Welcome all to this exciting newsletter which contains relevant updates to the service we provide. We are excited that we have been able to develop and improve our services with you at the forefront of this change. Shaping your EQA requirements to meet your needs is crucial and it is really important to us that we continually work together to drive these improvements, without your involvement none of this would be possible. The world of diagnostic testing is fast evolving, and keeping up with these changes is vital for safe and effective patient and public health management. It is essential for us (along with you) that we continue to remain the leader within the EQA arena and being a laboratory’s provider of choice.
It has also been very rewarding that many new countries are actively approaching us and very eager to develop a distributor arrangement with us for their country. This re-enforces the great work we do at UK NEQAS and are humbled and proud that our status continues to be recognised internationally. We want to be a provider that supports local EQA needs by working collaboratively to a shared vision of improving and enhancing diagnostic capabilities so laboratories achieve and maintain their standards of excellence within microbiology.
So do continue to read the rest of this newsletter that has been written by numerous UK NEQAS for Microbiology staff telling you about the activities they have been involved with. This will give you an insight into some of the exciting work that has been done over the last six months.
Here’s hoping that you all get some valuable time off from work to enjoy the benefits that summer brings with it, such as doing some outdoor activities in the fresh air, being with family and friends or even spending some time by yourself to relax. Our own health and wellbeing is just as important and we need to remember this. Whatever you are doing, have a fabulous time.
Nita Patel, Head of EQA Services
Whilst we have a core service that we have contractually agreed to deliver to you, we are also involved with numerous bespoke EQA programmes in collaboration with renowned international organisations.
Here is an insight on what we have done over the last year:
Invasive Bacterial Vaccine preventable diseases (IB-VPD) in collaboration with WHO
The WHO coordinated IB-VPD sentinel hospital surveillance network was formed in 2008. The Global IB-VPD laboratory network supports the laboratory confirmation of disease caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis and identifying the circulating serotypes. One way of monitoring laboratory performance is through an EQA programme that helps assess laboratory performance in diagnosis and serotyping/serogrouping of the identified pathogens. We have just concluded the last exercise that was sent out in 2023 and the findings continue to show a high level of laboratory proficiency.
Heart valve banking EQA in collaboration with the Scottish National Blood Transfusion Service
Heart tissue products donated usually after death are banked worldwide in order to support reconstructive cardiac surgery, operations that are required regularly to treat both congenital and acquired cardiac defects. Donations of substances of human origin necessarily includes a risk of transmitting infection to recipients. One of the steps taken is to test the tissue product for the potential presence of contamination and also decontaminating the heart tissue product often using an antibiotic cocktail. The results from a pilot distribution highlighted the differences in practice between different tissue banks further supporting the need for setting up such an EQA on a regular basis and to produce a best practice method document to attempt harmonisation of the testing.
Respiratory syncytial virus (RSV) in collaboration with the World Health Organization (WHO)
The global burden of human respiratory syncytial virus (RSV) is significant, particularly affecting children under the age of 5. Each year, RSV is estimated to cause 35 million serious respiratory infections, leading to 3.6 million hospitalisations approximately 110,000 deaths globally. Despite its impact, there is a lack of comprehensive data on the true burden of RSV in low- and middle-income countries (LMICs).
To address this gap, the World Health Organization (WHO) launched the Global RSV Surveillance Program in 2016 under its Global Influenza Program. This initiative was crucial for providing standardised scientific data to guide the future introduction of RSV vaccines and other treatments. Laboratories were selected from the Global Influenza Surveillance and Response System (GISRS) to be part of this surveillance program.
UK NEQAS for Microbiology was selected by WHO to offer a comprehensive External Quality Assessment (EQA) exercise for molecular detection of RSV and sequencing for these laboratories.
The second WHO EQA for molecular detection of RSV was conducted during 2019-2020, with 25 participants, a third round reached out to almost 70 participants in 2021-22. See https://onlinelibrary.wiley.com/doi/full/10.1111/irv.13073 for report.
Currently, UK NEQAS for Microbiology, in collaboration with the WHO and the CDC (Atlanta), is administering the fourth round of the WHO molecular detection of RSV EQA and sequencing to over 80 countries worldwide. This ongoing effort highlights the global commitment to enhancing RSV surveillance and ensuring accurate and consistent detection of the virus across diverse regions.
The Central Asian and European Surveillance of Antimicrobial Resistance (AMR) network (CAESAR) in collaboration with WHO
CAESAR is part of the Global initiative GLASS, the Global Antimicrobial Resistance Surveillance System and covers at least 19 countries. All laboratories participating in a national AMR surveillance network in these countries are required to follow standard operating procedures for specimen processing, species identification and sensitivity testing. This AMR surveillance focuses on invasive isolates of eight key bacterial species (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter species, Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus faecalis and Enterococcus faecium). UK NEQAS have been providing a comprehensive EQA schedule to these laboratories for many years, the findings from these exercises provides an insight into the quality of data generated and continues to demonstrate the increasing ability of the laboratories to report comparable results. This provides reassurance and confidence that data submitted for surveillance is robust and accurate thereby allowing public health interventions to be executed accurately.
You can read the full report from the exercise here: https://www.who.int/europe/publications/i/item/9789289058537
External quality assessment schemes to support European surveillance of Legionnaires’ disease in EU/EEA and Western Balkan countries in collaboration with European Centre for Disease Prevention and Control (ECDC)
UK NEQAS has been involved with this ECDC requirement for the provision of an EQA since 2019. The last exercise took place in 2023 and each year a report is generated describing the findings from the exercise for the detection, isolation, identification, and enumeration of Legionella species. This EQA was carried out in collaboration with our colleagues that provide proficiency testing (PT) schemes for the food, water and environmental laboratories. Legionnaires’ disease is a severe and sometimes fatal form of infection caused by the Gram-negative bacteria, Legionella spp. These bacteria are found in freshwater and soil worldwide and can contaminate constructed water systems. There are at least 60 species of Legionella and over 20 have been associated with human disease. Legionella pneumophila is the most common species isolated both from the environment and from human infections.
These exercises were unique in that it allowed both clinical and environmental laboratories in each country to work together to establish the causative agent associated with a water related outbreak. Throughout the exercises different outbreak scenarios were provided, such as that related to a dental practice to one associated with a water fountain.
If you wish to read the any of the EQA reports then you can access these on this link: https://www.ecdc.europa.eu/en/publications-data/external-quality-assessment-schemes-support-european-surveillance-legionnaires-1
European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) in collaboration with ECDC
Through our host organisation UK Health Security Agency’s Antimicrobial Resistance in Sexually Transmitted Infections (AMRSTI) we have been fortunate to provide an EQA that allows laboratories to be monitor performance, ascertain the comparability of results and attempt to harmonise methods used for antimicrobial susceptibility testing in Neisseria gonorrhoeae. The results from the 2023 exercise indicates that the Euro-GASP antimicrobial surveillance quality is of a good standard.
Read the full report: https://www.ecdc.europa.eu/sites/default/files/documents/Euro-GASP-EQA-2023-Neisseria-gonorrhoeae-final-revised.pdf
UK NEQAS are very privileged and honoured to continue supporting these EQA programmes and delivering on our core remit to be educational that enhances diagnostic capabilities world-wide.
To register, please click on this link.
Click here to see more info.
The UK NEQAS Microbiology 2024 Scientific Meeting will be taking place on Friday 29 November 2024 at the Holiday Inn, Bloomsbury, Central London.
The title of this year’s meeting is Quality Matters to us All.
Booking is now open via this link, the link also contains full meeting information and agenda.
If you would like any further information please send an email to: userday@ukneqasmicro.org.uk
We hope to see you at this year’s meeting.
The scoring policy for the Antimicrobial susceptibility scheme has been updated as of June 2024: www.ukneqasmicro.org.uk/participant-info/information-on-scoring/
The antimicrobial agents are scored based on the complexity ratings (a high difficulty rating is scored automatically (even if performance is <80%) unless the reference MICs span the breakpoint. In the case where the MIC’s reported by the two reference laboratories result in a difference in the interpretation of an antimicrobial agent, the result will not be scored. In addition, laboratories sometimes are required to susceptibility test isolates where there are no defined clinical breakpoints, using Epidemiological Cut OFF (ECOFF) or EUCAST “When there are no breakpoints” criteria to interpret. In these cases, although EUCAST recommends not reporting as S/R in a clinical setting, for the purposes of the NEQAS AS scheme we request reporting S/R for ease of analysis.
Based on participant feedback, the Carbapenemase-Producing Organisms scheme has recently undergone an update to allow participants to report the presence of more than one resistance mechanism more easily. The new format will be going live at the end of July 2024.
Below is an example of the updated results entry layout:
The development of new schemes that supports diagnostic testing is a key remit of ours especially if we are to support laboratories in understanding their own capabilities.
On the 1 July a pilot distribution for screening of group B streptococci (GBS) was sent out to laboratories in the UK who wanted to be part of this exercise. Screening for GBS throughout pregnancy is of high importance as during pregnancy GBS can infect the amniotic fluid which can lead to neonatal sepsis, pneumonia and meningitis. This organism can cause further complications, and in extreme circumstances death to the newborn child if they contract the organism through the birth canal during labour.
By developing and providing an EQA which focuses on the detection and identification of GBS, will give confidence to clinical laboratories and provide valuable information on their ability and capability to accurately detect and report results on GBS within vaginal and anorectal swabs. This scheme will aid with educating laboratory staff and emphasising the importance of early detection and treatment of GBS in pregnant women.
In the UK many laboratories will follow or refer to the UK Standards for Microbiology Investigations B 58 - Detection of carriage of group B streptococci (rcpath.org) which is readily available to all laboratories worldwide.
This pilot distribution has now closed and results are being analysed. After which a review will be undertaken to establish the future direction of this scheme. More information will be sent to participants shortly.
We welcome Dr Jaya Shrivastava on her return from secondment on 7th August 2024.
Parasites continue to represent a threat to global health with malaria cases resurgent as a result of COVID-induced disruption to health systems.
In 2023, imported malaria cases in the UK exceeded 2000 cases for the first time in 20 years, so maintenance of malaria microscopy skills has never been more important.
UK NEQAS Parasitology will shortly run a pre-pilot Digital Microscopy EQA for blood and faecal parasites.
