strategic enhancement of laboratory and epidemiology ... · march 29, 2003 world health...

March 29, 2003 World Health Organization CSR/LYON

Strategic Enhancement of LaboratoryStrategic Enhancement of Laboratoryand Epidemiology Surveillanceand Epidemiology Surveillance

WHO/CSR Lyon, France


Emerging/re-emerging Infectious DiseasesEmerging/re-emerging Infectious Diseases1996-20011996-2001


E P I D E M I C A L E R T & R E S P O N S E

Containknown risks

Containknown risks

Improvepreparedness

Improvepreparedness

Respond tothe unexpected

Respond tothe unexpected

G L O B A L P A R T N E R S H I PS

I N T E R N A T I O N A L H E A L T H R E G U L A T I O N S


Goals of the CSR capacity-Goals of the CSR capacity-strengthening programmestrengthening programme

l Enhance national, regional and global capacities for diseasesurveillance:§ strengthen public health laboratories§ strengthen epidemiological surveillance

l Promote implementation and sustainability throughpartnerships


0102030405060708090

1 4 7 10 13 16 19 22 25 28 31 34 37 40DAY

CASES

LabConfirmation

Outbreak Detection and ResponseOutbreak Detection and Response

Response

Opportunity for control

Detection/Reporting

FirstCase


l Supporting preparedness plans

l Strengthening of surveillance systems

l Enhancing inter-sectorial coordination

l Success story in Somalia:

– 2000: 7,496 cases

– 2001: 1,821 cases

Improving PreparednessImproving Preparedness

0102030405060708090

1 4 7 10 13 16 19 22 25 28 31 34 37 40

Outbreak Detection and ResponseWith Preparedness

Rapid Response

DAY

CASES

Early Detection

Potential Cases Prevented


To strengthen national capacities for detection andresponse to epidemic prone diseases through :

Strengthen Public Health labsStrengthen Epidemiologycapacities

Integrating epidemiological and laboratory activities


Laboratory & Epidemiology strengtheningLaboratory & Epidemiology strengthening WHO Programme, Lyon, France WHO Programme, Lyon, France

Cape Verde

Equatorial GuineaCentral African Rep.

CongoComoros

DR Congo

Chad

1st cohort

Sudan

IraqIran

Lebanon

Syria

Jordan

Yemen

2nd cohort

Romania

TurkeyBulgaria

Ukraine

Moldova

Russia

Belarus

3rd cohort

Georgia


§ Improve the capacity of laboratories to diagnose and controlepidemic prone diseases, by:

§ Improving supply of reagents and laboratory equipment

§ Upgrading technical expertise

§ Building national and international laboratory networks

§ Implementing quality control programmes


l 8-week introductory session in Lyonl 3-week additional sessions to set-up Plan of Actionl 2 in-country periods of implementation

Lyon LyonLyon

Plan of Action

InitialSession

2 monthsDesign

4-6 months Revision 3 weeks

Implementation of a pilot programme 16-18 months

Evaluation 3 weeks


l Provide basic knowledge in:laboratory methods,epidemiology and surveillance,information technology and communication

l Provide tools to organize the response to an epidemy/outbreak

l Provide tools for laboratory management :quality control, internal and externalstaff management and continuous training,communication with institutions and funding agencies

Design of a Plan of Action


PParticipantsarticipants

l Senior Biologists/Pharmacists

l In the national reference laboratory

l Involved in surveillance of epidemic-pronediseases

l Involved in Quality Control programmes


CASE STUDIESCASE STUDIES

Each case study is based on a real outbreak:

l2001 Group 1 AFROlMeningitis in Togo (1997) lCholera in Nigeria (1996) lYellow fever in Guinea (2000)

l2002 Group 2 EMROlMeningitis in Sudan (1998-99)lAmibiasis in Jordan (2001)lRift Valley Fever in Yemen (2000)

l2002 Group 3 EUROlLegionellosis in Turkey (2001)lShigellosis in Belarus (2001)lViral Meningitis in Romania (2002)


l Information and Communication Portal forNational Laboratories

l Follow-up visits– Build-up of national network– Collaboration with other institutions– Collaboration with local, regional WHO

Offices, AFRO, EMRO, EURO

Lyon LyonLyon


First GroupFirst Groupl Provision of essential reagentsl Connexion Internet (telephone line)l Follow-up visitsl Country outcomes

l National training of laboratory techniciansl Refurbishment of a regional laboratoryl National Comittees gathering heads of laboratories and epidemiology

servicesl National Surveillance Networksl Funding of programmes for Rebuilding/Equipment of National Public

Health Laboratories

20022002 2003200320012001

LyonLyon


Second GroupSecond Group

l Initial trainingl Follow-up visitsl Second training session - Plan of Actionl Creation of a web Portall Country outcomes

l National training of laboratory techniciansl National Comittees gathering heads of laboratories and epidemiology

servicesl National Surveillance Networks : Pilot programme in selected districtsl Funding of programmes for Equipment of Public Health Laboratories

20022002 20032003

LyonLyon


20022002 20032003

Lyon

Third GroupThird Group

l Initial trainingl Preliminary Plans of Actionl Web Portall Country outcomes

l Involvement as experts in Strengthening programmes funded by theEuropean Union for accession countries: Romania, Georgia, Bulgaria,Turkey


l Provide tools for the evaluation oflaboratory facilities and practices

l Promote the use of good biosafetypractices

l Advise on regulations for the safe transportof infectious materials

l Advise on safety and accountabilityof pathogens


l Provide tools for the assessment oflaboratory facilities and practices

l Promote the use of good laboratory practices

l Advise on revision and implementation ofstandardized operating procedures

l Advise on improvement of methodologies oflaboratory diagnostic


11 Anglophone countries

10 Francophone countries

3 Lusophone countries

3 International reference laboratories

3 consignments/year

Legend

Yellow: Enteric programme

M: Meningitis programme

P: Plague programme


l Customized to disease burden in the regionl For countries with limited resourcesl Ensuring the development of regional

epidemiology networks


l Oriented towards decisionmaking

l Using appropriate simpletechnology

lMeeting the challenges ofIHR

0

50

100

150

200

250

158 178 198 218 238 258 278 298

Data Model Low CI Upper CI

0

50

100

150

200

250

158 178 198 218 238 258 278 298

Data Model Low CI Upper CI


Surveillance and Response StrengtheningSurveillance and Response StrengtheningIntegrated and Multi-Disease SurveillanceIntegrated and Multi-Disease Surveillance

Community

Health Center

District Health Office

National Center

Vertical programmes

EPI TB STDMAL CHD Others

Duplication of workToo many forms

Too many bossesConflicting priorities

No feedback

Duplication of workToo many forms

Too many bossesConflicting priorities

No feedback

EPI TB STDMAL CHD Others


l At all levels of disease notificationl Beyond communicable diseasesl Optimizing resource allocationl Involve all laboratoriesl Not compromizing programme objectives


l Université de Lyon, Facultés de Médecinel Université de Lyon, Faculté de Pharmaciel Centre Européen de Santé Humanitaire (CESH)l Centre de Recherche Pasteur-Mérieux P4l Institut Pasteur, Parisl Institut de Veille Sanitairel Institut de Médecine Tropicale du Service de Santé des

Armées (IMTSSA) PHAROl Epicentre


- Centers for Disease Control and Prevention, Atlanta, Etats-Unisd’Amérique

- Programme Européen de formation en Epidémiologie d’interventionEPIET Paris France

- Institut Pasteur, Bangui, République Centrafricaine- Instituto Superiore di Sanita, Rome, Italie- Institut de Recherches pour le développement (IRD), Dakar, Sénégal- Liverpool School of Tropical Medicine and Hygiene, Grande-

Bretagne- London School of Tropical Medicine and Hygiene, Grande-Bretagne- The WHO Mediterranean Zoonoses Control Centre, Athènes, Grèce- WHO Collaborating Centre, Oslo, Norvège- Naval Medical Research Unit III (NAMRU 3), Le Caire, Egypte- WHO Regional Offices: EMRO, EURO, AFRO


l Consolidation (EMRO, EURO, AFRO)l Extension to new countries (Northern Africa

and Sahelian countries)l Establishment of knowledge network and

laboratory twinning programmel Decentralization


For further information Consult http://www.who.int/csr/labepidemiology/en/

Contact [email protected]

For further information Consult http://www.who.int/csr/labepidemiology/en/

Contact [email protected]

strategic enhancement of laboratory and epidemiology ... · march 29, 2003 world health...

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