Laboratory Gap Analysis across high

risk regions

Dr Maurice DemanouHead of Arbovirus Laboratory

(WHO Yellow Fever Reference Laboratory)CENTRE PASTEUR CAMEROON

Email. demanou811bis@gmail.com…………………

Lunch Symposium: Challenges in EID preparedness, the Yellow fever caseThe 2nd International Conference on (Re-)emerging Infectious Diseases

Addis Ababa, Ethiopia - March 13-15, 2019

DISCLOSURE

The Author has

nothing to disclose

OUTLINE

• AFRO Lab Network

• GAVI/WHO Assessments

• Gaps

• Way forward

Strong surveillance and LABORATORY CAPACITY is crucial

4

•Vaccine supply limitation, one of the primary pillars of the EYE

Strategy is to prioritize public health interventions based on risks.

High risk (27 countries)

Moderate risk (8 countries)

Potential for transmission (8 countries + 4 without data)

• Current limitations in YF diagnosis capacity,

particularly in Africa, A STRONG LABORATORY

NETWORK is crucial to ensure rapid and reliable

case confirmation and outbreak characterization.

AFRO Yellow Fever Laboratory Network

Ten years later…

YF laboratory network has been crucial in confirming multiple outbreaks during this time

Country Name of Laboratory City

Angola INSP Luanda

Benin Institut National de Santé Publique Cotonou

Burkina Faso Centre Muraz Bobo Dioulasso

Cameroon Centre Pasteur Cameroon Yaounde

CAR Institute Pasteur Bangui

Chad LABOHGRN N'Djamena

DRC National Institute for Biomedical Research (INRB) Kinshasha

Republic of Congo None (Refers to Kinshasha)

Cote d'Ivoire Institut Pasteur de Côte d'Ivoire Abidjan

Ethiopia Ethiopian Public Health Institute /EPHI, Virology and Rickettsiology Unit Addis Ababa

The Gambia National Health Laboratory Services, Royal Victoria Teaching Hospital Banjul

Ghana National Public Health and Reference Laboratory Accra

Guinea Centre Hospitalier Universitaire Donka, Projet des Fièvres Hémorragiques en Guinée Conakry

Guinea-Bissau Laboratoire National de Sante publique Bissau

Kenya Center for Virus Research, Kenya Medical Research Institute (KEMRI) Nairobi

Liberia National reference laboratory, Liberia Institute for Biomedical Research campus Charlesville, Margibi Couty

Mali Institut National de Santé Publique Bamako

Niger Niamey National Hospital Niamey

Nigeria 1. Yusuf Dantsoho Memorial Hospital Kaduna

1. Maitama District Hospital FCT/Abuja

1. Gombe Specialist Hospital Gombe

1. Central Public Health Laboratory Lagos

Senegal Institut Pasteur de Dakar Dakar

Sierra Leone National Public Health Laboratory Lakka

South Sudan None

Sudan National Public Health Laboratory Khartoum

Togo Laboratoire de Sérologie, Institut National d’Hygiène Lomé

Uganda Uganda Virus Research Institute Entebbe

Laboratories in Global Yellow Fever Laboratory Networkin Gavi-Eligible Countries at High Risk for Yellow Fever

SEVERAL GAPS RECORDED FOLLOWING

THE GAVI LABORATORY ASSESSMENTS

IN HIGH RISK AND GAVI ELIGIBLE COUNTRIES

No budget for YF laboratory

None of the laboratories assessed had a YF activity specific budget…

Reagent procurement

Shortages or Stock outs of critical reagents constitute a major cause of

testing interruptions or delays (20% of the samples were not tested at all

in National labs in 2017)

Sample shipments

Delays in reporting of confirmed case due to:

- Lack of funding for timely shipment of samples to RRL for confirmation

- Absence of collaboration of certain courier services

Funding, Procurement, Shipments

Sample testing

- Use of “In-house” serologic tests (MAC ELISA) with

non commercial reagents provided by different

laboratories (IPD, CDC, CPC, etc.)

- Multiple testing protocols within the network

- 92% of laboratories do molecular testing for other

pathogens, but <50% do such testing for yellow fever

- Lack of common molecular testing protocol or platform

Sample processing

- Laboratories often understaffed with multiple testing

responsibilities, so YF often relatively low priority

- Lack of training with current protocols at some laboratories

- Difficulties in monitoring IHC (No Levey Jennings graph, etc.)

- No routine or formal program for YF serologic or molecular

proficiency testing

- Infrequent accreditation visits

Staff, training & QA/QC

Equipment and facilities

Equipment and Facilities

- Lack of biosafety cabinets for sample processing

- Difficulties in repairing and maintaining equipment (No

regular preventive maintenance)

- Difficulties to calibrate instruments

- Laboratory space inadequate or shared across multiple

activities

- Electricity disruptions

Some of these gaps are currently been addressed:

- Funding from GAVI (8.2 million USD) to strengthen

laboratory capacity in high risk and GAVI eligible countries

- CDC has developed a MAC ELISA kit for YF which is under

validation, which should help address reagent logistic problems

- Regional YF diagnostic training workshop have or are been

organized: Uganda (2017), Cameroon (July 2019) and

Senegal (July-August 2019)

Way forward…(1/2)

Some of these gaps are currently been addressed:

- Already two RRLs for YF in Africa now (IPD and UVRI) and

one potential under consideration (CPC)

- Laboratory Technical Working Group (LTWG) is currently

working to address a common algorithm in the AFRO YF

Lab Network and allow case confirmation at national level

- CPC received 3 request from National labs for QA/QC

training (CAR, CHAD and DRC)

Way forward (2/2)

The end…

THANK YOU

Acknowledgement

Barbara W. Johnson

Gamou Fall

Jean-Luc Betoulle

Lee Hampton (GAVI)

Mick N. Mulders (WHO, HQ)