Responding to the novel coronavirus (2019-nCoV) emerging in Wuhan, China

Map of China highlighting Wuhan City where a novel coronavirus has emerged

By Scott J. Becker, executive director, APHL

As news spreads of the 2019 novel coronavirus (2019-nCoV) emerging in Wuhan, China, we at APHL are taking this threat seriously while also remaining calm and confident that our public health system is prepared. APHL has activated our incident command structure (ICS) to support our members and partners during the response.

Despite being a new respiratory virus strain, there is a familiarity that is reassuring to many of us in public health but can be unsettling to others. This new outbreak resembles SARS, MERS, H5N1 bird flu and other emerging respiratory diseases from the past. However, illness does not appear to be as severe as those previous viruses although our understanding of 2019-nCoV is still developing.

While there is a lot we don’t know about 2019-nCoV, this is what we do know about the outbreak response to prevent its spread:

  • As the first 2019-nCoV patient was identified in the United States, our public health system worked. Efforts to disseminate information to the public and to health care providers led to the patient self-identifying and allowed his providers to quickly initiate screening, isolation and eventual diagnosis. The specimen was immediately sent to CDC for rapid testing and results were promptly reported.
  • Public health laboratories are ready to process and ship specimens to CDC whose laboratory is currently the only one able to perform diagnostic testing in the US. CDC is working hard to develop and qualify a test that public health laboratories can use. Performing testing close to where the patient is being treated is ideal, but developing an effective test requires strong science and that takes time. We expect this new test to be ready for public health lab use in the coming weeks. CDC is already working closely with FDA to get an emergency use authorization (EUA) to deploy the test across the country in the event a US public health emergency is declared. (An EUA cannot be given until the US Secretary of Health and Human Services declares a public health emergency.)
  • For all of the critical players in our public health system – public health laboratory scientists, epidemiologists, CDC, FDA, health care providers and others – this is all in a day’s work. Frequent preparedness training and routine outbreak responses ensure that when a new disease emerges, the public health system is ready.

An outbreak of a new virus like 2019-nCoV can sometimes stir up panic and fear. We understand why some feel that way, but we are also confident that the public health system is working to stop this virus just as it has done with many others. We hope that our confidence in their expertise and abilities is reassuring for you. It is not time to panic – it is time to wash those hands, catch your coughs and continue to be vigilant during this cold and flu season.

We will continue to update this post with more information as it becomes available.

 

What is an Emerging Infectious Disease?

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Lab Culture Ep. 21: 2019 Year in Review

Collage of photos depicting APHL's 2019 year in review

Are we already at the end of 2019?! While to many of us it felt like the year flew by, APHL staff, members and partners accomplished a LOT in an effort to protect the public’s health. In this episode, Scott Becker, APHL’s executive director, reviews some of the highlights of the year along with Gynene Sullivan, APHL’s manager of communications, who is finalizing our Annual Report.

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Links:

APHL: Lung Injury Response Associated with Vaping

CDC: Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products

APHL work on opioids

Data: Elemental to Health advocacy campaign

Supporting rapid exchange of public health data is urgent, crucial and laden with challenges

APHL AIMS Platform

Lab Matters (Fall 2019): Making Data Fly

NewSTEPs Data Repository

APHL Newborn Screening Systems Quality Improvement Projects Award Recipients Announced

APHL Public Health Laboratory Fellowships

APHL Emerging Leader Program

Lab Culture Ep. 9: What is the APHL Emerging Leader Program?

CDC: US Measles Cases and Outbreaks in 2019

“Launching Whole Genome Sequencing in the Public Health Realm” Lab Matters (Fall 2013)

Accreditation for Human and Animal Food Labs

APHL Conferences

Lab Culture Extra: Progress in Sierra Leone

APHL Global Health Program: Countries we serve

Global Laboratory Leadership Programme (GLLP)

Laboratory Response Network (LRN)

Lab Culture Ep. 20: 20 Years of the Laboratory Response Network

“Two Decades of Preparedness Excellence: The Laboratory Response Network” Lab Matters (Fall 2019)

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

Strengthening Lab Biosafety & Biosecurity

“Ensuring Readiness for Rabies in Puerto Rico” Lab Matters (Spring 2019)

“Public Health System Recovery in Full Swing: Hurricane Response in Puerto Rico and the US Virgin Islands” Lab Matters (Spring 2019)

In Puerto Rico, a new molecular bacteriology lab allows better control of foodborne outbreaks

APHL Publications

“US officials identify ‘strong culprit’ in vaping illnesses” Associated Press (video interview)

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New Lab Matters: Making data fly

Cover of Fall 2019 issue of Lab Matters magazine illustrating high volume of data

In today’s technology-connected world, information moves quickly. But in the world of public health, pathogens often travel faster than the data needed to diagnose, treat and prevent illness. Reporting delays and incomplete or incompatible data delay insights into pressing public health problems. The solution? Investing in public health infrastructure and resources to rapidly deliver data to public health and clinical decision makers.

Here are a few of this issue’s highlights:

Read the full issue.

Subscribe and get Lab Matters delivered to your inbox, or read Lab Matters on your mobile device.

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APHL’s newborn screening program goes global

APHL's Jelili Ojodu receives the the Gerard Loeber Award for Contributions to Newborn Screening Expansion in Developing Countries

Outside of the US and other resource-rich nations, few countries have the capital, infrastructure and human resources required to sustain a newborn screening program. Despite these barriers, APHL staff and members have worked diligently to increase access to newborn screening worldwide. In recognition of these efforts, APHL

While much remains to be done to achieve this goal, as more countries consider the impact of non-communicable diseases on their populations, interest in newborn screening is growing. In the last year alone, APHL has received requests for technical assistance to develop or expand newborn screening programs from Brazil, Canada, Ghana, Jordan, India, Mexico, Nepal, Nigeria and Tanzania.

Such interest has led APHL to expand partnerships with nonprofits and governmental agencies to develop newborn screening guidance and resources. For example, APHL has collaborated with the Global Issues Working Group of the Sickle Cell Disease Coalition to develop a Global Resource Library with information on sickle cell disease activities worldwide and a public service announcement. In addition, the association worked with other sickle cell disease advocates to create tools to assess a nation’s needs and readiness to develop a sickle cell disease program. APHL is also currently collaborating with the US Centers for Disease Control and Prevention (CDC), the CDC Foundation, the Pediatric Endocrine Society and Vanderbilt University Medical Center to finalize a document detailing the capabilities required to launch a newborn screening program.

On the ground, APHL continues to extend its reach within Africa, South America, Europe and Southeast Asia. It supports development of implementation plans and strategies, offers related training and shares recent developments in US newborn screening. For example, APHL recently participated in the first Pan-African Workshop on Newborn Screening in Rabat, Morocco, where delegates reported on the status of newborn screening in their countries, and APHL discussed developing a newborn screening case registry to coordinate patient follow up, and infrastructure required for electronic data exchange of newborn screening results.

The association has also been collaborating with partners in India as that country gears up to implement universal newborn screening—a daunting undertaking in a country where 1.5 million babies are born each month. APHL recently teamed up with PerkinElmer to support newborn screening and genetics training for a fellow from Jaipur, whom APHL staff later visited to assess readiness for newborn screening new disorder implementation and technical assistance in that state. Currently, APHL is developing case studies about the benefits of newborn screening to educate physicians in Jaipur, and, with the International Neonatology Association (ISNS), is coordinating with local NBS leaders to explore opportunities to initiate an ISNS chapter in India.

Despite the challenges of strengthening newborn screening programs in countries where the service is now virtually unknown, Ojodu and his team foresee tremendous benefits to public health as well as national income and stability. Says Ojodu: “When we reduce or eliminate the symptoms of newborn screening disorders, kids are healthier, healthcare costs go down and mothers can take on income-generating work. This raises family income and, when multiplied by millions of families, also raises national income. We get a cascade of benefits from a single investment in public health.”

 

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APHL’s newborn screening program goes global

APHL's Jelili Ojodu receives the the Gerard Loeber Award for Contributions to Newborn Screening Expansion in Developing Countries

Outside of the US and other resource-rich nations, few countries have the capital, infrastructure and human resources required to sustain a newborn screening program. Despite these barriers, APHL staff and members have worked diligently to increase access to newborn screening worldwide. In recognition of these efforts, APHL Newborn Screening and Genetics Director Jelili Ojodu received the Gerard Loeber Award for Contributions to Newborn Screening Expansion in Developing Countries at the tenth in September. The award recognizes years of work by Ojodu and his team at APHL to make newborn screening the norm—not the exception—for babies around the world.

While much remains to be done to achieve this goal, as more countries consider the impact of non-communicable diseases on their populations, interest in newborn screening is growing. In the last year alone, APHL has received requests for technical assistance to develop or expand newborn screening programs from Brazil, Canada, Ghana, Jordan, India, Mexico, Nepal, Nigeria and Tanzania.

Such interest has led APHL to expand partnerships with nonprofits and governmental agencies to develop newborn screening guidance and resources. For example, APHL has collaborated with the Global Issues Working Group of the Sickle Cell Disease Coalition to develop a Global Resource Library with information on sickle cell disease activities worldwide and a public service announcement. In addition, the association worked with other sickle cell disease advocates to create tools to assess a nation’s needs and readiness to develop a sickle cell disease program. APHL is also currently collaborating with the US Centers for Disease Control and Prevention (CDC), the CDC Foundation, the Pediatric Endocrine Society and Vanderbilt University Medical Center to finalize a document detailing the capabilities required to launch a newborn screening program.

On the ground, APHL continues to extend its reach within Africa, South America, Europe and Southeast Asia. It supports development of implementation plans and strategies, offers related training and shares recent developments in US newborn screening. For example, APHL recently participated in the first Pan-African Workshop on Newborn Screening in Rabat, Morocco, where delegates reported on the status of newborn screening in their countries, and APHL discussed developing a newborn screening case registry to coordinate patient follow up, and infrastructure required for electronic data exchange of newborn screening results.

The association has also been collaborating with partners in India as that country gears up to implement universal newborn screening—a daunting undertaking in a country where 1.5 million babies are born each month. APHL recently teamed up with PerkinElmer to support newborn screening and genetics training for a fellow from Jaipur, whom APHL staff later visited to assess readiness for newborn screening new disorder implementation and technical assistance in that state. Currently, APHL is developing case studies about the benefits of newborn screening to educate physicians in Jaipur, and, with the International Neonatology Association (ISNS), is coordinating with local NBS leaders to explore opportunities to initiate an ISNS chapter in India.

Despite the challenges of strengthening newborn screening programs in countries where the service is now virtually unknown, Ojodu and his team foresee tremendous benefits to public health as well as national income and stability. Says Ojodu: “When we reduce or eliminate the symptoms of newborn screening disorders, kids are healthier, healthcare costs go down and mothers can take on income-generating work. This raises family income and, when multiplied by millions of families, also raises national income. We get a cascade of benefits from a single investment in public health.”

 

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In Puerto Rico, a new molecular bacteriology lab allows better control of foodborne outbreaks

Public health laboratory scientist performing tests

Sometimes a new facility is more than just four walls and a roof. In Puerto Rico, it was the springboard to improving foodborne outbreak response on the whole island.

In May 2019, Puerto Rico inaugurated a new molecular bacteriology laboratory at the Puerto Rico Department of Health’s laboratory (PRDOH) in San Juan. The original laboratory had been out of commission since Hurricane Maria devastated the island in 2017, and was rebuilt with APHL contracting support for repair and redesign. Today, the new laboratory boasts additional space for laboratory instruments, supplies and staff, as well as a reliable roof.

With the molecular bacteriology laboratory up and running, the PRDOH could take on a top goal: implementing whole genome sequencing (WGS) for foodborne outbreak response. WGS provides faster detection of pathogens than alternative methods, leading to rapid implementation of prevention and control measures and speedier investigation of foodborne outbreaks. Like other members of PulseNet, the US network for detection of foodborne outbreaks, the PRDOH needed to add WGS as another detection tool. Now, with a bit of assistance, it could.

APHL helped the PRDOH by procuring Illumina’s MiSeq Sequencing Platform and supporting installation and hands-on training for laboratory staff. The association also facilitated staff travel to CDC headquarters in Atlanta for a deeper dive into WGS methodology and procured BioNumerics software to upgrade the laboratory’s database so it could support WGS data. These efforts were all financed with crisis response funding from the US Centers for Disease Control and Prevention (CDC).

To date, the molecular bacteriology laboratory has made excellent progress toward implementing WGS methods for foodborne pathogens. The laboratory is now working toward validation of these methods; once validation is completed it will apply for certification under the Clinical Laboratory Improvement Amendments Program, which oversees standards and certification for human testing in the US. The laboratory also plans to introduce a new tool—matrix-assisted laser desorption/ionization – time of flight (MALDI-TOF) mass spectrometry—as a complement to WGS in the effort to detect foodborne outbreaks.

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In Puerto Rico, a new molecular bacteriology lab allows better control of foodborne outbreaks

Public health laboratory scientist performing tests

Sometimes a new facility is more than just four walls and a roof. In Puerto Rico, it was the springboard to improving foodborne outbreak response on the whole island.

In May 2019, Puerto Rico inaugurated a new molecular bacteriology laboratory at the Puerto Rico Department of Health’s laboratory (PRDOH) in San Juan. The original laboratory had been out of commission since Hurricane Maria devastated the island in 2017, and was rebuilt with APHL contracting support for repair and redesign. Today, the new laboratory boasts additional space for laboratory instruments, supplies and staff, as well as a reliable roof.

With the molecular bacteriology laboratory up and running, the PRDOH could take on a top goal: implementing whole genome sequencing (WGS) for foodborne outbreak response. WGS provides faster detection of pathogens than alternative methods, leading to rapid implementation of prevention and control measures and speedier investigation of foodborne outbreaks. Like other members of PulseNet, the US network for detection of foodborne outbreaks, the PRDOH needed to add WGS as another detection tool. Now, with a bit of assistance, it could.

APHL helped the PRDOH by procuring Illumina’s MiSeq Sequencing Platform and supporting installation and hands-on training for laboratory staff. The association also facilitated staff travel to CDC headquarters in Atlanta for a deeper dive into WGS methodology and procured BioNumerics software to upgrade the laboratory’s database so it could support WGS data.

To date, the molecular bacteriology laboratory has made excellent progress toward implementing WGS methods for foodborne pathogens. The laboratory is now working toward validation of these methods; once validation is completed it will apply for certification under the Clinical Laboratory Improvement Amendments Program, which oversees standards and certification for human testing in the US. The laboratory also plans to introduce a new tool—matrix-assisted laser desorption/ionization – time of flight (MALDI-TOF) mass spectrometry—as a complement to WGS in the effort to detect foodborne outbreaks.

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

Man vaping

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

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

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

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

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

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

# # #

More APHL’s support of the EVALI response

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

Man vaping

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

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

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

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

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

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

# # #

More APHL’s support of the EVALI response

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Humboldt County Public Health Lab was ready for ricin thanks to LRN

Humboldt County Public Health Laboratory team poses in the lab.

By Jody DeVoll, advisor, communications, APHL

Jeremy Corrigan, Humboldt County Public Health Laboratory manager, was having a quiet Tuesday morning when he received a call from a member of the local hazmat team. Workers processing mail at a nearby California state prison had found envelopes containing an unidentified white powder, and samples were being sent to the lab for testing. Meanwhile, 116 prison workers were under quarantine at the prison.

Fortunately, the Humboldt County laboratory was well prepared and equipped to handle this sort of request. As a member of the Laboratory Response Network for Biological Threats, the national laboratory system that protects Americans from serious biological threats, such as anthrax and plague, and from emerging infectious diseases, it is the only facility with these capabilities in this remote section of northern California.

Three Humboldt County Public Health Laboratory scientists dressed in protective gear take a selfie in the laboratory.Though the situation was urgent, Humboldt laboratory staff were careful to maintain chain of custody and preserve evidence and therefore did not immediately launch into testing when the samples arrived. Following protocol, they devoted two hours to documenting, photographing and opening the samples, handling them with the utmost care. Then they turned to testing with a time-resolved fluorescence immunoassay (TRF) followed by molecular testing.

The results were startling. Normally white powder samples come back negative for any select agent as so-called “white-powder incidents” are typically hoaxes, but these tested positive, specifically for ricin A chain. Ricin has two protein chains – ricin A chain and ricin B chain – and both must be present to have toxic effects. When ricin is used as a biothreat agent, the presence of A chain usually means testing will also reveal B chain.

Once Corrigan had the preliminary results, he called his Federal Bureau of Investigation (FBI) weapons of mass destruction contact, the US Centers for Disease Control and Prevention (CDC) and the prison incident commander. This was the beginning of an all-night phone marathon with the CDC, the FBI and local and state government officials. During a short break, Corrigan lay down for 30 minutes to rest his eyes.

Back at the laboratory early Wednesday morning, Corrigan’s next challenge was shipping. To be certain the samples were positive for ricin A chain and ricin B chain, they would have to go to a federal laboratory for confirmatory testing. However, the Humboldt laboratory did not have the materials required for shipping ricin and delivery would take up to two days. Seeing no other alternative, Corrigan placed the order for the shipping materials and waited.

Then came a call from an FBI agent traveling aboard a C-130 military transport aircraft announcing that he would be arriving within the hour to pick up the samples. Corrigan later learned that the California Governor’s Office and the FBI had prevailed upon federal authorities to make their resources available to expedite transport of the samples.

Once at the FBI laboratory, the samples tested positive for both ricin A chain and ricin B chain. The unidentified white powder from the prison mailroom was indeed ricin and the toxin was active. Using samples forwarded by the FBI, CDC laboratories reached the same conclusion. At this point, the acute phase of the incident ended for the laboratory as the focus shifted to the criminal investigation for the FBI and United States Postal Service. While not actively involved, Corrigan and his team at the Humboldt laboratory offered any additional testing support should the need arise.

Corrigan credits the Laboratory Response Network for his facility’s efficient response to the crisis. “The LRN backbone is what allowed us to respond so quickly. We had the protocols, the procedures, the partners, the proficiency and the relationships to handle the response.” He also commends the strong support he received from the county, the health department, the acting state public health officer and the Sonoma County Public Health Laboratory, which handled Humboldt’s overflow testing during the height of the crisis.

According to Corrigan, “The ricin event strengthened our existing relationships and allowed us to develop new ones.” To build upon this dynamic, he is planning a regional training that will bring together Humboldt laboratory staff, local hazmat teams, the sheriff’s department and the region’s civil support team.

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