Lab Culture Extra: Progress in Sierra Leone

APHL's Sierra Leone team

APHL has a long history of involvement in Sierra Leone where we’ve provided technical assistance to strengthen the nation’s laboratory system for over a decade. Following the 2014-2015 Ebola outbreak, we were invited back to build laboratory response capability for Ebola and other highly infectious diseases.

We found there was a lot to be done: a strategic plan for the laboratory system, renovation of the central lab, training and mentoring of lab staff, reducing turnaround time for Ebola testing, and much more.

With the engagement completed earlier this year, APHL Executive Director Scott Becker and Manager of Global Health Sherrie Staley share insights from APHL’s on-the-ground experience, which include the value of a healthy ram.

Listen here or wherever you get your podcasts.


Photo album — Progress in Sierra Leone

APHL joins partners in Sierra Leone to strengthen lab capacity in Ebola’s wake

High profile APHL team explores MOHS public health laboratory priority needs

APHL in Sierra Leone: Building a resilient lab system

Sierra Leone and Guinea: Building a resilient lab system

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New Lab Matters: The promise and challenge of newborn screening in 2019

New Lab Matters cover depicts a newborn baby

Newborn screening is a public health success story, ongoing for 56 years. On the one hand, new treatment and laboratory testing options open up the possibility of expanded screening panels. On the other hand, testing laboratories and follow-up providers are generally under-resourced and straining to keep pace with growing workloads. But as our feature article shows, scientists are working diligently to improve the accuracy and precision of existing tests and to bring on new disorders, even as they continue the high-stakes work of screening tens of thousands of infants a year.

Here are just a few of this issue’s highlights:

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Lab Culture Ep. 7: APHL’s International Team Meeting

Lab Culture Ep. 7: APHL’s International Team Meeting |

The APHL International Team Meeting allows for US-based APHL leadership and global health program staff and consultants working in-country to discuss organizational operations and key programmatic successes and challenges. In most cases, this is the only time during the year that these individuals have an opportunity to meet face-to-face. Participants from Zambia, Zimbabwe, Kenya, Tanzania, Mozambique, Guinea, Sierra Leone and APHL’s US headquarters were all in attendance.

In November, Scott Becker, APHL’s executive director, traveled to Johannesburg, South Africa for the second APHL International Team Meeting. While he was there, he sat down with five members of the APHL international team to discuss their work and what led them to pursue a career in laboratory science.

Interviews include:

  • Levi Vere, Laboratory Quality Monitoring Manager, APHL Zimbabwe
  • Shanette Nixon, Global Health Consultant, APHL
  • Esther Vitto, Laboratory Program Support, APHL Sierra Leone
  • Mohamed Fofanah, Associate Specialist, Administration and Finance, APHL Sierra Leone
  • Rufus Nyaga, LIS Technical Consultant and Project Manager, APHL Kenya
Scott Becker and Levi Vere Scott Becker and Shanette Nixon Scott Becker, Esther Vitto and Mohamed Fofanah Scott Becker and Rufus Nyaga


APHL’s Global Health Program

Mudslides in Sierra Leone

Zimbawe After Mugabe


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Partner, Train, Respond: Increasing Global Emergency Management Capacity

People walking a busy street in Zanzibar.

Countries in Africa are no strangers to major disease outbreaks that can result in illness and death of millions of people.  In the past two years alone the continent has experienced infectious disease outbreaks of cholera, meningitis, Ebola Virus Disease, Lassa fever, and Yellow fever, and other public health emergencies such as drought and famine.

Understanding the big picture

Training participants from Zanzibar discuss the development of an emergency management program
Training participants from Zanzibar discuss the development of an emergency management program.

It is vitally important to have a big picture perspective on emergency management and response – if one country is not prepared for a public health emergency, then all the countries in the region are susceptible to public health threats that can easily cross borders and impact surrounding countries. This is where public health emergency management (PHEM) comes in. In-country PHEM capacities and systems can be strengthened to support global health security. When the workforce is trained, emergency management infrastructure is in place, and functional systems exist, a country is better positioned to execute a coordinated response that can mitigate risk and save lives.

CDC and other international partners support ongoing efforts to help countries across Africa build capacity in outbreak detection and response. This includes preventing avoidable epidemics, detecting public health threats early, and responding rapidly and effectively to outbreaks of international concern. CDC provides expertise in PHEM to train emergency management technicians, provide input on emergency management operations, and guide development of functional processes and systems for ministries of health around the globe.

Getting the workforce ready to respond

In August 2017, CDC spearheaded a 5-day PHEM workshop in partnership with the World Health Organization, the United States Defense Threat Reduction Agency, and Public Health England.  The workshop brought together 55 emergency management staff members from across Africa to learn from experts in the field about how to enhance coordination and response capabilities of their country’s PHEM programs.

Participants came from seven countries – Tanzania, Uganda, Kenya, Ethiopia, Liberia, Sierra Leone, and Nigeria – which all share common interests and challenges related to emergency response. The training focused on developing core principles in PHEM, including trained staff, physical infrastructure, and processes to run a fully functional Public Health Emergency Operations Center (PHEOC). The training highlighted best practices, but since many of the participants had first-hand accounts of responding to public health events in their own countries, they were encouraged to share experiences and network with their peers.

Sharing knowledge and expertise

Public health professionals who work in emergency response know that it’s important to build relationships before an incident so that during a response you work effectively and efficiently with partners. One participant noted that the “rich, valuable contributions from other people’s experiences to build upon what I already knew” was one of the most rewarding parts of the workshop.

The tabletop exercises at the end of the workshop emphasized the importance of information and idea sharing. Participants engaged in tabletop exercises that simulated a response to a Yellow Fever outbreak in northern Tanzania. Participants were divided into 7 teams: management, plans, logistics, operations, finance and administration, communication, and partners. Each team had a mix of participants from different countries.  Teams utilized information they had learned throughout the workshop to developed response products, including an organizational structure chart, objectives for the response, and an initial situation report. This exercise led to a robust conversation about different approaches to public health emergency response.

Seeing response in action

Public Health Emergency Operations staff survey the scene after mudslides in Regent, Sierra Leone.
Public Health Emergency Operations staff survey the scene after mudslides in Regent, Sierra Leone.

A highlight of the training was when Dr. Ally Nyanga, the Tanzania Ministry of Health PHEOC Manager and an alumni of the CDC Public Health Emergency Management Fellowship, took workshop participants on a tour of the Tanzania PHEOC, a small room on the third floor of the Ministry of Health building. Previously used as a storage area for the library, the 10 x 20 foot PHEOC is now an efficient space that staff can use when they respond to public health emergencies and outbreaks.  To date, Tanzania’s PHEOC has been activated to respond to widespread cases of Aflotoxicosis, a type of severe food poisoning, and cholera outbreaks in Tanzania.

While the workshop is over and participants have returned home, the work that they do to prepare for the next public health emergency is ongoing. The workshop highlighted some important takeaways – you do not need a big space and high-tech equipment to respond quickly and efficiently to a public health emergency.  Instead, coordination to share information, resources, and ideas is vital to a successful emergency response, both in-country and across an entire region.

Learn more

Ebola Response: Year in Review

A person washing their hands at a water station in West Africa

Throughout the month of December, Public Health Matters is conducting a series of year-in-review posts of some of the most impactful disease outbreaks of 2015. These posts will give you a glimpse of the work CDC is doing to prevent, identify, and respond to public health threats.

Getting to Zero

Getting to Zero was a theme and goal that dominated much of CDC’s attention in 2015. In January 2015, The World Health Organization reported that the Ebola epidemic had reached a turning point with the most impacted countries, Liberia, Guinea and Sierra Leone, seeing declines in the number of new cases of Ebola.  This turning point came after a year of battling the worst Ebola outbreak in history—resulting in over 20,000 cases by December 2014.

While the spread of the disease and U.S. media attention was at its peak in 2014, some of CDC’s most impactful and important work took place in 2015. This year’s response to the Ebola epidemic was marked with many challenges and accomplishments, new discoveries, and continuous hard work by hundreds of CDC staff. The dedication of CDC and its partners throughout the year has also led to the successful end of widespread Ebola transmission in Liberia and Sierra Leone.

Ebola Vaccine Trials

In April 2015, CDC, in partnership with The College of Medicine and Allied Health Sciences, University of Sierra Leone, and the Sierra Leone Ministry of Health and Sanitation, began a clinical trial to test the potential of a new vaccine to protect against the Ebola virus. This vaccine trial, known as Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE), is designed to help protect against Zaire ebolavirus, the virus that is causing the current outbreak in West Africa.

Person getting a vaccine“A safe and effective vaccine would be a very important tool to stop Ebola in the future, and the front-line workers who are volunteering to participate are making a decision that could benefit health care professionals and communities wherever Ebola is a risk,” said CDC Director Tom Frieden, M.D., M.P.H.  “We hope this vaccine will be proven effective but in the meantime we must continue doing everything necessary to stop this epidemic —find every case, isolate and treat, safely and respectfully bury the dead, and find every single contact.”

This vaccine trial, along with a series of other vaccine trials taking place in West Africa, represents an important step in the response to the Ebola epidemic. In addition to the tireless efforts being made to completely eliminate Ebola cases, efforts to discover a vaccine could prevent an outbreak of this size in the future.

Leaving Lasting Infrastructures for Health

Programs like STRIVE seek to contribute not only to the future of Ebola prevention research, but also to the future of health care capabilities in the areas impacted by the Ebola epidemic. The STRIVE study is strengthening the existing research capacity of institutions in Sierra Leone by providing training and research experience to hundreds of staff to use now and for future studies.

CDC is leaving behind newly created emergency operation centers (EOC) in countries affected by widespread Ebola outbreaks.   The ministries of health will fully lead these new EOCs, which will provide a place to train healthcare workers to be better prepared to conduct outbreak surveillance and response.

Additionally, 2015 brought the official announcement of plans to create the African Centres for Disease Control and Prevention (African CDC). First proposed in 2013, the African CDC will seek ongoing collaboration with other public health entities across the continent and the world to elevate health outcomes for all citizens. Partners will assist by implementing activities, supporting the establishment of regional collaborating centers, advising the African CDC leadership and staff, and providing technical assistance.

Celebrate the Successes, Look to the Future

2015 brought significant progress in the Ebola response. Yet, while the successes and improvements made to public health infrastructure in West Africa are important to celebrate, the work continues to get to zero and end the largest Ebola outbreak in history.

As we draw closer to our goal of zero cases of Ebola, we are reminded of how critical it is to identify, prevent, and respond to outbreaks to prevent future epidemics of this magnitude.

APHL is a proud partner in the Global Health Security Agenda

Today President Obama announced the United States and 30 other nations have committed to join together to achieve the targets of the Global Health Security Agenda (GHSA).  APHL is proud to be a key partner in the effort to make the world safe from infectious disease threats.

APHL is working closely with US federal agencies as well as domestic agencies within African and Asian partner nations to achieve the following GHSA targets:

  • Countering antimicrobial resistance
  • Preventing the emergence and spread of zoonotic disease
  • Advancing a whole-of-government national biosafety and biosecurity system in every country
  • Establishing a national laboratory system
  • Strengthening real-time biosurveillance
  • Advancing timely and accurate disease reporting
  • Establishing a trained global health security workforce
  • Establishing emergency operations centers

APHL in Africa
Guinea, Kenya, Liberia, Sierra Leone, Tanzania, Uganda

To address the limited laboratory capacity and capability in many African nations, we are currently partnering with the African Society of Laboratory Medicine (ASLM) to provide technical and management assistance for design, development and implementation of the African Public Health Laboratory Network (APHLN).  Working with ASLM, APHL will convene stakeholders to develop the operational rules for the network, support laboratory accreditation and set goals for national public health laboratories. We will leverage existing laboratory models, notably the US Laboratory Response Network (LRN), to design an effective laboratory network for the continent.

As our GHSA work moves forward, APHL is also planning to initiate laboratory assessments, inventory and review of laboratory policies, training and mentoring of laboratory staff, support for development of biosafety facilities, and review of specimen referral systems, quality management system programs and capacity for detecting anti-microbial resistance.

APHL in Asia
India, Indonesia, Vietnam

In Asia, APHL is working directly with ministries of health and other national health officials to develop laboratory systems capable of safely and accurately detecting and characterizing pathogens causing epidemic disease. Lucy Maryogo-Robinson, APHL’s global health director, is traveling to partner countries in southeast and central Asia to plan activities under GHSA. In November she traveled with an APHL team to Vietnam to discuss projects to expand APHL’s longstanding relationship with that country.  Ongoing development of informatics systems and strengthening of capacity to respond to infectious diseases will be priorities.

APHL joins partners in Sierra Leone to strengthen lab capacity in Ebola’s wake

This week a team of APHL staff and consultants traveled to Freetown, Sierra Leone where they will join US federal and Sierra Leonean partners to launch a year-long project to support and strengthen the country’s laboratory system in the aftermath of the Ebola crisis. This initiative builds on APHL’s longstanding relationships with laboratory and public health partners in Sierra Leone. We are proud of these relationships; proud of our partners, staff and consultants; and eager to begin this critical work.

In addition to its project work in Sierra Leone, on October 15-16 APHL staff – in collaboration with the World Health Organization’s Regional Office for Africa and the African Society for Laboratory Medicine (ASLM) – will participate in the Regional Global Health Security Agenda (GHSA) Consultation for Laboratory Strengthening, a two-day meeting focused on developing resilient laboratory networks in Africa. This meeting will bring partners together to initiate and build consensus around an inclusive roadmap framework for the implementation of the Global Health Security Agenda across Africa.

Who is going?

APHL Staff: Scott Becker, executive director; Lucy Maryogo-Robinson, global health director; Ralph Timperi, senior advisor of laboratory practice & management

APHL global health consultants: Alpha Diallo, Paul Jankauskas, Kim Lewis and Jocelyn Isadore

What are the objectives of APHL’s work in Sierra Leone?

– APHL global health consultants will provide technical assistance to the Ministry of Health (MOHS) and National AIDS Secretariat of Sierra Leone in coordination with the Centers for Disease Control and Prevention (CDC) to strengthen laboratory infrastructure and capacity. This support will entail guidance on implementation of the National Laboratory Strategic Plan, mentoring and participation in the laboratory technical working group, and mentoring and training for the Central Public Health Reference Laboratory staff, all with the goal of strengthening lab capacity in Sierra Leone.

APHL joins partners in Sierra Leone to strengthen lab capacity in Ebola’s wake |– APHL, in collaboration with CDC Division of Global HIV/AIDS and the MOHS of Sierra Leone, will assist in the development and implementation of a National Laboratory Strategic Plan for the MOHS. APHL will conduct a range of activities to build capacity for testing at the Central Public Health Reference Laboratory and to develop a team of laboratory scientists who can conduct reference testing services and provide training to other laboratories in the MOHS network. A National Surveillance Strategic Plan will detail linkages between epidemiology and laboratory.

– APHL will support the laboratory science staff at the Central Public Health Reference Laboratory through training and mentoring in testing methods, quality systems, laboratory management and accreditation. APHL will expand staff knowledge and increase the number of staff at the Central Public Health Reference Laboratory in order to increase testing volume and the range of tests.

– APHL will work to strengthen laboratory management and move the Central Public Health Reference Laboratory towards accreditation. APHL will review the National Laboratory Strategic Plan to assess Sierra Leone accreditation goals, and work towards accreditation through training, mentoring and implementation of improvement projects.