Laboratory Training for Field Epidemiologists Strengthening Laboratory and Epidemiology...

E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists

Strengthening Laboratory and Epidemiology

Collaboration

Introduction

May 2007


Learning objectivesLearning 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?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 collaborationConditions 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 ObjectivesModule 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 objectivesSpecific 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: 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


Field epidemiologists should be able to: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


1. Engage in positive interactions with the 1. Engage in positive interactions with the laboratorylaboratory

• 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 collect2. 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 3. Appropriately collect, label, package and transport samplesand 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 4. Identify key laboratory investigations for selected syndromes and/or suspected selected syndromes and/or suspected

pathogenspathogens

• 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 5. Identify when and which typing methods should be used 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, 6. Identify the need for, and use of, antimicrobial susceptibility testingantimicrobial 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 7. Identify the role of the laboratory for public health surveillancepublic health surveillance

• Understand the principles of laboratory-based surveillance

• Understand how the laboratory contributes to surveillance


8. Understand the role of laboratory 8. Understand the role of laboratory quality assurancequality 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: 9. Interpret laboratory test results: sensitivity, specificity and causality sensitivity, specificity and causality criteriacriteria

• 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 Content of the Module

• Lectures

• Case studies

• Communication exercise


LecturesLectures• Sampling strategies

• Specimen management

• Laboratory techniques

• Microbiology

• Immunology

• Quality assurance

• Interpretation


Facilitated case studiesFacilitated 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 exerciseCommunication exercise

• Johari windows technique

• Understand each other’s perspective when epidemiologists work with laboratory specialists


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 Training

Canadian Field Epidemiology Program

Thailand Ministry of Health

Institut Pasteur

Laboratory Training for Field Epidemiologists Strengthening Laboratory and Epidemiology...

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