title: Strengthening the diagnostic capacity to detect Bio Safety Level 3 organisms in unusual respiratory viral outbreaks.
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.
  
  
  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.
authors.affiliation: Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. Liselotte.van.Asten@rivm.nl
authors.forename: Liselotte
authors.initials: L
authors.lastname: van Asten
authors.forename: Mariken
authors.initials: M
authors.lastname: van der Lubben
authors.forename: Cees
authors.initials: C
authors.lastname: van den Wijngaard
authors.forename: Wilfrid
authors.initials: W
authors.lastname: van Pelt
authors.forename: Robert
authors.initials: R
authors.lastname: Verheij
authors.forename: Andre
authors.initials: A
authors.lastname: Jacobi
authors.forename: Pieter
authors.initials: P
authors.lastname: Overduin
authors.forename: Adam
authors.initials: A
authors.lastname: Meijer
authors.forename: Dirk
authors.initials: D
authors.lastname: Luijt
authors.forename: Eric
authors.initials: E
authors.lastname: Claas
authors.forename: Mirjam
authors.initials: M
authors.lastname: Hermans
authors.forename: Willem
authors.initials: W
authors.lastname: Melchers
authors.forename: John
authors.initials: J
authors.lastname: Rossen
authors.forename: Rob
authors.initials: R
authors.lastname: Schuurman
authors.forename: Petra
authors.initials: P
authors.lastname: Wolffs
authors.forename: Charles
authors.initials: C
authors.lastname: Boucher
authors.forename: Charles
authors.initials: C
authors.lastname: Bouchier
authors.forename: Jurjen
authors.initials: J
authors.lastname: Schirm
authors.forename: Louis
authors.initials: L
authors.lastname: Kroes
authors.forename: Sander
authors.initials: S
authors.lastname: Leenders
authors.forename: Joep
authors.initials: J
authors.lastname: Galama
authors.forename: Marcel
authors.initials: M
authors.lastname: Peeters
authors.forename: Anton
authors.initials: A
authors.lastname: van Loon
authors.forename: Ellen
authors.initials: E
authors.lastname: Stobberingh
authors.forename: Martin
authors.initials: M
authors.lastname: Schutten
authors.forename: Marion
authors.initials: M
authors.lastname: Koopmans
mesh_terms: 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*