Abstract
The Ontario Public Health Laboratories system (OPHL) is in the midst of a six-year plan to implement molecular tools for pandemic influenza diagnostics in one central and three regional public health laboratories. This plan has been formulated as a consequence of: 1) experiences gained through severe acute respiratory syndrome (SARS), and comments of the members of the Expert Panel on SARS and Infectious Disease Control (i.e., the Walker report); 2) a review of pandemic preparedness literature; 3) historical and epidemiologic discussions about previous pandemics; and 4) suggestions made by various pandemic working committees. The OPHL plan includes: 1) an aggressive restructuring of the overall molecular microbiology testing capacity of the OPHL; 2) the ability to shift influenza testing of samples between designated OPHL laboratories; and 3) the development of screening tools for pandemic influenza diagnostic tests. The authors believe that investing in increased molecular testing capacity for regional laboratories outside the greater Toronto area will be beneficial to the OPHL system whether or not an influenza pandemic occurs. Well-trained technologists and microbiologists, and the introduction of new technologies, will facilitate the development of a wide variety of molecular tests for other infectious diseases at public health laboratories geographically distant from Toronto, thus enhancing overall laboratory testing capacity in the province of Ontario.
Key words: Pandemic planning, influenza, molecular testing, RT-PCR, diagnosis
Résumé
Le système des laboratoires de santé publique de l’Ontario (LSPO) est à mi-parcours d’un plan de six ans visant à mettre en œuvre des outils moléculaires pour le diagnostic de la grippe pandémique dans un laboratoire central et trois laboratoires régionaux de dépistage sanitaire. Le plan en question a été formulé d’après: 1) les leçons de la crise du syndrome respiratoire aigu sévère (SRAS) et les commentaires des membres du Comité d’experts sur le SRAS et la lutte contre les maladies infectieuses (rapport Walker); 2) l’examen de la documentation sur la préparation à une pandémie; 3) les analyses historiques et épidémiologiques des pandémies antérieures; et 4) les suggestions de divers comités de travail sur les pandémies. Le plan des LSPO englobe: 1) une restructuration approfondie de l’ensemble des outils de dépistage basés sur la microbiologie moléculaire dans les laboratoires; 2) la possibilité de transférer d’un LSPO désigné à un autre l’analyse des échantillons grippaux; et 3) l’élaboration d’outils de sérodiagnostic de la grippe pandémique. Selon les auteurs, le fait d’investir davantage dans la capacité de dépistage moléculaire des laboratoires régionaux à l’extérieur du Grand Toronto serait bénéfique pour le système des LSPO, peu importe si une pandémie de grippe survient ou non. Des technologues et des microbiologistes bien formés, ainsi que l’implantation de nouvelles technologies, faciliteront l’élaboration d’un vaste éventail de tests moléculaires pour d’autres maladies infectieuses dans les laboratoires de dépistage sanitaire éloignés de Toronto, ce qui devrait améliorer globalement la capacité de dépistage en laboratoire en Ontario.
Mots clés: planification entourant une pandémie, grippe, tests moléculaires, RT-PCR, diagnostic
References
- 1.MacDougall H. Toronto’s Health Department in action: Influenza in 1918 and SARS in 2003. J Hist Med Allied Sci. 2007;62(1):56–89. doi: 10.1093/jhmas/jrl042. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ontario Expert Panel on SARSInfectious Disease Control. Emergency Preparedness. For The Public’s Health: Initial Report of the Ontario Expert Panel on SARS and Infectious Disease Control. 1st. 2007. pp. 103–32. [Google Scholar]
- 3.Chowell G, Ammon CE, Hengartner NW, Hyman JM. Transmission dynamics of the great influenza pandemic of 1918 in Geneva, Switzerland: Assessing the effects of hypothetical interventions. J Theor Biol. 2006;241(2):193–204. doi: 10.1016/j.jtbi.2005.11.026. [DOI] [PubMed] [Google Scholar]
- 4.Viboud C, Grais RF, Lafont BA, Miller MA, Simonsen L. Multinational impact of the 1968 Hong Kong influenza pandemic: Evidence for a smoldering pandemic. J Infect Dis. 2005;192(2):233–48. doi: 10.1086/431150. [DOI] [PubMed] [Google Scholar]
- 5.Hrehorovich V, Dyal WW, Schrack WD., Jr. Influenza epidemic in Pennsylvania. Health Serv Rep. 1972;87(9):835–44. doi: 10.2307/4594684. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Viboud C, Tam T, Fleming D, Miller MA, Simonsen L. 1951 influenza epidemic, England and Wales, Canada, and the United States. Emerg Infect Dis. 2006;12(4):661–68. doi: 10.3201/eid1204.050695. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Viboud C, Tam T, Fleming D, Handel A, Miller MA, Simonsen L. Transmissibility and mortality impact of epidemic and pandemic influenza, with emphasis on the unusually deadly 1951 epidemic. Vaccine. 2006;24(44–46):6701–7. doi: 10.1016/j.vaccine.2006.05.067. [DOI] [PubMed] [Google Scholar]
- 8.Pandemic Influenza Committee: Pandemic Influenza Laboratory Preparedness Network. Pandemic Influenza Laboratory Preparedness Plan. 2007. [Google Scholar]
- 9.Abed Y, Goyette N, Boivin G. Generation and characterization of recombinant influenza A (H1N1) viruses harboring amantadine resistance mutations. Antimicrob Agents Chemother. 2005;49(2):556–59. doi: 10.1128/AAC.49.2.556-559.2005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Bright RA, Medina MJ, Xu X, Perez-Oronoz G, Wallis TR, Davis XM, et al. Incidence of adamantane resistance among influenza A (H3N2) viruses isolated worldwide from 1994 to 2005: A cause for concern. Lancet. 2005;366(9492):1175–81. doi: 10.1016/S0140-6736(05)67338-2. [DOI] [PubMed] [Google Scholar]
- 11.Mishin VP, Novikov D, Hayden FG, Gubareva LV. Effect of hemagglutinin glycosylation on influenza virus susceptibility to neuraminidase inhibitors. J Virol. 2005;79(19):12416–24. doi: 10.1128/JVI.79.19.12416-12424.2005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Kiso M, Mitamura K, Sakai-Tagawa Y, Shiraishi K, Kawakami C, Kimura K, et al. Resistant influenza A viruses in children treated with oseltamivir: Descriptive study. Lancet. 2004;364(9436):759–65. doi: 10.1016/S0140-6736(04)16934-1. [DOI] [PubMed] [Google Scholar]
- 13.Gubareva LV, Kaiser L, Matrosovich MN, Soo-Hoo Y, Hayden FG. Selection of influenza virus mutants in experimentally infected volunteers treated with oseltamivir. J Infect Dis. 2001;183(4):523–31. doi: 10.1086/318537. [DOI] [PubMed] [Google Scholar]
- 14.Brown IH. Advances in molecular diagnostics for avian influenza. Dev Biol (Basel) 2006;124:93–97. [PubMed] [Google Scholar]
- 15.Cheng SM, Vainionpaa R, Zhao P, Li F, Hu A, Forrest B, et al. Detection of influenza B in clinical specimens: Comparison of high throughput RT-PCR and culture confirmation. Virus Res. 2004;103(1–2):85–90. doi: 10.1016/j.virusres.2004.02.018. [DOI] [PubMed] [Google Scholar]
- 16.de Bach VCJ, Phan TQ, Vo MH, Tran TT, Nguyen BH, et al. Fatal avian influenza A (H5N1) in a child presenting with diarrhea followed by coma. N Engl J Med. 2005;352(7):686–91. doi: 10.1056/NEJMoa044307. [DOI] [PubMed] [Google Scholar]
- 17.Taubenberger JK, Morens DM. 1918 Influenza: The mother of all pandemics. Emerg Infect Dis. 2006;12(1):15–22. doi: 10.3201/eid1209.05-0979. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Morens DM, Fauci AS. The 1918 influenza pandemic: Insights for the 21st century. J Infect Dis. 2007;195(7):1018–28. doi: 10.1086/511989. [DOI] [PubMed] [Google Scholar]
- 19.Reichert TA, Christensen RA. It’s not about smoldering or neuraminidase: There were 2 variants of the A(H3N2) pandemic virus differing in internal genes. J Infect Dis. 2005;192(10):1858–60. doi: 10.1086/497153. [DOI] [PubMed] [Google Scholar]
- 20.Reid AH, Janczewski TA, Lourens RM, Elliot AJ, Daniels RS, Berry CL, et al. 1918 influenza pandemic caused by highly conserved viruses with two receptor-binding variants. Emerg Infect Dis. 2003;9(10):1249–53. doi: 10.3201/eid0910.020789. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Patterson KD, Pyle GF. The geography and mortality of the 1918 influenza pandemic. Bull Hist Med. 1991;65(1):4–21. [PubMed] [Google Scholar]
- 22.Sattenspiel L, Herring DA. Simulating the effect of quarantine on the spread of the 1918–19 flu in central Canada. Bull Math Biol. 2003;65(1):1–26. doi: 10.1006/bulm.2002.0317. [DOI] [PubMed] [Google Scholar]
- 23.Ontario Ministry of HealthLong-Term Care. Pandemic/avian influenza is suspected -specimen collection and transportation guidelines. 2007. [Google Scholar]
- 24.Nolte FS. Case studies in cost effectiveness of molecular diagnostics for infectious diseases: Pulmonary tuberculosis, enteroviral meningitis, and BK virus nephropathy. Clin Infect Dis. 2006;43(11):1463–67. doi: 10.1086/508871. [DOI] [PubMed] [Google Scholar]
- 25.Burt T, Mages ME. After the storm: Experiences and insights from the front. Healthc Exec. 2006;21(2):24–30. [PubMed] [Google Scholar]
- 26.Rodriguez H, Aguirre BE. Hurricane Katrina and the healthcare infrastructure: A focus on disaster preparedness, response, and resiliency. Front Health Serv Manage. 2006;23(1):13–23. doi: 10.1097/01974520-200607000-00003. [DOI] [PubMed] [Google Scholar]