Introduction
Strengthening
Laboratory and Epidemiology
Collaboration
May 2007
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
A N D
R E S P O N S E
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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
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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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
A N D
R E S P O N S E
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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
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R E S P O N S E
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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
A N D
R E S P O N S E
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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
A N D
R E S P O N S E
Field epidemiologists should be able to:
1.
Engage in positive interactions with laboratory specialists
2.
Identify appropriate samples to collect
3.
Appropriately collect, label, package and transport
specimens
4.
Identify key laboratory investigations for selected
syndromes and/or suspected pathogens
5.
Identify when and which typing methods should be used
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
A N D
R E S P O N S E
Field epidemiologists should be able to:
6.
Identify the need for and use of antimicrobial susceptibility
testing
7.
Identify the role of the laboratory in public health
surveillance
8.
Understand the role of laboratory quality assurance
9.
Interpret laboratory test results: sensitivity, specificity
and causality criteria
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
A N D
R E S P O N S E
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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
A N D
R E S P O N S E
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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
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R E S P O N S E
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)
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
A N D
R E S P O N S E
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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
A N D
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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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
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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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
A N D
R E S P O N S E
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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
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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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
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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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
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Content of the Module
•
Lectures
•
Case studies
•
Communication exercise
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
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Lectures
•
Sampling strategies
•
Specimen management
•
Laboratory techniques
•
Microbiology
•
Immunology
•
Quality assurance
•
Interpretation
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
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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
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
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Communication exercise
•
Johari windows technique
• Understand each other’s perspective when
epidemiologists work with laboratory specialists
P I D E M I C A L E R T
Laboratory Training for FieldEEpidemiologists
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Introduction
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
Canadian Field Epidemiology Program
Thailand Ministry of Health
Institut Pasteur
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Laboratory Training for FieldEEpidemiologists
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Training