Strengthening Laboratory and Epidemiology Collaboration

1. Introduction Strengthening Laboratory and Epidemiology Collaboration May 2007

2. Learning objectives At the end of this presentation, participants should know: • The goal of this course • The specific objectives of the course • The methods used during the course

3. Why this course? Public health is multidisciplinary • Epidemiologists, clinicians, laboratory specialists, environmental specialists, entomologists, veterinarians, nurses Specialists may have different • Skills, knowledge, working habits, perspectives Specialists need to collaborate often on • Surveillance, outbreak investigations, studies Activities must be coordinated to reach common goals

4. Conditions for successful collaboration Identify common goals • Applied public health (action) • Research Understand that there are different perspectives Recognize different skill sets Respect different working cultures Communicate effectively

5. Module Objectives To facilitate communication and collaboration between epidemiologists and the laboratory by: • Providing epidemiologists with basic training in microbiology techniques and analysis • Providing epidemiologists with the laboratory perspectives of public health investigations

6. Specific objectives • Develop field epidemiologists’ knowledge of basic laboratory sciences • Identify ways to have better collaboration between the laboratory specialists and the epidemiologists • Prepare the epidemiologist to ask the right questions when collaborating with laboratory specialists

7. Field epidemiologists should be able to: • Engage in positive interactions with laboratory specialists • Identify appropriate samples to collect • Appropriately collect, label, package and transport specimens • Identify key laboratory investigations for selected syndromes and/or suspected pathogens • Identify when and which typing methods should be used

8. Field epidemiologists should be able to: • Identify the need for and use of antimicrobial susceptibility testing • Identify the role of the laboratory in public health surveillance • Understand the role of laboratory quality assurance • Interpret laboratory test results: sensitivity, specificity and causality criteria

9. 1. Engage in positive interactions with the laboratory • Understand why and when to engage the laboratory • Learn how to communicate with the laboratory by learning their language • Take into account the needs, objectives and perspectives of the team: • Laboratory specialists, clinicians, veterinarians, environmental specialists, entomologists

10. 2. Identify appropriate samples to collect • Think critically while working with laboratory specialists • Identify surveillance, clinical, laboratory needs • Estimate the number of samples needed to confirm the cause of the outbreak • Define sampling strategy - mode of transmission, syndrome • Seek external advice for atypical scenarios • Collect samples ethically

11. 3. Appropriately collect, label, package and transport samples Identify criteria to select an appropriate laboratory • virulence, type of testing, location, time, needs (diagnostic vs specialised testing) For each type of sample, know: • Collection protocol • Documentation, labeling requirements l • What to include (patient, outbreak information, tracking system) • Appropriate bio-safety packaging and transportation requirements (UN)

12. 4. Identify key laboratory investigations for selected syndromes and/or suspected pathogens • Understand advantages and disadvantages of key microbiological methods • Understand basic immunology principles • Understand use of microbiological techniques as epidemiologic tools : • Time frame for antigen/pathogen detection • Windows for antibody detection • Time required to obtain results • Cost, sensitivity, specificity and limitations

13. 5. Identify when and which typing methods should be used • Identify typing methods that can: • Confirm the existence of an outbreak (e.g. when epidemiological methods are insufficient) • Identify the cause of disease (e.g. environmental reservoir) • Describe the phylogeny of pathogen

14. 6. Identify the need for, and use of, antimicrobial susceptibility testing • Understand anti-microbial resistance and implications for antibiotic use • Understand when to ask for antibiotic resistance patterns • Understand the need for laboratory-based surveillance for antibiotic resistance • Interpret antimicrobial resistance results in a public health context

15. 7. Identify the role of the laboratory for public health surveillance • Understand the principles of laboratory-based surveillance • Understand how the laboratory contributes to surveillance

16. 8. Understand the role of laboratory quality assurance • Think critically about laboratory quality assurance • Think critically about laboratory methods • Ensure that the corresponding laboratory has the highest possible level of quality assurance

17. 9. Interpret laboratory test results: sensitivity, specificity and causality criteria • Understand sensitivity, specificity and causality criteria • Interpret laboratory results according to: • Sensitivity and specificity • Context • Incidence/prevalence of the disease • Host-pathogen relationship

18. Content of the Module • Lectures • Case studies • Communication exercise

19. Lectures • Sampling strategies • Specimen management • Laboratory techniques • Microbiology • Immunology • Quality assurance • Interpretation

20. Facilitated case studies • General aspects of collaboration with the laboratory • Communication • Sampling strategy • Specimen management • Interpretation of the results • Management of an outbreak where the pathogen may be unknown

21. Communication exercise • Johari windows technique • Understand each other’s perspective when epidemiologists work with laboratory specialists

22. Developed by the Department of Epidemic and Pandemic Alert and Response of the World Health Organization with the assistance from:European Programme for Intervention Epidemiology Training Canadian Field Epidemiology Program Thailand Ministry of Health Institut Pasteur Introduction