Use of Sentinel Laboratories by Clinicians to Evaluate Potential Bioterrorism and Emerging Infections

Abstract

With the persistent threat of emerging infectious diseases and bioterrorism, it has become increasingly important that clinicians be able to identify the diseases that might signal the occurrence of these unusual events. Essential to a thoughtful diagnostic approach is understanding when to initiate a public health investigation and how to appropriately use commonly performed microbiology procedures in the sentinel laboratory to evaluate potential pathogens. Although diagnostic test development is evolving rapidly, recognizing many of these pathogens continues to challenge the capabilities of most sentinel laboratories. Therefore, effective, ongoing communication and education among clinicians, infection control personnel, sentinel laboratorians, public health authorities, and Laboratory Response Network reference laboratorians is the key to preparedness.

Pregnancy, Birth, and Infant Health Outcomes from the National Smallpox Vaccine in Pregnancy Registry, 2003–2006

“…The information sheet also specified that, in the event of pregnancy loss or other adverse outcomes, registry professionals would coordinate laboratory testing of fetal or infant specimens (e.g., skin lesions) for vaccinia, if desired. This included viral culture and PCR testing by Laboratory Response Network facilities and/or the CDC Poxvirus Laboratory [32].…”

Validation of a Microsphere-Based Immunoassay for Detection of Anti-West Nile Virus and Anti-St. Louis Encephalitis Virus Immunoglobulin M Antibodies

“…After its initial introduction, more than half of the state health laboratories have adopted it as part of their arboviral diagnostic repertoire and have participated in annual proficiency testing of split samples provided by the DVBID. Many are using the technology in conjunction with other tests that utilize the same instrumentation, such as Salmonella serotyping (14), cystic fibrosis mutation detection (22), Mycobacterium tuberculosis spoligotyping (3), antinuclear antibody testing (5), respiratory virus testing (18), and bioterrorism preparedness (17). Thus, the instrumentation, while costly, may be used for an everexpanding array of procedures.…”

Biological Toxins and Bioterrorism

“…These labs performed the highest level of diagnostic testing associated with high-consequence pathogens and were also responsible for the research, development, and validation of new diagnostic technologies. Figure 2 below diagrams the LRN hierarchy and primary responsibility at each level (Pien et al 2006;Snyder 2005 evaluating potential bioterrorism events should recognize the following guidelines and implement them into their practices: (a) optimal specimen collection instructions should be obtained from sentinel labs intended to receive them; the recipient laboratory should also be alerted to the nature of the sample being shipped; (b) sentinel laboratories should limit sample and culture manipulations to those required for referral to reference labs when necessary; (c) environmental, food, animal, or plant samples should not be sent to sentinel labs; these should be sent directly to LRN reference labs; and (d) sample manipulations should be performed in biosafety cabinets whenever possible. Following the anthrax attacks in 2001, laboratories were inundated with human and environmental samples due to public panic.…”

“…CDC had primary responsibility for the full characterization of biological agents while USAMRIID's role was to support CDC in surge capacity situations. Diagnostic laboratories should all have access to a clinical microbiologist certified by the American Board of Medical Microbiology or other equivalent body (Pien et al 2006). Law enforcement and first responders sent environmental samples to level A laboratories which were not intended to receive them.…”