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No. 3, 2009

MYCOBACTERIOLOGY LABORATORY BRANCH UPDATE

Collaboration within the Village

Laboratory activities had a strong presence at this year’s National TB Conference held in Atlanta, GA, June 15–18, 2009. The conference theme was “TB Elimination—It Takes a Village,” and the role of the laboratory in achieving TB elimination was described in many sessions and presentations.

On June 15, the 2009 TB Laboratory Meeting was held, and featured presentations by Dr. Beverly Metchock, Dr. Lauren Cowan, and Ms. Kimberly McCarthy, all from DTBE, and also Dr. David Warshauer from the Wisconsin State Laboratory of Hygiene. Ms. Kelly Wroblewski, from the Association of Public Health Laboratories (APHL) and Dr. Angela Starks, DTBE, moderated. Representatives from approximately 50 state and other public health TB laboratories attended the meeting. The session was very interactive and included electronic polling and online demonstrations.

Dr. Warshauer introduced the newly revised APHL/CDC project: “Mycobacterium tuberculosis: Assessing Your Laboratory,” an online tool designed to assist laboratories in assessing the quality of their laboratory’s TB diagnostic practices.  This year APHL, in conjunction with CDC and clinical and commercial laboratorians, has updated the content of the original 1995 tool to reflect the profound changes to TB diagnostics in the ensuing years. The final version is now available on the APHL website.

Ms. McCarthy presented on the importance of performance indicators for smear, culture, and drug susceptibility testing in mycobacteriology laboratories. Drawing on her vast experience in the global field of TB laboratories, Kimberly explained the importance of laboratory indicators, defined approaches to evaluating lab performance, and outlined eight candidate indicators that could be used by TB labs to assess their overall performance.

Dr. Cowan provided an overview of assays used for universal genotyping in the United States. Session participants were given the opportunity to analyze sample spoligotyping and MIRU-VNTR typing data to generate a report.  In addition, Lauren described how genotyping can assist public health laboratories in suspected false-positive culture investigations. Universal genotyping permits TB programs to establish simple algorithms to flag suspected errors and identify possible false-positives, and therefore, help to reduce improper treatment of noninfected persons.

Dr. Metchock’s presentation, “On the Hot Seat: Cases from the Reference Laboratory,” described actual case scenarios from various state public health labs that elucidated the need for better communication between labs, TB programs and physicians, and for labs to recognize the need for timely follow-up and investigation of lab results that are outside of normal ranges.

The take-home message of this year’s lab meeting was that it is imperative for the laboratory community to provide health care providers and TB controllers with accurate results within acceptable turn-around times, while providing a safe work environment for laboratorians. Currently, plans are being made by APHL to continue the collaboration between the laboratory and the TB program by convening a colocated laboratory meeting in 2010.

—Submitted by Tracy Dalton, PhD, and Frances Tyrrell, MPH, MT (ASCP)
Div of TB Elimination

 

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