Laboratory Integration in Influenza Surveillance Dr Geethani Wickramasinghe NIC- Sri Lanka
Jan 02, 2016
Introduction
Sri Lanka is a developing country with limited resources
There was no organized continuous influenza surveillance until recent past (2007)
Initially, only outbreak surveillance 1998 - Inf A H3N2 Sydney 5/97
Influenza surveillance was initiated under AI preparedness plan of GISN
Focal point- Epidemiology unit of MoH
National influenza network
ILI surveillance 2005 - started from Western province
in Childrens hospital (LRH), Colombo 2007 - Extended to sentinel sites, 20
sites to include all the provinces
SARI surveillance 3 sites (LRH, GH/Matara, TH
Peradeniya) -2010
Network of labs -1 NIC & 2 provincial (Southern & Central)
Training programmes were conducted by the Epi – Lab team in these sites. ICN were trained in collection of samples & proper transport. Introduced case definitions
At the start VTM & swabs were prepared by the NIC & distributed to these sites. Now commercial swabs & media are used
Each site – 30 specimens / month to NIC
Laboratory methods Initially - DFT & Virus isolation Rapid tests were not used Later molecular techniques
Conventional PCR initially rt Rt PCR introduced in 2009
2010 - Changed testing protocols All specimens - PCR Positives – virus isolation SARI samples - PCR & DFT for all respiratory viruses
Participated in WHO EQA programmes since 2007 – 9 panels -now 100% performance
Laboratory Accreditation by CDC in 2010
FundsWHO, WB, CDC - Equipments, Reagents Tsunami Funds/pasteur institute -
Training programmes
District Week Ending
Sentinel Hospital Date of Report
Definition of ILI : Person with the Fever of Rapid onset (over 380 C) . cough and sore throat , in the absence of another
diagnosis
Date (Day,
week)
Number of New Visits
Total < 1 year 1 – 4 years 5-9 years 10-14 years 15-49 years 50-64 years Over 65
Total Visit # ILI Total Visit # ILI Total Visit # ILI Total Visit # ILI Total Visit # ILI Total Visit # ILI Total Visit # ILI Total Visit # ILI
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total for Week
Population
Incidence
Rate (per
100,000)
ICN Signature
Weekly Data Collection Form for Cases of Influenza- Like Illness (ILI)
Weekly Data Collection Form for Severe Acute Respiratory Infection (SARI) Hospitalizations
District Week Ending
Sentinel Hospital Date of Report
Surveillance of Severe Acute Respiratory Infection (SARI)
Date (Day, week) Number of New Visits
Total < 1 year 1 – 4 years 5-9 years 10-14 years 15-49 years 50-64 years Over 65
Total hospitalized
# SARI Total hospitalized
# SARI Total hospitalized
# SARI Total hospitalized
# SARI Total hospitalized
# SARI Total hospitalized
# SARI Total hospitalized
# SARI Total hospitalized
# SARI
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total for
Week
Population
Incidence Rate
(per 100,000)
ICN Signature
Dissemination of information
Data reporting – by telephone, fax & emails weekly / monthly print reports
To the Epidemiology unit & MoH During the pandemic - daily reports Weekly data to Flunet Monthly technical committee meetings - human/animal surveillance, Epid unit, Health Education
Bureau for communication, control activities
During the pandemic - guideline preparation & management protocols, control & preventive
strategies - by the technical committee
Dissemination of data
Hospital performance published monthly in WER and Unit Website & presented at the monthly AI/PI technical committee meeting
Also presented quarterly for the Quarterly Review Meeting of Epidemiologists & published in Quarterly Epidemiological Bulletin
Data Compilation and Feed back
National level feedback
Weekly Epidemiological Report (WER)
Quarterly Epidemiological Bulletin
www.epid.gov.lk
0
200
400
600
800
1000
1200
JAN MAR MAY JUL SEP NOV
2006
2007
2008
2009
2010
Rain fall pattern from 2006 - 2010
Liaison with reference laboratories
Sharing of Influenza viruses with ref labs WHO CC – Melbourne, Ausralia & Hong Kong
University Inf sub types & un-typed viruses - 2-3/year, World
Courier- Global funds
Benefits - Confidence - Sub typing of untypable viruses - Anti-viral susceptibility monitoring - Gene sequencing
Problems
Inadequate collection of specimens from some sentinel sites
Difficulty in transport of specimens from distance sites
Poor performance of sub-national laboratories
Initiation of anti-viral susceptibility monitoring & sequencing studies by the NIC
Control activities
Health Education
School closure
Vaccine recommendations 2010 - Introduced mono-valent Pandemic
influenza vaccine
2011 – Seasonal vaccine was registered for the first time in SL depending on the Inf surveillance data
Future Improvement of sub-national laboratories
Improvement of routine surveillance activities
Disease burden studies
Initiation of drug resistance monitoring
Collaborative research with animal surveillance center – VRI
Gene sequencing