

Thank you