Strengthening national laboratories’ oversight capacity to support measles and rubella elimination

WHO

Detection and control of communicable diseases would not be possible without accurate laboratory data on when and where a particular disease is circulating. WHO/Europe therefore works with all Member States to steadily improve the quality and reliability of the laboratory data used to determine the Region’s progress towards measles and rubella elimination. The latest step in this process is to support accredited laboratories at national level in developing country-specific oversight mechanisms to ensure quality data is received from all levels of their countries’ disease surveillance systems.

No disease elimination verification without quality data

Measles and rubella are targeted for elimination in the European Region. Each year the independent European Regional Verification Commission for Measles and Rubella Elimination (RVC) meets to review country reports and verify whether each country remains endemic for these diseases or has successfully prevented the viruses or stopped them from spreading within their borders. To make these assessments, the RVC requires reliable evidence, including the volume and outcome of laboratory testing of suspected cases, in addition to the number and proportion of children vaccinated each year. As a country progresses toward measles and/or rubella elimination, increasingly complex laboratory evidence is required to verify the country’s status.

Critical steps towards in-country oversight

WHO/Europe coordinates the European Measles and Rubella Laboratory Network (MR LabNet). Each of the national laboratories in this network undergoes regular external quality assessment through an annual accreditation programme. They all also benefit from periodic regional meetings, technical updates and training.

In many Member States, however, measles and rubella testing is often performed in non-WHO-accredited laboratories and several Member States still fail to provide information about the proficiency of these laboratories. Strengthening the role of national laboratories in overseeing the performance of subnational laboratories in these countries has become a critical need in monitoring the Region’s measles and rubella elimination efforts.

Supported by their health authorities, some WHO-accredited national laboratories have undertaken different approaches to ensure quality, ranging from limited periodic quality control to establishing and coordinating national laboratory networks with a comprehensive accreditation system aligned with that of WHO.

To support Member States that have not yet initiated an oversight mechanism in line with WHO recommendations, WHO/Europe organized a technical consultation for the MR LabNet on 14–15 November 2019. The meeting brought together delegations from 8 countries; senior laboratory experts from the regional reference laboratory in Berlin, Germany, and the global specialized laboratory in London, United Kingdom; a representative of the Regional Verification Commission; and an observer from the European Centre for Disease Prevention and Control. Together they reviewed their national contexts and developed country-specific work plans for establishing national networks and/or oversight mechanisms, including preliminary monitoring and evaluation indicators. WHO/Europe will compile country best practices and lessons learned and share them in a publication to provide inspiration and guidance to other countries that have not yet established oversight mechanisms.

Establishing oversight mechanisms and/or national measles and rubella laboratory networks compliant with MR LabNet standards will not only optimize the participation of these networks in national and regional processes to verify disease elimination, but also contribute to strengthening the quality of vaccine-preventable disease surveillance.