CDC-ASM Joint Workshop for Lab Support of Enteric Diseases Outbreak Surveillance and Response, Kenya  

The proper collection, transport, laboratory processing, identification, and reporting of test results for specimens during outbreaks of diarrheal and other syndromes is a critical component in the management of such occurrences. Since 2008, there has been an ongoing outbreak of cholera in Kenya. Accurate and timely laboratory identification of the etiological agents of outbreaks has been challenging for Kenya's District and Provincial hospitals. Support from the Global Disease Detection (GDD) Laboratory within the Centers for Disease Control and Prevention (CDC)-Kenya was requested by the Ministry of Public Health and Sanitation (MoPHS) at the District and Provincial hospital levels to help with the isolation and antibiotic susceptibility testing of the etiological agents from the outbreak samples. A course in the rapid and classical methods of identification of etiological agents was needed for Surveillance Officers, i.e., Public Health Officers, Clinical Officers, and laboratory technologists working in outbreak-prone districts.  

A workshop was designed for building the capacity of District-based health personnel, including microbiology bench technologists, to provide support in enteric disease outbreak surveillance and response. This effort, driven by Joseph O. Oundo, CDC-GDD, was a collaborative endeavor between CDC-GDD Kenya, Field Laboratory Epidemiology Training Program (FELTP)-MoPHS Kenya, CDC-National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED)-Atlanta, CDC-Global AIDS Program, and ASM LabCap to strengthen microbiology services at district and provincial levels.  

From 19-23 October 2009, 39 participants convened in Nairobi for the fiveday course, which covered the basic principles of epidemiology and outbreak detection; determination of proper samples to collect in an outbreak; collection, packaging, and transport of biological samples from an outbreak; and rapid testing for detection of Vibrio cholerae, Shigella dysenteriae Type 1, Salmonella typhi, and Shiga toxin-producing Escherichia coli from biological samples.  

ASM facilitators discussed techniques for processing samples and methods for culture, identification, and susceptibility testing of the four enteric pathogens. Overviews of Gram staining, laboratory diagnosis of common opportunistic and other outbreak pathogens, quality control, and media preparation were also included.  

The methods detailed in the presentations were demonstrated with real cultures and organisms. During the laboratory practical, technologists working in groups performed the rapid tests and were given unknown samples containing known enteric pathogens for identification and susceptibility testing.  

The course illustrated the critical link between epidemiology, outbreak investigation, rapid and traditional detection by the laboratory. As a result, Clinical Officers, Surveillance Officers, and laboratory technologists better understand that the accuracy and importance of public health action depends on the data from the laboratory and that laboratory personnel must be active players in the public health system.  

Development of this publication was supported by Cooperative Agreement Number U2GPS001947-01 from the Department of Health and Human Services/Centers for Disease Control and Prevention (CDC), National Center for HIV, STD, and TB Prevention (NCHSTP), Global AIDS Program (GAP). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.  

Strengthening Acid-Fast Bacilli Smear Microscopy External Quality Assessment Programs-Tanzania  

The National Health Laboratory Quality Assurance and Training Centre (NHLQATC) in Dar as Salaam, Tanzania, was the venue for a workshop entitled "Strengthening Acid-fast Bacilli (AFB) Smear Microscopy External Quality Assessment (EQA) Programs" from 7-11 December 2009. The course was sponsored by the United States President's Emergency Fund for AIDS Relief (PEPFAR). The intermediate to advanced level workshop was a follow-up for countries which participated in a Training of Trainers AFB smear microscopy course two years ago in Kampala, Uganda. Of the 14 countries represented in the workshop, participants were primarily from sub-Saharan Africa, but EQA teams from Vietnam and the Caribbean Region also attended.  

The objectives of the workshop included implementation strategies for AFB smear microscopy EQA management at national, regional, and rural health center levels; strengthening panel test preparation skills, validation and administration strategies; strategies for integrating and assessing AFB smear microscopy, rapid HIV testing, and other disciplines in national quality assurance programs within different country levels of service; and post workshop program review strategies for in-country follow- up implementation support.  

The training focused on cost-effective and human resource-efficient information customized for national programs based on tuberculosis (TB) prevalence, country population, and availability of resources. Participants included Quality Officers with TB-related duties, National Reference Laboratory or EQA unit technologists, Centers for Disease Control and Prevention (CDC) laboratory advisors or technologists supporting EQA activities, laboratory consultants, and mentors supporting various countries.  

The External Quality Assessment for AFB Smear Microscopy Guidelines published by the World Health Organization, International Union Against TB and Lung Disease, CDC, KNCV, Research Institute of Tuberculosis, Association of Public Health Laboratories, and the recently adapted training curriculum developed by USAID, TBCAP, and the Global Laboratory Initiative was the source of the workshop material.  

Bereneice Madison, CDC Global AIDS Program-International Laboratory Branch (Atlanta), was the course director and was supported by CDC laboratory scientists Kimberly McCarthy and Mary Garcia; World Health Organization AFRO Region TB Focal Person Anthonia Abosi; TB CAP-Zambia-Ellah Banda Nyambe; American Society for Microbiology Senior Program Specialist Lynee Galley; and technical consultants, Shirematee Baboolal, Mary Beth Baker, Charlotte Probst, Gabriela Torrea, and Kay Withnall.  

Country teams with implemented EQA programs AFB smear microscopy programs shared experiences, challenges encountered, best practices, and lessons learned. Strategies for integrating other laboratory disciplines and AFB smear microscopy quality assurance programs were reviewed. At the close of the course, each country team identified an additional EQA component (on-site supervision, panel testing, or blinded rechecking) to implement or strengthen in the coming year. ASM Consultants will provide technical assistance follow-up through ASM's LabCap Program with CDC-GAP International Laboratory Branch.  

Development of this publication was supported by Cooperative Agreement Number U2GPS001947-01 from the Department of Health and Human Services/Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Global AIDS Program. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of CDC.