Curran Martin D, Ellis Joanna S, Wreghitt Tim G, Zambon Maria C
Health Protection Agency, East of England, Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QW, UK.
Respiratory Virus Unit, Health Protection Agency, Colindale, London NW9 5HT, UK.
J Med Microbiol. 2007 Oct;56(Pt 10):1263-1267. doi: 10.1099/jmm.0.47336-0.
Avian (H5N1) influenza continues to pose a significant threat to human health, although it remains a zoonotic infection. Sensitive and robust surveillance measures are required to detect any evidence that the virus has acquired the ability to transmit between humans and emerge as the next pandemic strain. An integral part of the pandemic planning response in the UK was the creation in 2005 of the UK National H5 Laboratory Network, capable of rapidly and accurately identifying potential human H5N1 infections in all regions of the UK, and the Republic of Ireland. This review details the challenges that designing molecular detection methods for a rapidly evolving virus present, and the strategic decisions and choices required to ensure successful establishment of a functional national laboratory network, providing round the clock testing for H5N1. Laboratory partnerships have delivered improved real-time one-step multiplex PCR methodologies to ensure streamlined testing capable of not only detecting H5 but also a differential diagnosis of seasonal influenza A/B. A range of fully validated real-time PCR H5 confirmatory assays have been developed to run in parallel with a universal first-screening assay. Regular proficiency panels together with weekly surveillance runs, intermittent on-call testing for suspect cases of avian flu in returning travellers, and several outbreaks of avian influenza outbreaks in poultry that have occurred since 2005 in the UK have fully tested the network and the current diagnostic strategies for avian influenza. The network has clearly demonstrated its capability of delivering a confirmed H5N1 diagnosis within 3-4 h of receipt of a sample, an essential prerequisite for administration of the appropriate antiviral therapy, effective clinical management, disease containment and implementation of infection control measures. A functional network is an important means of enhancing laboratory capability and building diagnostic capacity for a newly emerging pandemic of influenza, and is an essential part of pandemic preparedness.
甲型（H5N1）禽流感病毒持续对人类健康构成重大威胁，尽管它仍是一种人畜共患感染病。需要采取灵敏且有力的监测措施，以发现该病毒获得人际传播能力并演变为下一个大流行毒株的任何迹象。英国应对大流行计划的一个重要组成部分是在2005年建立了英国国家H5实验室网络，该网络能够快速、准确地识别英国所有地区以及爱尔兰共和国潜在的人类H5N1感染病例。本综述详细介绍了为快速演变的病毒设计分子检测方法所面临的挑战，以及确保成功建立一个能提供H5N1全天候检测的功能性国家实验室网络所需的战略决策和选择。实验室合作伙伴关系带来了改进的实时一步多重PCR方法，以确保检测流程简化，不仅能够检测H5，还能对季节性甲型/乙型流感进行鉴别诊断。已开发出一系列经过充分验证的实时PCR H5确证检测方法，可与通用的初筛检测方法并行运行。定期能力验证样本检测、每周监测运行、对回国旅行者中疑似禽流感病例的间歇性随叫随到检测，以及自2005年以来英国发生的几起家禽禽流感疫情，都对该网络和当前的禽流感诊断策略进行了全面检验。该网络已清楚地证明，它有能力在收到样本后的3 - 4小时内做出H5N1确诊诊断，这是给予适当抗病毒治疗、有效临床管理、疾病控制和实施感染控制措施的必要前提条件。一个功能性网络是增强实验室能力和建立针对新出现的流感大流行的诊断能力的重要手段，也是大流行防范的重要组成部分。
