Laboratory preparedness and response
National influenza centres (NICs) and other public health laboratories play a key role in global health security by confirming human cases infected with emerging influenza viruses or other respiratory pathogens causing severe disease, such as avian influenza A(H7N9) or Middle East respiratory syndrome coronavirus (MERS-CoV).
WHO/Europe supports NICs to develop the capacity to detect such emerging pathogens by:
- facilitating the sharing of viruses among institutions of the WHO Global Influenza Surveillance and Response System (GISRS);
- providing rapid guidance for laboratory detection, training and external quality assessment (EQA) programmes;
- providing regular updates on influenza and GISRS-related information.
Response to the 2009 pandemic
Within weeks of the first detection and characterization of the pandemic H1N1 virus, the WHO Collaborating Centre for Reference and Research on Influenza (WHO CC) at the United States Centers for Disease Control and Prevention (CDC), Atlanta, United States of America, distributed PCR detection kits to NICs across the globe.
NICs in the European Region, as elsewhere in the world, played a frontline role in the response to the pandemic. Their first task was to ensure that they could detect cases infected with the new virus.
In addition to providing guidance on laboratory testing, biosafety and sample transport procedures, WHO facilitated the shipment of PCR kits and other reagents provided by the WHO CC in Atlanta, as well as sampling materials to laboratories that lacked sustainable resources. WHO continued to provide proficiency panels through the WHO External Quality Assessment Programme (EQAP), which was updated to include the pandemic A(H1N1)pdm09 virus. Global and regional teleconferences on virological issues were held, which were deemed extremely useful by laboratories for sharing experience and good practice.
In the aftermath of the 2009 pandemic, WHO/Europe conducted an evaluation of pandemic preparedness among NICs in the Region. A number of success factors were identified, including close collaboration between laboratory networks and access to international information and support, activities that strengthen laboratory quality and government-approved pandemic plans.
Pandemic preparedness activities have continued to emphasize these areas.
Response to emergence of avian influenza A(H7N9)
In 2013, rapid sharing of A(H7N9) viruses with WHO resulted in the rapid provision of testing protocols, reagents and control materials to NICs and other public health laboratories. Immediately after the first cases of A(H7N9) were reported to WHO in March 2013, WHO/Europe in collaboration with ECDC and the European Reference Laboratory Network for Human Influenza (ERLI-Net) developed guidance for establishing real-time RT-PCR assays for the detection of avian influenza A(H7N9) virus and conducted rapid reviews of laboratories’ capacities to detect this emerging virus.
Two months after sequence information on the first reported case of avian influenza A(H7N9) was made available, newly developed molecular detection assays had been extensively deployed among NICs in the WHO European Region ensuring detection of the avian influenza A(H7N9) viruses in the majority of countries on submission of a sample to an NIC.
External quality assessment programmes for influenza are being conducted in 2014 to validate newly established A(H7N9) detection assays. In addition, WHO/Europe is developing training programmes for NICs to be better prepared to rapidly detect emerging influenza and other respiratory viruses with pandemic potential.