Q&A with Iowa lab’s safety officer, Drew Fayram: How the CDC/APHL biosafety and biosecurity program created a culture of safety

Q&A with Iowa lab’s safety officer, Drew Fayram: How the CDC/APHL biosafety and biosecurity program created a culture of safety | www.APHLblog.org

APHL recently checked in with Drew Fayram, the safety officer at the State Hygienic Laboratory at the University of Iowa, to get his perspective on the progress of the CDC/APHL biosafety and biosecurity program. Initiated in 2016 with support from the Domestic Ebola Supplement to the Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement, the program aims to strengthen biosafety and biosecurity practices at public health and clinical laboratories nationwide. The Centers for Disease Control and Prevention (CDC) and APHL are collaborating as partners in this initiative.

Prior to becoming the safety officer, Drew served at the Iowa laboratory as an Emerging Infectious Disease Fellow and as the first manager of the Center for the Advancement of Laboratory Science.

Tell us about laboratory biosafety and biosecurity risk management prior to the CDC/APHL program.

Prior to the CDC/APHL program, there was great variation in biosafety and biosecurity staffing at public health laboratories. Many labs had someone who worked on biosafety part-time in addition to other roles, while a few larger labs had several biosafety specialists and added another to conduct outreach to clinical laboratories when funding became available through the CDC/APHL program.

At Iowa, we had a safety officer who had other extensive management duties. After she retired, we hired another individual to oversee safety, security and building operations. In 2015 when we received funding from the CDC/APHL program, I assumed all of the biosafety roles at the Hygienic Lab, along with outreach to clinical labs. A year later, our Safety and Security Officer retired and I took on all safety duties, including but not limited to biosafety.

How has the CDC/APHL biosafety and biosecurity program benefited you as a laboratory safety officer?

Q&A with Iowa lab’s safety officer, Drew Fayram: How the CDC/APHL biosafety and biosecurity program created a culture of safety | www.APHLblog.orgThe CDC/APHL program has benefited me professionally and personally. Historically, there was no formal entry point into the field of laboratory biosafety and biosecurity. As far as I know, no US colleges offer a major in biosafety. But now the field is becoming more standardized with common resources and language, which has made it easier to bring you up to speed on regulations and best practices. The CDC/APHL program has played a big role in this, along with other groups like the American Biological Safety Association International (ABSA).

For me, the CDC/APHL program has helped advance my skills and build professional connections through in-person training, online meetings and networking opportunities. Through the program, I have connected with staff from other public health labs, CDC, ABSA International, USAMRIID and the Eagleson Institute, as well as laboratory scientists from other countries. The connections with ABSA are particularly valuable, as people there have spent their careers helping scientists conduct laboratory science safely. Without the support of the CDC/APHL program, I would never have been able to meet so many people in such a short time and so early in my career, nor would I have received the quantity or quality of training made possible by the program.

Has the program led to improvements in biosafety and biosecurity practice at the State Hygienic Laboratory in Iowa?

The trainings offered through the CDC/APHL program have better prepared me to serve as a resource for staff to help identify tools and best practices in biosafety and biosecurity. As a matter of fact, I was a few minutes late to this interview because someone stopped me in the hall to ask a question about a biosafety issue. I believe my efforts to serve in this role encourage staff to remain more alert to biosafety and biosecurity considerations. It’s becoming part of our culture. I also work closely with our Safety Committee, which brings together staff from all areas of the lab to proactively address safety issues at our facility before they cause anyone potential harm.

How has the CDC/APHL program changed biosafety and biosecurity practices at clinical labs in Iowa?

Our lab has offered workshops on rule-out of bioterrorism agents to clinical labs in our state for many years, and we have always emphasized biosafety practices at these workshops. The CDC/APHL program has allowed us to offer additional workshops specifically focused on biosafety and biosecurity to train clinical labs on how to conduct a biosafety risk assessment to make sure that they are taking appropriate steps to mitigate risks associated with infectious agents. The assessment is theirs, not mine. I share an assessment template, but advise them to adjust it to meet their needs. The staff then conduct the assessment at their facility themselves.

For some staff, the assessment is a new experience. Many are familiar with quality risk assessment, but not biosafety risk assessment. But regardless of past experience, staff have successfully identified potential, actionable risks, such as biosafety cabinets that require replacement or procedures that should be performed inside a biosafety cabinet.

As a result of the assessments, I’ve started to see a change in attitude at clinical laboratories. Before, staff accepted risks because they recognized the importance of fast test results for ensuring the best patient outcome possible. They may have thought, “That extra step is going to slow me down, and our patients aren’t going to get their treatment as quickly.” Now through the CDC/APHL program, risk assessment is becoming a part of daily operations, and labs are finding ways to mitigate risk while still getting test results quickly.

What’s more, our relationship with these laboratories continues beyond the risk assessment. I usually get around one phone call and several emails each week from clinical laboratories asking biosafety-related questions. Many clinical labs now have staff who, as part of their regular duties, are paying additional attention to biosafety issues and engaging in conversations about best practices. I believe the consideration of biosafety issues in every day practice is an even more valuable outcome of the CDC/APHL program than putting a checkmark in a box on a risk assessment form.

If Congress does not reauthorize funding for the CDC/APHL biosafety and biosecurity program in 2018, how would this affect public health labs and their clinical laboratory partners?

If the program is not continued, we risk losing our investment in highly trained laboratory biosafety officers in public health labs. There is a tight market for this skill set. If federal funding does not continue to support these positions, many biosafety officers could be scooped up by universities and research centers, leaving the public health system without their expertise.

Q&A with Iowa lab’s safety officer, Drew Fayram: How the CDC/APHL biosafety and biosecurity program created a culture of safety | www.APHLblog.org

Likewise, clinical labs could lose training resources provided by biosafety officers, such as training on packaging and shipping infectious substances. Each clinical lab should have a minimum of two staff trained for this purpose, and frequent turnover at these labs means that new staff often must start from the beginning.

Unfortunately, we’re already experiencing some challenges. The number of packaging and shipping trainings offered by APHL contractor Dr. Pat Payne has been reduced, and we are on the waiting list to get her back. She is a true expert on this highly complex topic who keeps up on the latest IATA and DOT requirements, and other developments affecting shipping of hazardous agents. The reduction in trainings results from cuts to the cooperative agreement that supports APHL training.

In Iowa, our lab has made a commitment to continue the biosafety program regardless of federal funding. If need be, we may offer fewer workshops, develop fewer resources and contract for fewer third-party developed courses, but we will continue to serve as a resource for clinical labs in our state. However, I expect that many – if not most – public health labs may not have the capacity to make this kind of commitment.

What would you say to legislators who discounted the value of the CDC/APHL biosafety and biosecurity program?

I would say that the duty of the public health system is to protect the health of the public. This includes their constituents. The CDC/APHL biosafety/biosecurity program was initiated to address issues identified during the US response to domestic Ebola cases in 2014 and other biosafety mishaps that occurred in the United States around that same time. You’ll remember that several US health professionals contracted Ebola Virus Disease. They and their families, along with those who provided care for these patients, lived with the associated stigma. Some people were hesitant to be around them out of fear for their own safety. Some, like Nina Pham, the Vietnamese nurse who contracted Ebola from a patient, continue to battle ongoing health problems as well.

US laboratory scientists are exposed routinely to hazardous pathogens, and the risks associated with this work must not be ignored. The CDC/APHL program is crucial to ensuring the nation’s public health system responsibly and vigilantly safeguards the health of their laboratory staff and communities during future public health emergencies. We must continue to take steps to proactively mitigate risks to healthcare and public health laboratory professionals.



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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.

The post New Lab Matters: Sharing the value of public health laboratories appeared first on APHL Lab Blog.

Lab Culture Ep. 2: Hill Day 2017

Lab Culture Ep. 2: Hill Day 2017 | www.APHLblog.org

On March 6, a small group of APHL members and our policy staff visited House and Senate offices as part of our annual Hill Day. Peter Kyriacopoulos, APHL’s senior director of public policy, interviewed the group following their meetings to get their immediate thoughts.


ELC Program: Essential Funding for Public Health Lab Response

Epidemiology and Laboratory Capacity fact sheet

APHL Advocacy PrioritiesLab Culture Ep. 2: Hill Day 2017 | www.APHLblog.org

Hill Day group:

Chris Whelen – laboratory director, Hawaii Department of Health State Laboratories Division

Sara Vetter – manager, Infectious Disease Laboratory, Minnesota Department of Health Public Health Laboratory

Jennifer Rakeman – assistant commissioner, New York City Department of Health and Mental Hygiene

Denise Toney – director, Virginia Division of Consolidated Laboratory Services

Peter Kyriacopoulos – senior director of public policy, APHL

Celia Hagan – manager of public policy, APHL

Nisha Quasba – public policy intern, APHL

The post Lab Culture Ep. 2: Hill Day 2017 appeared first on APHL Lab Blog.

Milwaukee public health lab gives students a hands-on experience

Milwaukee public health lab gives students a hands-on experience | www.APHLblog.org

Each year the City of Milwaukee Health Department organizes a Back-to-School Health Fair for local children. The health fair allows Milwaukee’s most underserved students to access free immunizations, annual check-ups, public health education, blood lead testing and school supplies.

This year the Milwaukee Health Department Laboratory (MHDL) presented an innovative information booth at the fair that showcased its contributions to the community and encouraged young people to pursue careers in laboratory science. “Studies show that it’s critical to reach out to kids and stimulate their scientific curiosity at a young age,” explained Dr. Steve Gradus, director of MHDL. “Experiences like this can capture their imagination and inspire them to pursue a career in public health.”

Milwaukee public health lab gives students a hands-on experience | www.APHLblog.orgAt the booth, families met Noah Leigh, virologist II at MHDL, who explained how germs are spread. With his hands covered in Glo-germ™ lotion, Noah shook hands with children and invited them to look at their hands under a UV light to see how he had spread “germs” (really the Glo-germ lotion) to them without them realizing it. This exercise supported a healthy habit and reinforced parents’ advice – “That’s why I always tell you to wash your hands before you eat!” – with a scientific explanation from a real-life public health scientist.

Children donned safety glasses to become special lab assistants for the day, and visited an imaginary classroom to play “Guess Who’s Sick,” a game created by booth designers Beth Pfotenhauer, virologist III, and Dr. Kwadwo Owusu-Ofori, lab operations manager. Using pipettes and micro-well plates to guess who was sick, kids shouted, “Look! He’s Sick! He’s Sick!” as bubbles spilled out of the multi-well plate containing the samples of “sick” children. “Wow that was a neat experiment! Even I learned something,” said parents as they thanked the MHDL staff for the educational experience.
Milwaukee public health lab gives students a hands-on experience | www.APHLblog.orgWhile the children were busy, MHDL scientists took the opportunity to discuss laboratory services with the parents and teachers. “Most visitors were familiar with beach water testing or lead testing, but were not aware of the laboratory services as a distinct division of the MHD,” commented Leigh. “It’s important to educate our community about all areas of the health department. It’s a two-way street. The public does its part by engaging in healthy habits like hand-washing and keeping vaccinations up-to-date, while the health department conducts disease surveillance and mitigates microbial and chemical health hazards.”

Staff provided language translations and easily interpretable pictures to communicate the basic premise of diagnostic testing to children from diverse cultural backgrounds. “The highlight for me was when a young Indian immigrant who spoke no English was able to play our game and correctly determine which kids were ‘sick’ just by pointing to our pictures,” said Pfotenhauer.

“The booth was a success! It provided a positive experience that quickly engaged children and hopefully inspired them to pursue a career in laboratory science,” said Dr. Owusu-Ofori. “The diverse demographics of the Back-to-School Health Fair site made this location ideal to expand our outreach. APHL reports that there aren’t enough emerging public health laboratory scientists to support the growing global population.” With its booth and creative programs, MHDL aims to bring those numbers up.

“Kudos to all our lab staff members who were actively engaged in this very successful effort, allowed better visibility for our public health laboratory in the community,” said Dr. Sanjib Bhattacharyya, deputy lab director.

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With PulseNet, handful of E. coli cases reveal multistate outbreak, prompt huge recall

With PulseNet, handful of E. coli cases reveal multistate outbreak, prompt huge recall | www.APHLblog.org

By Kim Krisberg

In 2014, two Ohio residents living more than 100 miles apart were diagnosed with an E. coli infection. Twenty years ago, the two cases might have been chalked up to coincidence — after all, tens of millions of Americans experience foodborne illness every year.

But thanks to a nationwide lab network known as PulseNet, public health officials could compare the genetic patterns of the Ohio cases to foodborne illness cases across the country, eventually detecting a multistate foodborne illness outbreak that led to the recall of 1.8 million pounds of ground beef products. Overall, 12 people across Ohio, Michigan, Massachusetts and Missouri were diagnosed with outbreak strains of Shiga toxin-producing Escherichia coli O157:H7, or STEC O157:H7, and more than half of those sickened had to be hospitalized.

“Without PulseNet, we may have never recognized this as a multistate outbreak,” said Scott Nowicki, MPH, epidemiologist at the Ohio Department of Health.

Several key activities came together in late spring 2014 that enabled public health officials in Ohio and Michigan to detect and contain the outbreak fairly quickly. First, after the Ohio Public Health Laboratory confirmed the initial two cases of STEC O157:H7, student interviewers with Ohio’s FoodCORE team — a Centers for Disease Control and Prevention-funded effort to strengthen state and local foodborne illness outbreak response — set out to interview the patients. It turned out both patients, who lived more than 100 miles apart, said they had eaten at the same local chain restaurant that specializes in serving undercooked hamburgers. It was a strong signal that undercooked beef, as opposed to contaminated produce, was the culprit, Nowicki said.

On the same day as the FoodCORE interviews, the Ohio Public Health Laboratory uploaded its test results for the local STEC O157:H7 cases to PulseNet. Previously, the lab, which routinely receives specimens of public health importance from health providers around the state, received isolates connected to the STEC O157:H7 patients. Lab staff then performed pulsed-field gel electrophoresis, or PFGE, to determine the sample’s DNA fingerprint pattern. They posted the fingerprint patterns to PulseNet and quickly noticed their PFGE results matched two isolates in Michigan.

With PulseNet, handful of E. coli cases reveal multistate outbreak, prompt huge recall | www.APHLblog.orgIn addition to a match, the PFGE pattern was also relatively uncommon, which was another strong signal of an outbreak rather than a string of isolated cases, said Eric Brandt, a laboratory scientist at the Ohio Department of Health, Bureau of Public Health Laboratory.

With the matching PFGE results, epidemiologists in Ohio and Michigan began comparing notes, finding that patients in both states reported eating at restaurants that serve undercooked beef. In particular, 92% of the 12 ill persons identified in the outbreak reported eating ground beef at such a restaurant before they became sick, and 73% said they may have eaten hamburger prepared rare, medium rare or undercooked.

From there, an intensive local, state and federal traceback investigation ensued, eventually tracing the ground beef at the restaurants where the STEC O157:H7 patients had eaten to the Wolverine Packing Company in Detroit. In May 2014, the meatpacking company recalled about 1.8 million pounds of ground beef that may have been contaminated with the pathogen. During the outbreak, five people were sickened in Ohio, five in Michigan, one in Massachusetts and one in Missouri. While seven of those people had to be hospitalized, none developed hemolytic uremic syndrome, a potentially life-threatening complication associated with STEC O157:H7 infection.

Nowicki noted that before PulseNet, it often took many more cases of foodborne illness for public health officials to recognize an outbreak and begin efforts to identify the source and prevent further disease. Indeed, he said the 2014 STEC O157:H7 outbreak is the perfect example of how PulseNet can quickly connect a small handful of seemingly isolated dots to reveal the outbreak lurking beneath.

“For identifying outbreaks,” Nowicki said, “PulseNet is invaluable.”

Brandt agreed, adding that “these very sporadic cases that cross state lines…those would have been much more difficult to detect in the pre-PulseNet days.” He also said that PulseNet, which celebrated its 20th anniversary this year, is “fundamental” to the Ohio Public Health Laboratory’s foodborne illness capacity, providing the lab’s primary infrastructure for cluster detection, bacterial subtyping, training, instrumentation and much more.

“PulseNet is crucial,” said Brandt, who’s spent most of his career working with PulseNet. “I can’t even imagine what it was like before.”

According to CDC, PulseNet identifies about 1,500 clusters of foodborne illness every year, about 250 clusters that cross state lines, and about 30 multistate outbreaks traced back to a food source. A recent economic evaluation of PulseNet found that every year, the laboratory network prevents more than 266,500 illnesses from Salmonella, nearly 9,500 illnesses from E. coli and 56 from Listeria. That translates into $507 million in reduced medical and productivity costs.

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2016 Annual Meeting — Day 3

2016 Annual Meeting -- Day 3 | www.APHLblog.org

Today we honored public health leaders from around the world. Congratulations to all award winners!

Check out our Storify for more tweets.

Top Tweets:

Photo Highlights:

Chris Whelen, APHL board president, presents awards to out-going board members and committee chairs

Chris Whelen, APHL board president, presents awards to out-going board members and committee chairs


2016 APHL award winners -- congratulations to all!

2016 APHL award winners — congratulations to all!


Meeting attendees enjoy breakfast in the exhibit hall

Meeting attendees enjoy breakfast in the exhibit hall

Utah raw milk outbreak was difficult – but not impossible – to stop

Utah raw milk outbreak was difficult – but not impossible – to stop | www.APHLblog.org

By several contributors from the Utah Department of Health

While the asserted health benefits of unpasteurized milk (aka, raw milk) have been debated, the public health community widely agrees that raw milk can carry potentially serious foodborne pathogens that are especially dangerous for high-risk groups like young children and the elderly. Based on our experiences in public health laboratory science and epidemiology, we are convinced that those risks outweigh any potential benefits.

Interstate sale and shipment of raw milk is illegal in the US, however several states do allow raw milk sales within their borders. As of October 2015, the sale of raw milk for human consumption was legal in 40 states: 11 states permit the sale of raw milk in retail stores, 19 states permit raw milk sales only on farms and 10 states only allow acquisition of raw milk through cow-share agreements. In our state, the sale of raw milk is legal with a permit obtained from the Utah Department of Agriculture and Food (UDAF).

Between May and November 2014, the Utah Department of Health (UDOH) noticed a dramatic increase in the number of cases with a Pulsed-Field Gel Electrophoresis (PFGE) strain rarely seen in the PulseNet Campylobacter database. Epidemiological investigations showed that over 50% of the sick people reported drinking or having contact with raw milk from a single dairy.

Initial testing of raw milk at the dairy was negative for Campylobacter so the dairy was allowed to continue selling raw milk. However, UDOH continued to identify cases which prompted a press release recommending that the public not drink raw milk.

I20 years of PulseNet: Preventing thousands of illnesses and saving millions of dollars | www.APHLblog.orgsolating Campylobacter in raw milk is difficult as it is such a fastidious organism. UDOH and UDAF met with local health departments and federal partners to discuss new sampling strategies. Following this discussion, microbiologists from the Utah Public Health Laboratory joined investigators to conduct a follow-up environmental assessment at the dairy. This time, the new sampling strategy was used. Raw milk was collected, and, because Campylobacter is sensitive to pH differences, it needed to be neutralized. We were then able to test it for Campylobacter. The same PFGE strain of Campylobacter making people sick was found in the neutralized raw milk. We had a match! Because of this finding, the dairy’s raw milk permit was immediately suspended.

The dairy’s raw milk permit was reinstated in October 2014 after multiple milk samples were found to have no pathogens. Shortly after, new Campylobacter cases infected with the same PFGE strain were entered into the PulseNet database and reported to UDOH. The dairy’s raw milk permit was revoked indefinitely. Since then, no cases of Campylobacter with the outbreak strain have been reported.

Utah’s public health lab scientists, epidemiologists and other public health professionals were determined to identify and confirm the source of this outbreak. Thanks to close collaboration with partners, we were able to stop this large outbreak and prevent additional illnesses.

This year we celebrate the 20th anniversary of PulseNet USA. Stories from highlighting PulseNet successes will be featured each month. Learn more about PulseNet from APHL and CDC.


Virginia: PFGE and whole genome sequencing show Salmonella outbreak who’s boss

Virginia: PFGE and whole genome sequencing show Salmonella outbreak who’s boss | www.APHLblog.org
This year we celebrate the 20th anniversary of PulseNet USA. Stories from highlighting PulseNet successes will be featured each month. Learn more about PulseNet from APHL and CDC.

By Marshall P. Vogt, MPH, district epidemiologist, VDH; Krisandra J. Allen, MPH, foodborne and waterborne disease epidemiology specialist, VDH; Jessica Watson Rosner, MPH, foodborne disease epidemiologist, VDH; Angela Myrick-West, MPH, regional epidemiologist, VDH; Lauren Turner, PhD, foodborne and advanced pathogen characterization lead scientist, DCLS

In August 2015, public health laboratory scientists at the Virginia Division of Consolidated Laboratory Services (DCLS) notified foodborne disease epidemiologists at the Virginia Department of Health (VDH) that they were sending data on four Salmonella Enteritidis isolates from a single rural county in central Virginia. They all had matching PFGE patterns. During case review, the epidemiologists identified four additional cases of salmonellosis from the same central Virginia county, but without matching PFGE patterns. All of the isolates were Salmonella Enteritidis, and the timing of the cases was also significant with all eight patients becoming ill within a few weeks of each other. Despite these commonalities, the eight Salmonella Enteritidis isolates encompassed three different PFGE patterns, which generally wouldn’t link them as a cluster. Were these simply sporadic individual cases or was it an emerging outbreak? Given the similar (albeit slightly different) PFGE patterns, similar location of the patients and relatively short time period of illness onset, there was enough to prompt further investigation.

As a PulseNet participating laboratory, DCLS also submitted the PFGE patterns and corresponding data to the PulseNet national database. PulseNet data in conjunction with epidemiological data can be used to quickly connect similar cases of foodborne illness to link them back to a common source.

Epidemiologists followed up on their earlier initial case interviews by immediately performing more in-depth interviews with the eight patients to identify potential commonalities prior to the onset of illness. Of the first four individuals with whom they spoke, three reported eating at the same local restaurant. The epidemiologists then began asking the remaining patients if they too had eaten at this specific restaurant during the seven days prior to getting sick. Six of the eight said “yes.”

Virginia: PFGE and whole genome sequencing show Salmonella outbreak who’s boss | www.APHLblog.orgWithin Virginia’s public health system, there is constant two-way communication between the public health laboratory scientists and the foodborne disease epidemiologists. In any investigation, even after turning over cluster information, the public health lab wants to hear what the epis are finding in their investigation; and the epis might want to know if additional testing or analysis is available to support their investigation. In this case, the epis told the public health lab scientists about their findings: despite the Salmonella Enteritidis isolates from the patients having three different PFGE patterns, six out of eight patients reported visiting the same restaurant within the same time period before becoming ill. It was beginning to sound like this was an outbreak with a common source, but more testing was needed to confirm.

The public health lab staff and epidemiologists agreed this information supported further testing using whole genome sequencing (WGS) to better understand the relationship between isolates. WGS offers a fast, inexpensive way to improve PulseNet’s surveillance, and it allows participating laboratories like DCLS to use resources more efficiently. In Virginia, this was the first application of WGS to a local outbreak investigation. WGS analysis showed that seven of the eight Salmonella Enteritidis isolates were highly genetically related. The WGS data provided support for the epidemiologists’ hypothesis that there was a common-source outbreak, most likely associated with a single restaurant.

Upon inspection, it was revealed that the restaurant had two serious issues related to temperature monitoring and control that were later corrected. No specific food was implicated during this investigation, but temperature abuse could have been a factor in allowing the proliferation of Salmonella in the facility.

While PFGE data helped identify the cluster and prompted an investigation, WGS information strengthened the correlation between the isolates and supported the epidemiologists’ investigation results to complete the story. Frequent communication and collaboration between the epis and public health lab scientists proved critical to both the identification and resolution of the outbreak.

Due to the success with this outbreak, the use of WGS for other investigations is ongoing in Virginia. WGS has been successfully used for several other outbreaks and continues to deliver that knockout punch for outbreak detection.

Interested in learning more about food safety or reporting foodborne illness in Virginia? Check out the Virginia Department of Health’s My Meal Detective site for food safety videos, restaurant inspection information and more!

Do you have a PulseNet success story that could be featured? Please send your 500 word document and a photo that best represents the story to PFGE@cdc.gov with subject line, “PulseNet Success Story- [Name of the State],” to be a part of the celebration!

Virginia: PFGE and whole genome sequencing show Salmonella outbreak who’s boss | www.APHLblog.org

APHL’s top blog posts of 2015

APHL’s top blog posts of 2015 | www.APHLblog.org

As 2015 comes to a close, we’re taking a walk down memory lane. Public health headlines included Listeria in ice cream, the Animas River mine waste spill, continued Ebola response and recovery, and the loss of too many public health colleagues. Dedicated public health professionals were as busy as ever.

This was also the year we updated our blog with a more dynamic homepage and more subscription options! We hope you’ve enjoyed reading our posts. Many thanks to the APHL staff, members and partners who wrote and contributed to these stories; and thank you to our readers who keep coming back.

Here are the most popular APHL blog posts of 2015:

10. University of Oregon outbreak highlights collaboration between public health and clinical care – As a meningococcal disease outbreak struck this college campus, the public health and clinical care systems had to work quickly and closely to stop this rare but serious disease.

9. From The Lorax to the Laboratory – Vanessa Burrowes shared her story of struggling to find the right career path, discovering public health and feeling like it was the one field that would allow her to “have it all.”

8. Q&A with NewSTEPs: Bringing routine CCHD newborn screening to every state – The Newborn Screening Technical assistance and Evaluation Program (NewSTEPs) is a program of APHL in collaboration with the Colorado School of Public Health that, among other things, supports states that are adding critical congenital heart disease (CCHD) screening to their newborn screening program. But CCHD screening isn’t a laboratory test… So why is APHL involved?

7. The Tenacity of Tuberculosis: MDR-TB – Tuberculosis is the second largest cause of mortality of any single pathogen behind HIV. As the world tries to move toward elimination of this disease, public health faces the next major obstacle to tuberculosis control: multi-drug resistant TB (MDR-TB).

6. It is never just a cold – Did you know there are more than 200 viruses behind the common cold? What are they and why are they so difficult to control?

5. Newborn Screening: This Tiny Test is a Big Job That’s Always Improving – APHL’s executive director, Scott Becker, responded to the growing concerns about newborn screening timeliness and how newborn screening programs are working to improve.

4. Lab sciences grad program brought me from the yogurt factory to public health – On a whim, Joe Shea decided to check out a seminar on public health grad programs. It was there that he first learned about the Wadsworth Center’s (New York’s state public health laboratory) Master of Science in Laboratory Sciences (MLS) program. Attending that seminar would change the course of his entire career.

3. Newborn screening saved these babies. How are they doing now? – Remember all of those adorable babies we featured on our blog during the 50th Anniversary of Newborn Screening in 2013? We checked back in with some of those families to find out how they’re doing.

2. Dear Dr. Hunt: This female scientist has something to say. And it isn’t that she loves you. – After hearing the sexist comments made by a Nobel Prize winning biochemist, APHL’s director of membership and marketing, Linette Granen, had some choice words to offer in response. As she said, “[W]e can and we have – and we hope to inspire the next generation to do the same.”

And the most popular blog post of 2015…

1. 5 Things You Didn’t Know (but Need to Know) about Listeria – After a few high profile Listeria outbreaks earlier this year, we decided it was time to share some important information about this serious bacteria. Did you know Listeria can grow on foods even while in the cold temperatures of a refrigerator? Yeah… you should probably read this post.


When you have the flu, it isn’t just about you

By Melissa Warren, Senior Specialist, Influenza, APHL

Fever, body aches, cough… you suspect the flu. You drag yourself out of bed to visit your healthcare provider where they use a swab to take a small sample from your throat or nose for a point-of-care diagnostic test. It’s positive; you’ve got the flu. After stopping at the pharmacy to pick up the antiviral medication that was prescribed, you head home to hunker down under the covers and queue up Netflix.

Unfortunately for the sample your healthcare provider collected, there is no time to rest. The point-of-care diagnostic test was just the beginning; that test gives your healthcare provider the information they need to provide treatment. But the public health system needs more information on how your case fits into the national – and, in many ways, the global – flu picture. At the end of the week, your healthcare provider’s laboratory staff sends all relevant samples to the public health laboratory. This is where your sample’s journey in the public health system begins.

Samples like yours inform the WHO, WHAT, WHEN and WHERE of influenza activity:

  • WHO is being most affected? Young children or the elderly? Are positive patients hospitalized or outpatient? Were they vaccinated or not?
  • WHAT type/subtype of flu is making people sick and how prevalent is that type/subtype? Furthermore, what is the specific strain and does it match well with the current vaccine?
  • WHEN did the season start, when does it peak and when will it end?
  • WHERE are people getting sick? What is happening in each state and/or region?

TWhen you have the flu, it isn’t just about you | www.APHLblog.orghis is a look at the journey your sample will take and how it will help the public health system respond to this flu season and prepare for the next. Get ready, little sample! It’s a long ride…

(Click the infographic to view larger size.)

Arrival at the public health laboratory

Your sample arrives at the public health laboratory’s centralized check-in where the package is opened, paperwork is reviewed and a laboratory identity is created (your personal identity no longer accompanies the sample). Because public health labs receive hundreds of samples every day for not only respiratory illnesses such as flu, but also diarrheal illnesses, sexually transmitted infections, newborn genetic screening and many others, this process is critical to ensure each sample is accurately documented and delivered to the appropriate laboratory for testing. In fact, during the course of one flu season, a state public health laboratory can receive approximately 4,000 samples for influenza testing alone!

Once that process is completed, your sample is delivered to the virology lab for testing.

Testing Begins

Your sample has been kept cold and properly stored to maintain the integrity of the virus, which is important for the laboratory testing. This lab uses a molecular method called PCR to rapidly amplify and detect a region of viral RNA. In fact, the PCR test performed at public health labs is specially designed to not only confirm and subtype flu, but also to detect new and emerging flu viruses. This is an important function of public health labs as our nation’s first line of detection for novel flu viruses.

Results received and reporting begins

The test results for your sample indicate you are sick with influenza B. Because your case is typical for flu season, state epidemiologists do not initiate further investigation. However, the data from your sample does get included in their weekly summary report informing physicians and the public of influenza activity in your state. Furthermore, this information is recorded electronically in the laboratory information management system (LIMS) and a lab report is faxed back to your healthcare provider’s office. (This information typically would not impact your treatment.) Data is also transmitted to the Centers for Disease Control and Prevention (CDC) for national flu surveillance using the Public Health Laboratory Interoperability Project (PHLIP). Standardized PHLIP messaging simplifies the secured electronic transfer between public health laboratories. Once at CDC the data contributes to FluView, their weekly flu surveillance report.

Further characterization of specimen

Your sample was selected to be included in your state public health lab’s biweekly shipment to their designated national Reference Center – one of three National Influenza Surveillance Reference Centers, state public health laboratories that act as an extension of CDC’s Influenza Division – where it will be isolated and further characterized.

Every two weeks during flu season, all state and some local public health laboratories participate in national surveillance by sending up to eight influenza specimens to one of three National Influenza Surveillance Reference Centers. These eight specimens consist of up to two samples of the four seasonal strains of flu: influenza A(H3N2), influenza A(H1N1)pdm09, influenza B/Yamagata lineage and influenza B/Victoria lineage positive specimens. When combined with all of the other public health lab submissions, this relatively small number of samples allows CDC to watch closely for drift. (Drift happens when small genetic changes accumulate over time as a virus replicates and result in viruses that are antigenically different. When this happens, the body’s immune system may not recognize those viruses and may have trouble fighting them off). And with all of that information, CDC can be 95% confident that, should a drift variant emerge at 3% prevalence or higher across the country, at least one of those drift variants will be detected over a month surveillance period. Knowing about drift sooner would hopefully lead to a quicker response than before this submission guidance was in place. At the reference centers and CDC, these specimens undergo further antigenic and genetic characterization which generates data that helps select strains to be used in the development of future seasonal vaccines.

Finally your sample gets to rest

After a whirlwind of tests, your sample finally gets to rest in a chilly -80°C freezer. Public health laboratories keep samples like yours should additional testing be needed and to aid in the development and validation of new laboratory tests or methods.

Your little sample contributes in a big way

While the sample sits frozen, the data remains actively in play. Public health officials will look at the data from your sample along with thousands of other data points to determine what influenza strains are circulating in the United States, detect novel viruses and monitor whether the virus begins to drift away from the strains in the vaccine. On an even bigger scale, vaccine strain selection is a global process so your sample may ultimately inform vaccine strain selection for the entire world.

Next time you are sick and your healthcare provider takes a little sample from your nose, remember that you are not only getting the diagnosis necessary for your own treatment but you’re contributing to national and global influenza response.

Read more about influenza response:

When you have the flu, it isn’t just about you | www.APHLblog.org