LABORATORY SUPPORT FOR

MANAGEMENT OF VACCINE
PREVENTABLE DISEASES
 Introduction

Surveillance and management of vaccine-
preventable diseases requires the close
collaboration of clinicians, public health
professionals and laboratorians

Public health measures relies on clinical and
laboratory reports of vaccine-
preventable diseases

Appropriate specimen collection and
laboratory testing is essential
 Childhood Vaccines
-Diptheria -Pertussis
-Hib -Pneumococcal dis
-Hepatitis A -Polio
-Hepatitis B -Rubella
-Measles -Tetanus
-Mumps -Varicella
 Other Vaccines

-Anthrax - Plague
-Cholera - Rabies
-Influenza - Smallpox
-Japanese encephalitis - Typhoid
-Meningococcus - Yellow Fever
Laboratory Role in Management of
Vaccine Preventable Diseases
1. Support for rapid investigation of disease
outbreaks

2. Support for improved surveillance of vaccine

preventable diseases

3. Assessment and monitoring of immunization

status

4. To develop and maintain testing resources,

standard procedures and quality assurance
 Laboratory Role in Management of
Vaccine Preventable Diseases (2)

5. Analyse data and provide feedback of the

results to public health authorities

6.The national Reference Laboratory to

provide technical support, training,
guidance and quality assurance to all
laboratories within the country
 Responsibilities of Hospital Labs

Identification of infectious agent by serology

and/or isolation using standard procedures
and reagents

Referral of isolates to the National Ref lab
for isolate identification and/or
serotyping

Reporting results

Coordination with EPI case investigators

Coordination and implementation of
containment activities
Responsibilities of National Reference Labs (1)

Identification of infectious agent by serology

and/or isolation using standard procedures
and reagents

Perform serotyping of isolates

Referral of isolates (eg polio and influenza)
to the Global Specialised Labs/WHO
Collaborating Centre

Reporting results in a timely manner

Serve as centre for training the laboratory
personnel from hospital laboratories
Responsibilities of National Reference Labs (2)

Coordinate quality assurance program and

validation of hospital labs in the country

Provide guidelines for proper specimen
collection, transportation and laboratory
testing

Coordination and implementation of
containment activities

Coordination with EPI case investigators
 Responsibilities of Global Specialized Labs (1)

Definitive identification of isolates using all
available technologies, including genetic
characterization, to reveal the origin of
isolates

Preparation and distribution of relevant
standards, reference reagents and training
materials

Preparation and distribution of proficiency test
panels

Provision of consultants to evaluate and advise
on lab services and provide specialized
training
 Responsibilities of Global Specialized Labs (2)

Participation in collaborative studies to assess

proposed standards and reference materials

Research aimed at improving the speed,
sensitivity, specificity and applicability of
methods for diagnosis of vaccine
preventable diseases

Reporting results in a timely manner
 Laboratory Testing (1)
1. Isolation of infectious agent by culture
technique

Diptheria, H influenzae, Influenza,

Pertussis, Pneumococcus, Polio

For virus all isolation work is carried

out in the Ref Lab

For bacteria serotyping is carried out

in the Ref lab
 Laboratory Testing (2)

The following should be considered for
collection of specimen for culture:
 Timing
 Appropriate site
 Proper collection
 Proper transportation
 Alert the laboratory of disease
suspected especially agents that
requires special culture media
 Laboratory Testing (3)
2. Specific Antibody Testing

HAV, HBV, Measles, Mumps, Rubella,

Varicella

IgM

Paired sera for IgG

Problem: recently vaccinated patients

(except HBV)
 Laboratory Testing (4)
3. Antigen Detection

H influenzae, Influenza

Antigen detection may be used as an
adjunct to culture especially in severe
or unusual clinical presentation to
initiate therapy (eg Varicella)

Patients who have received
antimicrobial agents before specimens
are obtained for culture (however,
positive Ag from urine and serum is
not reliable for diagnosis of invasive
Hib)
 Laboratory Testing (5)
4. Nucleic Acid Detection

Diptheria, HAV, Influenza, measles,
mumps, pertussis, rubella, polio

May be useful to detect common
source of outbreaks

In cases where isolation of infectious
agent is not always possible eg in
patients who have received
antimicrobial agents

Can discriminate between vaccine and
wild type (eg Polio, VZV)
 Laboratory Testing (6)

Problem: PCR assays varies among labs and in
most cases direct comparison with culture is
necessary for validation

Molecular epidemiologic surveillance allow
the building of a sequence database that will
help track transmission pathways of the
infectious agent strains circulating in the
country (measles, rubella, diphtheria,
pertussis and polio)

Ultimately as diseases progress toward
eradication, monitoring circulation of these
agents becomes an essential component in
surveillance activities
Importance of a Standard Set of
Laboratory Procedures
To ensure optimum laboratory surveillance
of vaccine preventable diseases at a time
when number of cases are fewer :

false positive serologic results will be

more likely

it will become increasingly important to

detect any importation of virus in
the community
Effective laboratory support for surveillance
requires that:

health-care professionals are aware of
the system and its requirements

appropriate specimens are collected and
sent to a laboratory capable of
performing the necessary tests

reliable equipment is used and tests
performed correctly

timely feedback is provided to the
appropriate authorities

the integrity of the surveillance system is
monitored on an ongoing basis
 Conclusion
Both the public health authority and the lab
have a role in ensuring optimum lab surveillance:

Public health: to educate the health-care

providers on the impt of lab testing and
to make sure that the lab resources are
accessible

Lab: to develop and maintain testing

resources, SOP & QAP, and to analyse
data and provide feedback to the public
health authorities