Lab Matters Winter 2018 | Page 9

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Illinois Department of Health medical advice poster. Photo: Science Photo Library

Thanks to the APHL-CDC“ Right Size” project, launched in 2010, CDC can calculate just how many specimens must be collected and forwarded to the NIRCs each week of flu season to assure a representative selection of viruses for surveillance purposes— not too few and not unnecessarily many. The Wisconsin State Laboratory of Hygiene, for example, receives and processes 800 to 1,000 specimens / year from 17 states( AL, AR, IA, IL, IN, LA, KS, MI, MN, MI, MS, ND, NE, OK, SD, TX, WI) for national surveillance, plus additional Wisconsin specimens to support in-state influenza activities.

Nationwide, said Jernigan, roughly 70-80,000 specimens / year are tested for virologic surveillance. Of those, around 30-40 % are positive for influenza. The three NIRCs receive a subset of those positive specimens and collectively submit 3,000 to 4,000 viral isolates to CDC each year.

Outside public health— in clinics, hospitals, long-term care facilities and other point-of-care sites— gains have also been made. Perhaps the most salient is the rise of the rapid influenza diagnostic test( RIDT). Although handheld, rapid test devices were around during the 2009 pandemic, they required human intervention to interpret results and were notoriously unreliable.

Current devices, said Shult, are machine read and“ a big step up” from firstgeneration RIDTs. Additionally, the newest devices can report test results directly to the cloud, giving public health authorities access to real-time data. In Wisconsin, where Shult and colleagues are studying the devices, community RIDT sites send patient specimens to the State Laboratory of Hygiene for confirmatory PCR testing. So far, the scientists have found sensitivity in younger individuals in excess of 80 % during early infection.

Yet, even with all these improvements— PCR, enhanced surveillance, next-generation sequencing and reliable RIDTs— Jernigan said,“ We’ re at a better place than we were, but we’ re still not where we should be.”

In the United States and worldwide, critical preparedness gaps persist:

• Inadequate surveillance in birds and swine.

• A limited selection, and limited availability, of antiviral drugs and other medical countermeasures.

• Lack of low-cost, highperforming antivirals.

• Inability to make vaccine quickly or to assure its effectiveness.

• Suboptimal specimensharing among countries.

Many nations face additional challenges. For example, based on attainment of International Health Regulation goals, just a third of countries worldwide are ready for a pandemic response.

And although global influenza surveillance and information-sharing are improving— especially in China and Southeast Asia where virulent avian flu strains have arisen— inadequate laboratory capacity has left influenza“ data deserts” across large swaths of the globe.