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WHO IB-VPD and Rotavirus Surveillance Bulletin - January 2019

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 2017. 
In this edition, we would like to highlight the WHO Global Rotavirus, Pediatric Diarrheal Surveillance, Invasive Bacterial Diseases, Laboratory and Disease Burden meetings that were held from 26th-30th November 2018 in Cape Town, South Africa. Global and regional reference laboratories, global partners, donors and WHO convened to review the current progress and future directions of the surveillance networks. 
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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 2017, the WHO Global Rotavirus Surveillance Network had data reported from 62 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 2017 (including zero reporting, if reported to WHO) Countries must report a minimum of 80 cases (all sites combined) in 2017 unless rotavirus vaccine was introduced in the country prior to 2017 (i.e., in 2016 or earlier).

Update on the 2017  Rotavirus External Quality Assessment of Laboratory Performance

Among the rotavirus laboratories that participated in the external quality assessment (EQA) exercise in 2017, 97.3% (n=108) of the laboratories passed the enzyme immunoassay (EIA) exercise to identify rotavirus. Among the laboratories that have genotyping capacities, 95% (n=55) 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 2017. 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. 

Update on the 2017 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 new, molecular diagnostic technology called TaqMan Array Card (TAC) singleplex real-time PCR that simultaneously detects more than 20 enteric pathogens.

Thirty 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 thus far, 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 four pathogens with a similar burden: Shigella, Cryptosporidium, norovirus, and adenovirus. Analysis is ongoing to further define the etiology by region and country.

The Global Rotavirus and Pediatric Diarrhea Surveillance, Laboratory, and Disease Burden Meetings were held from 26-30 November 2018 in Cape Town, South Africa.

The objectives of the meetings were to (1) review the current status, protocol, and preliminary results of Global Rotavirus Surveillance Network and Global Pediatric Diarrhea Surveillance, (2) discuss priorities and future opportunities for global diarrheal disease surveillance, (3) review the validation of laboratory procedures for an updated WHO global rotavirus laboratory manual, (4) review 2017 rotavirus EQA and QC results and logistics for 2018 EQA, (5) develop a high level outline for VPD Surveillance Data Management Pamphlet, (6) identify common assumptions, major differences, and aspects that may inform and align future iterations of the pediatric diarrhea mortality models, and (7) discuss within WHO the future of the Global IB-VPD Surveillance Network.

Sixty-nine participants attended from across the globe comprising WHO HQ and Regional Offices epidemiology, laboratory and data surveillance focal points, Regional Reference Laboratories, the Bill & Melinda Gates Foundation, the U.S. Centers for Disease Control and Prevention and other partners and external technical experts.

Global Invasive Bacterial Vaccine-Preventable Disease Surveillance Network

In 2017, the WHO Global Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance Network had data reported from 54 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 2017 (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 2017 unless the pneumococcal conjugate vaccine was introduced in the country prior to 2017 (i.e., in 2016 or earlier).

Update on the 2017 IB-VPD External Quality Assessment of Laboratory Performance

In 2017, 92% (n=108) 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 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 12 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 and thus allows laboratories to enhance data quality and reliability and co. 

Leveraging the IB-VPD Laboratory Network to Build on Diphtheria Diagnostics  

Laboratory training facilitators and participants during the diphtheria laboratory workshops at the Research Institute for Tropical Medicine (Manila, Philippines, top two photos) and the American University of Beirut (Beirut, Lebanon, bottom two photos) 

In 2018, diphtheria laboratory training workshops were facilitated in 3 WHO Regions including EMR (held in Lebanon), EUR (held in Cyprus), and WPR (held in the Philippines). These workshops were facilitated by WHO in collaboration with Public Health England which is a WHO Collaborating Center for diphtheria. During these training, lectures were given on topics including diphtheria surveillance, the global disease burden of diphtheria, biosafety issues, pertussis, invasive bacterial disease surveillance, quality assurance and quality control programs, and laboratory networks.

The participants had the opportunity to do a hands-on training in laboratory testing for diphtheria including bacterial culture, screening tests, and molecular methods (PCR). At the end of the workshops, the majority of the participants looked forward in setting up their own reference laboratory for diphtheria at their institutions including both bacteriology and molecular capacities.

By leveraging the WHO IB-VPD global laboratory network, laboratory capacity can be strengthened and utilized at the country level to detect vaccine preventable diseases, not only for meningitis and pneumonia but also for diphtheria and other bacterial pathogens.

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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