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Polio Eradication Initiative (PEI) contribution in strengthening public health laboratories systems in the African region N

Friday, 7th of October 2016

Vaccine, Volume 34, Issue 43, 10 October 2016, Pages 5164–5169

Polio Eradication Initiative Best Practices in the WHO African Region

Polio Eradication Initiative (PEI) contribution in strengthening public health laboratories systems in the African region

http://dx.doi.org/10.1016/j.vaccine.2016.05.055

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Highlights

•Efficient laboratories are key to the success of any disease programme.

•PEI resources have contributed efforts in strengthening laboratory capacity in the region.

•These contributions have not been systematically documented as lesson learnt.

•With PEI programme on the ramp down, this paper documents it contributions for posterity.

Excerpts below; full text is at http://www.sciencedirect.com/science/article/pii/S0264410X16303814

Abstract

Background

The laboratory has always played a very critical role in diagnosis of the diseases. The success of any disease programme is based on a functional laboratory network. Health laboratory services are an integral component of the health system. Efficiency and effectiveness of both clinical and public health functions including surveillance, diagnosis, prevention, treatment, research and health promotion are influenced by reliable laboratory services. The establishment of the African Regional polio laboratory for the Polio Eradication Initiative (PEI) has contributed in supporting countries in their efforts to strengthen laboratory capacity. On the eve of the closing of the program, we have shown through this article, examples of this contribution in two countries of the African region: Côte dIvoire and the Democratic Republic of Congo.

Methods

Descriptive studies were carried out in Côte dIvoire (RCI) and Democratic Republic of Congo (DRC) from October to December 2014. Questionnaires and self-administered and in-depth interviews and group discussions as well as records and observation were used to collect information during laboratory visits and assessments.

Results

The PEI financial support allows to maintain the majority of the 14 (DRC) and 12 (RCI) staff involved in the polio laboratory as full or in part time members. Through laboratory technical staff training supported by the PEI, skills and knowledge were gained to reinforce laboratories capacity and performance in quality laboratory functioning, processes and techniques such as cell culture. In the same way, infrastructure was improved and equipment provided. General laboratory quality standards, including the entire laboratory key elements was improved through the PEI accreditation process.

Conclusion

The Polio Eradication Initiative (PEI) is a good example of contribution in strengthening public health laboratories systems in the African region. It has established strong Polio Laboratory network that contributed to the strengthening of capacities and its expansion to surveillance of other viral priority diseases such as measles, yellow fever, Influenza, MERS-CoV and Ebola.

This could serve as lesson and good example of laboratory based surveillance to improving diseases prevention, detection and control in our middle and low income countries as WHO and partners are heading to polio eradication in the world.

1. Introduction

The World Health Organization (WHO) African Region bears the highest burden of communicable diseases including vaccine preventable diseases and non-communicable diseases [1]. Since 1994, several laboratory networks have been established in the African Region as part of immunization programmes. These include polio, measles, and yellow fever. In some countries, these networks utilize the same infrastructure and human resources.

The laboratory network established in the African Region for the Polio Eradication Initiative (PEI) is composed of national and regional reference laboratories (Fig. 1). This network has supported PEI by effectively confirming outbreaks of the different types of strains of polioviruses. The quality of results correlates with the availability of resources, such as laboratory quality standards and the availability of skilled staff.

The WHO global polio laboratory network is the largest public health laboratory network ever created. The African Regional Polio Laboratory Network forms part of this network and consists of three Regional Reference Laboratories (RRLs) based in Central African Republic, Ghana, and South Africa. In addition, 13 Intratypic Differentiation (ITD) laboratories are responsible for isolation of polioviruses from faecal samples using standardized procedures and reagents, molecular characterization of isolates and referral of critical isolates to a sequencing laboratory. In the African region, the RRLs in South Africa and in Ghana also provide genetic sequencing services to the African polio lab network.

The polio laboratory network is also in charge of reporting results to stakeholders in coordination with the PEI programme for further case investigations and poliovirus containment activities. As of January 2016, the most recent result to note is the eradication of the poliovirus type 2 in September 2015 [2]. The performance of these laboratories are regularly monitored and documented through WHO annual accreditation exercises and showed several successes in the current achievement.

The measles and yellow fever laboratory network has been built on a similar platform as the polio lab network and is currently made up of 37 Laboratories including RRLs based at Institut Pasteur de Côte dIvoire in Côte dIvoire, Uganda Virus Research Institute in Uganda, Institut Pasteur de Dakar in Senegal, and National Institute of Communicable Diseases (NICD) in South Africa. Cote dIvoire, Uganda and NICD laboratories cover regional functions for measles while Senegal laboratory covers regional functions for yellow fever. Because most of the measles elimination programs in the WHO African Region have moved to case based surveillance (which requires laboratory confirmation of all cases), laboratory support has become critical in assessing program progress.

The laboratory is indispensable for infectious diseases diagnosis, required for confirmation and is an important component of surveillance and response in line with existing and new frameworks such as the Integrated Disease Surveillance and Response (IDSR), the International Health Regulations (IHR 2005), the One Health approach and the Global Health Security Agenda (GHSA).

In the WHO African Region, despite the progress made during the recent years for investigation and response to epidemic prone diseases, laboratory services and systems are in general not fully efficient in supporting disease surveillance and control. Laboratories show weaknesses regarding the overall organization, qualified human resources, sustained financial support and required infrastructures and materials as well as compliance with quality assurance management and biosafety and security measures [3].