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Lab technology plays important role in control of vaccine-preventable diseases
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Improvements in technologies and tools have created greater opportunity for physicians to use the lab in the diagnosis and control of vaccine-preventable diseases, according to a speaker.
“Some of the lab tools are increasingly powerful, and the opportunities and the ways in which the lab can help immunization efforts will increase over time as well,” said Larry Anderson, MD, director of the division of viral diseases for the CDC. “What I want to do is talk about diagnosis and characterization, immunity and vaccine safety with examples of how the lab helps identify problems, issues and also provides a solution or helps solve the problem.”
Anderson cited several recent examples of diseases that presented significant challenges that might have wreaked more havoc had certain lab tools been unavailable — including outbreaks of respiratory disease that were misdiagnosed as pertussis.
Substantial cost and efforts were associated with one of the outbreaks, Anderson noted, with nearly 1,000 people being sent home from work until diagnostic testing was negative for pertussis. He also said many people needlessly received the postexposure vaccine as a result of the misdiagnosis.
“Why was the diagnosis missed? Classic features of pertussis come later in the course of illness, and case definition requires two weeks,” Anderson said. “Later in the disease, diagnostic tools are less sensitive, and problems with tests’ specificity create more difficulties.”
Anderson also said test results during the outbreak were misinterpreted, with researchers deeming intermediate levels as positive when they should have been considered indeterminate. The use of effective polymerase chain reaction assays, however, aided in correctly diagnosing the disease.
“Pneumococcal disease is another nice example of the importance of characterization agents,” Anderson said. “The marked decrease in cases in 1999 show that most cases associated with the vaccine are effectively prevented, although there are residual cases, and some of those serotypes actually increased over time, and lab information showed which [serotypes] needed to be included in PCV13.”
Anderson said there is an escalated prevalence of disease caused by serotype 19A. The advent of PCV13, however, should cause a substantial decrease in disease associated with these serotypes.
Anderson said lab technologies play a critical role in garnering information and studying the efficacy and safety of other vaccines, including Rotarix and the potential waning effectiveness of the mumps vaccine. He said, however, that the data also confirmed these vaccines remain successful in preventing and containing outbreaks of vaccine-preventable diseases, and future lab technology will help further their development as diseases change.
“The opportunities to use the lab are increasing because of these really powerful tools,” Anderson said. “The lab is an integral, or should be an integral, part of vaccination programs.
Anderson L. The importance of the laboratory in vaccine preventable diseases. #23038. Presented at: 44th National Immunization Conference; April 19-22, 2010; Atlanta.