Accelerating progress towards MR elimination, |1 | Update from Regional Measles & Rubella Laboratory Network, African Region Hotel Royal, Geneva, Switzerland, June 2016 Update from Regional Measles & Rubella Laboratory Network, African Region Hotel Royal, Geneva, Switzerland, June 2016 Accelerating Progress towards Measles & Rubella Elimination

Accelerating progress towards MR elimination, |2 | Outline  Measles & rubella surveillance program  Distribution of laboratories  Main activities  Laboratory performance indicators  Detected genotypes  Main Challenges  Way forward

Accelerating progress towards MR elimination, |3 | AFR Measles Rubella Program  Measles elimination target by 2020  Measles (M) or Measles & Rubella (MR ) SIAs going on in the Region :  WHO/AFR MR weekly partners updated by teleconference  CRS (congenital rubella syndrome) surveillance implemented in countries that have / are about to introduce rubella containing vaccine  Regular monitoring of surveillance performance indicators  Measles outbreaks: gaps in population immunity (low routine and SIAs coverage), and shift of epidemiological susceptibility to older age groups.  Measles verification process: not initiated yet

Accelerating progress towards MR elimination, |4 | Category 2020 target Last 12 months Incidence (% countries < 5 per million population) 100% 36%56%47%53%48%77%53% Incidence of confirmed measles per million population <1/ per million Non-Measles Febrile Rash Illness rate ≥2 per 100,000 pop’n % of districts reporting ≥ 1/100,000 suspected measles cases with blood specimens at least 80% 86%82%84%78%77%82%81% % of suspected cases with adequate blood specimens at least 80% 96%82%91%78%85%82%88% Measles Surveillance Performance Indicators: AFR,

Accelerating progress towards MR elimination, |5 | Distribution of MR Laboratories  N=49 labs  Newly established: SEY & MAS  One lab/country except NIE (4) & ETH (3)  No lab: EQG, STP, CAV  Funding: MR initiative National Lab Sub National Lab Regional Ref. Lab

Accelerating progress towards MR elimination, |6 | Main Lab. AFR Network Activities  Implementation of internal/external quality control system  Training (bench work & data management)  Weekly lab data reporting & analysis  Monitoring of performance indicators & ensuring follow up actions  Strengthening quality assurance  Accreditation reviews & lab annual directors meeting  WHO support: kits, basic supplies, funds for operationnal cost

Accelerating progress towards MR elimination, |7 | Date of trainingType of trainingCountries involvedNumber of lab participating Partners Augt 2015Onsite IgM Serology & QC Seychelles WHO, NICD 2-13 Nov 2015Serology, real time and genotyping PCR, Sequencing Kenya, Ethiopia, South Africa, Tanzania, Uganda, Zambia and Zimbabwe 7 UVRI- Entebbe, CDC- Atlanta, HPA- UK & WHO- HQ & IST ESA 6-10 Jun 2016Onsite IgM Serology & QC Mauritius1WHO, NICD Planned Jul 2016IgG Serology in Entebbe Ethiopia & Uganda2UVRI Laboratory Training conducted, Above training was conducted in Eastern & Southern Africa

Accelerating progress towards MR elimination, |8 | Main Laboratory Performance Indicators

Accelerating progress towards MR elimination, |9 | Workload at laboratory East Southern labs tested highest number of specimens. Of the 3 RRLs, IPCIV received the least number of specimens

Accelerating progress towards MR elimination, | Timeliness & Completeness in Sharing Database Suboptimal completeness & timeliness in sharing database on a weekly basis due to challenges in internet connectivity, competing activities

Accelerating progress towards MR elimination, | IgM Results Turn Around Time Stock out of kits adversely affected this indicator especially in 2016

Accelerating progress towards MR elimination, | 2015 Measles & Rubella Proficiency Test DescriptionNumberComments Labs participating in Proficiency Testing (PT) 37Pending testing by some labs Labs that passed PT test by old scoring 33 Labs that passed PT by new scoring, but lost points 18Reasons: Cut off value missing, in-house quality control reference not used, late reporting, expired kits Labs that have failed PT using new scoring 61 lab did not run all specimens on rubella Reporting by website submission: challenging for some labs, ultimately used old system

Accelerating progress towards MR elimination, | Lab. Accreditation Exercises Type of accreditation Year * No conducted No scheduled On site visit 7127 Correspondence 1213 Total8241 Accreditation process by desk review (correspondence): to be selectively intensified in 2016

Accelerating progress towards MR elimination, | Recent Measles Outbreaks  Ethiopia – 2015 and 2016 ( throat swabs collected- B3 genotype)  Nigeria – 2015 (59 throat swabs collected- B3 genotype)  DR Congo – 2016 (54 throat swabs collected- B3 genotype)  Uganda – 2015 (73 OFs and 14 throat swabs – B3 genotype)  Sierra Leone – early 2016, Liberia  Namibia – 2015, Equatorial Guinea – 2015 and 2016  Gabon – early 2016 (12 throat swabs collected- B3 genotype)

Accelerating progress towards MR elimination, | D10 B2 B3 D4 D2  Identified from specimens collected from outbreak & QC  Sequencing lab: NICD,UVRI, IPCIV & CDC  B3 genotype largely circulating (In 2016 identified in DRC, GAB, NIE & TOG)  Submission on MeaNS done Measles Genotype Identified: *

Accelerating progress towards MR elimination, | 1 st Report of Rubella genotype 2B in West Africa (IPCIV) Branch of rubella genotype 1G tree: contains sequences from CIV, Ghana, and Nigeria Branch of rubella genotype 2B tree: contains sequences from DRC, Burundi, and India

Accelerating progress towards MR elimination, | Main Challenges  Suboptimal weekly reporting timeliness/completeness – Internet connectivity problems – Competing laboratory activities  Regular stock out of measles & rubella kits  Lack of reagents for PCR & sequencing activities  Insufficient /inadequate coordination between lab & surveillance – Missed opportunity to collect specimens for virus isolation/genotyping

Accelerating progress towards MR elimination, | Main Challenges (cn’t)  Suboptimal collection of specimens for virus detection and logistics for it  Refusal from DHL carrier to carry blood specimens since Ebola outbreak event (West & Central Africa)  Insufficient funds to cover lab activities – To purchase kits, sequencing reagents/supplies, consumables – To organize trainings, – For lab operations

Accelerating progress towards MR elimination, |  Advocate for additional funding for the lab network - 2,4 Millions USD needed per annum  Strengthen collaboration between lab & surveillance to monitor for outbreaks and allow timely collection of specimens for genotyping  Complete accreditation reviews  Additional training on rubella sequencing needed by CIV RRL  Secure alternative carriers to transport specimens for QC Way Forward

Accelerating progress towards MR elimination, | Acknowledgements  NLs & Surveillance teams  3 RRLs  WHO/HQ  CDC

Accelerating progress towards MR elimination, | Phase 1 completed Planned PEF EMRO Countries Reported progress on completion of GAPIII, Phase I