In an effort to promote the PPHSN’s ongoing activities for laboratory support, SPC, together with WHO, the Pasteur Institute of New Caledonia and other allied members, organised a regional workshop, “LabNet 2006”. The workshop was held from 31 July to 4 August at the Institute of Research and Development in Noumea, New Caledonia.

The objectives of the meeting were to:

• update the participants on the progress of LabNet development, including lab-based
  surveillance activities;
• assess the current situation of lab testing and specimen shipment with regard to PPHSN
  target diseases, and plan further developments, particularly for pandemic flu preparedness;
• review and discuss the linkages and support available through reference laboratories of the Australian and New Zealand Public Health Laboratory Network;
• discuss and clarify the technical aspects of laboratory tests available for PPHSN target diseases;
• discuss participants’ experiences in the use of rapid tests (leptospirosis, dengue and influenza); and
• further assess the training needs of laboratory health professionals, and demonstrate test methods.

Announcements were sent to all 22 PICTs, members of PPHSN and allied members for participant nominations. Of the 22 PICTs, only Guam and Tokelau did not attend, due to last-minute emergencies.

The agenda for the meeting focused on the major issues and functions of ongoing LabNet activities: the performance of PPHSN testing, specimen shipping and quality assurance activities. The presenters for the meeting – well-known experts in various lab areas from LabNet L3 lab partners, SPC epidemiologists and specialists, and other professionals from allied member groups – provided valuable knowledge in lab performance and epidemiology functions, particularly relating to PPHSN disease issues. Presentations included:

– Mr John Elliott (Pacific Paramedical Training Centre – PPTC, New Zealand) on quality assurance activities and mechanisms;

– Mr Subroto Banerji (CDC, USA) on current specimen handling, packaging and shipping mechanisms;

– Ms Sue Best (NRL, Australia) on HIV testing standards and quality assurance, updated proposals and mechanisms, and L3 test provisions at NRL;

– Dr Alain Berlioz-Arthaud (IPNC) on updated test methods (dengue, influenza, etc.), leptospirosis surveillance data, and L2/L3 test provisions at IPNC;

– Dr Ian Barr (WHO-CC, Melbourne, Australia) on current influenza testing mechanisms and L3 test provisions at WHO-CC;

– Dr Isabelle Bergeri (WHO, Manila) on WHO provisions, support and resources for LabNet performances; and

– SPC epidemiologists and specialists on current testing mechanisms, future LabNet activities and epidemiology functions.

In addition to the presentations by guest speakers, participants worked in initial group sessions during the meeting to address current LabNet activities. The main topics addressed in this session were:

– PPHSN disease testing currently being done at L1 and L2 labs;

– L3 labs currently utilised for referral testing;

– quality assurance activities currently utilised in L1 and L2 labs; and

– training mechanisms currently utilised in L1 and L2 labs.

As a follow-up activity to this group session, participants put together development plans for three key areas of performance in their labs: implementing recommended PPHSN disease testing, addressing and implementing essential quality assurance (EQA) activities (quality control and EQA for PPHSN disease testing; QA for equipment maintenance, inventory management and specimen collection; QA for blood bank and microbiology), and training mechanisms and needs.

Following is a summary of the output from participants.

• The majority of L1 and L2 labs are utilising LabNet-recommended test methods for PPHSN disease testing.
• The laboratories not utilising recommended tests committed to implementing them, where it is applicable to do so, by 2007.
• All countries performing recommended PPHSN disease testing are utilising the minimum quality control testing provided with the test kits. The majority of the countries are also subscribing to EQA programmes from various providers (PPTC, NRL, French Government offerings). Some tests’ performances currently cannot be verified with an EQA mechanism due to the unavailability of testing material from the providers (e.g. dengue, measles, rubella, influenza fluorescent stain).
• A few laboratories have fully developed and implemented QA activities in their operations.
• All laboratories without such activities committed to developing and writing SOPs and implementing the six recommended QA activities.
• All countries indicated their desire for the following training mechanisms and issues:
  – on-site training in the lab for new test methods;
  – provision of QA process and management training by PPTC and NRL; and
  – training in laboratory standards to attain accreditation.

Recommended tests for PPHSN disease testing

Target disease	Recommended test
Dengue	Panbio strips, Pentax
Leptospirosis	Panbio rapid test
Measles	Dade Behring
Rubella	Dade Behring
HIV	Screening: Serodia, Determine      EIA: Dade Behring, Vironostika, Abbott
Influenza	Rapid test: Quidel QuickVue, Binax Now Fluorescent stain: BioRad
Cholera	Culture: TCBS agar, ID, serology
Typhoid	Culture: Selective agar,TSI, ID, serology

Recommended QA activities
– QC for PPHSN target disease testing
– EQA for PPHSN target disease testing
– QA: Equipment maintenance
– QA: Specimen collection
– QA: Inventory management
– QA: Blood bank QC
– QA: Microbiology QC

The main outcomes of the workshop were:
– knowledge of current capacities of PICTs’ labs to support PPHSN activities;
– knowledge regarding updated and new test methods to be implemented in countries;
– knowledge of mechanisms to improve the lab testing capacities of PICTs’ labs;
– testing and support provisions from L2 and L3 LabNet members; and
– ability for LabNet members to improve communication networks and working relationships.

Subsequent meeting of the Technical Working Body

After the conclusion of the workshop, members of the LabNet Technical Working Body (TWB) met to discuss the outcome of the meeting and follow-up actions, as summarised below.

• Develop and write an SOP for shipping protocols for LabNet functions.
• Finalise and implement an HIV testing strategy that utilises two rapid tests, for countries with limited access to immediate confirmation testing.
• Obtain testing material for PPTC to prepare for additional EQA provisions (dengue, measles, leptospirosis and influenza).
• Assist Mataika House in developing and implementing a consistent mechanism for specimen logistics in Fiji (customs clearance, specimen shipping and transport in Fiji).
• Conduct further evaluations on the Pentax test for dengue to replace the currently recommended PanBio test.
• Evaluate the possibility of a centralised procurement system to assist countries in obtaining critical supplies for PPHSN testing.

Detailed information on LabNet 2006 and the LabNet TWB meeting can be viewed on the PPHSN website: http://www.spc.int/phs/PPHSN/Meetings/LabNet/LabNet-2006-workshop.htm.

Albert Gurusamy
Laboratory Specialist/ADB Consultant for PPHSN

Acknowledgements
The two meetings were held with financial assistance from the Asian Development Bank, France and the New Zealand Agency for International Development through the PREPARE project, and the Global Fund to fight AIDS, Tuberculosis and Malaria.