A World Health Organization (WHO)/National Bacteriological
Laboratory meeting was held in Stockholm, Sweden, from June 16 to
June
18, 1982, to review rapid laboratory virus diagnosis, with special
emphasis on coordination of production, quality control, and supply
of
reagents. A summary of the meeting follows.*
Recent advances in rapid diagnostic techniques: Existing rapid
diagnostic techniques and recent relevant advances pertaining to a
number of viral infections were reviewed. The major advances in
viral
respiratory-disease diagnosis include the successful extension of
immunofluorescence techniques to more laboratories, use of
large-scale
production of antibodies in eggs, and development of sensitive
solid-phase immunoassays for detection of virus antigens in
nasopharyngeal secretions. For diarrheal diseases, immunoassays
for
both rotaviruses and adenoviruses have been further refined and
standardized, and monoclonal antibodies have been used in ELISA
tests
for rotavirus. In the hepatitis area, advances include growth of
hepatitis A virus in tissue-culture systems, use of antigens for
IgM
immunoassays, the recent production of hepatitis B core antigen
from
bacteria through genetic engineering, and development of
immunoassays
for both antigen and antibody associated with the "delta" antigen.
The diagnosis of dengue has been facilitated by development of
monoclonal antibodies to all four dengue types. Detection of IgM
antibodies during the acute phase of both dengue and Japanese
encephalitis is of value in rapid diagnosis. Development of
microscopic slides containing stable, inactivated, formalin-fixed
antigens for Lassa and Ebola viruses has facilitated the detection
of
antibodies by immunofluorescence.
*A full report of the meeting may be obtained from the Virus
Diseases
Unit, Division of Communicable Diseases, World Health Organization,
CH-1211, Geneva 27, Switzerland.
Reagents for quality control and distribution: Preparation of
reagents can be commercial or WHO-sponsored, but working reagents
supplied by WHO should consist of large lots suitable for quality
control and wide distribution. Quality control must be carried out
by
at least two reference laboratories separate from the producer and
must include not only serologic reagents but also the solid-phase
supports and any other materials used in each assay system.
Advances
in biotechnology might change the availability and quality of
reagents
and the feasibility of production in the near future, but this
eventuality should not delay the implementation of current plans.
General recommendations: The Group recommended that a
coordinated
program be developed to ensure the availability of reagents within
the
network of WHO Collaborating Centres and National Laboratories for
the
diagnosis of the following diseases: viral hepatitis; respiratory
viral diseases, including measles; viral gastroenteritis;
arthropod-
and rodent-borne viral diseases; rubella; and herpes-virus-group
diseases.
To implement a program in each of these areas, it was agreed
that
coordinators within the WHO Collaborating Centers, together with
their
associates, be appointed and assume responsibility for 1)
identifying
specific tests recommended for rapid diagnosis, taking into account
considerations of cost, simplicity, and accuracy; 2) defining
reagents
and test material required and identifying specific suppliers of
reagents; 3) defining minimum standards of quality and performance
of
reagents and other material; 4) developing a strategy for
distributing
reagents within the network of WHO Collaborating Centres for
Reference
and Research and cooperating national laboratories; 5) assisting
WHO
in developing and implementing training courses and selecting
suitable
candidates for training; 6) evaluating rapid virus diagnostic tests
performed in field situations; and 7) soliciting and reviewing
information on new tests and new reagents, including monoclonal
antibodies that might have application in rapid virus diagnosis.
Reported by WHO Weekly Epidemiological Record 1982;57:257,261.
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