International external quality assessment scheme for the laboratory diagnosis of diphtheria

An international external quality assessment (EQA) scheme has been establis hed so as to evaluate the proficiency of specialist, national diphtheria re ference laboratories in the laboratory diagnosis of diphtheria. Six simulat ed clinical specimens were freeze-dried and distributed to 23 participants in 20 countries. Participants were asked to isolate, identify and perform t oxigenicity, testing on any corynebacteria present and to complete a simple questionnaire describing the procedures and reagents used. Only three labo ratories obtained correct biochemical and toxigenicity, results for all six specimens. The majority of laboratories performed better with toxigenicity testing than with the biochemical identification. Of concern were the resu lts from three laboratories that failed to isolate any corynebacteria from four or more of the specimens. In one centre this was shown to be due to la ck of availability of 'in-date' media and, in the other two, was presumed t o be due to lack of experience in primary laboratory diagnostics for this o rganism. It is essential that countries, globally, maintain awareness and l aboratory capabilities in this specialised area of microbiology. EQA is an invaluable process, which enables laboratories to monitor, evaluate and imp rove their own performance in such areas.