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Terms of Reference for

National Influenza Centers of the Global Influenza

Surveillance and Response System

Introduction

The National Influenza Centers (NICs)1 together with the World Health Organization (WHO)

Collaborating Centres for Influenza (WHO CCs) 2 , WHO Essential Regulatory Laboratories

(ERLs) and H5 Reference Laboratories form the Global Influenza Surveillance and Response

System (GISRS) coordinated by the WHO Global Influenza Program (GIP).

WHO GISRS, previously known as the Global Influenza Surveillance Network (GISN) until 2011,

was established in 1952. It has been, and is, the primary global mechanism and resource for

surveillance and control of influenza. GISN was renamed as GISRS after adoption of resolution

WHA64.5 by the Sixty-fourth World Health Assembly in May 2011 3 . The GISRS network

continuously monitors the evolution of influenza viruses around the world in the interest of public

health, conducts risk assessment and recommends risk management measures. GISRS functions

through efficient sharing of influenza viruses and surveillance information, provision of technical

support and updated reagents by and to GISRS members, as endorsed by national authorities of

host countries of GISRS institutions. The function of GISRS is coordinated by the GIP across the

three levels of WHO: headquarters, regional offices and country offices.

NICs are national institutions authorized and designated by their national health ministry and

subsequently recognized by WHO for the purpose of participating in the work of GISRS under the

applicable WHO terms of reference (ToRs). A NIC may have additional obligations under the

national authority of its host country.

General conditions

National Influenza Centres:

 serve as a reference laboratory for influenza in their country;

 serve as a technical resource on influenza-related matters for their national authority;

 serve as a key point of contact to WHO on issues related to influenza in their country;

 adhere to their national and/or international biosafety standards for work with influenza

viruses,

 adhere to national and international regulations on the transport of dangerous goods

(Class/division 6.2)4 when shipping clinical specimens and/or virus isolates,

 meet quality requirements of national or international quality standards, as applicable, and

participate in external quality assessment programmes (EQAP) provided by WHO to GISRS,

and

 maintain a high level of technical proficiency by participating in training provided by GISRS.

1 http://www.who.int/influenza/gisrs_laboratory/national_influenza_centres/list/en/ 2 http://www.who.int/influenza/gisrs_laboratory/collaborating_centres/list/en/ 3 http://apps.who.int/gb/ebwha/pdf_files/WHA64-REC1/A64_REC1-en.pdf 4 http://www.who.int/ihr/capacity-strengthening/infectious-substances/en/

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As part of GISRS, NICs may handle influenza viruses belonging to three categories:

Category 1: human seasonal influenza viruses;

Category 2: influenza viruses with human pandemic potential and, therefore, classified as

“PIP biological materials” (PIP BM) 5 ; and

Category 3: other influenza viruses from animal or environmental specimens that are not

classified as “human seasonal influenza viruses” or PIP BM.

When working with human seasonal influenza viruses (Category 1)

 NICs collect influenza viruses either through an established network of physicians, health care

centers or other sentinel sites, and/or they solicit influenza virus-positive samples from

laboratories providing diagnostic services. Patients included in the surveillance should

preferably meet the syndromic case definition of influenza-like illness (ILI)6, acute respiratory

infection (ARI) or severe acute respiratory infection (SARI). If possible, patients of all age

groups should be represented in the surveillance system.

 According to available resources, NICs identify influenza viruses by molecular detection

methods and/or virus culture and/or immunological methods.

 NICs differentiate between influenza A and influenza B viruses and attempt to identify the

subtype of influenza A viruses and the lineage of influenza B viruses. To be assisted in this,

NICs can obtain updated reagents from WHO CCs of GISRS.

 Influenza A viruses that cannot be typed or subtyped with updated reagents from the WHO

CCs of GISRS, including those without clear-cut results, must be immediately sent to a WHO

CC of GISRS.

 NICs report unusual or novel influenza viruses to their national authority according to the

domestic and international rules and regulations including the International Health

Regulations (IHR) (2005).7

 NICs report timely8, defined virological surveillance information either directly to WHO’s

FluNet platform 9 or indirectly to a regional platform for uploading into WHO’s FluNet

platform. Other epidemiological information, if available, is reported to WHO’s FluID

platform 10 either by the NIC or another focal point as designated by the host country.

Reporting should be done weekly during the months when seasonal influenza is commonly

observed, but preferably throughout the year.

5 “PIP biological materials”, for the purposes of this Framework (and its annexed Standard Material Transfer Agreements

(SMTAs) and terms of reference (TORs)) and the Influenza Virus Tracking Mechanism (IVTM), includes human clinical

specimens, virus isolates of wild type human H5N1 and other influenza viruses with human pandemic potential; and

modified viruses prepared from H5N1 and/or other influenza viruses with human pandemic potential developed by WHO

GISRS laboratories, these being candidate vaccine viruses generated by reverse genetics and/or high growth re-assortment.

Also included in “PIP biological materials” are RNA extracted from wild-type H5N1 and other human influenza viruses

with human pandemic potential and cDNA that encompass the entire coding region of one or more viral genes. 6 http://www.who.int/influenza/resources/documents/WHO_Epidemiological_Influenza_Surveillance_Standards_2014.pdf?ua=1 7 http://www.who.int/ihr/publications/9789241580496/en/ 8 Results for the previous week should be reported the following week by Thursday 12:00 UTC even if incomplete. Already

submitted results should be updated when more detailed results, e.g. subtype detection become available. 9 http://www.who.int/flunet 10 http://www.who.int/influenza/surveillance_monitoring/fluid/en/

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 NICs are required to send representative seasonal influenza virus isolates and/or clinical

specimens to one or more WHO CCs of GISRS of their choice11. However, it is important to

note that the same viruses should not be sent to multiple WHO CCs. Together with the

biological material, NICs should also provide associated available virological, clinical and

epidemiological background information and if available, also sequence data.

 Shipments should be timed to provide WHO CCs with the most recently circulating viruses

for further characterizations to inform decisions made at twice yearly vaccine composition

recommendation meetings, according to relevant WHO guidance materials on selecting and

shipping of seasonal influenza viruses to WHO CCs of GISRS12.

 NICs immediately report to their national authorities and to WHO any observation of unusual

influenza activity in their country.

When working with influenza viruses that are “PIP biological materials”

(Category 2)

Terms of Reference are described in Annex 5 of the PIP Framework13 (reproduced in Annex 1).

NICs share Influenza Viruses of Pandemic Potential (IVPP) according to relevant WHO guidance

materials14.

When working with other influenza viruses from animal or environmental

specimens that are not classified as “human seasonal influenza viruses” or

PIP BM (Category 3)

Occasionally, NICs may receive influenza viruses that do not fall in the categories of human

seasonal viruses or PIP BM; for example, viruses from animal or environmental specimens.

 NICs follow applicable national and/or international biosafety requirements to avoid cross-

contamination with viruses of human origin. Such material should preferably be handled in

facilities away from those where human specimens and viruses are investigated.

 NICs share virus samples with WHO CCs of GISRS of their choice to support GISRS risk

assessment following national and international rules and regulations. It is the responsibility

of the NICs to ensure that appropriate permits and other national/international documents and

approvals are in place to facilitate virus-sharing.

11 http://www.who.int/influenza/gisrs_laboratory/logistic_activities/en/ 12 http://www.who.int/influenza/gisrs_laboratory/national_influenza_centres/NIC_virus_sharing_guidance_20171103.pdf?ua=1 13 http://www.who.int/influenza/resources/pip_framework/en/ 14 http://www.who.int/influenza/gisrs_laboratory/national_influenza_centres/IVPP_Sharing_Guidance_20171103.pdf?ua=1

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Annex 1. Extract (pp 49-52) from Annex 5 of the Pandemic Influenza Preparedness Framework

for the sharing of influenza viruses and access to vaccines and other benefits: National Influenza

Centres, Terms of Reference related to work with Pandemic Influenza Preparedness Biological

Materials15

15 http://apps.who.int/iris/bitstream/10665/44796/1/9789241503082_eng.pdf

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