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

NATIONAL INFLUENZA

SURVEILLANCENETWORK

(NISN)

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

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

NUCLEIC ACID DETECTION 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

GUIDELINE OF INFLUENZA SURVEILLANCE QUALITY EVALUATION (2011)

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