Laboratory Integration in Influenza Surveillance

1. Laboratory Integration in Influenza Surveillance Dr Geethani Wickramasinghe NIC- Sri Lanka

2. 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

3. 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)

4. 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

5. 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

6. Participated in WHO EQA programmes since 2007 – 9 panels -now 100% performance • Laboratory Accreditation by CDC in 2010 • Funds • WHO, WB, CDC - Equipments, Reagents • Tsunami Funds/pasteur institute - Training programmes

8. Weekly Data Collection Form for Cases of Influenza- Like Illness (ILI)

11. 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

12. 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

13. Data Compilation and Feed back National level feedback Weekly Epidemiological Report (WER) Quarterly Epidemiological Bulletin www.epid.gov.lk

14. ILI surveillance in SL - 2005- 2009

15. ILI Surveillance – Samples Received from sentinel sites - 2010 NIC/MRI

16. Virus activity in Sri Lanka from 2005 - 2008

17. Rain fall pattern from 2006 - 2010

18. PA(H1N1) cases from June 2009–May 2011

19. Age Distribution of Confirmed cases & deaths in 2009 & 2010 NIC/MRI

20. 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

21. 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

22. 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

23. 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

24. Thank you