david featherstone epi / ivb who/hq
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David Featherstone
EPI / IVB WHO/HQ
Measles Partners Meeting Measles Partners Meeting
23-25 September 200823-25 September 2008
WashingtonWashington
Global Measles Rubella
Laboratory Network: Update
WHO Vaccine Preventable Disease Lab Network
Overview Overview Overview Overview
Why do we need a laboratory network?
How is it performing?
Challenges and opportunities
WHO Vaccine Preventable Disease Lab Network
Why do we need a laboratory network? Why do we need a laboratory network? Why do we need a laboratory network? Why do we need a laboratory network?
44
Potential measles transmission Potential measles transmission pathways!pathways!
WHO Global Measles and Rubella Laboratory Network: 2001-2007
124 Sub-National L
abs
124 Sub-National L
abs
10 Sub-National 10 Sub-National LabsLabs
164 countries =164 countries = Global Specialised Labs
National Laboratories Regional Reference Labs172
Global Specialised Labs
National Laboratories Regional Reference Labs80
N= 679 labs
+ 331 "SNLs" 31 "NLs"
2007
2001
As of July 2008
5
WHO Vaccine Preventable Disease Lab Network6
0
20
40
60
80
100
120
140
160
180
Measles YF JE Polio
JE
YF
Measles
Polio
Integrated lab activities Integrated lab activities (Excluding sub-national Labs)(Excluding sub-national Labs)
WHO Vaccine Preventable Disease Lab Network7
0
50000
100000
150000
200000
250000
Nu
mb
er o
f sa
mp
les
rece
ived
2004 2005 2006 2007
WPR
SEAR
EUR
EMR
Americas
AFR
Data as of June 08
~400,000 tests run in 2007 for M & R
LabNet Workload: Measles serology samples tested LabNet Workload: Measles serology samples tested
(~80% samples also tested for Rubella in 2007) (~80% samples also tested for Rubella in 2007)
WHO Vaccine Preventable Disease Lab Network8
0
20
40
60
80
100
120
140
160
180
No
. o
f L
abs
Par
tici
pat
ing
2001 2002 2003 2004 2005 2006 2007
<90% Not pass
90-95% Pass
100% Pass
Pending
98% passed
94% passed90%
passed
94% passed
96% passed
ScoreScore
98.5% 98.8%
Year of PT DistributionYear of PT Distribution
WHO LabNet Quality - Proficiency Test WHO LabNet Quality - Proficiency Test Measles IgM Results 2001-2007Measles IgM Results 2001-2007
WHO Vaccine Preventable Disease Lab Network9
Capacity buildingCapacity building
Training workshops – New labs recently incorporated into
LabNet– New staff: constant staff turnover – New techniques– Reference/Specialised Lab staff visit
labs– Lab staff visit Reference/Specialist
Labs,
Skills – Serology, QA/QC, – Lab Management,
Data Management, – Virus isolation, – Molecular Techniques, Sequencing, – Trouble shooting
AFR EMR EUR SEAR PAHO
Serology 3
1
1 2
Cell culture 1
1PCR
Sequencing
QA/QC 3 1
Lab Workshops 2007-08
1010
Challenge - 1Challenge - 1
Scaling-up molecular surveillance Scaling-up molecular surveillance to identify transmission pathwaysto identify transmission pathways
1111 WHO Vaccine Preventable Disease Lab Network
Development of WHO Development of WHO Global genotype databaseGlobal genotype database
Password protected SharePoint on-line Password protected SharePoint on-line access access
Viruses submitted from 1979 to 2008 Viruses submitted from 1979 to 2008
Real-time access Real-time access Number of
virusesGenotypes Countries WHO
Regions
MeasleMeasles s
28232823 1818 7474 66
RubellaRubella 194194 1111 2121 55
Data as of 10 Sept 2008
11
WHO Vaccine Preventable Disease Lab Network
Measles Genotype Detection- WHO LabNet 1979 -2008
Measles Genotype Detection- WHO LabNet 1979 -2008
No
. o
f vi
ruse
s su
bm
itte
d
0
200
400
600
800
1000
1200
1979 1984 1987 1989 1993 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
H2
H1
G3
G2
E
D9
D8
D7
D6
D5
D4
D3
D2
C2
C1
C
B3-2
B3-1
B3
B2
A
?B2
?
12
Global Measles Virus Genotypes 2007Global Measles Virus Genotypes 2007
Key
D4D4B3B3
D6D6
D9D9D8D8
D5D5
H1H1
Global Measles Virus Genotypes 2008 (Sept)Global Measles Virus Genotypes 2008 (Sept)
Key
D4D4
D8D8
D9D9
H1H1
D5D5
During January 1–July 31, 2008, 131 measles cases werereported to CDC from 15 states and the District of Columbia(DC)….
Among the 131 cases, 17 (13%) were importations: threeeach from Italy and Switzerland; two each from Belgium, India,and Israel; and one each from China, Germany, Pakistan, thePhilippines, and Russia…..
Nine of the importations were in U.S. residents who had traveled abroad, and eight were in foreign visitors. An additional 99 (76%) of the 131 cases were linked epidemiologically to importationsor had virologic evidence of importation….
1616
Challenge - 2Challenge - 2
Developing and validating Developing and validating procedures for non-invasive procedures for non-invasive collection of samples and collection of samples and transportation without cold chain transportation without cold chain
1717
Alternative samples to serum Alternative samples to serum for measles and rubella for measles and rubella
diagnosisdiagnosis
WER: 25, 2008, 83, 225–232 and MMWR: 2008; 57:657-660
WHO Vaccine Preventable Disease Lab Network18
Schematic of wild type measles virus Schematic of wild type measles virus infection*infection*
Incubation 7-18 days
Pati
en
ts p
osit
ive
Day of illness*
*
-1 3
IgM: Serum/DBS/OF
7 14 28 35 9021 60
Virus culture
-3 1 5
25%
50%
100%
75%
Fever
Rash
**Day 0 = first day of rash
(-3 to 5 days)
(0 to 5 days)
Virus detection: OF
Virus detection:
DBS
DBS=Dried Blood Spot
OF = Oral fluid sample
Virus detection = RT-PCR
* WER: 25, 2008, 83, 225–232 and MMWR: 2008; 57:657-660 June 2008
1919
Challenge - 3Challenge - 3
Meeting the programmatic need Meeting the programmatic need for increased workload and for increased workload and reduced testing turnaround timereduced testing turnaround time
2020
Surveillance Indicators through the Elimination Stages: PAHO
2005
1997
2000
0
10,000
20,000
30,000
40,000
50,000
2003 2004 2005 2006 2007
Source:MESSEPI week 52
Sa
mp
les
Pro
cess
ed
0
20
40
60
80
100
% lab results reported <=4 days
Pe
rce
nta
ge
2003 2004 2005 2006 2007
Laboratory Workload in Americas: Specimens Processed and Reporting Timeliness
Laboratory Workload in Americas: Specimens Processed and Reporting Timeliness
WHO Vaccine Preventable Disease Lab Network
No of Labs
(AFRO)
Approx cost of supplies / year
Approx cost per lab
Polio 16 $800,000 $50,000
Measles Rubella*
38 $548,000 $14,500
YF 23 $40,000 $2,000
Equipment (12%)
Assays (78%)
Computers/IT (1%)
Consumables other than assays (8%)
* Measles & Rubella costs 2006
Recurring costs in maintaining LabNet Recurring costs in maintaining LabNet WHO African RegionWHO African Region
WHO Vaccine Preventable Disease Lab Network
Global number of kits WHO procured per annum
0
200
400
600
800
1,000
1,200
1,400
1,600
2003 2004 2005 2006 2007
Measles kits Rubella kits Supplementary
WHO Vaccine Preventable Disease Lab Network
Total Cost of kits WHO procured per annum
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000
2003 2004 2005 2006 2007
Total cost
WHO Vaccine Preventable Disease Lab Network
PolioPolio– CDC, USAID– DIFID – Rotary – UNF – Gov'ts of Netherlands, Finland, Italy – Others
Measles and rubellaMeasles and rubella – CDC
YFYF – IFFIM– CDC (reagents)
JEJE – PATH / CVP– CDC (GDD)
WHO
Major external partners of VPD Major external partners of VPD LabNetLabNet
National Ministries of Health provide infrastructure and staffing costs
Funds
Needs
WHO Vaccine Preventable Disease Lab Network
Validating procedures for transporting samples without refrigeration
Reducing meetings frequency: ~every 2nd year
Integrating training and meetings with other disease programmes
Encouraging countries to take on more costs in their surveillance programme budget
Local production and validation of measles and rubella assays: China, Russian Federation
Meeting the Challenge of Limited funding
WHO Vaccine Preventable Disease Lab Network
Serving 164 countries
Timely reliable results
Virus tracking and information sharing
Outbreak detection and control
Challenge -Balancing needs with resources
Meeting challenge - Innovation and "belt-tightening"
THANK YOU!!
Conclusions – "The Best Kept Secret"
Global public good
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