Download GIHSN-Template for call 2017

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 completed form 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
[email protected].
Country/region
Address of the
institution:
Contact
(email and phone number):
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1. Relevant expertise and experience of the applicant
Expertise
in
influenza and in
vaccines
Experience in
conducting
epidemiological
studies, in
particular similar
active
surveillance
studies
Role in the
national/regional
influenza
surveillance
system
YES
Provide a list of up to five relevant publications or other achievements
NO
YES
Provide details of relevant projects or activities
NO
YES
Provide details of the collaboration
NO
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2. 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
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Scientific
Detail capacity to implement the GIHSN generic protocol. Provide detail of local adaptations, strategy for the enrolment
relevance of the of patients and swab collection; capacity to use e-CRF (electronic Case Report Form) for on-site data collection; collection
proposal and the of healthcare use data is a plus.
proposed design
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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
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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.
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Level
of
co- Provide a description of the costs for conducting the study based on the template below. Please note that the foundation
funding from the 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
applicant
Example of budget table:
Type of costs
Brief description
Budget (Euros)
Covered by site
Management,
research, statistical
staff
Case recruitment,
case collection
Laboratory testing
Other
Requested to the
foundation
(i.e number of days, estimated cost per day, ,
staff salary )
(I.e transport, PCR kits and other reagents
for RNA isolation and reverse transcription
purchase)
(General expenses, delivery of documents,
printing expenses,)
Total
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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: [email protected]
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