A CC perspective on the three Cs:Collaboration, Communication and Capacity building

Anne KelsoDirector

WHO Collaborating Centre for Reference and Research on Influenza

5th WHO National Influenza Centres Meeting, Vientiane, June 2011

The three Cs

Collaboration

Communication

Capacity building (Patrick Reading)

• virological surveillance and isolation of vaccine viruses• research

Collaboration in virological surveillance and isolation of vaccine viruses

Countries that submitted samples to WHO CCs in 2010

US CDC (Atlanta) NIMR (London) VIDRL (Melbourne) NIID (Tokyo) CCDC (Beijing)

Collaboration in virological surveillance and isolationof vaccine viruses (1)

What CCs need from NICs:

What NICs need from CCs:

Collaboration in virological surveillance and isolationof vaccine viruses (1)

What CCs need from NICs:

What NICs need from CCs:

• Urgent submission of any novel or unsubtypable viruses• Submission of representative recent circulating viruses to provide a global picture and contribute to vaccine strain selection by WHO• Any relevant clinical or epidemiological information• Submission of some clinical specimens for isolation of vaccine candidates

Collaboration in virological surveillance and isolationof vaccine viruses (1)

What CCs need from NICs:

What NICs need from CCs:

• Urgent submission of any novel or unsubtypable viruses• Submission of representative recent circulating viruses to provide a global picture and contribute to vaccine strain selection by WHO• Any relevant clinical or epidemiological information• Submission of some clinical specimens for isolation of vaccine candidates

• Urgent identification of novel or unsubtypable viruses• Rapid reporting of results for circulating viruses (eg, strains, antiviral drug resistance) • Availability of vaccines matched to circulating viruses in your country• Anything else?

Collaboration in virological surveillance and isolationof vaccine viruses (2)

Novel and unsubtypable viruses:

• Contact us first:- email, telephone, fax, smoke signals… (not facebook or twitter!)

• We can discuss technical issues, compare primer sequences, etc

• We can prepare to receive the viruses

• Send us the viruses as soon as possible

• Urgent samples go to the front of the queue!

• We will contact you about the results as soon as we have them.

Timing of virus submission to CCs: strain selection

WHO Consultation forSouthern Hemisphere

WHO Consultation forNorthern Hemisphere

Collaboration in virological surveillance and isolationof vaccine viruses (3)

Representative recent circulating viruses:

• Send some viruses as often as you can

• They are most useful if they are recent

• Send some early in your season as well as later, so we have results in time for WHO Consultation

• Inter-season viruses are also useful

• Send us clinical or epidemiological information if you have it.

We are testing a new electronic submission form – easier for NICs?

Collaboration in virological surveillance and isolationof vaccine viruses (4)

Representative recent circulating viruses:

• We will report HI and antiviral resistance results as soon as we have them

• Reporting time depends on….shipping timedelays in customs if we don’t know samples are comingwhether virus needs to be isolatedhow easily it grows in MDCK cellshow many other viruses arrive at same timehow urgent

• Please tell us if you need more information or explanation of results in reports.

* Samples received in the year following sample date

Samples submitted to WHO CC at VIDRL, 2007 – 2010

4044 samples47 laboratories20 countries

Analysis of submitted viruses at WHO CC

Clinicalspecimen

Antigenic analysis (HI, MN)

HA and NA sequence

Antiviral drug sensitivity(phenotypic, genotypic assays)

Other testing(eg, human serology)

Confirm HI & sequence

Raise ferret antiserumEgg isolate

Vaccine candidates

Isolate

MDCK isolateMDCKcells

Eggs

PCR Sequence

What else do we do with submitted viruses?

• Supply HI data to Cambridge University for antigenic cartography

• Raise post-infection ferret antisera against interesting viruses

• Full genome sequencing; test for reassortment (pyrosequencing)

• Follow up viruses showing unusual neuraminidase inhibitor resistance

• Analyse reactivity of serum panels from vaccine trials (Australia, Japan, Europe, US) with recent reference strains

• Prepare reagent kits for provision to requesting laboratories

• Study pathogenicity, transmission and immunological responses in ferrets

The importance of egg-isolated viruses

• Regulators require that influenza vaccine viruses are isolated and passaged exclusively in hen’s eggs (or primary egg-derived cells).

• WHO Collaborating Centres obtain egg isolates as candidate vaccine strains for provision to vaccine manufacturers (after reasssortment of type A viruses).

• Viruses are adapted growth in eggs by amniotic passage then growth in the allantoic cavity.

Timing of virus submission to CCs: vaccine candidates

WHO Consultation forSouthern Hemisphere

WHO Consultation forNorthern Hemisphere

WHO recommendations for seasonal vaccinesYear Month A(H1N1) A(H3N2) B2000 February A/New Caledonia/20/99 A/Moscow/10/99 B/Beijing/184/93

September A/New Caledonia/20/99 A/Moscow/10/99 B/Sichuan/379/99

2001 February A/New Caledonia/20/99 A/Moscow/10/99 B/Sichuan/379/99

September A/New Caledonia/20/99 A/Moscow/10/99 B/Sichuan/379/99

2002 February A/New Caledonia/20/99 A/Moscow/10/99 B/Hong Kong/330/2001

September A/New Caledonia/20/99 A/Moscow/10/99 B/Hong Kong/330/2001

2003 February A/New Caledonia/20/99 A/Moscow/10/99 B/Hong Kong/330/2001

September A/New Caledonia/20/99 A/Fujian/411/2002 B/Hong Kong/330/2001

2004 February A/New Caledonia/20/99 A/Fujian/411/2002 B/Shanghai/361/2002

September A/New Caledonia/20/99 A/Wellington/1/2004 B/Shanghai/361/2002

2005 February A/New Caledonia/20/99 A/California/7/2004 B/Shanghai/361/2002

September A/New Caledonia/20/99 A/California/7/2004 B/Malaysia/2506/2004

2006 February A/New Caledonia/20/99 A/Wisconsin/67/2005 B/Malaysia/2506/2004

September A/New Caledonia/20/99 A/Wisconsin/67/2005 B/Malaysia/2506/2004

2007 February A/Solomon Islands/3/2006 A/Wisconsin/67/2005 B/Malaysia/2506/2004

September A/Solomon Islands/3/2006 A/Brisbane/10/2007 B/Florida/4/2006

2008 February A/Brisbane/59/2007 A/Brisbane/10/2007 B/Florida/4/2006

September A/Brisbane/59/2007 A/Brisbane/10/2007 B/Florida/4/2006

2009 February A/Brisbane/59/2007 A/Brisbane/10/2007 B/Brisbane/60/2008

September A/California/7/2009 (pdm) A/Perth/16/2009 B/Brisbane/60/2008

2010 February A/California/7/2009 A/Perth/16/2009 B/Brisbane/60/2008

SH 2010NH 2010-11SH 2011NH 2011-12

September A/California/7/2009 A/Perth/16/2009 B/Brisbane/60/2008

2011 February A/California/7/2009 A/Perth/16/2009 B/Brisbane/60/2008

WHO recommended vaccine viruses from WPRYear Month A(H1N1) A(H3N2) B2000 February A/New Caledonia/20/99 B/Beijing/184/93

September A/New Caledonia/20/99 B/Sichuan/379/99

2001 February A/New Caledonia/20/99 B/Sichuan/379/99

September A/New Caledonia/20/99 B/Sichuan/379/99

2002 February A/New Caledonia/20/99 B/Hong Kong/330/2001

September A/New Caledonia/20/99 B/Hong Kong/330/2001

2003 February A/New Caledonia/20/99 B/Hong Kong/330/2001

September A/New Caledonia/20/99 A/Fujian/411/2002 B/Hong Kong/330/2001

2004 February A/New Caledonia/20/99 A/Fujian/411/2002 B/Shanghai/361/2002

September A/New Caledonia/20/99 A/Wellington/1/2004 B/Shanghai/361/2002

2005 February A/New Caledonia/20/99 B/Shanghai/361/2002

September A/New Caledonia/20/99 B/Malaysia/2506/2004

2006 February A/New Caledonia/20/99 B/Malaysia/2506/2004

September A/New Caledonia/20/99 B/Malaysia/2506/2004

2007 February A/Solomon Islands/3/2006 B/Malaysia/2506/2004

September A/Solomon Islands/3/2006 A/Brisbane/10/2007

2008 February A/Brisbane/59/2007 A/Brisbane/10/2007

September A/Brisbane/59/2007 A/Brisbane/10/2007

2009 February A/Brisbane/59/2007 A/Brisbane/10/2007 B/Brisbane/60/2008

September A/Perth/16/2009 B/Brisbane/60/2008

2010 February A/Perth/16/2009 B/Brisbane/60/2008

SH 2010NH 2010-11SH 2011NH 2011-12

September A/Perth/16/2009 B/Brisbane/60/2008

2011 February A/Perth/16/2009 B/Brisbane/60/2008

Collaboration in research

Collaboration in research: the goal….

• Collaboration on projects of mutual interest where each party brings specific expertise and/or resources (viruses, data, techniques etc)

For example:

with authors from Australia, South Africa, Cambodia, Thailand, Taiwan, New Caledonia, Macao, Singapore, Malaysia, Philippines and New Zealand

• If we can help with your research, please let us know.

Emergence and spread of oseltamivir-resistant A(H1N1) influenza viruses in Oceania, South East Asia and South Africa

Aeron C. Hurt, Joanne Ernest, Yi-Mo Deng, Pina Iannello, Terry G. Besselaar, Chris Birch, Philippe Buchy, Malinee Chittaganpitch, Shu-Chun Chiu, Dominic Dwyer, Aurélie Guigon, Bruce Harrower, Ip Peng Kei, Tuckweng Kok, Cui Lin, Ken McPhie, Apandi Mohd, Remigio Olveda, Tony Panayotou, William Rawlinson, Lesley Scott, David Smith, Holly D'Souza, Naomi Komadina, Robert Shaw, Anne Kelso and Ian G. Barr

Antiviral Research 83(1): 90 – 93 (2009)

Communication

Communication

How can we help each other through communication?

• Good human relationships underpin all successful endeavours

• Share virological, technical and other information so we can help each other and do our own work more effectively

• Strengthen our collaborative networks.

MeetTalk

EmailReportBrowse

www.influenzacentre.org

The three Cs

Collaboration

Communication

Capacity building (Patrick Reading)

• virological surveillance and isolation of vaccine viruses• research

Acknowledgements

WHO National Influenza Centres and other submitting laboratories

WHO Collaborating Centres and others in GISRS

Staff of the Melbourne WHO Collaborating Centre:

The Melbourne WHO Collaborating Centre for Reference and Research on Influenza is supported by the Australian Government Department of Health and Ageing.

Chantal Baas, Ian Barr, Iwona Buettner, Natalie Caldwell, Louise Carolan, Michelle Chow, Yi-Mo Deng, Joelle Dharmakumara, Chris Durrant, Aeron Hurt, Pina Iannello, Naomi Komadina, Karen Laurie, Leah Leang, Tasoula Mastorakos, Katie O’Bryan, Heidi Peck, Patrick Reading, Rob Shaw, Helen Sjogren