Shinnick Thomas M, Iademarco Michael F, Ridderhof John C
Division of TB Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), USA.
MMWR Recomm Rep. 2005 Apr 15;54(RR-6):1-12.
Since the mid-1990s, public health laboratories have improved tuberculosis (TB) test performance, which has contributed to the resumption of the decline in TB incidence in the United States. However, to eliminate TB in the United States, further improvements are needed in laboratory services to support TB treatment, prevention, and control. A critical step is the development of an integrated system that ensures prompt and reliable laboratory testing and flow of information among laboratorians, clinicians, and TB-control officials. Challenges to developing such a system include 1) establishing lines of communication among laboratorians, clinicians, and TB-control officials; 2) expediting reporting of laboratory results, which can avoid delayed or inappropriate treatment and missed opportunities to prevent transmission; 3) developing evidence-based recommendations for use of new laboratory technologies; 4) maintaining staff proficiency in light of declining numbers of specimens to test, workforce shortages, and loss of laboratory expertise; and 5) upgrading laboratory information systems and connecting all partners. The report of the Association of Public Health Laboratories Task Force presents a framework to improve the future of TB laboratory services and describes the role of the laboratory in TB treatment and control, Task Force processes, general principles and benchmarks, and steps for the dissemination of the Task Force recommendations. This MMWR expands on the Task Force report by describing specific actions and performance measures to guide development and implementation of an integrated system for providing TB laboratory services. CDC and the Association of Public Health Laboratories have developed these guidelines so that laboratorians, clinicians, public health officials, administrators, and funding entities can work together to ensure that health-care providers and TB-control officials have the information needed to treat TB patients, prevent TB transmission, and ultimately eliminate TB in the United States.
自20世纪90年代中期以来，公共卫生实验室已提高了结核病检测性能，这有助于美国结核病发病率再度下降。然而，为在美国消除结核病，实验室服务仍需进一步改进，以支持结核病治疗、预防和控制。关键一步是建立一个综合系统，确保实验室检测迅速可靠，并保证实验室工作人员、临床医生和结核病防控官员之间的信息流通。建立这样一个系统面临的挑战包括：1）在实验室工作人员、临床医生和结核病防控官员之间建立沟通渠道；2）加快实验室结果报告，以避免治疗延误或不当以及预防传播的机会错失；3）制定基于证据的新实验室技术使用建议；4）鉴于待检测标本数量减少、劳动力短缺和实验室专业知识流失，保持工作人员的专业水平；5）升级实验室信息系统并连接所有合作伙伴。公共卫生实验室协会特别工作组的报告提出了一个改善结核病实验室服务未来的框架，并描述了实验室在结核病治疗和控制中的作用、特别工作组的工作流程、一般原则和基准以及传播特别工作组建议的步骤。本《发病率与死亡率周报》通过描述具体行动和绩效指标，对特别工作组的报告进行了扩充，以指导提供结核病实验室服务的综合系统的开发和实施。美国疾病控制与预防中心和公共卫生实验室协会制定了这些指南，以便实验室工作人员、临床医生、公共卫生官员、管理人员和资助实体能够共同努力，确保医疗服务提供者和结核病防控官员获得治疗结核病患者、预防结核病传播以及最终在美国消除结核病所需的信息。
