WHO African Region (AFR) 2014-2015

In fiscal year 2014, there were twelve bilateral cooperative agreements to build or enhance sustainable influenza surveillance in the sub-Saharan region of Africa. These agreements are with ministries of health or institutions designated by a country’s Ministry of Health (MOH) to work with the U.S. Centers for Disease Control and Prevention (CDC).

Direct country support through non-research cooperative agreements is established in the following 12 countries:

In addition, CDC’s direct assistance to the countries listed above supports capacity building in six neighboring African countries, Burkina Faso, Mauritania, Niger, Senegal, Sierra Leone, and Togo, to enhance surveillance systems.

CDC also supports the World Health organization’s (WHO) Regional Office for Africa (AFRO) through a cooperative agreement.

Core activities of CDC bilateral agreements and technical assistance include:

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

CDC also partners with:

The U.S. Naval Medical Research Unit No. 3 (NAMRU-3) in Accra, Ghana supporting Burkina Faso, Mali, Mauritania, and Togo to build influenza surveillance systems.

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 (USAID) to support activities in Burkina Faso, Malawi, Mozambique, and Republic of Congo.

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

In fiscal year 2013, CDC expanded its cooperative agreement portfolio to include a Vaccine Policy component.

Country support was established in Kenya and Uganda to introduce or expand the use of seasonal influenza vaccines.

Core activities of these agreements include:

Conducting a needs assessment to identify barriers to vaccine introduction.
Developing a three-year action plan to introduce vaccines.
Implementing the plan.
Introducing or expanding vaccine use to the target population through development of a national policy.

In addition to the capacity building grants identified above, CDC’s Influenza Division also supports research collaborations with institutions in Ghana, Kenya, Malawi, Senegal and South Africa. These collaborations focus on demonstrating the burden of influenza-associated illness in sub-Saharan Africa, identifying risk factors for severe influenza, measuring influenza-associated morbidity and mortality and documenting influenza vaccine effectiveness.

Richard Davis, MSFS (until June 2015)
Project Officer
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Pretoria, South Africa
Email: rbdavis@cdc.gov

Carolina Granados, MPH (as of October 2015)
Project Officer – East Africa
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Atlanta, GA
Email: hsy7@cdc.gov

April Vance, MPH (as of October 2015)
Project Officer – South Africa
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Atlanta, GA
Email: abv8@cdc.gov

Thelma Williams, MPH
Project Officer – West Africa
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Atlanta, GA
Email: tdw6@cdc.gov

Adam Cohen, MD, MPH (until August 2015)
Director, Influenza Program
CDC–South Africa
Pretoria, South Africa
Email: dvj1@cdc.gov

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

Talla Nzussouo N., BS, MD, MS
Regional Epidemiology and Laboratory Advisor
CTS Global, Inc.–Contractor
U.S. Centers for Disease Control and Prevention
Noguchi Memorial Institute for Medical Research
University of Ghana, Legon
Accra, Ghana
Email: isq2@cdc.gov

Stefano Tempia, DVM, MSc, PhD
Influenza Technical Advisor CTS Global, Inc.–Contractor
U.S. Centers for Disease Control and Prevention
National Institute for Communicable Diseases
Johannesburg, South Africa
Email: stefanot@nicd.ac.za

Sandra Chaves, MD, MSc (as of August 2015)
Director, Influenza Program
CDC–Kenya
Nairobi, Kenya
Email: schaves@cdc.gov

WHO African Region (AFR) Map

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, Malawi, Senegal and South Africa are shaded with black diagonal stripes to indicate Research Cooperative Agreements. Mali and Mozambique are light green to indicate Capacity Building Cooperative Agreements. 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. Mauritius, and Seychelles 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.

Disseminated weekly bulletins on virological surveillance of influenza through the AFR influenza laboratory network.
Provided strategic guidance, technical and financial support, and coordination to Member States to strengthen the virological and epidemiological surveillance of influenza to better prepare against seasonal, zoonotic, and pandemic influenza threats in the WHO African region.
Collaborated closely with the Food and Agricultural Organization (FAO) to provide technical guidance and assistance to countries in West Africa that are facing outbreaks of influenza A (H5N1) in poultry.

The WHO Regional Office for Africa is currently in the fourth year of its five-year cooperative agreement. With the support from U.S. CDC, 30 (64%) of 47 countries in the region have developed and maintained sentinel surveillance and laboratory capacity for the diagnosis of influenza. Support includes technical and financial assistance to Member States to strengthen their national influenza surveillance systems, with a specific focus on influenza-like illness (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 detection of influenza viruses. This support has also enhanced the laboratory capacity in the region to identify MERS-Coronavirus and Ebola virus.

During the first quarter of 2015, three countries (Gabon, Mauritania, and Republic of Congo) received support to strengthen their national influenza surveillance systems.

Surveillance Activities

Reviewed the status of influenza virological surveillance in the African region from 2010 to 2013. Results were published in the November 2014 edition of the Integrated Disease Surveillance and Response quarterly bulletin.
Worked with the respective governments of Burundi and Mauritania to conduct an assessment of their influenza surveillance systems (July/August 2014). The assessment revealed that both countries do not have functional virological and epidemiological influenza surveillance systems in place.
Attended the 4th African Network Influenza Surveillance and Epidemiology (ANISE) Meeting held in Cape Town, South Africa (5–6 Dec 2014) and chaired a session on “Setting the Stage for Influenza Vaccine Introduction” during this meeting.

As of December 2014, the Regional Laboratory Network comprises 30 National Influenza Reference Laboratories. With support from grants, members of the influenza laboratory network are sharing weekly data on influenza virological surveillance. Between week one and week sixteen (AFRO weekly data updated on 24 April 2015), the networking laboratories tested 9,115 specimens for influenza viruses and found that 1,318 (14%) were positive. The Democratic Republic of Congo was supported to enhance capacity for virological surveillance of influenza.

Laboratory Activities

Disseminated weekly virological surveillance data through the AFR Influenza Laboratory Network.
Provided essential reagents and supplies to Algeria, Burkina Faso, Central Africa Republic, Republic of Congo, Senegal, and Togo for enhancing and sustaining laboratory testing of ILI and SARI clinical specimens.
Provided financial support to the Democratic Republic of Congo in order to strengthen the National Institute of Biomedical Research (INRB) for enhancing virological influenza surveillance.
Strengthened Zimbabwe’s national influenza reference laboratory with financial support.

WHO AFRO in collaboration with WHO Headquarters (HQ) is implementing the laboratory and surveillance component of the Pandemic Influenza Preparedness (PIP) framework in two selected countries, Ghana and Tanzania. Both countries are focusing on activities aimed at strengthening their capacities to monitor trends in circulating influenza viruses. In addition, Tanzania is also implementing activities aimed at strengthening its national capacity to detect novel influenza viruses.

Cameroon and Zambia have recently been recruited to join the PIP implementation project. The overall target is to obtain participation from 11 countries in the WHO African region. Efforts are underway to gain participation from seven more countries: Algeria, Burundi, Congo, Madagascar, Mozambique, Sierra Leone, and South Africa. To avoid duplication of efforts, the WHO staff focal point on influenza ensures harmonization of the CDC influenza project and PIP.

Preparedness Activities

Ghana and Tanzania – Conducted self-assessment surveys of their influenza laboratory using WHO standardized tools.
Tanzania – Conducted training on influenza specimen collection and shipment for staff in newly established influenza sentinel sites. Procured IT equipment for the Ministry of Health, laboratories, and sentinel sites to enhance data sharing and ensure monitoring and assessment of influenza events of international concern.
Ghana National Influenza Center (NIC) – Supported sub-regional influenza capacity by training two staff members from Nigeria and Côte d’Ivoire on influenza virus isolation (18–27 March 2015).
Ghana – Established 24 sentinel sites for influenza surveillance in all regions, between January and April 2015, as part of influenza preparedness. Sent samples from patients with ILI for assessment by the NIC.

Participated in and helped facilitate the Influenza Estimating Burden Workshop in Cape Town, South Africa on 4 December 2014.
Supported three participants from Burkina Faso, Niger, and Togo to attend the Grants Proposal Writing Workshop held in Johannesburg, South Africa from 13–17 April 2015.
Organized and facilitated a workshop for preparedness and response to influenza and respiratory pandemics in the context of the International Health Regulations (IHR 2005) in Yaoundé, Cameroon. Thirty participants from eleven countries – Angola, Burundi, Cameroon, Gabon, Central African Republic, Democratic Republic of Congo, Sao Tome and Principe, Senegal, Chad and Equatorial Guinea – in the African region attended the workshop (4–8 November 2013).
Organized a training workshop in Ouagadougou, Burkina Faso on Building the Capacity for Influenza Sentinel Surveillance. Participants were clinicians from sentinel sites, laboratory technicians, and epidemiologists (22–25 April 2014).

Ibrahima-Socé Fall, MD, PhD
Director of Health Security and Emergency Cluster
WHO Regional Office for Africa (AFRO)
Brazzaville, Republic of Congo
Email: socef@who.int

Ali Ahmed Yahaya, MD
Regional Advisor Integrated Disease Surveillance WHO Regional Office for Africa (AFRO)
Brazzaville, Republic of Congo
Email: aliahmedy@who.int

Soatiana Rajatonirina, MD, PhD
Medical Officer, Surveillance
WHO Regional Office for Africa (AFRO)
Brazzaville, Republic of Congo
Email: rajatonirinas@who.int

Gisèle Caroline Nitcheu Hachom Wabo, PhD
Manager, Regional Management Support Unit
WHO Regional Office for Africa (AFRO)
Brazzaville, Republic of Congo
Email: nitcheug@who.int

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