Accelerating Progress towards Measles & Rubella Elimination Update from Regional Measles & Rubella Laboratory Network, African Region Hotel Royal, Geneva, Switzerland, 21 -23 June 2016 1 | Accelerating progress towards MR elimination, 2016
Outline v Measles & rubella surveillance program v Distribution of laboratories v Main activities v Laboratory performance indicators v Detected genotypes v Main Challenges v Way forward 2 | Accelerating progress towards MR elimination, 2016
AFR Measles Rubella Program v Measles elimination target by 2020 v Measles (M) or Measles & Rubella (MR ) SIAs going on in the Region : v WHO/AFR MR weekly partners updated by teleconference v CRS (congenital rubella syndrome) surveillance implemented in countries that have / are about to introduce rubella containing vaccine v Regular monitoring of surveillance performance indicators v Measles outbreaks: gaps in population immunity (low routine and SIAs coverage), and shift of epidemiological susceptibility to older age groups. 3 | Accelerating progress towards MR elimination, 2016 v Measles verification process: not initiated yet
Measles Surveillance Performance Indicators: AFR, 2010 -2016 Category Incidence (% countries < 5 per million population) Incidence of confirmed measles per million population Non-Measles Febrile Rash Illness rate Last 12 2013 2014 2015 month s 2020 target 2010 2011 100% 36% 56% 47% 53% 48% 77% 53% <1/ per million 172 42 25 76. 9 40 39. 4 29. 3 ≥ 2 per 100, 000 pop’n 4. 1 4. 4 3. 4 2. 9 3. 0 2. 5 2. 2 84% 78% 77% 82% 81% 91% 78% 85% 82% 88% % of districts reporting ≥ 1/100, 000 at least suspected measles 86% 82% 80% cases with blood specimens % of suspected cases at least with adequate blood 96% 82% towards 4 | Accelerating progress 80% MR elimination, 2016 specimens
Distribution of MR Laboratories v N=49 labs v Newly established: SEY & MAS v One lab/country except NIE (4) & ETH (3) National Lab Sub National Lab Regional Ref. Lab 5 | Accelerating progress towards MR elimination, 2016 v No lab: EQG, STP, CAV v Funding: MR initiative
Main Lab. AFR Network Activities v Implementation of internal/external quality control system v Training (bench work & data management) v Weekly lab data reporting & analysis v Monitoring of performance indicators & ensuring follow up actions v Strengthening quality assurance v Accreditation reviews & lab annual directors meeting v WHO support: kits, basic supplies, funds for operationnal cost 6 | Accelerating progress towards MR elimination, 2016
Laboratory Training conducted, 2015 -16 Date of training Type of training Countries involved 16 -22 Augt 2015 Number of lab participating Partners Onsite Ig. M Seychelles WHO, NICD Serology & QC 2 -13 Nov 2015 Serology, real Kenya, Ethiopia, South 7 UVRI- Entebbe, time and Africa, Tanzania, CDC- Atlanta, HPA genotyping Uganda, Zambia and - UK & WHO- HQ PCR, Zimbabwe & IST ESA Sequencing 6 -10 Jun 2016 Onsite Ig. M Mauritius 1 WHO, NICD Serology & QC Planned Jul Ig. G Serology Ethiopia & Uganda 2 UVRI Above training was conducted in Eastern & Southern 2016 in Entebbe Africa 7 | Accelerating progress towards MR elimination, 2016
Main Laboratory Performance Indicators 8 | Accelerating progress towards MR elimination, 2016
Workload at laboratory East Southern labs tested highest number of specimens. Of the 3 RRLs, IPCIV received the least number of specimens 9 | Accelerating progress towards MR elimination, 2016
Timeliness & Completeness in Sharing Database Suboptimal completeness & timeliness in sharing database on a weekly basis due to challenges in internet connectivity, competing activities 10 | Accelerating progress towards MR elimination, 2016
Ig. M Results Turn Around Time Stock out of kits adversely affected this indicator especially in 2016 11 | Accelerating progress towards MR elimination, 2016
2015 Measles & Rubella Proficiency Test Numb Description er Comments Labs participating in 37 Pending testing by Proficiency Testing some labs (PT) Labs that passed 33 PT test by old scoring Labs that passed 18 Reasons: Cut off PT by new scoring, value missing, inbut lost points house quality control reference not used, late reporting, expired kits Reporting by website submission: challenging for some labs, ultimately Labs that have 6 1 lab did not run all used old system failed PT using new specimens on scoring rubella 12 | Accelerating progress towards MR elimination, 2016
Lab. Accreditation Exercises Year 2015 2016* Type of No No No accreditation conduct schedule ed ed d On site visit 7 1 27 Corresponde nce 1 2 13 Total 8 2 41 Accreditation process by desk review (correspondence): to be selectively intensified in 2016 13 | Accelerating progress towards MR elimination, 2016
Recent Measles Outbreaks v Ethiopia – 2015 and 2016 (throat swabs collected- B 3 genotype) v Nigeria – 2015 (59 throat swabs collected- B 3 genotype) v DR Congo – 2016 (54 throat swabs collected- B 3 genotype) v Uganda – 2015 (73 OFs and 14 throat swabs – B 3 genotype) v Sierra Leone – early 2016, Liberia v Namibia – 2015, Equatorial Guinea – 2015 and 2016 v Gabon – early 2016 (12 throat swabs collected- B 3 genotype) 14 | Accelerating progress towards MR elimination, 2016
Measles Genotype Identified: 2005 v Identified from 2016* specimens collected from outbreak & QC B 3 B 2 D 4 D 2 D 10 15 | Accelerating progress towards MR elimination, 2016 v Sequencing lab: NICD, UVRI, IPCIV & CDC v B 3 genotype largely circulating (In 2016 identified in DRC, GAB, NIE & TOG) v Submission on Mea. NS done
1 st Report of Rubella genotype 2 B in West Africa (IPCIV) Branch of rubella genotype 1 G tree: contains sequences from CIV, Ghana, and Nigeria 16 | Accelerating progress towards MR elimination, 2016 Branch of rubella genotype 2 B tree: contains sequences from DRC, Burundi, and India
Main Challenges v Suboptimal weekly reporting timeliness/completeness – Internet connectivity problems – Competing laboratory activities v Regular stock out of measles & rubella kits v Lack of reagents for PCR & sequencing activities v Insufficient /inadequate coordination between lab & surveillance – Missed opportunity to collect specimens for virus isolation/genotyping 17 | Accelerating progress towards MR elimination, 2016
Main Challenges (cn’t) v Suboptimal collection of specimens for virus detection and logistics for it v Refusal from DHL carrier to carry blood specimens since Ebola outbreak event (West & Central Africa) v Insufficient funds to cover lab activities – To purchase kits, sequencing reagents/supplies, consumables – To organize trainings, – For lab operations 18 | Accelerating progress towards MR elimination, 2016
Way Forward v Advocate for additional funding for the lab network - 2, 4 Millions USD needed per annum v Strengthen collaboration between lab & surveillance to monitor for outbreaks and allow timely collection of specimens for genotyping v Complete accreditation reviews v Additional training on rubella sequencing needed by CIV RRL v 19 | Accelerating progress towards MR elimination, 2016 Secure alternative carriers to transport specimens for
Acknowledgements v NLs & Surveillance teams v 3 RRLs v WHO/HQ v CDC 20 | Accelerating progress towards MR elimination, 2016
Reported progress on completion of GAPIII, Phase I Phase 1 completed Planned PEF EMRO Countries 21 | Accelerating progress towards MR elimination, 2016
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