Laboratory Results and
Operations in WHO Phase 6
Dr. Attaporn Taweetungtragoon
CYBELES
Phnom Penh, Cambodia
October 12-15, 2009
Laboratory Testing during WHO Phase 6
is not “Business as Usual”
No. of cases per day
30
20
10
Too Late to Contain?
1
10
Days after first case
20
World Health Organization, Regional Office for The Western Pacific
30
Background
The Protocols are based on Detection,
Investigation, and Reporting
 Rapid Response and Containment
 The strategy is geographically based
 Containment and Buffer zone operations
include
Surveillance and on going laboratory testing
Containment communications
Antiviral administration

Containment/Buffer Zone Checklist
Identification of Laboratories
 Field Response Teams
 Sample Collection
 Specimen testing and reporting
 Specimen shipping
 Specimen storage
 Logistical support

Early Detection and Rapid response




Reliable Laboratory testing can provide resource focus,
disease patterns, and patient contact/education
Buffer zone testing is also indicated as part of the
Surveillance program
Buffer zone lab testing will continue as long as the
containment is on going
Containment and Buffer Zone key tasks
--Extensive antiviral prophylaxis and treatment -Surveillance and LABORATORY
TESTING
--Assessment of the novel virus
What do we need for setting up
PCR/ qRT-PCR lab for Flu tests


Instruments
Supplies
Cold reagents
 Room temperature supplies


Well trained lab staffs
Illustrated PCR Workflow
Prepare the RNA template
Extraction of Nucleic Acid
(RNA/DNA)
Automatic extraction
Manual RNA extraction
Prepare the RT-PCR reactions
System Software
Run the experiment
Design and set up PCR
experiment
Amplification plot
Interpretation of the result
RNA /DNA Extraction Systems

Small Scale Extraction System
(8 samples/run)

Big Scale Extraction
System (96 samples/run)
Variety of PCR and Real-Time
RT-PCR Instruments
Big scale laboratory instrument
Real-Time PCR
SENSOQUEST
Small scale laboratory
Instrument
PCR
Real-Time RT-PCR System Software
Interpretation of Results
Target
Pathogen
Internal
control
Negative
control
Positive
control
Interpretation
POS
POS
NEG
POS
POS
NEG
POS
NEG
POS
NEG
NEG
NEG
NEG
NEG
INVALID
POS
POS
POS
POS
INVALID
What can go wrong with Laboratory
results?

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
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

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Sample collection methods are poor
Lack of refrigeration in shipping and storage
process
RT-PCR testing done incorrectly
Positive results are not identified
Results are not reported in a timely manner
Results are not numbered and stored correctly
Leaders do not understand the meaning of the
results because they are not displayed correctly
The results are not acted in time because the
leaders do not understand how important the
results are.
WHO Laboratory Confirmation
http://www.who.int/countries/en/#J

Laboratory in Cambodia


The WHO Representative in
Cambodia
No. 177-179 corner Streets Pasteur
(51) and 254 PO Box 1217 Phnom
Penh Cambodia
Laboratory in Japan

WHO Technology Transfer
Programme Office
c/o International Medical Centre of
Japan
1-21-1 Toyama, Shinjuku-ku
Tokyo JAPAN

Laboratory in Thailand


The WHO Representative
Soi Bamrasnaradoon, Permanent
Secretary Building 3, 4th Floor
Tiwanond Road
Nonthaburi 11000 Thailand
Host Nation
Laboratory that is
Ministry of Health
operated
Laboratory Testing and
preparedness
Testing all suspected cases is preferred but may
not be possible
 Potential large numbers will be tested if
Containment operations are initiated requiring
local, state and federal coordination
 Equipment and consumable supply
requirements
 WHO collaborating centers and other reference
Labs will perform molecular and genetic studies

National Pandemic planning for
Laboratory operations



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Identify all Laboratories in the country and list
their capabilities
Identify Labs that can perform Novel virus
testing
Test all Laboratory proficiencies annually with
WHO
Work with WHO as a regional partner
Laboratory Field Response
Teams



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Establish fast response Laboratory teams
(May include military component)
Must have vaccinations, passports
Team members must have training in
influenza diagnostics, safe specimen
handling, and dangerous goods packaging
& shipping
National authorities must stockpile adequate
PPE, specimen collection and transportation
materials, and swabs.
Specimen Collection, Shipping,
Reporting, & Storage


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Develop a consistent and systematic method to
label specimens that links them to patients and
epidemiological data.
Ensure import and export documents are in place
in advance.
Determine which staff can interpret and report
the results.
Develop a plan & capacity for storing
representative specimens, isolates, and nucleic
extracts for research and evaluating mutations
Summary
Laboratory testing is on going from pre
pandemic to recovery
 Supplies and equipment must be utilized in
training activities
 Field and in-house Lab testing is a critical
component of Containment and Buffer zone
operations
 Laboratory testing will determine effectiveness
of operations and drive decision-making at all
levels
