The Dengue Laboratory Network of the Americas (RELDA) is a key component of the IMS-dengue for strengthening the scientific and technical capabilities of laboratories to support national dengue prevention and control programs. The network was created in2008 , which includes a framework for action in the countries to standardize laboratory protocols for dengue diagnosis, train human resources from the national reference laboratories, introduce a regional research agenda and quality management system in network laboratories, and integrate the available scientific and technical capabilities in the Region to ensure a timely response to dengue outbreaks and epidemics and regional contingencies.
RELDA's objective is to strengthen the scientific and technical capabilities of the Region's laboratories in order to provide timely, quality epidemiological surveillance and response to dengue outbreaks in support of national programs for the prevention and control of dengue and other viral diseases.
- Standardized laboratory protocols for dengue diagnosis.
- Standardized reagents and regionally evaluated, nationally validated commercial kits.
- Human resources at national reference laboratories trained to meet identified needs.
- Implementation of a research agenda based on the priority areas identified.
- Implementation of a quality management system in network laboratories that includes standard operating procedures (SOP) and a code of ethics; routine use of standard and special biosafety procedures; participation in the external evaluation program through proficiency panels and vertical and horizontal audits.
- All available scientific and technical capabilities in the Region integrated to facilitate a timely response to dengue outbreaks or epidemics and contingencies.
Dengue is a growing public health problem worldwide, particularly in the Americas. As part of the PAHO/WHO effort to tackle this challenge through a new, integrated work model that includes health promotion and the search for new linkages, the Ministers of Health of the Americas adopted Resolutions CD43.R4 and CD44.R9 during the Directing Councils of 2001 and 2003, respectively. The latter resolution established the Integrated Management Strategy for Dengue Prevention and Control (IMS-dengue) as an area for PAHO/WHO technical cooperation to the Member States.
More recently, during the 27th Pan American Sanitary Conference, the Ministers adopted CSP27.R15, urging the countries to implement national strategies and technical cooperation to reduce the social, economic, and political burden that dengue represents.
Laboratories in the IMS-dengue
Laboratories are a key component of the Integrated Management Strategy for Dengue Prevention and Control. Strengthening the PAHO/WHO Collaborating Centers and national reference laboratories for dengue diagnosis through information exchange and technology transfer among them is a strategic intervention. PAHO/WHO considers it a priority to strengthen national laboratories, upgrade skills, and promote a quality management system to guarantee good virological and epidemiological surveillance of dengue and the standardization of reporting criteria. Moreover, dengue control will depend on the potential findings of interdisciplinary research and intervention studies, as well as technological innovation.
Creation of the Dengue Laboratory Network of the Americas (RELDA)
As a first step toward reaching these objectives, two meetings were held with the Collaborating Centers. The first took place in August 2006 in Buenos Aires, Argentina and was attended by the PAHO/WHO Collaborating Center in that country for the study of dengue and its control ; the Pedro Kouri Institute of Tropical Medicine (IPK) of Havana, Cuba; the Evandro Chagas Institute(IEC), the PAHO/WHO Collaborating Center for Research, Diagnostic Reference, and Training in Arbovirus and an institute of Brazil's Secretariat of Health Surveillance ; the "Dr. Julio Maiztegui" National Institute of Human Virological Diseases (INEVH) of Pergamino, Argentina, the PAHO/WHO Collaborating Center for reference and research on arboviruses and viral hemorrhagic fevers; the WHO Collaborating Centre for Dengue and Dengue Hemorrhagic Fever Reference and Research, San Juan laboratories, Dengue Branch, Division of Vector-borne Infectious Diseases, Centers for Disease Control and Prevention (CDC), San Juan, Puerto Rico, jointly with PAHO/WHO.
At this meeting, the need for the Collaborating Centers, jointly with the national reference laboratories, to play a more active role in implementing the Integrated Management Strategy for Dengue Prevention and Control was stressed. The need to survey the laboratories to learn about their dengue diagnostic capabilities, as well as their limitations, was also noted, and the creation of a joint quality management system integrating the Region's dengue surveillance systems was explored. Also discussed was the need for a website (link) to furnish key information on each center and laboratory, structures, resources, technical expertise, and research projects.
A survey of the Region's laboratories was therefore conducted (http://www1.paho.org/english/ad/dpc/cd/den-cc.htm) that yielded detailed country information on laboratory capabilities, the techniques in use, and the networks in which the laboratories participate.
In August 2007, the second meeting of the PAHO/WHO Collaborating Centers for dengue was held in Havana, Cuba, to follow-up on the agreements reached at the Buenos Aires meeting. Participating were the Collaborating Centers for dengue of Argentina, Brazil, and Cuba, as well as PAHO/WHO. The main focus of the meeting was the network's participation in implementing the IMS-dengue, strengthening joint research in the Region, planning the components of the quality management system for dengue diagnosis, and procuring financing for the Collaborating Centers and the preparation of reagents and their exchange between the Collaborating Centers and national reference laboratories. Formal establishment of the Dengue Laboratory Network of the Americas was proposed, involving all the national reference laboratories already conducting dengue surveillance and the Collaborating Centers. This called for a joint meeting of the Collaborating Centers and national reference laboratories.
In June 2008, PAHO/WHO brought the Collaborating Centers and national reference laboratories together to reach agreement on the creation the Dengue Laboratory Network of the Americas (RELDA). Participating in the event were the heads of the dengue laboratories of the Collaborating Centers for dengue of Argentina, Brazil, Canada, the Caribbean represented in Carec, Cuba, and Puerto Rico, in addition to the chiefs of virology of the national reference laboratories of Bolivia, Costa Rica, the Dominican Republic, Ecuador, El Salvador, French Guiana, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, and Venezuela. Chile, Colombia, and Uruguay were unable to participate. At the meeting, the RELDA guidelines were drafted and the framework for the work, with expected results and specific activities, was jointly developed.
In August 2009, the III Meeting of the Dengue Laboratory Network of the Americas (RELDA) was held in Havana, Cuba. The event's participants included the PAHO/WHO Collaborating Centers for dengue and the national reference laboratories. The heads of the dengue laboratories of the WHOCC for dengue and other arboviruses of Argentina, Brazil, and Cuba participated, along with the chiefs of virology of the national reference laboratories of Bolivia, Chile, Colombia, Costa Rica, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, and Venezuela. In addition, the Caribbean countries of Belize, Guyana, Jamaica, and Suriname joined the network.
At the meeting, Dr. Guadalupe Guzmán (IPK, Cuba) was named RELDA Coordinator for 2 year term, and a first technical advisory committee was formed, made up of five WHO Collaborating Centers (Argentina, Brazil, Canada, Cuba, and Puerto Rico) and four subregional coordinators (CAREC, North America, Mexico and Central America; Andean Region and Southern Cone).
Forms to become a RELDA member
- Cuestionario para los Laboratorios Nacionales de referencia para el diagnóstico de dengue/Survey for the national Reference labs for dengue diagnostic
- Preguntas complementarias del Cuestionario para identificar capacidades y necesidades de los Laboratorios miembros de la RELDA