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Front Public Health. 2019 Jun 18;7:150. doi: 10.3389/fpubh.2019.00150. eCollection 2019.

Bigger and Better? Representativeness of the Influenza A Surveillance Using One Consolidated Clinical Microbiology Laboratory Data Set as Compared to the Belgian Sentinel Network of Laboratories.

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Department of Microbiology, LHUB-ULB, Pole Hospitalier Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
Sciensano, SD Epidemiology and Surveillance, Service 'Epidemiology of Infectious Diseases', Brussels, Belgium.
Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
UCLH/UCL Biomedical Research Centre, NIHR, London, United Kingdom.
Research Centre on Environmental and Occupational Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
National Influenza Centre, Sciensano, Brussels, Belgium.
Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, United Kingdom.
Department of Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
International Agency for Research on Cancer, World Health Organization, Lyon, France.
Innovation and Business Development Unit, LHUB-ULB, Pole Hospitalier Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.


Infectious diseases remain a serious public health concern globally, while the need for reliable and representative surveillance systems remains as acute as ever. The public health surveillance of infectious diseases uses reported positive results from sentinel clinical laboratories or laboratory networks, to survey the presence of specific microbial agents known to constitute a threat to public health in a given population. This monitoring activity is commonly based on a representative fraction of the microbiology laboratories nationally reporting to a single central reference point. However, in recent years a number of clinical microbiology laboratories (CML) have undergone a process of consolidation involving a shift toward laboratory amalgamation and closer real-time informational linkage. This report aims to investigate whether such merging activities might have a potential impact on infectious diseases surveillance. Influenza data was used from Belgian public health surveillance 2014-2017, to evaluate whether national infection trends could be estimated equally as effectively from only just one centralized CML serving the wider Brussels area (LHUB-ULB). The overall comparison reveals that there is a close correlation and representativeness of the LHUB-ULB data to the national and international data for the same time periods, both on epidemiological and molecular grounds. Notably, the effectiveness of the LHUB-ULB surveillance remains partially subject to local regional variations. A subset of the Influenza samples had their whole genome sequenced so that the observed epidemiological trends could be correlated to molecular observations from the same period, as an added-value proposition. These results illustrate that the real-time integration of high-throughput whole genome sequencing platforms available in consolidated CMLs into the public health surveillance system is not only credible but also advantageous to use for future surveillance and prediction purposes. This can be most effective when implemented for automatic detection systems that might include multiple layers of information and timely implementation of control strategies.


Belgium; clinical microbiology laboratory; influenza A; sequencing; surveillance

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