A Public Health Laboratory Response to the Pandemic.


  • 影响因子:3.65
  • DOI:10.1128/JCM.01110-20
  • 作者列表:"Pabbaraju K","Wong AA","Douesnard M","Ma R","Gill K","Dieu P","Fonseca K","Zelyas N","Tipples GA
  • 发表时间:2020-07-23

:An outbreak of coronavirus disease 2019 (COVID-19) caused by a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) began in Wuhan, Hubei, China, in December 2019 and spread rapidly worldwide. The response by the Alberta Precision Laboratories, Public Health Laboratory (ProvLab), AB, Canada, included the development and implementation of nucleic acid detection-based assays and dynamic changes in testing protocols for the identification of cases as the epidemic curve increased exponentially. This rapid response was essential to slow down and contain transmission and provide valuable time to the local health authorities to prepare appropriate response strategies. As of May 24, 2020, 236,077 specimens were tested, with 6,475 (2.74%) positives detected in the province of Alberta, Canada. Several commercial assays are now available; however, the response from commercial vendors to develop and market validated tests is a time-consuming process. In addition, the massive global demand made it difficult to secure a reliable commercial supply of testing kits and reagents. A public health laboratory serves a unique and important role in the delivery of health care. One of its functions is to anticipate and prepare for novel emerging pathogens with a plan for pandemic preparedness. Here, we outline the response that involved the development and deployment of testing methodologies that evolved as SARS-CoV-2 spread worldwide, the challenges encountered, and mitigation strategies. We also provide insight into the organizational structure of how a public health response is coordinated in Alberta, Canada, and its benefits.


: 由新型冠状病毒肺炎冠状病毒 (新型冠状病毒冠状病毒2 [新型冠状病毒]) 引起的2019 (SARS-CoV-2) 冠状病毒病疫情始于2019年12月中国湖北武汉,并在全球迅速蔓延。加拿大艾伯塔省精准实验室公共卫生实验室 (ProvLab) 的回应包括开发和实施基于核酸检测的检测方法,以及随着流行病曲线呈指数增长,用于识别病例的检测方案的动态变化。这种快速反应对于减缓和遏制传播至关重要,并为地方卫生当局准备适当的应对战略提供宝贵时间。截至2020年5月24日,检测了236,077份标本,在加拿大阿尔伯塔省检测到6,475份 (2.74%) 阳性。现在有几种商业测定法可用; 然而,商业供应商对开发和市场验证测试的响应是一个耗时的过程。此外,巨大的全球需求使得难以确保检测试剂盒和试剂的可靠商业供应。公共卫生实验室在提供卫生保健方面发挥着独特而重要的作用。其功能之一是预测和准备新出现的病原体,并制定大流行防备计划。在这里,我们概述了随着SARS-CoV-2在世界范围内传播而演变的测试方法的开发和部署,遇到的挑战和缓解策略。我们还深入了解加拿大艾伯塔省如何协调公共卫生应对措施的组织结构及其好处。



来源期刊:Acta cytologica
作者列表:["Yu GH","Glaser LJ","Gustafson KS"]

METHODS::The cytologic evaluation of serous effusions may be challenging for a number of reasons. Distinction of benign, reactive conditions from malignancy represents the main focus when examining these specimens. The morphologic diagnosis of malignancy may be difficult due to the relative paucity of abnormal cells. In other situations, cellularity is not an issue, but the ability to confidently identify a second, foreign (i.e., tumor) population within a background mesothelial cells on the basis of cytomorphologic features alone may pose problems. Cases with definitive morphologic evidence of malignancy may require additional studies in order to determine the tumor subtype and, in the case of carcinoma, the primary site of origin. Cases in which a definitive and precise diagnosis of malignancy is made may be optimal candidates for further molecular testing in order to gain prognostic information and guide personal therapeutic decisions. Finally, while an inflammatory or infectious condition can be suggested on the basis of cellular components and associated background elements, the identification of causative agent(s) may be difficult without additional studies. In all of these situations, the use of ancillary studies and techniques is critical; their utility and appropriate application are the subject of this review.

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来源期刊:Laboratory medicine
作者列表:["Yang R","Zhang R","Zhang Y","Huang Y","Liang H","Gui G","Gong S","Wang H","Xu M","Fan J"]

METHODS:OBJECTIVE:To assess the rate of, and risk factors for, human cytomegalovirus viremia (HCMV) in donor+/recipient+ (HCMV serostatus matched) hematopoietic stem-cell transplantation (HSCT) recipients. METHODS:HCMV DNA from 144 donor+/recipient+ HSCT recipients was examined by quantitative polymerase chain reaction (qPCR). RESULTS:The cumulative incidence of HCMV viremia was 69.4% (100/144) during the 48 weeks after HSCT. In a multivariate analysis, acute graft-versus-host disease (aGVHD) was discovered to be a risk factor for the occurrence of HCMV viremia (P = .006). The cumulative incidence of HCMV viremia and increasing DNA loads were significantly associated with aGVHD occurrence (P = .001 for each). The occurrence of late-term HCMV viremia was associated with aGVHD (P = .001) and a higher DNA load during the first 12 weeks after HSCT (P = .04). CONCLUSIONS:aGVHD is a risk factor for HCMV viremia. Recipients with aGVHD who have a high HCMV DNA load should be strictly monitored to prevent HCMV activation.

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作者列表:["Charpentier E","Benichou E","Pagès A","Chauvin P","Fillaux J","Valentin A","Guegan H","Guemas E","Salabert AS","Armengol C","Menard S","Cassaing S","Berry A","Iriart X"]

METHODS:OBJECTIVES:Malaria is one of most common tropical diseases encountered in travellers and migrants. It requires an urgent and reliable diagnosis considering its potential severity. In this study, performance of five diagnostic assays were evaluated in a nonendemic region and compared prospectively to quantitative PCR (qPCR). METHODS:A prospective study was conducted at Toulouse Hospital from August 2017 to January 2018 and included all patients with initial Plasmodium screening. Thin and thick blood smears (TnS, TkS), quantitative buffy coat (QBC), rapid diagnostic tests (RDTs) and commercial loop-mediated isothermal amplification (LAMP) were independently performed on each blood sample and compared to our qPCR reference standard. RESULTS:The study encompassed 331 patients, mainly returning from Africa. qPCR detected 73 Plasmodium-positive samples (including 58 falciparum). Individually, LAMP had a 97.3% (71/73) sensitivity, far ahead of TnS (84.9%, 62/73), TkS (86.3%, 63/73), QBC (86.3%, 63/73) and RDT (86.3%, 63/73). RDT demonstrated a high sensitivity for falciparum (98.3%, 57/58) but missed all ovale, malariae and knowlesi infections. Specificity was excellent for all techniques (99.6-100%). The most sensitive diagnosis strategies were TnS + RDT (95.9%, 70/73), TnS + LAMP (97.3%, 71/73) and TnS + RDT + LAMP (100%, 73/73), about 10% higher than strategies using exclusively microscopy, TkS + TnS (87.7%, 64/73) or QBC + TnS (87.7%, 64/73). TnS remains necessary for Plasmodium species identification and quantification. Adding sequentially TnS only on LAMP-positive samples did not decrease TnS + LAMP strategy sensitivity. CONCLUSIONS:In nonendemic countries, the currently recommended microscopy-based strategies seem unsatisfactory for malaria diagnosis considering RDT and LAMP performance, two rapid and sensitive assays that require limited training.

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