# Presentation: 094233

## Global Surveillance Updatenew vaccines surveillance and its integration

- Cristiana Toscano

## Outline

- Surveillance for new vaccines (Rota and Pneumo/Hib)
- Transition ADIPs surveillance
- Funding
- Strategy
- Ongoing activities
- New vaccines surveillance
- VPD surveillance integration
- Next steps

## ADIP coordinated Rotavirus and Pneumococcal Disease Surveillance Networks, as of 2008

**Rotavirus Surveillance Network**

**Slides: Umesh Parashar/CDC and Orin Levin/PneumoADIP**

## Global status of new vaccines surveillance

**ADIP ́s phasing out schedule:**
- Pneumo and Rota ADIPs - by December 2008.
- Hib Initiative - by June 2009.
**Post ADIP surveillance:**
- Moving from time-limited surveillance projects to sustainable networks.
- Country-owned.
- Sentinel surveillance.
- Integrated with existing networks.
- WHO regional offices coordination.
- Technical support from WHO and partners.
**Proposed structure for New vaccine surveillance:**

**Notes:**
Vaccine initiatives have all indicated interest to pursue some research activities beyond actual end of contract.
Adequate funding has not yet been secured.
Take advantage of infra structure and capacity built by these networks

## Surveillance Structure"Layer approach"

- Not financially and operationally feasible to expect all sites to conduct all various surveillance activities. Surveillance structure considering a "layer approach":
- Hospital sentinel sites – "core sites":
- meningitis and rotavirus surveillance.
- 1 per country, in larger countries up to 3 sites.
- Additional select sites – "enhanced sites":
- sepsis surveillance.
- 1 sites for every 3 countries.
- Population-based sites to generate incidence estimates:
- 1 one site per region (6 Regions + 3 AFRO sub-regions).
- Laboratory networks
- Local, sub-regional, regional and global level.
- Centers of excellence
- Specialized epidemiologic studies to complement surveillance

## Transition to WHO of the Ongoing Surveillance Sites currently Coordinated by the ADIPs 

- July 2008 - July 2010
- 14.9 million USD
- Surveillance for pneumococcal, Hib and rotavirus disease.
- Sites to be prioritized as per pre-defined criteria
- Layer** **structure
- 1 pop based site and 1-3 hospital based site, at a maximum, in countries with multiple sites

**APPROVED****!!!!**

## Transition Timeline for Transition

## GAVI AVI Accelerating the Introduction of Pneumococcal and Rotavirus Vaccines2009-2015

- WHO costing of its areas of responsibility presented to GAVI
**27 March 2008**
- Areas of work for input
**Surveillance**
- Training
- Cold chain, logistics & waste management
- Research
- Prequalification and NRA strengthening
- Advocacy & communications
- Programme management
- Personnel/Salaries

## Assumptions for Surveillance Costing

- Costing considering funding for the GAVI eligible countries only
- It is expected that surveillance activities will be implemented in stages, considering GAVI estimated introduction year by country
- 2008-2010 = 25 countries
- 2011 = 16 countries
- 2012 = 20 countries
- 2013 = 9 countries
- 2014 = 2 countries
- Various types of surveillance sites in the GAVI eligible countries would be in place by 2014
- Country level surveillance staff will be supported during start up period (till 3 years), when countries will pick up these salaries

## AVI status

- Now merged into GAVI Work Plan
- Budget and activities for 2009-2010 submitted
- Sept 2nd
- Reviewed by GAVI board in October
- Final budget for 2009-10
- 6.7 million USD

## Project to Gates Foundation - Surveillance demonstration project in Central Africa 5 year surveillance demonstration project in the Central African sub-region
Strengthen surveillance and response capacity and quality through training, infrastructure improvements and other measures
Partnership
WHO – IVB and Lyon
CDC – FELTP, GID and technical groups (bacterial diseases, rotavirus, others)
Countries to be defined
Consultation and discussion with RO
Further development of surveillance networks, considering 
existing VPD networks 
networks of public health laboratories being established as a result of the IHR implementation 
Local capacity building for epidemiology, laboratory, data management
considering the FELTP platform

- Strengthen surveillance and response capacity and quality through training, infrastructure improvements and other measures
- Partnership
- WHO – IVB and Lyon
- CDC – FELTP, GID and technical groups (bacterial diseases, rotavirus, others)
- Countries to be defined
- Consultation and discussion with RO
- Further development of surveillance networks, considering
- existing VPD networks
- networks of public health laboratories being established as a result of the IHR implementation
- Local capacity building for epidemiology, laboratory, data management
- considering the FELTP platform

**Other perspectives**

## Non GAVI eligible countries
Middle income countries
VPD surveillance integration	
Full scale will take some time
Funding is slowly being made available but...not to a full extent needed

- Middle income countries
- VPD surveillance integration
- Full scale will take some time
- Funding is slowly being made available but...not to a full extent needed

**Anticipated Gaps ****in VPD Surveillance Funding**

## Next Steps for ADIP Surveillance Transition

- Assessment of existing sites and surveillance data being generated
- Meetings with all RO
- Personnel
- Technical issues
- Admin and contractual issues
- Prioritization and definition of sites to be continued
- Global standards
- Data standardization
- Laboratory networks
- Inventory of existing and operating surveillance sites and  networks
- Develop and make available standardize manuals/guidelines

## Data standardization

- Define minimum data set to be collected at site/country level
- Define common indicators to be used by the networks
- Data to be shared and periodicity
- countries to Regions
- Regions to Global level
- Feedback
- Global integrated new vaccines surveillance bulletin
- Meeting Oct 6-7th, 2008 in Geneva

## Laboratory networks in the sub-regional, regional, and global levels 

- Establish a rotavirus/bacterial diseases laboratory technical advisory group
- Formalize a global rotavirus laboratory network
- considering a tiered structure such as measles and polio and lab networks
- Establish global laboratory standards for quality assurance, proficiency testing, accreditation
- Develop and distribute laboratory manuals
- diagnosis and characterization of rotavirus and invasive bacterial infections
- Establish new national/sub-national/Regional labs where needed
- Standardize lab data collection, sharing, and feedback in the Regions
- Laboratory training workshops in the various Regions
- Laboratory meetings to be held in conjunction with epi TAG meetings in the Regions
- Personnel for Rota and Bacterial Laboratory network implementation in place in all the RO
- Establishment of a supply system for procurement of laboratory diagnostic items to support PBM and rotavirus surveillance network

**Notes:**
Laboratory networks are essential component of surveillance systems
Regional and Global bacteriology laboratory networks will be established as a network of national public health laboratories which are linked to specialized reference laboratories which are be responsible for:
- Conducting special complex procedures
- Standardization of sample collection & processing
- Training
External quality assurance
Accreditation

## Manuals and guidelines

- Under clearance for official WHO publication
- "Generic Protocol for Monitoring Impact of Rotavirus Vaccination on Gastroenteritis Disease Burden and Viral Strains"
- "Rotavirus vaccine introduction manual"
- "Manual of rotavirus detection and characterization methods"
- Being drafted
- Hib impact assessment manual
- Pneumo impact assessment manual
- Laboratory procedures for diagnosis of bacterial pathogens targeted by invasive bacterial diseases surveillance

## Inventory of existing surveillance

- Develop up-to-date inventory of surveillance networks operating in each country
- all existing syndromic surveillance and laboratory networks
- Monitor activities, assess gaps and opportunities
- Identify areas for strengthening and expansion
- Identify gaps and/or overlaps between syndromic surveillance activities
- Map integration opportunities
- Compare and contrast regional activity for sharing information & lessons learned between regions
- Feedback to global partners and donors
- Jeanette Rainey's invaluable support
- To be finalized by early October

## Example of inventory output 1:Countries with Meningitis-Encephalitis Surveillance

- Yes (64 member states or 33%)

- No  (129  member states or 67%)

- Data collected from regions and partners, Draft not  for distribution

- Slide date: 19 June 2008

- The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.  Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
- ©WHO 2008. All rights reserved

## Example of inventory output 2:Countries with Meningitis-Encephalitis Surveillance by GAVI eligible status

- Data collected from regions and partners, Draft not  for distribution

- Slide date: 19 June 2008

## Example of inventory output 3:Countries with Rotavirus Surveillance by Source of Funding 

- Data collected from regions and
- partners, Draft not  for distribution

- Slide date: 19 June 2008

- The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.  Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
- ©WHO 2008. All rights reserved

## Small next steps Towards integration

- Integrated training, technical support and meetings
- Integrated data management
- Dissemination of surveillance data
- Inventory
- New Vaccines Surveillance Bulletin
- Monitor Progress
- Annual new vaccine surveillance regional meetings
- Demonstration projects for integrated VPD activities