4th Global Meeting on Implementing New and Under-utilized Vaccines, 23-25 June 2010
Workgroup 8. Data quality and surveillance - Is this as good as it gets? Can information on immunization be improved?
Background
Global surveillance networks have been developed to provide pertinent information related to the introduction and use of new and underutilized vaccines. The overarching goal of this surveillance is to provide readily available, high-quality data for decision makers particularly as related to issues surrounding vaccine introduction and use. During the past two years, the existing and divergent rotavirus and invasive bacterial diseases surveillance networks have been transitioned into one system, coordinated by WHO. Major activities during the transition period included contracting with sentinel sites, securing global and regional reference laboratories, and standardizing surveillance data collection and reporting. A layered approach to surveillance was also established: layer 1 as “core surveillance" taking place at hospital sentinel sites (1 per country) for bacterial meningitis and severe diarrhea, layer 2 as “added surveillance” at additional select sites for invasive bacterial disease (bacteraemic pneumonia/sepsis, 1 site for every 3 countries), and layer 3 as “enhanced population-based surveillance" to determine incidence of IBD and rotavirus diarrhea (at least 1 site per region).
Main Topics of Discussion
- Review of vaccine coverage data with discussion of activities to improve quality of this data, and identification of potential lessons learned to enhance the new vaccines surveillance data
- The existing WHO coordinated surveillance systems for rotavirus and invasive bacterial diseases.
- The availability of new vaccines surveillance data for decision makers, particularly the MoH
- The quality of data that has been collected by these surveillance networks
- The use of data generated at the country, regional, and global levels. Specifically that the sentinel strategy can be erroneously viewed as a 'special study' by the MoH, rather than as an ongoing surveillance activity.
- The MoH views surveillance data as vital for making decisions on vaccine introduction, and encourages WHO's partnership in the surveillance activities including training, supervision, and advocacy
- Ongoing surveillance following vaccine introduction is needed for multiple reasons, e.g., to identify causes of diarrhea/meningitis other than rotavirus/H. influenzae or S. pneumoniae, to identify non-vaccine pneumococcal strain types causing disease and monitor serotype replacement, to monitor impact of vaccines, to monitor antimicrobial resistance patterns, and to help identify other prevention activities besides vaccines.
Recommendations
- WHO and partners need to encourage the engagement of the ministries of health to have full ownership of the surveillance system and use the data for decision making at all levels.
- The importance of surveillance and the subsequently generated data uses at country level should be communicated clearly to decision makers and public health professionals. It should be a continuous reinforcement that "sentinel surveillance" for rotavirus and invasive bacterial diseases is not research, but rather part of an ongoing surveillance activity that is set up differently from other routine vaccine preventable diseases surveillance systems.
- MOH may consider conducting regular supervision of sentinel sites possibly integrated with other public health activities. This should also assist with improving surveillance data quality.
- WHO should consider the development of advocacy tools, and technical guidelines to share with MOH.
- The data standards developed in 2008 may need to be refined/simplified.
- For example, further standardization across the surveillance network should be reviewed with particular attention to standardizing case definitions for invasive bacterial disease.
- To improve surveillance quality, guidelines are currently under development for 1) IBD assessment (epidemiology and laboratory) and 2) Sentinel site selection and IBD data analysis.