In late 1985, the Association of State and Territorial Public Health Laboratory Directors (ASTPHLD) first recognized the need for standardization and uniformity of human immunodeficiency virus (HIV) test procedures, interpretation and reporting among public health laboratories. In 1986, the HIV Committee of ASTPHLD conducted its first Consensus Conference, with the objective of promoting quality and uniformity among laboratory programs through the exchange of data, sharing of expertise and formulation of consensus recommendations. There were 41 participants at this conference that addressed four topics: enzyme-linked immunosorbent assay (ELISA), Western blot, immunofluorescence and methods standardization.

These surveys continue to serve as a glimpse of public health laboratory activities at a point just prior to a Consensus Conference. Generally, the surveys offer some benefit to Consensus Conference deliberations by providing data for emerging issues or identifying problems not previously thought to be an issue.

Response to the surveys continues to fall short of replies from all 54 states and territories. Each has its own reason for not responding, but it would be nice if someday the response was 100%. Figure 1 shows that responses were received from 42 states, one territory and one city. The fact that states with significant involvement in the human immunodeficiency virus (HIV) epidemic did not respond greatly reduces the overall value of this survey, but the limited data must suffice.

Clostridium difficile is a major cause of gastrointestinal infections. In 1978, Bartlett and colleagues identified C difficile and its toxin as the cause of the antibiotic-associated pseudomembranous colitis (PMC). Within a few years, there was the development of a diagnostic assay, a description of a clinical and pathological spectrum of the disease, a definition of risk factors and characterization of the two toxins that account for the pathological event. Additional information regarding the microbiology, pathogenesis, clinical manifestations, diagnosis and treatment has rapidly developed. These features are beyond the scope of this report, and the reader is referred to several recent reviews.