RyanNovak,MenAfriNetDirector,CDCJasonMwenda,WHO-AFRO

MVPClosureConferenceAddisAbaba,Ethiopia23February2016

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MenAfriNet aregionalcatalyst

PARTNERSHIPISKEYTOENDINGEPIDEMICMENINGITISINAFRICA

Photocredits:MVP

IntegratedDiseaseSurveillanceandResponse

ComplementaryMeningi?sBeltSystems

•  IDSRbasedtools• Labconfirma?onofallcases• Popula?onbasedrates

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EnhancedMeningi?sSurveillance

CaseBasedSurveillance

Partne

rship

VaccineIm

pact

Decision

Making

Research MenAfriNet

•  Consor?umofPartners•  ReinforceCBSstrategically•  PlaHormforcollabora?on

CaseBasedSurveillance:BurkinaFasoexperience,2009-12

Ref:MMWR(2012)v.61No.50

TheMenAfriNetModel

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CountryEngagement

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Country Districts MenAfriNetDistricts MenAfriNetPopula?on

Burkina 63 63(100%) 18,450,494(100%)

Mali 59 10(17%) 3,714,680(21%)

Niger 42 9(20%) 3,689,293(20%)

Togo* 5 2(40%) 406,000(6%)

Total 169 84(40%) 23,031,362(42%)

*Onlythe5northerndistrictsoftheSavanesRegioninTogoareconsideredpartofthemeningiGsbelt.

2015MenAfriNetSurveillanceSites

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1 Designatepopula?onundersurveillance

•  Burkina:naVonal•  Mali/Niger:5-10districts•  Togo:onedistrict

2 Countryworkplanwithbudget •  MissionTASeptember-October

3 AdaptSOPtocountrycontext •  CasedefiniVons•  Listofvariables•  Surveillanceindicators•  CommunicaVon

4 Training/Workshops •  Regionaldatamanagementworkshop(EpiInfoandDMSorientaVon)•  NaVonalSurveillanceWorkshop(TrainingoftheTrainers,surveillance/

laboratory/datamanagementSOPs)•  CascadetrainingintheDistricts

5 Datacollec?on/management •  DefinenetworkrolesandresponsibiliVes•  toolsateachlevel

6 Specimencollec?on •  DefinenetworkrolesandresponsibiliVes7 Specimenconfirma?on •  PCR

•  QA/QCprogram

8 Supervision •  Definefrequency,rolesandresponsibiliVes9 Analysisofdata •  Definefrequency,rolesandresponsibiliVes10 Dissemina?onofdata/informa?on •  SubmitdataregionallytoMenAfriNetDataManagementTeam;

•  Providefeedbackresults/performancetoactorsinthesystem.•  Definefrequency,rolesandresponsibiliVes

11 Par?cipateinnetworkmee?ngs •  CountryMenAfriNetprojectleadwillparVcipateinmonthlyTechnicalSubcommieeeteleconferencestoprovideprogressupdate;

•  PresentdataandlessonslearnedatAnnualMenAfriNetPartnersMeeVng;

12 Finalreport •  ClosedataatendofmeningiVsseasonandclean/analyze;•  Prepare/submitannualMenAfriNetprojectreportincludinglessons

learnedandrecommendaVons.

MenAfriNetCountryWorkPlan

StrengtheningLaboratoryConfirma?on

CountryReal-?mePCRImplemented

PCRSerotypingAdded

QA/QC,EQA,PTProgram

BurkinaFaso 2008,2014* 2015 2010

Mali 2010,2015* 2014

Niger 2011,2014* 2016 2015

Ghana 2012,2016* 2016 2014

*SwitchtoDirect-PCRreal-Gmeassay

RevisedTools10

NetworkDataManagement11

WHOAFROMenAfriNetData

Repository

MenAfriNetQuarterly

CBSBulle?n

DataaccessrequestWHOHQ

BurkinaFaso MaliNiger Togo

WHO-IST/WADataManager

MenAfriNetDataManagers

Data

validaGon

RegionalDataManagementTeamWHOWeeklyEnhancedMeningi?sSurveillanceBulle?n

MenAfriNetQuarterlySurveillanceFeedbackBulle?n

•  2015QuarterlyBulleVns1-4•  2015SummaryMenAfriNetBulleVn•  Subscribebyemailtoadiallo@cdc.gov

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MenAfriNetSurveillancePerformanceIndicators TargetMenAfriNet

2015

1 %ofdistrictsreporVngcasebasedmeningiVsdata(includingzeroreporVng) >80% 96%

2 %ofreportedmeningiVscaseswithoutcomeknown >90% 41%

3 %completenessofMenAfriVacvaccinestatus >80% 16%

4 %ofreportedmeningiVscaseswithalumbarpunctureperformed >80% 97%

5 %ofCSFspecimensreceivedatanylaboratoryusingaT-Iboele >50% 23%

6 %ofCSFspecimensreceivedatanaVonalreferencelaboratory >70% 72%

7 %ofreportedcaseswithdelayof<7daysforspecimentransporttonaVonalreferencelaboratory >50% 21%

8 %ofreportedcaseswithaGramStainperformedatanon-NaVonalLab* >70% 60%

9 %ofCSFspecimensreceivedataNaVonalLabandanalysedbyaconfirmatorytest* >90% 98%

10 %ofCSFspecimens,culturecontaminated <10% 4.3%

11 %ofCSFspecimens,PCRresultscontaminated <10% 0.1%

12 %ofCSFspecimensconfirmed(Hi,Spn,Nm&otherpathogens) >30% 36%

*Nigerdatamissing,calculatedbasedonBurkina,Mali,Togoonly.

Dataforac?on

14/24

•  EvaluatetheimpactofMenAfriVac™

•  Guideresearchlong-termeffec?veness,herdimmunity,serogroupreplacement;

•  Informdecision-making,EPIintegra?onandvaccinedevelopmentforotherserogroups.

Photocredits:MVP

MenAfriNetSurveillanceDataweeks1-53,2015

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From:MenAfriNetSurveillanceAnnualBulleGn2015

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MenAfriNetNmCResponse•  April3,2015Nigerdeclaresepidemic

•  April9,2015MenAfriNetresponse•  April-Julydeployed15stafffrom5countries,400person-dayscontributed

•  South-SouthcollaboraVonBurkinaFasoDLM&CHUP-CDGdeployedfortechnicalassistance

•  13localhiresrecruitedtoprovidesurgecapacity

•  Deployedamobilelab(LaboMobil)

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0

500

1,000

1,500

2,000

2,500

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Cases

Week

EpidemicofserogroupCmeningi?s—Niger,January–June2015

•  8,502suspectedmeningiVscases;•  573deaths(CFR=6.7%);•  1,456of4,039CSFPCRposiVve.

1087;79%

196;14%

101;7% NmCNmWS.pn

ConfirmedCasesbyWeekvs.Ini?alReportedResults,NiameyRegion–January1-June28,2015

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0

20

40

60

80

100

120

140

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Cases

Week

NmC NmW NmX NmInd

I

ICGRequest,04/22/2015:NmW:25(69%)NmC:4(11%)

I

Sitrep,04/13/2015:NmW:40%NmC:34%

Importanceof?melycasebasedsurveillanceduringanepidemicresponse

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SporadiccasesofserogroupCconfirmedinBurkinaFasoandMali,2015

PCV13Impact—BurkinaFaso

•  MenAfriNetreal-VmePCRplapormincludesthethreemainbacterialmeningiVspathogens

•  PCV13integratedintoEPIOctober2013•  EvaluaVngPCV13impact2014-16

–  Implementedserotypingin4of5naVonalreferencelabs

– ConducVngretrospecVveserotypingofbankedspecimens

–  Indirectcohortstudy,enhancedvaccinestatus

Takehomemessages•  Countryownership=sustainability•  BroadpublichealthcapacitybuildingisachievablewhenacountrypriorityisusedasthemodelimplementaVon—IDSR&meningiVs

•  MenAfriNetmodelisasuccessful,expandableplapormforvaccineevaluaVon

•  JobisnotdoneonserogroupAepidemiceliminaVon•  EpidemicduetootherserogroupswillconVnuetoplaguetheregionunVlalow-costconjugatemulVvalentvaccineisavailable—preparednesscriVcal

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AcknowledgementsMinistriesofHealthBurkinaFaso,Mali,Niger,Togo

DrIsaïeMedah,MSDLMBurkinaFasoPrRasmataOuédraogo,CHUP-CDGBurkinaFasoPrLassanaSangaré,CHU-YOBurkinaFasoPrSambaSow,CVDMaliDrSeydouDiarra,INRSPMaliDrRanaouAbaché,DNSNiger

WHOAFRO,IST/WA,GenevaDrRichardMihigo,DrAssimawePana,DrDjamillaCabral,DrChantalKambiré,DrMamoudouDjingarey,PrDenisKandolo,ClementLingani,DrWilliamPerea,DrOlivierRonveaux,KatyaFernandez,AlainPoy

AgencedeMédecinePréven?veDrBradGessner,DrBertheLafourcade,DrJenniferMoïsi

NorwegianIns?tuteofPublicHealthPrDominiqueCaugant&DrPaulKristensen

Meningi?sVaccineProjectDrFMarcLaforce&DrMarie-PierrePreziosi

Bill&MelindaGatesFounda?onGAVI Photocredits:MVP

Formoreinforma?onpleasecontact:RyanT.Novak,PhDMenAfriNetDirectorMeningiVsandVaccinePreventableDiseasesBranchDivisionofBacterialDiseasesNaVonalCentersforImmunizaVonandRespiratoryDiseasesCentersforDiseaseControlandPrevenVonPhone+1(404)6398579;BNK4@CDC.GOV

MenAfriNetisBillandMelindaGates-fundedinternaGonalconsorGumledbyCDC,WHO,AMP,andAfricanMinistriesofHealthtoimprovemeningiGscase-basedsurveillanceintheMeningiGsBelt

BACKUPSLIDES

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MenAfriNetGovernance

AdvisoryBoard:DominiqueCaugantBrianGreenwoodF.MarcLaForce

Marie-PierrePreziosiSambaSow

DavidStephensTumaniCorrah

CDCFounda?on(primarygrantee)

TheBill&MelindaGatesFounda?on

MenAfriNetSites Data

ManagementTeam

Laboratory

DataManagement

Evalua?on&Research

SteeringCommisee1:AMPCDC

WHOAFRO

Advisory,non-voVng:BMGF&CDCF

CDC(projectlead)PrincipalInvesVgator

ProjectDirectorProjectCoordinator

Surveillance&Outbreak

WorkGroup

s2

1TheMenAfriNetSteeringCommiUeeisthemaindecisionmakingbody2EachWorkGroupisChairedbyapartnernominatedbytheSteeringCommiUeeandaCDClead.

WHO-CCEQAMol.Epi.

TechnicalsubcommiseeAMP,CDC,WHO(HQ,AFRO,IST),WorkGroup

Chairs,MenAfriNetSiteFocalPoints

Communi-ca?ons

Update10/13/15

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Challenges Opportuni?esMVPending •  EngageWHOcountryoffices

•  MenAfriNetConsorVumincreasedrollfortechnicalsupport

PartnercoordinaVon

•  Governance•  MenAfriNetWorkingGroups•  Teleconferences&meeVngs

Epidemics •  Focusonhighprioritydeliverables•  Leverageregionalcapacity•  “South—South”collaboraVon

Security

•  Countryownership•  Indirectengagement&mentoring•  Regionaltechnicalassistance

Funding •  RecruitnewMenAfriNetpartners•  GAVI,USAID,GHSinfrastructure•  ExpandMenAfriNet(i.e.PCV13)

Minimumdataelements28

Tchirozérine

Aguié

Arlit Bilma

Boboye

Birni N'Konni Bouza

Dakoro

Diffa Dogon-doutchi Dosso

Filingué

Guidam-Roumdji

Gaya

Goure

Illéla Keita

Loga Madaoua

Madarounfa Magaria Maïne Soroa

Matamèye

Mayahi Mirriah

N'guigmi

Kollo

Ouallam

Say

Tahoua Tanout

Téra Tessaoua

Tillabéri

Zinder Maradi

Abalak

Tchintabaraden

Agadez

Niamey

NigerepidemicofserogroupCmeningococcalmeningi?s2015

AlertDistricts(n=6)

EpidemicDistricts(n=13)

*MeningiGs epidemic thresholds for response aredefined according to WHO outbreak guidelines2015:AlertthresholdisanaUackrateof3–9casesper100,000persons,andtheEpidemicThresholdisanaUackrateof≥10casesper100,000persons.

EpidemicstatusJanuary–June2015*

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Source:WHOEbolaSituaGonReport28Oct15;MenAfriNet;NigerMS/DSRE;BurkinaFasoMS/DLM