Global Influenza Hospital surveillance Network
Template for the response to the Call for proposals -Season 2017-2018
This template is proposed to facilitate your application to the GIHSN call for proposals.This completedform will be used for the applicant scoring and funds allocation.
The full proposal should not be longer than 8 pages (Arial 11).Proposal should be submitted at the latest on July 15, 2017 by email to.
Country/regionAddress of the institution:
Contact
(email and phone number):
- Relevant expertise and experience of the applicant
Expertise in influenza and in vaccines / YES
NO / Provide a list of up to five relevant publications or other achievements
Experience in conducting epidemiological studies, in particular similar active surveillance studies / YES
NO / Provide details of relevant projects or activities
Role in the national/regional influenza surveillance system / YES
NO / Provide details of the collaboration
- Proposed implementation for the GISHN
Presentation of the catchment area, type of population and participating hospitals / Detail level of Influenza-like Illness (ILI)activity during the influenza season, location and size of the study sites (size of the hospital, number, location in the country, estimated population of the hospital catchment area, age group), capacity to link clinical and virological information for included patients. Estimate the number of Laboratory Confirmed Influenza (LCI)expected to be captured and provide justification
Scientific relevance of the proposal and the proposed design / Detail capacity to implement the GIHSN generic protocol. Provide detail of local adaptations, strategy for the enrolment of patients and swab collection; capacity to use e-CRF (electronic Case Report Form) for on-site data collection; collection of healthcare use data is a plus.
Team organisation and dedicated staff for active surveillance / Provide a short description of the profile of the persons who will be primarily responsible for carrying out the proposed activities and a description of the team organization and allocated time for the project
Institution infrastructure and on-site laboratory capacities to test influenza strains by RT-PCR / Detail laboratory capacities to test influenza stains by RT-PCR (capacity to type H1, H3, B influenza strains and to subtype Flu B Yamagata and Victoria lineages). Strain sequencing capacity is a plus.
Level of co-funding from the applicant / Provide a description of the costsfor conducting the study based on the template below. Please note that the foundation do not intend to cover the full cost of the activity and that the level of co-funding will be a key driver for the selection
Example of budget table:
Type of costs / Brief description / Budget (Euros)
Covered by site / Requested to the foundation
Management, research, statistical staff / (i.e number of days,estimatedcost per day, , staff salary )
Case recruitment, case collection
Laboratory testing / (I.e transport, PCR kits and other reagents for RNA isolation and reverse transcriptionpurchase)
Other / (General expenses, delivery of documents, printing expenses,)
Total
Required documents:
The following documents should be provided along with this completed proposal form:
√Charter of the institution (document demonstrating that the institution is a not for profit organisation and specifying its mission/size)
√Budget extracts from the previous year
√Yearly activity report
√Bank details
Sites should be compliant with their ethical and national regulations for the conducting of the surveillance; any obligation related to data protection and data transfer to the platform (OpenHealth Company based in France) should be anticipated.
In case of any question related to the call for proposals, please contact:
Foundation for Influenza Epidemiology- GIHSN Template for call – Season 2017-20181|Page