emerging and re-emerging infectious diseases and ...bamras.ddc.moph.go.th/userfiles/emerging...

Emerging and Re-Emerging Infectious Diseases and Regulation on Laboratory practice

โรคตดเชออบตใหม อบตซา และกฏหมายระหวางประเทศสาหรบหองปฏบตการ

Aree Thattiyaphong Ph.D. NIH, DMSc. aree.t@dmsc.mail.go.th

Outline • IHR 2005

• GHSA

• EIDs

• Laboratory diagnosis & Surveillance &Preparedness

3

Brief History of the International

Health Regulations (IHR) 1851: First International Sanitary Conference, Paris

1951: first International Sanitary Regulations (ISR) adopted by WHO member states

(กฎสขาภบาลระหวางประเทศ) 1969: ISR replaced and renamed the

International Health Regulations (IHR) (กฎอนามยระหวางประเทศ) 1995: call for Revision of IHR 2005: IHR (2005) adopted by the World Health Assembly (สมชชาอนามยโลก) 2006: World Health Assembly vote that IHR (2005) will enter into

force in June 2007

The International Health

Regulations (2005) • Established by negotiation between States

• Adopted at the World Health Assembly (2005) & binding on WHO’s Member States

• Entry into force of IHR June 2007 • Voluntary early compliance - Avian Flu – 2006 WHA • The purpose is to prevent and respond to the international

spread of disease while avoiding unnecessary interference with international traffic and trade

• August, 8, 2014 WHO declared Ebola outbreak in West Africa

PHEIC (Public Health Emergency for International Concern)

4

1969 2005

implement a control of travelers and goods

when crossing borders and entering

countries (e.g., need for appropriate

vaccinations such as yellow fever)

นกทองเทยวฉดวคซนเมอเขาประเทศทเสยง

ตอโรคทระบ

organize the containment of the risk at the

source, so that risks do not escape control

and spread out of the country.

จดการความเสยงภายในประเทศไมให

แพรกระจายออก

a list of epidemic-prone diseases to be

specially controlled (smallpox, yellow fever,

and cholera)

มรายชอโรคใหควบคม ไขทรพษ ไขเหลอง

อหวาตกโรค

report any event constituting a threat for the

international community, whether caused by

a disease or other sources such as chemical

spill, or even a nuclear event.

รายงานภยฉกเฉนทเกดจากเชอโรค สารเคม

นวเคลยร ภยพบต

preset measures, which have to be adopted

by all countries

วางมาตรการททกประเทศตองปฏบตตาม

replaced by a more flexible set of adapted

responses according to the nature of the

event constituting the threat, that will be

implemented by countries with the help of

WHO and the international community

การตอบสนองภยฉกเฉนขนกบชนดของภยของแต

ละประเทศ โดย WHO ใหความชวยเหลอ

6

National IHR Focal Points “The national centre, designated

by each State Party which shall be accessible at all times for communication with WHO Contact Points” (Article 4)

National IHR Focal Point shall be

accessible at all times for communications with WHO IHR Contact Points

WHO shall designate IHR

Contact Points, which shall be accessible at all times for communications with National IHR Focal Points

-WHO: IHR Contact Point -National IHR Focal Point

IHR 2005: Prerequisites • Adequate and trained public health staff

• Strong information and communication systems

• Timely and reliable public health laboratory

capacity

• Efficient and swift management of public health

actions including logistics

• Adequate resources

• Coordination with other sectors

• Global commitment, transparency and legally

bound obligations

7

Accepted

15 June

2007

2009 2014 2012

PLANING IMPLEMENTATION

EXTENTION

Timeline for implementing IHR in Thailand

WHO SEARO: 2 countries implemented IHR in 2014

: Thailand & Indonesia

IHR 8 Core capacities 1. National legislation, policy and financing 2. Coordination and NFP communication 3. Surveillance 4. Response 5. Preparedness 6. Risk communication 7. Human resource capacity 8. Laboratory

8.1 Laboratory diagnostic and confirmation capacity

8.2 Laboratory biosafety and biosecurity

Points of Entry

ชองทางเขาออก

Hazards -infectious -Zoonosis -Food safety -Chemical -Radiation

Decision instrument (Annex 2) 4 diseases to notify polio ( wild type virus), smallpox, human influenza new subtype), SARS.

Diseases to use the algorithm: cholera, pneumonic plague, Yellow Fever, Viral haemorragic fevers (Ebola, Lassa, Marburg), West Nile Fever, méningococcal disease.

Any event of potential international public health concern ( unknown or other

events/diseases)

Core capacity 8 Laboratory

Component 8.1 Laboratory diagnostic and confirmatory capacity

Indicator 8.1.1 Laboratory services available to test for priority health threats

8.1.1.1 Is there a policy to ensure the quality of laboratory diagnostic capability (e.g. licensing, accreditation)?

8.1.1.2 Are national standards/guideline available?

8.1.1.3 Does your country have access to networks of international laboratories to meet diagnostic and confirmatory laboratory requirements and support outbreak investigations for events specified in Annex 2 of IHR?

8.1.1.4 Is there national laboratory capacity to meet diagnostic and confirmatory lab requirement for priority diseases?

8.1.1.5 Is an update and accessible inventory of public and private laboratories with relevant diagnostic capacity available

8.1.1.6 Do national reference laboratories participate successfully in EQAS for major public health disciplines for diagnostic laboratories?

8.1.1.7 Are more than 10 non-AFP hazadous specimens per year referred to national reference laboratories for examination

8.1.1.8 Are all national reference laboratories accredited to international standards or national standards adapted from international standards?

8.1.1.9 Are there national reference regulation compatible with international

guidelines in force for packaging and transport of clinical specimens?

8.1.1.10 Is there a functional system for collection, packaging and transport for clinical specimens?

8.1.1.11 Have sample collection and transportation kits been pre-positioned at appropriate levels for immediate mobilization during a PH event?

8.1.1.12 Has staff at national or relevant levels been trained for the safe shipment of infectious substances according to international standards (ICAO/IATA)?

8.1.1.13 Do the processes for shipment of infectious substances when investigating an urgent public health event consistently meet ICAO/IATA standards?

8.1.1.14 Can clinical specimens from investigation of urgent public health events be delivered to appropriate national or international reference

laboratories within the appropriate timeframe of collection for testing or transport?

8.1.1.15 Have at least 10 hazardous specimens per year shipped internationally to a collaborating laboratory as part of an investigation or exercise?

Core capacity 8 Laboratory

Component 8.2 Laboratory biosafety and biosecurity

Indicator 8.2.1 Laboratory bosafety and laboratory biosecurity (Biorisk management) practice in place and implemented

8.2.1.1 Are biosafety guidelines accessible to laboratories?

8.2.1.2 Are regulations, policies or strategies for laboratory biosafety available?

8.2.1.3 Has a responsible entity been designated for laboratory biosafety and biosecurity?

8.2.1.4 Are relevant staff trained in laboratory biosafety and laboratory biosecurity guidelines?

8.2.1.5 Has an institution or person responsible for inspection, (could include certification of biosafety equipment) of laboratories for compliance with biosafety requirements been identified?

8.2.1.6 Has a biorisk assessment been conducted in laboratories to guide and update biosafety regulations, procedures and practice, including for decontamination and management of infectious waste?

Laboratory system: IHR 2005

2010: Mapping and assessment of Lab system

2013: เครอขายหองปฏบตการโรคตดเชออบตใหม

2014: Link เครอขายโรคตดเชออบตใหมของคน กบ

สตว

Re-convene the joint working group to begin

capacity building capacity

Activities should focus on

- Data management

- Detection and diagnosis for IHR pathogens

-Biosafety and biosecurity

-Perform S-LAT

-Staffing level and competency

-Sampling transportation

-Collaboration with diseases surveillance

services

-Increase the role of RMSCs within national

public health system

source: executive summary prepared by Dr.

Antione Pierson

Recommendation for next step activities

เครอขายหองปฏบตการโรคตดเชออบตใหม

Established in 2556

ฉบบท 3

ผานความเหนชอบจากครม.

เมอ 28 ส.ค.55 20

Objectives

หองปฏบตการไดรบการพฒนาสมรรถนะ

ตรวจจบการระบาดของโรค ระบบการเฝาระวงโรคทาง

หองปฏบตการ

ขอมลโรคตดเชอทางของประเทศ

ความรวมมอระหวางหองปฏบตการ

65 labs, DMSc. labs, Hospital Labs

เชอกอโรคทเฝาระวง No Bacteria Virus Food/water-

borne 1. Y. pestis Enterovirus (EV 71,

Coxsackie A) V. cholerae O1, O139

2. B. anthracis Dengue Shigella spp

3. Leptospira interogan Chikungunya Salmonella spp.

4. Ligionella pneumophila Smallpox etc.

5. S. pneumoniae SARs

6. S. suis VHF (Ebola, Marburg, CCHF, RVF)

7. West Nile

“Laboratory Diagnosis of zoonotic pathogens”

Lab staff : กรมปศสตว : เครอขายโรคตดเชออบตใหม

Anthrax, Plaque, Dengue, West Nile, Leptospirosis

30-31 July, 1 Aug 2557 4-5 Aug 2557

เครอขายหองปฏบตการ

พ.ศ. 2540: เครอขายเฝาระวงเชอดอยา พ.ศ. 2548: เครอขายไขหวดใหญ พ.ศ. 2553: เครอขายก าจดโรคหดตามพนธสญญานานาชาต พ.ศ. 2556: เครอขายหองปฏบตการโรคตดเชออบตใหม สมาชก 64 หองปฏบตการ

GHSA

Global Health Security Agenda

GHSA • เปนความพยายามของนานาชาต ภายใตการรเรมของ

สหรฐอเมรกา และมประเทศตางๆ อกกวา 38 ประเทศ เขา

รวมในโครงการ

• ผลกดนใหนานาประเทศจดล าดบ GHSA เปนเรองส าคญ

ระดบนานาชาต ในการเรงด าเนนการตามแนวทางกฎ

อนามยระหวางประเทศ ( IHR2005) ใหส าเรจ

• มงเนนการพฒนาขดความสามารถของประเทศในการ

ปองกน เฝาระวงและตอบโตโรคระบาดขามพรมแดน

( Prevent, Detect, Respond) โดยใชแนวคดสขภาพ

หนงเดยว เปนฐาน

เปาหมาย Package

Prevent -1 AMR (contributing country) Lead Canada, Germany, Natherlands, Sweden, UK

Prevent-2 Zoonotic Disease

Prevent-3 Biosafety and Biosecurity

Prevent-4 Immunization

Detect-1 National Lab System (Lead country)

Lead: South Africa, US, Thailand

Detect-2/3 Real-time surveillance

Detect-4 Reporting

Detect-5 Workforce Development

Respond-1 EOC

Rspond-2 Linking PH with Law and Multi-sectoral

Rapid Response

Respond-3 Medical Coutermeasures and PD

นโยบายกระทรวง

บรณาการระบบการเฝาระวงควบคมโรค

งบประมาณ 2558

กรมวทยาศาสตรการแพทย

1. การพฒนาระบบการเฝาระวงทางหองปฏบตการ

เครอขาย AMR

เครอขายโรคตดเชออบตใหม (Ebola : DRA)

มาตรฐานวธวเคราะห

2. การพฒนาบคคลกร (อบรม สมมนา)

-AMR

-โรคตดเชออบตใหม

-Biosafety, Biosecurity

Emerging Infectious Diseases

Classification of Emerging Infectious Diseases

Newly emerging

– Have not previously been recognised in man

Re- emerging/resurging

– Existed in the past but are now rapidly increasing either in incidence or in geographical or human host range

Deliberately emerging

– Microbes are those that have been developed by man, usually for evil use

What did Emerging Infectious Diseases have in Common?

Almost all caused by zoonotic pathogens Most spread by modern transportation Laboratory and clinical diagnosis were problematic Poor communication among countries Major economic impact

Dramatic Increase in Emerging Infectious Diseases?

Demographic Changes (Population Growth)

Modern Transportation (Globalization)

Increased Movement of People, Animals, Commodities

Climate change

Lack of Public Health Infrastructure

Regional Workshop on Laboratory Diagnosis of Emerging Bacterial Diseases 23-27th September 2013 CMC Vellore, India Dr. Aparna Singh Shah, M.D.

Viral emerging infection in SEAR

Year

1999 Nipah virus

2003 Chandipura

2003 SARS

2004 H5N1

2006 Chikungunya

2009 H1N1 (pandemic flu)

2010 CCHF

2012 HFMD

2012 MERS-CoV

2013 H7N9

Laboratory diagnosis & Surveillance &Preparedness

Regional Workshop on Laboratory Diagnosis of Emerging Bacterial Diseases 23-27th September 2013 CMC Vellore, India Dr. Aparna Singh Shah, M.D.

?Reliable public health laboratory capacity What laboratories can do???

Timely accurate Diagnosis

Support Surveillance

Molecular characterization

Drug susceptibility testing

Virulence studies

Epidemiological characterization

Assessment of immune response

R&D for drugs and vaccines

Information and material sharing with global network

Surveillance

Treatment

Diagnosis

Quality

Lab

Ebola virus disease (EVD)

• Formally known Ebola

hemorrhagic fever

• Family Filoviridae

• Genus: Ebolavirus, Marburgvirus, Cuevavirus

• Ebolavirus 5 species

1. Zaire Ebolavirus

2. Sudan Ebolavirus

3. Bundibugyo Ebolavirus

4. Tai Forest Ebolavirus (Ivori cote ebolavirus)

5. Reston Ebolavirus

Country Cum cases past 21 days Cum deaths HCW

Case/deaths

Guinea 2292 321 1428 121/62

Liberia 7719 225 3177 363/174

Sierra

Leone

7897 1319 1768 138/106

Nigeria 20 * 8 11/5

Sengal 1 0 0

Mali 8 * 6 2/

USA 4 - 1 3/0

Spain 1 0 0

17,942 6,388

December 10, 2014

การเตรยมความพรอมของหองปฏบตการ

ใน ประเทศไทย

1 1.1 EVD testing ตรวจ Ebola virus

1.2 ตรวจ มาลาเรย ไขเลอดออก , Multiplex Real-Time

PCR

2 Collection and transportation of specimens from hospital

laboratories across the country to the Department of

Medical Sciences with WHO safety standard protocol

3 Propose the model, DRA (BSL-2 lab, BSL-3 practice)

for hospital laboratory to safely deal with specimens

from suspected Ebola cases and other high risk group

pathogens

4 Provide the training course on the collection,

transportation, the proper use of personnel protection

equipment (PPE), waste management as well as for

EVD and non-EVD testing for laboratory personnel,

(DMSc, Hospitals)

กรมวทยาศาสตรการแพทย

ผลด าเนนการ

APRIL- DECEMBER 2014

44

Triple Packaging

Specimen management

Laboratory Diagnosis

1. DMSc.

2. Chulalongkorn U.

Laboratory Diagnosis of suspected Ebola cases

-10 patients (20 specimens)

-All were negative for Ebola and Dengue virus

-4 were positive for malaria

BSL-2 Laboratory + BSL-3 lab practice

Hospital Laboratory for treatment and

monitor patients

for high risk group pathogens response

(Ebola, Marburg, CCHF, etc)

Non-EVD testing ; Malaria, Dengue, CBC, Blood

Chemistry (BUN, Creatinine, Electrolyte, ALT, AST, etc)

Face shield

Goggle

Head cover Glove

N95 mask Long sleeve gown

31 hospital labs

assigned by the

end of Dec 2014,

19 labs already

being established

Designated Receiving Area (DRA)

Participant : Medical Scientists/

Medical Technologist 100

September 9, 2014

Workshop :

Safe Management of

Patients with Ebola

Virus Disease

Participant : Medical Scientists/

Medical Technologist 200

September 24, 2014

Seminar : Laboratory

testing of specimens

suspected Ebola virus

Participant : Medical Scientists/

Medical Technologist 200

September 24, 2014

Seminar : Laboratory

testing of specimens

suspected Ebola virus

Participant : Specialist 40

September 29, 2014 Round-table seminar : “Situation analysis of laboratory-based

surveillance system for Ebola and other VHF in Thailand”

Middle EAST Respiratory Syndrome-Corona Virus (MERS-CoV)

20 Sept 2012-31 Oct 2013

146 cases, 62 deaths, (8 countries) 121 cases, 51 deaths ซาอดอาระเบย

24 April 2014 345 cases, 107 deaths, (14 ประเทศ) 272 cases -ซาอดอาระเบย 72/345 health-care workers

SARS-CoV – 2003 MERS-CoV- Sept 20, 2012-April 2014

โครงการเฝาระวงโรคไวรสทางเดนหายใจในผปวยทกลบ จากแสวงบญทประเทศซาอดอาระเบย

2556 -- ผแสวงบญ 10400 คน ภาคใต 7500 คน

ตรวจ MERS-CoV ใน ผป ทกราย ไมพบ ตรวจวเคราะห ไวรสชนดอนๆ 16 ชนด

2557- ตรวจ MERS-CoV ใน ผป ทกราย ไมพบ

ตรวจหา ไวรส 16 ชนด

Overall Detection of Respiratory Viruses

จาก ผป ทกลบจากพธฮจน 2556

0

10

20

30

40

50

Single Pathogen Multi-pathogen No detectedpathogen

45.37%

32.87%

21.76%

Pathogens detected Number %

MERS-CoV 0 0

Single Pathogen 98 45.37

Multi-pathogen 71 32.87

Total number of episodes with pathogens detected 169 78.24

No detected pathogen 47 21.76

Total number of episodes 216 54

@Udonthani_23 Apr 2014

0

1

2

3

4

5

6

7

8

9

10

Multi-Pathogen Pathogens detected %

Co-detection, 2 pathogens

-HRV+AdV/FluA/OC43/229E/RSV-A/RSV-B/PIV1/PIV3 9.26/4.63/3.7/1.39/0.46/0.46/0.

46/0.46

-AdV+FluA/OC43/PIV3/229E/MPV 1.39/1.39/0.46/0.46/0.46

-FluA + PIV4 0.46

Co-detection, 3 pathogens

-HRV+AdV+FluA/FluB/OC43/NL63/RSV-B 2.31/0.46/2.31/0.93/0.46

-AdV+FluA+OC43 0.46

Co-detection, 4 pathogens

-HRV+AdV+FluA+229E 0.46

55 @Udonthani_23 Apr 2014

Distribution of Overall Respiratory Viruses

No MERS-CoV positive case

At least one virus in 98 (45.37%) patients / Multipathogen in 71 (32.87%) patients

FluA, FluB, PIV-1, PIV-3, PIV-4, HRV, RSV-A, RSV-B, hMPV, HEV, HCoV-229E, HCoV-

NL63, HCoV-OC43 and AdV

HRV in 108 (50%) patients / AdV in 58 (26.85%) patients / FluA in 47 (21.76%) patients

The most frequent combinations were HRV plus AdV, followed by HRV plus Flu A

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

45.00

50.00

1

HRV

AdV

FluA

OC43

229E FluB MPV NL63 RSV-B

PIV3 PIV1 PIV4 RSV-A

HEV HBoV PIV2

HRV 50.00% AdV 26.85% FluA 21.76% OC43 9.72% 229E 2.78% FluB 1.85%

MPV 1.39% NL63 0.93% RSV-B 0.93% PIV3 0.93% PIV1 0.46% PIV4 0.46%

RSV-A 0.46% HEV 0.46% HBoV 0% PIV2 0%

56 @Udonthani_23 Apr 2014

ผลการเฝาระวงไวรสทางเดนหายใจจาก ตย ผป

กลบจากพธฮจน (MERS-CoV – Negative :2557)

Gender # pts Pos

(%)

FLU A

(%)

Multi-infection

(%)

M 50 46

(46.5)

3 (3.0) 20 (22.2)

F 49 41

(41.40)

7 (7.1) 23 (23.2)

Total 99 87

(87.9)

10

(10.1)

43 (43.4)

Influenza

Flu A/B by PCR Typing and subtyping Influenza A by real time RT-PCR

ตรวจยนยนดวยวธ realtime RT-PCR โดยใช primer/probe อกชดหนง

หรอ ทา DNA gene sequencing

H1N1 H3N2 H5N1 H7N9 เฝาระวงเชอดอยา

Phase I “Development of Influenza Surveillance Networks” Five years : 15 Sep.2004 -14 Sep.2009-

ILI : 5 sample/week/site

Phase II “Strengtening Thailand’s Influenza Surveillance Network to Support Influenza Control Policy and Improve Pandemic Preparedness ”

Five years : 15 Sep.2009 -14 Sep.2014 ILI : 10 sample/week/site SARI : 5 sample/week/site

Laboratory-based Influenza Surveillance network partly supported by US-CDC & BOE

viral isolation

14 RMSc labs network

SPECIMEN PROCESSING FOR ILI/PNEUMONIA (FLU SURVEILLANCE)

specimens from sentinel sites

Thai NIC

Viral confirmation at WHO collaborating

center. Monitoring

Drug resistance

real time PCR real time PCR

Viral confirmation at Thai NIC

Monitoring Novel Influenza strains

26 July2013

1. Established diagnostic method (Real-Time PCR) 2. Provided training to network members 3. Constructed plasmid for positive control, distributed to Lab Network members

Preparedness for investigation/diag of H7N9

Organism

July

2014

Aug

2014

Sept

2014

Oct

2014

Nov

2014

Dec 2014

Wk 49 Wk 50 Wk 51 Wk

52

A/H1pdm09 /12

(3.48%)

3

(1.05%)

3

(1.41%)

4

(4.04%)

0

(0%)

1

(10.0%)

0

(0%)

Flu A(H3) 12

(3.48%)

6

(2.10%)

6

(2.82%)

4

(4.04%)

13

(16.6%)

4

(40.0%)

4

(22.22%)

Flu B 79

(22.9%)

32

11.19%)

22

(10.33%)

6

6.06%)

3

(3.85%)

0

(0%)

0

(0%)

Total of Test 345 286 213 99 78 10 18

ตารางท 1 ผลการตรวจหาสารพนธกรรมเชอไวรสไขหวดใหญจ าแนกตามสายพนธ

ในกลมตวอยางผปวย ILI และ SARI ระหวางวนท 1 กรกฎาคม 2557 ถง 13 ธนวาคม 2557

www.thainihnic.org

(รพ แมสอด รพ. พระปกเกลา รพ. ประจวบครขนธ ส. บาราศนราดร)

“Knowing is not enough; we must apply. Willing is not enough; we must do.”

Goethe

AMR

AMR

2. Training course on WHONET Program June 16-17

2014

http://www.vajira.ac.th/ic/wp-content/uploads/downloads/2010/09/

Antibiogram 2000-2013

Antibiogram

44.8 46.9 49.9 48.6 48.3 50.8 51.2 51.5 51.6

55.6 53.4

56.2 54.5

36.6 33.7

48

53.5 49.8

53.7

48.7 50.8

55.6 59.7 60.5

57.9

64.2

60.7

44.3 47.7

49.7

52.8

52.7 57.4 57.8 57.7

60.8 62.9 63.6 63

66.4

68

36.5

42

44 47.2 47.6

56.4 54.6 56.2 60.7

62.9 59

64.1

20.3 25

21.8 21.4

22.5

27.4 29.1

38.8 43.6

52.9 53.5 51.3

57.7 57.63

4.4 7

19.4

27

37.6

44.9 47.4

50.4 54.4 55.7

60.1 59.3 63.6

64.7

0

10

20

30

40

50

60

70

80

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Amikacin Cefepime Ciprofloxacin

Piperacillin/Tazobactam Ampicillin/Sulbactam Imipenem%R

Antimicrobial Resistance rates of Acinetobacter spp.by year

(NARST-28 hospitals, 2000-2013)

Diphtheria (2555) Corynebacterium diphtheriae, toxin-producing strain

Gram positive bacilli, non-spore forming

(Tellurite blood agar) Diphtheria toxin: modified Elek test

Toxin subunit A PCR

พบผปวยรายแรก 24 มถนายน 2555 ท เลย

Diphtheria Test method

Culture, Biotyping

Toxin detection -(Elek test)

- (PCR)

Molecular typing -MLST

Protective Immunity- microneutralization

ตวอยาง C. Diphtheriae (%)

Toxin positive (%)

5818 (ก.ค. 55-ก.ย. 56) 349 (6) 168/349 (48.1)

2556-2557: PTให ศวก.

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ดานซาย ST243 15

ดานซาย ST244 4

ดานซาย ST245 5

ผาขาว ST243 1

ผาขาว ST123 1

วงสะพง ST243 1

วงสะพง STnew1 1*

หลวง ST246 1

สวรร คหา ST243 5

หลมเกา ST243 9

หลมเกา ST247 1

กาญจนดษ ST249 1

เมอง ST248 1

ไชยา STnew2 1

เบตง ST248 1

เมอง ST248 1

MLST type of C. diptheriae outbreak in 012

อดรธาน ST243

นครราชสมา STnew4 1

มหาสารคาม ST209 1

นราธวาส ST209 1

ปตตาน ST248 1

STnew3 1

นครศรธรรมราช ST248 3

ลาว แขวงบอแกว ST248 2 ประเทศลาว

ST type Biotype

123

209

243 mitis

244 gravis

245 gravis

246

247 gravis

248 mitis

249

newST-1

newST-2

newST-3

newST-4

Anthrax

Bacillus anthracis Known as doom’s day bug

Risk group 3 pathogen

Epidemiology

Human Anthrax & Transmission

• Cutaneous - Contact with infected tissues, wool, hide, soil

• Inhalational - Tanning hides, processing wool or bone. LD50 for humans is 8000 to 10 000 spores

• Gastrointestinal - Undercooked meat

• Anthrax meningitis

Animal Transmission

• Ingestion - Most common

• Herbivores - Contaminated soil

• Carnivores - Contaminated meat

• Inhalation

• Mechanical (insects)

(Meselson et al., 1994)

Outbreak The “Black Bane” of cattle in 1600s

1979 – Inhalational anthrax after accidental release from a microbiology facility at Sverdlovsk USSR

1980 – used as a bio weapon by Rhodesian

and S. African apartheid forces to destroy

livestock and create food shortage

1993 – Aum Shinrikyo, a religious cult in

Japan attempted biological warfare

2001 –Spores sent in envelopes to prominent

people in US govt. 22 cases, 5 deaths

Lab diagnosis

• Microscopy

• Culture

• Animal inoculation

(inject 10 000 cfu/ml into mice or guinea pigs,

42-48 hours died)

• Antigen detection

– Immunochromatography

– Ascoli precipitin test

• Nucleic acid amplification test

Polychrome Methylene Blue M'Fadyean's reaction

• caused by Yersinia pestis, gram-

negative cocco-bacilli • Enterobacteriaceae • Plague is a highly virulent

zoonotic disease • Primarily an infection of

rodents and their fleas • Spread to humans, causing

pandemics • Reemerging disease in many

parts of the world • Potential Bioterrorism Agent

Plaque

countries with known presence of plague in wild reservoir species

Risk group 3 pathogen

Wide rodent

• Rat flea

• Xenopsylla cheopis, X.astia, X.brasiliensis,

• Human flea

• Pulex irritans

Vectors

reservoirs

76

77

• Enzootic in rodents

• 1994–2003 - 28,530, 2015 deaths, for a case-fatality rate of 7.1%

• 2004 to 2009, a total of 12,503 cases of human plague, 843 deaths, were reported by 16 countries in Africa, Asia and the Americas

• Microscopy and culture : IF • Serology : Antigen antibody detection – ELISA • Rapid : Immunochromatographic test • Nucleic acid detection test : PCR

79

Laboratory diagnosis

• Lymph node aspirates, tissue from buboes

• Blood – 4 samples at 30 minute intervals

• Respiratory samples- Sputum, BAL, Tracheal aspirates, Lung biopsy, Throat swabs

• Serum – paired for serology • CSF • Autopsy specimens –

lymphoid tissue, lung tissue, bone marrow

หองปฏบตการจลชววทยา เตรยมตวอยางไร

1.Diagnostic capacity---Network (knowledge)

1.การวเคราะห

2.การสงตอตวอยาง (บรรจภณฑ)

3.ท าเนยบผเชยวชาญ

2.Quality system (LA/ISO15189)

3. Boiosafety , Biosecurity, Biorisk management

(BSL, BSC, PPE, good practice)

Continuous learning (e-learning, training), New

Technology

Role of Laboratory

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