Reported Cases of Dengue and Dengue Haemorrhagic Fever, 19801996

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Oyewale Tomori, Wake Up It is time for your
presentation
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Sustaining AFP Surveillance Laboratory Support
for Polio Eradication

11th TFI 10th ARICC Meeting 2-5 December 2003,
Luanda, ANGOLA
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Sustaining Surveillance/Laboratory Support
Outline of Presentation

• AFP surveillance activities in 2003
• AFRO polio laboratory network, 2003
• Virus surveillance molecular epidemiology
• Challenges for surveillance laboratory
  activities
• Conclusions/recommendations for TFI
  consideration

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Certification standard AFP Surveillance achieved
at regional level in 2003

• Since 00 non-AFP rate gt1.0
• gt80 of AFP cases with 2 adequate stool samples
  since 02.
• Stool adequacy rate up in South/East blocks.
• 1 bad stool in 20 still arrive in labs.

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Certification Standard AFP Surveillance
2003
2002
LIB CAE
ALG BOT MAL
MAD
Data as of 31st Oct
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Distribution of Polio Compatible Cases
2002
2003
Data as of 31st Oct
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Certification standard AFP Surveillance achieved
at regional level in 2003

• Non-AFP rate has remained above target since
  2000.
• gt80 of AFP cases with 2 adequate stool samples
  since 2002.
• Significant improvement in stool adequacy in
  South/East blocks.
• Maintaining stool integrity quality in transit
  to labs still problematic.

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Status of stools on arrival in Labs
WILD POLIO FREE
WILD POLIO CIRCULATING
BAD SAMPLES
GOOD SAMPLES
COUNTRIES
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Reasons for BAD Stool What to do

• 625 (4.2) of 14,635 samples, BAD
• For 300 bad samples arriving in 9 labs
• 135 (45) insufficient in quantity for testing
• 74 (25) arrived with break in cold chain
• 36 (12) arrived in the labs bone dried
• Re-train/update field staff on
• Collecting at least 3-5gm of stool,
• Proper cold box packaging for shipment
• 123 (41) shipped in unsuitable
  containers-leading to leakage in transit
• Purchase distribute, as appropriate, standard
  stool collection kits

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AFRO Labs 03 Accreditation Summary
ALL 16 LABS FROM ALG TO MAD
ACCREDITED
DR Congo

Regional Lab.
National Lab.
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Stool Flow Thru Network Labs Jan. 02- Nov..03
.from Sunrise to Moonlight
STOOL SAMPLES
2000
2001
2002
2003
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WHO-AFRO Polio Laboratory Network Stool Samples
Tested 1997-2003
, up to 26 Nov.
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AFRO Polio Laboratory NetworkTwo Performance
Indicators for 1999-2003
98
94
88
80
76
28 day result turnaround
63
15.5
13.7
13.5
12.6
10
8.2
NPENT target
7,239
11,641
18,662
18,217
13,950
, up to 26 Nov.
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AFRO Polio Laboratory NetworkWild Poliovirus
isolation rates (), 97-03
All polio isolates
Wild polio isolates
2933
7239
11,641
18,602
18,217
13,950
367
, up to 19 Nov.
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Age Distribution of 196 AFP cases with confirmed
WPV in 2003

• Polio cases
• 101 (51.5) in children below 2 yrs
• 84 (42.9) in the 2-5 yr age group
• 11 (5.6) in those over 5 yrs old

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Vaccination Status of 178 AFP Cases with WPV in
2003

• Vaccination status
• 30.3 of cases had zero dose
• 56.2 had between 1-3 doses
• 13.5 had more than 3 doses

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AFRO Poliovirus Circulation, Jan-Oct. 03
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Wild Poliovirus Circulation in Africa

• Nigeria remains Africas major polio problem.
• Currently accounts for (88) of Africas total,
  with 21 of 37 states/territory reporting polio
  cases.
• 179 of (71.3) of NIE cases reported by 5
  states KNS, KBS, BAS, KTS JIS, . KNS with
  76 cases ore 30.3 of NIE cases.
• Good news however ..Huge epidemic means large
  number of naturally immunized children timely,
  aggressive and good SIA will knock out polio in
  NIE.

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Wild Poliovirus Circulation in Africa 2003

• GHA is becoming Africas next major polio
  problem.
• ZAM contained 2001-2002 Angola importation), but
  in GHA, WPV has spread from the north to 4 other
  regions between Feb. Sep 2003, and.
• GHA is now in reverse exportation of WPV to
  neighbouring TOG BFA as revealed by sequence
  data- (closest matches for recent TOG-BFA-GHA
  viruses).
• Is CIV next for GHA virus exportation?
• ..GHA-WES-JOM-03-001 virus is right on
  GHA-CIV border.

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Nigeria Wild Poliovirus Isolations 02 03
Sub(?Optimal)NIDs
Number of cases
Polio 1
Polio 3
2002
2003
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Circulation of WPV-1 B clusters-West Africa, 2002
2003 October

• Of 8 WPV1 B genotype no viruses of clusters A,C,
  D, E, G H
• Cluster E viruses have not been detected since
  2001
• Cluster B viruses circulated in BAS, BOS, KDS,
  KNS, JIS YBS

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Circulation of WPV-1 B clusters-West Africa, 2002
2003 October

• Of cluster I viruses
• I-4 I-7 are yet to be detected in 2003
• Cluster I-2 circulated in KNS, GMS,NAS, NIS, FCT
  LAS
• Cluster I-3 viruses found in 12 of NIE states,
  in NIG, BFA GHA

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Circulation of WPV-1 B clusters-West Africa, 2002
2003 October

• Circulation of cluster I-5 was limited to KBS,
  KDS NAS
• Cluster I-6 circulated in ADS, JIS, KNS KTS,
  2 provinces Niger Republic
• The F cluster virus has been found only in KBS so
  far in 2003

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• Of 4 PV3 clusters
• B cluster virus silent o far in 03
• Cluster A viruses detected in
• KBS, NIS, SOS, ZAM of Nigeria,
• and in Tahoua in Niger Republic
• Cluster C viruses have circulated
• in BAS, JIS, KNS, KTS, NIS, FCT
• in Zinder in Niger Republic
• Cluster D most active virus
• Account for 80 of cases
• Circulating in BAS, BNS, JIS,
• KDS, KNS, KTS

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Circulation of WPV in Ghana 2003
GHA-NOR-EAM-03-001 DONSETL 26 APRIL 03
GHA-NOR-YEN-03-001 DONSETL 02/02/03)
GHA-NOR-EAG-03-001 DONSETL 07 MAY 03
GHA-BAR-KPO-03-002 DONSETL 03 JULY 03
GHA-EAS-KBR-03-001 DONSETL 04 JUNE 03
GHA-ASH-KUM-03-001 DONSETL 29 SEP. 03
GHA-WES-JOM-03-001 DONSETL 08 JULY 03
GHA-CEN-KAS-03-001 DONSETL 09-SEP 03
Updated as of 19 Nov. 2003
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Circulation of WPV in Africa 2003
as of 5 Oct 2003, date of onset
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WHO-AFRO TCG TARGET60 DAYS FROM ONSET-ITD
RESULT

• At country level
• 20-30 of samples kept for 5-7 days after
  collection
• Once shipped gt90 received in lab within 3 days
• At laboratory level
• In 2003 , 30 of isolates still arrive regional
  labs more than 3 days after shipment

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WHO-AFRO TCG TARGET60 DAYS FROM ONSET-ITD
RESULT

• At laboratory level
• Need better follow up on couriers/shippers.
• CAR lab not accessible.

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TCG 60 Days Field Laboratory Performance
Performance ( of target)
2002
2003
2001
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Sustaining Surveillance-Laboratory Support

• The road to success IS ALWAYS under
  Construction,
• SO
• Time to look at some CHALLENGES proposed
  SOLUTIONS

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SURV-LAB CHALLENGES IN 2003Challenges
Solutions

• Undue delay in shipping collected stools to labs

• Make field officers aware of TCG (60 day onset-
  to-ITD) recommendation.
• Plan accordingly, for rapid shipment after stool
  collection.

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SURV-LAB CHALLENGES IN 2003Challenges
Solutions

• 10-30 of stools arrive labs unsuitable for
  testing

• Treat stools with same deserving respect as
  vaccines.
• Ship under cold chain condition and in
  appropriate containers.

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SURV-LAB CHALLENGES IN 2003Challenges
Solutions

• Difficulties with inter-lab shipment of virus
  isolates.
• Security situation in CAF adversely affecting ITD
  testing sequencing.
• If CIV situation deteriorates, problems for 6
  countries served by CIV.

• Engage courier companies in constant dialogue
  for improved service.
• Plans in progress to upgrade 2 national labs for
  ITD testing.
• Alternative polio labs identified for, and primed
  to provide diagnostic service for concerned
  countries.

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SURV-LAB CHALLENGES IN 2003Challenges
Solutions

• Fund shortfall
• Delay in procuring supplies to 4 labs
• Difficulties with renewing SSA/APW contracts for
  lab staff
• Future of polio labs, dwindling resources
  integration with other lab networks

• Discussion on what fund is available and when,
  needed for better planning.
• Current CDC support for lab staff always
  appreciated anticipated.
• Integration of LabNets, without loss of
  standards, needed for maximization of human
  resources funds.

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Our Greatest Challenge
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The African Child The TFI
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Appreciation

• To partners
• Rotary, CDC, USAID, Lederle-Wyeth.
• To colleagues all over the world.
• To those who gave courage to speak OUT.