Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin Workshop Summary (2008) / Chapter Skim
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5 Laboratory and Epidemiological Capacity
5 Laboratory and Epidemiological Capacity
Pages 69-80
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From page 69... ...
Finally, two case studies focused on the experience and challenges in establishing a sustained operation of laboratories in Tanzania, and on clinical laboratory and epidemiological field training in Southeast Asia. Veterinary and Agricultural Laboratory Capacity in Resource-Constrained Countries James Pearson, former director of the National Veterinary Services Laboratory and senior staff member of the World Organization for Animal Health (OIE)
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From page 70... ...
describe safe methods for managing infectious materials in the laboratory environment where they are being handled or maintained. There are four BSLs, with BSL-1 representing a basic level of containment relying on standard microbiological practices and BSL-4 representing the most advanced containment when working with dangerous and exotic agents that pose a high individual risk of life-threatening disease (which may be transmitted via the aerosol route and for which no vaccine or therapy is available)
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From page 71... ...
In short, it is "an enemy that we don't really know very well." The current epizootic of avian influenza reached Africa in January 2006. Africa was not prepared, Capua explained, though the OIE Reference Laboratory community quickly realized that the virus would spread and "there would be no way to stop it." Africa had not previously experienced a highly pathogenic avian influenza epizootic, and most African countries lacked an early warning system in their poultry populations.
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From page 72... ...
Moreover, birds succumb to many lethal infections on the African continent, so the spread of highly pathogenic avian influenza (H5N1) was not immediately seen as a priority.
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From page 73... ...
. This network, created in response to a Department of Homeland Security directive, is designed to coordinate laboratory capacity at the state and federal levels for early disease detection, rapid response, and appropriate recovery to animal health emergencies.
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, FMD, highly pathogenic avian influenza (H5N1) , African swine fever, Newcastle disease, rabies, rinderpest, and contagious bovine pleuropneumonia.
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From page 75... ...
Current partners include the Muguga Laboratory in Kenya; the Botswana Vaccine Institute; Veterinary Laboratory Agencies in the United Kingdom; the National Veterinary Services Laboratory in Ames, Iowa; and the University of Minnesota. Through these collaborations, the central laboratory has been able to handle or process many more samples than it could on its own, to reduce handling risks, and to confirm results.
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From page 76... ...
KEMRI has a national reporting system that uses integrated disease surveillance and response and conducts sentinel surveillance in hospitals and refugee camps. To work around the lack of computer capacity in remote regions, KEMRI has also been promoting the use of cell phones CDC's Kenya International Emerging Infections Program through the Kenya Medical R esearch Institute began in 2004 to establish diagnostic and epidemiological capacity in Kenya to address diseases of epidemic potential.
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From page 77... ...
Echoing some of the earlier discussions, Farrar pointed out that Asia is a disease hotspot because it is particularly fertile ground for zoonotic pathogens to emerge from wildlife and domesticated animals, and for drug resistance to develop. He views drug resistance as "the world's most important emerging health problem." Farrar reported that infectious disease accounted for 25 percent of all deaths in the patient population of the H ospital for Tropical Diseases in Ho Chi Minh City, Vietnam -- a facility with 600 beds dedicated to infectious disease patients, with more than 1,000 patients annually, and serving a population of nearly 40 million Vietnamese.
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From page 78... ...
"For all of these, Asia is the champion of the World Series," he suggested, because of the burden of existing endemic disease, drug resistance, and the frequent emergence of new pathogens. Looking forward, Farrar believes the most promising approach to sustainable global disease surveillance and response is international collaboration, but he was careful to say that large, international organizations are only part of the answer, and that "sustainable collaborative work must be based close to where the problems are." Clinical and scientific capacity that is locally rooted is critical, which means that "we have to bridge that biotechnological divide, and bring that knowledge base to where things are that matter." He illustrated the point with the example of the international response to the highly pathogenic avian influenza (H5N1)
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From page 79... ...
A participant observed that even within the United States, government agencies "don't always talk to each other," and that looking internationally, "getting them to work and think collectively before a crisis is key." Participants also identified more practical challenges: for example, combining resources seems particularly logical in resource-challenged countries, but setting up and running a laboratory that meets international biosafety standards and protocols for both human and veterinary laboratory testing procedures could be a significant challenge. Others noted the cultural divide between the human and veterinary health communities.
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From page 80... ...
Technology offers potential solutions to many of the challenges of coordination, remote field work, and rapid response, and a large tech nology company such as Google has the potential to offer valuable support with data management, software, and related resources. The question was raised, in that context, whether technology -- hand-held devices, mobile d iagnostics -- could actually make it possible to bypass some of the current challenges facing central laboratories.
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