Influenza Surveillance Takes More Than a Village

The fear of pandemic avian influenza in 2004 spurred the CDC to initiate an international capacity-strengthening program.

This program focused on routine laboratory diagnostics to detect seasonal and novel influenza viruses, as well as routine sentinel surveillance for influenza-like illness and severe acute respiratory infections.

The CDC works with other countries’ ministries of health (or their national equivalent) to build national surveillance systems, provide technical assistance, and integrate the countries into the World Health Organization (WHO) Global Influenza Surveillance and Response System.

The program tapers funding over 5 years to encourage self-sufficiency. The funding goes toward equipment, materials, locally employed personnel, hands-on training, long-term technical follow-up, and follow-up assessments.

A study published in the June 2016 issue of Emerging Infectious Diseases shows that the program has been successful in that it has generated markedly improved surveillance capacity, circulating strains identification, novel strain recognition, vaccine strain selection, and non-influenza illness identification.

The study authors used WHO data and a retrospective survey of participating countries. The retrospective survey in English, French, and Spanish assessed the countries’ beliefs concerning CDC contribution to increased surveillance, identification of additional respiratory pathogens, and response to the 2009 H1N1 pandemic influenza outbreak.

All 35 countries surveyed had remarkable all-around improvement in their ability to track influenza and other respiratory illnesses.

Countries with lower baseline reporting to FluNet showed greater improvement than those that reported weekly or near weekly at baseline. Almost all of the countries (32 of 35) reported that the capacity-strengthening program enhanced their response to the H1N1 pandemic.

The surveillance improvements were critical during the Ebola and Middle East Respiratory Syndrome responses. The program encouraged a sense of ownership that 32 countries indicated increased their support for laboratory funding.

The 8 participating Central American countries expressed satisfaction with technical assistance more than funding alone.

The CDC’s capacity-building program has enriched laboratory and sentinel surveillance of circulating strains, novel strains, and noninfluenza illnesses.