Review of the DoD-GEIS Influenza Programs Strengthening Global Surveillance and Response (2008) / Chapter Skim
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5 Naval Medical Research Unit 3 Egypt Avian and Pandemic Influenza Activities
5 Naval Medical Research Unit 3 Egypt Avian and Pandemic Influenza Activities
Pages 97-122
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From page 97... ...
Though NAMRU-3 has historically been dedicated to a laboratory- and field-based infectious-disease research mission, influenza surveillance activities have been conducted at NAMRU-3 since the 1999 initiation of funding from the Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS) for seasonal influenza surveillance activities.
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From page 98... ...
Revised A site visit team of the Institute of Medicine (IOM) Committee for the Assessment of DoD-GEIS Influenza Surveillance and Response Programs visited NAMRU-3 from March 4-9, 2007. A list of the people with whom the site visit team met and the itinerary that was followed can be found at the end of this chapter.
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From page 99... ...
. MANAGEMENT AND PLANNING Generally, DoD-GEIS activities at NAMRU-3 are coordinated by the director of the Research Sciences Department and carried out by other research departments, including virology research, disease surveillance, enteric disease research, and vector biology research.
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From page 100... ...
Given the importance of its geopolitical location in the Middle East, one of NAMRU-3's greatest strengths is its reliance on Foreign Service Nationals to play key roles in the management and activities of the laboratory. NAMRU-3 has used this strength in expanding its avian/pandemic influenza programs and broadening its laboratory capacity, thus strengthening activities for the countries in the EMRO region.
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From page 101... ...
Conclusions The site visit team noted that the planning and implementation of specific projects being conducted by NAMRU-3 were well executed but the organizational strategy needed to guide the laboratory's future influenza activities is lacking. NAMRU-3 staff were planning to hold a meeting regarding the laboratory's organizational direction and how NAMRU-3 can best meet the needs of countries in the region.
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From page 102... ...
Human Surveillance Both independently and in its role as a WHO collaborating center, NAMRU-3 works to strengthen national laboratory capacity and also functions as a reference laboratory for countries across the region. In its effort to make best use of the supplemental funding for AI/PI influenza and strengthen the regional influenza network, NAMRU-3 has focused most of its funding for human influenza surveillance on providing support equipment and technical assistance to national influenza laboratories in places like Egypt, Afghanistan, Syria, Pakistan, Oman, Saudi Arabia, and Morocco (NAMRU-3, 2007b)
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From page 103... ...
SOURCE: NAMRU-3, 2007b. tries in the EMRO region plus Nigeria, with the majority of samples coming Figure 5.2 from NAMRU-3's host country, Egypt.
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From page 104... ...
Conclusions While NAMRU-3 is not conducting any human surveillance activities itself, the committee found that NAMRU-3 is an integral advisor to host country government in development of its surveillance programs and the associated laboratory capacity. As the regional surveillance network expands, the committee feels it would be beneficial to expand diagnostics to include
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From page 105... ...
In terms of avian surveillance, the committee found that NAMRU-3 is working successfully with the Ministry of Environment to conduct influenza surveillance on wild bird populations in Egypt. However, NAMRU-3 does not conduct routine surveillance on domestic bird or poultry populations in Egypt.
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From page 106... ...
NAMRU-3 also does the primary screening of wild bird samples for its other collaborative wild bird surveillance sites, including samples sent to Egypt from NAMRU-3's sister laboratory, USAMRU-K. Conclusions NAMRU-3 facilities play an essential role in supporting influenza surveillance in Egypt and the region.
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From page 107... ...
RESPONSE CAPACITY NAMRU-3 has two primary response capacity functions. First, since it serves as a reference or quality control laboratory for many of the national central laboratories in the EMRO region, it has been called upon to provide surge capacity when the number of either human or animal samples exceeds the capacity of national laboratories.
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From page 108... ...
Surge Capacity Because of its role as a WHO collaborating center, NAMRU-3 will extend its functions beyond outbreak response in the next influenza pandemic. As has occurred in the past, NAMRU-3 will be called upon to provide surge capacity as the number of possible pandemic influenza samples increases.
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From page 109... ...
TABLE 5-2 Summary of Surge Capability at NAMRU-3 -- Altered Algorithm (Influenza A and H5 first) Condition NAMRU-3 Field Sites × 4 Total Samples Molecular Diagnostics 1,600 specimens/ 450 specimens/ 3,400 specimens/ week week week Sequencing 60 specimens/ 0 60 specimens/week week Culture (SPF & MDCK)
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From page 110... ...
Six personnel from enterics, three from disease surveillance, and one from vector biology have been given formal training on influenza diagnostics or are competent in molecular techniques such as RNA extraction, or both. Four individuals would be performing extractions at all times while one person would begin real-time runs on selected gene targets, which adds up to a requirement of five molecular diagnostics personnel required per 9hour shift, with some overlap.
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From page 111... ...
CAPACITY BUILDING The AI supplemental funding has been used to strengthen NAMRU-3's internal capacity, which includes its service as the WHO Regional Influenza Reference Laboratory, and also its capacity in countries within the region, such as Jordan, Libya, Ghana, and Afghanistan, where NAMRU-3 has satellite laboratories (NAMRU-3, 2007b)
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From page 112... ...
To this end NAMRU-3 has expanded influenza surveillance expertise and diagnostic capacity throughout the region, including the countries of Azerbaijan, Djibouti, Egypt, Ghana, Iran, Iraq, Jordan, Kazakhstan, Kenya, Kyrgyzstan, Lebanon, Libya, Morocco, Nigeria, Oman, Pakistan, Saudi Arabia, Sudan, Syria, Ukraine, and Uzbekistan. Capacity-building endeavors undertaken by NAMRU-3 generally incorporate a preliminary on-site assessment to determine the exact needs of the laboratory in terms of both infrastructure and expertise.
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From page 113... ...
In addition to its work in Egypt, NAMRU-3 has used the fiscal year 2006 DoD-GEIS-AI supplemental funding to substantially expand laboratory capacity in four targeted satellite laboratories in Jordan, Libya, Ghana, and Afghanistan. Equipment and reagents were purchased and delivered to all of these countries to establish their first national influenza centers.
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From page 114... ...
the development of a solid plan of strengthening regional countries' laboratory capacity with regard to avian influenza and maintaining this capacity through training, quality assurance, and proficiency testing; (2) continued collaboration with WHO to develop an external quality assurance system for national central laboratories in the EMRO region; and (3)
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From page 115... ...
The close relationship between NAMRU-3 and the Ministry of Health has enabled NAMRU-3 to work strategically and efficiently in Egypt in support of the national avian influenza surveillance network. In terms of other Egyptian national partners, NAMRU-3 and the Egyptian Ministry of Environment have a strong collaborative relationship focused on the surveillance of migratory birds and routinely share information between each other, as NAMRU-3 performs all diagnostic assays.
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government in general. Multilateral Agencies Because of NAMRU-3's status as a WHO regional influenza reference laboratory, it works very closely with both EMRO and WHO headquarters in Geneva.
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with diagnostic support, outbreak response capacity, and training. To date, NAMRU-3 has been able to contribute by providing specimen collection to a number of military preventive medicine units in Iraq, Kuwait, Qatar, and Djibouti.
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From page 118... ...
Army Medical Research Unit-Kenya. While there are certainly fruitful collaborations taking place between NAMRU-3 and other DoD entities, it was not completely clear to the IOM site visit team how communication and coordination with the DoD-GEIS headquarters and other DoD-GEIS sites is realized.
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U.S. Naval Medical Research Unit No.
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3 Sam Yingst, Viral and Zoonotic Diseases Research Program, U.S. Naval Medical Research Unit No.
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Adam Armstrong 1230-1230 Lunch 1400-1400 Briefing on Disease Surveillance Program Capt. Edward Kilbane 1600-1600 Briefing on Viral and Zoonotic Diseases Research Program Lt.
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From page 122... ...
122 REVIEW OF THE DOD-GEIS INFLUENZA PROGRAMS Thursday, March 8, 2007 0830-0900 Briefing with program heads 0900-1000 Overview of Vector Biology Research Program Lt.
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