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Rapid Laboratory Virus Diagnosis

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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