Management and Quality Evaluation of
Influenza Surveillance Network in China
Dr. Wang Dayan
WHO Collaborating Center for Reference and Research on Influenza
National Influenza Center of China
National Institute for Viral Disease control and Prevention
China CDC
2011-6-10, Vientiane ,Lao’s
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Content
Brief introduction of Chinese NISN and
Responsibility of NISN
Management and Quality Evaluation of
NISN
Changes
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Part 1:
Introduction of Chinese NISN and
Responsibility of NISN
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History of Chinese NIC and National Influenza
Surveillance Network (NISN)
Started influenza
surveillance
1952
Chinese NIC
jointed GISN
1957
1981
Established
Chinese National
Influenza Center
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Structure of Chinese National Influenza Surveillance
Network (NISN)
Ministry of Health
WHO
China CDC
DCER Office
IVDC
CNIC
Sentinel
hospitals
Lab
Provincial CDC
Provincial BoH
Lab
PrefectureCDC
Prefecture BoH
Lab
County CDC
County BoH
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Expansion of National Influenza
Surveillance Network (NISN)
Network laboratories
Sentinnel hospitals
600
500
No.
400
300
200
100
0
Time
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Expansion of National Influenza Surveillance
Network(NISN)
63 network labs
197 sentinel hospitals
Before April, 2009
411 network labs
556 sentinel hospitals
June, 2009
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Surveillance Objectives
 To monitor influenza activity in mainland China.
 To Determine what influenza viruses are circulating.
 To detect changes in antigenic, genetic characteristics,
and provide evidence for recommending circulating
strain and vaccine strain
 To monitor the novel influenza virus for the response
to influenza pandemic.
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8
Influenza surveillance information system
ILI reporting
ILI hospital sentinels
Specimens collection
Send specimens to labs
Specimens
information
& results
Network laboratories
Detecion
Isolates to NIC
Re-identification
CNIC
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Real-time Database(1)
ILI report to Influenza Surveillance information system
No. of ILI by age
group
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Total no.
of patients
Real-time Database(2)
Chinese Influenza Surveillance Information System
ILI surveillance
data
Virological
surveillance data
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Real-time Database(3)
Information System for serological surveillance of Occupational
exposure population and environment surveillance
environment
surveillance data
 Newly established
 Avian flu related
Serological
surveillance data
CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION
Work progress of sentinel hospitals
500
400
300
July, 2009
Sep, 2009
Oct, 2010
200
100
0
<85% report
ILI data
95% report
ILI data
97% report
ILI data
80% collect
87% collect
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 2 5 8 11 14 17 20 23 26 29 32 35 38 41 44 47 50
specimen
specimen
2010
2009
2010
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Work progress of network labs
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Responsibility of NISN (1)
CNIC
Oct,2010
WHO CC
Undertake the responsibilities and ToRs
as WHO CC.
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Responsibility of NISN(2)
CNIC
Provincial
CDCs
WHO CC
Reference Centers
at provincial level
Establish the capacity of antigenic, genetic and
drug resistance analysis；
 Manage the influenza surveillance network of each
province, and Provide training, quality assurance
and control for each network；
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Responsibility of NISN(3)
CNIC
WHO CC
Provincial
CDCs
Reference
Centers
at provincial level
Network
Labs
Labs with the capacity
of virus isolation and
nucleic test
Establish the capacity of virus isolation and nucleic test；
Organize, manage the hospital-based ILI surveillance
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Part 2:
Management and Quality Evaluation
of NISN
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Routine technical support to NISN
Provide standard reference reagents
Training workshops: year round
National influenza surveillance
guideline &Technical manual
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Providing reagents to NISN
RT-PCR
Reagents for HI test
seasonal virus, serology test
Primer/probe sets
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rRT-PCR
Trainings to the NISN every year
CNIC organized
Provincial CDC organized
----Workshops, hands on training
Sample collection
virus isolation
nucleic acid test
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National influenza surveillance guideline
&Technical manual
April, 30, 2009
May, 11, 2009
May, 03,2009
Sep, 3, 2010
Sep, 30, 2009
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Quality assessment to NISN
Real time feed back of the test results of
CNIC to NISN through the surveillance
system
External quality assessment panel for
nucleic acid test for NISN every year
Site supervision to network labs every year
Quality assessment to NISN twice a year
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Seasonal Influenza laboratory
work in CNIC
Virus Isolates
Sent from
Network Labs
Incepting virus
Data Entry
HA<16
HA
Feed back
MDCK Cell or
Egg Passage
HA≥16
Virus Storage
(desiccation,
liquid)
Antigenic Analysis
HA<16
PCR
undetectable
Genetic Analysis
Drug Resistance
Analysis
Lab Training
Virus Sharing
Data Sharing
Reagents Support
to NISN Lab
NISN lab/ASEA
WHO CC
(CDC/NIID~~)
HI tables
Sequence
HA/HI KIT
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Ferret Anti-sera
H3N2
HIN1
H1N1
pdm
B-Vic
BYam
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Verification of Isolates from NISN by CNIC
Common problems:
•Mixture of different subtypes
•Can’t distinguish B-Vic and B-Yam
•Reported wrong type/subtype
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QAP for nucleic acid test
Year
No. of laboratories participated
2007
30 provincial network laboratories
2008
30 provincial network laboratories
31 local network laboratories
2009
411 labs
2010
411 labs
Panel:10 samples:β-propiolactone inactivated egg isolates
Test the stability: frozen/thaw, RT
Concentration:
Cross detection of different subtypes
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QAP for nucleic acid test
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Supervision
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Quality Evaluation Program
网
络
实
验
室
（
家
）
70
60
50
40
30
20
10
0
35
Management of provincial CDC
Quality: work load, timeliness, quality
省
/
市
（
家
）
15
10
毒
株
滴
度
（
）
天
内
送
检
毒
株
情
况
选
送
毒
株
得
分
评估指标
标
本
信
息
(0/1)
鸡
胚
分
离
情
况
结
案
报
告
(0/1)
复
核
一
致
性
细
菌
培
养
情
况
(0/1)
标
本
分
离
阳
性
率
标
本
采
集
个
案
信
息
评估指标
(0-
毒
株
复
核
阳
性
率
WHO
接
收
后
鉴
定
时
间
15
送
检
毒
株
量
及
溢
洒
情
况
HA>8
送
检
毒
株
数
NIC
HI
标
本
分
采
型
集
情
况 间后
送
实
验
室
时
实
验
室
检
测
2)
(0-5)
报告及时性 评估指标
5分
4分
3分
2分
1分
0分
送
检
标
识
情
况
5
分
4
分
3
分
2
分
20
0
70
60
50
40
30
20
10
0
采
样
数
25
5
报告完整性
网
络
实
验
室
（
家
）
30
5分
4分
3分
2分
1分
0分
25
网
络 20
实 15
验
室 10
（ 5
家
） 0
得分
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80
The Quality Evaluation results
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Challenges for NISN
Financial funds
from central
government
How to
Strengthen the
management of
NISN
Network laboratories
Technical &
reagent support
Sentinel hospitals
Information
exchange timely
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Conclusions and suggestions
 Governmental coordination plays a key role
 Scientific based decision-making is the
fundamental for public health
 Pandemic preparedness for H5N1 & other
subtypes are rewarded
 International cooperation is essential for the world
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Contact information for WHOCC
China
Director: Dr. Yuelong Shu
WHO Collaborating Center for Reference and Research on Influenza,
National Institute for Viral Disease Control and Prevention, China CDC.
155 Changbai Road,
Changping District,
102206,
Beijing, China.
Tel: +8610 58900851,
Fax: +8610 58900851,
Email: whocc-china@cnic.org.cn,
Website :http:// www.cnic.org.cn/eng/
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Acknowledgments
•
•
•
•
WHO
CDC
WHOCCs
CCDC/CNIC colleagues
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Thank You!
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