Strengthening influenza surveillance capacity in the Eastern Mediterranean Region: Nearly two decades of direct support from the United States Centers for Disease Control and Prevention

Since 2004, the US Centers for Disease Control and Prevention (CDC) Influenza Division (ID) has supported seven countries in the Eastern Mediterranean region and the World Health Organization Regional Office for the Eastern Mediterranean to establish and strengthen influenza surveillance. The substantial growth of influenza surveillance capacities in the region demonstrates a commitment by governments to strengthen national programs and contribute to global surveillance. The full value of surveillance data is in its use to guide local public health decisions. CDC ID remains committed to supporting the region and supporting partners to translate surveillance data into policies and programs effectively.

United States Centers for Disease Control and Prevention support for influenza surveillance, 2013-2021

Objective

To assess the stability of improvements in global respiratory virus surveillance in countries supported by the United States Centers for Disease Control and Prevention (CDC) after reductions in CDC funding and with the stress of the coronavirus disease 2019 (COVID-19) pandemic.

Methods

We assessed whether national influenza surveillance systems of CDC-funded countries: (i) continued to analyse as many specimens between 2013 and 2021; (ii) participated in activities of the World Health Organization's (WHO) Global Influenza Surveillance and Response System; (iii) tested enough specimens to detect rare events or signals of unusual activity; and (iv) demonstrated stability before and during the COVID-19 pandemic. We used CDC budget records and data from the WHO Global Influenza Surveillance and Response System.

Findings

While CDC reduced per-country influenza funding by about 75% over 10 years, the number of specimens tested annually remained stable (mean 2261). Reporting varied substantially by country and transmission zone. Countries funded by CDC accounted for 71% (range 61-75%) of specimens included in WHO consultations on the composition of influenza virus vaccines. In 2019, only eight of the 17 transmission zones sent enough specimens to WHO collaborating centres before the vaccine composition meeting to reliably identify antigenic variants.

Conclusion

Great progress has been made in the global understanding of influenza trends and seasonality. To optimize surveillance to identify atypical influenza viruses, and to integrate molecular testing, sequencing and reporting of severe acute respiratory syndrome coronavirus 2 into existing systems, funding must continue to support these efforts.

Improved capacity for influenza surveillance in the WHO Eastern Mediterranean Region: Progress in a challenging setting

BACKGROUND

The World Health Organization Regional Office for Eastern Mediterranean has partnered with the United States Centers for Disease Control and Prevention (CDC) to strengthen pandemic influenza preparedness and response in the Region since 2006. This partnership focuses on pandemic preparedness planning, establishing and enhancing influenza surveillance systems, improving laboratory capacity for detection of influenza viruses, estimating the influenza disease burden, and providing evidence to support policies for the introduction and increased use of seasonal influenza vaccines.

METHODS

Various published and unpublished data from public and WHO sources, programme indicators of the CDC cooperative agreement and Pandemic Influenza Preparedness Framework were reviewed and analysed. Analyses and review of the programme indicators and published articles enabled us to generate information that was unavailable from only WHO sources.

RESULTS

Most (19/22) countries of the Region have established influenza surveillance system; 16 countries in the Region have designated National Influenza Centres. The Region has seen considerable improvement in geographic coverage of influenza surveillance and influenza detection. Virus sharing has improved and almost all of the participating laboratories have achieved a 100% efficiency score in the WHO external quality assessment programme. At least seven countries have estimated their influenza disease burden using surveillance data and at least 17 are now using seasonal influenza vaccines as a control strategy for influenza illness.

CONCLUSION

The Region has achieved substantial progress in surveillance and response to seasonal influenza, despite the adverse effects to the health systems of many countries due to acute and protracted emergencies and other significant challenges.