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Emerging and Re-Emerging Infectious Diseases and Regulation on Laboratory practice
โรคตดเชออบตใหม อบตซา และกฏหมายระหวางประเทศสาหรบหองปฏบตการ
Aree Thattiyaphong Ph.D. NIH, DMSc. [email protected]
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
THANK YOU FOR GIVING ME A CHANCE