update the participants on the progress of LabNet development;

assess the current situation of laboratory testing and specimen shipment with regards to Pacific Public Health Surveillance Network (PPHSN) target diseases, including SARS, and plan further developments;

review and discuss the linkages and support available through reference laboratories of the Australian and New Zealand Public Health Laboratory Network;

discuss and clarify laboratory techniques available for the PPHSN target diseases;

become familiar with the use of rapid tests (leptospirosis, dengue and influenza) and DVBS (measles);

assess training needs of laboratory health professionals;

update the participants about lab-specific bioterrorism issues and discuss practical lab-related aspects;

discuss and agree on possible lab-based surveillance activities.

Assessment of current capacity of the network — plenary presentations of L2 laboratories (New Caledonia Pasteur Institute, Mataika House in Fiji, Guam Public Health Laboratory and French Polynesia Malardι Institute);

Lab-specific bioterrorism issues —  plenary presentations on the global anthrax laboratory network and laboratory preparedness for bioterrorism and outbreak-prone diseases in the Northern Pacific;

Lab-specific training needs —  one plenary presentation of the Pacific Paramedical Training Centre (PPTC) including the Regional External Quality Assurance Programme.

the shipment of specimens to other laboratories for confirmation testing

the number of specimens needed to be tested to confirm an outbreak

the linkages between L1 and L2 laboratories to be strengthened

the development of a website for laboratory personnel

the production of guidelines for quick response

the training of laboratory personnel

personal safety procedures, with proper handling of specimens and use of safety equipments to be emphasised

PPHSN target diseases should be incorporated into QA programme (for those not yet included);

regular meetings on aspects of QA should be organised with clinicians;

information should be exchanged and shared more readily;

laboratory auditing should be organised among PICTs;

an inventory of QA/QC programmes, policies, and protocols of all PICTs laboratories should be completed;

PPHSN should request PPTC to provide QA/QC for all PICTs laboratories and provide standardisation; §

teaching institutions should have standard teaching materials; and

PPHSN should request the National Reference Laboratory in Melbourne, Australia, to support PICTs laboratories in very specific areas (e.g. serology).

PPHSN allied membership and a review of status of memorandum of understanding (particularly with PPTC-WHO) should be organised under the PPHSN framework by the end of 2003.

QC should be extended to the shipment of dengue and leptospirosis, measles and influenza samples, depending on PICT priorities (typhoid and cholera are already included).

Auditing conducted by PPTC should be continued and the recommendations should be passed on to the PPHSN QA technical group for further action (regional and political). Internal QC promotion and supervision should also be included in the process.

The output of the WPRO laboratory meeting at the end of October 2003 should be taken into account.

Standard operating procedures (SOPs) should be shared. Examples of laboratory handbooks for clinicians from Tonga, Fiji Islands and Samoa should be posted on the PPHSN website and PacNet by the end of 2003.

PPHSN guidelines should include SOPs, and should be used as references, as soon as finalised (beginning 2004).

PPTC should design training according to QC results as of 2004. This should be implemented as from 2005, with support from PPHSN other allied bodies/partners (Fiji School of Medicine, Palau Area Health Education Center) and using PPHSN guidelines as reference. PPTC should continue with the management and QA training programme. PICTs (e.g. ministries of health) should be used as alternative training sites.

Lab-based surveillance activities

Regional support (including presentations on the Australian Public Health Laboratory Network, public health laboratory services in New Zealand (Environmental Science and Research Ltd), the Victorian Infectious Diseases Reference Laboratory, the influenza laboratory network and practical aspects of specimen shipment)

LabNet development planning

Training — organise training/certification on IATA packaging/shipping, training of trainers in the same area, and technical training of staff.

Technical support — develop guidelines for diagnosis confirmation (including specimen needed and test available).

Supplies/stockpiles — arrange one stockpile per country/hospital. Delays in shipment of supplies should be minimized, with key person being responsible for shipping.

Testing guidelines — L2 laboratories could provide support for the six PPHSN target diseases plus others (STIs, HIV, TB). The latest laboratory manuals and protocols for target diseases should be available.

Communication — PPHSN should try to make sure that each laboratory has Internet access, to facilitate the sharing of information and communication of laboratory results. An electronic list server of L2 and L3 contact persons should be available.

Overseas testing — laboratories should acknowledge receipt of the specimens and try to quickly return the results. This would avoid anxiety for the sender and accelerate the notification to the physician and the initiation of patient management.

Other issues — L2 laboratories should be able to provide test kits (e.g. rapid test for lepto, etc.) in case they are needed by an L1 laboratory.
                   — Current capacities of the laboratories should be assessed.
                   — An MOU between L1, L2 and L3 laboratories should be prepared.

Last updated on February 19, 2004