CDC findings mark a breakthrough in investigation of lung injury associated with vaping

Man vaping

Statement from Scott J. Becker, executive director, Association of Public Health Laboratories

Silver Spring, MD, November 8, 2019 — “Test results announced today by the Centers for Disease Control and Prevention mark a breakthrough in the ongoing investigation of lung injury associated with e-cigarette use or vaping.

“Laboratory scientists testing samples of lung fluid from 29 patients found vitamin E acetate present in all samples. These results provide direct evidence of this toxin at the primary site of injury within the lungs. They also complement tests conducted by the Food and Drug Administration and state public health laboratories that identified vitamin E acetate in e-cigarette or vaping products.

“While this is a big step in helping us understand what may be causing these injuries, these findings do not rule out the potential for other compounds or ingredients as contributing factors. There may be more than one cause of the outbreak.

“APHL applauds state public health laboratories, CDC, FDA and partners including the Council of State and Territorial Epidemiologists for their extraordinary collaboration and tireless and innovative work.

“This has been a complex investigation, and the work continues. But good science takes time, and public health laboratory work is critical to helping solve this important health challenge and stopping the outbreak.”

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More APHL’s support of the EVALI response

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CDC findings mark a breakthrough in investigation of lung injury associated with vaping

Man vaping

Statement from Scott J. Becker, executive director, Association of Public Health Laboratories

Silver Spring, MD, November 8, 2019 — “Test results announced today by the Centers for Disease Control and Prevention mark a breakthrough in the ongoing investigation of lung injury associated with e-cigarette use or vaping.

“Laboratory scientists testing samples of lung fluid from 29 patients found vitamin E acetate present in all samples. These results provide direct evidence of this toxin at the primary site of injury within the lungs. They also complement tests conducted by the Food and Drug Administration and state public health laboratories that identified vitamin E acetate in e-cigarette or vaping products.

“While this is a big step in helping us understand what may be causing these injuries, these findings do not rule out the potential for other compounds or ingredients as contributing factors. There may be more than one cause of the outbreak.

“APHL applauds state public health laboratories, CDC, FDA and partners including the Council of State and Territorial Epidemiologists for their extraordinary collaboration and tireless and innovative work.

“This has been a complex investigation, and the work continues. But good science takes time, and public health laboratory work is critical to helping solve this important health challenge and stopping the outbreak.”

# # #

More APHL’s support of the EVALI response

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APHL Newborn Screening Systems Quality Improvement Projects Award Recipients Announced

Newborn screening laboratory scientist at work

The Association of Public Health Laboratories (APHL) is pleased to announce the recipients of the Newborn Screening Systems Quality Improvement Projects awards. Funded through a cooperative agreement with Genetic Services Branch of the US Health and Human Services Health Resources and Services Administration (HRSA), these awards will provide funding to support continuous quality improvement (CQI) initiatives led by state newborn screening programs.

The Newborn Screening Systems Quality Improvement Projects build on the combined success of previous HRSA Maternal and Child Health Bureau funded cooperative agreements for NewSTEPs, NewSTEPs 360 and the NewSTEPs Timeliness Collaborative Improvement and Innovation Network (CoIIN). However, the Newborn Screening Systems Quality Improvement Projects are unique in that agencies are able to identify specific system challenges within their programs and request the funding necessary to work through their challenges using CQI methods. The ultimate goal is to improve their state or territorial newborn screening program thus improving health outcomes for newborns.

A total of 14 project proposals from 12 agencies were selected to participate in the QI projects, with focus areas including newborn screening timeliness, improvements to long- and short- term follow-up, patient and provider education, health information technology (HIT) and improvements to results reporting. These agencies include:

  • Alaska Department of Health and Social Services
  • Colorado Department of Public Health and Environment
  • Georgia Department of Public Health Laboratory
  • Georgia Department of Public Health Laboratory
  • Heluna Health in partnership with the California Department of Health
  • Iowa Department of Public Health
  • Louisiana Office of Public Health Laboratories
  • Minnesota Department of Health
  • New York State Department of Health
  • Puerto Rico Newborn Screening Program
  • Puerto Rico Newborn Screening Program
  • South Carolina Department of Health and Environmental Control
  • Tennessee Department of Health
  • Virginia Department of General Services/Division of Consolidated Services

In addition to funding support, awardees of the Newborn Screening Systems Quality Improvement Projects participate in a multidisciplinary collaborative network focused on improving newborn screening. They will receive customized coaching and technical assistance on designing and implementing their quality improvement project; support around data and reporting; and opportunities to disseminate their projects to other members of the newborn screening community.

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This program is 100% funded through Cooperative Agreement # UG8MC31893 from the Health Resources and Services Administration. All publications and presentations are solely the responsibility of the authors and do not necessarily represent the official views of HRSA.

The Association of Public Health Laboratories (APHL) works to strengthen laboratory systems serving the public’s health in the US and globally. APHL’s member laboratories protect the public’s health by monitoring and detecting infectious and foodborne diseases, environmental contaminants, terrorist agents, genetic disorders in newborns and other diverse health threats.

 

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APHL honors public health leaders at 2019 annual meeting

Award winners

The Association of Public Health Laboratories (APHL) is pleased to announce the winners of its annual awards for outstanding achievements in laboratory science, creative approaches to solving today’s public health challenges and exemplary support of laboratories serving the public’s health. Awardees were honored during a ceremony at the 2019 APHL Annual Meeting in St. Louis, Missouri. Congratulations to all award winners!

The following awards were presented:

Healthiest Laboratory Award – This award is given to an APHL member laboratory that is committed to safety, environmental process, environmental policy and employee health and wellness.

Thomas E. Maxson Education, Training and Workforce Development Award – This award was established in August of 1998 in memory of Dr. Maxson, and honors an APHL member who is a public health or clinical laboratory practitioner, trainer or educator who has made significant contributions to public health laboratory practice by creating, delivering or developing continuing education opportunities, programs, policies or practices for the laboratory community. For the first time, the Maxson award was presented at the Public Health Laboratory Training Conference in April.

On the Front Line Award – This award honors an individual or organization outside of the association’s membership who makes significant contributions to APHL, its membership and mission.

Emerging Leader Award – This award honors an individual whose leadership has been instrumental in one or more advances in laboratory science, practice, management, policy or education within his or her first five to ten years in the profession.

Leadership in Biosafety and Biosecurity Award – This award honors a laboratory scientist with over 10 years of related service in the field of biosafety and biosecurity in a state and/or local public health laboratory.

Silver Award – This award honors a laboratory scientist with 10 to 15 years of service in a governmental public health laboratory that is recognized as a leader both within their home laboratory as well as external to their laboratory. This year we have two recipients of the Silver Award.

Gold Standard Award – This award recognizes an individual who makes or has made significant contributions to the technical advancement of public health laboratory science and/or practice.

Champion of the Public Health Laboratory Award – This award honors federal, state and local elected officials and executive branch employees who have recognized the importance of state and local governmental laboratories that perform testing of public health significance either through support of legislation or federal agency decisions.

Presidential Award – This award recipient is selected by APHL’s president and given to individuals who have made significant contributions to the Association’s work to promote policies that strengthen public health laboratories. This year there are two award winners.

Lifetime Achievement Award – This award recognizes an individual who has established a history of distinguished service to APHL, made significant contributions to the advancement of public health laboratory science or practice, exhibited leadership in the field of public health, and/or positively influenced public health policy on a national or global level.

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Congratulations to 2019 APHL newborn screening award winners

Congratulations to 2019 APHL newborn screening award winners | www.APHLblog.org

At the 2019 Newborn Screening and Genetic Testing Symposium in early April, APHL presented awards to leaders in the field of newborn screening. We commend the exceptional and innovative work of all those who were nominated.

The following awards were given:

George Cunningham Visionary Award in Newborn Screening – This year’s recipient was Ming Chan, PhD, retired director of the Florida Bureau of Public Health Laboratories (BPHL).

Dr. Chan has been influencing newborn screening and laboratory science in the state of Florida since 1972. In that time, under various capacities at the Florida BPHL, Dr. Chan has implemented and overseen numerous advances in environmental chemistry, clinical chemistry, newborn screening and genetic testing, and bacteriology, serology, and virology. Some of his accomplishments include:

  • adopting automation and a Laboratory Information Management System (LIMS) for the chemistry section that tracked specimen testing and interfaced analytical equipment for the electronic transfer of results;
  • development and implementation of newborn screening test procedures for the state’s Infant Screening Program in 1979; and
  • early adoption of SCID testing after its addition to the recommended uniform screening panel.

In 2008, he retired as the director of Florida’s BPHL but returned to newborn screening as a consultant to continue ensuring healthy outcomes for infants through early disease detection.

Harry Hannon Laboratory Improvement Award in Newborn Screening – This year’s recipient was Victor Skrinska, PhD, DABCC. Dr. Skrinska is the Head of Section for the metabolic laboratory and the National Newborn Screening Laboratory in Doha, Qatar since 2009.

Dr. Skrinska’s research and method development of homocystinuria screening by way of measuring total homocysteine in dried blood spots using LC-MS/MS increased the accuracy of screening, resulting in timely identification and reporting of cases. He has also spearheaded the expansion of conditions screened in Qatar to include alpha and beta thalassemias, as well as expansion to other newborn screening conditions through the use of second tier screening methods. He has championed quality improvement in the laboratory and has been able to make these achievements independent of any political crises and embargos on his country.

Judi Tuerck Follow Up and Education Award – APHL honored the efforts of two individuals this year: Barbara Ferreira, BSN, Area Service Center Director at Harbor-UCLA in California and Amy Gaviglio, MS, CGC, short-term follow-up supervisor for the Minnesota newborn screening program.

Ms. Ferreira has overseen the screening of more than 20 million babies during her 40 year tenure with the state of California. She has improved and influenced the quality of newborn screening follow-up both nationally and within her state. Her experience has advanced the quality of newborn screening at the national level through her active participation on the Education and Training workgroup of the Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC) and the document development committee of the Clinical Laboratory Standards Institute (CLSI). Through participation in APHL’s Collaborative Improvement and Innovation Network and NewSTEPs 360 projects, she implemented measures to improve the timeliness of newborn screening in California.

Amy Gaviglio has been working in newborn screening follow-up in Minnesota for the past 12 years and has been the short-term follow-up supervisor for 10 of those years. She has been intimately involved in Minnesota’s implementation of new disorders, both for screening and for improving the communication of newborn screening results. Ms. Gaviglio has also been a leader in facilitating the initiation and maintenance of screening efforts for critical congenital heart disease in MN, and used this experience to facilitate screening in other states seeking to do the same. She has been instrumental in promoting training for implementation of DNA-based techniques in screening and her expertise has been widely acknowledged through her professional activities at the national level, which include her Vice Chair position for the CLSI Expert Panel on Newborn Screening, membership on the American College of Medical Genetics and Genomics ACT sheet workgroup, and membership on ACHDNC’s Education and Training workgroup, as well as numerous APHL committees and workgroups.

Everyday Life Saver Award – For the inaugural presentation of this award, APHL recognized the work and accomplishments of Krystal Baumert, follow-up coordinator for the Nebraska newborn screening program. Ms. Baumert has been working in newborn screening follow-up for over 25 years. Ms. Baumert was involved in the development of one of the first electronic match systems in the country to be able to accurately account for every newborn’s results, and she continues to work with PerkinElmer (Nebraska’s contracted newborn screening laboratory) to develop clear, effective daily reports for monitoring, tracking and follow-up so that none of the babies in Nebraska are lost to follow-up.

Congratulations to all award winners.

This program was supported by Cooperative Agreement # 5NU60OE000103 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC or the Department of Health and Human Services.

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APHL Receives $7.5 Million Award to Strengthen Newborn Screening Systems

APHL Receives $7.5 Million Award to Strengthen Newborn Screening Systems | www.APHLblog.org

Congratulations to APHL’s Newborn Screening and Genetics team and the NewSTEPs team! Below is the official announcement of the award.

The Association of Public Health Laboratories (APHL) has been awarded a five-year cooperative agreement of up to $7.5 million by the Genetic Services Branch of the US Health and Human Services Health Resources and Services Administration (HRSA) to maintain and manage the Newborn Screening Technical assistance and Evaluation Program (NewSTEPs). A component of the APHL Newborn Screening and Genetics Program, NewSTEPs provides quality improvement initiatives to strengthen newborn screening systems, a data repository, technical assistance and resources to state newborn screening programs and stakeholders.

“We are honored to receive this award,” said Jelili Ojodu, director of APHL’s Newborn Screening and Genetics Program and director of NewSTEPs. “This funding will allow us to continue provide states with robust and comprehensive tools that will allow them to improve the efficiency of the services they provide to newborn babies.”

Named one of the ten greatest public health achievements of the 20th century, newborn screening saves or improves the lives of more than 12,000 babies annually in the US. For babies who test positive for one of the genetic, metabolic, heart or hearing conditions, newborn screening can prevent serious health problems or even death.

NewSTEPs helps facilitate newborn screening initiatives and improve programmatic outcomes to enhance the quality of the newborn screening system through data driven quality improvements.

 

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This project is 100% supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,500,000. The contents are those of the author(s) and do not necessarily represent the official views of, nor endorsement, by HRSA, HHS or the U.S. Government.

The Association of Public Health Laboratories (APHL) works to strengthen laboratory systems serving the public’s health in the US and globally. APHL’s member laboratories protect the public’s health by monitoring and detecting infectious and foodborne diseases, environmental contaminants, terrorist agents, genetic disorders in newborns and other diverse health threats.

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APHL: President Trump’s FY 2019 budget request is “disheartening and disappointing”

APHL: President Trump’s FY 2019 budget request is “disheartening and disappointing” | www.APHLblog.org

APHL: President Trump’s FY 2019 budget request is “disheartening and disappointing” | www.APHLblog.org

The Association of Public Health Laboratories (APHL) is very concerned about the decline in federal funding for public health functions such as detection, surveillance and response in the administration’s budget for fiscal year 2019. “It is extremely disheartening and disappointing to see such severe cuts to public health programs at CDC, HRSA, USAID and the Department of State at a time when the services they support are most in need,” said Scott Becker, executive director of APHL. “What is more, these cuts to public health funding come after a historic bipartisan agreement between Congress and the White House to increase federal spending overall for the next two years.”

CDC cuts include:

HRSA cuts include:

Global Health Programs:

  • $1.26 billion cut to Department of State Global Health Programs which includes funding provided to CDC for PEPFAR; and
  • $1.11 billion cut to USAID Global Health Programs.

While the majority of the president’s budget proposal is grim for public health, there were a few areas that are not as dark. APHL was pleased to see that the budget request designates $175 million to CDC to address the growing opioid crisis. Additionally, funding for the Global Disease Detection Program would increase by $51 million and funding for the Public Health Emergency Preparedness program would increase by $4.5 million.

As Scott Becker explained, “The director of the president’s Office of Management and Budget said, ‘the budget is a messaging document.’ In that case, the message to the American people seems to be, ‘Good luck if there is an outbreak or other public health emergency because federal early warning and response programs won’t be there to help you through.’”

APHL will continue work with Congress to assure that funding levels continue at the much-higher amounts provided in previous years. Adequate levels of federal support for state and local laboratory contributions are critical to the nation’s public health security.

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APHL responds to “banned words,” remains focused on CDC’s budget

APHL responds to “banned words,” remains focused on CDC’s budget | www.APHLblog.org

By Scott J. Becker, executive director, APHL

Recent news concerning limits on language permissible in CDC budgetary communications has drawn considerable attention in the media. As a longstanding partner of CDC, APHL shares its commitment to science-based work to protect the public’s health and improve its health status. We are heartened by CDC Director Fitzgerald’s statement that CDC remains committed to evidence-based work described using all appropriate language, and we are confident that CDC will continue to serve all communities, including those most vulnerable and diverse.

Our primary focus is on ensuring that CDC receives funding that will enable APHL members – local, state and territorial public health laboratories – to do the vital work necessary to detect and respond to public health threats. We feel strongly that, while the words CDC uses in their budget submission are extremely important, the funding levels are at least equally deserving of our attention.

We look forward to working with the Administration and Congress to ensure the best scientific evidence is used in all public health decision making and that all public health professionals are able to use language that appropriately conveys the public health policies and programs that allow for improvement for the health of our nation.

You can also read Scott Becker’s letter to the editor of The Washington Post on this matter.

 

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APHL: US needs an environmental health surveillance system to prevent crises like Flint

APHL: US needs an environmental health surveillance system to prevent crises like Flint | www.APHLblog.org

By Megan Latshaw, director, environmental health, APHL

The public health crisis caused by inordinately high levels of lead contamination in Flint, Michigan is inexcusable, urgent and not as uncommon as many may believe. Over the last decade funding for environmental health services and testing has declined at the local, state and federal levels. The crisis in Flint serves as a critical reminder that our nation needs to reexamine and refocus its environmental health system, policies and practices.

The United States lacks a coordinated environmental health surveillance system at the local and state levels similar to the systems we have for infectious disease detection. The failure to establish and utilize such a system has allowed for crises like the one in Flint.

Did you know that most public health laboratories test air, soil and water as well as people for contaminants? In fact, many of these laboratories also certify other labs in their state to do similar testing. So why aren’t we making better use of these functions?

When there is an emergency, the Environmental Protection Agency’s (EPA) Water Laboratory Alliance (WLA) serves as a network of laboratories willing to provide support by sharing supplies or even performing testing. However, the WLA has not been activated in the Flint response. If it was, it would provide access to 140 laboratories across the country that could offer support.

Additionally, most public health laboratories receive funding from the Laboratory Response Network for Chemical Threats (LRN-C) to test blood and urine for contaminants. To date, however, the LRN-C has not been activated to respond to the Flint disaster. If it was, it could provide the ability to test thousands of samples using high-quality CDC-approved methods.

During non-emergencies, the Centers for Disease Control and Prevention (CDC) measures more than 250 chemicals in blood of US residents, but the data cannot be used to answer questions at the state or community levels. In order to produce such data, local and state public health laboratories need to conduct biomonitoring (looking at whether and how environmental contaminants are being absorbed into people’s bodies) as part of routine public health surveillance.

Currently CDC funds nine states to build biomonitoring capability and capacity, as well efforts to create a National Biomonitoring Network of laboratories. To move toward a true environmental health surveillance system, this funding needs to be expanded to include an additional 10 laboratories.

When fully implemented, the National Biomonitoring Network will harmonize the way local and state agencies measure chemical exposures in people, allowing collaboration among laboratories in order to build efficiency and comparability of data across the country. In the future, a data repository will allow analysis of trends over time and within a specific geographical area. This network will be a significant step toward establishing an environmental health surveillance system in the US. It would mean that communities concerned about potential chemical exposure would have better answers and policymakers would have better data to help them make better decisions.

Finally, investing in the Environmental Health Tracking Network would bring us even closer to an environmental health surveillance system. This network provides access to data on environmental hazards (such as lead in water), exposure data (such as blood lead levels) and health effects (such as birth defects). However, the Environmental Health Tracking Network only includes 26 local and state health departments. Additional resources are needed to build out the system to better identify environmental health issues before they become large, significant problems. A fully-functioning network would lead to a better understanding of patterns related to certain birth defects and the impact of pollution on asthma and other respiratory illnesses.

In order to prevent another crisis like the one in Flint, we must prioritize environmental health as part of our broader commitment to public health. APHL feels strongly that every citizen has a right to clean water, no matter where they live. Our government has a duty to provide this. The US needs an environmental health surveillance system, and we see the public health laboratories as a vital component of such a system.

APHL: US needs an environmental health surveillance system to prevent crises like Flint | www.APHLblog.org