The Paediatric Bacterial Meningitis Surveillance Network: An update

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The Paediatric Bacterial Meningitis Surveillance
Network An update

• NetSPEAR Annual Meeting
• Nairobi, 9-11 November 2006
• Dr. B. Mhlanga WHO IST South/East

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Paediatric Bacterial Meningitis Surveillance
Challenges 2002-2005

• Unpredictable financing for surveillance
• Lack of capacity at sites within some countries
  to produce quality data
• Relatively low performance at 40 of sites
• Slow intra-country expansion of PBM-SN
• (Botswana), Ghana, Kenya, Tanzania, Uganda,
  (Zambia).
• Incidence rates for meningitis cannot be
  calculated at majority of sentinel sites (no
  defined catchments)
• Regional Reference Laboratory layer not
  established.
• Limited integration into national surveillance
  activities

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PBM-SN Update - 2006

• 22 countries have maintained surveillance and EQA
  program
• Guidelines for certification drafted
  (implementation in 2007)
• 4 PBM surveillance network countries assisted to
  conduct assessments of impact of Hib vaccine
  introduction out of 6 scheduled for completion
  2006.
• Resource Mobilization
• Documentation/Peer review publication
• Funding secured for Reference Laboratory (Pneumo
  ADIP).
• Global Hib Initiative strengthening capacity to
  conduct PBM surveillance in targeted countries
• Expand Surveillance Rotavirus disease in
  collaboration with the PBM surveillance sites (5
  pilot countries)

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AFRO-PBM Surveillance Status
EMRO
Not Trained
Trained-Reporting
Not Reporting
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Patients Isolation 2005-6
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PBM surveillance performance indicators
in AFR, 2003 - 2005
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Quality of Data 2002-5

• Exclusion Criteria
• Not reporting 12 months
• Grading Criteria (Low and High Performance)
• gt1 indicator missed for a quarter in any year
• Sensitivity of bacterial isolation (20) missed
  
• gt a quarter in any year
• Sensitivity of Hib isolation missed gt a
  quarter..
• No reporting gt a quarter in any 1 year

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Quality of Data 2002-5
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PBMS Network Reporting gaps

• Operational problems SIL, ERI
• Staff turnover - BOT
• Industrial action MAL
• Policy issues - BEN
• Surveillance allowances for
• team/data managers - ZIM

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Hib vaccine introduction supported
by GAVI

• Gambia 1995, South Africa 1998
• Burkina Faso (Jan. 2006), Mali (2005 - 2007)

Excluded Benin (reporting) Ghana, Kenya, Zambia
(performance)
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Total patients with lab samples, H. influenzae,
and S. pneumoniae isolated in 8 countries without
Hib vaccine, 2002-2005
12
Total patients with lab samples, H. influenzae,
and S. pneumoniae isolated, 2002-2005, 3
countries with Hib vaccine introduced in 2002
13
Total patients with lab samples, H. influenzae,
and S. pneumoniae isolated, 2002-2005, 2
countries with Hib vaccine introduced 2004-2005
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Pneumococcal Surveillance

• 1640 ve CSF cultures from 25 countries
• Providing good pre-vaccine baseline trend in 13
  countries
• Qualitative data provided
• Burden rate need to add rural sites
• No serotyping?missed opportunity
• Serotype baseline
• Serotype epidemiology
• Funding now in place for Ref Lab (West Block) in
  collaboration with partners

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Rotavirus Surveillance

• Financial support provided to 5-countries
  (Cameroon, Ghana, Kenya, Uganda and Zambia) to
  initiate rotavirus surveillance
• Rotavirus surveillance launched in 3 countries
  (Ghana, Kenya and Uganda) as of July 06.
  Specimen collection started.
• Plan for expansion of the rota network - 3
  countries by end of 2006 (Ethiopia, Senegal,
  Zimbabwe)

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Addressing network issues I

• Reporting
• WHO EPI focal point, WHO EPI sub-regional teams
• Competition for attention with polio, measles,
  and routine.
• Support regional staff for EPI/New vaccines (Hib
  Initiative)
• (Add fourth item (new vaccine surveillance) to
  TORs)
• Capacity within AFRO to provide technical support
  to the (PBM site) laboratories
• Microbiologist
• AFRO data manager part time
• Completeness of data
• Insufficient analysis some issues not discovered

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Addressing network issues II

• Annual WER/MMWR, progress report
• Forces in-depth analysis, issue identification
• Lab supplies and site data management
• 1500 per site per year
• Need to establish system of central WHO purchase
  and delivery for essential lab supply components
• Reference Laboratory West Africa
• (WHO, MRC-Gambia, AMP). Pneumococcal ADIP

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Addressing network issues III

• Low performance sites
• Introduce certification system
• Annual meeting not held in two years (2003-4).
• Sufficient funding
• Maintain regularity
• 2006 meeting Jan 15-16, Brazzaville, Congo with
  Hib Initiative/AFRO Francophone Decision Makers
  Meeting

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Addressing network issues IV

• Incidence rates for meningitis cannot be
  calculated at majority of sentinel sites (no
  defined catchments)
• One urban sentinel site is not representative of
  national burden of disease
• Intra-country expansion of PBM-SN slow
  (Botswana), Ghana, Kenya, (Rwanda), Tanzania,
  Uganda, (Zambia).
• Inter- and Intra-country expansion
• Angola, DRC, Ethiopia (and Nigeria) not yet
  covered
• Collaboration Hib Initiative and NetSPEAR

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Addressing network issues V

• Efficiencies if combine Hib, S.p. and rotavirus
• Same pediatrician and data entry person
• Same annual meeting
• Same WHO logistics system for delivery of
  essential supplies
• Cross supervision from lab expert
• Same data manager

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Future Surveillance in support of New vaccines

• Countries should have at least 2 sites
• Urban site
• Rural site with defined catchment population for
  burden (rate) estimate
• Collaborate with Universities and Research
  Centers
• Resource mobilisation countries
• Funding for New Vaccine Surveillance in cMYP
• Integrate with surveillance for other new
  vaccines
• Pneumococcal surveillance (East Africa NetSPEAR
  Kenya, Uganda Tanzania)
• Rotavirus surveillance (5 countries)

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Summary I

• Providing quality bacteriologic surveillance in
  13 countries
• Demonstrating impact of Hib vaccine (88
  reduction) after 3 yrs
• Need to provide local new vaccine surveillance
  information for addtional AFRO countries (e.g.
  Angola, DRC, Nigeria)
• Provide better burden information for new
  vaccines in pipeline (pneumo, rotavirus.)

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Summary II

• Provide adequate funding
• Funding for at least two sites in multi-year plan
  for all countries
• 40 of sites need increased quality in culture
  sensitivity and/or reporting
• Increase operational funding from 1500 to 2500
  per site per year
• (WHO country staff to add new vaccine
  surveillance site monitoring to TORs)
• Start accreditation/certification system
• Start lab supply procurement system
• (Hire bacteriologist and data manager)

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THANK YOU!

• Acknowledgements
• GAVI, CVF, Pneumo and Rota ADIPs,
• HiB Initiative
• WHO HQ, AFRO, ICSTs
• Countries WHO MOH- EPI,
• PBM Site Teams
• Partners CDC, NHLS, WHO
• Collaborating Centres