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 City 31 August – 1 September 2015 Christopher Oxenford Laboratory Strengthening and Biorisk Management Team Global Capacities, Alert and response Department WHO Lyon

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)

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

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

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

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

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 A quality management system handbook and CD ROM Reference material for those providing training on QMS

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 The stepwise approach helps laboratories prioritise quality improvement activities When all the steps have been completed the laboratory may seek accreditation against ISO

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

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

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)

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

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 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

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

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

Global capacities, alert and response ¡Muchas gracias!

Global capacities, alert and response

Risk of dengue Even Europe is at increased risk