Effect of Culture-Independent Diagnostic Tests on Future Emerging Infections Program Surveillance - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

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Effect of Culture-Independent Diagnostic Tests on Future Emerging Infections Program Surveillance - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 9—September 2015
THEME ISSUE
Emerging Infections Program

Emerging Infections Program

Effect of Culture-Independent Diagnostic Tests on Future Emerging Infections Program Surveillance

On This Page

• Current Status of CIDTs in the EIP Network
• Measuring Disease Burden Trends and Evaluating Public Health Interventions
• Detecting Other Emerging Pathogens
• Analyzing Microbiological and Molecular Characteristics
• Future Considerations and Directions
• Conclusions
• Suggested Citation

Tables

• Table 1
• Table 2

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• PDF [724 KB - 7 pgs]
• RIS [TXT - 2 KB]

Gayle Langley , John Besser, Martha Iwamoto, Fernanda C. Lessa, Alicia Cronquist, Tami H. Skoff, Sandra Chaves, Dave Boxrud, Robert W. Pinner, and Lee H. Harrison

Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (G. Langley, J. Besser, M. Iwamoto, F.C. Lessa, T.H. Skoff, S. Chaves, R.W. Pinner); Colorado Department of Public Health and Environment, Denver, Colorado, USA (A. Cronquist); Minnesota Department of Health, St. Paul, Minnesota, USA (D. Boxrud);Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (L.H. Harrison)

Suggested citation for this article

Abstract

The Centers for Disease Control and Prevention Emerging Infections Program (EIP) network conducts population-based surveillance for pathogens of public health importance. Central to obtaining estimates of disease burden and tracking microbiological characteristics of these infections is accurate laboratory detection of pathogens. The use of culture-independent diagnostic tests (CIDTs) in clinical settings presents both opportunities and challenges to EIP surveillance. Because CIDTs offer better sensitivity than culture and are relatively easy to perform, their use could potentially improve estimates of disease burden. However, changes in clinical testing practices, use of tests with different sensitivities and specificities, and changes to case definitions make it challenging to monitor trends. Isolates are still needed for performing strain typing, antimicrobial resistance testing, and identifying other molecular characteristics of organisms. In this article, we outline current and future EIP activities to address issues associated with adoption of CIDTs, which may apply to other public health surveillance.

The Centers for Disease Control and Prevention (CDC) Emerging Infections Program (EIP) network conducts population- and laboratory-based surveillance for foodborne, health care–associated, respiratory, and invasive bacterial pathogens of public health importance. The main objectives of surveillance are to 1) measure disease burden and monitor disease trends over time, 2) evaluate the impact of public health interventions, 3) track microbiological and molecular characteristics of pathogens, and 4) detect emerging infectious disease threats. EIP data are used for national projections of disease incidence and formulation of national public health policy for prevention and control of disease. Central to accomplishing these objectives is accurate laboratory detection of the pathogens under surveillance.

In the field of microbiology, culture remains the standard for detection of most organisms, but in clinical settings, detection of pathogens is increasingly reliant on culture-independent diagnostic tests (CIDTs). CIDTs include antigen-based tests and molecular tests. The most commonly used molecular tests are the nucleic acid amplification tests, which include PCR. In clinical settings, most CIDTs have several advantages over culture. Foremost, CIDT results can be obtained more rapidly than culture, a feature that can be critical for clinical decision-making. Additionally, CIDTs may require less technical expertise to perform. Although initial adoption of these newer technologies can be expensive, costs generally decline over time, particularly those associated with labor.

CIDTs have the potential to improve estimates of disease burden because 1) they may be more sensitive than culture, 2) their relative ease of use may increase the number of patients tested, 3) they may enable detection of organisms for which there are currently no practical laboratory tests, and 4) they may increase the ability to detect polymicrobial infections. However, incorporating CIDTs into public health surveillance presents several challenges. Interpreting trends in disease incidence can be difficult because of changes to testing practices and surveillance case definitions. Although also true for culture, detection of molecular material may not reflect the presence of a living microbe and true disease, especially when detected from nonsterile body sites. At least for now, it is generally more difficult to assess microbiological and molecular characteristics, such as pathogen subtypes and antimicrobial drug resistance and genotypes, without bacterial isolates. Addressing these and other factors that affect estimates of disease burden and the characterization of infectious pathogens is critical for public health surveillance systems and clinical decision-making. EIP sites have a long history of close collaboration between CDC, state and local public health departments, academia, and clinical laboratories, making them uniquely positioned to help chart the course in addressing these concerns. Because many infections are already being diagnosed by use of CIDTs and more CIDTs will probably be developed and used in the near future, a path for addressing these issues is urgently needed. This article provides an overview of current testing practices for pathogens under EIP surveillance and addresses how EIPs plan to advance their core objectives in the face of this dynamic diagnostic environment.

Dr. Langley is a medical epidemiologist in the Respiratory Diseases Branch at CDC and medical director of ABCs.

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Tables

• Table 1. Case definitions and status of microbiological testing, by Emerging Infections Program activity and pathogen, 2010–2014
• Table 2. Plans for measuring disease burden and analyzing microbiological and molecular characteristics in the era of culture independent diagnostics, Emerging Infections Program

Suggested citation for this article: Langley G, Besser J, Iwamoto M, Lessa FC, Cronquist A, Skoff TH, et al. Effect of culture-independent diagnostic tests on future Emerging Infections Program surveillance. Emerg Infect Dis. 2015 Sep [date cited]. http://dx.doi.org/10.3201/eid2109.150570

DOI: 10.3201/eid2109.150570