WHO African Region (AFR) 2012-2013

CDC direct country support via non-research cooperative agreements is established in the following countries:

In addition, CDC supports the World Health Organization (WHO) Regional Office for Africa (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).
• 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 in building influenza surveillance: Burkina Faso, Mali, Mauritania, and Togo.

Institut Pasteur in Paris, France to support activities in Cameroon, Central African Republic, and Senegal.

World Health Organization in Geneva, Switzerland and the U.S. Agency for International Development to support activities in Burkina Faso, Malawi, Mozambique, and Republic of Congo.

The Indian Ocean Commission in Port Louis, Mauritius to enhance surveillance in Mauritius and build capacity in the Seychelles.

CDC expanded its cooperative agreement portfolio in 2013 to include two new cooperative agreements with Kenya and Uganda to introduce or expand the use of seasonal influenza vaccines by public health programs outside the United States. Core activities of the agreement include: conducting a needs assessment to identify barriers, developing a three-year action plan to introduce vaccines, implementing the plan and introducing or expanding vaccine use to the target population through a national policy.

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

Thelma Williams, MPH
Project Officer
Extramural Programs
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Atlanta, GA
Email: twilliams1@cdc.gov

Meredith McMorrow, MD, MPH, FAAP
Medical Epidemiologist
International Epidemiology and Response Team Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Atlanta, GA
Email: mmcmorrow@cdc.gov

A map of the WHO African Region (AFR) shows all 47 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, Comoros, Côte d’Ivoire, Democratic Republic of Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinée-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Republic of Congo, Rwanda, Sao Tome & Principe, Senegal, Seychelles, Sierra Leone, South Africa, South Sudan, Swaziland, Togo, Uganda, United Republic of Tanzania, Zambia and Zimbabwe.

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

CDC Influenza Division Field Staff, indicated by a yellow dot, 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.

WHO National Influenza Centers (NICs), indicated by a purple dot, are located in the following cities: Abidjan, Accra, Algiers, Antananarivo, Bangui, Candos, Cape Town, Dakar, Entebbe, Ibadan, Nairobi, Sandringham, and Yaoundé.

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

• Supporting island countries in the Indian Ocean to adapt the sentinel surveillance protocol.
• Expanding the Influenza Laboratory Network in the WHO African Region.
• Collaborating with CDC for providing primers to the AFR Influenza Laboratory Network for detection of A(H7N9) by PCR.
• Countries supported to use the infrastructure of influenza reference laboratories for confirmation of MERS-CoV.
• Maintaining weekly data on virological surveillance of influenza in FluNet.
• Sustaining performance of the External Quality Assurance Programme (EQAP) of the AFR influenza laboratory network.

US CDC Direct Support

The five-year cooperative agreement “Surveillance and Response to Seasonal and Pandemic Influenza by the World Health Organization Regional Office for Africa” begun on September 30, 2011 and is in its second year of implementation. The WHO Regional Office for Africa (AFRO) is located in Brazzaville, Republic of Congo. The Office serves 47 countries of which 30 are targeted by this project. In 2013, WHO AFRO staff provided support to countries in the Region through on-site training, review of protocols, strengthening laboratory capacity through provision of laboratory reagents and equipment and hands-on training sessions for selected laboratories.

WHO AFRO staff and consultants are providing standardized guidelines and protocols, on-site training on both epidemiological and virological surveillance of influenza.

Support has been provided in 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.

The WHO/AFRO Protocol for “National Influenza Sentinel Surveillance” has been disseminated to Member States and was adapted by Zimbabwe for the local context. In addition, island nations of the Indian Ocean namely Comoros, Madagascar, Mauritius, Seychelles and Reunion were trained on the new protocol and are being supported to develop/update their protocols using the WHO generic protocol. Countries are continuing to report the epidemiologic characteristics of ILI and SARI using Integrated Disease Surveillance and Response (IDSR) as a platform.

Surveillance Activities

• Disseminated the WHO/AFRO protocol for “National Influenza Sentinel Surveillance”.
• Adaptation of the protocol for National Influenza Sentinel Surveillance by Zimbabwe.
• Conducted the following key activities: site visit to assess needs and necessary adjustments, support organization of national workshops for adaptation of the WHO generic guideline to the local context, on-site training at the sentinel sites using the adapted protocol and regular teleconferences to troubleshoot any identified bottlenecks.
• Continued support and guidance through teleconferences to Burundi, Malawi, Mozambique, Republic of Congo and Sierra Leone to kick-start epidemiological surveillance activities after providing onsite-visits and training on epidemiological surveillance of influenza.

As of August 2013, the Regional Influenza Laboratory Network comprised of National Influenza Reference Laboratories in 30 countries. 13 laboratories from 12 countries are registered as National Influenza Centres (NIC) – Mauritius has been designated recently. Burundi, Malawi, Mozambique, Republic of Congo, Sierra Leone and Zimbabwe have been supported to enhance capacity for virological surveillance of influenza. The laboratory in Tanzania will soon be designated as NIC. The members of the Influenza Laboratory Network are sharing weekly data on virological surveillance of influenza (Mozambique and Republic of Congo started sharing weekly data on influenza). Between week one and week thirty-one in 2013 [AFRO weekly data updated on August 4, 2013], the networking labs tested 26,568 specimens for influenza and found that 3,756 (14%) were positive for influenza. Of the 1,100 influenza viruses detected in the Region, 65% were identified as influenza A and 35% were identified as influenza B. Of the influenza A viruses that were subtyped, the A (H1N1)pdm09 was the predominant subtype.

Laboratory Activities

• Joined the EQAP for influenza laboratories (Republic of Congo). As a result, the performance on influenza EQAP for 27 laboratories in 25 countries is being monitored.
• Supported six countries (Burundi, Malawi, Mozambique, Seychelles, Sierra Leone and Zimbabwe) in maintaining virological surveillance of influenza through provision of reagents and supplies for specimen collection and conducting PCR.
• Provided Mauritius and Seychelles with equipment (Real time PCR machines) and Seychelles, in addition received a Biosafety Cabinet. Burundi received a Real-Time PCR machine through USAID and is being supported on Biosafety Cabinet Level 2, microcentrifuge eppendorf and micropipettes. On-site training on PCR including collection and handling of specimens in selected sentinel sites was conducted in Burundi, Mozambique, Republic of Congo and Sierra Leone. Zambia is being provided with reagents for virus isolation and training will be done in close collaboration with the National Institute for Communicable Diseases (NICD) in South Africa once the reagents are received by the laboratory.

WHO/AFRO in collaboration with partners is finalizing the development of a framework for supporting countries to develop comprehensive epidemic and pandemic preparedness plan that will include acute infectious respiratory diseases.

Preparedness Activities

• Through the CDC project and Emerging Pandemic Threats (USAID) program, collaboration between human and animal health strengthened for joint surveillance and outbreak investigation including influenza public health risks at the human-animal interface.

• Trained scientists from influenza laboratories in Burundi and Sierra Leone on conducting real-time PCR in Rwanda and Ghana respectively.
• Participated in the training on influenza organized for the Indian Ocean Island nations of Comoros, Madagascar, Mauritius, Seychelles and Reunion.
• Participated in the retraining of the Zimbabwe sentinel surveillance staff.

JOB AIDS for collection, storage and transport of specimens for laboratory confirmation of Middle East Respiratory Syndrome coronavirus (MERS-CoV): available in English, French and Portuguese on the WHO AFRO Website.

Kebede S, Conteh I, Steffen C et al. Establishing a national influenza sentinel surveillance system in a limited resource setting, experience of Sierra Leone. Health Research Policy and Systems 2013, 11:22.

Francis Kasolo, MD, PhD
Director, Disease Prevention and Control Cluster
Disease Prevention and Control Cluster
WHO Regional Office for Africa
Brazzaville, Republic of Congo
Email: kasolof@who.int

Benido Impouma, MD
Epidemic Preparedness and Response Regional Adviser
Disease Surveillance and Response Programme Area
WHO Regional Office for Africa
Brazzaville, Republic of Congo
Email: impoumab@who.int

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

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