For some agents, such as influenza, dengue, and hantaviruses, commercially available diagnostic kits that can be used in settings with minimal laboratory facilities have overcome this obstacle. Nonetheless, the user, who may not be a trained laboratorian, still needs to collect the specimen appropriately and interpret the results correctly.
One of the most important aspects of a global strategy for monitoring of emerging diseases, especially those caused by viruses, is ensuring the proper level of biosafety containment and strict adherence to biosafety procedures to allow safe handling of pathogenic organisms. The importance of biosafety precautions was demonstrated by the recurrence of SARS-CoV in Singapore, Taiwan, and China in late 2003 to early 2004 due to laboratory acquired infections.38-40 Most organisms are classified in one of four distinct biosafety levels, depending on the seriousness of the disease they produce, their transmissibility, and the availability of effective treatment or vaccines.41 Biosafety levels 3 and 4 are required for handling the most dangerous pathogens and require highly specialized facilities. The physical plant required to support a biosafety level 4 laboratory is considerable, and maintenance expenses are high. Consequently, only a few exist in the world, and all serve as major referral laboratories.
Laboratory diagnosis is not confined, however, to state-of-the-art facilities. The use of field laboratories can be a factor in the rapid containment of outbreaks of emerging infectious diseases. During the 2000-2001 outbreak of Ebola hemorrhagic fever in Uganda, laboratory testing was performed at a field laboratory established by CDC and supplemented by additional testing at CDC and other reference centers.18 The availability of the field lab was determined to be a key logistic element in containing the outbreak rapidly.42
Pathology laboratories also make critical contributions to the identification of new and emerging infectious diseases.43 Pathologists have had a frontline role in identifying the causal agents, describing the pathogenetic processes, and guiding the early phases of the epidemiologic investigations of several recently described diseases, including hantavirus pulmonary syndrome,44 new variant Creutzfeldt-Jakob disease,45 and SARS.46 Clinicopathologic studies have also been useful in delineating the pathogenesis of emerging infectious diseases such as West Nile virus encephalomyelitis.47 Immunologic and molecular methods, including immunohistochemistry (IHC), in situ hybridization, and polymerase chain reaction (PCR), have revolutionized the ability of pathologists to diagnose and study infectious diseases and are likely to ensure an increasing role of pathology as an active partner in surveillance activities.43
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