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Arboviruses continue to pose serious public health threats in the World Health Organization (WHO) Western Pacific Region. As such, laboratories need to be equipped for their accurate detection. In 2011, to ensure test proficiency, the WHO Regional Office for the Western Pacific piloted an external quality assessment (EQA) programme for arbovirus diagnostics. By 2016, it had grown into a global programme with participation of 96 laboratories worldwide, including 25 laboratories from 19 countries, territories and areas in the Region. The test performance of the 25 laboratories in the Region in 2016 was high with 23 (92%) reporting correct results in all specimens for dengue and chikungunya viruses. For Zika virus, 18 (72%) of the 25 laboratories reported correct results in all specimens, while seven (28%) demonstrated at least one error. When comparing iterations of this EQA programme in the Region between 2013 and 2016, the number of participating laboratories increased from 18 to 25. The first round only included dengue virus, while the latest round additionally included chikungunya, Zika and yellow fever viruses. Proficiency for molecular detection of dengue virus remained high (83-94%) over the four-year period. The observed proficiency for arbovirus diagnostics between 2013 and 2016 is an indicator of laboratory quality improvement in the Region.

Arboviruses such as dengue virus, yellow fever virus, Zika virus and chikungunya virus are major threats to human health globally, including countries in the Eastern Mediterranean Region (EMR).This study aimed to assess laboratory proficiency in EMR countries for detection of dengue virus, yellow fever virus, Zika virus and chikungunya virus.A global external quality assessment programme for arbovirus diagnostics was developed and run in 2016 and 2018. National-level public health laboratories were instructed to apply the polymerase chain reaction detection method on specimen panels containing dengue virus, yellow fever virus, Zika virus and chikungunya virus.Over both rounds of the programme, 100% of participating EMR laboratories correctly detected yellow fever virus and chikungunya virus, ≥ 84.6% detected dengue fever virus and ≥ 76.9% detected Zika virus.While participating EMR countries demonstrated good proficiency in detecting arboviruses, only half of them were enrolled in the global external quality assessment programme, providing an incomplete picture of regional capacity. Effort should be put into increasing participation in subsequent rounds.أداء مختبرات إقليم شرق المتوسط في برنامج تقييم الجودة الخارجي لمنظمة الصحة العالمية لتشخيص الفيروسات المنقولة بالمفصليات.رينال سكويرز، كريستوفر أوكسنفورد، سيباستيان كوجنات، فرانك كونينجس.تشكل الفيروسات المنقولة بالمفصليات مثل فيروس حمى الضنك، وفيروس الحمى الصفراء، وفيروس زيكا، وفيروس الشيكونجونيا، تهديدات رئيسية لصحة الإنسان على الصعيد العالمي بما في ذلك بلدان إقليم شرق المتوسط.هدفت هذه الدراسة إلى تقييم الكفاءة المختبرية في بلدان إقليم شرق المتوسط للكشف عن فيروس حمى الضنك وفيروس الحمى الصفراء وفيروس زيكا وفيروس الشيكونجونيا.أُعد ونُفذ برنامج عالمي لتقييم الجودة الخارجية لتشخيص الفيروسات المنقولة بالمفصليات في عامي 2016 و 2018. وصدرت تعليمات إلى مختبرات الصحة العامة على الصعيد الوطني بتطبيق طريقة التفاعل السلسي للبوليميراز (PCR) على مجموعة عينات تحتوي على فيروس حمى الضنك، وفيروس الحمى الصفراء، وفيروس زيكا، وفيروس الشيكونجونيا.خلال جولتي البرنامج العالمي اكتشفت المختبرات المشاركة في التقييم فيروس الحمى الصفراء وفيروس الشيكونجونيا اكتشافًا صحيحًا بنسبة %100، واكتشفت فيروس حمى الضنك بنسبة أكبر من أو يساوي %84.6، واكتشفت فيروس زيكا بنسبة %76.9.برغم أن بلدان إقليم شرق المتوسط المشاركة أظهرت إتقانًا جيدًا في الكشف عن الفيروسات المنقولة بالمفصليات، فقد سُجِّل نصفها فقط في برنامج تقييم الجودة الخارجية العالمي، وهذا يعرض صورة غير مكتملة لقدرات الإقليم. وينبغي بذل الجهود لزيادة المشاركة في الجولات التالية.Performance des laboratoires de la Région de la Méditerranée orientale dans le cadre du programme d’évaluation externe de la qualité de l’Organisation mondiale de la Santé en matière de diagnostic des arbovirus.Les arbovirus tels que le virus de la dengue, le virus de la fièvre jaune, le virus Zika et le virus chikungunya constituent des menaces majeures pour la santé humaine dans le monde, y compris dans les pays de la Région de la Méditerranée orientale.La présente étude visait à évaluer l’aptitude des laboratoires dans les pays de la Région pour la détection des virus susmentionnés.Un programme mondial d’évaluation externe de la qualité pour le diagnostic des arbovirus a été mis au point et adopté en 2016 et 2018. Les laboratoires de santé publique nationaux ont reçu l’instruction d’appliquer la méthode de détection par amplification génique sur des panels d’échantillons de laboratoires contenant le virus de la dengue, le virus de la fièvre jaune, le virus Zika et le virus chikungunya.Au cours des deux cycles du programme, 100 % des laboratoires participants de la Région de la Méditerranéenne orientale ont correctement détecté le virus de la fièvre jaune et le virus du chikungunya, un pourcentage supérieur ou égal à 84,6 % ont détecté le virus de la dengue et un pourcentage supérieur ou égal à 76,9 % de ces laboratoires ont détecté le virus Zika.Alors que les pays participants de la Région de la Méditerranée orientale ont démontré une bonne maîtrise de la détection des arbovirus, seulement la moitié d’entre eux étaient inscrits au programme mondial d’évaluation externe de la qualité, fournissant une image incomplète de la capacité régionale. Des efforts devraient être déployés pour accroître la participation aux cycles suivants.

Objective: Accurate laboratory testing is a critical component of dengue surveillance and control. The objective of this programme was to assess dengue diagnostic proficiency among national-level public health laboratories in the World Health Organization (WHO) Western Pacific Region. Methods: Nineteen national-level public health laboratories performed routine dengue diagnostic assays on a proficiency testing panel consisting of two modules: one containing commercial serum samples spiked with cultured dengue viruses for the detection of nucleic acid and non-structural protein 1 (NS1) (Module A) and one containing human serum samples for the detection of anti-dengue virus antibodies (Module B). A review of logistics arrangements was also conducted. Results: All 16 laboratories testing Module A performed reverse transcriptase polymerase chain reaction (RT-PCR) for both RNA and serotype detection. Of these, 15 had correct results for RNA detection and all 16 correctly serotyped the viruses. All nine laboratories performing NS1 antigen detection obtained the correct results. Sixteen of the 18 laboratories using IgM assays in Module B obtained the correct results as did the 13 laboratories that performed IgG assays. Detection of ongoing/recent dengue virus infection by both molecular (RT-PCR) and serological methods (IgM) was available in 15/19 participating laboratories. Discussion: This first round of external quality assessment of dengue diagnostics was successfully conducted in national-level public health laboratories in the WHO Western Pacific Region, revealing good proficiency in both molecular and serological testing. Further comprehensive diagnostic testing for dengue virus and other priority pathogens in the Region will be assessed during future rounds.

Objective: To conduct an external quality assessment (EQA) of dengue and chikungunya diagnostics among national-level public health laboratories in the Asia Pacific region following the first round of EQA for dengue diagnostics in 2013. Methods: Twenty-four national-level public health laboratories performed routine diagnostic assays on a proficiency testing panel consisting of two modules. Module A contained serum samples spiked with cultured dengue virus (DENV) or chikungunya virus (CHIKV) for the detection of nucleic acid and DENV non-structural protein 1 (NS1) antigen. Module B contained human serum samples for the detection of anti-DENV antibodies. Results: Among 20 laboratories testing Module A, 17 (85%) correctly detected DENV RNA by reverse transcription polymerase chain reaction (RT-PCR), 18 (90%) correctly determined serotype and 19 (95%) correctly identified CHIKV by RT-PCR. Ten of 15 (66.7%) laboratories performing NS1 antigen assays obtained the correct results. In Module B, 18/23 (78.3%) and 20/20 (100%) of laboratories correctly detected anti-DENV IgM and IgG, respectively. Detection of acute/recent DENV infection by both molecular (RT-PCR) and serological methods (IgM) was available in 19/24 (79.2%) participating laboratories. Discussion: Accurate laboratory testing is a critical component of dengue and chikungunya surveillance and control. This second round of EQA reveals good proficiency in molecular and serological diagnostics of these diseases in the Asia Pacific region. Further comprehensive diagnostic testing, including testing for Zika virus, should comprise future iterations of the EQA.