Introduction Strengthening Laboratory and Epidemiology Collaboration May 2007
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
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
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
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
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
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
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
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
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
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)
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
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
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
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
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
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
Content of the Module • Lectures • Case studies • Communication exercise
Lectures • Sampling strategies • Specimen management • Laboratory techniques • Microbiology • Immunology • Quality assurance • Interpretation
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
Communication exercise • Johari windows technique • Understand each other’s perspective when epidemiologists work with laboratory specialists
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
