2014-10-30-世界卫生组织-Draft_report_of_the_IB-VPD_Laboratory_Technical_Working_Group_Meeting_-_November_2014_14页_636kb

Summary of WHO-Coordinated IBVPD Surveillance Network Laboratory TWG Meeting (2014)

1. Background

• Established in 2011, the Laboratory Technical Working Group provides guidance for the WHO-Coordinated IBVPD Surveillance Network to strengthen capacities for monitoring invasive bacterial diseases (Strep pneumo, Hi influenzae, Neisseria meningitidis).
• A 2013 Strategic Review endorsed recommendations for network strengthening; this 2014 meeting evaluated implementation progress and discussed enhancing the network's functions from surveillance to vaccine impact monitoring.

2. Meeting Objectives

1. Review implementation of Strategic Review recommendations, data flow, performance monitoring, and site assessments.
2. Address data quality issues and improve laboratory reporting.
3. Define future directions for Quality Assurance and Quality Control (QA/QC).
4. Discuss optimization of laboratory procedures.

3. Key Findings & Recommendations

Network Overview and Regional Updates

• Significant progress made in implementing 26 of 30 ITAG recommendations.
• Challenges remain in sample referral and testing processes (storage, logistics, regulations), data linkage and low rates of bacterial isolation.

Improving Data Quality

• PCR Diagnostics: Increase in diagnostic yield for bacterial meningitis.
• Reporting Issues: Missing data at sentinel sites; low bacterial isolation rates.
• Recommendations to Improve Data Quality:
  • Standardize RRL PCR reporting forms by end of 2014.
  • Bridge clinical-laboratory data by using a unique patient ID number.
  • Implement web-based tool for data cleaning and feedback; pilot in PAHO and SEARO.
  • Focus on quality of initial lab testing (use of reagents, proper specimen prep).

Quality Assurance and Control (QA/QC)

• External Quality Assessment (EQA):
  • High performance by most labs in 2014.
  • Recommendations for 2015 EQA: Consistent contractors, agreed timelines, updated lab details early.
• Laboratory QC for Confirmatory Testing (RRL-CDC GRL):
  • High concordance rates reported (91% detection, 93% ST/SG).
  • Procedures for handling discrepant results remained effective.
  • Recommended stable timelines and further refinement of QC processes.

Optimizing Laboratory Procedures and Capacities

• Procurement: Timely availability of lab supplies is an issue, especially in AFR/EUR.
• Direct PCR for CSF: Recommended validation and adoption in interested RRLs to save time and reduce contamination risk.
• Bacteriology Capacity: Focus on building site-level capacity using assessments.
• References and Equipment: Guidance on lab equipment and supplies to be compiled.

4. Conclusion

The meeting identified progress in several areas but flagged ongoing challenges in sample referral, data linkage, and QC processes. Recommendations focus on enhancing data quality, standardizing reporting, strengthening QA/QC, and optimizing use of new techniques like Direct PCR.