Diagnosis, an essential link for preventive medicine

By the bioMérieux Editors | Reading time: 4 min

PUBLICATION DATE: NOVEMBER 22, 2023

While calls for more prevention in public health strategies are increasing, in vitro diagnosis appears to be a major tool at all stages: stratification of risk factors, screening and early diagnosis, establishment of prognosis, monitoring of the effectiveness of treatments, and long-term monitoring of complications and/or relapses. Explanation, with Isabelle Tongio, Director of Public and Government Affairs at bioMérieux.

Under the weight of a Covid-19 pandemic of unprecedented suddenness and scale, our health systems have clearly shown their limits in dealing with such a crisis. Added to this is a rise in healthcare costs which is no longer sustainable, with a strong environmental impact. In light of such observations, more and more voices are calling for a shift from curative medicine to preventive medicine. In November 2020, the European Commission's proposals for a “Europe of health” placed this topic at the heart of the 2021-2027 objectives. Then in 2021, it was the OECD that called for allocating more resources to improving health prevention. In a context of inequality in access to care, prevention is also a way to “reach out to” and “bring back” disadvantaged populations into health systems.

Having the right information at hand

When we think of prevention, we think of vaccination first, and then behavior. But in reality, prevention is based on a vaccination-behavior-diagnosis triangle, which has largely proven itself during the Covid-19 crisis. In vitro diagnosis (IVD) is an essential building block of preventive medicine for providing robust, usable, traceable over time, non-redundant information. This data will help us to make the right decisions on the medical, health, organizational and economic levels.

“In its prevention strategy, each health system will designate populations to be targeted as a priority. By relying on in vitro diagnosis, people at risk can be identified, screened and tested, monitored, and taken care of in a timely manner, if there is a need for medical treatment” clarifies Isabelle Tongio, Director of Public Affairs and government at bioMérieux.

Benefits at each level of prevention

With the development of increasingly rapid, sensitive, easy-to-use technologies, including by patients themselves, and the possibility of testing more and more biological markers, diagnostic tests are key at all levels of medical prevention:

Primary prevention: to prevent the onset of illness.
- The Covid-19 crisis has revealed in an unprecedented way the importance of IVD in managing a pandemic. While viral sequencing played an important role from the early days of the crisis for the development of both diagnostic tests and vaccines, it remains an essential tool for monitoring the emergence of new variants. It should be noted that, for the first time, on a voluntary basis and in large numbers, patients were able to take control of their own diagnosis in order to avoid transmission of the disease to those around them in the event of a positive result.

Secondary prevention: to reduce the prevalence of a disease in a population through detection at an early stage.
- Let’s look at tuberculosis, for example. Beyond the need for early diagnosis of active tuberculosis, screening of asymptomatic subjects with latent tuberculosis is a critical challenge on a global scale. The treatment of these patients at risk of progressing to active tuberculosis has dual benefits, impacting the patients themselves in a positive way, but also the population as a whole, by reducing the reservoir of tuberculosis bacilli.

Tertiary prevention: to reduce complications and the risk of relapse, after the onset of the disease.
- In the case of a severe, rapidly progressing disease such as sepsis, procalcitonin, which helps with early diagnosis, significantly increases patients' chances of survival. At the same time, it has demonstrated its effectiveness in guiding the discontinuation of antibiotics in patients with suspected or confirmed sepsis^1-3, and thus contributes to the critical fight against antibiotic resistance.

Quaternary prevention: to prevent unnecessary or excessive medical treatment.
- The use of faster multiplex molecular tests for the early diagnosis of pediatric meningoencephalitis makes it possible, in just one hour, to optimize hospital management of a case of serious bacterial disease or, in the event of viral disease, to send the child home, thus avoiding the effects of overmedication. The benefits are immediate, both for the patient and for optimizing hospital flows and expenses⁴.

Preventive medicine made easier by advances in diagnosis

Driven by scientific, medical, technological and digital progress, the IVD offering is evolving, making its use easier in preventive medicine. Now feasible outside of central laboratories, the tests can be used both in hospitals and in community medicine, sometimes by patients themselves, without compromise on quality. Which is a key benefit when one of the specificities of prevention is to target mostly asymptomatic or mildly ill people. Furthermore, certain biomarkers in infectious diseases and oncology make it possible to further customize patient care. Finally, digital technology facilitates medical decision-making and helps avoid unnecessary action, thanks to consolidated information.

At a time when the right use of care, the ability to react, and the reduction of the healthcare environmental footprint are at the heart of concerns, preventive medicine and in vitro diagnosis play a major role. The challenge for diagnosis is to provide the right test, for the right patient, at the right time, in the right place. Viewed in this light, in vitro diagnostics could effectively contribute to this shift towards prevention and health promotion, with all the possible side benefits in terms of public health

References:

1. Claxton AJ, Thompson-Leduc P, Kirson NY, Rice B, Hey J, Iankova I, et al. Efficacy and Safety of Procalcitonin Guidance in Patients With Suspected or Confirmed Sepsis: A Systematic Review and Meta-Analysis. Crit Care Med. 2018;46(5):691-8.

2. Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, Panagaki A, Melachroinopoulos N, Drakou E, et al. Procalcitonin to Reduce Long-Term Infection-associated Adverse Events in Sepsis. A Randomized Trial. Am J Respir Crit Care Med. 2021;203(2):202-10.

3. Schuetz P, Wirz Y, Sager R, Christ-Crain M, Stolz D, Tamm M, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2017;10(10):CD007498.

4. Duff S, Hasbun R, Ginocchio C, Balada-Llasat J, Zimmer L, Bozzete S. Economic Analysis of Rapid Multiplex Polymerase Chain Reaction Testing for Meningitis/Encephalitis in PediatricPatients. Future Microbiol 2018.