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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

Cycle threshold values for paired blood and swab samples.Cases where whole blood (▪) and swab (□) samples were available for testing the same day are shown. Viral loads from both sample sources were comparable and do not consistently indicate one sample source as more suitable for viral load determination.
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pntd-0001183-g005: Cycle threshold values for paired blood and swab samples.Cases where whole blood (▪) and swab (□) samples were available for testing the same day are shown. Viral loads from both sample sources were comparable and do not consistently indicate one sample source as more suitable for viral load determination.

Mentions: A comparison of detection of MARV from oral swabs and EDTA blood was performed on 63 individuals from whom both specimen types were available from the same day. Both samples sources yielded identical test results in 98.5% of the individuals with roughly 33% positive and 66% negative for MARV. Cycle threshold (Ct) values for most paired samples did not differ markedly indicating similar viral loads in both specimen sources (Figure 5). Testing on some patients did provide disparate results for blood and swab samples but test results were identical even in these instances. Similarly, for 12 individuals, both oral and nasal swabs specimens were collected which resulted in identical test results and no significant differences in Ct values for the positives. Additionally, 3 breast milk specimens from laboratory-confirmed female MHF cases were analyzed and shown to be positive for MARV (data not shown).


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)

Cycle threshold values for paired blood and swab samples.Cases where whole blood (▪) and swab (□) samples were available for testing the same day are shown. Viral loads from both sample sources were comparable and do not consistently indicate one sample source as more suitable for viral load determination.
© Copyright Policy
Related In: Results  -  Collection

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

pntd-0001183-g005: Cycle threshold values for paired blood and swab samples.Cases where whole blood (▪) and swab (□) samples were available for testing the same day are shown. Viral loads from both sample sources were comparable and do not consistently indicate one sample source as more suitable for viral load determination.
Mentions: A comparison of detection of MARV from oral swabs and EDTA blood was performed on 63 individuals from whom both specimen types were available from the same day. Both samples sources yielded identical test results in 98.5% of the individuals with roughly 33% positive and 66% negative for MARV. Cycle threshold (Ct) values for most paired samples did not differ markedly indicating similar viral loads in both specimen sources (Figure 5). Testing on some patients did provide disparate results for blood and swab samples but test results were identical even in these instances. Similarly, for 12 individuals, both oral and nasal swabs specimens were collected which resulted in identical test results and no significant differences in Ct values for the positives. Additionally, 3 breast milk specimens from laboratory-confirmed female MHF cases were analyzed and shown to be positive for MARV (data not shown).

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