WHO/FAO/OIE and National Leptospirosis Reference Centre, Royal Tropical Institute, KIT Biomedical Research, Meibergdreef 39, 1105 AZ, Amsterdam, The Netherlands,
Curr Top Microbiol Immunol. 2015;387:273-88. doi: 10.1007/978-3-662-45059-8_11.
The general goal of reference centres is to support the community, from diagnostic laboratories to research institutions, in the execution of their work by providing reference strains and reagents and giving instructions and recommendations to individual colleagues and national and international organisations on a wide variety of issues. There are different levels of reference centres, from local to international, with an increasing package of tasks and responsibilities. Local reference centres might limit activities to diagnostic confirmation by applying standard testing, while international reference centres cover a wider range of activities from design, validation and harmonisation of diagnostic and reference technologies to international monitoring associated with recommendations on the global burden and distribution of leptospirosis and its prevention and control to national and international health decision makers. This chapter focusses on four major pillars constituting reference tasks in addition to the obvious provision of reference substances, i.e. Research and training, Diagnosis, Identification of Leptospira and Surveillance. Due to financial and organisational constraints, reference centres are restricted in their capacity for basic research and consequently focus on applied research into various aspects of leptospirosis. They offer training, either individually or groupwise, that might vary from standard technologies to novel sophisticated methodologies, depending on the need and requests of the trainee. Most reference centres are involved in the confirmation of preliminary diagnosis obtained at peripheral levels, such as local hospitals and health centres, while other major activities involve the design and validation of diagnostics, their international harmonisation and quality assurance. Identification of causative Leptospira strains (or serovars) is key to the identification of infection sources and is critical for surveillance. Hence, reference centres also focus on the development, application and provision of methods that are required for unambiguous characterisation of new and recognised Leptospira strains and the maintenance of the integrity of strain collections. In line with their central role, reference centres are frequently associated with local, national and/or international surveillance activities linked to an advisory role and the production of guidelines. Such surveillance activities usually comprise collation of morbidity and mortality data, signalling of outbreaks and the investigation of infection sources and risks.
参考中心的总体目标是通过提供参考菌株和试剂，以及就各种问题向个别同事以及国家和国际组织提供指导和建议，为从诊断实验室到研究机构的社区提供支持。参考中心有不同的级别，从本地到国际，任务和责任也越来越多。本地参考中心的活动可能仅限于通过应用标准测试进行诊断确认，而国际参考中心则涵盖从设计、验证和协调诊断和参考技术到与全球范围内的莱姆病负担和分布及其预防和控制相关的国际监测以及向国家和国际卫生决策者提出建议等更广泛的活动。本章重点介绍了除了提供参考物质之外，参考任务的四个主要支柱，即研究和培训、诊断、钩端螺旋体鉴定和监测。由于财务和组织方面的限制，参考中心的基础研究能力受到限制，因此专注于莱姆病各个方面的应用研究。它们提供培训，无论是个别培训还是小组培训，培训内容可能从标准技术到新颖复杂的方法学，具体取决于学员的需求和要求。大多数参考中心都参与了对基层（如当地医院和保健中心）获得的初步诊断的确认，而其他主要活动则涉及诊断的设计和验证、其国际协调以及质量保证。鉴定病原体钩端螺旋体（或血清型）是确定感染源的关键，对监测至关重要。因此，参考中心还专注于开发、应用和提供用于明确鉴定新确认的钩端螺旋体菌株以及保持菌株收集完整性所需的方法。根据其核心作用，参考中心通常与地方、国家和/或国际监测活动相关联，承担咨询和制定准则的作用。此类监测活动通常包括收集发病率和死亡率数据、发出暴发信号以及调查感染源和风险。
