Highly pathogenic and contagious microbial threats have continued to appear and persist globally for the past 40 years, namely through the transmission of disease from animals to humans. Such diseases include human immunodeficiency virus (HIV), severe acute respiratory syndrome (SARS), COVID-19 (SARS-CoV-2), and influenza A viruses such as H1N1 in 2009. As these viruses evolve, the mutations they develop could potentially lead to silent outbreaks that are missed by diagnostic tests, highlighting the crucial role of global viral surveillance programs to keep pace with viral diversity.
Current global disease surveillance programs conducted by organisations such as the World Health Organisation (WHO) and Abbott's Global Viral Surveillance Program work to bolster public health responses to disease. The programs allow healthcare systems to be alerted to emerging infectious diseases, and ultimately reduce the incidence and impact of these diseases on populations.
Dr Sarah Garner is a pathologist at Austin Health in Melbourne, Victoria and was three years into her PhD in HIV Virology and Immunology at the University of Melbourne when the COVID-19 pandemic took hold in Melbourne. She immediately switched gears to join the healthcare workforce to look after COVID-19 patients in clinical wards.
Now she is working at Austin Health as a COVID Pathologist. "Ensuring that the instruments are actually picking up the variants you want them to pick up is critical," Dr Garner said of working with assays for COVID-19 testing.
Significant work was done in the state of Victoria to monitor the progress of COVID-19 variants, particularly at the Microbiological Diagnostic Unit (MDU) in Melbourne which specialised in sequencing the virus.
"The MDU play a big role in feeding that data back to us and letting us know what’s happening in terms of variants," said Dr Garner.
In developing their assays, Abbott's molecular R&D team was able to design criteria which could identify and address the challenge of rapidly evolving viruses being able to avoid detection, and how this could impact infectious disease control.
Dr John Hackett is Divisional Vice President of Applied Research and Technology at Abbott’s diagnostics business and looks after Abbott's Global Viral Surveillance Program. He is an expert in infectious disease and disease surveillance:
"We had the goal of being able to come up with approaches to mitigate the impact of genome diversity, so we could design an assay today that would be relevant years down the road," said Dr Hackett.
This gives pathology laboratories the confidence that COVID-19 is not going undetected in the community.
Dr Garner said: "I know that the Abbott assays have conserved areas in molecular assays. They're the ones that aren't going to get easily changed by variants."
"If there's a shift to a new variant and it is very different to what we've seen, we can still pick up those conserved regions so that we can still detect it with our PCRs."
With international borders opening and winter around the corner, the conversation quickly turns to the double burden of COVID-19 and influenza circulating in the community.
"What we are thinking about now is what are the platforms that we're going to be able to use that are not only going to detect COVID, but to detect Influenza A and B," Dr Garner said.
"How do we reflex to using an assay that's going to detect multiple targets?"
Assays are now available which detect both COVID-19 and influenza, with Dr Garner's molecular laboratory looking at verifying those assays quickly, so that we're ready when the influenza comes," she said.
Surveillance programs such as Abbott's Global Viral Surveillance Program can also have an impact on vaccine development and modification. Dr Mary Rodgers is a Principal Research Scientist who manages the program with Dr Hackett. She stated the importance of the program for vaccinations:
"Surveillance is helpful for ensuring that diagnostic tests continue to work but also to inform vaccine developers what strains are circulating," Dr Rodgers said.
Dr Garner said: "There'll often be studies that'll come out within a couple of months of the variant appearing, some neutralisation studies that will give us an idea of how the vaccines might be affected with new variants."
The value of global surveillance systems for disease cannot be overstated, allowing infectious disease experts to remain ahead of the curve and prepare public health responses with ample notice. This will result in better disease management and mitigate the impact diseases have on populations in the future.
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