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WHO IB-VPD and Rotavirus Surveillance Bulletin - February 2020

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 2018. 
In this edition, we would like to highlight the Global Rotavirus and Pediatric Diarrhea Surveillance Network Meeting meeting that was held from 18-21 November 2019 at Rio de Janeiro, Brazil. Global and regional reference laboratories, global partners, donors and WHO convened to review the current progress and future directions of the surveillance networks. 
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 2018, the WHO Global Rotavirus Surveillance Network had data reported from 55 Member States.

* Graphs 1 & 2 include sites/countries meeting these performance criteria: Sentinel sites must report cases for at least 10 months of the year 2018 (including zero reporting, if reported to WHO) Countries must report a minimum of 80 cases (all sites combined) in 2018 unless rotavirus vaccine was introduced in the country prior to 2018 (i.e., in 2016 or earlier).


Update on the 2018 Rotavirus External Quality Assessment of Laboratory Performance

Among the rotavirus laboratories that participated in the external quality assessment (EQA) exercise in 2018, 106 of the 108 laboratories (98%) passed the enzyme immunoassay (EIA) exercise to identify rotavirus. Among the laboratories that have genotyping capacities, 54 of the 57 laboratories (95%) 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. 


Update on the 2018 Global Pediatric Diarrheal Surveillance

Established by WHO, the Global Rotavirus Surveillance Network aims to assess the burden and vaccine impact of severe rotavirus disease in hospitalized young children. WHO, Member States and main technical partners, the U.S. Centers for Disease Control and Prevention (CDC) and the University of Virginia (UVA), have contributed in leveraging the Global Rotavirus Surveillance Network to establish the Global Pediatric Diarrhea Surveillance (GPDS) network to further study the etiology of diarrhea among hospitalized children under 5 years of age by using a molecular diagnostic technology called TaqMan Array Card (TAC) singleplex real-time PCR that simultaneously detects more than 20 enteric pathogens.

Twenty-nine countries worldwide shown in Figure 2 with high performing surveillance are part of GPDS and are contributing to gathering important global data that will provide for many countries first ever estimates of pathogen specific diarrhea related to hospitalizations among children under 5 years. These data will contribute to a better estimation of pathogen-specific disease burden among young children with severe diarrhea and improve our understanding of the main causes of diarrhea among this age group. These data on the burden of pediatric diarrhea will not only be important to monitor the success of rotavirus vaccination but will also provide evidence for the role of additional enteric vaccines that are currently in development, such as ETEC, Shigella and norovirus.

In countries that have introduced rotavirus vaccine, surveillance of children hospitalized with diarrhea has shown a decline of rotavirus prevalence of 40%. The causes of diarrhea in GPDS, based on the testing completed from 2017 to 2018, are shown in Graph 4. Despite the dramatic decline in rotavirus disease due to use of rotavirus vaccine, rotavirus remains the leading cause of diarrhea requiring hospitalization in children under 5, though there is variation country by country. After rotavirus, there are three pathogens with a similar burden: Shigella, adenovirus, and norovirus. Analysis is ongoing to further define the etiology by region and country.


2019 Global Rotavirus and Pediatric Diarrhea Surveillance Network Meeting

The 2019 Global Rotavirus and Pediatric Diarrhea Surveillance Network Meeting was held from the 18th to 21st of November in Rio de Janeiro, Brazil. Sixty-five participants attended the meeting, including WHO headquarters, regional, and country staff, and partners of the network.
The first day of the meeting consisted of a session with WHO headquarters and PAHO to discuss PAHO-specific updates and small group discussions with representatives from the six PAHO countries that are part of Global Pediatric Diarrhea Surveillance (GPDS) and from the Regional Reference Laboratories in Brazil and CDC. Day two presentations and discussions covered site performance and assessment tools, laboratory quality assurance and control systems, data management, new rotavirus vaccines, vaccine impact studies, and the full value of vaccines assessment (FVVA). Day three presentations and discussions covered new TAC cards and TAC validation, poliovirus containment in stool samples, norovirus genotyping, potential need and use of controls, updates on the WHO Enterics Burden Working Group, factors associated with diarrheal mortality, and mortality burden estimates.

Data from the Global Rotavirus Surveillance Network and GPDS are being used to assess etiology of pathogens causing diarrheal disease and factors associated with diarrheal deaths. Rotavirus remains the leading cause of severe pediatric diarrhea in all WHO Regions, with Shigella, adenovirus, and norovirus as the next leading etiologies. Diarrheal mortality is primarily in the African Region and is primarily due to rotavirus. Studies are on-going to assess rotavirus vaccine impact as well as evaluation of two new rotavirus vaccines. WHO will continue to support all participating countries to improve the quality of their surveillance and will use data from the network to answer important public health questions on pediatric diarrheal disease.


Global Invasive Bacterial Vaccine-Preventable Disease Surveillance Network

In 2018, the WHO Global Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance Network had data reported from 51 Member States. 


** Graphs 6 & 7 include sites/countries meeting these performance criteria: Sentinel sites must report cases for at least 10 months of the year 2018 (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 2018 unless the pneumococcal conjugate vaccine was introduced in the country prior to 2018 (i.e., in 2017 or earlier).


*** Graph 8 includes reported serotype data from countries that have and have not universally introduced the pnuemococcal conjugate vaccine in 2016-2018.

Update on the 2018 IB-VPD External Quality Assessment of Laboratory Performance


In 2018, 80% (n=95) of the 119 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 for pathogen identification by testing on viable bacterial cultures. For NLs and RRLs with molecular testing capacities, they were also tested on their ability in serotyping/serogrouping the bacterial pathogens using PCR on simulated clinical samples of cerebrospinal fluid (CSF). In addition to the IB-VPD laboratories, an additional 13 laboratories participated in the EQA from the Meningitis African Network (MenAfriNet) and WHO Collaborating Centers for meningitis. The performance of these laboratories was evaluated separately particularly on their performance in detecting and serogrouping Neisseria meningitidis. 

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 to implement corrective actions and improve performance.

EQA continues to be a critical tool in highlighting the gaps and weaknesses in each participating laboratory. Furthermore, the EQA program is a key component of quality assurance systems to monitor and evaluate laboratory data collected through invasive bacterial disease surveillance.


WHO New Vaccine Surveillance Poster


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.

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