Introduction & Background:

In 1965 a Clinical & Public Health Division was set up at the then National Health Laboratories to provide laboratory support to the medical facilities of newly incepted capital of the country. In addition to routine medical laboratory services, this Division was successful in achieving recognition and the identity of being a unique public sector facility at national level. The Division is now functional with the name of Public Health Laboratories Division (PHLD) and has been identified as a WHO Collaborative Centre for Research and Training in Viral Diagnostics.

Besides service delivery the PHLD has been a source for dissemination of information and technical training in the new developments complementing internationally recognized priority areas and targets.

 Objective: 

Disease prevention and control using laboratory medicine tools and public health interventions as per the mandate and functions assigned under NIH Ordinance 1980.

Mission:  

This Division would provide diagnostic services to the general public while taking in to account the highest possible quality assurance norms, would function as research and training base for laboratory professionals and take standard preventive measures in case of disease outbreaks in the country.

Organization: 

This Division comprises of the Departments of Virology, Microbiology, Molecular Biology, Hematology, Histopathology, Cyto-genetics, Chemical Pathology, Immunology, Electron Microscope, Reproductive Physiology, Parasitology and Environmental Health. In addition Epidemic Investigation Cell is also the part of this Division. It comprises of 69 technical professionals with support of 41 personnel.

Performance/ Achievements:

Routine and specialized services: 

Since more than three decades, this Division is engaged in routine and specialized laboratory diagnoses of pre and post transitional disorders on the referred patients and biological samples from almost all over the country.

Postgraduate research facilities are provided to the national and international universities, organizations and institutes.

The patients and/ or their samples are referred to this Division from different hospitals of Islamabad and Rawalpindi and other cities. The salient features of these services include:

HIV screening: for routine screening and confirmation of indeterminate cases referred by provinces and other  health facilities like blood banks.

Hepatitis profile: for hepatitis A, B, C and E including titration levels of antibodies, immunoglobulins and detection of various antigens.

Diagnosis of other viral diseases: including Polio, Measles, Rubella, Toxoplasma, Rabies and CMV.

Electron Microscopy (both Transmission and Scanning)

Cytogenetics & Chromosomal analysis.

Haemoglobin Bone Marrow Studies: on the referred cases

Hormonal assays: including complete reproductive hormonal (estrogen, progesterone, LH) and thyroid hormone profile (Free T3, Free T4, TSH).

Tumor markers: PSA, C125, CEA, BhCG and AFP.

Fine needle aspiration (FNA): specialized services for Histopathology Department of the Division also renders FNA.

Monitoring of the drinking water quality: by the Environmental Health Department.

Epidemic handling: division has contributed in situations like of SARS. Anthrax and Avian Influenza.

Implementation of Disease Early Warning System (DEWS) and investigation of outbreaks/events / epidemics.

Liquid Nitrogen: produced and given to different organizations.

Yellow fever vaccine: Vaccine is administered along with issuance of International Health Certificates to the patients going to endemic areas.

 Other important activities:

Epidemic Investigation Cell:

Disease surveillance and control in the country is being carried out by the special technical and laboratory support of this cell.  Since long, the NIH has been playing pivotal role in laboratory investigation of the disease. However to transform it into regular service an Epidemic Investigation Cell (EIC) was established during 1998. Since then WHO assisted project, Disease Early Warning System (DEWS) is being implemented through the EIC. The work is carried out through orientation and training workshops on DEWS tools, lab support for epidemiological studies and logistic support to the epidemic prone/hit districts. This activity has resulted in producing 1900 trained personnel on DEWS tools and the EIC has attended 211 real and alleged out breaks ever since 1998  as per following details:

Food and waterborne: Gastroenteritis, typhoid, Hepatitis A&E; Airborne:  Meningitis, diptheria, and measles; Blood borne:  Hepatitis B&C, CCHF; Insects borne:  CCHF, Malaria, Leishmaniasis.

 Regional Reference Laboratory for Polio Eradication:

AFP surveillance has met WHO-established targets for key indicators since 1994 and the country shifted to virological classification in 1996. Testing of all samples is carried out at the Virology Department, of Public Health Laboratories Division (PHLD) i.e. WHO Regional Reference Laboratory (RRL) for Polio Eradication Initiative. There is strong coordination between the laboratory and EPI programme and quality laboratory results are provided in a timely manner and hence promoting prompt response in the field. RRL performance is evaluated each year by two methods through accreditation and proficiency panel testing.

The Regional Reference Laboratory (RRL) for Polio Eradication is providing support to the whole of country for detection and diagnosis of Polio Virus strains in the reported Acute Flaccid Paralysis cases. This evidence-based data helps identification and launch in time control measures to cheek the Polio incidence in the vulnerable population.

The laboratory has to be accredited each year by the WHO for test proficiency; laboratory has successfully passed the proficiency panels each year. Regional Reference Laboratory (RRL) has scored 100% proficiency panel results for virus isolation and identification, ELISA and PCR for the current year (2003).

Molecular Virology Sequencing Laboratory:

The Regional Reference Laboratory (RRL) for Polio Eradication has been upgraded with the addition of sequencing capability for confirmation and typing of polio virus with the technical assistance from WHO, Rotary International and  JICA as 6^th of its kind in the world

Blood Safety:

The concept of safe blood transfusion services implies, getting blood from healthy voluntary donors, ensuring proper storage of blood, preparing blood components, screening donor blood to ensure that it is safe from infections and avoiding its irrational use. In order to meet these requirements the Ministry of Health has taken the following additional steps through PHLD: 

• Formulation and approval of the National Blood Policy and National Strategic Framework.

• Establishment of the Secretariat of National Blood Transfusion Committee at PHLD

• The National Reference Center for Blood Transfusion (NRCBT) is being established at the PHLD under a MoU signed with the International Consortium for Blood Safety (ICBS)

• Two scientists have been trained through WHO-EMRO to work in NRCBT

Collaborations: 

• The PHLD is collaborating with various international development agencies and institutions, more importantly WHO, UNICEF and UNAIDS. Besides this, the PHD is engaged in international collaboration with institutions like CDC, Atlanta USA and other WHO designated reference centers in USA, Europe and Middle East.

 

• The College of Physicians and Surgeons of Pakistan accepts the training completed in this Division of NIH as a pre requisite for MCPS (Clinical Pathology).

• The students from various postgraduate medical institutes and universities in the country also approach this Division for completion of research required for their Fellowship examinations, PhD, M.Phil and MSc. qualifications.

WHO assisted projects:           

1.    Disease Surveillance & Control: Resulted in establishment of Epidemic Investigation Cell (EIC) at NIH. Served through out the country through technical and laboratory support by Logistic and capacity enhancement activities.

 

2.    Health Laboratory Support: 45 pathologist/ laboratory scientists and 50 laboratory technologists/ technicians were trained in different lab methodologies.

TDR Projects:  

1.    The project submitted by PHLD, "Study of etiology and antibiotic susceptibility of infective agents of acute bacterial Meningitis in Rawalpindi and Islamabad", has been approved by WHO/TDR. 

 

2.    The project, “Epidemiology of Cutaneous Leishmaniasis in Larkana district of Sindh Province", has been completed.

Bio-threats:

Anthrax: 

National Institute of Health received 230 samples from 194 different sources to confirm or rule out the presence of Anthrax spores. These samples were taken from environment as well as individuals exposed to suspected material received through their mails and other sources and consisted of clinical as well as non-clinical samples. Clinical samples included nasal swabs and skin swabs taken from individuals who were exposed to the powder or letter laced with suspected powder received through mail. Non-clinical and environmental samples consisted of suspected powder, the letter or packet in which the powder was received as well as samples from surfaces and inanimate objects which were contaminated by the powder accidentally spilt during opening of suspected letters or packets.

The samples were analyzed for anthrax spores by culture for Bacillus anthracis, animal pathogen city tests as well as by direct microscopy. Although all the samples analyzed were found to be negative for Anthrax spores, the incidents created widespread panic and harassment in the general public. The following are the results: 

Crimean Congo Hemorrhagic Fever (CCHF): 

In Pakistan, the first CCHF outbreak occurred during January 1976 at Rawalpindi General Hospital (RGH) amongst a surgical team resulting in the death of the index case, his father, the attending surgeon (Dr. Mateen Siddiqui) and a theater attendant. After the above-mentioned occurrence of 1976, outbreaks occurred mostly in Balochistan province during 1978, 1987, 1994, 1995, 1998 and 1999 involving 4 to 9 cases per year. For confirmatory diagnoses virology department of the division is collaboration with the National Institute of Virology South Africa.   The detail of CCHF samples/cases dealt is given below:   

Human Resource Development:

International:

Two officers of the PHLD were trained on the advanced molecular techniques for detection of HIV, HCV and HBV, Good Laboratory Practices (GLPs), Quality Assurance (QA) for three months duration in Germany and Holland in collaboration with the ICBS and WHO.  

National:  

Roll Back Malaria meetings (Macro level) with Provincial Chiefs and Directors Malaria Control are held time to time obtaining their full commitment for participation in RBM planning and implementation.

National Plan on Prevention and Control of Rabies in Pakistan:  meetings of provincial focal persons were held according to the schedule.

National Training Workshop on Quality Assurance in Clinical Chemistry.

Disease Early Warning System (DEWS) - workshops under DEWS were held in pilot areas for orientation and capacity building of local health professionals from public and private sectors regarding prompt action against out breaks to minimize morbidity and mortality.       

Departmental / In house: 

• All the Departments are facilitated with computers and manpower trained for use.
   

• Management of the Division is being administered through a Technical working Group (TWG) within given terms of reference. Monthly meeting of TWG is held to review the performance.
   

•  Scientific club has been established in the Division for regular fortnightly lectures by the departmental and visiting professional.
   

•  Intra lab Quality control meetings / visits / evaluation and support by the designated QA team conducted in the division to check Development of SOPs / Quality Control tools inspected by QA and produce quality work.

Medical Technology: 

Practical training of B.Sc. Medical Laboratory Technology College students in different disciplines is a regular feature of this division. Research work of M. Sc. and M. Phil. students from educational institutions, like Quaid-e-Azam and Arid Agriculture Universities, is being facilitated at various laboratories of the division, which gives them orientation to plan, implement, conduct and prepare research reports for their degrees.

Under the Overseas volunteer programme, one candidate from Japan is presently working in the laboratory of environmental health..

Academic growth of Professionals: 

•  Completion of PhDs in Bio Sciences from Qaid e Azam University by two officers.
   

• Completion of M.Phil (Pathology ) , from PIMS by one officer
   

• Enrollment of two technologists in MSc programme at ARID University.

Visits: 

Professionals, delegates, student groups and health staff from national and international organizations visited the PHLD for orientation and awareness about the specialized functioning, sophisticated facilities and equipment.

Research & Publications:

Data generated through routine and specialized activities was disseminated at national and international for a through publications, presentations, and communication in scientific journals, conferences and seminars.

Future Plans:

• Acquisition of new technologies

• Training of professionals

• Introduction of MIS in the PHLD

• Establishment of molecular level techniques for  various disciplines

• Participation in National and International research activities

• Dissemination of evidence based information to the policy makers, public   representatives, professionals, press and relevant agencies.

• Implementation of three WHO Projects.