Partnering to streamline review

orcid.org/0000-0001-8771-7239   I’m happy to announce PLOS’ participation in a new service, Review Commons, that will provide a platform for rapid, objective, journal-independent peer reviews for manuscripts and preprints. We are excited to be part

Lab Culture Extra: Progress in Sierra Leone

APHL's Sierra Leone team

APHL has a long history of involvement in Sierra Leone where we’ve provided technical assistance to strengthen the nation’s laboratory system for over a decade. Following the 2014-2015 Ebola outbreak, we were invited back to build laboratory response capability for Ebola and other highly infectious diseases.

We found there was a lot to be done: a strategic plan for the laboratory system, renovation of the central lab, training and mentoring of lab staff, reducing turnaround time for Ebola testing, and much more.

With the engagement completed earlier this year, APHL Executive Director Scott Becker and Manager of Global Health Sherrie Staley share insights from APHL’s on-the-ground experience, which include the value of a healthy ram.

Listen here or wherever you get your podcasts.

Links:

Photo album — Progress in Sierra Leone

APHL joins partners in Sierra Leone to strengthen lab capacity in Ebola’s wake

High profile APHL team explores MOHS public health laboratory priority needs

APHL in Sierra Leone: Building a resilient lab system

Sierra Leone and Guinea: Building a resilient lab system

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Self-directed regional networks: Connecting neighbors strengthens labs

The Pacific Rim Consortium met in person for the first time at the Hawaii Public Health Laboratory in March, 2019.

(Photo: The Pacific Rim Consortium met in person for the first time at the Hawaii Public Health Laboratory in March, 2019.)

How can a public health laboratory with limited resources sustain and expand its capabilities? One strategy is to leverage the resources and expertise of its neighbors.

With support from the US Centers for Disease Control and Prevention (CDC), APHL is assisting with development of self-directed regional laboratory networks (SDRN) to facilitate collaboration and resource management among neighboring public health and environmental laboratories. SDRNs operate independently, establishing their own governance and strategic priorities based on their unique needs. Soon these networks will be linked through a Coordination Council, which will bring together representatives from each of the SDRNs for joint planning and resource development.

A growing community of networks

Today, 48 states and one territory, Guam, are members of an SDRN. The original SDRN was founded over forty years ago when laboratory directors in New England came together in the mid-1970s to share common concerns around newborn screening legislation then pending in multiple states. This group evolved to become the New England Public Health Laboratory Directors Group (NEPHLD), and then became NEEPHLD when it expanded its constituency to include laboratories responsible for environmental testing.

However, the regional model did not pick up momentum until a review by APHL and CDC demonstrated its value in the early 2000s. This provided the impetus to form the Northern Plains Consortium in 2006, the Southeast Consortium in 2015, the Mid-Atlantic Consortium in 2017, and the Midwest, Pacific Rim, Four Corners and Central Plains networks in 2018 and 2019.

Members “have our back”

SDRN member laboratories report many benefits from participation. Members share technical expertise, technologies and capacity, and they forge relationships with colleagues at other laboratories, making it easier to collaborate when emergencies arise or a testing system goes down. Emily Travanty, PhD, scientific director of the Laboratory Services Division at the Colorado Department of Public Health and Environment reports: “Our fellow consortium members have our back when we need them. For example, the Utah Public Health Laboratory did TB testing for us when our laboratory was in the midst of renovations. Because of them, we were able to still meet our test turn-around times and keep our customers happy.”

Members also collaborate on fundraising, informatics systems, training and leadership development, as well as recruitment and retention. According to Denise Toney, PhD, director of the Virginia Division of Consolidated Laboratory Services:

“The Mid-Atlantic Consortium provides a venue to share ideas, resources and expertise across our region so we don’t have to reinvent the wheel. One project we worked on collectively was a compensation study, funded by CDC and APHL. Our members are using this data to educate their own state leaders about the salary levels needed to recruit and retain top-notch scientific staff in our region.”

SDRNs show strong prospects for the future, with planning in progress within and across networks. With sustainability a perennial challenge for state and local laboratories, that’s good news for public health.

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APHL: Engaging for change in emergency diagnostics

APHL: Engaging for change in emergency diagnostics | www.APHLblog.org

The process for developing and deploying emergency diagnostics to laboratories nationwide will now be more efficient. A new entity, the Tri-Agency Task Force for Emergency Diagnostics, has brought together representatives from the Centers for Disease Control and Prevention (CDC), the Federal Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS) to coordinate systems for rapid delivery of tests, reagents and guidance to public health and clinical laboratories.

APHL contributed to the development of the Task Force by communicating the potential value of such a mechanism. Beginning in the early months of the 2016 Zika pandemic and continuing long after, the association and its member laboratories engaged federal partners in a dialog around systems for cross-agency coordination of emergency diagnostics.

“The federal partners recognized that instead of relying on APHL to coordinate communications during a crisis, having a more permanent solution in place would be more effective,” explains Peter Kyriacopoulos, senior director of public policy at APHL. “With CDC taking the lead, the Tri-Agency Task Force for Emergency Diagnostics has been established. Whenever the next disease comes along, this group will be ready to get to work.”

Kelly Wroblewski, APHL’s infectious disease director, adds that the Task Force makes communication more routine. “Having communication channels already open will make it easier to get the response going as quickly and efficiently as possible,” she says.

Since 2016, the threat of Zika has subsided. In 2017 and 2018, there wasn’t another outbreak, but Zika will likely come back. But this time, the public health community will be ready.

“With the Tri-Agency Task Force in place, we’re much better off than we were in 2016,” says Kyriacopoulos. “Other improvements, like more efficient ways to send data electronically, are still needed. But the systems we had and the new ones we’ve introduced have strengthened communication and coordination.”

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Are antibiotics making printers great…again?

Are antibiotics making printers great...again? | www.APHLblog.org

By Eric Ransom, APHL-CDC Antimicrobial Resistance Fellow

Let’s be honest: printers have never been that great. These frustrating devices turn what should be a simple office task into a game of chance. Is there paper? Did it jam? Can I get by without replacing the toner cartridge… again? Ugh! I personally cannot wait until this archaic technology sails off into the sunset. Goodbye frustration and hello forestation.

You can imagine my surprise when I heard a PRINTER could help fight one of the most significant public health threats of our time: antibiotic resistance. That’s right. The end of the antibiotic era looms, but hope lies with a printer!

To be fair, this is not your ordinary printer that puts ink to paper. This is a bioprinter that “prints” antibiotics! The technology ultimately helps clinicians decide which antibiotic is most likely to be effective in treating an infection. Prescribing the proper antibiotic is key to saving lives today and preserving antibiotics for tomorrow.

More specifically, the bioprinter makes antibiotic panels for broth microdilution susceptibility testing, a gold-standard method in clinical and public health microbiology. To make an antibiotic panel, the bioprinter dispenses minuscule amounts of antibiotics into a 96-well plate containing liquid that supports microbial growth. Microbiologists can then add a patient’s microbe to the plate and observe which antibiotic (or combination of antibiotics) inhibits growth. If an antibiotic inhibits growth on the plate, chances are good that it will also inhibit growth in the person. Results are shared with clinicians so they can prescribe the best antibiotic(s) to treat the infection. What makes the bioprinter unique is that it can easily make antibiotic plates with complex antibiotic combinations and new-to-market antibiotics. The latter is especially exciting given it can take years before new-to-market antibiotics are included on commercially available plates and systems found in most hospital laboratories.

In 2018, the Centers for Disease Control and Prevention announced a pilot program to implement the bioprinter technology in the Antibiotic Resistance Laboratory Network, a consortium of 56 public health laboratories that aims to rapidly detect and respond to antibiotic resistance. The pilot program already uses the bioprinter to offer expanded antibiotic susceptibility testing for hard-to-treat infections in four public health laboratories: Wisconsin State Laboratory of Hygiene, Minnesota Department of Health Public Health Laboratory, Wadsworth Center Laboratories and Tennessee State Public Health Laboratory. This susceptibility testing is free, compliant with patient testing regulations, and available for all qualifying isolates from any hospital laboratory. The testing is also performed within three working days to quickly assist clinicians with therapeutic management.

The pilot program has already begun susceptibility testing with a new drug combination (aztreonam-avibactam) against Enterobacteriaceae producing a metallo-β-lactamase (MβL). These are some of the most resistant microbes, and there are very few effective treatment options. To qualify for this particular testing, isolates must be non-susceptible to all current β-lactam antibiotics (including either ceftazidime-avibactam or meropenem-vaborbactam). Moving forward, the pilot program will expand testing to include other highly resistant microbes and new-to-market antibiotics.

So how exactly does the bioprinter pilot program work in practice? Let’s say a hospital patient has symptoms of a serious infection. Samples from the patient are tested in the hospital’s laboratory to identify the responsible microbe and to determine possible treatment options. If the microbe is found to be highly resistant and clinicians are in need of additional treatment options, the microbe is sent to one of the four public health laboratories piloting the bioprinter program. Microbiologists there can use the bioprinter to print plates for testing the newest antibiotics to see what, if any, are effective in treating the patient’s infection. Results are then returned to clinicians where the patient is being treated.

Implementation of the bioprinter in the AR Lab Network has the potential to be truly impactful. First, clinicians are given a resource to find new, effective treatment options for their patients’ most resistant infections. Second, compiled data from this pilot program can be used to improve antibiotic prescribing, capture national antibiotic efficacy, help establish antibiotic breakpoints and even inform infection control and prevention practices.

The bioprinter pilot program is a remarkable step forward in the fight against antibiotic resistance. It is important to realize though that this crisis still requires comprehensive long-term intervention including discovery of new antibiotics, development of new diagnostics, and an unequivocal commitment to antibiotic stewardship in healthcare and beyond. In the short term, though, a printer might just be exactly what the doctor ordered.

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APHL and Canadian Public Health Laboratory Network Reaffirm Cross-border Partnership with MOU

APHL and Canadian Public Health Laboratory Network Reaffirm Cross-border Partnership with MOU | www.APHLblog.org

Recently APHL and the Canadian Public Health Laboratory Network (CPHLN) signed a new memorandum of understanding (MOU) that reaffirms their long-standing collaboration and updates the specifics of the MOU. Executive Director Scott Becker, MS, and President Joanne Bartkus, PhD, traveled to the National Microbiology Laboratory (NML) in Winnipeg, MB, to formalize the agreement with the Scientific Director General of the NML and federal co-chair of CPHLN Matthew W. Gilmour, PhD., and current provincial co-chair Paul Van Caeseele, MD.

To hear more about this cross-border partnership, APHL spoke with Theodore Kuschak, PhD, Director, Office of Networks and Resilience Development, National Microbiology Laboratory, and CPHLN secretariat member, and Graham Tipples, PhD, Medical-Scientific Director of the Provincial Public Health Laboratory in Alberta, and past provincial co-chair of CPHLN.

What prompted APHL and CPHLN to establish the first Canada-US MOU in 2004?

Kuschak: I was hired in 2003 to lead the CPHLN and met Scott Becker at a meeting in Toronto a week later. We started talking and came up with the idea for an MOU as a way to formalize the relationship between our two networks. We’ve maintained an MOU from 2004 to this date, with modifications and re-signing in 2008, 2011 and now in 2018.

Actually, our Canadian laboratory organization precedes 2004, going back all the way to 1947 when provincial lab directors created a Technical Advisory Committee to advise the national lab. This group disintegrated in the late 1990s, but resurfaced as the CPHLN after the 9/11 and anthrax attacks. CPHLN member labs collaborate and assist each other, much as public health labs do in the US. All provincial and federal CPHLN labs operate on an equal footing, which makes the network unique.

How does the MOU benefit CPHLN and its member laboratories?

Kuschak: The MOU enables our provincial labs to break through the governmental hierarchy and interact directly with state public health labs. If a provincial lab director has a particular challenge, he or she can be linked through APHL to a state lab director who is dealing with the same issue. Additionally, the MOU makes it easier to obtain approval for travel and for other collaborative activities to support our partnership.

More broadly, the CPHLN-APHL relationship facilitates collaboration on technical issues, interventions like exchange of information, knowledge, and participation in APHL board of directors meetings, annual meetings, and other activities.

CPHLN also benefits from APHL’s work to develop standards, guidelines and tools to strengthen laboratory practice. For instance, we’ve adapted the Core Functions of Public Health Laboratories and worked with APHL to develop the Laboratory Assessment Tool for use by all public health labs.

How does this cross-border laboratory partnership benefit the public’s health?

Kuschak: It makes such a difference to have long-established personal relationships on both sides of the border.  We can pick up the phone and get answers from each other when we need them. As a result, we can respond more quickly to events – and the faster we respond, the sooner our data is available to guide patient care.

Tipples: The ongoing exchange between the two networks also helps to ensure the consistency of lab diagnostics and surveillance in support of patient care and public health action. This is vital considering the number of people who cross the Canada-US border daily.

How does the APHL/CPHLN collaboration support public health emergency preparedness?

Tipples: It’s often said that emerging diseases know no borders. A disease threat in the US is a threat in Canada as well. We participate in PulseNet and other international disease surveillance systems such as influenza and measles. Occasionally, specimens from Canada go to CDC for analysis if we lack the capability, as occurred very early on during the Zika outbreak.

Kuschak: Our US network partners are always ready to help in an emergency. In 2014 we wanted to know what was happening with Ebola testing in Texas. If we’d contacted the state health laboratory, they would have said, “Who are you?” Instead we called Scott [Becker] and he got back to us within a day with the information we needed.

Here’s another example: Many years ago I was at APHL’s old offices in downtown DC when I got a call from Frank Plummer, who was then the director general of our national lab. Frank explained that there had been an issue with a proficiency panel distributed by a diagnostics company to labs in the US and Canada. The panel included a particularly concerning pathogen strain. I asked, and received approval, to share this news with Scott so that he could alert APHL member labs. I then had to get on the phone to tell our provincial labs to handle the panel with appropriate bio safety precautions. Scott set me up with an office and a phone, and offered to get me anything I needed, including lunch. You can’t beat that kind of support!

Do you foresee opportunities to expand the APHL/CPHLN partnership? 

Tipples: Collaboration between the two networks has expanded already. As a member of APHL’s Training and Workforce Development Committee, I’ve had a chance to assist with development of the new DrPH in Public Health Laboratory Science and Practice program, designed to address the shortage of CLIA laboratory directors. I was also able to pull in the NML’s talented lead bioinformatician to contribute to the development of the bioinformatics component of the curriculum.

And as of 2017, there’s a place reserved for a Canadian in APHL’s Emerging Leader Program. We’re excited to have CPHLN represented in this excellent leadership development program.

Kuschak: Our public health agency has asked for more lab involvement in shaping nation-wide health planning. We’ll be collaborating on development of a national strategy for preparedness and response to viral hemorrhagic fevers, development of a public health genomics strategy for Canada, and other work. As we move forward with this and similar initiatives, you can be sure that we’ll be on the phone once again with our American colleagues.

 

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