|
(Revised version including data from Colombia which had been erroneously excluded)
Dear Colleagues,
We are pleased to share the latest bulletin of the World Health Organization (WHO)-coordinated Global Rotavirus and Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance Networks. This bulletin reports the most up-to-date global surveillance data reported to WHO on pediatric diarrhea, meningitis, and pneumonia from the calendar year of 2016.
In this edition, we would like to highlight the WHO Global IB-VPD Surveillance Strategic Review and the Global Rotavirus and Pediatric Diarrheal Surveillance Network meetings that were held from 14th-17th November 2017 in Geneva, Switzerland. Global and regional reference laboratories, global partners and WHO convened to review the current progress and future directions of the surveillance networks. As part of expanding the rotavirus surveillance network, the global pediatric diarrheal surveillance now allows identification of a wider range of diarrhea-causing pathogens. A more detailed description is provided below in the Global Rotavirus Surveillance Network section.
If you have trouble viewing the graphics in this bulletin, please open the bulletin in your browser or change your settings to allow image download (instructions here). Please forward the bulletin to other interested parties or share on social media. We appreciate feedback on the bulletin, and you can subscribe or unsubscribe using the link at the bottom. We also welcome new countries who would like to join the network.
Thank you to everyone from staff at the sentinel surveillance hospitals to the country, regional and global partners who make this surveillance possible.
We hope you enjoy the bulletin!
The WHO Global Rotavirus and IB-VPD Surveillance Team
|
|
|
In 2016, the WHO Global Rotavirus Surveillance Network had data reported from 59 Member States and 134 sentinel surveillance hospitals.
|
|
| * Graphs 1 & 2 include sites/countries meeting these performance criteria:
Sentinel sites must report cases for at least 10 months of the year 2016 (including zero reporting, if reported to WHO)
Countries must report a minimum of 80 cases (all sites combined) in 2016 unless rotavirus vaccine was introduced in the country prior to 2016 (i.e., in 2015 or earlier).
|
|
|
Update on the 2016 Rotavirus External Quality Assessment
|
|
| Among the rotavirus laboratories that participated in the external quality assessment (EQA) exercise in 2016, 100% (n=119) of the laboratories passed the enzyme immunoassay (EIA) exercise to identify rotavirus. Among the laboratories that have genotyping capacities, 88% (n=60) of the laboratories passed the genotyping exercise. The rotavirus proficiency testing panels consisted of lyophilized, non-infectious samples. Year by year, there has been a significant amount of improvement in the laboratories' capacities in EIA and genotyping for rotavirus.
All laboratories received individual feedback as well as a global report that evaluated the overall EQA performance in 2016. The laboratories that had difficulties in the genotyping exercise have been followed up by each WHO Region and the rotavirus global reference laboratory at U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.
EQA continues to be an important tool in highlighting the gaps and weaknesses in each participating laboratory and thus allows laboratories to enhance data quality and reliability.
|
|
|
Regional Rotavirus Molecular Laboratory Training for Western Pacific Region Countries
|
|
| Laboratory training facilitators and participants during the rotavirus laboratory training at the Murdoch Children's Research Institute (MCRI) in Melbourne. |
|
|
|
The rotavirus laboratory training was conducted at the Murdoch Children's Research Institute (MCRI) in Melbourne which serves as a regional reference laboratory (RRL) for rotavirus. Participants from national laboratories in Vietnam, Lao People's Democratic Republic, Fiji, Philippines, and Cambodia joined the training. Facilitators were from the MCRI rotavirus laboratory and the rotavirus global reference laboratory at CDC Atlanta.
The scientific program included training on basic rotavirus diagnosis by EIA and molecular techniques, including polymerase chain reaction (PCR) for diagnosis and genotyping. In addition, WHO global and regional overviews of the rotavirus surveillance networks were given. This was also an opportunity for each country representatives to discuss about specific country issues and review laboratory results from the 2016 WHO EQA exercise.
|
|
|
Update on the 2017 Global Pediatric Diarrheal Surveillance
|
|
In January 2017, 49 sites in 30 countries in the Global Rotavirus Surveillance Network were leveraged to create Global Pediatric Diarrheal Surveillance (GPDS) in partnership between WHO, CDC, and the University of Virginia, with financial support by the Bill & Melinda Gates Foundation and the Gavi Alliance. The objectives of GPDS are to continue to monitor the impact of rotavirus vaccine while also determining the hierarchy of causes of pediatric diarrhea requiring hospitalization in a post-rotavirus vaccine era. Data generated by GPDS will contribute to global diarrheal disease burden estimates and provide molecular information that will aid in vaccine development for pathogens such asShigella, norovirus and ETEC. The GPDS sites expanded their case definition from only children hospitalized with acute watery diarrhea recommended for rotavirus surveillance to all pediatric diarrhea, including non-acute and bloody cases. A randomly selected subset of diarrhea cases enrolled will be tested for more than 20 enteropathogens using quantitative PCR (qPCR) via Taqman array cards. The sites selected for participation in GPDS conduct continuous surveillance and enroll a minimum of 100 cases per year. Each participating site sends 25 samples per three-month quarter to a RRL for PCR testing with Taqman array cards. During 2017, refresher or new laboratory trainings were held at RRLs in South Africa, Belarus, Ghana, and China for training on laboratory assessments including swipe tests for contamination, nucleic acid extractions, Taqman array card set up and runs, qPCR data analysis and quality control. Sites began enrolling cases using the expanded case definition between January and May 2017, and surveillance data have been received by WHO headquarters for nearly 10,000 severe diarrheal cases. The majority of pediatric diarrhea cases reported in GPDS thus far has been acute watery diarrhea. The first set of samples has been shipped to the six RRLs where testing using Taqman array cards is ongoing. Following the first full year of surveillance, the qPCR data will be linked to the surveillance and clinical data to estimate the attributable fractions for each enteropathogen by country, region, and globally. In the coming year, WHO and partners will focus efforts to improve the expansion of GPDS and will seek to include sites from the WHO Eastern Mediterranean region. |
|
|
The Republican Research and Practical Center for Epidemiology and Microbiology (Minsk, Belarus, top 2 photos), Memorial Institute for Medical Research (Pretoria, South Africa, bottom right photo), and the Noguchi Memorial Institute for Medical Research College of Health Sciences (Accra, Ghana, bottom left photo), which serve as the rotavirus RRLs, participated in the TACarray training to launch the GPDS.
|
|
|
|
Global Invasive Bacterial Vaccine-Preventable Disease Surveillance Network
|
|
|
In 2016, the WHO Global Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance Network had data reported from 58 Member States and 123 sentinel surveillance hospitals.
|
|
| ** Graphs 4 & 5 include sites/countries meeting these performance criteria:
Sentinel sites must report cases for at least 10 months of the year 2016 (including zero reporting, if reported to WHO)
Tier 1 countries (conducting meningitis surveillance only) and Tier 2 countries (also conducting pneumonia/sepsis surveillance) must report respectively a minimum of 80 and 400 cases (all sites combined) in 2016 unless the pneumococcal conjugate vaccine was introduced in the country prior to 2016 (i.e., in 2015 or earlier).
|
|
|
Update on the 2016 IB-VPD External Quality Assessment
|
|
| In 2016, 94% (n=116) of the participating IB-VPD laboratories passed the EQA, including the regional reference laboratories (RRLs), national laboratories (NLs) and sentinel site laboratories (SSLs). All laboratories were evaluated on pathogen identification by testing on viable cultures. For NLs and RRLs with PCR capacities, they were also tested on their ability in serotyping/serogrouping the bacterial pathogens using simulated clinical samples of cerebrospinal fluid (CSF).
All laboratories received an individual report with a global report that provided an evaluation of their performance as well as a comparison to other laboratories. The laboratories that had difficulties in passing the EQA have been followed up by each WHO Region and the IB-VPD global reference laboratory at U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.
EQA continues to be a critical tool in highlighting the gaps and weaknesses in each participating laboratory and thus allows laboratories to enhance data quality and reliability.
|
|
|
European Regional Workshop on Direct Real-Time Polymerase Chain Reaction (PCR) for Detection and Characterization of IB-VPD
|
|
|
Laboratory training facilitators and participants during the laboratory workshop at the R.G. Lugar Center for Public Health Research, National Center for Disease Control and Public Health (NCDC) of Georgia.
|
|
|
| In April 2017, laboratory experts from national laboratories in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Ukraine, and Uzbekistan and the Regional Reference Laboratory in the Russian Federation attended a WHO-coordinated workshop facilitated by experts from the Global Reference Laboratory at CDC.
As part of global efforts to improve surveillance of IB-VPD, WHO European Regional Office and Headquarters organized a hands-on training workshop to expand global use of the new direct real-time polymerase chain reaction (PCR) method for detection and characterization of bacterial meningitis agents. This workshop also created a platform to strengthen coordination between national, regional, and global IB-VPD laboratories and to share experiences and lessons learned among participating countries in the European Region.
The workshop facilities were kindly provided by the R.G. Lugar Center for Public Health Research, National Center for Disease Control and Public Health (NCDC) of Georgia.
|
|
|
Weekly Email Update on Vaccine-Related Literature
The International Vaccine Access Center (IVAC) at Johns Hopkins University conducts a weekly Pubmed literature search on the following antigens: pneumococcus, rotavirus, Hib, meningococcus and HPV. The general topics included in the search for the above listed antigens are disease burden, vaccine impact, vaccine introductions, vaccine programs and optimization, and economics. The recurring search began in 2013 to keep partners up to date on emerging literature and findings. IVAC has made this literature search more accessible in an effort to reach larger audiences with up to date research and findings on important vaccine antigens. You can subscribe here: http://goo.gl/forms/naoyfXhlZ5
|
|
|
Acknowledgements
WHO gratefully acknowledges the dedicated efforts of the numerous individuals and organizations involved with compiling this surveillance information, including Ministries of Health, sentinel hospitals, as well as the network of global, regional and national reference laboratories. WHO also gratefully acknowledges the financial support from Gavi, the Vaccine Alliance, that is provided to eligible countries and additional support from the U.S. Centers for Disease Control and Prevention and the Bill & Melinda Gates Foundation.
|
|
|
| Please contact us at This email address is being protected from spambots. You need JavaScript enabled to view it. or reply to this email for questions and feedback on the bulletin. Feel free to share with colleagues, friends and on social media! |
|
|
|
