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Global Measles and Rubella Laboratory Network Support for Elimination Goals, 2010-2015

Saturday, 7th of May 2016

Global Measles and Rubella Laboratory Network Support for Elimination Goals, 2010-2015

Weekly Epidemiological Record

Excerpt below; full text is at  http://www.who.int/wer/2016/wer9118.pdf?ua=1

Discussion

The capacity of the GMRLN to support elimination efforts increased substantially during 2010–2015; all laboratories now follow standard testing protocols and participate in a rigorous quality control programme. In addition, all regional laboratories, and many national laboratories, have established molecular testing, including reverse transcription-polymerase chain reaction (RT-PCR) and sequence analysis. The global specialized laboratories and regional reference laboratories conduct periodic training workshops and convene annual meetings to review progress and develop recommendations to improve laboratory-based surveillance. In many countries, GMRLN laboratories provide a platform for strengthening overall laboratory capacity and surveillance for other VPDs, including yellow fever and Japanese encephalitis, and support detection and response activities during public health emergencies such as the Ebola, chikungunya, dengue and Zika viruses. Further integration of surveillance for other VPDs, including rotavirus diarrhoea, is feasible and will help sustain the investments made in establishing and building GMRLN capacity.

A continuing challenge to the GMRLN is a long-standing shortage of human and financial resources. The workload will increase as the GVAP regional measles and rubella elimination targets draw near. The laboratory network will need to expand to meet the demand for high quality laboratory data to support for verification of elimination, particularly in the South-East Asia Region, with 2 new national laboratories to be nominated in Myanmar and Nepal and at least 20 new subnational laboratories planned for Thailand, Indonesia, and India. To address the challenge of ongoing training needs related to personnel turnover and network expansion, GMRLN conducts workshops and intensive onsite training activities in all regions. To enhance measles and rubella elimination efforts, the GMRLN continues to develop and evaluate novel technologies including molecular methods such as RT-PCR to confirm cases. Evaluations of high throughput serologic assays for more efficient assessments of population immunity and point-of-care assays for rapid case confirmation in remote areas have demonstrated promising results as potential new tools. Advanced molecular techniques, including the use of next-generation sequencing, should improve the resolution of molecular epidemiologic studies.

As polio eradication approaches, the efforts will increasingly focus on achieving regional measles and rubella elimination goals.14 Polio legacy planning has begun to transition polio assets to strengthen routine immunization services and measles and rubella elimination efforts, while maintaining the essential polio functions of containment and surveillance.15 In many countries, GPLN and GMRLN laboratories are already located in the same institution, and share staff, infrastructure, quality control programmes, technical training, and biosafety/biosecurity procedures. An advanced “state of-the-art” global laboratory network providing real time disease surveillance has been the backbone of the polio eradication programme. Therefore, ensuring the sustainability and strengthening of the GMLRN should be designated as a high priority for polio legacy planning and transitioning of polio assets.