Laboratory Strengthening

Under Integrated Disease Surveillance Programme (IDSP) strengthening public health labs is an important component that is mainly focused on developing lab capacity in India such that states have the diagnostic facilities to conduct surveillance of epidemic-prone diseases in a decentralized manner. The IDSP public health lab strengthening plan is currently based on two strategies:

1. Strengthening of district public health labs in the country in a phased manner

Laboratories at District hospitals are being strengthened for the diagnosis of epidemic-prone diseases with respect to deficient equipment, manpower, and funds for consumables.

The district public health labs under IDSP are expected to:

a) Perform testing for lab confirmation of epidemic-prone diseases for both outpatients and inpatients attending the hospital so as to generate lab-confirmed surveillance data and

b) Support outbreak investigations in the district

c) Report weekly surveillance data on L forms.

These labs are expected to perform at least the following tests:

a) Blood culture for Typhoid

b) Stool culture for cholera and other common enteropathogens

c) IgM ELISA for Dengue (in endemic areas)

d) ELISA for Hepatitis A & E

e) ELISA / rapid test for Leptospirosis (in endemic areas)

f) Tests for other outbreak prone diseases prevalent locally

2. Referral lab network

Under this network, services of existing functional laboratories (at government medical colleges) are being used to allow access to quality laboratory services for the investigation of outbreaks in the linked districts. The implementation process involves certification of labs by a team of experts from the state followed by the signing of an MoU between SSU and referral labs and disbursement of annual grants to the referral labs. The referral labs are to be monitored through quarterly reports submitted by them to the SSU and the CSU (in prescribed format).

Tests to be performed by the state referral labs are:

- Cholera and other enteropathogens: culture and sensitivity and serotyping

- Typhoid: Blood Culture & antimicrobial sensitivity (including isolate confirmation with specific antisera

- Bacterial meningitis-rapid latex agglutination test, CSF examination-wet mount, gram stain, and culture & antimicrobial Sensitivity

- Hepatitis A&E- IgM ELISA

- Measles- IgM ELISA

- Dengue- IgM ELISA

- Leptospirosis-ELISA/Rapid test

- Diphtheria-Smear examination, culture, and toxigenicity testing

- Any other tests for locally prevalent epidemic-prone disease (to be identified by the state)

To ensure the success of the implementation, the project has provided guidelines for various activities and assures continuous handholding at the state and district levels.

Another important aspect of IDSP is to strengthen reporting of laboratory-confirmed surveillance data using the L form. All the referral labs under the lab network are also to report their weekly data using the L forms.