|Year : 2020 | Volume
| Issue : 2 | Page : 137-138
Moving beyond clinical medicine: Revised mandate for public health microbiology
Rahul Narang1, Pradeep Deshmukh2, Banke Lal Sherwal3
1 Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
2 Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
3 Director, Rajiv Gandhi Super-Speciality Hospital, Delhi, India
|Date of Submission||02-Jul-2020|
|Date of Decision||11-Jul-2020|
|Date of Acceptance||15-Jul-2020|
|Date of Web Publication||29-Aug-2020|
Dr. Rahul Narang
Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Narang R, Deshmukh P, Sherwal BL. Moving beyond clinical medicine: Revised mandate for public health microbiology. Indian J Med Microbiol 2020;38:137-8
|How to cite this URL:|
Narang R, Deshmukh P, Sherwal BL. Moving beyond clinical medicine: Revised mandate for public health microbiology. Indian J Med Microbiol [serial online] 2020 [cited 2020 Sep 18];38:137-8. Available from: http://www.ijmm.org/text.asp?2020/38/2/137/293911
The ongoing pandaemic caused by the severe acute respiratory syndrome novel coronavirus disease (COVID-19) has affected all of humanity. At the same time, it has opened vistas for collaboration among various disciplines of science and humanities that is needed to better build critical and much-needed capabilities and capacity to respond to ongoing and future public health threats.
On diagnostic and surveillance front in India, COVID-19 diagnostic laboratories were created in various government and private medical colleges, veterinary colleges, ICMR, DBT and CSIR institutes, universities and by large chains of private corporate laboratories. Since the disease was novel, the diagnostic kits were also designed after its advent and used after validation by the ICMR-National Institute of Virology, Pune. At the community level also, the public health experts and microbiology laboratories are working hand in hand on surveillance of the disease.
Looking at the extent of disease, the Board of Governors of the erstwhile Medical Council of India have ordered that all the medical colleges in India should have a biosafety level 2 (BSL-2) laboratory for infectious pathogens in the department of microbiology. They have also given the infrastructure requirements for the same. This is a welcome step and should be taken up in an accelerated manner.
During the past many years, India has made tremendous progress towards the control of communicable diseases and is striving hard to prevent major vaccine-preventable diseases. As we proceed towards this goal, the country has started facing challenges of various existing and newly emerging zoonotic diseases with outbreaks of dengue, dengue haemorrhagic fever, chikungunya, H1N1, H5N1, Japanese encephalitis, Kyasanur Forest disease, Crimean-Congo haemorrhagic fever, Nipah virus disease, COVID-19, scrub typhus and anthrax in various parts of the country. At the same time, cattle have been found to be infected with Mycobacterium tuberculosis in addition to Mycobacterium bovis, indicating that reverse zoonoses are also taking place. In addition to these viral and bacterial diseases, a number of parasitic and fungal infections also share a zoonotic origin. Increasing interaction of humans, with domesticated animals in the form of livestock rearing and pets as well as with wildlife due to an increasing number of national wildlife reserves, has led to close contact at the animal-human interface.
India should thus also contemplate the present situation in a larger landscape, including various other diseases that are prevalent in the country and that may emerge in the future. India's public health laboratory system, though functional, has a limited approach. The basic idea of public health laboratory system should incorporate the prevailing diseases; however, different vertical programmes in India have their own laboratories with different tier structure, for example, tuberculosis (TB), Malaria, Viral Research and Diagnostic Laboratories (VRDL) and HIV laboratories with no horizontal integration.
It has been suggested that an integrated infrastructure using a common platform for multiple diseases can be a cost-effective method for resource-limited settings. The Maputo Declaration for Public Health Laboratory System in 2008 helped Africa to develop good quality public health laboratories based on integrated laboratories under the African Society for Laboratory Medicine (ASLM).
In the same line, VRDL network in India is also a successful experiment and now the VRDL is also working on bacterial agents in addition to viral agents as originally conceived.
Similarly, the Integrated Disease Surveillance Project (IDSP) was launched in November 2004 with the objective to strengthen/maintain decentralised laboratory-based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained rapid response team. One of the components of the project was to strengthen public health laboratories. Under this 50 district, public health laboratories were supposed to be strengthened by 2010 and all-district laboratories in the country by 2011 (IDSP.https://idsp.nic.in/index4.php?lang=1&level=0&linkid=313&lid=1592). Despite, IDSP's progress over the years, focus remained on common epidemic-prone diseases and capacity to upscale and repurpose remained limited.
We propose that in every district, at least one integrated Public Health/One Health laboratory may be created/strengthened, and if possible, the same may be directly linked to the medical and veterinary colleges of the district or the neighboring district. The departments of microbiology in both medical and veterinary colleges, community medicine and veterinary public health can be members of this integrated laboratory and may conduct diagnosis, surveillance and consortium-based research on prevalent and emerging communicable diseases. For this purpose, the integrated laboratories may develop linkages with other research laboratories, universities, foreign collaborators and industry. The corporate social responsibility of companies may also help in strengthening these laboratories further. The efficiency in the functioning of medical microbiology departments that have well-trained microbiologists and technologists has been demonstrated during the ongoing pandemic of COVID-19. Some of the departments are already running well-functional laboratories for TB, HIV and VRDL. This proposed integrated laboratory may incorporate various disease-specific programme laboratories and provide diagnostic and surveillance support for the whole district. In a phase-wise manner, the BSL-2 laboratories may be upgraded to BSL-3.
The regional laboratories may function as such and may be linked to regional All India Institute of Medical Sciences (AIIMS). The regional AIIMS may act as mentoring institutes for integrated laboratories as they did for COVID-19. This will ultimately lessen the work of overburdened National Reference Laboratories to focus on their mandate of providing laboratory reference/referral services for confirmatory testing, surveillance and research, training, maintaining quality assurance and perform technical evaluation of reagents and diagnostic kits.
The need for integrated surveillance at the human-animal interface for rapid detection and response to emerging coronavirus infections using One Health approach has also been expressed by Bhatia 2020. By proposing an integrated laboratory, we are not trying to create a parallel system but to strengthen the existing network and to enhance its scope of work.
Similar to ASLM, the Indian Association of Medical Microbiologists can play a significant role by designing the curriculum that incorporates the scope of teaching the latest technologies, including those in the pipeline, training of human resources, quality assurance and monitoring and evaluation of the programmes along with various other stakeholders.
| ~ References|| |
Nkengasong JN, Mbopi-Keou FX, Peeling RW, Yao K, Zeh CE, Schneidman M, et al
. Laboratory medicine in Africa since 2008: Then, now, and the future. Lancet Infect Dis 2018;18:e362-e367.
Bhatia R. Need for integrated surveillance at human-animal interface for rapid detection and response to emerging coronavirus infections using one health approach. Indian J Med Res 2020;151:132-5.
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