WHO-Coordinated Global Rotavirus and Pediatric Diarrhea Surveillance

Transcription

1 WHO-Coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Adam L. Cohen Thirteenth International Rotavirus Symposium Minsk, Belarus 29 August 2018

2 Why do countries conduct vaccine-preventable disease surveillance? Pre-vaccine introduction Impact of introduction Long-term monitoring To describe disease burden to make decisions about vaccine introduction Across all phases To monitor trends to show impact and costeffectiveness of vaccine and vaccination program To monitor changes in disease after introduction To document control, elimination, and eradication Identify outbreaks for immediate action for effective reactive vaccination campaigns Components of surveillance can be leveraged to monitor other VPDs and other diseases without vaccines Identify unreached populations not getting vaccinated for targeted delivery strategies Ref: Cohen, A. et al. Using surveillance and economic data to make informed decisions about rotavirus vaccine introduction. Vaccine Aug 18.

3 Why do countries conduct vaccine-preventable disease surveillance? Pre-vaccine introduction Impact of introduction Long-term monitoring To describe disease burden to make decisions about vaccine introduction Across all phases To monitor trends to show impact and costeffectiveness of vaccine and vaccination program To monitor changes in disease after introduction To document control, elimination, and eradication Identify outbreaks for immediate action for effective reactive vaccination campaigns Components of surveillance can be leveraged to monitor other VPDs and other diseases without vaccines Identify unreached populations not getting vaccinated for targeted delivery strategies Ref: Cohen, A. et al. Using surveillance and economic data to make informed decisions about rotavirus vaccine introduction. Vaccine Aug 18.

4 Summary of updated WHO minimum recommended VPD surveillance standards Country commitment Surveillance commitment in every country Surveillance commitment varies by country Nationwide, casebased with laboratory confirmation of every case Nationwide, aggregate with laboratory confirmation of outbreaks Sentinel, case-based with laboratory confirmation of every case Measles Poliomyelitis - - Diphtheria Meningococcus Rubella Hepatitis A Hepatitis B Mumps Congenital rubella syndrome H. Influenzae Influenza Japanese encephalitis Pertussis Pneumococcus Rotavirus Typhoid Other (e.g. VPDs have different minimum standard of surveillance based on context) Neonatal Tetanus (no lab confirmation) Cholera (event-based) HPV (surveillance not recommended) Non-neonatal Tetanus (no lab confirmation) Varicella (no lab confirmation) Yellow fever (pending)

5 Summary of updated WHO minimum recommended VPD surveillance standards Country commitment Surveillance commitment in every country Surveillance commitment varies by country Nationwide, casebased with laboratory confirmation of every case Nationwide, aggregate with laboratory confirmation of outbreaks Sentinel, case-based with laboratory confirmation of every case Measles Poliomyelitis - - Diphtheria Meningococcus Rubella Hepatitis A Hepatitis B Mumps Congenital rubella syndrome H. Influenzae Influenza Japanese encephalitis Pertussis Pneumococcus Rotavirus Typhoid Other (e.g. VPDs have different minimum standard of surveillance based on context) Neonatal Tetanus (no lab confirmation) Cholera (event-based) HPV (surveillance not recommended) Non-neonatal Tetanus (no lab confirmation) Varicella (no lab confirmation) Yellow fever (pending)

6 Countries that conducted rotavirus surveillance in 2017

7 WHO Global Rotavirus Surveillance and Laboratory Network (GRSN and GRLN), 2017

8 Rotavirus positivity among children enrolled in GRSN, by WHO Region, 2017 WHO Global Invasive Bacterial Vaccine Preventable Disease and Rotavirus Surveillance Network Bulletin, July 2018,

9 Rotavirus positivity among children enrolled in GRSN, by Country, 2017 WHO Global Invasive Bacterial Vaccine Preventable Disease and Rotavirus Surveillance Network Bulletin, July 2018,

10 Trends in rotavirus genotype distribution globally, Nakamura, et al. WHO-coordinated Global Rotavirus Laboratory Network: A Platform to Leverage Pediatric Diarrheal Disease Surveillance. International Rotavirus Symposium, Minsk

11 Global rotavirus vaccine impact using Global Rotavirus Surveillance Network, ,140 children hospitalized with AGE from 349 sites in 82 countries Aliabadi, et. al. Unpublished

12 Global rotavirus vaccine impact using Global Rotavirus Surveillance Network, ,140 children hospitalized with AGE from 349 sites in 82 countries RVV intro. Aliabadi, et. al. Unpublished

13 Global rotavirus vaccine impact using Global Rotavirus Surveillance Network, ,140 children hospitalized with AGE from 349 sites in 82 countries RVV intro. Aliabadi, et. al. Unpublished

14 Global rotavirus vaccine impact using Global Rotavirus Surveillance Network, ,140 children hospitalized with AGE from 349 sites in 82 countries RVV intro. Rotavirus prevalence decreased by nearly 40% following vaccine introduction Aliabadi, et. al. Unpublished

15 Leveraging GRSN to understand other pediatric diarrheal diseases Global Rotavirus Surveillance Network (GRSN) Pilot TAC card testing in 4 Regional Reference Laboratories Global Pediatric Diarrhea Surveillance (GPDS)

16 Countries with Sites Participating in GPDS 16

17 GPDS Expanded Case Definition Global Rotavirus Surveillance Network (GRSN) Case Definition: Acute (<14 days) watery diarrhea (AWD) Global Pediatric Diarrhea Surveillance (GPDS) Expanded Case Definition: All pediatric diarrhea regardless of duration or presence of blood in stool Acute (<14 days) and persistent ( 14 days) diarrhea Watery and bloody diarrhea Watery Bloody Acute (<14 days) AWD (GRSN Case Definition) All diarrhea (GPDS Case Definition) Persistent ( 14 days)

18 GPDS Methods 100 specimens per year from each of 37 participating sites in 32 countries o Two countries starting 2019 o Tested by TAC in Regional Reference Laboratories (3-6 countries per RRL) Only cases, no controls: Pathogen quantities in each diarrheal sample from GPDS combined with strength of association (odds ratio) between pathogen quantity and diarrhea based on modeled association with case status from GEMS case-control study (Liu J and Platts-Mills J, et al, Lancet 2016)

19 Global Pediatric Diarrhea Surveillance Taqman Array Card (TAC) Port L R Rotavirus Rotarix_NSP2 & RotaTeq_VP6 VP4_P[4] VP4_P[6] VP4_P[8] VP4_P[10] & P[11] VP4_P[9] & Ebola MS2 Astrovirus Sapovirus Shigella/EIEC (ipah) Rotavirus (CDC) VP7_G1 VP7_G2 VP7_G3 & G4 VP7_G9 VP7_G8 & G10 VP7_G12 MS2 Norovirus GI & GII Norovirus GII.4 & GI.1 Adenovirus 40/41 & Pan S. flexneri (non 6) & S. flexneri 6 S. sonnei 12 S. Other (boydii, dysen, flex6) S. dysen Type 1 & M.tb 11 18S Aeromonas 10 B.fragilis & C.difficile Campylobacter jejuni/coli 9 Salmonella V. cholerae 8 EAEC_aaiC & aata EPEC_eae & bfpa 7 ETEC_STh & STp ETEC_LT 6 ETEC_CFA/I & CS1 ETEC_CS2 & CS3 5 ETEC_CS5 & CS6 STEC_stx1 & stx2 4 PhHV PhHV 3 Cyclospora & Isospora E.bieneusi & E.intestinalis 2 Cryptosporidium & E.histolytica Giardia & Strongyloides 1 Ancyclostoma & Necator Ascaris & Trichuris GI pathogen assay Clinical Sample Control Manufacture Positive Control

20 Clinical Presentation of Pediatric Diarrhea (GPDS), 2017-present--Preliminary results Global AFR AMR EUR SEAR WPR 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Acute watery Acute bloody Persistent watery Persistent bloody

21 Attributable fraction of pediatric diarrhea etiology, GPDS, Global, Preliminary results 35% Attributable Fraction (95% CI) 30% 25% 20% 15% 10% 5% 0%

22 Attributable fraction of pedatric diarrhea etiology, GPDS, by Syndrome, Preliminary results 35% 30% Watery Bloody Attributable Fraction (95% CI) 25% 20% 15% 10% 5% 0% 06/09/2018

23 Attributable fraction of pediatric diarrhea etiology, GPDS, by Age group, Preliminary results 35% 30% Infants (<1 y) Older (1-<5y) Attributable Fraction (95% CI) 25% 20% 15% 10% 5% 0%

24 Summary Rotavirus and pediatric diarrhea surveillance is critical to generate date for use at country, regional and global levels Should be responsive to the needs of country for national vaccine policy (e.g., rotavirus vaccine introduction and impact) Provides data for global policy (e.g., enteric vaccines in development such as Shigella, ETEC, and norovirus) Continue GPDS for 2 full calendar years of surveillance and consider long-term First full year of data available early 2019 Maintain sustainable Global Rotavirus and Pediatric Diarrhea Surveillance Network through capacity building and country and external funding

25 Acknowledgements Sentinel surveillance hospitals Ministries of Health WHO Country and Regional offices National, Regional, and Global Reference laboratories Partners (U.S. CDC, Gavi, BMGF, University of Virginia)

26 Thank you Adam L. Cohen, WHO 20, Avenue Appia 1211 Geneva Switzerland