Lab Matters Winter 2018 | Page 9

feature

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 .