title: Impacts of culture-independent diagnostic practices on public health surveillance for bacterial enteric pathogens.
abstract: For decades, culture has been the mainstay of diagnostic testing for bacterial enteric pathogens. This paradigm is changing as clinical laboratories adopt culture-independent methods, such as antigen-based tests and nucleic acid-based assays. Public health surveillance for enteric infections addresses 4 interrelated but distinct objectives: case investigation for localized disease control; assessment of disease burden and trends to prioritize and assess impact of population-based control measures; outbreak detection; and microbiologic characterization to improve understanding of pathogens, their virulence mechanisms, and epidemiology. We summarize the challenges and opportunities that culture-independent tests present and suggest strategies, such as validation studies and development of culture-independent tests compatible with subtyping, that could be adopted to ensure that surveillance remains robust. Many of these approaches will require time and resources to implement, but they will be necessary to maintain a strong surveillance system. Public health practitioners must clearly explain the value of surveillance, especially how outbreak detection benefits the public, and collaborate with all stakeholders to develop solutions.
authors.affiliation: Disease Control and Environmental Epidemiology Division, Colorado Department of Public Health and Environment, 4300 Cherry Creek Dr S, Denver, CO 80426, USA. alicia.cronquist@state.co.us
authors.forename: Alicia B
authors.initials: AB
authors.lastname: Cronquist
authors.forename: Rajal K
authors.initials: RK
authors.lastname: Mody
authors.forename: Robyn
authors.initials: R
authors.lastname: Atkinson
authors.forename: John
authors.initials: J
authors.lastname: Besser
authors.forename: Melissa
authors.initials: M
authors.lastname: Tobin D'Angelo
authors.forename: Sharon
authors.initials: S
authors.lastname: Hurd
authors.forename: Trisha
authors.initials: T
authors.lastname: Robinson
authors.forename: Cynthia
authors.initials: C
authors.lastname: Nicholson
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Mahon
mesh_terms: D002487:Centers for Disease Control and Prevention, U.S.; D046508:Culture Techniques / Q000379:methods* / Q000592:standards; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000639:trends; D004196:Disease Outbreaks; D004755:Enterobacteriaceae / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000175:diagnosis*; D005260:Female; D005516:Food Microbiology / Q000379:methods / Q000639:trends; D006801:Humans; D007753:Laboratories / Q000592:standards; D008297:Male; D008828:Microbiological Techniques / Q000379:methods* / Q000639:trends; D011159:Population Surveillance / Q000379:methods*; D014481:United States