afr measles-rubella tag meeting, 2015 1 |1 | the performance of the regional laboratory network...

AFR Measles-Rubella TAG Meeting, 20151 |

The Performance of the Regional Laboratory Network

Nairobi, 2-3 June 2015

The Performance of the Regional Laboratory Network

Nairobi, 2-3 June 2015

AFR Measles-Rubella TAG Meeting


Outline

Distribution of measles laboratories in AFR Region

Performance indicators

Measles genotypes

Main Challenges

Way forward

Question for TAG members


Distribution of Measles Rubella Lab.

National Lab

Sub National Lab

Regional Ref. Lab

N=47 labs

One lab/country except NIE (4) & ETH (3)

No lab: EQG, STP, CAV, SEY, MAS

Funding: MR initiative


Distribution of Measles Rubella Lab. Network (cn’t)

Coordination at IST level- 1 lab person: IST ESA- 1 lab person: ISTs

CA/WA

Diagnostic capacities- Serology: all labs- Virus isolation/PCR:

selected labs- Sequencing: 3 RRLs


Main Lab. Network Activities

Standardization: equipments (purchased by WHO), technique, kits, testing algorithm, lab database

External quality control system in place

Regular trainings (bench work & data management) organized

Monitoring of performance indicators

Accreditation review & lab director meeting

WHO support: kits, basic supplies, funds for operationnal cost


Main Lab. Performance Indicators

Indicators Monitoring TargetTimeliness & completeness in sharing databases with IST

WeeklyEach Monday / Tuesday (CA

& WA) or Friday (ESA)

Timeliness in sending out IgM results to national level

Weekly > 80% within 7 days

Timeliness in sending out IgM results of confirmatory testing to national laboratory (RRL only)

Quarterly > 80% within 14 days

Specimen received at lab in good condition Monthly > 90%% serum sent to RRL for confirmatory testing Quarterly > 10%

Measles/Rubella Proficiency Test results Yearly > 90%


Timeliness & Completeness in Sharing Database

Few labs have met the expected target (>=80%) due to internet connexion challenges, conflicting priority activities, staffing problems


Workload at Laboratory

2014 :Drop in number of specimens received at NLs in WA & in number of specimens received at IPCIV RRL (Impact of EVD outbreak)Increase in number of specimens received at NICD RRL (re establishment of testing)


Workload at Laboratory (cn’t)

Few shipments performed by NLs in 2014 vs 2013

No shipment performed by some labs

Refusal from DHL carrier to organize shipment of blood specimen due to on going EVD outbreak in WA


Quality of Specimens

Specimens received in good condition in most of the case. 90% minimum target met except for specimen received at NICD lab in 2014)


Measles IgM

Suspected case of measles

Blood specimen

IgM)+/-( IgM)+( IgM)-(

Rubella IgM

Repeat Measles IgM

Measles IgM)-/+( Measles IgM

)+(

Rubella IgM )-( Rubella IgM)+( Rubella IgM)+/-(

Measles IgM)-(

Lab. Testing Algorithm


Lab. Testing Algorithm (cn’t)

Some labs do not strictly follow algorithm & run simultaneous measles & rubella IgM test to save times


Timeliness in sending out IgM results to EPI/surveillance

WA below the 80% expected target in 2013 & 2014 due to shortage of kits (NIE impact)- Long term shortage of kits in 2014 (funding issues) affected most labs


Timeliness in sending out IgM results to EPI/surveillance

National Laboratory

IST WA, 2004

Timeliness (%) in sharing IgM

results

Shortage of measles/rubella

kits

Country affected by EVD

outbreak

ALG31 BEN69 BFA100 CIV95 GAM50 GHA94 GUI64 MAI76 MAU70 NIE-CPHL20 NIE-FCT97 NIE-SGH54 NIE-YDMH25 NIG88 SEN32 SIL0 TOG59


Timeliness in sending back IgM Results to NLs

Expected target not met - By IPCIV RRL in 2013 & 2014- By NICD RRL in 2014

IPCIV= RRL for 27 NLs. High number of specimens usually received (incl. from Nigeria)

Shortage of kits has affected this indicator for IPCIV


High number of kits purchased in 2014 (twice more) than 20013

Increasing needs from labs. Reason: outbreak ???

Unit price for Siemens IgM kit: Measle & rubella (295 Euros each), Supplementary (39 Euros)

Total cost (excluding transport)- 2013: 172 264 Euros- 2014: 337 592 Euros

Supply of Kits


Proficiency Test & Accreditation status

Excellent performance obtained for annual Proficiency Test except 1 lab (not accredited) - Sub optimal documentation & implementation of internal quality control procedures (provisionally accredited),


D10

B2

B3

D4

D2

Measles Genotype Identified: 2005-2014

Identified from specimen collected from outbreak & QC

Sequencing performed lab: NICD,UVRI & CDC

IPCIV: sequencing started in 2015

B3 largely circulating (In 2014 identified in ZIM,NIE & TOG)


Main Challenges

Suboptimal weekly reporting timeliness/completeness– Internet connectivity problems– Competing laboratory activities

High staff turn over in some labs (ETH, MAL, South Sudan)

Inconsistency in management of lab reagent– Stock outs ok kit due to outbreaks– Inaccuracy in estimating the needs & supply of kits with short expiring date

Insufficient/inadequate coordination between lab & surveillance – Continuous collection of blood specimen during measles outbreaks– Missed opportunity to collect specimen for virus isolation/genotyping


Main Challenges (cn’t)

Limited funding to cover lab activities (heavily dependant on WHO)– To purchase kits & sequencing reagents/supplies– To organize trainings

Effect of EVD outbreak- Shipment of QC specimen stopped in several countries, - 2014 lab director meeting cancelled


Way Forward

Integration of additional measles lab: SEY, Mauritius (countries on elimination mode)

Full implementation of sequencing activities at IPCIV RRL

Strengthen collaboration between lab & surveillance

Secure alternative carriers to transport specimens for QC

Reconvene annual lab director meeting

Advocate for additional funding for the lab network- Explore Nigeria willingness to purchase kits


How can we advocate /mobilize more funds to cover measles laboratory network needs ???

Question For MR TAG Members

afr measles-rubella tag meeting, 2015 1 |1 | the performance of the regional laboratory network...

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