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SCOTTISH CLINICAL VIROLOGY CONSULTANTS GROUP

APPROVED MINUTES OF MEETING

Wednesday 12 March 2014 (10am-1pm) – Reception Room, Perth Royal Infirmary

1. / Welcome and Apologies / Actions
Welcome (Present)
Ingó Johannessen (Chair; IJ), Celia Aitken (CA; teleconf), Roger Evans (RE; teleconf), Rory Gunson (RG; teleconf), Paul McIntyre (PMcI), Pamela J Molyneaux (PJM), Eleri Wilson-Davies (EWD), Dave Yirrell (DY)
Apologies
John AG Bremner (JAGB), Kate Cuschieri (KC), Kirstine Eastick (KE), Craig Ferguson (CF), Heli Harvala (HH), Sandeep Ramalingam (SR)
2. / Draft Minutes of Last Meeting
Draft minutes of last meeting (6 November 2013) accepted as accurate record with an amendment to item 1 (RE by teleconf) and 3.ii.iii (PJM taken over co-ordination from RG); IJ will forward to SMVN for uploading on website. / IJ
3. / Matters Arising
3.i / Blood-Borne Viruses (BBV)
3.i.i / Quantitative HBsAg and HBV resistance testing
qHBsAg offered now by GRI and RIE on Abbott and DiaSorin platforms, respectively. GRI offers HBV resistance testing.
GRI have looked into HBcAb IgG avidity assays but do not offer such testing at this time. Instead, samples can be referred to BBV services at PHE if required.
3.i.ii / HCV antigen, avidity and resistance testing
GRI and RIE offer HCV Ag testing on the Abbott platform in addition to HCV PCR assays. Other centres offer HCV PCR approaches. There have been issues with the HCV Ag assay in terms of concerns regarding kit batch variability as well as general concerns regarding the Architect machines and possible issues with their probes that may translate into cross-contamination of samples.
GRI is developing HCV IgG avidity and results are promising as regards venous blood but some issues remain regarding stored samples and DBS. The latter is of particular concern since follow up is often DBS rather than fresh venous blood. Whilst HPS is keen on the assay for epidemiological questions, the clinical utility of the assay needs to be clarified.
As for HCV resistance testing (for NS3 PIs; Q80K), GRI and RIE can offer such analyses but the clinical demand and clinical utility of such tests remains to be clarified. The assays primarily remain a research tool for now.
3.i.iii / Added item: HIV avidity and NPT testing
GRI and RIE have established HIV IgG avidity assays and GRI will go live on 1 April 2014 with HPS support.
All centres (except Raigmore) offer HIV NPT (for high risk groups), that are often (ARI, RIE) offered together with syphilis NPT (and, for RIE, HCV NPT).
3.ii / Gastroenteritis Viruses
3.ii.i / Hepatitis E virus
UoE (Peter Simmonds; PS) had offered RIE (and SCVCG) to genotype all new HEV cases, which the meeting agreed was a good way forward as a SCVCG collaborative project. Thus, the suggestion was that all centres would forward such samples to RIE for analyses in PS’ laboratory.
3.ii.ii / Norovirus
SG HAI PU has sent out an offer for laboratories to consider 3-year rental of Cepheid machines with HAI PU funding for running costs with a view to assess common pathogens by rapid NAAT-based methods as a proof-of-principle assessment of such approaches. RIE has trialled such an approach to norovirus PCR testing in the MoE ward setting with encouraging preliminary results in terms of turn-around time and impact on management. The Luminex platform is another approach – but the SG HAI PU offer centred on Cepheid. The meeting agreed that it would be helpful for SCVCG to have input into the study design of any such proposal. Each centre will consider the matter and feed back to SG HAI PU.
3.ii.iii / Laboratory test panels
For GI pathogens, ARI, Dundee and Raigmore use PCR-based assays for norovirus testing but immunochromatographical tests for rotavirus (<5-6yo) and adenovirus (<5yo). GRI uses PCR-based assays for norovirus, rotavirus, adenovirus, sapovirus and astrovirus testing in the <10yo group and for IPC purposes. RIE tests norovirus and rotavirus by PCR, the latter in the <5yo group.
3.iii / Rash Viruses
3.iii.i / Measles
IJ raised the matter of a letter from HPS requesting Virology input regarding measles (see circulated letter). In particular, HPS wished to learn from each centre (1) which measles IgG assay(s) were used from 2008 onwards and (2) details of any measles IgG-negative results obtained during the same time (date of birth, date of test and test result only). The meeting agreed to provide HPS with the information directly. IJ will inform HPS of the outcome. / IJ
3.iii.ii / Parvovirus B19
All centres have observed an increase in parvovirus B19, which is in line with UK data.
3.iv / Respiratory Viruses
3.iv.i / Influenza A
All centres offer FA PCR testing, and all centres are using the same FA matrix assay for this purpose. GRI is funded by HPS to sequence approx. 150 representative respiratory samples (outbreaks, vaccine failures, severe respiratory infection and deaths) from across Scotland. The sequence data (alongside its interpretation) is submitted to the various national and international surveillance agencies.
3.iv.ii / MERS-CoV
The MERS-CoV PCR assay is now offered at GRI and RIE.
3.iv.iii / Laboratory test panels
All centres offer FA, FB, RSV, PF1-4 and ADV PCR-based tests. In addition, ARI, Dundee, GRI and RIE offer rhinovirus testing. ARI, GRI and RIE also offer mycoplasma and CoV testing; bocavirus can be tested at GRI and RIE. Pertussis testing is on offer but only in selective cases and the same applies to legionella (PCR-based assays at GRI and RIE but referred serology at ARI, Dundee and Raigmore).
Update from CF (after the meeting) re FAL:
‘FAL respiratory panel (FT diagnostics) – FluA (incl H1N1 subtyping), FluB, paraflu 1-4, rhino, adeno, metapneumo, bocavirus, RSV A/B, mycoplasma pneumoniae and coronaviruses: NL63, 229E, OC43, HKU1. The panel can also detect enteroviruses and parechovirus, however these have not been clinically evaluated so we do not report them on respiratory samples.’
3.v / VHF
3.v.i / Scottish approaches
CA informed that Porton Down would not wish to be too involved in a Scottish version of their service but have suggested the use of commercially available front line assays for ‘common’ imported pathogens. Their service handles samples in Cat 3 unless culture is required, which then necessitates use of their Cat 4 facilities. The meeting agreed that it would be helpful to Scotland if it were possible to embed front line assays nationally – and dovetail such approaches to a Scottish Imported Fever Service and establishment of high security unit(s). CA will go back to Porton/PHE for further input. Already, IJ has suggested a Scottish approach to SG HAI PU (Camilla Wuiff), and the initial response was positive. / CA
3.vi / SCVCG
3.vi.i / Specialist training and configuration of infection services
The matter of joint medical training requires further consideration by SCVCG in terms of suggestions for a way forward with particular reference to impending/possible establishment of joint infection units.
4. / Updates/For Information
No items raised.
5. / Reports
No items raised.
6. / AOCB
RE raised the matter of HSV IgM testing in the TORCH context, and it turns out that no centre offers such testing. Samples can be sent to PHE, but the clinical utility of such an approach remains unclear.
CA raised the matter of ensuring SMVN receives annual overview of SCVCG activity, which the meeting agreed would be helpful. IJ will consider the best way of providing such information although we already feed into annual SMVN activity (see prior SMVN reports).
IJ suggested that SCVCG establish a Deputy Chair for the group who could partake in the work along similar lines observed with other bodies. Equally, he stated that he had discussed such a position with EWD who was very interested in taking on such a role should the meeting be agreeable to such an approach. The meeting agreed to both suggestions and, thus, EWD is our Deputy Chair with immediate effect. / IJ
7. / DONM
Wednesday 11 June 2014 - 10am to 1pm; PRI
Wednesday 12 November – 10am to 1pm; Pentlands Science Park, Moredun
Wednesday 11 March 2015 - 10am to 1pm; PRI

Approved SCVCG Minutes – 12 March 2014

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ACTIONS FROM MOST RECENT MEETING

Item / ACTIONS
from Meeting on 12 March 2014 / By / Update
48 / Forward minutes of last meeting to SMVN. / IJ / Completed
49 / Inform HPS of outcome regarding provision of measles data. / IJ / Completed
50 / Obtain further input from PHE regarding VHF approaches / CA / Completed
51 / Ensure SCVCG annual input into SMVN / IJ / Completed

ACTIONS FROM PRIOR MEETINGS

Item / ACTIONS
from Meeting on 6 March 2013 / By / Update
12 June 2013
1 / Forward minutes of last meeting to SMVN. / IJ / Completed
2 / Forward RG’s ADV/ CMV/ EBV Report to SMVN as an example of good practice in the laboratory setting. / IJ / Completed
3 / Forward IJ’s protocol for BBV testing in HDx setting to SMVN. / IJ / Completed
4 / Circulate draft anti-HBs statement. / IJ / Completed
5 / Collate data from Scottish laboratories and assess cost-benefit of HBV screening/ immunisation options with a view to suggest an SCVCG approach. / PMcI / see Agenda for 12 June 2013
6 / Forward RIE HAV audit to SCVCG for information. / KET / Completed
7 / Update SCVCG regarding HEV business case. / IJ / see Agenda for 12 June 2013
8 / Update SCVCG regarding norovirus funding application. / KET / see Agenda for 12 June 2013
9 / Clarify the ‘Norovirus: Report for HAITF National Policy Group’ document with particular reference to the use of individual tests, TAT
< 1 working day, and 7-day laboratory working. / KET / see Agenda for 12 June 2013
10 / Update SCVCG regarding rotavirus strain diversity study. / RG / see Agenda for 12 June 2013
11 / Circulate spreadsheet with the status of each data outcome of BBV and sexual health action plan. / KET / Completed
12 / Remove ‘NHS Quality Improvement Scotland Hepatitis C Project Group’ from list. / IJ / Completed
13 / Ensure representation of SCVCG at next meeting of Reference Laboratories Working Group. / DY / Completed
14 / Clarify with Prof D Goldberg whether there is duplication of work between different groups looking at HBV in pregnancy. / PMcI / No response obtained; will not be pursued further at this point
15 / Circulate document from Scottish Zoonosis Group on roles and responsibilities. / RG / Completed
16 / Forward SMI document on CMV serology to IJ for assessment. / KET / Completed
17 / Ensure appropriateness of current influenza B primers/probes at PCR Working Group. / DY / Completed; deemed appropriate
18 / Ascertain by Doodle poll the most suitable date for next meetings - at PRI. / IJ / Completed
Item / ACTIONS
from Meeting on 12 June 2013 / By / Update
6 November 2014
19 / Forward minutes of last meeting to SMVN. / IJ / Completed
20 / Inform Scottish BASHH and SHIVAG of consensus approach to HBV testing and HAV/HBV vaccination in the GUM setting. / PMcI,KET / Completed
21 / Supply PMcI with data to ascertain the nationwide situation as regards HBsAg/HBcAb status of GUM attendees. / All / Completed
22 / Forward 2012 HPS report on HIV in Scotland. / IJ / Completed
23 / Suggest to HPS that they increase granularity of Scottish HIV prevalence data. / CA/KET / Completed
24 / Seek guidance from HPS Medical Director’s Office as to how best to ensure SCVCG representation in decision-making processes that have direct impact on the laboratories. / IJ
25 / Forward GGH’s document on testing in immigrant populations in GGC. / CA / Completed; pertained to BBV test offer
to asylum seekers
26 / Discuss the Grampian approach to universal BBV testing for new GP patients with Prof Goldberg and Dr Martin Donaghy of HPS. / PJM / Completed; similar to 25 above – pertained to BBV test offer to high risk individuals (not all GP patients);
?offer MMR at same time
27 / Forward a draft of indicator conditions that the Scottish laboratories may wish to adopt as reference to when to add an automated reporting comment suggesting additional HIV testing. / CA / SCVCG labs to implement
by 1 August 2014
28 / Assess whether ARI’s lab system is able to convert assay values automatically into log10 values. / PJM / Completed
29 / Tayside will trial reporting HIV VL in both c/mL as well as IU/mL for a period of 3 months and report their experience back to SCVCG. / PMcI/DY / Completed
30 / Forward samples (and relevant clinical information) on cases of acute HAV in 2013 to RG for genotyping. / All / Completed
31 / Amend wording of SCVCG HEV Business Case with a view to ensure it reflects that funding is being sought to enhance each laboratory’s HEV serological diagnostic service; forward to Alison Smith-Palmer for assessment; report back to SCVCG in due course. / SR / Completed
32 / Forward Norovirus Report to the SMVN Steering Group for assessment with a view also to seek input from the HAI Task Force (IJ/KET). / IJ/KET / Completed
33 / Forward rotavirus-pos stool samples collected between Sept 2012 and May 2013 to PJM for assessment of strain diversity. / All / Completed
34 / Forward UK SMI P1i4 (‘Surveillance of Polio in the UK’). / IJ / Completed
35 / Circulate draft Raigmore response to CPA non-conformity as regards handling/processing of respiratory samples for comments to ensure alignment with other laboratories. / EW / Completed
36 / Obtain further clarification of the role of individual staff grades in handling and shipping samples as well as ensuring appropriate packaging is kept in designated locations (HH/SR). / HH/SR
37 / Draft VHF learning module in liaison with SCVCG and NHS Scotland. / HH/SR
38 / Forward a draft outline proposal to SCVCG for consideration of establishment of RIPL satellite service in Scotland (possibly including Scottish IFS). / CA
39 / Forward GGH VHF SOP for information. / CA / Completed
40 / Present a draft consensus approach to VHF at next SCVCG meeting. / CA/HH/IJ/SR / Completed
41 / Request Dr Martin Donaghy’s input into next SCVCG meeting with a view to walk through possible closer ties with HPS Medical Director’s Office. / IJ / Martin had to cancel at last minute and has now retired.
42 / Put together a 1-page summary of arrangements for closer working with HPN. / RG / Completed
43 / Inform SCVCG as to what information is required to support the drafting of a consensus approach to screening prior to implementation of biologicals/immunomodulatory therapy. / EW/CA / CA will drat a document with DB well in time for circulation prior to next meeting
44 / Raigmore to work with SCVCG on prospective toxoplasma testing for a period of 3 months with a view to present the findings – and suggest a way forward – at the next SCVCG/SDVG meeting on 6 November at Moredun. / EW / Completed; gone to SMVN; EWD will ensure RE can make any final comments
Item / ACTIONS
from Meeting on 6 November 2013 / By / Update
12 March 2014
45 / Forward minutes of last meeting to SMVN. / IJ / Completed
46 / Forward updated version of paper on VZV vaccination and the immunosuppressed state. / CA / Completed
47 / Provide SCVCG comments on HPS consultation on transmission-based precautions prior to the deadline of 11 November 2013. / JAGB / Completed

Approved SCVCG Minutes – 12 March 2014