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Introduction:
National Influenza Centre is one of the newly established and highly equipped departments of National Public Health Laboratory (NPHL) designated by Ministry of Health and Population (MoHP) and recognized by World Health Organization (WHO) for the purpose of participating in WHO Global Influenza Programme. Upon such recognition by WHO, NIC become member of the WHO Global Influenza Surveillance Network.
Influenza Surveillance started since 2004 from Jhapa, eastern part of Nepal with the aim to identify the influenza viruses from suspected cases of influenza like illness (ILI) and immediate response to minimize the circulation of viruses during outbreak. Initially, specimens collected from suspected cases of ILI were performed by Rapid Diagnostic Test (RDT) for identification of influenza viruses. Later on, molecular diagnostic assay based influenza surveillance was started with the introduction of Real-Time PCR (RT-PCR) at National Public Health Laboratory (NPHL) from 2009. During pandemic influenza outbreak in 2009, NPHL had played a key crucial role together with Epidemiology and Disease Control Division (EDCD), Department of Health Services including international organizations (WHO, WARUN). NPHL has been designated as National Influenza Centre (NIC) on 19th April, 2010. Influenza virus isolation, identification and characterization by serological molecular diagnostic assay were successfully started within one year and 28 isolates were shipped to WHO Collaborating Centre
(WHOCC) Japan on 27th November, 2011.
Terms of References (TORs):
General:
Serve as the key point of contact between the World Health Organization and the country of origin for virological and epidemiological Surveillance of influenza and provision of influenza virus isolates to the WHO Global Influenza Surveillance Network. Maintain active Communication with the members of the WHO Global Influenza Suveillance Network.
Virus isolation and Shipment:
Collect appropriate clinical specimens from patients throughout each year and especially during the influenza Season and outbreaks for the isolation of influenza virus. Undertake initial identification of virus type and subtype. Forward representative virus isolates and any low reacting viruses using the WHO reagents kit provided through the WHO network to a WHO Collaborating Centre for Reference and Research on Influenza within a defined period. Alert the WHO Global Influenza Programme on any influenza isolate that cannot be readily identified using reagents provided through the WHO network and immediately forward the isolate to a WHO Collaborating Centre for Reference and Research on Influenza.
Communication and Information-sharing:
Alert WHO and/or any of the WHO Collaborating Centers immediately on the emergence of outbreaks of influenza viruses that cannot be readily identified with the reagents in the WHO kit, or other indications of the emergence of influenza viruses with pandemic potential. Report regularly during the influenza season preferably weekly by electronic means on the extent of national influenza activity and intensity of virological surveillance and ensure timely distribution of this information at relevant national and international levels through for example WHO FluNet. Provide to the WHO Global Influenza Programme an annual national Summary on influenza activity, virological surveillance and other relevant information on the influenza epidemiological situation.
National influenza Surveillance Network (NISN):
Sentinel sites of NISN have been selected on the basis of region, geographical situation, human population density and possible epidemic prone areas of country for provision of representative influenza samples throughout the nation to NIC. The ten NISN sentinel sites are:
Eastern Region:
Central Region:
Western Region:
Mid-Western Region:
Far-Western Region:
These sentinel sites collect samples from suspected patients meeting case definition of Influenza like ilIness (ILI) and Severe Acute Respiratory Infection (SARI) for virus identification and isolation. Participating hospital laboratory perform rapid test and give immediate feedback to clinicians and dispatch samples collected in viral transport media (WTM) to NPHL maintaining cold chain within 48 hours of Collection. Patan Academy of Health Sciences (PAHS) and Walter Reed AFRIMS Research Unit Nepal (WARUN) are collaborating partners for active support during influenza season and sharing of specimen with NIC, International organization such as WHO and WHO-IPO has been supporting in various aspects during influenza outbreak and specimen transportation from sentinel sites of NISN.
NSN Co-ordination committee:
Chairman: Director, National Public Health Laboratory
Members:
Director, Epidemiology and Disease Control Division
Co-ordinator, Avian influenza Control Project (Human component
Director, National Health Education, Information and Communication Center
WR/Representative, World Health Organization
VC/Representative, Patan Academy of Health Sciences Head, Walter Reed/AFRIMS Research Unit Nepal
Chief Representative, WHO-IPD
Chief, Central Veterinary Laboratory
Co-ordinator, Avian influenza Control Project (Animal component)
Member Secretary:
Microbiologist, National Influenza Center
Historical Activities on influenza Virus:
June 2009: Detection and molecular characterization of pandemic influenza virus AH1N1 in human Specimen collected at Tribhuvan International Airport during pandemic influenza virus outbreak 2009 .
October 2009: Community spread of Pandemic influenza AH1N1 2009 was established in Kathmandu valley on 15th October, 2009.
2010: Establishment of highly equipped National Influenza Centre at NPHL.
April, 2011:Madin Darby Canine Kidney (MDCK) Cell line had been successively cultured and propagated at NPHL for the isolation and characterization of influenza and para-influenza viruses.
June, 2011: Influenza virus was successively isolated and characterized from clinical specimen collected and preserved at NPHL.
27th November 2011: A total of 28 influenza viruses were isolated and characterized at NPHL and Submitted to WHOCC, National Institute of Infectious Diseases, Japan
Current Activities:
Human Cases of influenza Specimen Collection, storage, transportation and processing at NIC, NPHL.
Detection and characterization of influenza virus types (Influenza A & B) & subtypes (Influenza. A/H1, AH3, A/H1N1 Pdm, A/H5) by RT-PCR.
Influenza Virus isolation & identification by Serological/Immuno-fluorescence Assay (IFA) technique.
Sharing influenza isolates with WHOCC for the development of candidate vaccine.
Sharing week-wise influenza report with GISRS.
Sharing any unidentified influenza isolate with Global Influenza program for reference and research on influenza.
Immediate response on Influenza like Illness (ILI) and Severe Acute Respiratory infection (SAR) outbreak with co-ordination of Epidemiology & Disease Control Division.
Co-ordination and sharing of information about human influenza activity with Animal Health Component.
Co-ordination and management of diagnostic kits accessories, Sample collection, storage and transportation of clinical specimen from NISN sentinel sites to NIC, NPHL.
Situation up-date and feedback information sharing to all NISN sentinel sites.
International Technical Support:
Financial Support:
Ministry of Health & Population, Nepal, WHO-Country Office, Nepal, WHOSEARO, India and WHO-Head Quarter, Geneva.
Diagnostic Test Support:
IRR CDC, Atlanta, Georgia, USA, WHOCC, National Institute of Infectious Disease, Japan, Institute of Wirology, Hong Kong University and NIH, Department of Medical Sciences, Thailand.
External Quality Assessment Support: WHO Influenza EQAP, Virology Division, Centre for Health Protection, Hong Kong SAR and CDC, Atlanta.
