MICROBIOLOGY
and can be set up in a space of around 15–20 m2
, it is focused on being able
to provide blood culture, urine and CSF results without relying on experienced microbiology personnel. It includes all necessary equipment to implement basic microbiology testing and incorporates a mini-LIMS system as well as training resources in an easy to follow, accessible format. As it is a modular system it can be easily transported and installed. Rather than being merely a conceptual solution, the Mini-Lab system is already in use at more than 13 sites worldwide. It has undergone field evaluation studies in both Haiti and the Central African Republic assessing not only the reproducibility and accuracy of its results but also, crucially, its usability and sustainability. However, Dr Natale also highlighted that the Mini-Lab does not represent or replace a full diagnostic service, and it is essential to integrate with local infection control and antibiotic governance policies. Nonetheless, systems such as the Mini-Lab with the capacity to increase the accessibility of basic microbiology and susceptibility testing could have a significant role in increasing access to healthcare diagnostics and improve global antimicrobial surveillance.
Developing a tool for global outbreak response Highlighting a different approach to testing in resource-limited countries, Dr Daniel Carter, UKHSA, Porton Down, gave a fascinating talk on the UK Public Health Rapid Support Team (UK-PHRST) Rapid Response Mobile Laboratory (RRML) as a critical tool for global outbreak response. Established in response to the 2013–2016 West African Ebola outbreak, the UK-PHRST is a multidisciplinary unit comprising epidemiologists, virologists, social scientists, and logistics experts. It operates as a collaboration between the UK Health Security Agency and the London School of Hygiene & Tropical Medicine, and has three key areas of focus: outbreak response, research, and global public health capacity strengthening.
The RRML is a deployable laboratory designed to support outbreak investigations, especially in low-resource or remote settings. It is capable of processing up to 50 samples daily and includes modules for biosafety, PCR diagnostics, and sequencing. The biosafety module ensures safe sample inactivation within the glove-box while the PCR module facilitates detection using validated in-house and commercial
assays. These modules are transported with the team on passenger aircraft, which can bring some limitations in terms of weight and size of equipment. Dr Carter discussed how genomic methods can be utilised at the outbreak centre to identify the causative agent using both targeted (eg syndromic panels like BioFire for respiratory and gastrointestinal pathogens) and untargeted methods (eg metagenomic sequencing using Oxford Nanopore’s GridION platform). These capabilities were demonstrated during the 2018 chikungunya outbreak in Kassala, Sudan, where sequencing confirmed the strain and co-infections, and Dr Carter discussed a current feasibility study in Kenya on deploying portable sequencing to enhance outbreak response as part of a research project Future priorities include upgrading RRML technology, enhancing workflows (eg automation), developing serology capabilities, and achieving international accreditation. Recruitment and training of reservists are ongoing to ensure rapid deployment capacity, and Dr Carter encouraged anyone who was interested to apply in the next round of applications.
Wastewater analysis for epidemiological surveillance After a break for lunch allowing delegates opportunity to re-fuel and acquaint themselves with the comprehensive trade show, the afternoon session resumed with an interesting talk on wastewater analysis. Dr Alexander Shaw, a research fellow at Imperial College, London, has an ongoing interest in using wastewater analysis as a tool for epidemiological surveillance for infectious diseases.
Chikungunya virus particles. The capabilities of genomic methods were demonstrated during the 2018 chikungunya outbreak in Kassala, Sudan, where sequencing confirmed the strain and co-infections (transmission electron micrograph [TEM]).
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Dr Shaw identified the types of scenarios in which wastewater testing may be a useful tool and discussed both the advantages and limitation of this approach. Initially using polio as an example, he was able to highlight several examples where wastewater surveillance can be used to confirm polio-free status but is also able to detect potential re-introductions of virus. This has led to public health interventions such as pre-emptive vaccination programmes and health education campaigns being put in place prior to the recognition of symptomatic cases, and in some examples preventing the re-emergence of clinical disease. With a good understanding of wastewater networks, it is possible to apply these principles on a more local level, either by population centre or even individual buildings, though as Dr Shaw pointed out the more targeted the approach the closer we come to
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Cynthia Goldsmith/CDC Public domain Wikimedia Commons
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