Nigerian malaria researcher joined the Milwaukee laboratory for a cultural exchange beyond the bench

Nigerian malaria researcher joined the Milwaukee laboratory for a cultural exchange beyond the bench | www.APHLblog.org

Nearly two years ago, a malaria researcher named Dr. Abel Olusola “Sola” Idowu left Lagos, Nigeria and emerged into the frosty, winter air of Milwaukee, Wisconsin. Milwaukee, a quintessential Midwestern American city, may not be associated in many people’s minds with global health, but this Fulbright Scholar knew better: this journey was the opportunity of a lifetime.

Sola had pursued a Fulbright Visiting Researcher scholarship to continue his PhD research, which focused on how Plasmodium falciparum develop resistance to antimalarial drugs and the public health implications of such resistance. Not only would he be exposed to new ideas and techniques, but it was also “an opportunity for cultural exchange that would promote understanding among people of different nations,” Sola recalls. He chose Milwaukee for the opportunity to access the research facilities and learn from the staff at the University of Wisconsin-Milwaukee (UWM) and City of Milwaukee Health Department Laboratory (MHDL), which he knew would help expand his technical capabilities and enhance the quality of his research.

My research at MHDL enabled me to learn new skills, especially in molecular techniques, and to appreciate processes in a public health laboratory with the kind assistance of the wonderful staff of the laboratory,” Sola said. “The state-of-the-art facilities at MHDL and the UWM College of Health Sciences were an eye opener for me. Overall, it was a rewarding experience that enabled me to accomplish my doctoral research objectives.” It also helped him build a network with other researchers, as his research collaborations extended beyond Milwaukee to the Malaria Branch of the US Centers for Disease Control and Prevention (CDC) in Atlanta and the Wadsworth Center, the New York State Department of Health’s laboratory.

As he had foreseen, though, his research findings weren’t the only lessons he took away from his time in the US: Sola formed new relationships, both professional and personal, and experienced firsts such as surviving a Wisconsin winter, eating new American cuisine, volunteering at a local food pantry and Habitat for Humanity, and visiting historic sites in New York, Philadelphia, Milwaukee and Chicago.

I returned to my country with fond memories of my time in the US and look forward to (the) future opportunity to visit again,” Sola said.

Building a Culture That Grows More than Pathogens

Supporting research and experiences like Sola’s is part of MHDL’s larger, ongoing efforts to develop a strong laboratory workforce—both locally and globally—and cultivate a culture that encourages staff to work beyond the laboratory bench.

Over the last five years, MHDL has hosted internships and research rotations for over 60 local students, and, in addition to countless student tours, the laboratory’s leadership and staff routinely participate in career fairs, academic and community outreach events. MHDL has also hosted several international professional and student groups, including Nigerian public health professionals participating in the US State Department’s International Visitor Leadership Program, students from Kashiwa High School in Japan, and public health laboratory professionals from India and the Botswana Ministry of Health. The lab also hosted another University of Lagos PhD student, Dr. Nwamaka Igbokwe, who researched E. coli and antimicrobial susceptibility testing in drinking water at UW-Milwaukee and MHDL in 2012.

Laboratory Director Dr. Sanjib Bhattacharyya leads his staff by example through his involvement in global lab efforts, particularly around infectious diseases. Bhattacharyya, a current member of APHL’s Global Health Committee and the Milwaukee Global Health Consortium (MGHC) Advisory Committee, has served as CDC’s Influenza real-time PCR trainer, provided coaching and mentoring to public health laboratory professionals, Ministry of Health in Lesotho and Uganda, participated in APHL’s National Center for Public Health Lab Leadership coaching program. He has also represented APHL at the World Summit on Antivirals in Kunming, China, lectured on Influenza in India and gastrointestinal pathogen testing in Monaco. Closer to home, Bhattacharyya, an adjunct faculty at UWM, is engaged in dialogs with Zilber School of Public Health to develop public health laboratory leadership and management curriculum to integrate with school’s global health programs.

MHDL leadership and passionate laboratory staff work together to engage their local and global community to build strong public health laboratories and protect public health.

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Public health laboratory response capability advanced through – and in spite of – the Zika outbreak

Public health laboratory response capability advanced through – and in spite of – the Zika outbreak | www.APHLblog.org

When a health threat like the Zika virus disappears from the headlines, public health systems may appear to have halted their work. In fact, their efforts continue behind the scenes as lessons and enhancements from the last response are incorporated into public health systems and processes to enhance ongoing surveillance and inform future responses.

The US response to the 2016 Zika virus pandemic followed this pattern of event, insights and enhancements to public health response systems. It built upon past developments, such as the creation of the Laboratory Response Network (LRN) in 1999 and introduction of expedited approval of diagnostic tests in 2009, to drive improvements that will make future responses more rapid, robust and flexible.

Below are examples of how public health laboratory response capability advanced through – and in spite of – the Zika outbreak.

Zika Tests Deployed via EUA

During the 2009 H1N1 influenza outbreak, the public health community took advantage of a tool that had not been utilized previously: the Emergency Use Authorization or EUA. Under an EUA, the Food and Drug Administration (FDA) takes steps to speed up the typically long, laborious approval process for new drugs, devices and diagnostic tests, and authorizes emergency use of the product even if it has not yet gone through normal channels of approval.

On February 26, 2016, the secretary of the Department of Health and Human Services declared Zika to be a Public Health Emergency activating the EUA mechanism for expedited Zika diagnostic testing approval. By mid-March, the FDA granted EUAs for two key Zika tests. The first, the Trioplex Real-time RT-PCR, was a polymerase chain reaction (PCR) designed to detect the virus in a patient’s blood or urine. The second, the Zika MAC-ELIA, was an immunoglobulin M (IgM) test used to locate antibodies in the blood. Because of the expedited approval process under the EUA, these tests were approved in a matter of weeks instead of months or years.

Labs Roll Out Zika Tests in Record Time

By the time the FDA issued these EUAs, the tests had already been validated or shown to be effective in detecting the Zika virus in many laboratories. This required testing large numbers of samples—not an easy task in a high-pressure situation.  But the Centers for Disease Control and Prevention (CDC) found a way. Drawing on labs with the most testing expertise, the agency redirected its teams to focus on Zika. CDC’s Dengue Branch in Puerto Rico and its office in Fort Collins worked on the rollout of the tests and provided technical support to state laboratories participating in the emergency effort.

In the meantime, state and local public health labs weren’t waiting around. They were also validating PCR and IgM tests, and training on the required methods and technology.  “This proved to be crucial,” explained Kelly Wroblewski, director of infectious diseases at APHL. “Many scientists working in public health labs were not familiar with the serologic testing methods being used. Public health laboratories had largely moved to kit-based tests and the expertise required to implement this more complex method had been lost. On top of that, many labs didn’t have the proper equipment to perform the more manual tests. Due to funding cuts over the past 15 years, the labs had lost much of the capacity they had had during the West Nile outbreak that occurred about 15 years ago.”

CDC tried to fill this gap by offering more training once it began distributing the newly validated tests to qualified labs in the LRN. It provided technical assistance to labs conducting the test to ensure that they were ready for an expected surge of samples. By January 2017, LRN labs had conducted 25,439 RT-PCR tests and 35,349 Zika MAC-ELISA tests.

Inspections Postponed to Prepare for Zika Testing

In the midst of training and testing, the Centers for Medicare and Medicaid Services (CMS), which is charged with oversight of all laboratory-developed tests (LDTs), notified LRN laboratories that inspectors would be arriving to review Zika testing procedures and documentation to ensure the accuracy of test results. Though this was CMS’ prerogative under the Clinical Laboratory Improvement Amendments (CLIA), the timing could not have been worse.

“Our members began alerting us that they were anxious about the CLIA inspectors showing up at their labs,” recalls Eric Blank, chief program officer at APHL. “They were especially concerned about preparing all the necessary documentation for the inspectors.” As it had done during the H1N1 outbreak in 2009, APHL negotiated with CMS to delay inspections until the acute crisis had passed.

Task Force Launched to Coordinate Response to Future Crises

During a public health emergency, APHL works diligently to connect public health laboratories to APHL’s federal agency partners, CDC, FDA and CMS. “The federal partners along with APHL recognized the need for an improved, collective emergency response to public health emergencies,” explains Peter Kyriacopoulos, senior director of public policy at APHL. “CDC, FDA and CMS established a new entity, the Tri-Agency Task Force for Emergency Diagnostics. When the next disease comes along, this task force will enable the nation to respond much more effectively than before.”

Wroblewski 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.”

For more information about public health laboratory response to the Zika crisis, check out APHL’s book, A Complex Virus, A Coordinated Response: Public Health Labs Battle Zika.

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Lab Culture Ep. 18: Alaska state virology lab — Freezing temps, wild animals, and extremely dedicated staff

Lab Culture Ep. 18: Alaska state virology lab -- Freezing temps, wild animals, and extremely dedicated staff | www.APHLblog.org

Every area of our country is unique in ways that make public health laboratory work vary from one state or locality to another. But just as Alaska is different from the lower-48 states in most ways, their public health lab’s work is too. Have you ever considered all the ways it might be different to work in the Alaska state lab in Fairbanks? This episode of Lab Culture reveals some of the many ways in which working in Alaska is unlike anywhere else.

Listen here, in iTunes or wherever you get your podcasts.


Jayme Parker
Manager, Virology Unit, Alaska State Public Health Laboratory (Fairbanks)

Nisha Fowler
Microbiologist, Alaska State Public Health Laboratory (Fairbanks)

Links:

Virology Unit of the Alaska State Public Health Laboratory

Alaska Department of Transportation and Public Facilities — FAQs

Alaska’s permafrost/ice lenses

 

 

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Congratulations to 2019 APHL newborn screening award winners

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

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

The following awards were given:

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

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

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

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

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

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

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

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

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

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

Congratulations to all award winners.

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

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APHL: 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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Enhancing detection of newborn screening conditions via data analytics

Enhancing detection of newborn screening conditions via data analytics | www.APHLblog.org

For over 50 years, newborn screening programs across the United States have implemented laboratory screening and follow-up programs to detect and report infants at high risk for rare diseases. As we look towards the future, current testing challenges will likely become more pronounced with the anticipated addition of new conditions to the Recommended Uniform Screening Panel (RUSP), increasing sophistication of testing platforms and methodologies, and greater complexity of biomarker profiles.

Building the data analytic capacity of newborn screening programs will help support the analysis and interpretation of patient data, providing tools and resources to create efficiencies in time-intensive program activities.

APHL and the Newborn Screening and Molecular Biology Branch of the Centers for Disease Control and Prevention (CDC) are exploring solutions aimed at improving the interpretation of laboratory tests by expanding data analytic capacity in the following ways:

  • Increasing state newborn screening programs’ capacity to evaluate and interpret laboratory test data by providing Newborn Screening Bioinformatics Fellows
  • Creating a Newborn Screening Data Analytic Workgroup focused on sharing and harmonizing best practices and solutions
  • Enhancing data-driven decision making in the newborn screening community by designing and developing data science resources to address newborn screening-specific data challenges

In March 2019, APHL and CDC hosted a national meeting in Atlanta, GA to broaden their efforts, engage state newborn screening programs in a collective data analytics initiative, and discuss progress toward enhanced disease detection utilizing improved data analytics resources and technologies specific to newborn screening.

The meeting provided a forum for participants to discuss the needs around biochemical and molecular screening methodologies and their related data analytics requirements, as well as the value of data to improving health outcomes.

This national dialogue will help guide CDC development of an in-house data analytics resource that will improve the interpretation of biochemical and molecular test results.

This activity was supported by Cooperative Agreement #NU60OE000103-04 funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC or the Department of Health and Human Services.

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Lab Culture Extra: How the Wisconsin state lab developed a test for brodifacoum and why it matters

Lab Culture Extra: How the Wisconsin state lab developed a test for brodifacoum and why it matters | www.APHLblog.org

In the spring of 2018 patients suffering from profuse bleeding swamped emergency rooms in Illinois and Wisconsin. The cause? Synthetic cannabinoids laced with rat poison

When an outbreak of contaminated synthetic cannabinoids reached Wisconsin in 2018, scientists at the Wisconsin State Laboratory of Hygiene (WSLH) rushed to develop the first quantitative method for diagnostic testing of brodifacoum, a powerful anticoagulant used in rat poison. Thanks to their work, patients with brodifacoum poisoning can now be treated with a precisely calibrated dose of vitamin K and that treatment can be ended when it is no longer medically necessary. Previously, physicians had to guess when to end treatment and re-start it if they guessed wrong.

WSLH’s Noel Stanton, Chemical Emergency Response Coordinator, and Bill Krick, an Advanced Chemist in the Chemical Emergency Response Unit, speak with Public Affairs Director Jan Klawitter about the test’s development and the outbreak that made it necessary.

 

 

Links:

Wisconsin State Laboratory of Hygiene (WSLH)

Accolades for WSLH’s Chemical Emergency Response Team

Synthetic Cannabinoids (K2, Spice) – Wisconsin Department of Health Services

Lab Matters: Indiana and Wisconsin Respond to Synthetic Cannabinoid Contamination

Laboratory Response Network (LRN)

APHL in Action archives

The post Lab Culture Extra: How the Wisconsin state lab developed a test for brodifacoum and why it matters appeared first on APHL Lab Blog.

Lab Culture Extra: How the Wisconsin state lab developed a test for brodifacoum and why it matters

Lab Culture Extra: How the Wisconsin state lab developed a test for brodifacoum and why it matters | www.APHLblog.org

In the spring of 2018 patients suffering from profuse bleeding swamped emergency rooms in Illinois and Wisconsin. The cause? Synthetic cannabinoids laced with rat poison

When an outbreak of contaminated synthetic cannabinoids reached Wisconsin in 2018, scientists at the Wisconsin State Laboratory of Hygiene (WSLH) rushed to develop the first quantitative method for diagnostic testing of brodifacoum, a powerful anticoagulant used in rat poison. Thanks to their work, patients with brodifacoum poisoning can now be treated with a precisely calibrated dose of vitamin K and that treatment can be ended when it is no longer medically necessary. Previously, physicians had to guess when to end treatment and re-start it if they guessed wrong.

WSLH’s Noel Stanton, Chemical Emergency Response Coordinator, and Bill Krick, an Advanced Chemist in the Chemical Emergency Response Unit, speak with Public Affairs Director Jan Klawitter about the test’s development and the outbreak that made it necessary.

 

 

Links:

Wisconsin State Laboratory of Hygiene (WSLH)

Accolades for WSLH’s Chemical Emergency Response Team

Synthetic Cannabinoids (K2, Spice) – Wisconsin Department of Health Services

Lab Matters: Indiana and Wisconsin Respond to Synthetic Cannabinoid Contamination

Laboratory Response Network (LRN)

APHL in Action archives

The post Lab Culture Extra: How the Wisconsin state lab developed a test for brodifacoum and why it matters appeared first on APHL Lab Blog.

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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The LRN’s job is to prepare, detect and respond. But what exactly does that mean?

The LRN’s job is to prepare, detect and respond. But what exactly does that mean? | www.APHLblog.org

As one of the nation’s emergency response systems, the Laboratory Response Network (LRN) is known for detecting and responding to all types of health threats. Its mission is to maintain an integrated network of laboratories that can respond to bioterrorism, emerging infectious diseases, chemical terrorism and other public health emergencies. During an emergency, one of the LRN’s most critical functions is ensuring that US laboratories have the right test at the right time.

When a public health threat emerges, one of the first tasks of public health systems is to make sure that laboratories are able to test for the causative agent, whether biological, chemical or radiological. However, the Centers for Disease Control and Prevention (CDC) quickly works with these laboratories and other partners to get the tests in place using equipment found in LRN reference laboratories. For instance in 2014, CDC partnered with the Department of Defense (DoD) and the LRN deployed a test for Ebola. The network  rolled out training and other programs to ensure quality testing and reporting. This approach ensured laboratories such as the Texas Department of State Health Services Laboratory was ready to test for Ebola before it struck. Similarly, CDC quickly worked with the Food and Drug Administration (FDA) to secure an Emergency Use Authorization (EUA) assay for Zika and again deployed the test via the LRN to laboratories across the country. Where training was needed, CDC partnered with APHL to deliver these skills to public health laboratory scientists. Whatever the testing needs may be, the LRN jumps into action to ensure testing capabilities are in place for an effective response.

So what exactly does the LRN do to support and expedite development and deployment of such tests? The LRN:

  • Collaborates with the specialized laboratory developing the test. This may be a laboratory at a government agency, such as CDC or DoD, or a private entity.
  • Optimizes the test to ensure it provides reliable results, operates on instrumentation available nationwide and integrates with systems for reporting of test results.
  • Prepares and submits a request to the FDA for use of the test on an emergency basis. This Emergency Use Authorization (EUA) details test detection limitations, reagents, instruments, authorized users and other technical information.
  • Issues proficiency tests to assure laboratory scientists across the network are capable of properly performing the tests and generating accurate results.
  • Quickly deploys the test to LRN laboratories with the capability to test for the agent.
  • Provides a mechanism for standardized electronic data exchange of test results.
  • Facilitates communications across partners such as APHL, DoD, FBI and other stakeholder.

Here are examples of public health emergences where the LRN made sure the proper test was at the proper laboratory just in time to initiate the response:

As a founding partner, APHL recognizes the value of the LRN and celebrates its accomplishments across the last 20 years. The LRN, via funding from CDC’s Public Health Emergency Preparedness Cooperative Agreement, provides a warm base for public health laboratories, positioning them to respond to all threats including the 2009 pandemic influenza and the recent opioid epidemic. Though many Americans have never heard of the LRN, the Network is nonetheless there, keeping us safe from threats known and unknown.

For more information about the Laboratory Response Network, visit CDC’s “The Laboratory Response Network Partners in Preparedness” webpage.

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