Summary analysis of 2010 survey of National Influenza Centres in the WHO Global Influenza Surveillance Network (World Health Organization, April 22 2011)

[Giuseppe]

[Source: World Health Organization, Weekly Epidemiological Record, full PDF document, (LINK). Extract, edited.]


Weekly epidemiological record
Relev? ?pid?miologique hebdomadaire
22 APRIL 2011, 86th year / 22 AVRIL 2011, 86e ann?e
No. 17, 2011, 86, 161?172
http://www.who.int/wer

Summary analysis of 2010 survey of National Influenza Centres in the WHO Global Influenza Surveillance Network


National Influenza Centres (NICs), which are designated by national authorities and recognized by WHO, are the backbone of the WHO Global Influenza Surveillance Network. After the 2009 influenza A(H1N1) pandemic, the WHO Global Influenza Programme conducted its third survey(1) of laboratory capacities in NICs to identify gaps that will need to be addressed to enable further development of NICs and the network.

The questionnaire used in the survey was developed by WHO with support from the network. It was posted in the collab information centre(2) and sent by mail to all NICs on 13 October 2010. As of 15 November 2010, 104/135 (77%) NICs from 93 countries, areas and territories had responded. The percentages discussed in this article are based on the total number of NICs that responded, unless indicated otherwise.


Laboratory diagnosis and virological surveillance

• A total of 103/104 (99%) NICs that responded collected seasonal specimens; in the 2007 survey, 70/76 (92%) indicated that they collected specimens.
• An increased number of NICs have a subnational network of laboratories: 102/104 (98%) in 2009 compared with 71/76 (93%) in 2006.
• A total of 98/104 (94%) NICs performed virus isolation. Tissue culture was used by all NICs conducting virus isolation; the percentage of NICs using eggs for virus isolation continued to decrease, from 27/73 (37%) in 2006 to 32/98 (33%) in 2009. A large proportion of NICs (32/98; 33%) tested samples first with polymerase chain reaction (PCR) and then performed virus isolation.
• During 2007?2008, the number of seasonal influenza viruses isolated by individual NICs ranged from 0 to >4000. During 2008, a total of 82/104 (79%) NICs sent seasonal viruses (isolates or clinical specimens) to WHO Collaborating Centres on influenza.(3)
• The use of real-time PCR increased from 44/76 (58%) NICs in 2006 to 102/104 (98%) in 2009. The use of sequencing also increased, from 31/76 (41%) in 2006 to 51/104 (49%) in 2009. However, use of the haemagglutination inhibition assay continued to decrease, from 67/76 (88%) in 2006 to 85/104 (82%) in 2009.
• Altogether 47/104 (45%) NICs performed antiviral susceptibility testing using genotypic assays; 20/47 (43%) of these NICs also conducted phenotypic evaluation.

Pandemic response and preparedness

• During the pandemic period (April 2009?August 2010), 1 261 089 specimens were received by the 104 NICs that responded to the survey; 1 206 486 (96%) of these were tested, of which 340 616 (28%) were positive for pandemic influenza A(H1N1) 2009 virus.
• The surge in the number of samples sent for testing stretched laboratory capacity to the limit. NICs highlighted the importance of holding regular training for back-up staff, implementing better prioritization of specimens for testing to avoid a shortage of reagents, utilizing automated electronic reporting of results, and upgrading testing capacity at subnational laboratories.

Equipment, biosafety, quality assurance and training

• Almost all NICs (103/104; 99%) reported having equipment for real-time PCR and biological safety cabinets. A total of 16/104 (15%) reported having a pyrosequencer, and 26/104 (25%) had a fluorometer. The need for new equipment was prioritized as pyrosequencers, nucleic acid sequencers and freezers.
• There was an increase in the number of NICs having Biosafety Level (BSL) 3 facilities or BSL-4 facilities, from 29/76 (38%) in 2006 to 48/104 (46%); 56/104 (53%) had BSL-2 facilities as their highest level of containment.
• A total of 103 NICs (99%) participated in the WHO External Quality Assessment Project for detection of influenza viruses using PCR.
• Most of the training that NIC staff received during the survey period was on molecular biology techniques, followed by training on shipping infectious materials and laboratory management. Areas of training that should be prioritized were identified as sequencing, antiviral susceptibility testing and molecular biology techniques.

Shipment, funding and staffing

• Altogether 97/104 (93%) NICs reported that they were aware of WHO?s influenza shipment fund project; 71/104 (68%) used this fund for shipment during 2009. Altogether, 94/97 (97%) rated implementation of the project as good or excellent, and particularly mentioned the timely collection of packages, communication and other logistical services.
• The number of NICs that had a budget allocated specifically for influenza activities, and the number of staff involved in influenza-related activities, increased when compared with previous surveys; budgets increased in 73/104 (70%) NICs in 2007 and in 89/104 (86%) in 2009. However, 42/104 (40%)NICs believed that more staff were needed to cover the workload at their laboratory.

FluNet and WHO terms of reference for NICs

• A total of 66/104 (64%) NICs reported using FluNet weekly or monthly; this percentage had decreased compared with the 2007 survey when 63/69 (91%) reported using it. The reasons cited for using Flu-Net less often included a lack of staff, or reporting to a WHO regional office instead.
• A total of 103 (99%) were aware of the terms of reference for NICs in comparison with 63/76 (83%) in the 2007 survey. Altogether, 82 (80%) considered that the terms of reference accurately reflect their contribution to WHO, while 21 (20%) considered that the terms of reference reflected their contribution only moderately well.

Editorial note.

The 2010 questionnaire collected more information than is presented here. A more detailed report will be published on the WHO web site. As with previous surveys, the full data set will form the basis for developing global and regional action plans to continue strengthening the Global Influenza Surveillance Network. WHO thanks the staff of all NICs which responded to the survey for the time spent completing the questionnaire and the large amount of information provided.(4)

1. Two surveys were conducted by WHO in 2002 and 2007 and summaries of their results were published in the Weekly Epidemiological Record; see No. 42, 2002, pp. 350?356 and No. 16, 2008, pp. 133?144.
2. For more information about the EZcollab information centre, see (LINK).
3. For a list of WHO Collaborating Centres on influenza, see (LINK).
4. For additional information, please contact the Virus Monitoring, Assessment and Vaccine Support Unit, Global Influenza Programme at WHO (email: GISN@who.int).

(?)
-
-----