VIROLOGY SURVEILLANCE
n Enterovirus 5 UTR PCR n Enterovirus Genogroup C VP1 RTPCR n EPICR COMBINATION n Human Rhinovirus Real Time PCR n Enterovirus VP1 Genotype n RSV (respiratory syncytial virus) ribonucleic acid detection assay
n Influenza A Subtyping n Adenovirus serotype by sequencing
Table 1. UKHSA Colindale – Virology Surveillance Profile.
Upon arrival of the sample, the various profiles can then be performed. Once the results have been validated,
they are ready to be returned to the GP. Another advantage of LabLinks is that this is now possible electronically with the result message being sent back via the X-Lab Labgnostic network. The referring laboratory receives the result into the LIMS and may choose to auto validate prior to transmission to the GP via GPLinks as a PMIP message. The GP is able to receive the surveillance result in the same format as the routine activity sent to them and this can be filed within the patient record. The current Virology Surveillance
Profile performed by the UKHSA at Colindale is shown in Table 1. In addition to the Virology sampling described above, a Microbiology workflow and a
Engaging with the RSC Virology initiative equips our GP surgery with vital information about local viral activity. By keeping abreast of the latest virology data, we can tailor our patient care strategies to reduce the risk of viral transmission during consultations and procedures.
Dr Shahbaz Ali, Managing Partner at Woodstock Bower Group Practice, Rotherham
Serology workflow run in a very similar way. The Microbiology profile performed by the Liverpool Clinical Laboratories is shown in Table 2. The Serology workflow does not generate a clinical result; however, a result confirming receipt of sample is returned to close the request/result loop.
Oxford-Royal College of GPs Clinical Informatics Digital Hub One of the unique strengths and benefits of the RCGP RSC is the ability to combine the view of the surveillance sampling results alongside the GP record of the patient tested. This is achieved in the following way: A weekly routine is run on participating
GP’s practice systems that extracts patient record data. The following data fields are extracted: n Pseudonymised NHS number. n Pseudonymised date of birth. n Demographic data: age, sex, ethnicity. n Location data: lower super output area (regional areas with a typical resident population of 1,000 – 3,000 people). n Clinical data that are coded data within
n EPEC PCR n Campylobacter PCR n Vibrio PCR n Salmonella PCR n Norovirus NAAT n EaggEC PCR n Aeromonas PCR n Rotavirus PCR n Shigella PCR n Norovirus PCR n Clostridium perfringens PCR n Cyclospora PCR n Clostridioides difficile toxin EIA
n Coronavirus PCR (seasonal coronaviruses) n FLNT RCGP COM n Adenovirus n Enterovirus Genogroup A VP1 RTPCR n Enterovirus Genogroup B VP1 RTPCR n Influenza Typing n Human metapneumovirus n Sarbecovirus PCR
the record (eg BP 120/80, shortness of breath by a severity code; fractures of a limb by left or right).
n Coded medication. n Staff information: workforce/workload data such as staff role, hashed GMC (General Medical Council registration).
A range of security measures are used to ensure patient confidentiality. The data are pseudonymised before being transferred to the Oxford-Royal College of GPs Clinical Informatics Digital Hub (ORCHID) secure and central data hub hosted by The University of Oxford. This ensures the data used for surveillance and research can never be used to identify a patient. Principles of UK GDPR are applied to ensure data are stored securely, only the data that is required is stored (data minimisation), and data access is restricted to approved researchers conducting ethically approved research. In a similar way, the results generated by the performing laboratory are also pseudonymised and fed into the ORCHID data hub (see Fig 4).
The data within the hub are then able to be analysed and interrogated allowing a range of reports to be produced. This includes the UKHSA Disease Surveillance report which is how the positive H1N2 result that we started this article with was discovered. It is also used to produce a weekly Communicable and Respiratory Disease Report which reports on 37 monitored conditions.
The pseudonymised data may also be linked with other NHS data for analysis, including hospital episode statistics. The success of the RCGP RSC is attributable to the following: n A long history of working with the GP community fully supported by the RCGP.
n Astrovirus PCR n Giardia PCR n EaggEC PCR n Micro Reflex Report n Yersinia PCR n ETEC PCR n Adenovirus PCR n Norovirus RNA (ribonucleic acid) detection assay
n Cryptosporidium PCR n Escherichia coli STEC PCR n Entamoeba histolytica PCR n Sarbecovirus PCR
Table 2. Liverpool Clinical Laboratories - Microbiology Surveillance Profile.
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