The laboratory surveillance network in Latin America,

ages 5 and above.

Fifth Regional Pneumococcal Symposium.

Focusing in older children and adults.

Gloria Rey-Benito (FCH/IM, PAHO)

Sao Paulo, Brazil. March 5-6, 2013

Outline

Regional System of Vaccine II (SIREVA II), Regional results of the laboratory surveillance.

Regional System of Vaccines II (SIREVA II), National results of the laboratory surveillance in selected countries.

WHO IB-VPD Surveillance Laboratory Network.

Conclusions

Challenges

Regional System of Vaccine II (SIREVA II), Regional results of the laboratory surveillance.

S. pneumoniae Total de aislamientos invasores por país y por

periodo de vigilancia.

País 1994-98 2000-05 2006-10 2011 total

Argentina 1.006 1.277 1.431 424 4.138 Bolivia 151 166 51 368 Brasil 1.203 4.169 4.128 921 10.421 CAREC 178 97 27 302 Chile 495 4.182 4.350 746 9.773 Colombia 623 1.396 1.598 400 4.017 Costa Rica 222 251 53 526 Cuba 1.283 215 74 1.572 Ecuador 60 255 57 372 El Salvador 88 183 41 312 Guatemala 247 70 25 342 Honduras 65 43 14 122 México 426 1.039 867 241 2.573 Nicaragua 55 50 10 115 Panamá 189 212 62 463 Paraguay 667 866 108 1.641 Perú 172 172 29 373 R.Dominicana 487 328 56 871 Uruguay 352 884 970 199 2.405 Venezuela 492 267 44 803

Total 4.105 17.303 16.519 3.582 41.509 Cortesía Dr JM Gabastou - SIREVA II

Streptococcus pneumoniae Distribución de los aislamientos por grupos de edad y sexo, 2011

SIREVA II, 2011

Grupo de

edad

Sexo

Total Masculino Femenino SD

< 12 meses 320 58,0 221 40,0 11 2,0 552

12-23 meses 215 57,2 161 42,8 0 0,0 376

24-59 meses 285 53,9 242 45,7 2 0,4 529

Total

Grupos de edad

Streptococcus pneumoniae Distribución de los aislamientos por grupos de edad y enfermedad, SIREVA 2011, n=3.420

0

10

20

30

40

50

< 12 meses

12 a 23 meses

24 a 59 meses

5 a 14 años

15 a 29 años

30 a 49 años

50 a 59 años

≥ 60 años

Neumonía Meningitis Sepsis y bacteriemia Otra %

Cortesía Dr JM Gabastou - OPS

%

0

25

50

%

serotipos

0

5

10

15

20

25

30

35

40

45

1 3 4 5 6A 6B 7F 9V 14 18C 19A 19F 23F otros

2000-2005 n= 1.744

2006-2010 n= 1.626

2011 n=549

Streptococcus pneumoniae Evolución de los serotipos en ≥60 años, en procesos invasivos en la Región 2000-2005, 2006-2010 y 2011

SIREVA II, 2011 Cortesía Dr JM Gabastou - OPS

20.2

27.9

39.6

43.2 42.9 42.4

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Streptococcus pneumoniae Proporción de positividad, por grupos de edad, de “otros

serotipos” identificados en procesos invasivos, SIREVA 2011

44.9 42.6

35.0 28.1

41.7

37.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Fuente: Informes Regionales SIREVA II

42.5

12.0 7.4

14.2

7.8

16.2 28.0

10.3

9.5 18.9

10.9

22.4

Regional System of Vaccine II (SIREVA II), National results of the laboratory surveillance in selected countries.

%

0.0

25.0

50.0

%

0.0

25.0

50.0

%

serotipos

0.0

10.0

20.0

30.0

40.0

50.0

60.0

22F 33F 6C 15B 10A 11A 12F 15C 17F 23A 23B otros

%

0.0

25.0

50.0

%

0.0

25.0

50.0

%

serotipos

0.0

10.0

20.0

30.0

40.0

50.0

60.0

22F 33F 6C 15B 8 9A 9N 10A 11A 12F 13 18A 23A 24A otros

WHO IB-VPD Surveillance Laboratory Network.

20 | Global Monitoring and Surveillance Meeting 09-11 October 2012

Photo: NICD, RMPU, RRL AFR

WHO IB-VPD Surveillance

Laboratory Network

21 | Global Monitoring and Surveillance Meeting 09-11 October 2012

Assist countries in establishing well functioning laboratories with adequate quality assurance systems

Provide reliable, accurate and timely information

Monitor distribution of serotype/ serogroups of pathogens causing IB-VPD (Streptococcus pneumoniae, Haemophilus Influenzae and Neisseria Meningitidis)

Support evidence-based decision making on vaccine introduction

Objectives of the WHO IB-VPD LabNet

22 | Global Monitoring and Surveillance Meeting 09-11 October 2012

Recommendation from 2011 Global surveillance meeting

1. Global EQA should be improved and fully utilized to target labs that need support

2. Laboratory procedures to be optimized:

o RDTs available at sentinel hospital to improve diagnostics

o More characterization at the reference lab level (PCR) on support for sentinel hospitals

3. Standardized assessment tool for sentinel hospitals laboratories

4. Technical working group to guide lab network

RRL:COL

RRL: BRA

VEN

BOL

PAR

PER

ECU

CUB

GTM

PAN NIC

ELS HON

Hospital based surveillance

Countries No. SS*

Guatemala (GTM) 5

Honduras (HON) 3

El Salvador (ELS) 8

Nicaragua (NIC) 2

Panama (PAN) 4

Venezuela (VEN) 3

Ecuador (ECU) 4

Peru (PER) 5

Bolivia (BOL) 9

Paraguay (PAR) 7

Brazil (BRA) 1 (SINAN-meningitis only)

Total 53

RRLs : 2 (BRA, COL) NLs: 11 countries SCs: 53 hospitals

PAHO IBVPD network in Latin America: sentinel sites (SS)*

for children < 5 years (2010-2012)

Conclusions

Since 1993 the Americas Region started the laboratory based surveillance of Sp. neumoniae, H. influenzae y N. meningitidis, under the coordination of PAHO (Sistema Regional de Vacunas, SIREVA).

SIREVA improve the capacities of the laboratories for the identification of theses agents by means of the implementation of protocols and procedures of quality assurance standardized.

The identification of serotypes is similar but at the same time different between the countries of the Region, therefore it is important that the countries do the Sentinel Surveillance and give follow-up of his own reality.

There is a needed that the countries improve the integration of clinical, epidemiological and laboratory data that facilitates the decision of the introduction of new vaccines, evaluation of impact and the take of decisions in public health.

Challenges

• Continue with the strengthening of the capacity of response of the laboratories of sentinel sites of hospitalary sentinel surveillance.

• Support and mantain the quality of the results generated in all the levels of the laboratory network (Sentinel, National and Regional laboratories).

• Improve the compilation of data and the integration of the epidemiological and laboratory information.

• Improve the capacity to provide data on timely manner to decision makers.

SIREVA II, Regional Reports 2000-2011 http://new.paho.org/hq/index.php?option=com_content&task=blogcategory&id=3609&Itemid=3953

Acknowledgements

Personnel of Health of private and public laboratories

that sent strains for characterization under SIREVA II.

National Laboratories, Regional Reference Laboratories,

Consultants and Advisors of SIREVA II.

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