PBM Surveillance Network

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PBM Surveillance Network

• Opportunities and Challenges
• 11th Meeting of the TFI
• Luanda, Angola
• 2-5 December, 2003

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PRESENTATION OUTLINE

• Background
• Progress
• Challenges
• Opportunities
• Recommendation for TFI consideration

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WHO/AFRO PBM Surveillance Network

• Launched in 2001 in 26 countries
• June 17 Anglophone countries
• November 9 Francophone countries
• One sentinel site per country
• Largest paediatric ward in the capital
• Clinician, microbiologist, data manager, EPI
  manager and WHO EPI Country Officer
• Computer, software and recurrent expenses
• Average annual cost of USD8,000 per site Training
  (USD6,000), operation (USD2,000)

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Objectives of AFRO PBM Surveillance

• Demonstrate the burden of Hib and other major
  childhood bacterial meningitis diseases, locally
• Sensitise the public health community and general
  population to the importance of Hib disease and
  use of the vaccine in routine infant immunization
• Measure impact of Hib vaccine as it is introduced

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Achievements between 2001 2003

• High level of participation achieved
• 24/26 countries reporting in 2003
• Data reporting mechanisms in place
• Monthly profiles and indicators are posted in
  feedback table (AFRO bulletins) and AFRO PBM web
  page
• Quality assurance - laboratory introduced
• 23/26 countries participating in External Quality
  Assurance (AFRO-CSR/HQ-Lyons) system for
  laboratories (17 in 2002)
• Intra-country expansion begun (slowly)
• 2 countries (Uganda and Ghana)

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AFRO PBM Surveillance Network Trained
Countries Hib vaccine introduction
2003 Burundi Zambia (Senegal) Applications Benin
Burkina Faso Zimbabwe? Tanzania?
Gambia (95) RSA (98) Ghana (01) Kenya
(01) Uganda (02) Rwanda (02) Malawi (02)
Trained
Reporting
Hib vaccine intro Hib in 2003/4
Hep B
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Incidence of Hib Meningitisin Chilean children
less than 5 years of age
Hib vaccine, July 1996
Cases
1996
1998
1997
Years
Landaverde et al, Pan Am J Public Health, 1999
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AFRO PBM vaccine impact assessment Malawi
2001-2003 children less than 5yrs
Hib vaccine Jan 2002
Hib3 2002 64
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AFRO PBM, Hib Vaccine Preliminary Impact
Assessment

• Clear impact, good data
• Malawi Jan 02
• Impact , good data
• Uganda Jul 2001
• Impact cannot be assessed
• Kenya-Dec01, Ghana-Jan02, Rwanda- Jan02,

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PBM NetworkSurveillance Quality
Indicators
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Hib-PBM Network Results Two Quality Indicators
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Challenges

• Uptake of Hib vaccine remains relatively low in
  the region. Of 39 countries (2000-2) introducing
  Hib vacine, only 5 were from AFRO Region
• Financial sustainability of PBM
• Integration into national surveillance activities
• Regional Reference Laboratory layer not yet
  functioning
• Low rates of isolation of Hib at many sites
• Capacity within AFRO to provide technical support
  to the (PBM site) laboratories

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Opportunities

• Better placed to support countries soon to
  introduce Hib vaccine
• Collaboration
• East African Sub-regional network
  Wellcome/Kilifi (SPEAR) Kenya
• Building on PBM to support new vaccines
• Pneumococcal vaccine
• Rotavirus vaccine

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Pneumococcal Disease

• 800,000 to 1 million deaths per year
• More common in the developing world, rates of
  pneumonia up to 40X
• Severe pneumococcal disease greater in Hiv ve
  than in Hiv ve population
• Seven valent vaccine licensed in the USA (2000)
• 9 valent vaccine trial in SA
• Accelerated Development and Introduction Plan
  (ADIP) for pneumococcal vaccine development
  established under GAVI

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Pneumococcal vs Hib Disease

• Similar but even more challenging issues.
• Cost Financing and planning for sustainability
• Design/selection of appropriate vaccine (more
  than 90 serotypes)
• Recognition Burden of disease data and advocacy
• Surveillance more varied for pneumococcal
• Significant adult disease for pneumococcal
  disease

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PBM S-Network and Pneumococcal Surveillance

• CSF isolates from the rest of the network
• Enhanced pneumococcal surveillance at 5 selected
  sites (West , Central and Southern Africa) using
  blood cultures
• Collaboration with netSPEAR network in East Africa

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Recommendations

• AFRO, governments and partners should continue
  support to ensure that the PBM SN is maintained
  strengthened
• Certification to be introduced
• Regional Reference Lab layer functional
• Level of technical support necessary for the
  laboratories put in place