global capacities, alert and response improving laboratory quality to aid the control of dengue...
TRANSCRIPT
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Global capacities, alert and response
Improving laboratory quality to aid the control of dengue
Meeting of the WHO Collaborating Centres for detection of dengue
Instituto Nacional de Diagnóstico y referencia Epidemiológica (InDRE)
Mexico City31 August – 1 September 2015
Christopher Oxenford
Laboratory Strengthening and Biorisk Management Team
Global Capacities, Alert and response Department
WHO Lyon
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Global capacities, alert and response
WHO - Headquarters
• Global Capacities, Alert and Response Department• Laboratory Strengthening and Biorisk Management
Team
• Support countries to build laboratory capacity including to meet obligations under the IHR(2005)
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Global capacities, alert and response
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Global capacities, alert and response
Spread of vectors
• Other pathogens also spreading– Chikungunya virus
– Zika virus
– West Nile virus
• International travel means pathogens can spread to almost any place in the world within 24 hours
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Global capacities, alert and response
IHR requirement
• The International Health Regulations (2005) are the global framework for reporting and responding to global public health threats. They require countries to have:• Surveillance systems to detect outbreaks and monitor
the spread of disease
• Access to laboratory testing capability to confirm the cause of an outbreak in a timely manner
• The response mechanisms to deal with the outbreak
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Global capacities, alert and response
Laboratory testing
• To detect and monitor outbreaks• Monitor the impact of vaccination and other control
measures
• Needs to be reliable and timely• Ideally a laboratory should have a quality management
system in place
• The right result on the right test done on the right specimen & reported to the right people
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Global capacities, alert and response
Laboratory quality
• The QMS should cover all components of the laboratories' work• pre-analytical, analytical and post-analytical
• technical areas and administration
• Particular tests should not be seen in isolation but as part of a laboratory's overall function
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Global capacities, alert and response
Laboratory quality
• LSB team has prepared a number of tools to help laboratories improve quality• Laboratory assessment tools
• For individual laboratories and also national systems
http://www.who.int/ihr/publications/laboratory_tool/en/
• A quality management system handbook and CD ROM• Reference material for those providing training on QMS
http://www.who.int/ihr/publications/lqms/en/
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Global capacities, alert and response
Laboratory quality
• Laboratory Quality Stepwise Implementation (LQSI) tool• Developed in conjunction with the Royal Tropical Institute (KIT), the
Netherlands
• A practical guide for laboratories seeking to improve quality
• Based on ISO 15189
• The stepwise approach helps laboratories prioritise quality improvement activities
• When all the steps have been completed the laboratory may seek accreditation against ISO 15189
http://www.who.int/ihr/lyon/hls_lqsi/en/
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Global capacities, alert and response
Laboratory quality
• Proficiency testing (PT) a type of external quality assessment, is an important component of a QMS• It allows external monitoring of the laboratory's performance
• Helps identify existing and potential problems
• All errors identified in PT schemes should be followed up and corrective actions taken when necessary
• A number of vertical disease programmes within WHO run PT schemes
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Global capacities, alert and response
Proficiency testing
• Provides a means to understand the capacity and capabilities of laboratories• Panels often include surveys asking how tests are
performed
• Offers a framework to link laboratories informally• To distribute standardized methods and reagents
• To provide educational and other support
• These linkages could be critical during emergency situations
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Global capacities, alert and response
Proficiency testing
• Regional schemes are a means of fostering champions• Can be used to encourage national PT schemes
• LSB supports a number of regional and country-level PT schemes• AFR, EMR, WPR – Pacific islands
• Most cover basic bacteriology (ID & AST)
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Global capacities, alert and response
Proficiency testing
• This year LSB has organized a global PT scheme for MERS-CoV • The recent outbreak in Korea has highlighted the
importance of reliable laboratory testing even for pathogens that seem unlikely threats.
• The largest outbreak to date outside the ME
• 186 cases, 36 deaths
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Global capacities, alert and response
Dengue PT
A regional PT scheme for dengue was established by WPRO in 2013• It covered detection by PCR/ ELISA/ RDT and serology
• It was organized by the NEA Singapore
• 19 laboratories participated
• 15 laboratories scored the maximum, all were satisfactory
http://ojs.wpro.who.int/ojs/index.php/wpsar/article/view/317/503
A second panel was distributed in 2015 (24 labs)• Some laboratories in WHO/SEAR participated
• Chikungunya was added
• Overall performance was not quite as good as in 2013, most errors were in RDT/ELISA testing
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Global capacities, alert and response
Dengue PT
WHO/HQ is looking to expand the programme and make it global• All regional offices have endorsed this approach
• May seek to add specimens with additional arboviruses (? WNV)
• Seek to coordinate with PAHO and RELDA
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Global capacities, alert and response
Dengue PT
• Next steps• Plan a meeting with WHO CCs in other regions to build
on what is already in place without duplication
• Global PT scheme
• Networking activities
• The first round of PT distributed in the second half of 2016
• The input of the major institutions in PAHO will be vital to the success of this initiative
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Global capacities, alert and response
¡Muchas gracias!
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Global capacities, alert and response
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Global capacities, alert and response
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Global capacities, alert and response
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Global capacities, alert and response
Risk of dengue
• Even Europe is at increased risk