WHO-Coordinated Global Rotavirus and Pediatric Diarrhea ...
Transcript of WHO-Coordinated Global Rotavirus and Pediatric Diarrhea ...
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Adam L. CohenThirteenth International Rotavirus Symposium
WHO-Coordinated Global Rotavirus and Pediatric Diarrhea Surveillance
Minsk, Belarus | 29 August 2018
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Why do countries conduct vaccine-preventable disease surveillance?
Pre-vaccine introduction
• To describe disease burdento make decisions about vaccine introduction
Impact of introduction
• To monitor trends to show impact and cost-effectiveness of vaccine and vaccination program
Long-term monitoring
• To monitor changes in disease after introduction
• To document control, elimination, and eradication
• Identify outbreaks for immediate action for effective reactive vaccination campaigns
• Components of surveillance can be leveraged to monitor other VPDs and other diseases without vaccines
• Identify unreached populations not getting vaccinated for targeted delivery strategies
Acrossall
phases
Ref: Cohen, A. et al. Using surveillance and economic data to make informed decisions about rotavirus vaccine introduction. Vaccine. 2018 Aug 18.
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Why do countries conduct vaccine-preventable disease surveillance?
Pre-vaccine introduction
• To describe disease burdento make decisions about vaccine introduction
Impact of introduction
• To monitor trends to show impact and cost-effectiveness of vaccine and vaccination program
Long-term monitoring
• To monitor changes in disease after introduction
• To document control, elimination, and eradication
• Identify outbreaks for immediate action for effective reactive vaccination campaigns
• Components of surveillance can be leveraged to monitor other VPDs and other diseases without vaccines
• Identify unreached populations not getting vaccinated for targeted delivery strategies
Acrossall
phases
Ref: Cohen, A. et al. Using surveillance and economic data to make informed decisions about rotavirus vaccine introduction. Vaccine. 2018 Aug 18.
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Country commitment
Nationwide, case-based with laboratory confirmation of every case
Nationwide, aggregate with laboratory confirmation of outbreaks
Sentinel, case-based with laboratory confirmation of every case
Other (e.g. VPDs have different minimum standard of surveillance based on context)
Surveillance commitment in every country
• Measles• Poliomyelitis - -
• Neonatal Tetanus (no lab confirmation)
Surveillance commitment varies by country
• Diphtheria• Meningococcus• Rubella
• Hepatitis A• Hepatitis B• Mumps
• Congenital rubella syndrome
• H. Influenzae• Influenza• Japanese
encephalitis• Pertussis
Pneumococcus• Rotavirus• Typhoid
• Cholera (event-based)• HPV (surveillance not
recommended)• Non-neonatal Tetanus
(no lab confirmation)• Varicella (no lab
confirmation)• Yellow fever (pending)
Summary of updated WHO minimum recommended VPD surveillance standards
http://www.who.int/immunization/monitoring_surveillance/burden/vpd/standards/en/
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Country commitment
Nationwide, case-based with laboratory confirmation of every case
Nationwide, aggregate with laboratory confirmation of outbreaks
Sentinel, case-based with laboratory confirmation of every case
Other (e.g. VPDs have different minimum standard of surveillance based on context)
Surveillance commitment in every country
• Measles• Poliomyelitis - -
• Neonatal Tetanus (no lab confirmation)
Surveillance commitment varies by country
• Diphtheria• Meningococcus• Rubella
• Hepatitis A• Hepatitis B• Mumps
• Congenital rubella syndrome
• H. Influenzae• Influenza• Japanese
encephalitis• Pertussis
Pneumococcus• Rotavirus• Typhoid
• Cholera (event-based)• HPV (surveillance not
recommended)• Non-neonatal Tetanus
(no lab confirmation)• Varicella (no lab
confirmation)• Yellow fever (pending)
Summary of updated WHO minimum recommended VPD surveillance standards
http://www.who.int/immunization/monitoring_surveillance/burden/vpd/standards/en/
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Countries that conducted rotavirus surveillance in 2017
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WHO Global Rotavirus Surveillance and Laboratory Network (GRSN and GRLN), 2017
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WHO Global Invasive Bacterial Vaccine Preventable Disease and Rotavirus Surveillance Network Bulletin, July 2018, http://www.who.int/immunization/monitoring_surveillance/resources/NUVI/en/
Rotavirus positivity among children enrolled in GRSN, by WHO Region, 2017
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WHO Global Invasive Bacterial Vaccine Preventable Disease and Rotavirus Surveillance Network Bulletin, July 2018, http://www.who.int/immunization/monitoring_surveillance/resources/NUVI/en/
Rotavirus positivity among children enrolled in GRSN, by Country, 2017
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Trends in rotavirus genotype distribution globally, 2010-2016
Nakamura, et al. WHO-coordinated Global Rotavirus Laboratory Network: A Platform to Leverage Pediatric Diarrheal Disease Surveillance. International Rotavirus Symposium, Minsk. 2018.
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403,140 children hospitalized with AGE from 349 sites in 82 countries
Global rotavirus vaccine impact using Global Rotavirus Surveillance Network, 2008-2016
Aliabadi, et. al. Unpublished
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403,140 children hospitalized with AGE from 349 sites in 82 countries
Global rotavirus vaccine impact using Global Rotavirus Surveillance Network, 2008-2016
RVV
intr
o.
Aliabadi, et. al. Unpublished
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403,140 children hospitalized with AGE from 349 sites in 82 countries
Global rotavirus vaccine impact using Global Rotavirus Surveillance Network, 2008-2016
RVV
intr
o.
Aliabadi, et. al. Unpublished
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403,140 children hospitalized with AGE from 349 sites in 82 countries
Global rotavirus vaccine impact using Global Rotavirus Surveillance Network, 2008-2016
RVV
intr
o.
Rotavirus prevalence decreased by nearly 40% following vaccine introduction
Aliabadi, et. al. Unpublished
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Global Rotavirus Surveillance
Network (GRSN)
Pilot TAC card testing in 4 Regional
Reference Laboratories
Global PediatricDiarrhea
Surveillance (GPDS)
Leveraging GRSN to understand other pediatric diarrheal diseases
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16
Countries with Sites Participating in GPDS
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Acute(<14 days)
Persistent(≥14 days)
Watery
Bloody
• Global Rotavirus Surveillance Network (GRSN) Case Definition: Acute (<14 days) watery diarrhea (AWD)
• Global Pediatric Diarrhea Surveillance (GPDS) Expanded Case Definition: All pediatric diarrhea regardless of duration or presence of blood in stool
• Acute (<14 days) and persistent (≥14 days) diarrhea
• Watery and bloody diarrhea
GPDS Expanded Case Definition
AWD (GRSN Case Definition)
All diarrhea (GPDS Case Definition)
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• 100 specimens per year from each of 37 participating sites in 32 countries
o Two countries starting 2019
o Tested by TAC in Regional Reference Laboratories (3-6 countries per RRL)
• Only cases, no controls: Pathogen quantities in each diarrheal sample from GPDS combined with strength of association (odds ratio) between pathogen quantity and diarrhea based on modeled association with case status from GEMS case-control study (Liu J and Platts-Mills J, et al, Lancet 2016)
GPDS Methods
1
.8
.5
.3
0
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1 2 3 4 5 6 7 8
242322212019181716151413121110
987654321
GI pathogen assay Clinical Sample Control Manufacture Positive Control
PortL R
Rotavirus Rotavirus (CDC)Rotarix_NSP2 & RotaTeq_VP6 VP7_G1VP4_P[4] VP7_G2VP4_P[6] VP7_G3 & G4VP4_P[8] VP7_G9VP4_P[10] & P[11] VP7_G8 & G10VP4_P[9] & Ebola VP7_G12MS2 MS2Astrovirus Norovirus GI & GII
Sapovirus Norovirus GII.4 & GI.1Shigella/EIEC (ipaH) Adenovirus 40/41 & Pan
S. flexneri (non 6) & S. flexneri 6 S. sonneiS. Other (boydii, dysen, flex6) S. dysen Type 1 & M.tb18S AeromonasB.fragilis & C.difficile Campylobacter jejuni/coliSalmonella V. choleraeEAEC_aaiC & aatA EPEC_eae & bfpAETEC_STh & STp ETEC_LTETEC_CFA/I & CS1 ETEC_CS2 & CS3ETEC_CS5 & CS6 STEC_stx1 & stx2PhHV PhHVCyclospora & Isospora E.bieneusi & E.intestinalisCryptosporidium & E.histolytica Giardia & StrongyloidesAncyclostoma & Necator Ascaris & Trichuris
Global Pediatric Diarrhea Surveillance Taqman Array Card (TAC)
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Clinical Presentation of Pediatric Diarrhea (GPDS), 2017-present--Preliminary results
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
WPR
SEAR
EUR
AMR
AFR
Global
Acute watery Acute bloody Persistent watery Persistent bloody
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Attributable fraction of pediatric diarrhea etiology, GPDS, Global, 2017--Preliminary results
0%
5%
10%
15%
20%
25%
30%
35%
Attri
buta
ble
Frac
tion
(95%
CI)
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06/09/2018 |
Attributable fraction of pedatric diarrhea etiology, GPDS, by Syndrome, 2017--Preliminary results
0%
5%
10%
15%
20%
25%
30%
35%
Attr
ibut
able
Fra
ctio
n (9
5% C
I)
Watery
Bloody
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Attributable fraction of pediatric diarrhea etiology, GPDS, by Age group, 2017--Preliminary results
0%
5%
10%
15%
20%
25%
30%
35%
Attr
ibut
able
Fra
ctio
n (9
5% C
I)
Infants (<1 y)
Older (1-<5y)
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• Rotavirus and pediatric diarrhea surveillance is critical to generate date for use at country, regional and global levels
• Should be responsive to the needs of country for national vaccine policy (e.g., rotavirus vaccine introduction and impact)
• Provides data for global policy (e.g., enteric vaccines in development such as Shigella, ETEC, and norovirus)
• Continue GPDS for 2 full calendar years of surveillance and consider long-term
• First full year of data available early 2019
• Maintain sustainable Global Rotavirus and Pediatric Diarrhea Surveillance Network through capacity building and country and external funding
Summary
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Acknowledgements
• Sentinel surveillance hospitals• Ministries of Health• WHO Country and Regional offices• National, Regional, and Global Reference
laboratories• Partners (U.S. CDC, Gavi, BMGF,
University of Virginia)