Establishment of NIC in a post conflict and resource limited country (Afghanistan)

Background: Afghanistan’s National Influenza Centre was established at the Central Public Health Laboratory (CPHL) as (BSL-II) in March 2007.  The centre was created in response to the need for local monitoring of influenza cases in the wake of avian influenza outbreaks across south-east Asia. The NIC receives human samples from hospitals or communities where Influenza-like-illness (ILI) has been detected, through the DEWS system. These are delivered to the CPHL where processing and testing is conducted. Samples are additionally sent to NAMRU-3 Cairo and WHO RL for confirmation.   The CPHL is the National Center for Excellence in laboratory services for Afghanistan. It is functional as the National Reference Center for a range of diseases; National Training Center; Research Center for some infectious diseases; and Information Center for reporting national lab data. The CPHL require equipment, as well as support for reagents and consumables, logistics, IT systems, and staff costs. Currently, the CPHL provides virology (PCR), Serology (ELISA), Bacteriology, Biochemistry, Hematology, Prasitology and Urology services.  Methods: Initial infrastructure was put in place for a three-suite PCR lab and viral culture room by the US Naval Medical Research Unit No. 3 (NAMRU-3). The suite is currently located in the CPHL virology department and in at the Afghan National Army Hospital Lab (ANA) which provides technical assistance to the MoPH projects and to the Afghan National Army clients. Laboratory technicians have been trained by NAMRU-3 and others to perform selection of influenza PCR assays (a NAMRU-3 assay for A-H3, A-H5, the CDC swine flu assay) and viral culture.  Thus far, the facility has successfully partaken in two WHO-EQA Program assessments, with the result that the centre received WHO accreditation in January 2009. Furthermore, the CPHL receives quality control (QC) tests on regular basis and has achieved full score in EQA program 2012 for the detection of influenza virus A by PCR. Conclusion: The NIC activity in CPHL has received support from NAMRU-3 ,CDC and WHO. Testing for influenza A and B (including H5N1 avian influenza in humans and seasonal flu) is well established. The maintenance of this activity will be performed based on the current support of NAMRU-3 and future coordination with other partners, but unfortunately the NIC is running with several challenges such as lack of reagents, Kits, and sustainability.