Lab Matters Fall 2018 - Page 27

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. PublicHealthLabs @APHL …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 25