Dear Colleagues, The World Health Organization (WHO)-coordinated Global Rotavirus and Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance Networks include strong laboratories that generate high quality data to monitor disease trends over time. The IB-VPD laboratory network supports the laboratory confirmation of disease caused byStreptococcus pneumoniae, (Spn)Haemophilus influenzae(HI) andNeisseria meningitidis(Nm) and the identification of circulating serotypes/serogroups. Laboratory performance is monitored through quality assurance/quality control programmes and on-site assessment of the laboratories to ensure accurate data is collected. This bulletin highlights the 2015 laboratory data including the distribution of identified pathogens by bacterial culture, rapid diagnostic tests and polymerase chain reaction (PCR) assay and their serotype/serogroup distribution. In 2015, the IBVPD laboratory network included 100 Sentinel Hospital Laboratories (SHL), 28 National Laboratories (NL), nine Regional Reference Laboratories (RRL), and one Global Reference Laboratory (GRL) (Figure 2). A total of 99 (84%) out of the 118 labs that could participate in the 2015 EQA survey had a passing score while 19 (16%) showed challenges to pass the EQA exercise and are implementing corrective actions to improve diagnosis capacities.
The rotavirus laboratory network included 123 SHLs, 48 NLs, 10 RRLs, and one GRL (Figure 1). Rotavirus ELISA (EIA) testing is done at the SHL and genotyping of positive rotavirus is done at either the NL or RRL. A total of 113 out of 116 labratories (97%) that participated in EQA passed the EIA testing and 49 out of 54 labs (91%) with genotyping capacities had a passing score in the genotyping exercise.
Both the IB-VPD and rotavirus laboratory networks have immensely improved their capacities for diagnosis and serotyping/serogrouping of pathogens from clinical samples with combined efforts at SHLs, NLs, RRLs, and GRLs. Consequently, this has significantly strengthened the overall surveillance network that will continue to contribute to countries’ decisions for vaccine introduction and monitoring vaccine use and impact.
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We hope you enjoy the bulletin!The WHO Vaccine-Preventable Disease Surveillance teamIn 2015, the WHO Global Rotavirus Surveillance Network had data reported from 56 member states and 124 sentinel surveillance hospitals.In 2015, the WHO Global Invasive Bacterial Vaccine Preventable Disease (IB-VPD) Surveillance Network had data reported from 53 member states and 121 sentinel surveillance hospitals.
Asia has major gaps in understanding the burden of invasive bacterial vaccine-preventable disease (IB-VPD) and showing the impact of vaccines such as pneumococcal conjugate vaccines. Bangladesh is an exception in the region. In collaboration with the World Health Organization, the country has been conducting surveillance for IB-VPD and building laboratory capacity for several years. As a part of the WHO-coordinated Global IB-VPD Surveillance Network (GISN), Bangladesh has emerged as a model surveillance site within GISN and has had several successes. Of these successes, the strongest is that surveillance data from Bangladesh has been used to inform national vaccine policy decisions. Following national introduction of Hemophilus influenzae type b (Hib) vaccine in 2009, surveillance of bacterial meningitis in infants showed the dramatic impact of the vaccine in reducing number of confirmed Hib meningitis cases (1). The availability of ongoing IB-VPD surveillance data was used in the recent decision to introduce the pneumococcal conjugate vaccine in 2015 and was cited in the country’s successful Gavi application for PCV introduction (2). Bangladesh is now well-placed to demonstrate the impact of PCV. Bangladesh has one of the 2 population-based surveillance sites currently in GISN. Data from population-based surveillance sites can generate incidence and mortality rates and can be used in comparing populations and monitor serotype replacement. The country also has high laboratory performance and capacity which has further improved through the support and training provided through GISN. The country uses a tablet based data-management system for data collection. Bangladesh is also an excellent example of how IB-VPD surveillance can be leveraged to identify other severe vaccine-preventable diseases in children. Building on longstanding work in the country, Bangladesh is a part of a pilot study currently ongoing to assess the feasibility of integrating surveillance of typhoid fever and other invasive salmonella infections in 4 GISN countries, including Bangladesh (3). In addition, results from a study conducted in Bangladesh showed that adding rotavirus surveillance onto existing IB-VPD surveillance was successful and passed all WHO target performance indicators (4).
References1) Sultana NK, et al. (2013) Impact of introduction of the Haemophilus influenzae type b conjugate vaccine into childhood immunization on meningitis in Bangladeshi infants. J Pediatr. 163 (suppl 1):S73–8.2) Gavi Alliance Application Form for Country Proposals, For Support to new and Under-Used Vaccines (NVS) Submitted by The Government of Bangladesh. 10 Oct 2016 http://www.gavi.org/country/bangladesh/documents/3) World Health Organization. WHO Global Invasive Bacterial Vaccine Preventable Disease and Rotavirus Surveillance Network Bulletin. April 2016. http://us13.campaignarchive1.com/?u=920b793663d2f2d5f22813b38&id=f7893814544) Tanmoy AM, et al. (2016) Rotavirus Surveillance at a WHO-Coordinated Invasive Bacterial Disease Surveillance Site in Bangladesh: A Feasibility Study to Integrate Two Surveillance Systems. PLoS ONE. 11(4): e0153582.