Role of global disease detection laboratories in investigations of acute respiratory illness.

Keywords. respiratory infections; laboratory; International Emerging Infections Program.OVERVIEWOF THE GLOBAL DISEASEDETECTION (GDD) LABORATORIESSince2001, theCentersforDisease ControlandPreven-tion (CDC) has established 10 GDD Regional Centers,serving primarily resource-constrained locations inThailand,Kenya, Guatemala, Egypt, China, Bangladesh,Kazakhstan, India, South Africa, and Georgia [1].GDDlaboratories support the following GDD Center pro-gramsthatrequirediagnostictestingforemerginginfec-tious diseases: the International Emerging InfectionsProgram (IEIP), the One Health Program, the Field Ep-idemiology Training Program, the Influenza Program,and the Refugee Health Program (unique to the GDDRegional Center in Kenya). The laboratory leadersat each GDD Center also serve as the center’sadvisorfor the Strengthening Laboratory Capacity Program,through which theyadvise the host countryon means ofimproving laboratory capacity to support the Interna-tional Health Regulations [2]. In the 6 GDD Centerswhose IEIP programs conduct population-based surveil-lance for acute respiratory illness and other syndromes,laboratory support is provided through GDD laborato-ries (in Thailand, Kenya, and Guatemala), through labo-ratories run by the GDD partner institution (in ChinaandBangladesh),oracombinationofboth(inEgypt).The GDD laboratories in the GDD Regional Centersare each unique but have some commonalities(Figure 1). Each Center has 1 or more catchment areawith a defined population under surveillance; most ofthese are in rural areas, urban slums, or other areaswhere resources are limited. Each catchment area con-tains healthcare facilities where patients who meet sur-veillance case definitions for acute respiratory infectionand other syndromes are enrolled and provide speci-mens for analysis. These facilities range from poorly re-sourced primary care clinics to community or regionalhospitals, which contain a primary laboratory. Theprimary laboratory may be the hospital’s main clinicallaboratory, or it may be a physically separate IEIP labo-ratoryat the hospital. Routine clinical laboratory testingis conducted at the primary laboratories and includeschemistry analysis, hematologic analysis, microscopic,or rapid diagnostic testing for malaria; serologic orrapid diagnostic testing for human immunodeficiencyvirus; blood culture and susceptibility testing; and stoolculture and susceptibility testing. In some surveillancesites, specimens are transported to a secondary labora-tory for some of the routine tests.The secondary laboratory, usually the GDD partnerinstitution laboratory, conducts more advanced micro-biologic testing, including molecular, serologic, bacter-iologic, mycologic, mycobacteriologic, and virologicanalyses. Pathogen-specific tests are performed usingassays developed and validated by CDC reference labo-ratories, when possible.Specimen storage and transport from the primarylaboratory and clinics to the secondary laboratory pre-sents a number of challenges, which have been success-fullymanagedthroughoversightbytheGDDlaboratory