Evaluation of Laboratories Supporting Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance in the World Health Organization African Region, through the Performance of Coordinated External Quality Assessment

Inacio Mandomando; Jason M Mwenda; Tomoka Nakamura; Linda de Gouveia; Anne von Gottberg; Brenda A Kwambana-Adams; Martin Antonio; Augusto Messa Jr; David Litt; Shila Seaton; Goitom Gebremedhin Weldegebriel; Joseph Nsiari-Muzeyi Biey; Fatima Serhan

doi:10.3390/tropicalmed8080413

Evaluation of Laboratories Supporting Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance in the World Health Organization African Region, through the Performance of Coordinated External Quality Assessment

Trop Med Infect Dis. 2023 Aug 14;8(8):413. doi: 10.3390/tropicalmed8080413.

Authors

Inacio Mandomando^{1

2

3}, Jason M Mwenda⁴, Tomoka Nakamura^{5

6

7}, Linda de Gouveia⁸, Anne von Gottberg⁸, Brenda A Kwambana-Adams^{9

10}, Martin Antonio^{9

11

12}, Augusto Messa Jr¹, David Litt^{13

14}, Shila Seaton¹⁵, Goitom Gebremedhin Weldegebriel¹⁶, Joseph Nsiari-Muzeyi Biey¹⁷, Fatima Serhan⁷

Affiliations

¹ Centro de Investigação em Saúde de Manhiça (CISM), Maputo P.O. Box 1929, Mozambique.
² Instituto Nacional de Saúde (INS), Maputo P.O. Box 3943, Mozambique.
³ ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain.
⁴ World Health Organization (WHO), Regional Office for Africa, Brazzaville P.O. Box 06, Congo.
⁵ Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
⁶ School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan.
⁷ Department of Immunization, Vaccines and Biologicals, World Health Organization, 1202 Geneva, Switzerland.
⁸ Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg 2131, South Africa.
⁹ Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia.
¹⁰ Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L7 8XZ, UK.
¹¹ Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
¹² Centre for Epidemic Preparedness and Response, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
¹³ Respiratory and Vaccine Preventable Bacteria Reference Unit, United Kingdom Health Security Agency (Formerly Public Health England), London NW9 5EQ, UK.
¹⁴ World Health Organization Collaborating Centre for Haemophilus Influenzae and Streptococcus Pneumoniae, United Kingdom Health Security Agency (Formerly Public Health England), London SW1P 3JR, UK.
¹⁵ United Kingdom National External Quality Assessment Service (UK NEQAS) for Microbiology, United Kingdom Health Security Agency (Formerly Public Health England), London NW9 1GH, UK.
¹⁶ World Health Organization (WHO), Inter Country Support Team (IST), Harare P.O. Box 5160, Zimbabwe.
¹⁷ World Health Organization (WHO), Inter Country Support Team (IST), Ouagadougou 03 BP 7019, Burkina Faso.

Abstract

(1) Background: Laboratories supporting the invasive bacteria preventable disease (IB-VPD) network are expected to demonstrate the capacity to identify the main etiological agents of pediatric bacterial meningitis (PBM) (Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae) on Gram stains and in phenotypic identification. Individual reports of sentinel site (SSL), national (NL) and regional reference (RRL) laboratories participating in the World Health Organization (WHO)-coordinated external quality assessment, distributed by the United Kingdom National External Quality Assessment (EQA) Services (UK NEQAS) for Microbiology between 2014 and 2019 were analyzed. (2) Methods: The panels consisted of (1) unstained bacterial smears for Gram staining, (2) viable isolates for identification and serotyping/serogrouping (ST/SG) and (3) simulated cerebral spinal fluid (CSF) samples for species detection and ST/SG using polymerase chain reaction (PCR). SSLs and NLs tested for Gram staining and species identification (partial panel). RRLs, plus any SSLs and NLs (optionally) also analyzed the simulated CSF samples (full panel). The passing score was ≥75% for NLs and SSLs, and ≥90% for RRLs and NLs/SSLs testing the full panel. (3) Results: Overall, 63% (5/8) of the SSLs and NLs were able to correctly identify the targeted pathogens, in 2019; but there were challenges to identify Haemophilus influenzae either on Gram stains (35% of the labs failed 2014), or in culture. Individual performance showed inconsistent capacity, with only 39% (13/33) of the SSLs/NLs passing the EQA exercise throughout all surveys in which they participated. RRLs performed well over the study period, but one of the two failed to reach the minimal passing score in 2016 and 2018; while the SSLs/NLs that optionally tested the full panel scored between 75% and 90% (intermediate pass category). (4) Conclusions: We identified a need for implementing a robust quality management system for timely identification of the gaps and then implementing corrective and preventive actions, in addition to continuous refresher training in the SSLs and NLs supporting the IB-VPD surveillance in the World Health Organization, Regional Office for Africa (WHO AFRO).

Keywords: EQA; Haemophilus influenzae; Neisseria meningitidis; Streptococcus pneumoniae; vaccine-preventable disease.

Grants and funding

001/WHO_/World Health Organization/International