1.Preparedness for Zika virus testing in the World Health Organization Western Pacific Region
Raynal C Squires ; Frank Konings
Western Pacific Surveillance and Response 2016;7(1):44-47
On 1 February 2016, the World Health Organization (WHO) declared that clusters of microcephaly cases and other neurological disorders occurring in Zika virus (ZIKV)-affected areas constituted a public health emergency of international concern. Increased surveillance of the virus, including the requirement for laboratory confirmation of infection, was recommended. The WHO Regional Office for the Western Pacific therefore initiated a rapid survey among national-level public health laboratories in 19 countries and areas to determine regional capacity for ZIKV detection. The survey indicated that 16/19 (84%) countries had capacity for molecular detection of ZIKV while others facilitated testing through referral. These results suggest that robust laboratory capacity is in place to support ZIKV surveillance in the Western Pacific Region.
2.Preparedness for molecular testing of Middle East respiratory syndrome coronavirus among laboratories in the Western Pacific Region
Squires Raynal C ; Konings Frank
Western Pacific Surveillance and Response 2014;5(3):40-42
Since the notification of the first cases of Middle East respiratory syndrome coronavirus (MERS-CoV) in September 2012, a total of 837 laboratory-confirmed cases and 291 deaths have been reported globally as of 23 July 2014, primarily in the Arabian Peninsula. However, the possibility of importation of MERS-CoV in the World Health Organization (WHO) Western Pacific Region exists given the large number of individuals who travel annually to the Middle East for religious purposes, employment or other reasons.
3.Sex matters – a preliminary analysis of Middle East respiratory syndrome in the Republic of Korea, 2015
Jansen Andreas ; Chiew May ; Konings Frank ; Lee Chin-Kei ; Ailan Li
Western Pacific Surveillance and Response 2015;6(3):68-71
Convincing evidence suggests that females and males are different in regard to susceptibility to both infectious and non-infectious diseases. Sex and gender influences the severity and outcome of several infectious diseases, including leptospirosis, tuberculosis, listeriosis, Q fever, avian influenza and SARS.
4.External quality assessment for arbovirus diagnostics in the World Health Organization Western Pacific Region, 2013–2016: improving laboratory quality over the years
Mohammad Yazid Abdad ; Raynal Squires ; Sebastien Cognat ; Christopher John Oxenford ; Frank Konings
Western Pacific Surveillance and Response 2017;8(3):27-30
Arboviruses continue to pose serious public health threats in the World Health Organization (WHO) Western Pacific Region. As such, laboratories need to be equipped for their accurate detection. In 2011, to ensure test proficiency, the WHO Regional Office for the Western Pacific piloted an external quality assessment (EQA) programme for arbovirus diagnostics. By 2016, it had grown into a global programme with participation of 96 laboratories worldwide, including 25 laboratories from 19 countries, territories and areas in the Region. The test performance of the 25 laboratories in the Region in 2016 was high with 23 (92%) reporting correct results in all specimens for dengue and chikungunya viruses. For Zika virus, 18 (72%) of the 25 laboratories reported correct results in all specimens, while seven (28%) demonstrated at least one error. When comparing iterations of this EQA programme in the Region between 2013 and 2016, the number of participating laboratories increased from 18 to 25. The first round only included dengue virus, while the latest round additionally included chikungunya, Zika and yellow fever viruses. Proficiency for molecular detection of dengue virus remained high (83–94%) over the four-year period. The observed proficiency for arbovirus diagnostics between 2013 and 2016 is an indicator of laboratory quality improvement in the Region.
5.External quality assessment of dengue and chikungunya diagnostics in Asia Pacific region, 2015
Li Ting Soh ; Raynal C Squires ; Li Kiang Tan ; Kwoon Yong Pok ; HuiTing Yang ; Christina Liew ; Aparna Singh Shah ; John Aaskov ; Sazaly Abubakar ; Futoshi Hasabe ; Lee Ching Ng ; Frank Konings
Western Pacific Surveillance and Response 2016;7(2):26-34
OBJECTIVE: To conduct an external quality assessment (EQA) of dengue and chikungunya diagnostics among national-level public health laboratories in the Asia Pacific region following the first round of EQA for dengue diagnostics in 2013.
METHODS: Twenty-four national-level public health laboratories performed routine diagnostic assays on a proficiency testing panel consisting of two modules. Module A contained serum samples spiked with cultured dengue virus (DENV) or chikungunya virus (CHIKV) for the detection of nucleic acid and DENV non-structural protein 1 (NS1) antigen. Module B contained human serum samples for the detection of anti-DENV antibodies.
RESULTS: Among 20 laboratories testing Module A, 17 (85%) correctly detected DENV RNA by reverse transcription polymerase chain reaction (RT-PCR), 18 (90%) correctly determined serotype and 19 (95%) correctly identified CHIKV by RT-PCR. Ten of 15 (66.7%) laboratories performing NS1 antigen assays obtained the correct results. In Module B, 18/23 (78.3%) and 20/20 (100%) of laboratories correctly detected anti-DENV IgM and IgG, respectively. Detection of acute/recent DENV infection by both molecular (RT-PCR) and serological methods (IgM) was available in 19/24 (79.2%) participating laboratories.
DISCUSSION: Accurate laboratory testing is a critical component of dengue and chikungunya surveillance and control. This second round of EQA reveals good proficiency in molecular and serological diagnostics of these diseases in the Asia Pacific region. Further comprehensive diagnostic testing, including testing for Zika virus, should comprise future iterations of the EQA.
6.First round of external quality assessment of dengue diagnostics in the WHO Western Pacific Region, 2013
Pok Kwoon Yong ; Squires Raynal C ; Tan Li Kiang ; Takasaki Tomohiko ; Abubakar Sazaly ; Hasebe Futoshi ; Partridge Jeffrey ; Lee Chin Kei ; Lo Janice ; Aaskov John ; Ng Lee Ching ; Konings Frank
Western Pacific Surveillance and Response 2015;6(2):73-81
Objective:Accurate laboratory testing is a critical component of dengue surveillance and control. The objective of this programme was to assess dengue diagnostic proficiency among national-level public health laboratories in the World Health Organization (WHO) Western Pacific Region.Methods:Nineteen national-level public health laboratories performed routine dengue diagnostic assays on a proficiency testing panel consisting of two modules: one containing commercial serum samples spiked with cultured dengue viruses for the detection of nucleic acid and non-structural protein 1 (NS1) (Module A) and one containing human serum samples for the detection of anti-dengue virus antibodies (Module B). A review of logistics arrangements was also conducted.Results:All 16 laboratories testing Module A performed reverse transcriptase polymerase chain reaction (RT–PCR) for both RNA and serotype detection. Of these, 15 had correct results for RNA detection and all 16 correctly serotyped the viruses. All nine laboratories performing NS1 antigen detection obtained the correct results. Sixteen of the 18 laboratories using IgM assays in Module B obtained the correct results as did the 13 laboratories that performed IgG assays. Detection of ongoing/recent dengue virus infection by both molecular (RT–PCR) and serological methods (IgM) was available in 15/19 participating laboratories.Discussion:This first round of external quality assessment of dengue diagnostics was successfully conducted in national-level public health laboratories in the WHO Western Pacific Region, revealing good proficiency in both molecular and serological testing. Further comprehensive diagnostic testing for dengue virus and other priority pathogens in the Region will be assessed during future rounds.
7.Influenza virus detection: driving change in public health laboratories in the Western Pacific Region
Raynal Squires ; Patrick Reading ; Sheena Sullivan ; Ian Barr ; Frank Konings
Western Pacific Surveillance and Response 2018;9(5):68-70
Abstract
As we observe the 100th anniversary of the 1918 influenza pandemic, we are reminded of the importance of preparedness for and adequate response to influenza, and the critical role of influenza surveillance through laboratory detection. Influenza virus detection has helped drive the development of diagnostic and virology laboratories in the World Health Organization (WHO) Western Pacific Region over the last 10–15 years, at the same time strengthening their capacity to detect and respond to infectious threats beyond influenza. Such cross-cutting approaches are advocated under the Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies (APSED III),1 which continues to guide Member States in advancing implementation of the International Health Regulations, 20052 and has a dedicated focus on strengthening laboratory capacities.
8.From H5N1 to HxNy: An epidemiologic overview of human infections with avian influenza in the Western Pacific Region, 2003–2017
Sarah Hamid ; Yuzo Arima ; Erica Dueger ; Frank Konings ; Leila Bell ; Chin-Kei Lee ; Dapeng Luo ; Satoko Otsu ; Babatunde Olowokure ; Ailan Li ; WPRO Health Emergencies Programme Team
Western Pacific Surveillance and Response 2018;9(5):53-67
Abstract
Since the first confirmed human infection with avian influenza A(H5N1) virus was reported in Hong Kong SAR (China) in 1997, sporadic zoonotic avian influenza viruses causing human illness have been identified globally with the World Health Organization (WHO) Western Pacific Region as a hotspot. A resurgence of A(H5N1) occurred in humans and animals in November 2003. Between November 2003 and September 2017, WHO received reports of 1838 human infections with avian influenza viruses A(H5N1), A(H5N6), A(H6N1), A(H7N9), A(H9N2) and A(H10N8) in the Western Pacific Region. Most of the infections were with A(H7N9) (n = 1562, 85%) and A(H5N1) (n = 238, 13%) viruses, and most (n = 1583, 86%) were reported from December through April. In poultry and wild birds, A(H5N1) and A(H5N6) subtypes were the most widely distributed, with outbreaks reported from 10 and eight countries and areas, respectively.
Regional analyses of human infections with avian influenza subtypes revealed distinct epidemiologic patterns that varied across countries, age and time. Such epidemiologic patterns may not be apparent from aggregated global summaries or country reports; regional assessment can offer additional insight that can inform risk assessment and response efforts. As infected animals and contaminated environments are the primary source of human infections, regional analyses that bring together human and animal surveillance data are an important basis for exposure and transmission risk assessment and public health action. Combining sustained event-based surveillance with enhanced collaboration between public health, veterinary (domestic and wildlife) and environmental sectors will provide a basis to inform joint risk assessment and coordinated response activities.