Integrated Disease Surveillance and Response (IDSR)

1. Integrated Disease Surveillance and Response (IDSR) The Role of Laboratory in Surveillance and Response Ministry of Health and Sanitation

2. Learning objectives By the end of the session, the participants will be able to: • Describe and explain laboratory confirmation in disease surveillance • Describe priority diseases which require laboratory confirmation • Understand the importance of safe collection and transportation of specimen • Use laboratory results to identify and clarify local health problems

3. Laboratories in Public Health • Accurate and timely laboratory information has become the foundation upon which current disease treatment, prevention and control programs are based

4. Improving Laboratory Surveillance • One of the key pillars is improving laboratory capacity to: • Detect & accurately identify microbial agents that cause priority communicable diseases • Monitor the drug susceptibility patterns of disease agents • Strengthen the involvement of lab personnel in epidemiologic surveillance • Guide public health intervention strategies by giving timely results

5. Laboratory services are useful in all phases of disease response • Detection and confirmation of epidemics • Surveillance of endemic diseases (TB, Malaria) • Disease elimination and eradication • ALSO • Detection of new agents • Surveillance of anti-microbial resistance

6. Laboratory Services are Useful in... • Detecting and confirming clinical cases/epidemics • Identifying the immunological status/carrier rate/use of vaccine • Surveillance for disease elimination or eradication • Detection of new pathogens

7. Laboratory Services are Useful in... • Detection, treatment, and surveillance of anti-microbial/parasite resistance • Food and environmental analysis • Study of pathogenesis, immunogenesis, development of diagnostic reagents, anti-microbial drugs and vaccines.

8. Major ways of laboratory diagnosis • Microscopical Methods • In vivo/In vitro • Serological Methods • Molecular Diagnostic Techniques

9. Laboratory Tasks in Surveillance Pre-Analytic Patient/Client Prep Sample Collection Personnel Competency Test Evaluations Reporting • Data and Lab Management • Safety • Customer Service Post-Analytic Sample Receipt and Accessioning Record Keeping Sample Transport Quality Control Testing Analytic

10. Tasks that laboratories may be involved in • Specimen collection • Specimen processing • Specimen transport • Specimen testing • Recording results (manually or electronically) • Reporting results to • Sending agency • Public health authorities • Analysis of trends in isolation/identification

11. Requirement for laboratory analysis • Equipment and reagents available for suspected pathogen • Proficiency • Skill and experience of staff • Volume of samples tested • Adequate equipment, reagents and controls • Turnaround Time • Quality Control (internal and external)

12. Good Laboratory Practices... 1 • Proper collection of samples • Appropriate identification of specimens with special label on hazardous specimens • Prompt transportation to laboratory at appropriate temperature • Collection and storage under conditions that prevent deterioration of the sample before the performance of test

13. Good Laboratory Practices... 2 • Accurate performance of test • Release of reports after proper scrutiny • Delivery of reports to the correct destination in the shortest possible time

14. Levels of labs involvement • Field • Peripheral (e.g. health center, outpatients) • Intermediate (district/regional laboratory) • National (e.g. national meningitis reference) laboratory • International (International polio laboratory)

15. Example laboratory tasks in surveillance and response Collect Simple Tests Process + Transport P P P P P P Collect Confirmatory Tests Report Results Process + Transport Join Investigations I I • Specialised Tests • Transport to International Labs • Report results • Join Investigations • Training C P = peripheral level I = intermediate level C = central Level Highly specialised tests Report results Join Investigations Training International Laboratories

16. Some tests to be performed at peripheral Labs... • Microscopy for: • TB (Sputum) • Malaria (Blood) • Meningitis (CSF) • Diphtheria (Throat) • Plague • Filariasis • Ova and Cyst

17. Lab disease surveillance and response Before the outbreak • Preparedness • Continuous surveillance • Early warning signals • Outbreak detection

18. Lab disease surveillance and response During the outbreak • Sample collection • Preservation • Packaging • Shipment • Confirmation of aetiology • Monitor pathogens

19. Lab disease surveillance and response In between outbreaks • Pathogen and disease trends monitoring • Drug susceptibility testing • Intervention evaluation • Monitoring progress towards a control objective

20. Other laboratory surveillance activities • Food analysis: • Toxicology • Microbiology • Environmental: Water, industries • Research

21. Laboratory in epidemic detection • Many diseases with epidemic potential are detected using “syndromic” surveillance e.g. • Suspected measles = fever with rash • Suspected yellow fever = Fever with jaundice • Suspected cholera = Acute watery diarrhoea • Suspected meningitis = fever with headache + neck stiffness • It is important that when an outbreak is suspected laboratory confirmation of the diagnosis occurs as quickly as possible

22. Laboratory in Epidemic Detection ID ID Health Care Worker Report Form Laboratory Request Form ID Sample Public Health Team Laboratory Result

23. Laboratory in Epidemic Detection • This process requires systematic sampling transporting, testing and reporting • It should be well planned with each player understanding their role • The aim is to reduce the time to confirmation so that public health action can be taken

24. Laboratory in outbreaks and field investigations • Confirm the pathogen in the early cases • Monitor antimicrobial resistance (e.g. Cholera) • Special studies (e.g. sero-prevalence) • Confirm the end of the epidemic • It is usually not necessary for laboratory to confirm all cases during an epidemic!!

25. Monitoring trends in endemic disease • Would the Laboratory have a role to play in the surveillance of: • Acute bloody diarrhoea(dysentery) • Dengue • Malaria • Tuberculosis (TB) • HIV/AIDS

26. Surveillance of antimicrobial resistance • The development of antimicrobial resistance is the natural response of microorganisms to the selective pressure imposed by the use of antimicrobial agents • Overuse and misuse worsen the problem

27. Preparedness for lab surveillance and response • Identify a focal person to coordinate surveillance lab activities at all levels • Identify diseases of public health importance • Of these, identify diseases that require lab confirmation

28. Preparedness for lab surveillance and response • Determine tests to be performed • Map lab facilities, including reference labs • Map human resources available • Establish a functional laboratory network • Determine information flow

29. Primarycontainer Absorbent packaging material Specimen Specimen record Study # Date Sample Biohazard label Address to Address from Address label • Packaging infectious substances • for shipment Cap Secondary container Screw-on cap Outer (tertiary) container

30. Summary of lab Surveillance Sample collection, shipment, processing Collection of data Analysis Interpretation Dissemination • PUBLIC HEALTH ACTION • Priority setting, • Planning, • Implementing, • Control of diseases, • Evaluating health events • Investigation • Control • Prevention. ZIRURA

31. Summary Laboratory services are useful in all phases of disease response • Detection and confirmation of epidemics • Surveillance of endemic diseases (TB, Malaria) • Disease elimination and eradication • ALSO • Detection of new agents • Surveillance of anti-microbial resistance

32. THANK YOU