Yellow fever laboratory capacity on-site assessments in Africa: preliminary findings Maurice Demanou*, Barbara W. Johnson, Gamou Fall, Jean-Luc Betoulle, Chantal Reusken, Marion Koopmans, Lee Hampton, Mick N. Mulders ------- *Head of Arbovirus Laboratory (WHO Yellow Fever Reference Laboratory) Centre Pasteur Cameroon Email. demanou811bis@gmail.com The 2 nd International Conference on (Re-)emerging Infectious Diseases Addis Ababa, Ethiopia - March 13-15, 2019 Abstract #0-13
DISCLOSURE The Authors have nothing to disclose
OUTLINE Overview of the EYE Strategy Objectives Assessment Methods Results Conclusion/Recommendations
Global strategy to Eliminate Yellow fever Epidemics (EYE) - 2017-2026 2016: Urban and deadly yellow fever (YF) outbreaks in Angola - Democratic Republic of Congo (Kinshasa: >10M), - China February 2017: WHO with the support of partners, launched the global strategy to Eliminate Yellow fever Epidemics (EYE) with three strategic objectives: No Epidemics Preventive mass campaigns Strong routine immunization (introduction, performance) Catch-up campaigns No Sustained Transmission Rapid detection and lab confirmation Emergency stockpile No Exportation
Strong surveillance and LABORATORY CAPACITY is crucial Vaccine supply limitation, one of the primary pillars of the EYE Strategy is to prioritize public health interventions based on risks. High risk (27 countries) Moderate risk (8 countries) Potential for transmission (8 countries + 4 without data) Current limitations in YF diagnosis capacity, particularly in Africa, A STRONG LABORATORY NETWORK is crucial to ensure rapid and reliable case confirmation and outbreak characterization. 5
AFR Yellow Fever Laboratory Network Ten Years later YF laboratory network has been crucial in confirming multiple outbreaks during this time
OBJECTIVES The objective of the YF Laboratory assessments Examine factors that can affect YF laboratory capacity, to inform investment decisions by the Global Alliance for Vaccines and Immunisation (GAVI)
ASSESSMENT METHODS From September-December 2018 ON-SITE ASSESSMENTS of the current and potential YF diagnostic capacity of the national public health laboratories in African countries that are both eligible for GAVI support and at high risk of YF Based on a standardized questionnaire (WHO, GAVI, CDC) 4 Independent consultants in coordination with the World Health Organization (WHO)
4 INDEPENDANT CONSULTANTS BW Johnson M Demanou JL Betoulle G Fall Angola Cameroon Cote d'ivoire Ghana Liberia Mali Senegal Sierra Leone Uganda CAR Chad DRC Ethiopia Kenya South Sudan Sudan Benin Burkina Faso Cote d'ivoire Mali Rep Congo Togo Gambia Guinea Guinea-Bissau Niger Nigeria o Lagos, Central Public Health Laboratory o Kaduna, Yusuf Dantsoho Memorial Hospital o Gombe, Gombe Specialist Hospital o FCT/Abuja, Maitama District Hospital
STANDARDISED QUESTIONNAIRE Were examined: Yellow fever laboratory testing activity Data management Sample transportation and processing Laboratory technical staff capacity Quality control and laboratory maintenance Equipment and facility maintenance Procurement procedures Potential capacity based on testing for other diseases
RESULTS: MAC ELISA TESTING 23 national-, regional-, and proposed RRL were assessed: 17 (74%) do YF testing by MAC- ELISA (IgM-Antibody Capture Enzyme Linked Immuno-Sorbent Assay) In-house technique with reagents from different providers (CDC, IPD, etc.) 20% of samples were not tested at all by national laboratories in 2017 12/17 (71%) laboratories had shortages or stock-outs of reagents in 2017; There is no routine or formal program for YF serologic proficiency testing
RESULTS: MOLECULAR TESTING 23 national-, regional-, and proposed RRL were assessed: 21/23 (91%) laboratories have molecular testing platform, equipment, and trained staff (for other pathogens) 11/23 (48%) laboratories have incorporated molecular testing into their YF testing algorithm. 16/23 (70%) laboratories including the RRLs use biosafety cabinets for handling clinical specimens.
RESULTS: Coordination & data management There is a strong coordination between the national surveillance program and laboratory Data management and results reporting systems are good The coordination and cooperation between laboratories and WHO is appreciable.
RESULTS: sample transportation Overall functional domestic sample transport systems. However, international sample transport for confirmation of initial test findings to the RRL is not efficient due to lack of funds and/or collaboration of transporters, leading to delays in confirmation ranging from one to 17 months with an average of 3 months
RESULTS: Staff, budget and QA/QC The Laboratory staff are generally well-trained and experienced but a few have received training on YF-specific testing None of the laboratories have a dedicated budget for YF activities QA/QC and accreditation need improvement
CONCLUSION Essential baseline data for the improvement of YF laboratory diagnostic capacity, both at national and regional levels. The GAVI Board approved (29 Nov 2018) an amount of US 8.2 million during 2019-2021 to build & sustain capacity: Procurement and distribution of MAC-ELISA reagents/supplies; Production/distribution of validated YF MACELISA kits; Procurement of molecular testing equipment, supplies; Training workshops (YFV laboratory diagnostics & management) QA/QC programs, and accreditation.
RECOMMENDATIONS We recommend: Contracting courier services for sample international shipment; Provide technical training for preventive maintenance and calibration of equipment.
THE END THANK YOU Funding Coordination