Right Sizing Influenza Virologic Surveillance: A Roadmap to the Future

BACKGROUND:   The Association of Public Health Laboratories (APHL) and the Centers for Disease Control and Prevention (CDC) Influenza Division launched a three-year project in 2010 to define the core capabilities and the optimal “right size” for influenza virologic surveillance. The outcomes of the project will provide state, national and global surveillance requirements to inform policy decisions and disease prevention efforts. As part of this project, APHL and CDC developed the Right Size Influenza Virologic Surveillance Roadmap document outlining the requirements and tools for an effective national virologic surveillance system. Specific surveillance strategies addressed in the document include sampling approaches (i.e. sample size and representativeness), laboratory testing, quality systems, specimen referral, data management, and funding resources. METHODS:   Throughout the 2012-2013 influenza season, four states piloted the roadmap document, to evaluate the feasibility, utility and potential implementation strategies. Additionally in December 2012, APHL and CDC sponsored a tabletop exercise which was held to evaluate the utility of the draft Roadmap document, assess the feasibility and benefit of incorporating proposed requirements into state virologic surveillance programs, and identify potential best practices, barriers, and potential aids to include in implementation guidelines. Participants in the exercise included epidemiologists or influenza surveillance coordinators and public health laboratorians from fifteen states and one local jurisdiction.  RESULTS:   Feedback from project stakeholders, pilot studies, and the tabletop exercise were incorporated into the roadmap document to improve its utility and clarity. The pilot studies, tabletop exercise, and survey of the national influenza virologic surveillance landscape have also informed the development of an implementation guide which provides best practices for incorporating the roadmap requirements into state and local surveillance systems as well as the development of a communication toolbox to guide state and local PHLs as they justify funding for virologic surveillance and the impacts of the surveillance system to different target audiences.  CONCLUSIONS:  CDC and APHL will distribute the initial roadmap document to state and local public health laboratories and health departments in preparation for the 2013-2014 influenza season. This will include the implementation guide and communication toolbox. Each state will be able to use the surveillance guidance and materials provided with the roadmap to customize a surveillance strategy that will meet both national and state needs.