Strengthening the diagnostic capacity to detect Bio Safety Level 3 organisms in unusual respiratory viral outbreaks
Received 14 May 2009; accepted 15 May 2009. published online 10 June 2009.
Refers to corrigendum:
Corrigendum to “Strengthening the diagnostic capacity to detect Bio Safety Level 3 organisms in unusual respiratory viral outbreaks” [J. Clin. Virol. 45 (2009) 185–190]
, 30 December 2009
Liselotte van Asten, Mariken van der Lubben, Cees van den Wijngaard, Wilfrid van Pelt, Robert Verheij, Andre Jacobi, Pieter Overduin, Adam Meijer, Dirk Luijt, Eric Claas, Mirjam Hermans, Willem Melchers, John Rossen, Rob Schuurman, PetraWolffs, Charles Boucher, Jurjen Schirm, Louis Kroes, Sander Leenders, Joep Galama, Marcel Peeters, Anton van Loon, Ellen Stobberingh, Martin Schutten, Marion Koopmans
Journal of Clinical Virology
February 2010 (Vol. 47, Issue 2, Page 204) Full Text |
Full-Text PDF (89 KB)
Abstract
Background
Experience with a highly pathogenic avian influenza outbreak in the Netherlands (2003) illustrated that the diagnostic demand for respiratory viruses at different biosafety levels (including BSL3), can increase unexpectedly and dramatically.
Objectives
We describe the measures taken since, aimed at strengthening national laboratory surge capacity and improving preparedness for dealing with diagnostic demand during outbreaks of (emerging) respiratory virus infections, including pandemic influenza virus.
Study design
Academic and peripheral medical-microbiological laboratories collaborated to determine minimal laboratory requirements for the identification of viruses in the early stages of a pandemic or a large outbreak of avian influenza virus. Next, an enhanced collaborative national network of outbreak assistance laboratories (OAL) was set up. An inventory was made of the maximum diagnostic throughput that this network can deliver in a period of intensified demand. For an estimate of the potential magnitude of this surge demand, historical counts were calculated from hospital- and physician-based registries of patients presenting with respiratory symptoms.
Results
Number of respiratory physician-visits ranged from 140,000 to 615,000 per month and hospitalizations ranged from 3000 to 11,500 per month. The established OAL-network provides rapid diagnostic response with agreed quality requirements and a maximum throughput capacity of 1275 samples/day (38,000 per month), assuming other routine diagnostic work needs to be maintained.
Conclusions
Thus surge demand for diagnostics for hospitalized cases (if not distinguishable from other respiratory illness) could be handled by the OAL network. Assessing etiology of community acquired acute respiratory infection however, may rapidly exceed the capacity of the network. Therefore algorithms are needed for triaging for laboratory diagnostics; currently this is not addressed in pandemic preparedness plans.
aCenter for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
bNIVEL Netherlands Institute for Health Services Research, Utrecht, The Netherlands
cErasmus Medical Center, Rotterdam, The Netherlands
dLaboratorium voor infectieziekten, Groningen, The Netherlands
eLeiden University Medical Center, Leiden, The Netherlands
fJeroen Bosch Ziekenhuis, Den Bosch, The Netherlands
gRadboud University Nijmegen Medical Center, Nijmegen, The Netherlands
hst. Elisabeth Ziekenhuis, Tilburg, The Netherlands
iUniversity Medical Center Utrecht, The Netherlands
jMaastricht University Medical Center, Maastricht, The Netherlands
Corresponding author at: Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands. Tel.: +31 30 274 2115; fax: +31 30 274 4409.
1 For the Network of National Preparedness Laboratories Netherlands.
ABSTRACT