Assessment of laboratory diagnostic and surveillance system for enteric infections in Azerbaijan

Abstract

Purpose: Our study sought to gain a better understanding of the etiology of infections that fall within the generalized diagnosis of enteric infections with unassigned etiological agent. We hypothesized that meticulous assessment of patient diagnostic and surveillance data from enteric infections in Azerbaijan would increase our knowledge of the enteric disease situation in the country. In consequence, our ability to assign causative agents to enteric infections would be enhanced and gaps in public health detection and reporting requirements could be identified. Methods & Materials: Given the high number of AEI cases with unknown etiology in Azerbaijan, AEI patient data from 2014 to 2016 were analyzed using the Electronic Integrated Disease Surveillance System (EIDSS) and patient information from annual reports from the Bacteriology Laboratory at the Republican Center of Hygiene and Epidemiology. Results: The analysis revealed that yersinosis (0.3% of the cases), shigellosis (0.6%), and salmonellosis (5.7%) were the most common AEI cases. Opportunistic bacterial infections accounted for remaining cases. Between 2014 and 2016, notification of enteric infections improved with every year (i.e., 2014: 67.4% of timely notifications; 2015: 80.4%; 2016: 87.3%). EIDSS entry deficiencies included the lack of antibiotic treatment information in 57.4% of the cases, and an overwhelming incidence of AEI diagnosis based on clinical-epidemiological data (78.6%) and not confirmatory laboratory assays, indicating that treatment received was not etiologically substantiated. Absence of point-of-care, pathogen detection assays covering more agents, especially viral agents, might in part explain the high rate of clinical diagnosis of AEIs as "acute enteric infections of unknown etiology". In fact, in Azerbaijan, only rotaviruses are currently tested when viral enteric infections are suspected. Conclusion: Better communication among health system databases with established minimum data entry requirements, including treatment and disease chronology information, capability for multiple pathogen testing and improvement in the quality of EIDSS entries to reconcile electronic and paper forms of notification are needed. Use of rapid immunological or molecular diagnostic methods, or test strips using immunochromatographic technology, rather than traditional long-term culture assays, should expedite pathogen identification. Altogether, such efforts will improve diagnosis, treatment and spread control of diarrheal diseases in the country.