The document discusses ECDC and WHO collaborative activities to strengthen laboratory preparedness in Europe. It outlines several joint programs: 1) regional influenza surveillance where data is collected, analyzed, and discussed in teleconferences; 2) influenza virus characterization reporting; 3) biannual influenza meetings; 4) monitoring influenza-associated mortality; and 5) external quality assessments for influenza and RSV diagnostics. It also describes the Better Labs for Better Health initiative to identify needs to improve laboratory networks in southeast Europe and eastern Europe. Finally, it proposes establishing a European Region Laboratory Task Force for High Threat Pathogens to coordinate laboratory diagnostics and networks for priority diseases.

1. ECDC and WHO collaborative
activities to improve laboratory
preparedness
WHO Health Emergencies Programme
Dr Joanna Zwetyenga

2. Regional Influenza
Surveillance
https://flunewseurope.org/
• Data reported to The
European Surveillance
System (TESSy)
• WHO and ECDC analyze
data
• Three in-season
teleconferences with entire
network

3. Regional Influenza Surveillance (cont.)
https://ecdc.europa.eu/en/public
ations-data/influenza-virus-
characterisation-report-
summary-17-18
• Summary of influenza virus
characterization data reported by
National Influenza Centres to
TESSy
• February and June
• Submitted to the WHO
consultation on the
composition of influenza
vaccines
• End of season summary
published on ECDC website

4. Biannual Influenza
Meeting
6th WHO Regional Office for
Europe & European Centre for
Disease Prevention and Control
Joint European Influenza
Surveillance Meeting
June 6-8, 2018
Copenhagen, Denmark

5. Monitoring Influenza-Associated Mortality
• Models vital statistics data
(death certificates) to
estimate mortality
• Useful tool to assess burden
of severe disease
• 2 Joint publications: 2017,
2019
www.euromomo.eu

6. Joint European
external quality assessment programme for
influenza virus
•(RT-PCR) or other NAT, including typing, type A
H- and N-subtyping and type B lineage
determination, within a defined reporting
timeframe of 7 calendar days
rapid detection
•including follow-up strain characterization by
haemagglutination inhibition (HI) assay or virus
neutralisation (VN) and/or sequencing within a
defined reporting time frame of 36 calendar
days;
virus isolation
•determination of susceptibility to
neuraminidase inhibitors oseltamivir and
zanamivir by genotypic and/or phenotypic
methods within a defined reporting time frame
of 36 calendar days.
susceptibility
to
neuraminidase
inhibitors

7. Joint coordination of the WHO global RSV external quality assessment
programme in the WHO European Region
• Within the Phase-2 of the RSV
Surveillance Pilot Based on the
Global Influenza Surveillance and
Response System
• 25 Laboratories from 22 countries

8. Joint influenza virology working groups:
• 2019 Objectives and
opportunities
of Next Generation
Sequencing for
influenza surveillance
• 2014 and 2015 on
Influenza Surveillance
Characterization Data

9. Better Labs for Better Health
Establishing networks for emergency preparedness and
response
Public health laboratory networks in some countries are
poorly functioning and lack of inclusion in international
networks
Better Labs for Better Health is identifying needs to
improve countries’ laboratory preparedness to respond
to high threat pathogens
1rst workshop for south eastern European countries
2017
2nd workshop for Newly Independent States 2019

10. Albania, Armenia,
Azerbaijan, Bosnia & Herzegovina,
Georgia, Kazakhstan, Kyrgyzstan,
Moldova, Serbia, Tajikistan,
Turkey, Ukraine, Uzbekistan, and
Northern Macedonia
WHO European Region Priority Countries
Kosovo*
This designation is without prejudice to positions on status, and is in line with UNSCR 1244
and the ICJ Opinion on the Kosovo declaration of independence”.

11. How can we improve capacities in the Region to
rapidly detect and respond to emerging
pathogens?
Countries must strengthen their overall lab
systems to respond to emerging pathogens but:
• Limited or no funding
• Limited access to EQA
• Limited access to new diagnostic tools
• Limited integrated laboratory, clinical,
and epidemiological data
• Lack of inclusion in international
networks
Aedes aegypti /Zika transmission

12. Regional high threat pathogens
• WHE current focus: Ebola/VHF, Zika, Pandemic
Influenza, Cholera, Plague, YF, Dengue
• 10 years review of national data in WHO EUROPE
region and of the literature (on going study)
Anthrax
Botulism
Brucellosis
Chagas disease
Chikungunya virus disease
Cholera
Crimean-Congo Haemorrhagic Fever (CCHF)
Dengue
Ebola-Marburg viral disease
Echinococcosis
Enterohaemorrhagic Escherichia coli infection
Giardiasis
Hepatitis A
Lassa fever
Legionellosis
Leishmaniasis, Cutaneous
Leishmaniasis, Visceral
Leptospirosis
Listeriosis
Lyme disease
Omsk haemorrhagic fever
Plague
Q-fever
Rabies
Rift valley fever
Shigellosis
Tularaemia
Viral haemorrhagic fever with renal syndrome, Hanta virus disease
West Nile Virus
Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
Zika virus
Enterovirus (non-polio)
Taeniasis/Cysticercosis
Tick-borne encephalitis
Toxoplasmosis
Trichinosis

13. Laboratory networks
Specimen referral and
transport system /
Equitable specimen
sharing
Effective modern point
of care and laboratory-
based diagnostics /
Trainings
Laboratory testing for
detection of priority
diseases / Rapid
development of
diagnostic assays
Biosafety/Biosecurity
• Establish networks where
needed
• But not possible to establish
networks for every new
pathogen
Laboratory
quality system
Development/
provision of
reagents &
standards

14. Existing laboratory resources
WHO
Collaborating
Centers
(184)
International
Organizations
(CDC, ECDC,
WHO…)
International
laboratory
Networks
(EMERGE, EVD,
EDPLN, SECID…)
National Public
Health
Institutes and
laboratory
networks
WHO laboratory
networks
(ELI, LabNet, GPLN,
WHO/HIVResNet ,
Influenza laboratory
network…)
International
societies and
professional
associations
(ESCMID, EOQ,
EBSA)

15. Laboratory Focal Points
• Designated government position
• Coordinates national laboratory activities
• Key point of contact
• Enhance national and international
coordination
• Help identify needs and input for
capacity building
National
laboratory
networks

16. European Region Laboratory Task Force for High Threat
Pathogens
(Lab Task Force)
Lab Focal Points
WHO CCs
Organizations
LAB TASK FORCE
WHO/Europesecretariat
Laboratory
diagnostics for
high threat
pathogensand Networks

17. Next steps
ToRs of the Lab Task
Force finalized and
nominations in country
Tool for the assessment
of diagnostic capacities
being finalized
•Specimen referral -
transport
Trainings and
implementation of new
diagnostics