EP ID E M IC A LE R T A N D RESPO NSE Laboratory Training for Field Epidemiologists estigation strategies and methods Brought to you by
Jan 14, 2015
E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
Investigation strategies and methods
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E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
Learning objectivesLearning objectives
At the end of the presentation, participants should:
• Understand the principle of cultivating viruses
• Understand the methods and problems with cultivating viruses
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E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
Techniques to identify virusesTechniques to identify viruses
It can take a few hours to weeks to identify a virus
Techniques include:
• PCR (single round) or nested/semi-nested PCR
• Real-time PCR
• Direct electronic microscopy
• Antigen capture
• Isolation
– Long process
– Gold standard for viruses that can be cultured Brought to you by
E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
Virus cultureVirus cultureIs based upon amplification of potentially infectious pathogens
Implies intracellular replication of viruses in the cytoplasm or in the nucleus
Is controlled by regulations (i.e. bio-safety level 2, 3 or 4)
Allows for:
• Identification
• Further studies (e.g., Pathogenicity, antiviral sensitivity, research)
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E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
Virus cultureVirus culture
Long process
• Not always possible for front-line diagnosis
Primary objective for the diagnosis of an unknown disease
No generic protocol
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E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
How to go about virus culture?How to go about virus culture?Obtain suitable specimens
• Identified specimens with suitable information
Evaluate of chances of success of the process before start
Make sure transportation used cold chain
• 4°C
• -20°C
• Dry ice (-79°C)
Use suitable culture protocol
• In vitro/in vivo cell cultures Brought to you by
E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
Culture procedureCulture procedureUse of a variety of cell sources and techniques
Treatment of the specimen prior to inoculation
Follow-up
Viral detection:
• Non specific
– Cytopathogenic effect (microscope)
– Electronic microscopy identification (morphology)
• Specific
– Immunological detection: antigen detection, PCR, IFA…
Viral load estimation (titration, plaque assay)Brought to you by
E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
Limitations of cultures to identify Limitations of cultures to identify virusesviruses
Absence of detection system for the agent
Inappropriate culture systems
Viruses that cannot be cultured
A negative viral culture results does not mean that theagent is absent
• Need of other tests
• PCR can detect the viral genome in absence of the complete virus
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E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
Specimens used to culture virusesSpecimens used to culture viruses
Blood specimens
• EDTA
• Heparin
• Serum
Stool
Throat swabs
Naso-paryngeal aspirates
Stools, rectal swabs
Urine
Saliva
Cerebro-spinal fluid
Biopsy
• Skin (filoviridae)
• Organs (fixation with formaldehyde 10%)
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E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
Potentially infectious specimen formsPotentially infectious specimen forms
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E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
SequencingSequencing
Analysis of sequence of nucleic acid fragment afterPCR amplification
Comparison of the alignment of nucleotides with other sequences present in different data bases for theidentification of an agent
Confirmatory analysis
• Final DNA fingerprint is molecular signature of the micro-organism
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E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
Developed by the Department of Epidemic and Pandemic Alert and Response of the World Health Organization with assistance from:
European Program for Intervention Epidemiology Training
Canadian Field Epidemiology Program
Thailand Ministry of Health
Institut Pasteur
Investigation strategies and methods
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E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
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E P I D E M I C A L E R T A N D R E S P O N S E Laboratory Training for Field Epidemiologists
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