WHO African Region (AFR) 2011-2012

In addition, CDC supports the World Health Organization (WHO) African Regional Office (AFRO) via a cooperative agreement.

The core activities of our bilateral agreements and technical assistance are:

• To build sustainable national capacity for seasonal influenza, pandemic influenza and other emerging diseases and preparedness for implementation of International Health Regulations 2005 (IHR).
• To make routine contributions of surveillance data to WHO’s Global Influenza Surveillance and Response System (GISRS).
• To increase the geographic reach of WHO GISRS.
• To provide early access to critical virus isolates from humans and birds for WHO GISRS.
• To increase the quantity of shipments and influenza isolates provided by African influenza laboratories for analysis by WHO Collaborating Centers.
• To develop sustainable epidemiologic and virologic surveillance systems for severe influenza, in order to gain an understanding of the burden of disease from influenza in the WHO African Region.

In addition to our bilateral work, we also partner with the U.S. Naval Medical Research Unit No. 3 (NAMRU-3) in Accra, Ghana to jointly support the following West African countries that have started influenza surveillance: Burkina Faso, Mali, Mauritania, and Togo.

Richard Davis, MSFS
Project Officer
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: rbdavis@cdc.gov

Thelma Williams, MPH (from December 2011)
Project Officer
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Email: twilliams1@cdc.gov

A map of the WHO Africa Region (AFR) shows all 40 AFR member states/countries. The member countries, outlined with gray borders, include Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Ghana, Guinea, Guinea Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger, Nigeria, Republic of the Congo, Rwanda, Sierra Leone, South Africa, Swaziland, Tanzania, Togo, Uganda, Zambia and Zimbabwe.

Countries with shading indicate that the Influenza Division provides project funding and technical assistance through cooperative agreements. Kenya and Senegal are shaded with purple diagonal stripes to indicate Research Cooperative Agreements. Zambia and Madagascar are yellow to indicate they have Capacity Building Cooperative Agreements. Angola, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Nigeria, Rwanda, South Africa, Tanzania, and Uganda are shaded green to indicate that they have Sustainability Cooperative Agreements. Ghana and the Republic of the Congo are shaded dark green to indicate that they receive indirect funding from the Division.

CDC Influenza Division Field Staff, indicated by a yellow dot outlined in red, are located in the following cities: Accra, Nairobi, and Pretoria.

The Global Disease Detection [GDD] Sites, indicated by red X’s, are located in Nairobi and Pretoria.

The Division collaborates with the U.S. Department of Defense [DoD], indicated by an orange triangle, in Ghana (Accra).

WHO National Influenza Centers (NICs), indicated by a purple dot, are located in Abidjan, Accra, Algiers, Antananarivo, Bangui, Cape Town, Dakar, Kampala, Lagos, and Yaoundé.

The WHO African Regional Office (AFRO) Headquarters, indicated by a blue star, is located in Brazzaville, Republic of the Congo.

• The World Health Organization (WHO) protocol for national influenza sentinel surveillance was finalized and is available in English, French and Portuguese.
• Weekly data on virological surveillance of influenza has been maintained in FluNet.
• The WHO African Region influenza laboratory network has sustained good performance with regard to the WHO External Quality Assessment Project (EQAP).

U.S. CDC Direct WHO Regional Office Support

The five-year cooperative agreement Surveillance and Response to Seasonal and Pandemic Influenza by the World Health Organization Regional Office for Africa began on September 30, 2011, and is in its first year of implementation. WHO’s African Regional Office (AFRO) is located in Brazzaville, Congo. The Office serves 46 countries, of which 30 are targeted by this project.

WHO AFRO staff and consultants provide standardized guidelines and protocols, and on-site training on both epidemiological and virological surveillance of influenza. Support has been provided in the form of technical assistance to member countries to strengthen surveillance, preparedness, and response to priority diseases, but with a special focus on influenza-like illnesses (ILI) and severe acute respiratory infections (SARI). Countries within the network are regularly supplied with laboratory equipment and reagents, thus enhancing and sustaining diagnostic capacity for influenza in the region.

WHO AFRO protocol for national influenza sentinel surveillance has been disseminated to Member States. Countries have strengthened epidemiological surveillance of influenza through promoting the use of standardized case definitions, and improving collaboration between the officers in charge of epidemiological surveillance within the Ministry of Health (MOH) and the focal person of the national influenza laboratory. This ensures that the information generated is used by the MOH as well as ensuring that the Integrated Disease Surveillance and Response (IDSR) is used as a platform for strengthening influenza surveillance.

Surveillance Activities

• Developed the WHO AFRO protocol for national influenza sentinel surveillance. A draft was prepared, reviewed, edited and translated to English, French and Portuguese and then disseminated to the countries.
• Adapted the generic protocol to the local context, thus generating national protocols in the following countries: Angola, Cameroon, Ghana, Malawi, Nigeria, Rwanda, Senegal, Sierra Leone and Zambia.
• Conducted site visits to assess needs and necessary adjustments, supported organization of national workshops for adaptation of the WHO generic guideline to the local context, conducted on-site training at the sentinel sites using the adapted protocol, and provided training on FluNet and FluID to improve reporting.
• Conducted a site visit to Sierra Leone for strengthening epidemiological surveillance of influenza through IDSR.
• Supported Malawi with a site visit and training on sentinel surveillance at the sites selected by the MOH. Mozambique received technical support to adapt the tools and prepare for the training.

The Regional Influenza Laboratory Network is comprised of 29 National Influenza Reference Laboratories in 24 countries. Two laboratories, one in Sierra Leone and the other in Malawi, have been supported to enhance capacity for virological surveillance of influenza. With the support from the cooperative agreement, the members of the Regional Influenza Laboratory Network are sharing weekly data on virological surveillance of influenza.

Laboratory Activities

• Five new laboratories (Angola, Burkina Faso, Mali, Mozambique and Togo) have joined the EQAP for influenza laboratories. As a result, the performance on influenza EQAP for 26 laboratories in 24 countries is being monitored.
• Fifteen countries (Algeria, Angola, Central African Republic, Cote d’Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Mali, Niger, Nigeria, Rwanda, Senegal, Tanzania and Zambia) are being supported to maintain virological surveillance of influenza through provision of reagents and supplies for specimen collection and conducting PCR.
• Through provision and installation of equipment (including a real-time PCR machine) as well as reagents and essential laboratory supplies, Sierra Leone was able to start virological surveillance of influenza.

WHO AFRO, in collaboration with partners, is developing a framework for supporting countries to develop comprehensive epidemic and pandemic preparedness plans that will include influenza.

Preparedness Activities

• Financial and technical support was provided to South Africa to organize a national influenza vaccination campaign.
• Through the U.S. Centers for Disease Control and Prevention (CDC) project and Emerging Pandemic Threats program, collaboration was strengthened between human and animal health officials with regard to surveillance and outbreak investigation.
• A consultant was hired to provide a report on outbreaks occurring in the Region (including those related to influenza) in order to inform development of an epidemic preparedness and response framework.
• As part of the early warning system, information on ongoing acute public health emergencies in the Region is being collected, analyzed and shared through monthly bulletins.

• Training on sentinel surveillance of influenza in collaboration with WHO’s Global Influenza Program/Agence de Médecine Préventive (GIP/AMP) for eight countries (Angola, Cameroon, Ghana, Nigeria, Rwanda, Senegal, Sierra Leone, and Zambia) has been organized.
• A scientist from Sierra Leone’s influenza laboratory has been trained on conducting real-time PCR at Noguchi Memorial Institute for Medical Research (NMIMR) in Accra, Ghana.
• AFRO staff members were key facilitators during a training that was organized by CDC for nine West African countries (Burkina Faso, Cote d’Ivoire, Ghana, Mauritania, Mali, Niger, Nigeria, Senegal and Togo) on influenza sentinel surveillance. Participants were sensitized on the implementation of the surveillance of influenza in the context of IDSR.

Francis Kasolo, MD, PhD
Program Area Coordinator, Disease Surveillance and Response
WHO Regional Office for Africa
Brazzaville, Republic of Congo
Email: kasolof@afro.who.int

Benido Impouma, MD
Regional Manager, Epidemic Preparedness and Response
WHO Regional Office for Africa
Brazzaville, Republic of Congo
Email: impoumab@afro.who.int

Nathan Bakyaita, MD
Medical Officer, Surveillance
WHO Regional Office for Africa
Brazzaville, Republic of Congo
Email: bakyaitan@afro.who.int

Ali Ahmed Yahaya, MD
Medical Officer Laboratory
WHO Regional Office for Africa
Brazzaville, Republic of Congo
Email: bakyaitan@afro.who.int

Zabulon Yoti, MD
Medical Officer, Response
WHO Regional Office for Africa
Brazzaville, Republic of Congo
Email: yotiz@afro.who.int

Michael Tukuru
Manager, Regional Management Support Unit
WHO Regional Office for Africa
Brazzaville, Republic of Congo
Email: tukurum@afro.who.int