Review Article

Biosurveillance: A Review and Update

Table 2

Laboratory divisions within the laboratory response network.

Level A Laboratory (Sentinel Labs)Tier 1Approximately 2300 hospital and clinic labs were likely first to receive specimens. Role is to rule out and refer to a lab within LRN to confirm a diagnosis.
Level B Laboratory (Reference Labs)Tier 2Increased capabilities to confirm diagnoses of biological agent. County public health labs where role is confirmatory testing, initial susceptibility testing, and referral.
Level C Laboratory (Reference Labs)Tier 2Much like level B, State public health labs that confirm diagnosis and refer to national laboratory. There are approximately 160 reference labs (B and C).
Level D Laboratory (National Labs)Tier 3National laboratories whose primary responsibility is to further characterize the agent (CDC, USAMRIID have biosafety level IV (BSL-4) capabilities).