Journal Article

A Nationally Coordinated Laboratory System for Human Avian Influenza A (H5N1) in Thailand: Program Design, Analysis, and Evaluation

Rungrueng Kitphati, Anucha Apisarnthanarak, Malinee Chittaganpitch, Pranee Tawatsupha, Wattana Auwanit, Pilaipan Puthavathana, Prasert Auewarakul, Mongkol Uiprasertkul, Linda M. Mundy and Pathom Sawanpanyalert

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 46, issue 9, pages 1394-1400
Published in print May 2008 | ISSN: 1058-4838
Published online May 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/586752
A Nationally Coordinated Laboratory System for Human Avian Influenza A (H5N1) in Thailand: Program Design, Analysis, and Evaluation

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Background. The first phase of national surveillance for avian influenza (H5N1) human disease in Thailand occurred over a 4-month period that began on 1 December 2003. Subsequently, a nationally coordinated laboratory system (NCLS) for avian influenza (H5N1) was created to assess population-based surveillance, specimen procurement, case detection, and reporting at the national level.

Methods. We conducted a pre- and postintervention study to evaluate the NCLS designed during the 6-week interval from 1 April through 15 May 2004. During the pre-NCLS period (1 December 2003 through 31 March 2004), 12 cases of human avian influenza (H5N1) were confirmed. During the post-NCLS period (16 May 2004 through 31 December 2006), interventions were implemented for human avian influenza (H5N1) surveillance, case detection, and expedited, computer-based reporting.

Results. During the pre- and post-NCLS periods, 777 (85%) of 915 and 10,434 (95%) of 11,042 clinical respiratory specimens, respectively, were adequate for confirmatory testing (P<.001), the median time from procurement to results decreased from 17 days (range, 14–24 days) to 1.8 days (range, 0.25–4 days; P<.001), and the duration of specimen shipment decreased from 46.5 h to 21.1 h (P<.001). Thirteen cases of avian influenza (H5N1) were detected during the 31-month postintervention period. H5N1 reverse-transcriptase polymerase chain reaction and real-time reverse-transcriptase polymerase chain reaction sensitivity was 100% and specificity was 99.8%.

Conclusions. The NCLS exemplifies a systematic approach to national surveillance for avian influenza A (H5N1). This NCLS program in Thailand serves as a model for human avian influenza (H5N1) preparedness that can be adopted or modified for use in other countries.

Journal Article.  3417 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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