Laboratory staff perceptions

Laboratory staff perception of factors contributing to the a) success and b) barriers/challenges with respect to laboratory testing for arboviral infections (ref Q20)

Country	Successes	Barriers
Albania	Following the SOP for sampling, storage, transportation of the samples. Good quality of diagnostic kit with high specificity and sensitivity. Training of the staff.
Armenia	Sufficient human resources and laboratory equipment	Lack of protocols/algorithms for laboratory investigations (sometimes clinicians send samples with the indication "febrile diseases" and it's a challenge to decide for what the samples should be investigated).
Bosnia and Herzegovina
Bulgaria
Croatia	Interdisciplinary and multisectoral "One Health" approach
France	Mandatory case reporting, availability of RT-PCR in many laboratories at primary care level, automatic reporting.	Atypical symptomatology; delay or absence of consultation by the patient; absence of test prescription by doctors
Georgia	Possession of laboratory equipment/capacity as success.	Arboviral diagnostic laboratory staff perceives virus isolation as a barrier/challenge.
Germany	Seminars, training, higher compensations	Seminars, training
Greece	Regular participation to External Quality Assurance Services (EQAs) Funding Expertise of laboratory personnel - laboratory capacity Networking - good interpersonal communication among clinicians, laboratory experts and public health workers of the NPHO	Human resources
Hungary	The Hungarian National Reference Laboratory (NRL) for Viral Zoonoses is in close cooperation with the Hungarian NRL for Viral Exanthematous Diseases at the National Public Health Center (NPHC). The standard panel for investigating the aetiology of exanthematous illnesses includes screening for measles, rubella and/or parvovirus B19 viruses, while testing for WNV is in many cases not requested by the clinicians. As a result of the collaboration between the two reference laboratories, samples obtained from patients with exanthema, fever, myalgia and/or arthralgia are also involved in WNV screening during the transmission period.
Italy	We are trying to improve external evaluation tests (ring tests) in the network of regional reference laboratories.
Malta	Having enough personnel to do the work	Not always having reagents, kits available all the time due to laborious procedures to obtain such equipment (administrative)
Monaco
Portugal
Romania	Periodic training	Lack of reagents, lack of modern laboratory equipment
San Marino
Slovenia	Laboratory is equipped with BLS3 facility and has experienced staff, thus we are able to diagnose endemic and imported arboviral infections, including confirmatory tests, as NT or NGS. For TBE we have established a protocol to recognize and follow TBE vaccine breakthrough cases. The laboratory has a role of national and international reference centre for arbovirus diagnostics.	Main barrier is underestimation of arboviral infections, due to several reasons (unspecific clinical picture, insufficient knowledge on emerging arboviruses). We estimate that there are too few people tested for West Nile virus infection, which is probably due to the uncharacteristic clinical picture and insufficient knowledge of this emerging infectious disease.
Spain	Have a network. Have research projects.	More staff in the laboratory and more integration in One Health
Switzerland	Good and uncomplicated communication between health authorities and laboratories	Insufficient sample material for further testing at the reference laboratory
Turkey	Turkey is experienced in arboviral diseases diagnosis as Crimean Congo Hemorragic Fever is endemic in the country. The Reference Laborotory has very experienced staff and has a very high diagnostic capacity.