ASM LabCap’s contributions to disease surveillance and the International Health Regulations (2005)

ASM LabCap facilitated two five-day workshops entitled “Strengthening AFB Smear Microscopy EQA Programs”, one in English in December 2009 in Dar es Salaam with participants from Angola, Bahamas, Barbados, Botswana, Ethiopia, Jamaica, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Tanzania, Vietnam, Zambia, and Zimbabwe, and a francophone version in August 2010 in Dakar with participants from Senegal, Cameroon, Haiti, and Côte d’Ivoire. In line with Article 44 of the IHR(2005), which calls for States to share technical cooperation and assistance in order to strengthen and maintain public health capacities, these platforms allowed the participating countries to network and share experiences, challenges, best practices, and lessons learned from EQA implementation, as well as assess new opportunities to integrate AFB smear microscopy into other laboratory disciplines. ASM LabCap is providing follow-up support to many of the participating countries.

From February 22 through March 5, 2010, ASM LabCap and CDC/PEPFAR-Côte d’Ivoire organized in Abidjan, Côte d’Ivoire, its first course on Mtb culture, identification and DST for French-speaking African laboratorians. Scientists, managers, and technicians from the National TB Program and four major Ivorian TB laboratories attended the two-week course held at the National TB Reference Laboratory housed in the Pasteur Institute of Côte d’Ivoire (IPCI). The course was the first national training event in Côte d’Ivoire to help increase detection and reporting of multi-drug resistant (MDR)-TB using newer, more rapid technology. TB, in its MDR and extensively drug resistant (XDR) forms, is a disease with the potential of causing public health emergencies which fall within the scope of IHR(2005). Its early detection, control, and containment in endemic regions of Africa, such as Côte d’Ivoire, are steps towards improving international public health security.

ASM consultants have facilitated workshops on basic bench top procedures for clinical microbiology for a total of 145 participants thus far. The goal of each workshop, as developed by an ASM LabCap Committee Member, was to enable clinical microbiology laboratory technologists to instruct clinicians on proper choice and collection of patient samples for microbiological studies, to properly handle the samples in the laboratory with respect to initial testing and culture processes, to adequately identify the major pathogens in each site (and to not report non-pathogens), and to perform necessary antimicrobial susceptibility tests (AST) on those pathogens. These procedures are encompassed in a series of flow-charts and are demonstrated with real cultures and organisms. Participants learned in the laboratory by performing the procedures themselves. A list of the reagents and simple supplies used in the laboratory were provided to the participants for training and QC purposes in their own facilities. ASM LabCap places consultants in-country to work with the various participating laboratories as a follow-up to the training.

Since 2008, there have been ongoing diarrheal outbreaks in Kenya that have spread to several districts throughout the country, including Nairobi. Performing accurate and timely laboratory identification of the etiological agents of outbreaks has been challenging for Kenya’s District and Provincial hospitals, which have limited skills and resources. Consistent with IHR(2005)’s focus on strengthening laboratory-based surveillance systems for epidemic-prone diseases such as cholera, in October 2009, 39 district-based laboratory technologists, surveillance officers, and clinical officers convened in Nairobi for a workshop designed to build their capacity to provide support in enteric disease outbreak surveillance and response. This effort was a collaborative endeavor between CDC/GDD (Global Disease Detection) Kenya Field Epidemiology and Laboratory Training Program (FELTP), the Kenyan Ministry of Public Health and Sanitation (MoPHS), the CDC National Center for Emerging, Zoonotic & Infectious Diseases (NCEZID) in Atlanta, CDC/DGHA, and ASM LabCap. The course illustrated the critical link between epidemiology, outbreak investigation, and both rapid and traditional detection by the laboratory.

The trainees were presented with the basic principles of epidemiology and outbreak detection; determination of proper samples to collect in an outbreak; collection, packaging, and transport of biological samples from an outbreak; and rapid testing for detection of Vibrio cholerae, Shigella dysenteriae Type 1, Salmonella enterica serovar typhi, and Shiga toxin-producing E. coli from biological samples. Furthermore, ASM LabCap facilitators discussed essential microbiological procedures and techniques for processing samples and traditional methods for culture, identification and susceptibility testing of the four enteric pathogens. Overviews of Gram staining, laboratory diagnosis of common HIV-related OIs and other outbreak pathogens, QC, and media preparation were also included.

The U.S. CDC and China’s CDC collaborate to conduct active surveillance for patients hospitalized with community-acquired pneumonia in China. A three-month pilot project evaluating procedures for patient enrollment and specimen collection, transport, testing, and reporting, was conducted from mid-November 2008 to February 2009 in three sites (Panjin, Liaoning Province; Jingzhou, Hubei Province; Zhuhai, Guangdong Province). Patients enrolled in this study had specimens collected for microscopic examination, bacterial culture, viral culture, urine antigen testing, and polymerase chain reaction (PCR)-based identification. During the pilot, ASM LabCap evaluated the capacity at each site to perform non-PCR based testing, to provide guidance regarding necessary supplies and equipment at each site, and to write SOPs. ASM LabCap also provided additional technical guidance for the finalization of the study protocol.