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SCOTTISH CLINICAL VIROLOGY CONSULTANTS GROUP (SCVCG)

APPROVED MINUTES OF MEETING

Wednesday 7 November 2012 - Pentlands Science Park at Moredun

1. / Present / Actions
Ingólfur Johannessen (Chair; IJ), Celia Aitken (CA), John Bremner (JAGB), Roger Evans (RE; by ‘phone), Craig Ferguson (CF), Paddy Gibb (APG), Rory Gunson (RG), Heli Harvala (HH), Liz McCruden (EMcC), Pamela Molyneaux (PJM), Sandeep Ramalingam (SR), Kate Templeton (KET), Dave Yirrell (DY), Emma Watson (EW; by ‘phone)
2. / Apologies
Kate Cuschieri (KC), Kirstine Eastick (KE), Paul McIntyre (PMcI)
3. / Draft Minutes of Last Meeting (20 June 2012)
Accepted as accurate record; IJ will forward to SMVN. IJ updated the meeting that RIE had embarked on 7-day laboratory working, which entailed norovirus and respiratory PCR assays now being offered daily. PJM raised the perceived inequity of laboratory service across Scotland since other regions didn’t have similar capacity and would struggle to achieve it within current funding/staffing constraints. JAGB/KET explained that the change at RIE had been driven by clinical need and revision of working practices. Reconfiguration of laboratories was being carried out in order to achieve a greater degree of laboratory integration. DY/KET stated that 7-day laboratory working should be the goal of Scottish Virology laboratories, which the meeting agreed with provided such an aspiration was tied into provision of adequate resources. / IJ
4. / Matters Arising
4.i Blood-Borne Viruses
a) BBV Testing and HFEA
PJM raised an issue with the 8th edition of the HFEA’s Code of Practice (2009; circulated before the meeting) which seems to require gametes or embryos from HBsAg-neg/HBcAb-pos individuals to be kept under quarantine (see T50 a-b on p132). The meeting agreed that this seemed rather excessive in light of very low risk of HBV infection of other samples stored alongside such specimens. IJ will highlight the matter with UK CVN (Prof Zuckerman).
b) Diagnosis of Infection in HIV-Infected Individuals
CA had requested comments on a draft tabulated approach to infection in HIV-infected individuals, which she will submit to the HIV Clinical Leads group (integrated care pathway). Comments on the approach/suggestions should be directed to CA.
c) HBsAg-neg/HBcAb-pos Results and Haemodialysis/Infliximab
CF highlighted need for SCVCG input regarding these situations. IJ will seek input from RIE Hepatology as regards infliximab therapy but await Renal Association’s comments on draft SCVCG consensus approach to haemodialysis that questions the role of HBcAb testing in that setting (see also 5.1.a below).
4.ii Consensus Approach
a) ADV, CMV and EBV PCR Viral Load Assessments
RG outlined the results of a comparative study of PCR tests for ADV, CMV and EBV carried out at GGH (lab 1), RIE (lab 2), ARI (lab 3) and NWH (lab 4). All the labs performed in an adequate and similar manner in terms of virus detection and CMV quantification. The same applied to EBV quantification apart from NWH obtaining 0.5-1 log lower values than the other laboratories/QCMD. NIBSC now offer international standards for CMV and EBV quantification, and the meeting agreed the importance of incorporating such standards without delay into current approaches with a view to commence reporting CMV and EBV VL in IU/mL by 1 January 2013. Already, some of the laboratories have incorporated the CMV int’l standard. RG will follow this up and provide assistance if/when needed. APG and others highlighted the importance of consistency of reporting across the SCVCG/SMVN, which is embedded in the SCVCG Terms of Reference. Already, GGH has produced a draft approach for BMT patients along such lines with a view to provide consistent and comparable CMV VL values across the Scottish Laboratories. CA will re-circulate the draft for information. APG raised whether such consistent approach to laboratory testing should be highlighted to the CMO as examples of good laboratory practice.
4.iii Gastroenteritis Viruses
a) Hepatitis E Virus Business Case
The meeting thanked the authors for a well presented HEV business case that – following minor amendments (including addition of test data from all the Scottish labs, a summary page and page numbers alongside some shortening of text) should be presented as a Scottish-wide proposal to HPS. SR will collate the additional data and IJ will then forward the finalised document to Dr Martin Donaghy at HPS for assessment of how best to take matters forward in terms of approach and funding. Whilst one idea is to propose HEV instead of HAV testing in the context of initial acute hepatitis screening, the meeting was concerned that such an approach would risk missing clinically significant HAV cases.
b) Norovirus
- b.i) Report to HAITF NPG
KET stated that current expectation was for norovirus results to be available in less than 12 hours from receipt in the Virology laboratory, which IPCNs were now expecting for IPC management. The meeting discussed the logistical challenges of such a commitment in the absence of 7-day working across the country. EMcC/PJM suggested re-phrasing the statement to include results to be available within the laboratory working day, which would then depend on local definitions as regards exact service delivery. CA/DY raised the important matter of testing/POCT at the point of entry (eg, A&E) into hospital although such an approach should ideally involve PCR tests in light of the low (approx 70%) sensitivity of POCT for norovirus. Whilst the meeting agreed that testing was important for current management of norovirus (including closure of beds/bays/rooms/wards), it was also noted that the evidence base for the effectiveness of such an approach was weak. The meeting agreed the importance of expanding the evidence base by formulating relevant research questions and generate pilot data although EMcC stated that finding a suitable control group was a particular challenge. IJ highlighted that the circulated Report to HAITF NPG raised these issues and included research questions in need of answers as well as thoughts on possible funding for such projects (eg, SIRN). KET informed that she was in the process of drafting a grant proposal to the CSO to ascertain the clinical utility of a pan-gastroenteritis test panel (includes microbes and viruses) in the context above. IJ suggested that KET consider widening such an approach to all the Scottish Virology laboratories with a view to the grant application being in the name of the SCVCG although it could be led by her. KET stated that she would be happy with such an approach provided the SCVCG was supportive. The meeting voiced its support for the project as outlined. KET will move matters forward in liaison with SCVCG.
- b.ii) Potential Novel Pandemic Strain
The document highlighted the pandemic potential of the Sydney 2012 norovirus strain as informed by NoroNet. The strain may replace the New Orleans 2010 pandemic strain.
- b.iii) Source of Norovirus in Hospital Setting
CA stated that GG&C Healthboard had voiced an interest in ascertaining whether norovirus in the hospital setting pre- or post-dated virus circulating in community. The meeting felt that it was most likely to be the latter situation.
4.iv Rash Viruses
a) Measles Immunity and the OHS
PJM raised the issue of a Grampian Public Health Consultant not wishing to accept measles IgG-pos result in the OHS setting as evidence of HCW immunity to measles. The meeting agreed that in the absence of an international standard, and in light of UK immunisation guidance (the ‘Green Book’), the test provided means of assessing measles immunity in HCW without prior history of 2 MMR vaccine doses.
b) Rubella Reporting
CF raised the matter of reporting samples that tested rubella 0<IgG<10 IU/mL in two assays. Whilst the meeting ascertained that most laboratories now report such samples as ‘rubella IgG-neg’, DY raised that NWH reported such samples as ‘rubella detected <10 IU/mL’. The meeting agreed that all Scottish laboratories should report in a similar manner along consensus reached at last SCVCG meeting unless re-formulation of a consensus approach was warranted. HH highlighted that Finland is about to introduce a 3rd MMR booster into its immunisation schedule. IJ will clarify NWH’s approach and seek input from JCVI regarding the MMR schedule. Once the information is obtained, he will re-circulate rubella comments.
4.v Respiratory Viruses
a) H3N2v and Novel Coronavirus
The situation hasn’t changed from circulated statements. The influenza matrix assay will detect the composite H3N2 strain, and GGH offers testing for the novel coronavirus.
4.vi Viral Haemorrhagic Fever
a) New VHF Guidance – Sample Handling/Processing
CF raised the issue of sample handling outlined in the new VHF guidance document from DoH (2012). IJ outlined his understanding that all samples could be handled under level 2 conditions unless VHF had been confirmed by RIPL (Porton Down). Whilst the meeting agreed, CA highlighted GGH’s recent experience with CCHF that resulted in retrospective quarantine of samples once such confirmation had been obtained from RIPL causing considerable logistical problems after the event as it were (in the end, pt couldn’t be ventilated in isolation in Glasgow and was flown to RFH by RAF where he died). CA explained that introduction of analytical equipment into isolation rooms for sole use in the VHF context hadn’t been a straight-forward process. The meeting also discussed the vague use of the term ‘inactivation’ in the context of such samples since it was now clear that usual approaches to inactivation would render samples unsuitable for meaningful testing – unless RIPL could recommend a particular manner in which this was achievable without ruining the specimens. CA informed the meeting that RIPL is in the process of convening a UK-wide working group to address such challenges faced by Clinical Virology laboratories. She will represent SCVCG at such a meeting and feed back to the group.
JAGB highlighted that Lothian protocols included ?VHF assessments to be sought from IFS, which had resulted in a possible VHF sample being sent to RIPL following ID consultation although malaria film was positive. CA suggested ID units should be supplied with necessary materials for sending such samples directly to RIPL although that was only half the solution since other tests were required locally (eg, malaria tests). IJ/KET suggested that the Lothian protocol should be revised unless local VHF testing was introduced, which was an option if RIPL was happy to share their technical expertise. In the meantime, it was suggested that FAL consider seeking IFS assessment in liaison with ID physicians if/when the question of VHF arose. KET highlighted that HPS get billed directly by RIPL for their VHF service. IJ will contact Camilla Wiuff at HPS with a view to inform SCVCG of the cost incurred by VHF testing in Scotland that might support local implementation of testing.
4.vii SCVCG
a) Representation
- a.i) Childhood HBV Immunisation Leaflet
PJM had raised the matter of SCVCG input into the leaflet, and IJ had sent Kirsty Rankin (HPS) a request along such lines. Once response is obtained, IJ will circulate to SCVCG for comments.
- a.ii) HPN
IJ explained that Mary Quinn, Chair of HPN, had raised the matter of whether SCVCG representation was required now that SMVN was represented at HPN. For discussion, IJ deferred to (4.vii.b) below.
- a.iii) PCR Users Group
DY explained that the group should remain on the SCVCG’s agenda as a standing committee, which hadn’t changed following formation of SMVN. Also, he suggested that colleagues from Wales and Northern Ireland be invited to participate. APG stated he didn’t have any objection to this approach. Rather, he was very supportive and highlighted that HPA now seeks Scottish and Welsh representation at some of their meetings. DY will proceed along these lines and feed back to SCVCG.
- a.iv) Scottish Zoonoses Group
IJ stated that SZG was seeking SCVCG representation following Bill Carman’s departure. Interested parties should contact IJ.
b) Terms of Reference and SMVN Constitution
IJ raised the phrasing of SCVCG’s standing with SMVN as outlined in recent SCVCG minutes as being ‘an independent subgroup’ of SMVN. IJ felt that the use of the term ‘subgroup’ was rather unfortunate considering how it was used in the SMVN’s Constitution as a focused (often short-term) working group under the auspices of SMVN. DY suggested that the terminology be changed such that the SCVCG was ‘an independent group affiliated with the SMVN’. APG stated that this approach was consistent with the SMVN having a flat management approach rather than a hierarchical one, which was in line with the SMVN not being responsible for delivery of Scottish Microbiology/Virology service. The meeting agreed the change to the Terms of Reference. IJ will forward the information to SMVN (FMcK). / IJ
IJ
RG
CA
SR/IJ
KET
IJ
CA
IJ
IJ
DY
IJ
5.
6. / Updates/For Information
5.i Consensus Approach
a) HBV Immunisation & OHS Setting; BBV Testing & Haemodialysis
IJ stated that the SCVCG consensus documents had gone to Scottish OH Physicians and Renal Association, respectively. Preliminary assessment was that the OH medics would wish to adopt UK guidance (‘Green Book’) whilst the Renal Association was reviewing its guidance and wished both documents to reflect a common approach if possible. IJ will feed back when formal outcome is known (see also 4.i.c above).