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Li XIN, Ph.D
WHO Collaborating Center for Reference and Research on Influenza
Chinese National Influenza Center
National Institute for Viral Disease Control and Prevention
Chinese Center for Disease Control and Prevention
February 27, 2012
Chinese Influenza Surveillance Network Management and Quality Assessment System
Bangkok, Thailand m February 27th to March 2nd, 2012
Improving Influenza Laboratory Management Practices
Organization Structure of CNIC
CNIC
Lab Management
Group
Research
Group
Epidemiology
and Network
Management
Group
Pandemic
Preparation
and Response
Group
Virology
Surveillance
Group
China CDC
NIVDC
CNIC
MISSION
Surveillance
Weekly
report
Network
management
Virology
surveillance
Scientific
research
Vaccine
recommendation
Share with
WHO
Pandemic
preparation
& response
Epidemiology
surveillance
Share
information
with WHO
Nucleic acid detection evaluation
Quality control & evaluation
Providing
reagents &
technical
support
Supervision
WHO
Lab
Lab
Provincial CDC
PrefectureCDC
County CDC
Sentinel
hospitals
Lab
Provincial BoH
Prefecture BoH
County BoH
Structure of China NISN
DCER Office
CNIC
IVDC
China CDC
Ministry of Health
0
100
200
300
400
500
600
No
.
Time
Network laboratories Sentinnel hospitals
Expansion of overall Influenza Network (1)
411 network laboratories
556 sentinel hospitals
Expansion of overall Influenza Network (2)
63 network laboratories
197 sentinel hospitals
Management of NISN
Information
system
Technical &
reagent
support
Weekly report
Trainings &
meetings
Timely communicating with network laboratory whenever
found problems or errors
Supervision
Nucleic acid detection evaluation
Influenza surveillance quality evaluation
Decide subtypes (B, H1N1, H3N2,
H5N1 and pandemic H1N1)
Select virus
Subtyping
Gradient dilution
Sensitivity detection (using
conventional PCR & real time
RT-PCR)
Dilute into reasonable
dilution
Simulation test of transportation
and multiple freeze-thaw
cycling
Aliquot viruses and numbering
(10 samples)
Exclude contamination
Sending to network
laboratories
Results collection and
analysis
Feedback to MoH and CDCs
0
50
100
150
200
250
300
350
400
450
2007 2008 2009 2010 2011
No
. of
lab
pa
rtic
ipa
ted
in
th
e q
ua
lity
ass
ess
me
nt
pro
gra
m
local CDC confirmed after April 2009
local CDC confirmed before April 2009
local CDC confirmed before 2009
provincial CDC
0
0.2
0.4
0.6
0.8
1
1.2
0
5
10
15
20
25
30
35
No.of lab with all corrected results
accuracy rate
0
0.2
0.4
0.6
0.8
1
1.2
0
5
10
15
20
25
30
35
2008 2009 2010 2011
No.of lab with all corrected results
accuracy rate
0
0.2
0.4
0.6
0.8
1
1.2
0
5
10
15
20
25
2009 2010 2011
No.of lab with all corrected results
accuracy rate
0
0.2
0.4
0.6
0.8
1
1.2
0
100
200
300
400
2009 2010 2011
No.of lab with all corrected results
accuracy rate
Objectives
To strengthen influenza surveillance in
mainland China
To enhance influenza surveillance quality in
mainland China
To promote management of provincial CDCs
to prefectural CDCs
According to
Influenza surveillance information system
Public health emergency information system
CNIC laboratory database
Influenza surveillance annual reports submitted by
provincial CDCs
Virology surveillance
Surveillance network
management
sentinel hospital
ILI surveillance
PROVINCIAL CDC
Evaluation Target and Content
•Provincial CDCs
virology surveillance
•Prefectural CDCs
virology surveillance
•ILI surveillance
•Data report
•Management of
provincial CDCs to
prefectural CDCs
•Prefectural CDCs
manage the network
ONCE IN TWO YEARS
Influenza surveillance
quality (80%)
Influenza surveillance
network management (20%)
Influenza
surveillance quality
evaluation
• Evaluation
results of nucleic
acid detection
quality in
network
laboratories
• ILI outbreak
reporting
•Specimen
collection
•Reporting data
through
information
system
•Laboratory
detection in 24hs
•Virus isolation
•Reporting and
sending virus to
CNIC
• Attending
trainings
• Supervision to
sentinel hospitals
• Data analysis
• Feedback results
to sentinel
hospitals
•Reporting results
to higher level
CDC
• Quality of nucleic
acid detection
•Timeliness of nucleic
acid detection
•Correct rate of
subtyping
•Timeliness of
sending samples
•Sample volume (3ml)
•Consistency of lab
results with CNIC
• Sending more than 5
isolates each month
• Reporting correct
information
•Egg isolation
• Timeliness of ILI
reporting
• Missing rate of
ILI reporting
• Integrality of ILI
reporting
• Collecting
adequate
samples
• Timeliness of
sending samples
Outbreak
surveillance
management
Management
of prefectural
CDCs
Lab
virology
surveillance
Sentinel
hospital
Lab
detection in
province
• Organize
training
• Supervision
• Quality
evaluation to
provincial
network
• Data analysis
and reporting
Management
of provincial
CDC to
prefectural
CDCs
Influenza surveillance
quality (80%)
Influenza surveillance
network management (20%)
Influenza
surveillance quality
evaluation
• Evaluation
results of nucleic
acid detection
quality in network
laboratories
• ILI outbreak
reporting
•Specimen
collection
•Reporting data
through
information
system
•Laboratory
detection in 24hs
•Virus isolation
•Reporting and
sending virus to
CNIC
• Attending
trainings
• Supervision to
sentinel hospitals
• Data analysis
• feedback results
to sentinel
hospitals
•Reporting results
to higher level
CDC
• Quality of nucleic
acid detection
•Timeliness of nucleic
acid detection
•Correct rate of
subtyping
•Timeliness of
sending samples
•Sample volume (3ml)
•Consistency of lab
results with CNIC
• Sending more than
5 isolates each month
• Reporting correct
information
•Egg isolation
• Timeliness of ILI
reporting
• Missing rate of
ILI reporting
• Integrality of ILI
reporting
• Collecting
adequate samples
• Timeliness of
sending samples
Outbreak
surveillance
management
Management
of prefectural
CDCs
Lab
virology
surveillance
Sentinel
hospital
Lab
detection
in the
province
• Organize
training
• supervision
•Quality
assessment to the
provincial
network
• data analysis
and reporting
Management
of provincial
CDC to
prefectural
CDCs
Final score = ∑ score for each indicator
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