Collaboration to strengthen laboratories contributes to measles and rubella elimination

WHO/Mihail Grigorev

Laboratory technician working with pipette and samples

As part of its ongoing support to increase the quality of disease surveillance, WHO/Europe recently organized 2 meetings of the European Measles and Rubella Laboratory Network (MR LabNet). The meeting on 13–15 November 2018 gathered members of western and central European countries, and the partially overlapping meeting on 14–16 November 2018 brought together members of the Russian Federation and newly independent states.

High level of laboratory proficiency and sustained collaboration needed to achieve elimination

As the WHO European Region moves closer to measles and rubella elimination, laboratories play an increasingly important role in confirming suspected cases of measles, rubella and congenital rubella syndrome, and in monitoring viral genetic variants when cases occur.

To support them in this role, WHO/Europe coordinates MR LabNet, established in 2002. Through collaboration, training and annual assessments, WHO/Europe and MR LabNet members aim to meet the increased need for high-quality, case-based, laboratory-supported surveillance; effective testing of potential cases; and monitoring of progress towards elimination.

“The role of the Network is becoming increasingly important to support elimination-standard surveillance,” says Dr Myriam Ben Mamou, WHO/Europe Technical Officer and MR LabNet Coordinator. “Indeed, in low-transmission settings, the laboratory contribution to excluding endemic transmission has already become fundamental, and testing algorithms have been adapted accordingly in newly released WHO guidelines. WHO therefore works closely with all laboratories in the Network to ensure a high level of proficiency and performance of disease surveillance throughout the Region.”

Learning with and from each other

The meetings, held in Copenhagen, Denmark, provided updates on recent developments at WHO global and regional levels and the perspectives of the Regional Verification Commission for Measles and Rubella Elimination (RVC). More than 70 participants and observers from 50 Member States, partner agencies and the RVC attended.

Through thematic presentations, training activities and a poster session, the meetings also provided a forum for measles and rubella laboratories of the Region to present information on their performance, achievements, and research and development. They shared progress and experiences at the country level, and discussed challenges regarding laboratory aspects of measles and rubella surveillance.

In an interactive case-study session, participants emphasized the importance of analysing laboratory results together with corresponding epidemiological and clinical information to optimize testing strategies and correctly interpret laboratory data according to elimination status.

The meetings also provided the opportunity to:

  • enhance networking and collaboration among WHO national, regional reference and global specialized laboratories;
  • discuss accreditation reviews, external quality assessment issues and laboratory contributions to national verification processes;
  • present recent information about the comparison and procurement of measles and rubella serology kits;
  • update participants on the recent developments of the MR LabNet online learning tool;
  • present the new WHO laboratory manual and discuss the implications of the revised laboratory algorithms in different settings; and
  • hold a skill-strengthening session on viral sequence analysis and management, including reporting to WHO nucleotide surveillance databases.

Status of measles and rubella elimination in the Region

Progress towards measles and rubella elimination in the Region is uneven. Of the Region’s 53 countries, 43 have demonstrated to the RVC that they interrupted endemic transmission for at least 12 months as of December 2017. At the same time, the RVC expressed concerns at its meeting in June 2018 about inadequate disease surveillance and low immunization coverage in some countries.

Measles has spread in large parts of the Region in 2018, causing a record number of cases and scores of deaths, thereby threatening progress that has been made.