AFR Measles-Rubella TAG Meeting, |1 | The Performance of the Regional Laboratory Network Nairobi, 2-3 June 2015 The Performance of the Regional Laboratory Network Nairobi, 2-3 June 2015 AFR Measles-Rubella TAG Meeting

AFR Measles-Rubella TAG Meeting, |2 | Outline  Distribution of measles laboratories in AFR Region  Performance indicators  Measles genotypes  Main Challenges  Way forward  Question for TAG members

AFR Measles-Rubella TAG Meeting, |3 | Distribution of Measles Rubella Lab. National Lab Sub National Lab Regional Ref. Lab  N=47 labs  One lab/country except NIE (4) & ETH (3)  No lab: EQG, STP, CAV, SEY, MAS  Funding: MR initiative

AFR Measles-Rubella TAG Meeting, |4 | Distribution of Measles Rubella Lab. Network (cn’t)  Coordination at IST level -1 lab person: IST ESA -1 lab person: ISTs CA/WA  Diagnostic capacities -Serology: all labs -Virus isolation/PCR: selected labs -Sequencing: 3 RRLs

AFR Measles-Rubella TAG Meeting, |5 | Main Lab. Network Activities  Standardization: equipments (purchased by WHO), technique, kits, testing algorithm, lab database  External quality control system in place  Regular trainings (bench work & data management) organized  Monitoring of performance indicators  Accreditation review & lab director meeting  WHO support: kits, basic supplies, funds for operationnal cost

AFR Measles-Rubella TAG Meeting, |6 | Main Lab. Performance Indicators

AFR Measles-Rubella TAG Meeting, |7 | Timeliness & Completeness in Sharing Database Few labs have met the expected target (>=80%) due to internet connexion challenges, conflicting priority activities, staffing problems

AFR Measles-Rubella TAG Meeting, |8 | Workload at Laboratory 2014: Drop in number of specimens received at NLs in WA & in number of specimens received at IPCIV RRL (Impact of EVD outbreak) Increase in number of specimens received at NICD RRL (re establishment of testing)

AFR Measles-Rubella TAG Meeting, |9 | Workload at Laboratory (cn’t)  Few shipments performed by NLs in 2014 vs 2013  No shipment performed by some labs  Refusal from DHL carrier to organize shipment of blood specimen due to on going EVD outbreak in WA

AFR Measles-Rubella TAG Meeting, | Quality of Specimens Specimens received in good condition in most of the case. 90% minimum target met except for specimen received at NICD lab in 2014)

AFR Measles-Rubella TAG Meeting, | Measles IgM Suspected case of measles Blood specimen IgM(-/+) IgM(+) IgM(-) Rubella IgM Repeat Measles IgM Measles IgM (+/-) Measles IgM (+) Rubella IgM (-) Rubella IgM (+) Rubella IgM (-/+) Measles IgM (-) Lab. Testing Algorithm

AFR Measles-Rubella TAG Meeting, | Lab. Testing Algorithm (cn’t) Some labs do not strictly follow algorithm & run simultaneous measles & rubella IgM test to save times

AFR Measles-Rubella TAG Meeting, | Timeliness in sending out IgM results to EPI/surveillance WA below the 80% expected target in 2013 & 2014 due to shortage of kits (NIE impact)- Long term shortage of kits in 2014 (funding issues) affected most labs

AFR Measles-Rubella TAG Meeting, | Timeliness in sending out IgM results to EPI/surveillance National Laboratory IST WA, 2004 Timeliness (%) in sharing IgM results Shortage of measles/rubella kits Country affected by EVD outbreak ALG 31 BEN 69 BFA 100 CIV 95 GAM 50 GHA 94 GUI 64 MAI 76 MAU 70 NIE-CPHL 20 NIE-FCT 97 NIE-SGH 54 NIE-YDMH 25 NIG 88 SEN 32 SIL 0 TOG 59

AFR Measles-Rubella TAG Meeting, | Timeliness in sending back IgM Results to NLs  Expected target not met -By IPCIV RRL in 2013 & By NICD RRL in 2014  IPCIV= RRL for 27 NLs. High number of specimens usually received (incl. from Nigeria)  Shortage of kits has affected this indicator for IPCIV

AFR Measles-Rubella TAG Meeting, |  High number of kits purchased in 2014 (twice more) than  Increasing needs from labs. Reason: outbreak ???  Unit price for Siemens IgM kit: Measle & rubella (295 Euros each), Supplementary (39 Euros)  Total cost (excluding transport ) -2013: Euros -2014: Euros Supply of Kits

AFR Measles-Rubella TAG Meeting, | Proficiency Test & Accreditation status Excellent performance obtained for annual Proficiency Test except 1 lab (not accredited) - Sub optimal documentation & implementation of internal quality control procedures (provisionally accredited),

AFR Measles-Rubella TAG Meeting, | D10 B2 B3 D4 D2 Measles Genotype Identified:  Identified from specimen collected from outbreak & QC  Sequencing performed lab: NICD,UVRI & CDC  IPCIV: sequencing started in 2015  B3 largely circulating (In 2014 identified in ZIM,NIE & TOG)

AFR Measles-Rubella TAG Meeting, | Main Challenges  Suboptimal weekly reporting timeliness/completeness – Internet connectivity problems – Competing laboratory activities  High staff turn over in some labs (ETH, MAL, South Sudan)  Inconsistency in management of lab reagent – Stock outs ok kit due to outbreaks – Inaccuracy in estimating the needs & supply of kits with short expiring date  Insufficient/inadequate coordination between lab & surveillance – Continuous collection of blood specimen during measles outbreaks – Missed opportunity to collect specimen for virus isolation/genotyping

AFR Measles-Rubella TAG Meeting, | Main Challenges (cn’t)  Limited funding to cover lab activities (heavily dependant on WHO) – To purchase kits & sequencing reagents/supplies – To organize trainings  Effect of EVD outbreak -Shipment of QC specimen stopped in several countries, lab director meeting cancelled

AFR Measles-Rubella TAG Meeting, | Way Forward  Integration of additional measles lab: SEY, Mauritius (countries on elimination mode)  Full implementation of sequencing activities at IPCIV RRL  Strengthen collaboration between lab & surveillance  Secure alternative carriers to transport specimens for QC  Reconvene annual lab director meeting  Advocate for additional funding for the lab network - Explore Nigeria willingness to purchase kits

AFR Measles-Rubella TAG Meeting, | How can we advocate /mobilize more funds to cover measles laboratory network needs??? Question For MR TAG Members