The Direct Role of Laboratories in the Surveillance of Communicable Diseases, Examples from Different Countries and Suggestions for Turkey

As the diagnoses of most communicable diseases are confirmed by microbiological analyses, laboratory surveillance programs are implemented in many countries in addition to clinicians’ notifications. The objective of this review is to describe the direct role of laboratories in surveillance, to present some examples of its implementation in different countries, and to evaluate the situation in Turkey. UK, Australia, France and Italy were chosen as examples because their different laboratory surveillance scopes and methods. Laboratory surveillance has been started in the UK in 1940s and in Australia in the 1970s. All of the laboratories contribute to the surveillance in the UK and France, while sentinel surveillance schemes are applied in Australia and Italy. Laboratories in the UK report almost all of the infectious agents they have diagnosed. Most of the notifications are received by an electronic system called CoSurv which captures the data automatically from the laboratories. In Australia, laboratories report many infectious agents under the surveillance scheme LabVISE. In France, laboratories report the national notifiable diseases and participate in some sentinel surveillance schemes. There is a separate notification form for each of the 30 notifiable communicable diseases in France. Patient identities are anonymized in these three countries. In Italy, laboratories make electronic notifications and send the information on the patient openly, as in Turkey. In the former four countries, laboratories also notify the conditions that clinicians should notify, while in Turkey laboratories only report some infectious agents that clinicians do not have to notify. In Turkey the lists do not overlap. The notification volume per 100,000 population is 847.5 in the UK, 188.2 in Australia and 40.6 in Turkey. In Turkey, laboratory surveillance is restricted to only nine pathogens (Shigella, Salmonella, EHEC, Campylobacter, Listeria monocytogenes, Entamoeba histolytica, Cryptosporidium sp, Giardia intestinalis and Chlamydia trachomatis) classified as ‘Group D’ notifiable agents. The majority of notifiable diseases are classified as group A and C which should be notified only by clinicians. Some researches show that the notification rates of Group A diseases by clinicians are quite low and it is possible to reach the data on cases through laboratories. While the surveillance system changed in 2005 in Turkey, an increase in notification rates was not observed. Therefore, it would be appropriate to integrate laboratories into the surveillance of Group A, B, C notifiab