SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

Summaries Swiss MedLab 2008


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1Laboratoire de Virologie, Hôpitaux Universitaires de Genève, rue Micheli du Crest 24, 1211 Genève 14

“Management of suspect viral hemorrhagic fever patient in Geneva”

The goal of the Swiss National Centre for Emerging Viruses (CRIVE) is the detection of viruses of the biosecurity level class 3 and 4 in humans. This centre is part of the Laboratory of Virology which also houses the National centre for Influenza. It is localized at the University Hospital of Geneva and functions in close collaboration with the Federal Office of Public Health (FOPH).
The analysis of clinical specimens at risk to contain dangerous viruses has to be done in appropriate laboratory. To fulfil to this task, we set up the first laboratory of the P4 type in Switzerland to manage and analyse samples suspected of containing hemorrhagic fever viruses or other dangerous viruses, like avian influenza H5N1 or SARS. This is an improved P3 level laboratory which contains an isolator “glove box” type (within which the biosecurity level 4 is reached) under regulations that follow strict rules according to the reference laws. No amplification of class 4 viruses by cell culture or in animals is performed in this laboratory. The basic principle is a cascade of negative pressures increasing step by step from the first SAS to the isolator, in order to guaranty strict pathogens confinement.
In this room, virus inactivation is the main work performed on the clinical samples. Once this step is accomplished in high security conditions, the following analysis are serology and viruses. It is noteworthy that we can also carry out some complementary blood analysis (blood chemistry or coagulation tests for instance) by using several devices located in the isolator, for patients hospitalized in Geneva. Because hemorrhagic fever symptoms are not specific at the beginning of the disease, we also perform differential diagnostics for malaria, Dengue, HIV and acute hepatitis A, B and C and other agents.
The patient suspected of hemorrhagic fevers or other dangerous pathogens must be managed and treated in an appropriate manner, and these need harmonised coordination and case evaluation between the clinicians, infectious disease specialists and the microbiologists. One of the first priorities, for instance, is to estimate whether the patient should be isolated or not in special unit wards. The isolation leads to a heavy work load for the hospital staff. In order to limit the risks of pathogen transmissions, specific precautions have to be applied during any patient care and there is a need to avoid any direct contact with body fluids, particularly when the viral load is very high. This new laboratory provides a diagnostic facility in Switzerland and the samples don’t have to be sent in another special laboratory abroad anymore.
Concerning the packaging and the shipping terms of human samples by road in Switzerland, we clarified and normalized these points, according to national and international regulations, by working in collaboration with the Federal Office of Public Health and other concerned federal offices. This work has led to a document soon published in the “FOPH bulletin”. It indicates how to precede with samples from patients suspected of hemorrhagic fevers, Chikungunya or Tick-borne encephalitis for instance, taking and management and how to send them to Geneva. All the informations cited in this paragraph as well as our timetable and the list of analysis are also available on our web site (http://virologie.hug-ge.ch).
Some viruses are genetically very variable and evolve quickly. Consequently, the CRIVE has to adapt regularly the diagnostic tests for new variants viruses. Moreover, new detection tests have to be set up in case of outbreaks due to emerging or re-emerging viruses. Since 2005 the centre is also a member of the European Network for Imported Viral Diseases (ENIVD).
Dr Pascal Cherpillod (PhD)

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