The Role of NICs in Influenza Surveillance Good morning. Magdi Samaan Global Influenza Programme World Health Organization, Geneva

GISRS Network NIC Role in Influenza Surveillance OBJECTIVES GISRS Network NIC Role in Influenza Surveillance In this presentation I will go quickly over the Who GISRS network. then will briefly highlight the role of national influenza centres in influenza surveillance covering broadly some of their terms of reference.

GISRS Established in 1952 (mature network) Objective: protect the world from a clear and present danger: Human and animal influenza viruses, a silent formula for an eminent pandemic Members (so far) 144 National Influenza Centres in 117 countries; areas or territories 5 WHO Collaborating Centres for Reference and Research on Influenza 1 WHO Collaborating Centre for Studies on the Ecology of Influenza in Animals 3 "Essential" Regulatory laboratories 13 WHO H5 Reference Laboratories the establishment of the WHO Global Influenza Surveillance System or (GISRS) in 1952 recognized the need to monitor changes in the influenza viruses in relation to the impact of disease. It is the primary global mechanism and resource for surveillance and control of influenza. GISRS network is formed of National Influenza Centres (NICs), WHO Collaborating Centres on influenza (WHO CCs), Essential regulatory laboratories and WHO H5 reference labs.

144 NICs in 117 countries, areas and territories GISRS – the network WHO CCs/ERLs H5RL NICs 144 NICs in 117 countries, areas and territories This map shows the geographic distribution of the GISRS network. The recent expansion in the number and capacities of NICs over the past decade, with about 60% of countries participating in global influenza surveillance, has been due in part to pandemic threats from zoonotic infection (H5N1, H7N9, etc.). The GISRS network continuously monitors the evolution of influenza viruses around the world in the interest of public health, conducts risk assessment and recommends risk management measures

GISRS members of the Americas 29 NICs in 22 countries, areas and territories 2 WHO CCs 1 ERL 2 H5 Reference labs In the Americas, there are 29 NICs, two WHO Collaborating Centres, one Essential regulatory capacity and two H5 reference labs.

National Influenza Centres What is a national influenza centre, what is its role in influenza surveillance.

National Influenza Centres (NIC) What are National Influenza Centres (NIC) Officially designated by MoH and recognized by WHO TOR of NICs: http://www.who.int/influenza/gisrs_laboratory/national_influenza_centres/tor_nic.pdf Serve as the key point of contact between WHO and country Collected appropriate specimens; conduct virus detection and preliminary analysis; send representative specimens to WHO CCs Often the national reference laboratories for influenza diagnosis (seasonal, novel) National influenza centres are officially designated by their countries and then recognized by WHO. They operate under specific terms of reference which will be highlighted separately in another session of this meeting. A NIC serves as key point of contact between WHO and their country. NICs often act as the national reference lab for influenza diagnosis whether seasonal or novel influenza viruses. A NIC may have additional obligations under the national authority of its host country

NICs Public Health Responsibilities National and International Monitor/assess risk Detect/respond Prepare Sharing and Reporting For influenza and other respiratory virus infections National and international mandates The strong scientific base and expertise of many of the well-established NICs reflect to a large extent their national public health responsibilities, as part of the local healthcare system, which go beyond influenza and include more general emergency response capabilities. The NIC core function reflect the inter-dependency of diagnosis, virological surveillance, novel virus characterisation and epidemiology, outbreak preparedness and investigation, as well as applied research on improved test methodologies and medical counter-measures. Such responsibilities also to meet the requirements under the international health regulations of 2005 and the Pandemic Influenza Preparedness Framework for virus and benefit sharing.

Conduct influenza surveillance NICs responsibilities to the GISRS network Conduct influenza surveillance Timely sharing surveillance data within GISRS and with WHO Timely sharing viruses with WHO CCs Provide experts to different Expert working groups. NICs, as the foundation of the GISRS network, function through efficient sharing of influenza viruses and surveillance information, provision of technical support and updated reagents by and to GISRS members, as endorsed by national authorities of host countries of GISRS institutions. The function of GISRS is coordinated by the GIP across the three levels of WHO: headquarters, regional offices and country offices

NICs – technical capacity NICs collect influenza viruses (specimens from influenza national surveillance) Perform diagnostics for influenza Share influenza viruses with the WHO CCs Share surveillance data In terms of technical capacity, NICs collect influenza viruses either through an established network of physicians, health care centers or other sentinel sites, and/or they solicit influenza virus-positive samples from laboratories providing diagnostic services. According to available resources, NICs identify influenza viruses by different laboratories methods. NICs report timely, defined virological surveillance information to WHO. Share viruses with WHO CCs which contribute to the seasonal influenza vaccine composition updates. In the past 22 years, the NICs in the Americas processed over 12 million clinical specimens for influenza virus detection and subtyping, which probably have also been tested for other respiratory viruses. Such enormous amount of work has been achieved by NICs.

NICs output An important output from NICs surveillance is the data shared via FluNet (for virological data) and FluID (for epidemiological data), virus genetic sequence data and associated information on antiviral resistance of influenza viruses.

NICs output This is the latest influenza surveillance data of the NICs in the WHO region of the Americas.

NICs output This map show the countries which reported surveillance data whether virological or epidemiological to FluNet and FluID. Green color indicates both types of data were reported, it is clear that almost all the NICs in the Americas have done their share.

NICs – human-animal interface NICs, within GISRS, also act an early warning system to inform the global community on novel influenza viruses jumping the interspecies barrier. In their capacity provide rapid response to such events in collaboration with animal health sector and other national and international partners to control the virus spread and curtail further adaptation to human, in such sense to prevent emergence of a pandemic.

Zoonotic Candidate vaccine virus (CVV) development NICs Output Zoonotic Candidate vaccine virus (CVV) development Another pandemic preparedness output of NICs and GISRS is candidate vaccine viruses of influenza viruses with pandemic potential. This achieved through the surveillance, detection, virus sharing by the NICs coupled by the full genetic and antigenic characterization work done at the WHO CCs and development of such CVVs to be available in case of a pandemic caused by a virus strain antigenically similar to these CVVs.

Lastly, but not least, this image is just to remind us that an influenza pandemic is a fact and we know it will happen, but we don’t know when. We are now better prepared than 1918, but there is more work to be done.

Thank You http://www. who