Global Influenza Surveillance Network
Established in 1952, this global network of more than 100 virus laboratories in 83 countries monitors influenza activity and collects the viral isolates that determine the composition of the following year's influenza vaccines32 (Fig. 15-2). The isolates are characterized by WHO Collaborating Centers in the United Kingdom, Japan, Australia, and the United States. In addition to guiding the annual composition of recommended vaccines, the network operates as an early warning system for the appearance of influenza variants and novel strains that could signal the emergence of an influenza pandemic.
Global Laboratory Network for Poliomyelitis Eradication
International disease eradication strategies include a strong surveillance component. To support the Global Polio Eradication Initiative, WHO established the Global Laboratory Network for Poliomyelitis Eradication,33 which uses molecular techniques to determine whether wild-type polio is circulating in areas undergoing eradication efforts. Genomic sequencing capabilities and collaboration among network laboratories have allowed the tracking of virus
strains within and among countries and the identification of the origin of viruses imported into polio-free countries.34
Global Salmonella Surveillance System (Global Salm-Surv)
Started in 2000, WHO's Global Salm-Surv is a global network of laboratories and individuals involved in isolation, identification, and antimicrobial resistance testing of Salmonella and surveillance of salmonellosis. The goal is to enhance the capacity and quality of Salmonella surveillance, serotyping, and antimicrobial resistance testing throughout the world. Global Salm-Surv conducts an electronic discussion group, international training courses for microbiologists and epidemiologists, external quality assurance testing, and focused research projects on topics such as surveillance enhancement and burden of illness. Member institutions enter their top 15 Salmonella serotypes yearly in a web-based country databank that can be searched for serotype frequency nationally, regionally, or globally.
Global Project on Antituberculosis Drug Resistance Surveillance
Surveillance of antimicrobial resistance is fundamental for understanding trends, developing treatment guidelines, and assessing the effectiveness of interventions. In 1994, WHO, the International Union against Tuberculosis and Lung Disease (IUATLD), and other partners launched the Global Project on Antituberculosis Drug Resistance Surveillance in response to growing concern about drug resistance and its impact on TB control. The purpose of this network of reference laboratories is to measure the prevalence of anti-TB drug resistance in several countries using standard methods and to study the correlation between the level of drug resistance and treatment policies in those countries.
GOARN was launched in 2000 as a mechanism for combating international disease outbreaks, ensuring the rapid deployment of appropriate technical assistance to affected areas, and contributing to long-term epidemic preparedness and capacity building. GOARN electronically links more than 120 partner institutions and surveillance networks, which together possess the expertise, skills, and resources for rapid outbreak detection, verification, and response.29 The coordinated response to the large Ebola hemorrhagic fever outbreak in Uganda in 2000 demonstrated the merit of the principles on which the network is based and functions.18,35 The importance of GOARN was also evident in 2003, when WHO coordinated the unprecedented global response to SARS. Through GOARN, WHO mobilized the international public health, clinical, and research communities to rapidly identify and characterize the causative agent and to contain the spread of this new infectious agent, providing a new standard for future responses to global microbial threats.36
The Laboratory Response Network (LRN) was established by CDC in 1999 to respond quickly to acts of chemical and biological terrorism, emerging infectious diseases, and other public health threats and emergencies. The more than 120 federal, state, and local public health, veterinary, military, environmental, and international laboratories in the network have progressively stringent levels of safety, containment, and technical proficiency that enable them to recognize, rule out, confirm, or definitively characterize highly infectious agents using standardized protocols and reagents and to maintain communication through a secure web site.
The value of the LRN was demonstrated during the SARS epidemic, when validated reagents and protocols were rapidly distributed within weeks of the discovery of the etiologic agent (SARS-associated coronavirus [SARS-CoV7]) thereby providing diagnostic testing capability to each state.
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