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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Educating Children After Hurricane Maria

In September 2017, Hurricanes Irma and Maria roared through the Caribbean just 12 days apart. The schools on St. Croix and St. Thomas in the U.S. Virgin Islands (USVI) did not re-open until October 24. Teachers talked about how many of the books and materials in their classrooms were moldy and how teachers and staff had to help the janitorial staff clean up classrooms. Parents shared stories of their children coming home from school with mosquito bites all over their arms and legs. Schools could not always run the air-conditioning because they were operating using generators.

Finding a natural fit

As a team lead in the Division of Adolescent and School Health, I have expertise in how health departments and federal agencies should work with schools. So when I was deployed to support health communication activities in the US Virgin Islands after Hurricane Maria, I offered to support the USVI Department of Health doing health communication outreach to schools. We worked quickly to connect with schools and distribute materials to students and their families about how to stay safe and healthy after a hurricane.

Making a vision a realityChildren are the key to primary prevention because they are the drivers of the health behaviors we hope to change. -Malaika Washington

I worked with Director of Public Relations, Nykole Tyson, at the USVI Department of Health and the USVI Department of Education to determine how many children were enrolled on St. Croix, St. Thomas, and St. John and which educational materials from CDC to distribute. With support from the CDC Foundation, we printed and distributed flyer packets for over 16,000 K-12 students on the three islands to take home to their families. The packets contained CDC-developed materials about how to stay safe after a hurricane, including tips for food and water safety, how to prevent mosquito bites, the health risks from mold, how to avoid carbon monoxide poisoning, and mental health. Since 35% of the children on St. Croix speak Spanish, we made the messages available in both English and Spanish.

Each child was also given a copy of the Ready Wrigley Flooding and Mold Activity Book as part of the flyer packet. Ready Wrigley is a series of CDC-developed activity books for children 5-9 years old and their families to help them talk about and prepare for emergencies. There are nine Ready Wrigley books that provide tips, activities and a story about disaster preparedness. The flooding and mold activity book talks specifically about safe mold clean-up after a flood and how kids should never touch mold and always tell a grown-up if they see mold.

Giving children a voice

Malaika Washington reading the Ready Wrigley Flooding and Mold activity book to students in USVI.
Sharing the Ready Wrigley Flooding and Mold activity book with students in USVI.

American Education Week takes place every November. The USVI Department of Education contacted Director Tyson and asked her to read to elementary school students on St. Croix. She asked me if I would like to join her visits to kindergarten and first grade classrooms. I jumped at the chance to interact with students in-person and suggested we read the Ready Wrigley Flooding and Mold Activity Book. I even colored the pictures in the book and completed the activities so the children could follow along. We shared the Ready Wrigley books with the teachers at each school we visited, giving teachers enough copies of the book for every student to take one home.

All of the students really wanted their stories heard. One first grader recounted how his mother and grandparents told him to stay far away from the cleaning products while they cleaned up the mold in their home. Another little girl shared how she was personally impacted by mold. She had to sleep on the sofa in her home because there was mold all over her bed and the other furniture in her bedroom. Several other children described the mold they found on the front door of their homes after the hurricane.

Fulfilling a passion

Working with school-aged children is so rewarding. This deployment experience was the best I could have hoped for. The time I spent in the USVI made me realize my personal and professional goal to provide public health education materials to children and their families. I have always believed that public health prevention work should begin with school-aged youth and it is my lifelong public health mission to ensure that they have a voice.

Malaika Washington has been a Commissioned Corps Officer in the United Stated Public Health Service since October 2009. She is a team lead in the Division of Adolescent and School Health, the only division at CDC that funds education agencies directly. Her deployment to the U.S. Virgin Islands for the 2017 HHS Hurricane Response was the first time she deployed for a public health emergency.

New Lab Matters: Biomonitoring

New Lab Matters: Biomonitoring | www.APHLblog.org

In the 1970s, the National Health and Nutrition Examination Survey (NHANES) showed that gasoline lead was a major exposure for children and adults—a huge finding that would not have been known otherwise. Today NHANES provides a critical baseline for national background levels of exposure to other chemicals, but state efforts to test and document local, possibly elevated exposures to the new “alphabet soup” of PFOAs and PFOSs have been little funded and lagging. As our feature article shows, public health laboratories aim to change that through new technologies and the establishment of the new National Biomonitoring Network.

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

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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

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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National Hurricane Preparedness Week (May 7-13, 2017): It Only Takes One!

Hurricane Awareness Week

As the saying goes, “all politics are local.” The same goes for hurricanes. A busy hurricane season is not just defined by the total number of hurricanes in a season, but rather if any hurricane hits your local community.  It only takes one.  This mantra provides the impetus every May for the National Oceanic and Atmospheric Administration (NOAA) and its partners to participate in the National Hurricane Preparedness Week.  The goal of National Hurricane Preparedness Week is to motivate communities, businesses, and individuals to know their risks, take steps to prepare, and encourage their loved ones, neighbors, and social network to do the same.

This year, one preparedness action will be profiled each day of the week with useful tips and additional resources available for anyone to access. The seven actions are:Hurricane Awareness Tour

Beyond preparedness messaging, there is a lot going on during National Hurricane Preparedness Week. The Hurricane Awareness Tour brings the hurricane hunter aircraft to six East Coast locations over six days. At each location, school students, community leaders, and the public are invited to get an up close and personal experience with the science of hurricane exploration and the scientists who intentionally fly into the eye of a hurricane.

In addition, there will be “Scientists in the Classroom” webinars, public service announcements, and lots of social media buzz. Follow the social media conversations using the hashtags #hurricanestrong, #hurricaneprep and #ItOnlyTakesOne.

Preparedness isn’t just about checking off a “To Do” list, but is a 365-day a year mindset. And May is the perfect time to put the focus on hurricane and tropical storm preparedness. Whether you or family members live along, or are planning to visit, the coast where storm surge from tropical systems can be life-threatening, or are well inland in areas where these systems can bring flooding rains, taking steps now to be better prepared gives you the advantage when the threat becomes a reality.

Rhode Island laboratory responds to toxic algae bloom, safeguarding health and the local economy

Rhode Island laboratory responds to toxic algae bloom, safeguarding health and the local economy | www.APHL.org

by Kim Krisberg

Every week, the Rhode Island State Health Laboratory tests water from Narragansett Bay, monitoring the estuary for harmful toxin producing plankton that can contaminate the seafood that makes it to market. The testing protects both consumers and the fishermen who depend on a healthy bay for their livelihoods.

Last October, that routine testing revealed large numbers of the algae Pseudo-nitzschia — numbers much higher than what’s considered normal. Pseudo-nitzschia can produce a neurotoxin known as domoic acid. In people, domoic acid can lead to amnesic shellfish poisoning, which can result in permanent short-term memory loss and even death. So with the sudden algal bloom detected, laboratory staff quickly began toxicity testing. Tests came back positive.

The results meant the public health laboratory had just detected Rhode Island’s first Pseudo-nitzschia bloom and triggered a statewide contingency plan designed to keep contaminated shellfish from reaching people’s plates.

“Our goal is to protect public health, but this could also affect the shellfishing economy and the harvesters here — the whole reputation of Rhode Island shellfish could go down the drain if people did get sick,” said Henry Leibovitz, PhD, chief environmental laboratory scientist at the Rhode Island Department of Health State Health Laboratories.

Contingency plan activated, laboratory staff began testing shellfish meat collected from areas with high algae counts. The meat tested positive for domoic acid levels beyond safe thresholds set by the US Food and Drug Administration. In response, on October 7, Rhode Island’s Department of Environmental Management (DEM) officially closed down shellfish collection in parts of the bay. Leibovitz said it was the first time this particular type of algal bloom brought shellfish harvesting to a halt in the area.

As harvesting on the bay stopped, laboratory staff ramped up their testing of water and meat samples collected by the DEM as well as of quarantined shellfish already on the market.

“We wanted to prevent contaminated shellfish from getting to people and reopen the bay as soon as it was safe,” Leibovitz said.

Thankfully, none of the quarantined shellfish tested positive for contamination and within a few weeks, algae counts began dropping. A few weeks after the bloom began, Leibovitz said the number and density of plankton declined to a point where the shellfish had a chance to cleanse themselves of the toxin. Laboratory staff began seeing results well below safety thresholds so that Rhode Island shellfish were safe for consumption. By the beginning of November, DEM reopened the bay to shellfish harvesting.

Then in February, the laboratory detected another Pseudo-nitzschia bloom and high toxin levels — this time, in a part of the bay closest to the ocean. (On a side note, Leibovitz said some experts speculate that the initial bloom never really died out entirely off shore, and the bloom returned to the mouth of bay where it meets the ocean.) Based on the results, DEM shut down shellfish harvesting again on March 1, eventually reopening on March 24.

Throughout the two closures, no cases of human illness related to contaminated shellfish were reported.

During the blooms, laboratory scientists conducted hundreds of complicated tests in the span of a single month — “everyone had to stay late and get it done because we needed the answers right away,” Leibovitz said. He noted that even though the laboratory is prepared for such a surge, it’s still “very challenging” to keep up for weeks at a time.

That’s because within the laboratory’s water microbiology unit, none of the four scientists do shellfish testing on a full-time basis. They’re also responsible for testing drinking water, beach water, dairy samples, river water and animals for rabies. But when the algal bloom appeared, the entire water microbiology laboratory turned its attention to keeping toxic shellfish off people’s plates and re-opening the bay as quickly and safely as possible. At one point, scientists from a different division within the state laboratory were called over to help.

“It’s very time-consuming and our other responsibilities don’t stop,” Leibovitz noted. “We’ve always had a contingency plan in place, but the laboratory isn’t staffed to do this (level of testing) on a routine basis and last fall, it became routine.”

So, what caused the algal bloom? Leibovitz said, “no one really knows yet.” But one theory is that successful efforts to keep stormwater runoff out of Narragansett Bay has reduced nutrients in the bay to the point that Pseudo-nitzschia may not have the competition from other algal species that flourished for years in the nutrient-rich environment. The cleaner waters of the bay may now be more supportive of Pseudo-nitzschia growth as are the waters outside of the bay, where they typically thrive.

“The worry is that this could be the new normal,” Leibovitz said. “But the group that works in the water microbiology laboratory are really dedicated to ensuring Rhode Island shellfish in the market are good and safe to eat…when something like this happens, they step up.”

According to the Centers for Disease Control and Prevention, it’s unknown how many people in the US are sickened due to harmful algae blooms, as such occurrences aren’t tracked nationally. However, state and local public health agencies can now report such illnesses to the One Health Harmful Algae Bloom System, which launched last year. CDC did report that economic costs associated with such blooms have gone up in recent decades, costing the fishing and tourism industries millions of dollars each year.

Photo of Narraganset Bay via WPRI

From The Lorax to the Laboratory

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What’s in an environment?

Every year, more than 193 countries celebrate Earth Day on April 22nd. Earth Day reminds all of us of our personal and collective responsibility to preserve and protect the environment. Protecting the environment also helps us protect our health.

The word “environment” means different things for different people. For some the environment is the natural world—mountains, forests, rivers, oceans, animals, and the air around us. Others think of “tree huggers,” the green movement, or the motto “Reduce, reuse, recycle.” But everything in the world around us is part of the environment – it is the air we breathe, the water we drink, the soil beneath our feet, and much more. When environments are polluted or contaminated, they can cause harmful health effects in people.

Recent research has confirmed that many people think “public health” refers to government health programs. But public health is really about protecting populations—tribes, communities, cities, states, and nations—from threats to their health, safety, and well-being.

Bridging two worlds

Environmental public health combines these two topics, and focuses on protecting groups of people from environmental threats to their health and safety. CDC’s National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry focus on protecting people where they live, work, study, and play.

In order to protect people from environmental health threats, we need to understand basic human needs and how the environment can affect them. Meeting these needs contributes to our physical, mental, and emotional health.

  • Basic physical needs that are required for life
    • Air
    • Water
    • Food
    • Shelter
  • Needs for community that make life easier
    • Family
    • Church or other social group
    • Access to medical care
  • Emotional, spiritual, relational needs that contribute to personal happiness
    • A sense of control of life choices and events
    • Fulfillment
    • Ability to be close to others

Staying healthy depends on the safety of our environments. Natural disasters, such as tornadoes or hurricanes, can endanger our physical health by affecting the safety of food, water, and shelter. They can also create unsafe and unhealthy communities by disabling community services or making access to medical care more difficult. Finally, disasters can affect our mental and emotional health by creating family stress and eliminating any sense of control.





APHL’s March for Science Toolkit

APHL is a proud partner of the March for Science | www.APHLblog.org

APHL is a proud partner of the March for Science! We are champions for science everyday through our work and our support of laboratory scientists around the world. Science is the root of outbreak detection, prevention and response – without science there would be no public health. Our support is not about politics or opinions; it’s about standing with our colleagues, partners and members to strengthen the public health community by supporting science. The work we all do, whether as laboratory scientists or as support staff, is critical to protecting our communities from health threats.

APHL is a proud partner of the March for Science | www.APHLblog.orgWe at APHL are proud of the work that you do and we are excited to march in support of it!

March for Science
April 22, 2017

Washington, DC March for Science event details
Satellite March for Science events

Whether you’re participating in the March for Science in Washington, DC, at a satellite march, or in spirit from wherever you will be, we want to hear from you! Please share your photos, videos, audio recordings or written thoughts about the March for Science and its mission.

  • Tag #APHL in any March for Science posts on Twitter, Instagram, Facebook and Pinterest
  • Tag @APHL in any March for Science posts on Twitter and Instagram
  • Share on the APHL Facebook timeline
  • Tag yourself in any @APHL Instagram photos about the March for Science
  • Tweet us at @APHL with updates from the March for Science

APHL March for Science graphics:

Did you know April 22 is also Earth Day? And it is the first day of Lab Week? There is so much SCIENCE to celebrate!

  • Lab Week 2017 toolkit – There’s a Lab for That! APHL will celebrate the dedicated individuals working at local, state, environmental and agricultural laboratories which comprise the public health laboratory system.
  • Earth Day 2017

Help your friends and family better understand the work that you do by sharing these videos and blog posts:

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How Much Radon is In Your Home?

Focus on Radon Chemical Element from the Mendeleev Periodic Table

January is National Radon Action Month. Protect your home and your family from this invisible health risk.

Knowing how much radon is in your home could save your life. Radon is the second leading cause of lung cancer after cigarette smoking. If you smoke and live in a home with high radon levels, you increase your risk of developing lung cancer. The U.S. Environmental Protection Agency and the Surgeon General’s office estimate radon is responsible for more than 20,000 lung cancer deaths each year in the U.S.

What is radon?

Radon is a gas that forms naturally when radioactive metals – like uranium, thorium, or radium – break down in rocks, soil, and groundwater. Radon is invisible; you can’t see, smell, or taste it. When you breathe in radon, radioactive particles from radon gas can get trapped in your lungs. Over time, these radioactive particles increase the risk of lung cancer. It may take years before health problems appear.

Where does radon come from?

Radon comes naturally from the earth, and people are always exposed to it. Radon in air can come through cracks and gaps in buildings and homes. Some homes have higher levels of radon than others. Having your home tested is the only effective way to determine whether you and your family are exposed to high levels of radon.

How do I test for radon?

Testing is inexpensive and easy, and should only take a few minutes of your time. It requires opening a package, placing a small measuring device in a room, and then leaving it there for the desired period (which may be a few days, or as many as 90 days or more). The longer the testing period, the more relevant the results are to your home and lifestyle.Protect your family from radon

To test for radon:

  • Purchase a radon test kit.
  • Test your home or office.
  • Send the kit to appropriate sources to determine radon level.
  • Fix your home if radon levels are high.

How can I reduce my exposure to radon?

To reduce high radon levels in your home and protect yourself from an increased risk of lung cancer, you can take action.

  • Stop smoking and discourage smoking in your home.
  • Increase air flow in your house by opening windows and using fans and vents to circulate air. Natural ventilation in any type of house is only a temporary strategy to reduce radon.
  • Seal cracks in floors and walls with plaster, caulk, or other materials designed for this purpose. Contact your state radon office or call the National Radon Hotline at 1-800-SOS-RADON for a list of qualified contractors in your area and for information on how to fix radon problems yourself. Always test again after finishing to make sure you’ve fixed your radon problem.
  • Ask about radon-resistant construction techniques if you’re buying a new home. It’s almost always cheaper and easier to build these features into new homes than to add them later.

Learn More