Feedback on IVI's proposal for establishment of a regional network

[Hills, Susan (CDC/CCID/NCZVED)]

Thank you for the opportunity to comment on IVI’s proposal for establishment of a regional network for the control and prevention of JE in Vietnam, Cambodia and Lao PDR. I apologize for the delay in my response. My comments in large part mirror the earlier comments of Dr Barbara Johnson on the laboratory component of the proposal. Building on the activities and achievements of the GMS countries in recent years will be very important in moving forward. I think the best strategy will be to avoid repeating work, but, based on what has already been accomplished, focus efforts on maintenance of successful structures and identification of “next steps”.

 

In Cambodia, for example, there has been much progress in the last five years which includes:

·        Establishment of routine meningoencephalitis surveillance at 6 geographically-dispersed sites since 2006;

·        Development of a set of training materials (in Khmer);   

·        Conduct of a disability assessment, that demonstrated the impact of JE on children in terms of physical and cognitive sequelae;

·        Conduct of a cost effectiveness analysis;   

·        Preparation of a national plan for JE vaccine program implementation.  

 

I’d defer to the MOH staff in Cambodia to identify their priorities, as well as PATH and WHO who have been providing support for JE- related activities for many years in Cambodia. However, in terms of building on recent progress, support to ensure maintenance of strong surveillance (including regular analysis of data and supervision at sentinel sites) would likely be useful. In addition, the disability assessment identified that patients were not being followed up after neurological illness, which contributed to poor outcome. A strategy could be developed to facilitate patients being reviewed and followed up after acute illness, which would likely improve long term outcome.

 

In Vietnam during the last 3-4 years, in addition to piloting sentinel surveillance sites as mentioned in the proposal, Vietnam has also  

·        had several national meetings to discuss, draft, and get consensus on a national plan for expansion of JE surveillance;  

·        developed national guidelines on JE disease surveillance, with support from PATH and WHO;  

·        developed materials and a training program for surveillance staff;   

 

I think it would be important to build any new activities off the government’s existing national plan for expansion of surveillance. Rather than designating new sites in seven ecological regions, it would probably be best to use the national plan as a starting point, as other factors including access, vaccination coverage, disease burden, determination of whether disease is entering new areas, etc are likely to be important in site selection. The rationale for selecting two districts per province may also need to be considered further, as a survey a few years ago showed that JE cases typically go directly to the provincial-level hospital due to the severity of illness. 

 

It would probably be useful to get additional input from others with longer-term involvement in JE-related activities in the region. Both WHO and PATH have been active in supporting JE-related activities in the last 6 or 7 years. PATH staff were not able to attend the GMS forum, but I think it would be important that input from the PATH offices in Vietnam and Cambodia in particular be sought in development of any activities. There are also a number of key WHO staff who could provide some useful input to ensure activities build on what has already been accomplished, and continue to work towards the global goal of control of JE. Before deciding on a particular model, I think it would be important to further explore the human and technical resources that may be most beneficial to strengthen or expand surveillance in each country.

 

From a technical aspect, I am not sure what “standardization” of surveillance means in the document. While I fully support the concept of inter-country consistency of surveillance data, the particularities of local situations, and financial and logistical implications should be considered. As WHO has the major responsibility for technical support to countries for surveillance, they should play a major role in any discussions on this topic.

 

Thanks again for the opportunity to comment on this proposal. I hope these comments are useful. I hope there will be the opportunity to maintain and build on the progress with JE control in recent years.

Regards

Susan Hills