INFECTIOUS DISEASES
International Influenza Laboratory
Capacity Review Tool, which has since
been used in over 35 countries and helps
advance standards required to join the
World Health Organization’s (WHO) global
network of National Influenza Centers.
The centers collect, prepare and ship
viral specimens to WHO laboratories for
advanced monitoring and to inform the
agency’s annual recommendations on
influenza vaccine composition.
Flu surveillance and pandemic
readiness are some of a public health
laboratory’s most critical functions.”
Kelly Wroblewski, MPH
Since the tool’s release, a number of APHL
members have served as consultants
to laboratories overseas, using the tool
to assess laboratories and advise and
prioritize technical assistance efforts to
improve influenza monitoring. APHL and
CDC worked together to provide regional
trainings to target known competency
gaps on a variety of topics. In 2015, those
global efforts expanded even further
with the launch of an official mentorship
program between US laboratories and
public health laboratories abroad. The
program—a partnership with CDC and
done in collaboration with WHO/Europe
and the South East European Center for
Surveillance and Control of Infectious
Diseases—paired up APHL experts with
six influenza laboratories in southeastern
Europe to help them achieve National
Influenza Center requirements and boost
surveillance. The program also trained
local mentors to bring the information to
other countries in the region.
The mentorships lasted for two years,
with monthly activities. Of the six
influenza laboratories that participated,
one achieved National Influenza Center
status and two are in the process of
gaining the designation (one of the
laboratories already had the designation).
Last year, APHL kicked off its second
round of the mentorship program
with a cohort of 10 national influenza
laboratories in Africa.
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…And At Home
On the domestic front, APHL’s influenza
efforts also focus on expansion and
improvement and, in particular, on
building efficiency and resiliency into
surveillance systems. One of its recent
efforts was the 2013 release of the
first edition of the Influenza Virologic
Surveillance Right Size Roadmap,
which offers public health laboratories
a functional set of requirements for
optimizing their virologic surveillance
systems, boosting efficiency and
advocating on behalf of strong and well-
supported public surveillance systems.
The ultimate goal is to ensure that the
state-of-the-art influenza surveillance
systems that took years of effort and
investment to build can sustain even
in uncertain funding climates. In
particular, the roadmap—a partnership
between APHL and CDC—identifies key
surveillance questions critical to answer
at the state and national levels as well
as thresholds to guide a laboratory’s
decision-making process. The objective
is to help public health laboratories
maximize efficiency in their surveillance
systems while still producing reliable,
actionable data.
For example, said Wroblewski, the
roadmap estimates influenza testing
volumes for each state based on their
populations so that when the data is
aggregated nationally, health officials
can be confident that the emergence of a
novel influenza virus would be detected.
The effort boosts resiliency because it
generates representative surveillance data
without having to test every one of the
many thousands of influenza specimens
collected each season by physicians
and hospitals. “The goal is to ensure
that our limited resources for influenza
surveillance are applied in the most
effective way,” Wroblewski said.
Other projects boosting and streamlining
influenza surveillance include the Public
Health Laboratory Interoperability Project
(PHLIP), which APHL launched in 2005,
as well as the US National Influenza
Reference Centers (NIRC), which APHL
helped get up and running around the
time of the 2009 pandemic.
APHL.org
APHL runs the selection process for and
supports the country’s three NIRCs—now
located in New York, Wisconsin and
California—which serve as an extension
of CDC’s virus surveillance and diagnosis
branch, providing virus isolation, genome
sequencing and antiviral resistance
testing. NIRCs free up CDC to concentrate
on more specialized influenza testing
and serve as a key redundancy in the
influenza response system. Their extra
capacity, Wroblewski noted, is also key
to achieving the goals of the Right Size
project.
On PHLIP, better influenza surveillance
wasn’t the specific purpose when APHL
began it more than a decade ago, however
it’s “now become synonymous with the
transmission of flu data electronically,”
Wroblewski reported. PHLIP lets public
health laboratories send influenza-testing
data directly to CDC using specially
automated and standardized messages,
which means the data is ready for
analysis and health officials can get a
more rapid, real-time picture of influenza
circulation year-round. In the early
years of PHLIP, APHL set up servers in
Florida and Nebraska capable of routing
laboratory data to the correct contacts at
CDC; since then, APHL has moved PHLIP
to a cloud-based system. The system
essentially acts as a post office between
state laboratories and CDC, freeing up
considerable time that staff used to spend
on the clerical and administrative tasks
involved in sharing laboratory data. Today,
all but two state public health laboratories
can use PHLIP.
“Everything we do to improve flu
surveillance ultimately spills over into
improving a laboratory’s overall ability
to protect people’s health,” Wroblewski
said. “Influenza is formidable, but it’s also
preventable with strategic investments in
public health.” n
DIGITAL EXTRA:
Learn more about APHL’s influenza
contributions.
Fall 2018 LAB MATTERS
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