A regional LabNet workshop from 8 to 10 September 2003 followed the first EpiNet workshop in the previous week. The first two days were held at the Holiday Inn Hotel in Suva and the third day at Mataika House. It was co-organised by the Secretariat of the Pacific Community (SPC) and the World Health Organization (WHO) in collaboration with the New Caledonia Pasteur Institute (IPNC).
The objectives of the meeting were to:
- update the participants on the progress of LabNet development;
- assess the current situation of laboratory testing and specimen shipment with regards to Pacific Public Health Surveillance Network (PPHSN) target diseases, including SARS, and plan further developments;
- review and discuss the linkages and support available through reference laboratories of the Australian and New Zealand Public Health Laboratory Network;
- discuss and clarify laboratory techniques available for the PPHSN target diseases;
- become familiar with the use of rapid tests (leptospirosis, dengue and influenza) and DVBS (measles);
- assess training needs of laboratory health professionals;
- update the participants about lab-specific bioterrorism issues and discuss practical lab-related aspects;
- discuss and agree on possible lab-based surveillance activities.
Participants were laboratory professionals* members of national/territorial EpiNet teams from all the Pacific Island countries and territories, except the Commonwealth of the Northern Mariana Islands, Papua New Guinea, and Wallis and Futuna (who could not attend). Most of the members also participated in the EpiNet workshop. Additional experts were invited to assist in specific technical areas and/or as PPHSN allied members.
The format of the first two days was the same as for the EpiNet workshop: plenary presentations and discussions, group work and panel discussions. The third day included hands-on exercises with rapid tests. An overview of the workshop proceedings is presented below.
Day 1: Strengthening the network and bioterrorism
Chairperson: Mrs Vasiti Uluiviti, American Samoa
Rapporteur: Mr Taukea Okesene, Niue
After a short opening ceremony, the representative of the New Caledonia Pasteur Institute (IPNC), the institution with leadership in the LabNet Technical Working Body (TWB), gave a presentation on the origins and development of LabNet.
The sessions included:
- Assessment of current capacity of the network — plenary presentations of L2 laboratories (New Caledonia Pasteur Institute, Mataika House in Fiji, Guam Public Health Laboratory and French Polynesia Malardé Institute);
- Lab-specific bioterrorism issues — plenary presentations on the global anthrax laboratory network and laboratory preparedness for bioterrorism and outbreak-prone diseases in the Northern Pacific;
- Lab-specific training needs — one plenary presentation of the Pacific Paramedical Training Centre (PPTC) including the Regional External Quality Assurance Programme.
A series of issues came out of the discussions held after the presentations:
- the shipment of specimens to other laboratories for confirmation testing
- the number of specimens needed to be tested to confirm an outbreak
- the linkages between L1 and L2 laboratories to be strengthened
- the development of a website for laboratory personnel
- the production of guidelines for quick response
- the training of laboratory personnel
- personal safety procedures, with proper handling of specimens and use of safety equipments to be emphasised
After that, three working groups discussed training needs and Quality Assurance (QA) programmes.
Laboratory training needs
Each group identified different training needs. They included in-country training, overseas training, training to keep equipment to standard, IATA packaging and regulations, distance training, a link to a Palau proposal for training at Palau Community College (PCC), credit and recognition for each course from an academic institution (PCC, Fiji School of Medicine, etc.), coordination by Pacific Paramedical Training Centre (PPTC), gradually building to certificate and diploma.
Quality Assurance (QA) and Quality Control (QC)
All groups agreed that the External Quality Assurance programme run by PPTC should continue. They also recommended that an internal QA programme be encouraged and performed on a regular basis.
During the discussions it was also recommended that:
- PPHSN target diseases should be incorporated into QA programme (for those not yet included);
- regular meetings on aspects of QA should be organised with clinicians;
- information should be exchanged and shared more readily;
- laboratory auditing should be organised among PICTs;
- an inventory of QA/QC programmes, policies, and protocols of all PICTs laboratories should be completed;
- PPHSN should request PPTC to provide QA/QC for all PICTs laboratories and provide standardisation;
- teaching institutions should have standard teaching materials; and
- PPHSN should request the National Reference Laboratory in Melbourne, Australia, to support PICTs laboratories in very specific areas (e.g. serology).
As a result, a technical group was formed the next day to prepare a QA plan of operations. The core members are IPNC, PPTC, SPC and WHO, with PPTC as focal point. Supporting members include L2 and L3 laboratories and training institutions (Fiji School of Medicine, Palau Area Health Education Center). The role of the technical group is to strengthen QA through PPTC.
The members agreed on the following priorities:
- PPHSN allied membership and a review of status of memorandum of understanding (particularly with PPTC-WHO) should be organised under the PPHSN framework by the end of 2003.
- QC should be extended to the shipment of dengue and leptospirosis, measles and influenza samples, depending on PICT priorities (typhoid and cholera are already included).
- Auditing conducted by PPTC should be continued and the recommendations should be passed on to the PPHSN QA technical group for further action (regional and political). Internal QC promotion and supervision should also be included in the process.
- The output of the WPRO laboratory meeting at the end of October 2003 should be taken into account.
- Standard operating procedures (SOPs) should be shared. Examples of laboratory handbooks for clinicians from Tonga, Fiji Islands and Samoa should be posted on the PPHSN website and PacNet by the end of 2003.
- PPHSN guidelines should include SOPs, and should be used as references, as soon as finalised (beginning 2004).
- PPTC should design training according to QC results as of 2004. This should be implemented as from 2005, with support from PPHSN other allied bodies/partners (Fiji School of Medicine, Palau Area Health Education Center) and using PPHSN guidelines as reference. PPTC should continue with the management and QA training programme. PICTs (e.g. ministries of health) should be used as alternative training sites.
Day 2: Technical update – Strengthening the network
Chairperson: Mr Andrew Darcy, Solomon Islands
Rapporteur: Mr Raymond Seule, Vanuatu
The focus of the second day was on laboratory techniques for PPHSN target diseases and regional support.
The first session included plenary presentations on laboratory techniques for influenza, leptospirosis, typhoid and dengue, as well as Dried Venous Blood Spot (DVBS) specimens for measles.
Subsequent sessions covered the following three themes:
- Lab-based surveillance activities
- Regional support (including presentations on the Australian Public Health Laboratory Network, public health laboratory services in New Zealand (Environmental Science and Research Ltd), the Victorian Infectious Diseases Reference Laboratory, the influenza laboratory network and practical aspects of specimen shipment)
- LabNet development planning
Two groups examined the question: How can L2 and L3 laboratories assist the L1 laboratories?
- Training — organise training/certification on IATA packaging/shipping, training of trainers in the same area, and technical training of staff.
- Technical support — develop guidelines for diagnosis confirmation (including specimen needed and test available).
- Supplies/stockpiles — arrange one stockpile per country/hospital. Delays in shipment of supplies should be minimized, with key person being responsible for shipping.
- Testing guidelines — L2 laboratories could provide support for the six PPHSN target diseases plus others (STIs, HIV, TB). The latest laboratory manuals and protocols for target diseases should be available.
- Communication — PPHSN should try to make sure that each laboratory has Internet access, to facilitate the sharing of information and communication of laboratory results. An electronic list server of L2 and L3 contact persons should be available.
- Overseas testing — laboratories should acknowledge receipt of the specimens and try to quickly return the results. This would avoid anxiety for the sender and accelerate the notification to the physician and the initiation of patient management.
- Other issues — L2 laboratories should be able to provide test kits (e.g. rapid test for lepto, etc.) in case they are needed by an L1 laboratory.
— Current capacities of the laboratories should be assessed.
— An MOU between L1, L2 and L3 laboratories should be prepared.
The last day included hands-on exercises with rapid tests. Participants were familiarised with rapid tests for leptospirosis, influenza, dengue and the DVBS technique for measles specimens.
Copies of the latest draft of the PPHSN Strategic Plan, including EpiNet and LabNet aspects, were distributed to all the participants.
* Palau was represented by a public health physician.