Accelerating Progress towards Measles and Rubella Elimination 21

Accelerating Progress towards Measles and Rubella Elimination, 21 -23 June 2016, Hotel Royal, Geneva Global Health Security Agenda (GHSA) In the CDC Measles Mumps Rubella And Herpesviruses Laboratory Branch Joseph P. Icenogle, the CDC rubella Team CDC colleagues, and collaborators MMRHLB primary contributors Adaeze Ogee-Nwankwo Diane Waku National Center for Immunization & Respiratory Diseases Division of Viral Diseases

Why Care About Global Health Security PROBLEM DISEASES SPREAD NOT PREPARED ECONOMIC IMPACT Faster and farther At least 70% of countries not prepared SARS: $40 B Globally Ebola: >$30 B Globally

The Global Health Security Agenda • A unifying framework to improve our global response to disease outbreaks

Prevent Detect Respond 11 Action Packages AMR Zoonotics Laboratory Surveillance EOCs Public Health & Law Biosafety/Biosecurity Immunizations The US CDC GSL is involved in the implementation of these two packages in Reporting and Workforce Ghana Bangladesh MCM & PD

Ghana: Protecting Lives in the 2 nd Year of Life (2 YL) q Aim: Prevent morbidity and mortality from vaccine preventable diseases (VPD) by strengthening the second year of life (2 YL) immunization platform q 5 strategic areas § § § Training & Supervision Data Recording and Reporting Social Mobilization & Demand Program Integration VPD Surveillance Special Innovations

Strategic Area 5: VPD Surveillance q Objectives (MMRHLB) § Strengthen measles and rubella surveillance including laboratory capacity in Ghana to allow rapid response to outbreaks and identification of areas of inadequate vaccine delivery or uptake § Support activities related to implementation of CRS surveillance q Strategy § Activities for 2016 ü Assessment of the National Public Health Reference Laboratory using standardized laboratory assessment tools. Gap analyses ü Remote assistance and funding for procurement of laboratory reagents and equipment • Laboratory training workshop for measles and rubella detection and genotyping • Follow up visit to assess progress, sustainability and discuss next steps § Activities continue through 2019

Assessment of the Ghana National Public Health Reference Laboratory (NPHRL) q Team of 2 MMRHLB staff visited NPHRL in Mar 2016 q Objectives § Meet laboratory staff and key stakeholders, and tour the NPHRL § Complete two laboratory assessment tools: 1. the International Measles and Rubella Laboratory Capacity Review Tool 2. the WHO Laboratory Assessment Tool § Provide a report describing the status of laboratory capacity with recommendations for improvement based on data collected using both tools and observation of laboratory practices § Determine equipment and training needs for measles and rubella molecular testing

Tools q Tool 1: WHO Laboratory Assessment Tool - Facility Questionnaire q Eleven modules 1. 2. 3. Organization and management Documents Specimen collection, handling and transport 4. Data and information management 5. Consumables and reagents 6. Equipment 7. Laboratory testing performance 8. Facilities 9. Human resources 10. Biorisk management 11. Public health functions q q Gap analysis Summary

Tools q Tool 2: CDC International Measles and Rubella Laboratory Capacity Review Tool q Nine modules 1. Laboratory Contact Information 2. General Laboratory 3. Specimen Handling, Collection and Reporting 4. Virology Laboratory 5. Molecular Biology Laboratory 6. Laboratory Safety and Biosafety 7. Quality Assurance / Quality Control 8. Equipment 9. Training q Report template

Indicators 0 0. 2 0. 4 0. 6 0. 8 1 Organization and management Documents Specimen collection, handling and transport Data and information management Consumables and reagents Equipment Laboratory testing performance Facilities Human resources Biorisk management Public health functions WHO Laboratory Assessment Tool - Facility Questionnaire Summary Key: Red: < 50%, requires significant improvement Yellow: 50 -80%, some improvement is necessary Green: > 80%, the laboratory is in good standing

Gap Analysis 0 1 Financial resources for laboratory activities Human resources – qualifications and availability of suitable laboratory staff Equipment adequacy Reagent and consumable availability and delivery Specimen collection standardization and quality 5 5 3 Guidelines on laboratory practices Regulatory framework 4 1 Reagent and consumable quality Laboratory organization, service delivery structure 3 1 Equipment calibration and maintenance Transportation of specimens 2 0 Data management Laboratory safety or security Quality assurance Political commitment (national laboratory policies, budget, etc. ) Other WHO Laboratory Assessment Tool - Facility Questionnaire Summary 3 4 5 4 4 Key: 0 (no gaps) to 5 (high gaps) 5 5

Activities q Procure and install equipment for molecular biology § Ongoing q Provide reagent and supplies § Ongoing q Train NPHRL staff on molecular techniques for measles and rubella § Planned for 4 th quarter 2016

Linkage to CDC-supported projects in Ghana q GHS-activities can complement/be complemented by § Implementation of CRS surveillance (CGH/GID, GAVI-funded) § Identify challenges in rubella and CRS activities within the WHO -Global Measles and Rubella Laboratory Network (DVD/GID) § Laboratory capacity building for meningitis surveillance (GID/DBD)

Bangladesh GHS support q Phase I GHS country q Aim (MMRHLB): Strengthen surveillance for measles, rubella and CRS q Objectives: § Discuss challenges for surveillance of measles, rubella and CRS, and determine what areas CDC, in connection with GHSA, can provide support § Review case classification scheme for CRS

Bangladesh GHS support q Meetings with leadership and key personnel of various institutions: § § § CDC Bangladesh National Polio, Measles & AMES Laboratory (NPML) Expanded Program on Immunization (EPI) WHO Bangladesh Institute of Epidemiology, Disease Control and Research (IEDCR) § International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr, b) q Laboratory tours

Future plans q Engage the leadership of IPH (parent institution of NPML) and advocate for routine measles and rubella molecular testing, and for supportive supervision of NPML q Strengthen lab capacity to detect measles and rubella to improve laboratory support for case-based surveillance and outbreak investigations § Conduct a comprehensive baseline assessment of NPML § Facilitate a training workshop on measles and rubella virus culture, isolation, serology and molecular techniques (coordinate with SEARO regional laboratory coordinator and RRL (Thailand NIH)) § Procure reagents and additional equipment to perform lab tests § Establish measles and rubella molecular EQA § Conduct a follow-up visit to provide support and supervision, and monitor progress

Future plans, continued q Enhance surveillance for CRS and facilitate implementation of the WHO-SEAR regional surveillance protocol § Conduct a joint CDC/Mo. H/WHO-SEARO/WHO-Bangladesh evaluation of the current CRS surveillance system at the EPI program § Facilitate a training workshop on CRS epidemiology and surveillance for staff from all surveillance sites § Conduct a follow-up visit to the EPI program to provide support and supervision for CRS surveillance

Recommendation q Lab. Net should continue to seek to identify overlapping objectives with GHSA and work to engage in shared activities, even when different time lines, previous funding decisions, etc. present challenges. q Discussion to follow

Acknowledgements CDC Ghana NPHRL MMRHLB Paul Rota Adaeze Ogee-Nwankwo Diane Waku Emily Abernathy Bettina Bankamp Raydel Anderson Bangladesh DVD/OD Arunmozhi (Arun) Balajee Lia Haynes GID Mawuli Nyaku Ghana 2 YL team GMRLN David Opare Gifty Boateng David B Nartey Eric Aborgah Michael Adzgble CDC Bangladesh Kevin Russel Kathrine Strum-Ramirez Erin Kennedy WHO Bangladesh Jayantha Liyanage Stephen, Chacko Bangladesh Mo. H Khondoker Mahbuba Jamil (NPML) Tajul Islam Abdul Bari (EPI) The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Immunization & Respiratory Diseases Measles, Mumps, Rubella and Herpesvirus Laboratory Branch

Accelerating Progress towards Measles and Rubella Elimination, 21 -23 June 2016, Hotel Royal, Geneva Global Health Security Agenda (GHSA) In the CDC Measles Mumps Rubella And Herpesviruses Laboratory Branch National Center for Immunization & Respiratory Diseases Division of Viral Diseases