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The use of a mobile laboratory unit in support of patient management and epidemiological surveillance during the 2005 Marburg Outbreak in Angola.

Grolla A, Jones SM, Fernando L, Strong JE, Ströher U, Möller P, Paweska JT, Burt F, Pablo Palma P, Sprecher A, Formenty P, Roth C, Feldmann H - PLoS Negl Trop Dis (2011)

Bottom Line: Most cases were found among females in the child-bearing age and in children less than five years of age.There was a high concordance in test results between the MLU and the reference laboratory in Luanda operated by the US Centers for Disease Control and Prevention.Field laboratory capacity should be expanded and made an essential part of any future outbreak investigation.

View Article: PubMed Central - PubMed

Affiliation: Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.

ABSTRACT

Background: Marburg virus (MARV), a zoonotic pathogen causing severe hemorrhagic fever in man, has emerged in Angola resulting in the largest outbreak of Marburg hemorrhagic fever (MHF) with the highest case fatality rate to date.

Methodology/principal findings: A mobile laboratory unit (MLU) was deployed as part of the World Health Organization outbreak response. Utilizing quantitative real-time PCR assays, this laboratory provided specific MARV diagnostics in Uige, the epicentre of the outbreak. The MLU operated over a period of 88 days and tested 620 specimens from 388 individuals. Specimens included mainly oral swabs and EDTA blood. Following establishing on site, the MLU operation allowed a diagnostic response in <4 hours from sample receiving. Most cases were found among females in the child-bearing age and in children less than five years of age. The outbreak had a high number of paediatric cases and breastfeeding may have been a factor in MARV transmission as indicated by the epidemiology and MARV positive breast milk specimens. Oral swabs were a useful alternative specimen source to whole blood/serum allowing testing of patients in circumstances of resistance to invasive procedures but limited diagnostic testing to molecular approaches. There was a high concordance in test results between the MLU and the reference laboratory in Luanda operated by the US Centers for Disease Control and Prevention.

Conclusions/significance: The MLU was an important outbreak response asset providing support in patient management and epidemiological surveillance. Field laboratory capacity should be expanded and made an essential part of any future outbreak investigation.

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Related in: MedlinePlus

Field MARV diagnostic lab at Uige, Angola 2005; daily case load and positive sample detection.The height of each bar represents the total daily case load for the lab with the positive cases indicated by the solid portion.
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pntd-0001183-g003: Field MARV diagnostic lab at Uige, Angola 2005; daily case load and positive sample detection.The height of each bar represents the total daily case load for the lab with the positive cases indicated by the solid portion.

Mentions: The daily case load of the MLU fluctuated, with the number of individuals analyzed per day varying between 0 and 14 (Figure 3). This analysis often included multiple samples per individual on a single day and serial surveillance sampling of suspect and confirmed cases. The age and sex distribution of individuals tested were slightly shifted towards females (68%) and the younger age groups, in particular children under the age of 5 years (by far the largest single age group at 21%). The distribution of positive cases clearly demonstrated a larger proportion of females and children among the infected individuals (Figure 4).


The use of a mobile laboratory unit in support of patient management and epidemiological surveillance during the 2005 Marburg Outbreak in Angola.

Grolla A, Jones SM, Fernando L, Strong JE, Ströher U, Möller P, Paweska JT, Burt F, Pablo Palma P, Sprecher A, Formenty P, Roth C, Feldmann H - PLoS Negl Trop Dis (2011)

Field MARV diagnostic lab at Uige, Angola 2005; daily case load and positive sample detection.The height of each bar represents the total daily case load for the lab with the positive cases indicated by the solid portion.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3101190&req=5

pntd-0001183-g003: Field MARV diagnostic lab at Uige, Angola 2005; daily case load and positive sample detection.The height of each bar represents the total daily case load for the lab with the positive cases indicated by the solid portion.
Mentions: The daily case load of the MLU fluctuated, with the number of individuals analyzed per day varying between 0 and 14 (Figure 3). This analysis often included multiple samples per individual on a single day and serial surveillance sampling of suspect and confirmed cases. The age and sex distribution of individuals tested were slightly shifted towards females (68%) and the younger age groups, in particular children under the age of 5 years (by far the largest single age group at 21%). The distribution of positive cases clearly demonstrated a larger proportion of females and children among the infected individuals (Figure 4).

Bottom Line: Most cases were found among females in the child-bearing age and in children less than five years of age.There was a high concordance in test results between the MLU and the reference laboratory in Luanda operated by the US Centers for Disease Control and Prevention.Field laboratory capacity should be expanded and made an essential part of any future outbreak investigation.

View Article: PubMed Central - PubMed

Affiliation: Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.

ABSTRACT

Background: Marburg virus (MARV), a zoonotic pathogen causing severe hemorrhagic fever in man, has emerged in Angola resulting in the largest outbreak of Marburg hemorrhagic fever (MHF) with the highest case fatality rate to date.

Methodology/principal findings: A mobile laboratory unit (MLU) was deployed as part of the World Health Organization outbreak response. Utilizing quantitative real-time PCR assays, this laboratory provided specific MARV diagnostics in Uige, the epicentre of the outbreak. The MLU operated over a period of 88 days and tested 620 specimens from 388 individuals. Specimens included mainly oral swabs and EDTA blood. Following establishing on site, the MLU operation allowed a diagnostic response in <4 hours from sample receiving. Most cases were found among females in the child-bearing age and in children less than five years of age. The outbreak had a high number of paediatric cases and breastfeeding may have been a factor in MARV transmission as indicated by the epidemiology and MARV positive breast milk specimens. Oral swabs were a useful alternative specimen source to whole blood/serum allowing testing of patients in circumstances of resistance to invasive procedures but limited diagnostic testing to molecular approaches. There was a high concordance in test results between the MLU and the reference laboratory in Luanda operated by the US Centers for Disease Control and Prevention.

Conclusions/significance: The MLU was an important outbreak response asset providing support in patient management and epidemiological surveillance. Field laboratory capacity should be expanded and made an essential part of any future outbreak investigation.

Show MeSH
Related in: MedlinePlus