Strengthening the diagnostic capacity to detect Bio Safety Level 3 organisms in unusual respiratory viral outbreaks.
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.


OBJECTIVE
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.


METHODS
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.
van Asten
Liselotte
L
Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Liselotte.van.Asten@rivm.nl
van der Lubben
Mariken
M
van den Wijngaard
Cees
C
van Pelt
Wilfrid
W
Verheij
Robert
R
Jacobi
Andre
A
Overduin
Pieter
P
Meijer
Adam
A
Luijt
Dirk
D
Claas
Eric
E
Hermans
Mirjam
M
Melchers
Willem
W
Rossen
John
J
Schuurman
Rob
R
Wolffs
Petra
P
Boucher
Charles
C
Bouchier
Charles
C
Schirm
Jurjen
J
Kroes
Louis
L
Leenders
Sander
S
Galama
Joep
J
Peeters
Marcel
M
van Loon
Anton
A
Stobberingh
Ellen
E
Schutten
Martin
M
Koopmans
Marion
M
D003140:Communicable Disease Control / Q000379:methods*; D003264:Containment of Biohazards / Q000379:methods*; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D007753:Laboratories; D009426:Netherlands; D009975:Orthomyxoviridae / Q000145:classification / Q000302:isolation & purification; D012140:Respiratory Tract Diseases / Q000453:epidemiology* / Q000821:virology*; D014777:Virus Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology*; D014780:Viruses / Q000145:classification* / Q000302:isolation & purification*