Right Sizing Influenza Virologic Surveillance – First Year Success, Challenges and Next Steps

Brief Summary:
BACKGROUND: The Association of Public Health Laboratories (APHL) and the Centers for Disease Control and Prevention (CDC) Influenza Division launched a project in 2010 to define the core capabilities and the optimal “right size” for influenza virologic surveillance. APHL and CDC released the 1st Edition, Influenza Virologic Surveillance Right Size Roadmap document in July 2013 outlining the requirements for achieving an effective national virologic surveillance system and tools for decision-making processes and system implementation. Throughout the summer of 2013, a series of webinars and teleconferences were hosted with public health laboratories and health departments to introduce the document and provide tutorials on tools such as sample size calculators. State and local jurisdictions were guided to: 1) review the document, 2) identify areas that were already being achieved, 3) identify areas for improvement, and 4), as appropriate, start implementing changes gradually. METHODS: In December 2013 APHL hosted focus groups with 5 jurisdictions implementing specific components of the document. The purpose was to gather feedback on the Roadmap document to make improvements and learn about best practices for a 2nd Edition as well as understand barriers and challenges to implementation of the document. Throughout the 2013-2014 season, APHL and CDC will work with states to better determine how to incorporate alternate data (i.e., non-public health laboratory testing data) into their situational awareness sampling and how to appropriately address inherent biases in virologic surveillance sampling. Development of an additional sample size calculator using frequently updated situational awareness inputs to determine the optimal number of samples to be submitted from state and local health laboratories to CDC for vaccine strain selection and vaccine candidate development was also begun in December 2013. RESULTS: Feedback from focus groups and project stakeholders will inform development of the 2nd edition of the Influenza Virologic Surveillance Right Size Roadmap document, to be available prior to the 2014-15 influenza season. The sample size calculator for influenza vaccine strain selection will be evaluated in the 2014-15 season to determine the feasibility of implementing an interactive sample submission system based on real-time situational awareness inputs. CONCLUSIONS: CDC and APHL will distribute the 2nd Edition of the Influenza Virologic Surveillance Right Size Roadmap prior to the 2014-2015 season. The 2nd Edition will provide users with improved clarity, additional best practice examples and tools, and guidance on how to incorporate alternate data and address sampling biases.