1. WHO Operational Plan for RSV Surveillance Pilot
WHO Global Influenza Program
WHO HQ
May 10, 2016

2. RSV surveillance: WHY?
RSV in children <5 years of age (estimates 2005)
Annual global number of non-severe cases = 33.8 million
96 % in developing countries
Annual global number of severe cases = 3.4 million
91 % in developing countries
Annual global number of RSV-associated deaths = –
99 % in developing countries
Harish Nair et al. 2010; The Lancet 375(9725):

3. RSV surveillance: WHY? (2)
Caroline Breese Hall, New England Journal of Medicine 2001;

4. RSV surveillance: WHY? (3)

5. RSV Surveillance Pilot: OBJECTIVES
Feasibility of RSV surveillance built on GISRS platform
Evaluation of optimal RSV case definitions
Evaluation of optimal sampling strategies
Evaluation of testing algorithms
Build laboratory capacity for RSV testing in pilot countries
Identification of RSV seasonality
Evaluate reporting strategies
Identification of age and risk groups for severe RSV disease
Assess additional costs caused by RSV surveillance
Study evolution of RSV by subtype and genotype

6. RSV Surveillance Pilot: OBJECTIVES (continued)
Provide platform for future studies such as:
Global RSV surveillance
Vaccine studies
Cost-effectiveness and impact analyses of vaccines
Broader respiratory virus surveillance

7. RSV Surveillance Pilot WILL NOT PROVIDE
Data on population-based RSV disease burden
Specific data for assessment of RSV vaccine effectiveness
Data on economic burden due to RSV disease
Complete clinical description of RSV disease in risk- and age-groups
Data on validity of different case definitions

8. World Health Organization
14 May, 2018
RSV Surveillance Pilot
Experience from countries testing RSV along influenza surveillance reviewed
14 countries from 6 ROs nominated for pilot – to be rolled out in June 2016
RSV pilot countries
Reference laboratory
3 Specialized laboratories with long-standing experience with RSV
CDC Atlanta
NICD Johannesburg
PHE London Colindale

9. RSV Surveillance Pilot: HOW? (2)
Year-round surveillance
Duration 3 years
Real-time PCR detection of RSV
Primarily hospital-based surveillance
EQA to establish sensitivity and specificity of tests in use
Test protocols from CDC Atlanta
CDC Atlanta will make primer and probe kits available
Annual EQA for participating laboratories

10. RSV Surveillance Pilot: CASE DEFINITIONS
Up to 50% of RSV-infected young children
and elderly patients present without fever
ILI definition does not capture well RSV illnesses
Therefore:
Hospital-based surveillance:
Use SARI with and without fever
Community-based surveillance:
Use ARI with and without fever
In infants 0 – 3 months of age:
Include apnea and sepsis

11. Minimum sample size requirements for hospital surveillance:
500 samples per year from children 0 – 5 years of age
250 from children between 0 – 5 months
250 from children 6 months – 5 years
250 samples per year from individuals 5 – 64 years of age
250 samples per year from elderly (≥65 years of age)
3 Pilot laboratories in PAHO countries will test ALL samples collected from patients meeting the RSV criteria
Countries performing community surveillance without the possibility to include hospitalized patients meeting the expanded SARI case definition should continue to conduct ARI surveillance and use similar strategies to meet minimal sampling size.

12. RSV laboratory testing algorithm
Samples meeting the RSV criteria will be submitted to the Pilot NIC for testing

13. RSV Surveillance Pilot: Data Reporting
Laboratory data
Reported as aggregated data set through the FluNet
Case-based data
Collected on RSV standardized forms
Reported through separate data collection mechanism