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A Nsw Public Health Laboratory Network A NSW PUBLIC HEALTH LABORATORY NETWORK John Rooney formerly Specialist Medical Adviser AIDS/Infectious Diseases Branch, NSW Health Department ROLES OF DESIGNATED PUBLIC hIEALTH LABORATORIES •Capacity to respond to Statewide public health his article outlines a proposal to establish a Public requirements, including outbreak investigations, in THealth Laboratory Network (PHLN) in NSW, designed conjunction with the N5W Health Department. to meet requirements for high quality public health • Policy development (e.g. as a result of changing laboratory services and laboratory expertise by building on patterns of antibiotic resistance). existing services and facilities. The proposed PHLN, with • Education (e.g. the development and updating of the State's network of Public Health Units and the NSW testing algorithms for general practitioners and public Health Department's AIDS/Infectious Diseases and health practitioners). Environmental Health, Food and Nutrition Branches, will • Providing a Statewide and/or national reference provide an integrated public health service for the laboratory function. surveillance and control of infectious diseases, and the • Coordinating the NSW contribution to State, national capacity to monitor the safety of food arid water and the risk and international laboratory networks to facilitate the of harm from exposure to toxic substances in the collation and analysis of epidemiological data. environment. • Analysis and reporting of Statewide data in conjunction with the NSW Health Department. The PHLN will comprise a network of public health • Providing advice on changes in technology and laboratories formally designated to provide specified opportunities for improved efficiency in the services. Individual laboratories will represent foci of laboratory contribution to public health Statewide expertise in specific public health areas, while in investigations. combination the network will give NSW a comprehensive • Training and advice (e.g. in the identification of public health laboratory service. malarial parasites, vectors for arboviral infection). • Quality assurance (coordinating Statewide response to THE CURRENT SITUATION State. national and international programs). Public health laboratory services in NSW are provided • In conjunction with other laboratories and the through a variety of arrangements. Department the development of benchmarks and best practice for public health laboratory surveillance and . Many public and private clinical laboratories in investigation. NSW are involved in public health surveillance • Developing case definitions and standardised reporting through the requirement to notify certain infectious formats for notifiable conditions. diseases under the Public Health Act 1991. Most of • Ensuring the availability of techniques for low volume these notifications arise from clinical diagnostic requests in a way which avoids duplication by offering testing for individual patient management. the service on site or making sure any request can be Some laboratories also contribute to public health appropriately referred. through the analysis of food, water and • Receipt of isolates and 5amples for confirmatory environmental samples as well as human samples, testing, typing, or archiving (either as a voluntary role or as a required public health responsibility). both for research and in the investigation of disease • Providing a consultancy service to Public Health Units outbreaks. and the NSW Health Department An informal ad hoc network of specialist • Initiating public health research in conjunction with the laboratories, managed by a number of different Area Department, Public Health Units and other agencies. Health Services, provides expertise in specific public • Conducting and/or coordinating seroprevalence and health fields. other surveys in response to Statewide public health Specialist university, research and private priorities determined by the Department. laboratories also provide expertise in specific public • Providing specialist input into the Public Health health fields. Laboratory Advisory Committee. Although these arrangements have worked satisfactorily to date, the requirements of a modern, responsive and efficient public health service dictate a more formal and THE CONCEPT OF DESIGNATED LABORATORIES explicit structure. The intent of the PHLN is to identify designated Recent developments in the NSW Health system favour laboratories for the Department, public health such a structure. Responsibility for the Division of practitioners and external agencies. Designated Analytical Laboratories has been devolved from the NSW laboratories may provide generic or specialist services. Health Department to the Western Sydney Area Health Through the PHLN there will be a known point of contact Service, and the microbiology and virology laboratories of for the laboratory services needed to support any Statewide the Institute of Clinical Pathology and Medical Research public health contingency, including routine and planned at Westmead Hospital have been integrated. Thus several public health action, the investigation of outbreaks, and the significant Statewide public health functions have come response to emergencies and disasters which pose a threat together within the Western Sydney Area. The creation to public health. The PHLN does not seek to provide a neat of the South Eastern Area Laboratory Service and the bureaucratic framework, but rather a mechanism for rationalisation of pathology services within other Areas facilitating communication between laboratories, clinicians, are also likely to lead to new opportunities for public health practitioners and managers. laboratories to acquire or expand Statewide roles in certain fields of expertise. Vol.8JNo.4 25 Public Health Laboratory Network Continued from page 25 DE5GNATED PUBLIC HEALTH LABORATORY (TO DECEMBER 1997) Condition/s Designated laboratory (abbreviations are given The concept of designation implies neither pre-eminence nor below) an exclusive role in testing. In some instances (e.g. testing for malaria), laboratories will have exclusive roles. In other Arboviral diseases ICPMR DALJICPMR instances a laboratory is selected to have a coordinating role Chemicals in the environ ment Enteric diseases3 ICPMR/DAL and to provide advocacy and support for other laboratories Food safety' DALJICPMR which will continue to provide confirmatory and/or reference Hepatitis Not determined functions and contributions to research. Influenza SEALS Table 1 lists generic fi.mctions for designated laboratories. HIV/AIDS St Vincent's/SEALS Some designated laboratories will take on all these Legionella ICPMPJDAL functions, while others will fulfil only some generic Medical entomology (other functions. The functions to be undertaken by each than arboviral diseases) ICPMR designated laboratory will be negotiated between the NSW Malaria (and parasitic diseases other than giardiasis Health Department and the Area Health Service managing and cryptosporidium) ICPMR the laboratory, and will clearly be influenced by available Neisseria' SEALS/SWAPS expertise and resources. Quarantinabte and other rare, Three approaches maybe taken to the designation of exotic, or imported conditions ICPMR laboratories for specialist public health functions. Vaccine preventable diseases7 SEALS/ICPMR STDs ICPMR First, laboratories maybe designated for a single Tuberculosis and other disease or organism. This approach is likely to be mycobacteria ICPMR used for uncommon but important conditions. Water quality DALJICPMR Examples are: Zoonotic diseases' ICPMR - malaria, where the laboratory has a specific DAL = Division of Analytical Laboratories; ICPMR = Institute public health role; of Clinical Pathology & Medical Research, Westmead - Legiondlla infection, where responsibility must Hospital; St Vincent's = St Vincent's Hospital, Darlinghurst; be clear-cut in the event of an outbreak; and SEALS = South East Area Laboratory 5ervice; SWAPS = SoutF tuberculosis, which has specific public health West Area Pathology Service. implications, with the laboratory role in monitoring antibiotic resistance being of crucial 1. Including Dengue, Ross River Fever, BarmeJ Forest Disease, Murray importance. Valley Encephalitis, other Alpha, Bunya and Flaviviruses, Exotic and Second, laboratories may be designated for a group VHF viruses, of diseases or organisms. This may be more 2. Including pesticides, trace metals. 3. Including viral (rotavirus), bacterial (Campylobacter, salmonella, helpful for public health practice than designation shigella, yersinia, cholera, e colt...) Parasitai (cryptosporidium). for a single disease or organism. Vaccine- 4. Including listeriosis, botulism. preventable diseases (diphtheria, Huemophilus 5. Including gonorrhoea, meriingococcai disease. 6. Including cholera, plague, rabies, typhus, viral haemorrhagic fevers, influenzae, measles, mumps, pertussis, yellow fever, equine morhilhiform virus. Pneurnococcus, rubella and varicella) have been 7. Including diphtheria, haemophiius influenzae, measles, mumps, pneumococcus, poliomyelitis rubella, varicella. grouped because designated laboratories may have 8. Including chancroid, clilainydia trachomatis, donovanosis, herpes, particular roles, e.g. in coordinating prevalence syphilis. surveys to monitor the effectiveness of 9. Including brucellosis, hydatid disease, leptospirosis, Q fever. immunisation programs. Designating a laboratory for a specific public interested parties could be consulted in the development
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