Update from WHO HQ - WPRO | WHO Western Pacific … from WHO HQ •W. Zhang 29 May 2012 •Hanoi •WHO WPR and SEAR NIC Meeting Change of Network name (after adoption of WHA 64.5

Update from WHO HQ • W. Zhang

29 May 2012 • Hanoi • WHO WPR and SEAR NIC Meeting

Update from WHO HQUpdate from WHO HQ

Wenqing Zhang

6th WPR and SEAR NIC Meeting29-31 May 2012 ● Hanoi



Update from WHO HQUpdate from WHO HQ

� GISRS management including PIP Framework

� Virus surveillance

� Vaccine support

� Disease monitoring and management

� Collaboration and partnership



Change of Network name(after adoption of WHA 64.5 on 24 May 2011)Change of Network name

(after adoption of WHA 64.5 on 24 May 2011)

GISN(WHO Global Influenza Surveillance Network)

GISRS (WHO Global Influenza Surveillance and Response System)



GISRS coverageGISRS coverage

� 147 laboratories in 108 Member States (111 countries, areas or territories)

– 138 NICs in 108 Member States• Since May 2011: 2 new NICs – Qatar and Jordan

– 6 WHO Collaborating Centres– 4 WHO Essential Regulatory Laboratories– 12 WHO H5 Reference Laboratories



GISRS coverageGISRS coverage



WPR and SEAR resourcesWPR and SEAR resources

� 50% - 3 of the 6 WHO CCs

� 50% - 2 of the 4 WHO ERLs

� 50% - 6 of the 12 WHO H5 Ref Labs

� GISRS coverage

Region

#

countries

(areas

and

territories

#

countries

with NICs

% of

countries

covered

by GISRS

% of

pouplation

covered by

GISRS

AFR 46 11 23.9% 49.99%

AMR 36 22 61.1% 91.85%

EMR 22 14 63.6% 85.57%

EUR 53 40 75.5% 92.93%

SEAR 11 8 72.7% 99.88%

WPR 29 16 55.2% 99.91%



Development and communicationDevelopment and communication

� New GISRS CC development– VECTOR– NIHRD– PI

� NICs participating in WHO meetings– Vaccine composition consultations

• 4 NICs in Sept 2011 and Feb 2012 consultations each

– Other WHO meetings

� GISRS Information Platform based on EZCollab– 258 users http://ezcollab.who.int/gisrs– Sub-rooms e.g. free discussion space; Antiviral surveillance WG etc.– Register today if not yet done!

� Contact us: [email protected]



PIP Framework relatedPIP Framework related

� Communications– Info Note 1 and 2 to GISRS (Aug & Dec 2011)– Discussion with CCs/ERLs – face-to-face meetings, TCs

– Email exchanges

� Uninterrupted sharing PIP materials with non-GISRS recipients– Interim measures put in place

� GISRS TORs– NIC TORs: PIP part and non-PIP part being combined into one document– CC TORs

• Written acceptance received for those under PIP Framework

• TORs for individual CC – those on PIP in Framework + additional on PIP+ those on non-PIP will be

formatted into one whole-set TOR in the CC re-designation process







� IVTM (https://extranet.who.int/ivtm/)– Launched in 2008– Framework requires GISRS labs to record in IVTM transfers of PIP biological materials

– Information in IVTM

• Publically available

• Records of transfer of PIP biological materials

– H2N3, H3N2v, H5N1, H6N8, H7N7, H8N4, H9N2

• So far a total of 603 shipments of 448 materials recorded.

• Since 24 May 2011, a total of 122 shipments of 210 materials recorded

– Including 74 shipments to 45 non-GISRS laboratories

– Development• On-line tutorial models nearly done

• Assessment for further development ongoing




� More information: http://www.who.int/influenza/pip/en/



Virus surveillancelaboratory diagnostics

Virus surveillancelaboratory diagnostics

� Advisory group– PCR WG meetings: 14-15 June 2011; 26-27 June 2012

� Diagnostic protocols– Diagnostic protocols being updated: review existing protocols, including H5, H7 and

H9

� Quality: EQAP (PCR)– summary analysis of panels 9 and 10 published on WER in Jan 2012– panel 11 on-going; one panel per year as from 2012

� IRR: WHO CC in CDC Atlanta– IRR website to be launched soon Panel 9 Panel 10

AFR 62.5% 79.2%

EMR 78.6% 64.3%

EUR 74.6% 75.4%

PAH 78.1% 84.4%

SEAR 75.0% 75.0%

WPR 91.3% 83.3%

% of labs with 100% correct performance WHO

Region



Virus surveillancevirus monitoring


� Coordination of global virological surveillance– Virus evolutions potential of public health significant– Continuous monitoring of proportion of circulating viruses– Routine and ad-hoc TC with CCs– Bi-weekly update





� Strengthening GISRS virus monitoring capacity– Quality

• Representativeness

• Coverage: efforts in Africa and Middle-East

• PCR vs. virus isolation

– Emerging needs• Antiviral susceptibility surveillance

– 1stWG Nov 2011; website to be launched shortly

– 2nd WG 28-29 June 2012; focusing on practical guidance to NICs

• Tailored training: serology, sequencing

– Sustainability





� GISRS reporting to FluNet– Since 1 May 2011, 2 NICs in SEAR and 1 in WPR not yet reported to FluNet

� FluNet development– More SQL charts for public access on the WHO web

– Investigating • Tools for geographical maps with SQL Reporting Service

• Tools for data entry

• New IT platform to host FluNet

– Continue the collaboration with regional offices on data exchange mechanisms and FluNet customization



Virus surveillancevirus sharing and shipping logistics

Virus surveillancevirus sharing and shipping logistics

� WHO Shipping Fund Project (SFP)– Key component of GISRS function– Contract with World Courier renewed– Scale down

• Low and lower-middle income countries

• Emergencies

• Direct payment by recipient CCs

• Working with ROs

� E-tool underdevelopment for Infectious Substance Shipping Training

WHO Region # of shipments %AFR 18 14%AMR 32 25%EMR 10 8%EUR 37 29%

SEAR 5 4%WPR 26 20%

From 1 May 2011 - 30 April 2012

Region Long Name Income Group

SEAR People's Republic of Bangladesh Low income

SEAR Union of Myanmar Low income

SEAR Nepal Low income

SEAR Democratic People's Republic of Korea Low income

SEAR Kingdom of Bhutan Lower middle income

SEAR Republic of Indonesia Lower middle income

SEAR Republic of India Lower middle income

SEAR Democratic Socialist Republic of Sri Lanka Lower middle income

SEAR Democratic Republic of Timor-Leste Lower middle income

WPR Kingdom of Cambodia Low income

WPR Republic of Fiji Lower middle income

WPR Federated States of Micronesia Lower middle income

WPR Republic of Kiribati Lower middle income

WPR Lao People's Democratic Republic Lower middle income

WPR Republic of the Marshall Islands Lower middle income

WPR Mongolia Lower middle income

WPR Republic of the Philippines Lower middle income

WPR The Independent State of Papua New Guinea Lower middle income

WPR Solomon Islands Lower middle income

WPR Kingdom of Tonga Lower middle income

WPR Tuvalu Lower middle income

WPR Socialist Republic of Vietnam Lower middle income

WPR Republic of Vanuatu Lower middle income

WPR Samoa Lower middle income



Vaccine supportVaccine support

� Update WHO recommendations on vaccine composition– Sept 2011 – SH 2012; Feb 2012 – NH 2012-2013– 17-19 Sept 2012, Beijing

� Coordination of the development, evaluation and making available candidate vaccine reassortant viruses

– Chairing routine TCs with IFPMA and other manufactures• In particular after Feb 2012 with 2 changes of the components

– Update availability of new candidate vaccine viruses/potency reagents on WHO Website• Including seasonal, H5, H9 and H3N2 v

http://www.who.int/influenza/vaccines/virus/en/



Vaccine supportVaccine support

� Improving influenza vaccine virus selection process– 2nd Informal consultation Dec 2011 – publication under development– Continued efforts needed to equip the WHO process

• The 3rd consultation is postponed to 2013

� Regulatory support– Coordination with regulatory counterpart in WHO– CCs/ERLs support to alternative potency assay development– Cell culture project

� Policy support– SAGE



Respiratory disease monitoring and assessment- your data to protect the world against flu

Respiratory disease monitoring and assessment- your data to protect the world against flu

� Ongoing Risk assessment of human infection with influenza viruses with pandemic potential with monthly web updates

� Disease surveillance and monitoring biweekly and biyearly updates

� Fluid moved to a new platform, to facilitate quick upload of data. Eighty-four countries have data in Fluid now. [email protected]

� The Global influenza surveillance standards document is going through the clearance process

� Burden of disease manual is nearly completed

� Pandemic global burden project: sero-survey meta-analysis has been submitted and is under revision

� Pandemic mortality estimates

� Research agenda



Influenza and respiratory diseasesClinical managementInfluenza and respiratory diseasesClinical management

� Developing Norms & Standards (guidelines)

� Keep track on best treatment– Use of antivirals & other medicines– Resistance monitoring, risk assessment– Antiviral stockpile management– Promoting IMCI/IMAI, Oxygen use, severe influenza critical care.

� Use of Point-of-Care diagnostics

� Infection control, HCW vaccination policy

� Promote clinical research



GISRS Collaboration and partnershipGISRS Collaboration and partnership

GISRS teamGISRS, Influenza Viruses

and Vaccine Support

WHO/HQ/HSE

WHO ROs

WHO COs

FOS

QSS

IVR/IVB

IRD(Epi) team

PIP Secretariat

KMS

LEG

IHR/GCR

WHO CCs

NICs

WHO ERLs

H5 Ref labs

DCVMNIFPMA

USAID

GISAID

NIH

GEIS/DOD

ISIRV

OFFLU

BARDA



GISRS Collaboration and partnershipGISRS Collaboration and partnership

[email protected]

GISRS teamGISRS, Influenza Viruses

and Vaccine Support

WHO/HQ/HSE



Key messagesKey messages

� A key component of global health security – Proved through SARS; Pandemic H1N1 2009

� A continuous public health need– Nature of influenza virus decides

� A network, a global united team; appreciation from MS– NICs are backbone– All members, NICs, CCs, ERLs, H5 Ref Labs, playing an equally important, indispensable role

� Challenges ahead– Economic situation – sustainability– Increasing public health needs

� Opportunities ahead– PIP Framework implementation; political commitment– New technologies, more research– New vaccines, next generation vaccines – Strengthened partnership

� Commitments from WHO - COs, ROs and HQ



AcknowledgementAcknowledgement

� GISRS: NICs, CCs, ERLs, H5 Ref Labs

� ROs, COs, other WHO Dept./Office/Unit

� Financial support from USCDC, USAID

� External partners



Documents

Update from WHO HQ - WPRO | WHO Western Pacific … from WHO HQ •W. Zhang 29 May 2012 •Hanoi •WHO WPR and SEAR NIC Meeting Change of Network name (after adoption of WHA 64.5