NHL: The influenza journey
The story of the National Health Laboratory (NHL) of Timor-Leste is one of perseverance and success. Following independence in 2002, the NHL, along with the majority of the country’s health infrastructure, was in poor shape. However, through close collaborations between the Ministry of Health and WHO, the lab now has four full time technicians and the capacity to conduct a wide range of pathogen detection, including influenza typing and subtyping.
The Ministry of Health begin influenza surveillance in late-2016 with support from WHO Country Office for Timor-Leste under the Pandemic Influenza Preparedness (PIP) programme. Prior to this, no surveillance or testing was being conducted for influenza, a viral disease that causes substantial morbidity and mortality. “At the laboratory we were doing malaria, HIV, syphilis, measles, and a whole lot of other tests but influenza,” says Euegenia Antonio da Costa, lab technician at the NHL.
However, this changed once WHO’s PIP programme implementation began. The surveillance system now includes five influenza-like-illness (ILI) sentinel sites located throughout the Dili Municipality that collect samples from outpatients at Community Health Centres and three severe acute respiratory infection sentinel (SARI) sites in three municipalities (Dili, Baucau and Maliana) that collect samples from inpatients.
Trainings have been conducted for sentinel site staff for case definition and swab collection as well as NHL staff for influenza laboratory techniques. Alberina de Carvo Veira, a NLH laboratory technician, has had the opportunity to attend influenza specific trainings within the country and abroad through support from WHO Country Office for Timor-Leste under the PIP programme. “In 2016 I travelled to Pune in India and underwent three-week training at the National Institute of Virology on influenza typing and subtyping,” recounts Ms Veira. “The training was hands-on; we collected samples ourselves and tested them. It made me confident as a lab technician,” adds Ms Veira.
Although laboratory staffs were trained to detect influenza, the NHL initially struggled to get supplies and reagents and, most importantly, did not have samples to test. Supplies are now available and the lab has capacity to test approximately 50 samples per week. Through close collaborations between the Ministry of Health Surveillance and Epidemiology Division and WHO, the number of samples submitted to the lab has slowly increased. “For any national level laboratory, it is not just merely testing that can define its excellence but also surveillance. By November 2017 we’d managed to collect 31 samples and tested 13 of them, this is a small step but historical for us”, said Isamel Salvador da Costa Barreto, executive director, NHL. As of 1 March 2018, NHL has received 110 samples from sentinel sites and processed 94.
The journey of influenza surveillance and testing at NHL has been topsy-turvy but improvements have been steady. “Our long term vision is not just to perform certain tests and claim that we can do it. I wish for the NHL to be sustainable. We have started with influenza testing but I know we have a lot of gains to make in the area of surveillance,” adds Mr Barreto.