APHL says thank you

APHL says thank you | www.APHLblog.org

This year, APHL again joined Research!America and other public health partners to celebrate Public Health Thank You Day! Each year on the Monday before Thanksgiving, we take a moment to thank our staff, members, partners and others in the public health community for all the hard work they do to keep us safe and healthy.

A special thanks to all the unsung heroes in public health. I am especially grateful for those combating antibiotic resistance. It’s a difficult task, but we have the right people on it. Your talent and drive do not go unnoticed.

– Eric Ransom, APHL-CDC Antimicrobial Resistance Fellow

I am thankful for APHL members, associates, colleagues and partners who collaborate to promote, monitor and regulate public health.

– Tyler Wolford, senior specialist, Laboratory Response Network, Public Health Preparedness and Response

I am thankful for the school nutrition specialists who visit our school as part of the USDA Extension Program through the University of Maryland. They explain where food comes from and how to make healthy yet inexpensive choices in the foods we eat. Children stay engaged in what they learn by through simple recipes that are sent home each month. They even get my seven year old to try new snacks and vegetables as part of the “Two Bites” club.

– Shari Shea, director, Food Safety

Thank you, public health colleagues and partners, for your tireless dedication to the greater good. Whether you’re on the front lines or behind-the-scenes, the work you do is meaningful and appreciated! Many of you go above and beyond, especially when outbreaks emerge and disasters strike. Your passion, adaptability and commitment inspire me and I am grateful for the opportunity to work and learn with you.

– Robyn Sagal, specialist, Global Health

This year, I am thankful that the public health community reacted to Hurricanes Irma, Harvey and Maria quickly and collaboratively to ensure that the people affected have access to clean water, safe food and other essential resources.

– Sean Page, associate specialist, Public Health Preparedness and Response

It never gets old to say thank you to all of the unsung heroes who work in public health. These individuals ensure that our water is safe to drink; our food supply is safe and our communities are protected. From antibiotic resistance to Zika, public health scientists work tirelessly to protect communities. I salute all public health scientists and thank them for their hard work and dedication to public service.

– Chris Mangal, director, Public Health Preparedness and Response

This year, I am thankful for the collaborative nature of public health. Having just attended a multidisciplinary detection and response meeting, I really appreciate how intertwined different disciplines are from epidemiology to veterinary science, agriculture, clinical sector and laboratories. I am thankful when I see such respect being given from one sector to the other acknowledging that in order for public health to work the way it is supposed to we have to rely on each other.

– Stephanie Chester, manager, Influenza, Infectious Diseases

As we gear up for flu season, I’m thankful for all of the epidemiologists and laboratorians testing and sequencing influenza viruses. Thanks for keeping tabs on this ever-changing virus and keeping us prepared for the next pandemic.

– Elizabeth Toure, senior specialist, Global Health

I am thankful for hardworking colleagues dedicated to improving the health of all.

– Anne Gaynor, manager, HIV, Hepatitis, STD and TB Programs, Infectious Diseases

I’m thankful for all of the dedicated, passionate laboratory scientists who work in APHL’s member laboratories, tirelessly striving day in and day out to assure that our water is clean, our food is healthy, our babies grow up to be the best they can be, our families are safe from emerging infectious diseases and our world is a healthier place!

– Linette Granen, director, Membership & Marketing

I’m thankful that I can travel the world and know my vaccinations will protect me from deadly diseases!

– Madeline Rooney, specialist, Strategic Communications

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Biorisk management is fundamental to global health security

Biorisk management is fundamental to global health security | www.APHLblog.org

By Samantha Dittrich, manager, Global Health Security Agenda, APHL

Over the past 60 years, the number of new diseases per decade has increased nearly fourfold. Since 1980, the number of outbreaks per year has more than tripled. These alarming trends have serious implications for human and animal health as well as severe and lasting economic consequences in affected areas.

In order to address these human health threats, a One Health approach is needed. One Health recognizes that the health of people is connected to the health of animals and the environment, and calls for interdisciplinary collaboration and communication in healthcare and public health practice. With the Global Health Security Agenda (GHSA) in progress, the One Health approach is more important than ever before, and partners must come together to accelerate progress towards a world safe and secure from infectious disease threats.

Inside public health laboratories around the world, scientists handle dangerous pathogens while testing human, animal and environmental specimens for disease. But these pathogens aren’t just confined to laboratory vials and storage tubes: they travel. Often diseases originate in local communities where samples are collected at healthcare facilities that are not equipped to safely and securely handle them. Blood, stool and even animal carcasses may be stored at clinics or emergency operations centers for hours or even days before the samples are transported to laboratories, often on via methods that lack the security requirements for safe sample handling, storage and disposal.

  • Safe handling of pathogens in a laboratory or public health setting by scientists or clinicians is biosafety. Simply put, biosafety is keeping yourself (the public health laboratory professional) safe from laboratory mishaps.
  • Keeping dangerous pathogens secure and out of the hands of someone who may want to use them intentionally to harm others is biosecurity.

Biosafety and biosecurity are fundamental parts of the GHSA. Laboratory biorisk management means instituting a culture of rigorous assessment of the risks posed by infectious agents and toxins and deciding how to mitigate those risks. It involves a range of practices and procedures to ensure the biosecurity, biosafety and biocontainment of those infectious agents and toxins. Threats posed by deliberate release (aka, bioterrorism) and accidental release of infectious agents from a laboratory can happen anytime and anywhere. To mitigate the risks, it is critical that we are prepared to prevent, detect and respond to these threats.

Biorisk management is fundamental to global health security | www.APHLblog.org

As a partner in the GHSA, APHL collaborates with ministries of health worldwide to develop effective national laboratory systems. One of the ways we do that is by providing guidance to our global partners to reduce laboratory biosafety and biosecurity risk. All laboratories – whether they test human, animal or environmental specimens – should develop and maintain biorisk management systems tailored to their unique operations and risks. There is no one-size-fits-all biorisk management system.

Most recently, APHL drafted a Biorisk Management Framework as a tool for partners in Ghana. The Framework offers a comprehensive, systematic approach to laboratory biorisk management. It includes a list of essential elements Ghanaian laboratories can use to assess their operations and better integrate and enhance biosafety and biosecurity programs, whether it is a human, veterinary or environmental laboratory.

In the coming months, APHL will work with partners from public health laboratories, local hospitals, and the veterinary and research communities to discuss a comprehensive, standardized approach to the development of a national Biorisk Management Framework. The goal of this One Health effort is to reduce laboratory biosafety and biosecurity risk.

Preventing the next outbreak will require a One Health approach with close collaboration among the health, animal, agriculture, defense, security, development and other sectors. APHL will be there as a partner, advisor and sounding board for countries working to better manage laboratory biosafety and biosecurity risk.

 

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Lab Culture Ep. 6: What is the Biosafety Peer Network?

Ep. 6: What is the Biosafety Peer Network? | www.APHLblog.org

Lab Culture Ep. 6: What is the Biosafety Peer Network? | www.APHLblog.org

The Biosafety Peer Network (aka the Visiting Biosafety Official Program) links US local, state, and territorial public health laboratories with US-affiliated Pacific Island laboratories to facilitate mentoring and information sharing among biosafety officials and officers. The exchange is intended to foster a collaborative community, advance  biosafety and biosecurity in laboratories, and ultimately improve public health laboratory biosafety and biosecurity across the US. So what exactly does the Biosafety Peer Network do? Three members of this network — Rebecca Sciulli (Hawaii), Paul Fox (Hawaii) and Anne Marie Santos (Guam) sat down for a conversation about their work.

Photo: Paul Fox (left) and Rebecca Sciulli (center) giving Anne Marie Santos (right) a tour of the Hawaii Laboratories Division facility to showcase their biosafety practices, as part of the Peer Network program.

Links

Biosafety Peer Network Program Application

Laboratory Biosafety & Biosecurity Resources

Biosafety & Biosecurity Training

 

If you’re enjoying Lab Culture, please rate and review on iTunes and/or Stitcher!

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From Paper to PC in Mozambique: Implementing Electronic Laboratory Information Systems

From Paper to PC in Mozambique: Implementing Electronic Laboratory Information Systems | www.APHLblog.org

By Elizabeth Toure, senior specialist, Global Health, APHL, and Reshma Kakkar, manager, Global Health LIS, APHL

Dr. Isabel Pinto, Director of the National Directorate of Medical Assistance (DNAM) at the Mozambique Ministry of Health, has a clear and simple vision for the future of public health in Mozambique: quality information. “Information is key for all decisions,” she says.

Paper-based systems are the norm for tracking health information in most laboratories in Mozambique. There are backlogs of paper forms needing to be recorded into laboratory logbooks; patients waiting weeks or months for routine laboratory test results; and public health officials lacking timely disease surveillance data to inform public health responses. Simply put, paper-based systems are laborious, prone to errors and unmanageable.

Dr. Isabel Pinto, Director of the National Directorate of Medical Assistance (DNAM) at the Mozambique Ministry of Health | www.APHLblog.orgNow Dr. Pinto and her team are tackling this challenge with the help of APHL’s Mozambique field team. Their goal is to move all of Mozambique’s major laboratories from paper-based to electronic laboratory information systems (LIS) to better capture and track clinical and public health data. Laboratories around the world use LIS to manage patient and public health data including ordering diagnostic tests, capturing test results, generating reports and tracking samples.

Transitioning laboratories from a paper-based system to an electronic system is no small task. Dr. Pinto and the APHL Mozambique team began this endeavor by implementing an enterprise LIS for the country’s eight main referral hospital laboratories. Each laboratory first needed to be equipped with a network server to store and transmit data, the LIS software and computers to store and retrieve data from the server, diagnostic equipment that electronically transmits patient results to the LIS and well-trained laboratory staff to effectively use the LIS to support their work. In many cases, installing an LIS even requires an overhaul of the laboratory’s workflow because certain processes often prove to be redundant when an electronic system is introduced. After several years of intensive work and funding from the CDC and PEPFAR, all eight hospital laboratories are now equipped with LIS.

Beyond the LIS, a secure central database was also created within the Ministry of Health to capture the participating laboratories’ information. Data from all laboratories using the LIS are sent to this central database on a near real-time basis allowing for rapid analyses and reporting, and the ability for national decision makers, such as Dr. Pinto and her colleagues, to provide feedback to laboratories throughout the country.

With the central database at the Ministry of Health and LIS at major referral hospital laboratories, the APHL Mozambique team, working with the CDC, turned to the country’s health centers as the next phase. For these smaller health centers, installing LIS is not yet feasible due to limited infrastructure and staff capacity, so laboratory scientists still rely on a paper-based system to track their samples and data. The paper-based system becomes especially arduous when health centers need to send samples to a referral hospital for additional testing. To address this problem, APHL, working with the LIS vendor, developed a simple software application that creates a unique barcode for each sample after it is collected and transmits the test order and patient data electronically to the referral laboratory. The health center then ships the sample to the referral laboratory where the barcode is scanned into the LIS, and the previously entered patient and sample data are matched with this barcode. Once testing is completed, the referral laboratory returns the test results to the health center via the same application. While not the ultimate solution, it is a significant step forward. This software application drastically reduces the dependence on paper-based systems, which means faster and more accurate results for patients, higher data quality for public health officials and less overwhelmed laboratory staff. Thanks to funding through PEPFAR, nearly 60 health centers across Mozambique are now using this software application, and the APHL team is working with partners to install it at an additional 100 health centers.

Many challenges still remain. Most significantly, linking rural health centers to the system poses unique logistical and infrastructural challenges given inconsistent electricity and internet connectivity in those areas. The APHL Mozambique field staff continues to work to find creative solutions that will allow even the most remote locations to order tests and track results electronically.

Project by project, Dr. Pinto’s vision for Mozambique’s public health system is taking shape. Millions of laboratory records are flowing into Mozambique’s central database. What’s more, laboratories in Zambia, Tanzania, Kenya, Ethiopia and Vietnam have looked to Mozambique as a model for their own LIS solutions.

Now Dr. Pinto and her team face a new challenge: analyzing all that data.

 

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What you need to know about harmful algal blooms

What you need to know about harmful algal blooms | www.APHLblog.org

By Julianne Murphy, intern, Environmental Health

Warm weather brings nature walks, picnics and sunny days by the shore, but it can also bring unwanted changes to your favorite beach. As the temperature rises, lake and ocean waters can turn from blue to mossy green as algae proliferates in unsightly and potentially harmful algal blooms.

What are harmful algal blooms?

Algae are plant-like organisms of one or more cells that use sunlight to make food. Together they can form colonies called algal blooms in both marine and freshwater systems. Some of these algal blooms are hazardous to health, but not all algal blooms are harmful.

Harmful algal blooms may release toxins at concentrations unsafe to humans and animals and may drastically reduce oxygen available to aquatic life. In fresh water bodies, cyanobacteria, aka “blue-green algae,” can produce dangerous cyanotoxins; in saltwater or brackish water, acid-generating plankton – dinoflagellates and diatoms – can pose a health threat.

Should I be concerned about algal blooms?

Algal blooms can pose a risk for human and animal health. People and animals can become ill through eating, drinking, breathing or having direct skin contact with harmful algal blooms and their toxins. Illnesses vary based on the exposure, toxins and toxin levels. Public health and environmental laboratories test samples from harmful algal blooms to confirm the presence and level of toxicity. Remember, not all algal blooms are harmful.

How are public health officials responding to the increase in algal bloom events?

As climate change events amplify conditions favorable to algal blooms, public health scientists are studying when and where associated illnesses are occurring and how to mitigate the effects of exposure. Their efforts have led to increased laboratory testing and electronic surveillance measures at the state and federal level.

For example, public health and environmental officials in Alaska have been tracking and testing harmful algal blooms. The Alaska Harmful Algal Bloom Network, a collaboration of the Alaska Department of Health and Social Services (DHSS) and regional monitoring programs, analyzes fish kills, unusual animal behaviors and other related phenomenon to provide early warning of developing coastal marine blooms. DHSS scientists analyze human specimens for illnesses associated with harmful algal blooms, such as paralytic shellfish poisoning (PSP) caused by saxitoxins. PSP is a potentially fatal poisoning with no treatment except supportive care. Samples from symptomatic patients are forwarded to the Centers for Disease Control and Prevention (CDC) for confirmatory testing as needed. Testing of asymptomatic individuals may be included in future studies.

In addition, Alaska Department of Environmental Conservation (DEC) laboratories test marine shellfish meat samples protect public health and safety as well as for regulatory purposes, illness investigations and non-commercial shellfish upon request. This monitoring literally saves lives.

David Verbrugge, chief chemist at the DHSS Division of Public Health, explains the value of Alaska’s testing of harmful algal blooms, “[Laboratory analysis] helps us to understand the nature of PSP exposures: frequency of occurrence, confirmation when lacking meals to test, and the presence or absence of toxins in asymptomatic co-exposed groups. It also allows us to let people know what they are eating before they eat it.”

Is the CDC involved in testing and surveillance for harmful algal blooms?

Yes, only for freshwater. In 2016, CDC created the One Health Harmful Algal Bloom System to provide a voluntary, electronic reporting system for states, federal agencies and their partners. Using the system, which integrates human, animal and environmental health data using a One Health approach, public health departments and their environmental and animal health partners can report bloom events, and human and animal cases of associated illness. Members of the public may report a bloom event or a case of human or animal illness to the One Health system by contacting their local or state health department.

What is the outlook for future testing and surveillance of harmful algal blooms?

As climatic conditions become more favorable to development of harmful algal blooms, state and local health departments will have to ramp up surveillance and testing to protect public health and to preserve local revenue from beaches. These actions will come with a price tag, requiring action at all levels of government. Resources can be leveraged through collaboration to research and expand clinical testing capacity for these persistent health threats.

Learn More:

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Hurricane preparation and response resource list

Hurricane preparation and response resource list | www.APHLblog.org

Updated September 15, 2017

In the wake of hurricanes Harvey and Irma, public health laboratories in affected regions will be busy testing for potential environmental contamination, monitoring for increased water- and mosquito-borne diseases, or repairing damage to their own facilities. APHL has activated its Incident Command System (ICS) to support member laboratories with their response. The ICS team is participating in CDC’s Emergency Operations Center (EOC) State/Local and Partner Conference Calls, and will assist member labs with their response, facilitate communications between CDC and member labs, and share lab needs/stories with policy makers and the public.

Below are helpful resources for those communities hit by the recent storms. Many of these resources are useful for any severe weather event, not just Hurricanes Harvey and Irma.

Preparing for and weathering the storm

Hurricanes, Preparation and Response, EPA
Hurricane Preparedness Checklist, FDA
Preparing for a Hurricane or Tropical Storm, CDC
Flooding Toolkit, National Public Health Information Coalition
Disaster Assistance.gov, US government platform for locating disaster-related resources
Federal Emergency Management Agency (FEMA) Toll-free FEMA hotline for survivors of Hurricane Harvey: 1-800-621-FEMA

Keeping your family and community healthy after the storm

Food Safety:
Food Safety Tips for Areas Affected by Hurricane Irma, USDA press release
Protect Food and Water Before, During and After a Storm, FDA

Infectious Diseases:
Emerging and Zoonotic Infectious Diseases, CDC
Vector-borne Diseases, CDC​​​​​​​
Waterborne Disease Prevention, CDC

Drinking Water:
Drinking Water Safety and Testing Information for Texas, Texas Commission on Environmental Quality (accredited labs for microbial testing of drinking water, advice for customers of public water systems, disinfecting your well, etc.)
Drinking Water Testing and Information for Houston, TX, City of Houston
Private Wells: What to Do after the Flood, EPA
Private Wells: Water-related Diseases and Contaminants, CDC
Health Department Laboratory, Drinking Water Testing and Information, City of Houston

Other:
Carbon Monoxide Poisoning – Clinical Guidance, CDC
Mold: Cleanup and Remediation, CDC
Mold: Flood Cleanup, EPA
Waste Management, EPA

Rebuilding and repair

Cleanup after a Hurricane, CDC
Status of Systems in Areas Affected by Harvey, Texas Commission on Environmental Quality – drinking water, waste water and sewage, residential wells, flood waters, water infrastructure

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New Lab Matters: Sharing the value of public health laboratories

New Lab Matters: Sharing the value of public health laboratories | www.APHLblog.org

The need for a laboratory voice in budgetary discussions has become more urgent recently, and “human-to-human relationships” are as critical as technical knowledge. So how does a public health laboratory raise its profile within the community? By telling a good story…over and over again.

In the summer issue of Lab Matters, our feature article examines how laboratories are sharing their value, one interview, photo or outreach moment at a time.

Here are just a few of this issue’s highlights:

Subscribe and get Lab Matters delivered to your inbox, or read Lab Matters on your mobile device.

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Lab Culture Ep. 5: My Niece’s Positive Newborn Screen

My Niece's Positive Newborn Screen | www.APHLblog.org

My Niece's Positive Newborn Screen | www.APHLblog.orgFour years ago, as APHL joined with partners to celebrate the 50th anniversary of routine newborn screening in the United States, newborn screening hit more closely for APHL staff than it ever had before. Michelle Forman, manager of media and Lab Culture host, received a text that her new niece, Sloane, had a positive newborn screen. Her results were out of range for PKU. In this episode, Michelle interviews Sloane’s mom, Judith Forman, about that experience.

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Laboratory twinning builds strong lab systems and relationships

Laboratory twinning builds strong lab systems and relationships | www.APHLblog.org

By David Mills, PhD, retired director, Scientific Laboratory Division, New Mexico Department of Health

When I first got involved in twinning, I had no idea that Halloween costumes would be part of the process. Let me explain.

During my time as director of the New Mexico public health laboratory, APHL connected my team with an equivalent lab in Paraguay. This entailed sending personnel to train their laboratorians, who later came to Albuquerque to see our work in action. Our “twin” labs developed strong bonds and this “twinning” project left a good taste in everyone’s mouth.

A year later, when APHL asked if we’d help Uganda’s Central Public Health Laboratory evolve into a national reference lab, we jumped at the chance to twin again.

Our first step was to visit Uganda to learn about their priorities and see what was truly achievable. We had an instant rapport with the Ugandan team and their director, Steven Aisu, and our discussion quickly reinforced how well matched our labs were. Our team had just moved from an old, cramped facility to a state of the art facility, just as the Ugandan team needed to do.

Because Aisu’s team was developing a new paradigm without ever seeing the process in action, our task was to help them clearly visualize the goal and then make it a reality through technical assistance, management and leadership training. We were all excited to get started.

The second step was for Sally Liska, retired director of the San Francisco public health lab, and me to hold training sessions in Kampala, the capital of Uganda. I loved doing these interactive courses because, for me, teaching is the best way to learn.

The Ugandan team was eager to know everything about how we ran our biosafety level 3 (BSL-3) lab, so the third step was for the Ugandan team to visit our facility in New Mexico. They met with experts from epidemiology to IT, quality assurance to maintenance, as well as senior officials. They were especially interested in how we worked with agricultural and environmental partners; Aisu described such collaborations as akin to bridging chasms. We shared our hard-won experiences. His team quickly gained proficiency in physical and scientific quality systems.

Just as important, we built strong relationships that will last.

I invited the team to my home for their last night in New Mexico before their return flight to Uganda. It happened to be Halloween, but we had been so busy it hadn’t come up in conversation. When the first trick-or-treaters arrived, I suddenly realized that my friends had never experienced the holiday. They were surprised and enchanted to find witches, ghosts and other costumed children at the door. It’s a good thing they were delighted—150 creatures of the night rang our bell over the next few hours! The following morning, we said farewell, but not goodbye.

I retired in 2015, but my connection to the Uganda team has continued without breaking stride. In June 2016, I went to Kampala for two weeks to help them develop strategic plans for their national health lab system and for oversight and regulation of the country’s entire health system. On my team were APHL consultants Kim Lewis and John Pfister, who has retired from the Wisconsin state lab.

A month later, we three musketeers facilitated a stakeholders’ meeting to review those plans and helped refine the strategic plan for their new facility (built by CDC) as they prepared for the September 2016 grand opening.

The New Mexico team has continued working with the Ugandan team as they transitioned into their new roles, and I have jumped in with both feet as a consultant through APHL. If they can stand my jokes, the least I can do is help them take their next steps. It’s my calling.

A Little Extra Fun…

This story isn’t directly related to my work with the laboratory, but I love telling it! While we were in Uganda, we stayed in a small hotel where the friendly manager would often come and chat. One day, she asked, “Have you ever had an avocado before?” I said, “Yes, I make guacamole with avocados.” She’d never heard of guacamole, so I described it and she grimaced, saying, “That sounds terrible!” I offered to make some anyway.

Laboratory twinning builds strong lab systems and relationships | www.APHLblog.org

Two days later, I had a night off from teaching and was sitting in the lobby when the manager came up to me and said, “We’re ready! Let’s make the guacamole. The whole kitchen staff is waiting!” Sure enough, a chef with a tall white hat and his crew were lined up behind the ingredients: avocados, lemon juice, garlic, onions. I was astonished and eager to get cooking!

Together, we made a huge batch for the hotel staff and served it on fried corn tortillas. Everyone was game to try it. Although first their reactions were uniformly polite yet skeptical, they eventually grew enthusiastic.

My conclusion: Guacamole is an acquired taste.

 

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Public health labs aren’t just on the frontlines of vaccine-preventable outbreaks. They’re often the only line.

Public health labs aren’t just on the frontlines of vaccine-preventable outbreaks. They’re often the only line. | www.APHLblog.org

by Kim Krisberg

In the U.S., rates of vaccine-preventable diseases are so low that many commercial labs don’t even have the ability to test for them anymore. The shift reflects the hard work of decades-long immunization efforts. But it also means that when there is a vaccine-preventable outbreak, just about all of our rapid diagnostic capacity resides in one place: the public health lab.

The latest example of this is in Minnesota, where a measles outbreak hit 78 confirmed cases as of June 16. The state is typically home to less than a handful of measles cases each year — most years, the case count is between zero and two. At the Minnesota Department of Health’s Public Health Laboratory, which is the only lab in the state that can do real-time reverse-transcription polymerase chain reaction (rRT-PCR) testing for measles, staff have received more than 800 specimens for measles testing since April, with a goal of fully processing each one the same day it’s received. To stop an outbreak, both speed and accuracy are critical.

Fortunately, Minnesota lab workers are trained and ready to provide both. But sustaining that kind of surge capacity over the long run and in the face of new and emerging disease threats is always challenging — even in the best funding environments.

“We’ve spent a lot of time increasing our capacity over the last 10 years and we’re seeing that capacity being put to work,” said Sara Vetter, PhD, manager for infectious diseases at the Minnesota Public Health Laboratory. Vetter noted that Minnesota last experienced a measles outbreak in 2011 — “and that one seemed huge and it was just 26 cases of measles.”

This year’s measles outbreak is almost entirely concentrated in a Somali community in Minnesota’s Hennepin County, home to more than 1 million residents. The outbreak officially began on April 10, the same day the lab confirmed the first positive case. Nearly all the cases are among unvaccinated children younger than 4 years old. No deaths have occurred, though about a quarter of infections have led to hospitalization.

Inside the public health lab’s Virology/Immunology Unit, technicians track the measles outbreak using a rRT-PCR test, which allows them to detect the highly contagious virus much quicker than private labs that can perform serological testing for measles antibodies. That quickness is key, said Anna Strain, PhD, supervisor of the Virology/Immunology Unit, because it means the health agency’s epidemiology team can then quickly locate people who may have been infected and get ahead of the outbreak before it spreads.

The rRT-PCR test may be quicker than serological testing — it detects measles RNA, as opposed to measles antibodies, and is less confounding than serology — but it’s not completely definitive, Strain said. After conducting rRT-PCR testing on each of the more than 800 specimens that come into the lab, any positive specimens undergo genotyping to determine if the patient is infected with a wild-type measles strain or if the rRT-PCR is simply picking up on the live attenuated virus that’s contained in the measles-mumps-rubella vaccine. Genotyping can also determine if the case is related to the larger outbreak. (On a side note: In addition to its regular testing responsibilities, the Minnesota Public Health Lab is partnering with the Centers for Disease Control and Prevention and Canadian public health officials to develop a PCR test that’s specific to the vaccine strain of measles. Such an test would be particularly helpful in an outbreak, Strain said, because technicians could then forgo the extra step of genotyping.)

“It’s actually meant quite a lot of maneuvering,” Strain said, referring to the logistics of responding to the surge in measles testing. “In some ways, we were lucky that it happened in April when flu season was dying down — otherwise a number of testing staff trained for measles testing would have also been doing flu testing. If the (measles outbreak) had happened any sooner, it would have been really hard to keep up.”

From start to finish, the measles test takes about five hours, Strain said. Lab staff can process 10 measles specimens at a time and up to 30 specimens in day — though that’s a stretch, she noted. In comparison, the lab can process up to 150 flu samples in day and often does.

“As hard as it’s been in the lab, it’s been even harder for our epidemiologists — they’ve had more than 7,000 contacts to trace and to follow up on,” said Joanne Bartkus, PhD, director of the Minnesota Public Health Laboratory. “It’s been daunting for all of us.”

Vetter said that most of the lab’s current surge and response capacity is thanks to federal public health preparedness funding as well as funding from CDC’s Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Program, both of which currently sit on the budgetary chopping block. On preparedness, President Trump’s fiscal year 2018 budget proposal calls for cutting CDC’s emergency preparedness budget by $136 million — that’s on top of years of preparedness cuts public health agencies have already absorbed. (In total, Trump’s budget calls for cutting CDC’s budget by $1.2 billion, or a whopping 17 percent.) The ELC, on the other hand, is wholly entwined with the Affordable Care Act’s Prevention and Public Health Fund, which allocates $40 million in annual ELC funds to state and local health departments in every state. Under current ACA repeal-and-replace bills in Congress, the Prevention and Public Health Fund would disappear.

And while ELC and preparedness monies don’t categorically support the Minnesota lab’s vaccine-preventable disease work, Vetter said the funds have been essential in ensuring the lab can quickly scale up its response, regardless of whether the emergency is vaccine-preventable or not. In other words, the Minnesota lab has spent years building an all-hazards response system that readies it to face any health threat that lands at its doorstep. Being able to sustain that nimbleness, however, would be at risk if funding declined.

“Without that funding, we’d probably have to choose what we respond to because we’d run out of people and out of machines — we just couldn’t keep up,” Vetter said. “If our funding gets cut, we can’t maintain our machines, we can’t replace machines, we can’t train more people … what we do is very complex.”

At the same time the Minnesota Virology/Immunology Unit has been responding to the measles outbreak, it’s also been responding to a mumps outbreak on the University of Minnesota-Twin Cities campus, providing surge testing for a mumps outbreak in Washington state that recently hit nearly 900 cases, and taking in and testing about 20 specimens a week for Zika virus. All of that is in addition to its more regular duties, like rabies and West Nile monitoring.

In the wake of the measles outbreak, Minnesota Health Commissioner Edward Ehlinger, MD, MSPH, called on state policymakers to create and support a public health response contingency fund. Such a bill was introduced into the Minnesota House of Representatives for consideration in May.

“Our commissioner always says that data are the coins of public health,” Bartkus said. “And it’s the public health lab that creates that data.”

As of late May, Strain said the Minnesota measles outbreak — which exceeded total U.S. cases for all of 2016 — seemed to be entering a “tapering phase.” As she said that, however, she paused — and quickly added “we all just knocked on wood.”

 

For more on the Minnesota measles outbreak, visit www.health.state.mn.us/divs/idepc/diseases/measles.

 

 

 

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