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Among the most challenging issues discussed at the conference was the establishment of a Pacific-based network of reference laboratories to help countries where highly sophisticated biological analyses are not available locally.
A proposal was put forward at the conference for a network of reference laboratories that would provide support to in-country public health services for the detection and the confirmation of outbreaks of certain communicable diseases.
The proposal developed from a suggestion that a network of laboratories would complement the outbreaks early warning system provided by PACNET, the e-mail-based communication tool serving the Pacific Public Health Surveillance Network. A number of good laboratories operate in the Pacific but they are not linked together and the flow of information between them could be improved.
The proposed “outbreak identification network” would have three levels of laboratory (see figure 1). The “country level” laboratory would cope with specimen collection and field/rapid tests when available. The “diagnostic/confirmatory level” laboratory would be in charge of virus isolation and identification, serological typing and immunological studies. The “reference level” laboratory would be responsible for highly sophisticated diagnostics using molecular typing and genetic analysis.
It was recognised that there would be benefit from applying this approach to many endemic, communicable diseases. Eight candidate conditions were discussed:
- dengue
- measles
- influenza
- cholera
- leptospirosis
- typhoid
- rubella
- acute haemorrhagic conjunctivitis.
It was proposed that any networking arrangement should start modestly, by choosing only two or three conditions and establishing a sound and fully supported mechanism of surveillance, sample collection and shipping, and assurance of laboratory capacity and willingness to provide services for these conditions.
The initial selection of diseases will depend on:
- national priorities
- regional priorities
- laboratory capacities
- financial and logistic support.
The success of the laboratory network will depend on integration with effective surveillance and protocols at field level to detect suspected cases and co-ordinate public health action in the event of outbreaks.
Several laboratories in Fiji, New Caledonia and French Polynesia have already been identified as potential members of this public health laboratory network. Some of the reference level laboratories are existing WHO collaborating laboratories. The next steps will consist of implementing the assessment of current Pacific Island-based laboratory capacities to initiate the network.
