New Lab Matters: The ABCs of PFAS

New Lab Matters: The ABCs of PFAS | www.APHLblog.org

First discovered in the 1930s, per- and polyfluoroalkyl substances (PFAS) now pervade almost every aspect of modern life. In fact, PFAS compounds are found in everything from dental floss to cookware. But human exposure to PFAS comes at a cost, and as old compounds are removed from production, new compounds take their place. So how does a public health laboratory handle this challenge with limited resources? As our feature article shows, by establishing new public-private partnerships.

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

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SUIT UP for Lab Week — 2019 Lab Week ToolKit

SUIT UP for Lab Week -- 2019 Lab Week Toolkit | www.APHLblog.org

How do you suit up? With a crisp white lab coat and purple gloves? Or maybe in a fierce yellow hazmat suit? How about knee-high rubber boots and waders? However you SUIT UP, we want to see it! Take photos or video of you suiting up for Lab Week, and share on Instagram using #SuitUpforLabWeek.

Celebrate Lab Week April 21-27, 2019!

Join the conversation! Use and follow #LabWeek #SuitUpforLabWeek #APHL on:

Printables

Social media graphics

Sample social media posts

  • When evil pathogens appear, public health lab scientists don’t run the other way… they SUIT UP! http://www.aphlblog.org/ #LabWeek #SuitUpforLabWeek
  • Look at those ten little baby fingers and ten little baby toes! But does she have any serious heritable conditions? Newborn screening lab scientists SUIT UP to find out! http://bit.ly/2ERxbkQ #LabWeek #SuitUpforLabWeek
  • Millions of gallons of mine waste spilled into a river. Public health and environmental laboratory scientists immediately SUIT UP and go into response mode! http://bit.ly/2ERSWBc #LabWeek #SuitUpforLabWeek

Stories that highlight public health, environmental and agricultural laboratory work:

Videos

Celebration ideas

  • Celebrate Lab Week internally with a social event, banners or other decorations. Print posters, stickers and activity sheets shared below!
  • Hold an open house for media, elected officials, school groups, staff families and other members of the community. Check out the Milwaukee Health Department Laboratory’s story about their health fair for students.
  • Visit local elementary, middle and high schools to talk with students interested in science and health.
  • Write an op-ed piece for local newspapers and/or magazines to highlight the valuable contributions your public health laboratory staff are making in your community, city and/or state.
  • Do you have other ideas? Share them in our Facebook group, APHL Off the Bench, so others can enjoy them too!

Earth Day is April 22 – here are some ways to incorporate it into your Lab Week celebration:

  • Host a Green and Blue Day and ask staff to wear colors representing earth and water.
  • Hold a grounds-keeping afternoon: Invite staff and their families to help with weeding, mulch, planting, etc.
  • Ask if your regional EPA office plans to do something for Earth Day and join them as a partner.
  • Encourage employees to do Meatless Monday or purchase items at a local farmer’s market instead of the supermarket.
  • Encourage employees to carpool, take the bus, walk or ride their bike to work.
  • Learn more about the Water Environment Federation (WEF).

APHL is part of the Lab Week coalition.

 

 

The post SUIT UP for Lab Week — 2019 Lab Week ToolKit appeared first on APHL Lab Blog.

SUIT UP for Lab Week — 2019 Lab Week ToolKit

SUIT UP for Lab Week -- 2019 Lab Week Toolkit | www.APHLblog.org

How do you suit up? With a crisp white lab coat and purple gloves? Or maybe in a fierce yellow hazmat suit? How about knee-high rubber boots and waders? However you SUIT UP, we want to see it! Take photos or video of you suiting up for Lab Week, and share on Instagram using #SuitUpforLabWeek.

Celebrate Lab Week April 21-27, 2019!

Join the conversation! Use and follow #LabWeek #SuitUpforLabWeek #APHL on:

Printables

Social media graphics

Sample social media posts

  • When evil pathogens appear, public health lab scientists don’t run the other way… they SUIT UP! http://www.aphlblog.org/ #LabWeek #SuitUpforLabWeek
  • Look at those ten little baby fingers and ten little baby toes! But does she have any serious heritable conditions? Newborn screening lab scientists SUIT UP to find out! http://bit.ly/2ERxbkQ #LabWeek #SuitUpforLabWeek
  • Millions of gallons of mine waste spilled into a river. Public health and environmental laboratory scientists immediately SUIT UP and go into response mode! http://bit.ly/2ERSWBc #LabWeek #SuitUpforLabWeek

Stories that highlight public health, environmental and agricultural laboratory work:

Videos

Celebration ideas

  • Celebrate Lab Week internally with a social event, banners or other decorations. Print posters, stickers and activity sheets shared below!
  • Hold an open house for media, elected officials, school groups, staff families and other members of the community. Check out the Milwaukee Health Department Laboratory’s story about their health fair for students.
  • Visit local elementary, middle and high schools to talk with students interested in science and health.
  • Write an op-ed piece for local newspapers and/or magazines to highlight the valuable contributions your public health laboratory staff are making in your community, city and/or state.
  • Do you have other ideas? Share them in our Facebook group, APHL Off the Bench, so others can enjoy them too!

Earth Day is April 22 – here are some ways to incorporate it into your Lab Week celebration:

  • Host a Green and Blue Day and ask staff to wear colors representing earth and water.
  • Hold a grounds-keeping afternoon: Invite staff and their families to help with weeding, mulch, planting, etc.
  • Ask if your regional EPA office plans to do something for Earth Day and join them as a partner.
  • Encourage employees to do Meatless Monday or purchase items at a local farmer’s market instead of the supermarket.
  • Encourage employees to carpool, take the bus, walk or ride their bike to work.
  • Learn more about the Water Environment Federation (WEF).

APHL is part of the Lab Week coalition.

 

 

The post SUIT UP for Lab Week — 2019 Lab Week ToolKit appeared first on APHL Lab Blog.

New lab informatics courses introduce basics to non-specialists  

New lab informatics courses introduce basics to non-specialists | www.APHLblog.org

Two online laboratory informatics courses now on the CDC TRAIN site help laboratory staff to understand how their jobs relate to their laboratory’s informatics system. Developed by APHL and the Centers for Disease Control and Prevention (CDC) in collaboration with the APHL Informatics Committee and members of the target audience, the courses follow a TB specimen as it advances through testing and reporting to inform decisions by clinical care providers and public health agencies.

Historically the term “informatics” evoked fear among laboratory staff who avoided the unfamiliar discipline. Responsibility for the function often devolved to one person who became the de facto informatician more by accident than by intent. When the new skill set proved highly marketable, this individual often departed for new opportunities, leaving the laboratory with no one who could distinguish between LOINC and SNOMED codes, much less maintain the Laboratory Information Management System.

But times have changed. With electronic data now integral to work at both private and public sector laboratories, all staff require a basic knowledge of informatics. With an understanding of how the data they touch flows in and out of their facility, staff can improve the quality and speed of laboratory operations and, ultimately, patient treatment and disease control.

The two online courses, Life of a Specimen and Life of a Result, trace the testing and reporting process in plain language, explaining who comes into contact with the specimen at each point, when errors are most likely to occur and how to avoid them, and how a specimen becomes a result and is reported to stakeholders. Both courses offer P.A.C.E.® credits. Visit CDC TRAIN to register.

Specifically:

  • Life of a Specimen introduces staff roles in laboratory informatics, data relationships, data quality and standards, and the generation and flow of information as a specimen progresses through the pre-analytic, analytic and post-analytic phases.
  • Life of a Result examines how data and information move through and outside the laboratory to impact clinical care and public health decision making.  It covers the recipients of laboratory data, data and results storage, and communication of data and results to stakeholders.

The two courses would be a valuable addition to staff onboarding programs at laboratories of all types. Keith Higginbotham, IT systems manager at the Alabama Department of Public Health, laments that such training was not available earlier in his career:

“I wish I’d had access to this training when I was first starting out. It condenses a year’s worth of knowledge into a few hours, giving lab staff from all backgrounds a real head start. Those in leadership can become stronger advocates for their labs by better understanding their informatics needs and capabilities.”

A third course, which takes the student on a deeper journey into Laboratory Information Management Systems (LIMS), is in production and slated for release in 2019.

The post New lab informatics courses introduce basics to non-specialists   appeared first on APHL Lab Blog.

Lab Culture Ep. 17: Exploring bioinformatics: From fellow to full time in Virginia

Lab Culture Ep. 17: Exploring bioinformatics: From fellow to full time in Virginia | www.APHLblog.org

Kevin Libuit went from the APHL-CDC Bioinformatics Fellowship to a contractor to working full-time as a bioinformatician at the Virginia state lab (VA Division of Consolidated Laboratory Services (DCLS)). First he talks about when he discovered bioinformatics as a field and how the fellowship propelled his career. Then Kevin takes the mic and interviews Dr. Denise Toney, director of Virginia DCLS, about the value and growing need for bioinformaticians in public health labs.

 

 

Kevin G. Libuit, M.S.
Bioinformatics Lead Scientist, Division of Consolidated Laboratory Services (DCLS), Virginia Department of General Services

Denise Toney, PhD
Director, Division of Consolidated Laboratory Services (DCLS), Virginia Department of General Services

Links:

APHL-CDC Fellowships

APHL-CDC Bioinformatics Fellowships

Virginia Division of Consolidated Laboratory Services (DCLS)

APHL Off the Bench (new Facebook group!)

 

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Pandemic preparedness has been a boon for US flu surveillance, but it won’t maintain itself

Pandemic preparedness has been a boon for US flu surveillance, but it won’t maintain itself. | www.APHLblog.org

by Kim Krisberg

At the peak of the 2009 H1N1 flu pandemic, the Wisconsin state public health lab was routinely testing up to 300 specimens every day. On one day, the lab hit a record of nearly 500.

To generate results within 24 hours of receiving a specimen and keep up with its duties outside of flu surveillance, the lab added a second shift of flu testing on the weekdays and worked through the weekends. H1N1 definitely stressed the lab’s capacities, said Peter Shult, PhD, associate director of the Wisconsin State Laboratory of Hygiene, but it also demonstrated the value of years of investing in pandemic preparedness and response. In fact, Shult said that if the lab had received 300 flu specimens in a day only a few years before the H1N1 pandemic, “we’d have been backlogged immediately — it would have taken us weeks to catch up.”

As one might expect, years of preparing for another worldwide flu pandemic has also boosted the lab’s seasonal flu response. During the 2017-2018 flu season — one of the most severe in recent memory with an estimated 80,000 U.S. deaths — Shult said the Wisconsin lab was easily able to keep pace with a surge in testing demands, which while much lower than peak pandemic levels, were still about 30% higher than the average flu season.

“We were busy, but we could comfortably handle the specimen load without expanding testing hours or impacting turnaround times, and we could still carry out all of our other routine testing responsibilities,” said Shult, who also serves as director of the lab’s Communicable Disease Division. “All that speaks to the capacity we’ve developed regarding testing platforms and our staff being able to do this flu testing. …But funding is still needed to maintain this kind of capacity.”

That capacity building goes back more than 20 years when global health officials detected the first human infections of H5N1 avian influenza; a few years later in 2003, the virus re-emerged, spreading from Asia to Europe and Africa. While the virus very rarely spread from person to person, fears that H5N1, which has a mortality rate of about 60%, could evolve to easily transmit between people sparked a new chapter of pandemic preparedness that included billions in federal funding support and a key focus on improving flu surveillance and detection. By the time H1N1 hit in 2009, public health labs had transformed their flu capacities.

Just a few years before the H1N1 pandemic, for example, most public health labs relied on the traditional viral culture to gather data on the flu. Viral cell culture is a reliable way to identify flu strains and monitor which antivirals work best to treat infections, but getting results can take more than a week, which is hardly ideal in any disease outbreak, let alone a flu pandemic. By 2009, however, most labs had built the capacity to use and quickly deploy highly sensitive molecular assays — in particular, a technique known as real-time reverse transcription-polymerase chain reaction (RT-PCR) — that could turnaround flu results in less than a workday.

With a week shaved off testing times, as well as years of cross-training and drilling lab staff in pandemic response, it’s little surprise that investments in pandemic preparedness have also been a boon for seasonal flu surveillance.

“The last flu season was a high-volume one for public health labs, but it was also considered business as usual at this point,” said Stephanie Chester, MS, manager of APHL’s Respiratory Disease Program. “That’s a capacity that labs had been working toward for years, but you do need to maintain that warm base. If funding went down, it could certainly erode that capacity.”

In New Hampshire, the state public health lab tested more than 4,000 flu specimens during the 2009 pandemic. During a more typical year, it tests between 300 and 500 flu specimens from sentinel sites across the state, such as hospital labs and long-term care facilities, according to Carol Loring, MS, supervisor for the Virology and STD Laboratory at the New Hampshire Department of Health and Human Services’ Public Health Laboratories. Compared to clinical flu testing, which typically determines if a patient has influenza A or B, the state lab performs genotyping and subtyping to identify the specific strains circulating in the community, including potential pandemic strains, and to help monitor the effectiveness of each year’s flu vaccine. All that data, Loring said, helps clinicians make better diagnostic and prescribing decisions and helps public health workers more precisely target their prevention resources.

During the 2017-2018 flu season, Loring said the lab didn’t experience a significant increase in testing volumes, but it was prepared to face a surge.

“In my experience, our surge capacities evolve with each event,” she said. “We’re constantly training, drilling and preparing for the next pandemic.”

Loring noted that routine flu surveillance isn’t especially different from pandemic response — “the day-to-day tasks are the same, the only difference often is that there’s less interest from the public,” she said. Still, both capacities are heavily reliant on funding from CDC’s Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement (ELC), which is scheduled to begin a new five-year funding cycle in August 2019. A substantial portion of ELC funding, about $40 million a year comes from the Affordable Care Act’s Prevention and Public Health Fund, which the law established as the nation’s first mandatory funding stream dedicated to improving the public health system. If the ACA were repealed and those funds not replaced, it would be a major blow to the country’s flu surveillance system.

Inside the New Hampshire state lab, Loring said at least two instruments that the lab needs to perform nucleic acid extraction, a key step in the RT-PCR process, are slated for retirement by their manufacturers in the next few years. Replacement costs could run up to $100,000 and that’s just for the initial purchase, not the costs of regular maintenance.

“ELC funding is critical to enable us to purchase instruments,” she said. “If I don’t have the financial resources to maintain our instrumentation or update it, we’ll be that much less prepared for a pandemic.”

Also on Loring’s lab wish list: its own courier system for getting flu specimens into the lab. Right now, the lab depends on its clinical partners across the state to send in specimens for surveillance. Some send in their samples via US mail, others use courier services and some drive their samples over and drop them off. The hodgepodge of delivery methods makes it hard to predict when specimens will show up, and many don’t arrive within the recommended three days of being collected.

“A better specimen transport system would definitely help improve our efforts,” Loring said.

In Wisconsin, the state’s public health lab is also one of the country’s three National Influenza Reference Centers (NIRCs), which serve as extensions of the CDC Influenza Division’s Virology, Surveillance and Diagnosis Branch and allow the federal agency to focus on more advanced testing and global flu monitoring. As a state lab, the Wisconsin State Laboratory of Hygiene subtypes every flu specimen it receives, testing samples for flu as well as 18 other respiratory pathogens. As a NIRC, the flu specimens it receives from around the country have already been subtyped ; the center’s job is to conduct genetic sequencing and grow the specimen up with the traditional viral culture. The sequencing, in particular, is key to detecting signs of evolving genetic change and antiviral resistance.

Data generated by public health laboratory testing helps form the basis of CDC’s FluView, the agency’s weekly flu surveillance report. Data and specimens coming out of the three NIRCs — also located in New York and California — go onto CDC for additional study, inclusion in FluView and are fundamental to planning each year’s flu vaccine composition.

Shult, the Wisconsin lab’s associate director, said it’s critical to maintain the ability to quickly detect both novel and seasonal flu viruses across the public health system if responders hope to stay one step ahead of a potential outbreak.

“In 2009, H1N1 went across the country and the globe in a matter of weeks,” he said. “That’s how quickly a novel virus can emerge and spread globally.”

In 2009, at the peak of the pandemic’s first wave, the Wisconsin lab was routinely testing up to 300 specimens a day; in a more typical flu season, it receives a couple-hundred of specimens in a week. In the early days of the pandemic, the lab was the only one in the state that could perform real-time RT-PCR on H1N1 samples. Now, Shult said nearly 50 labs in the state use real-time RT-PCR in their flu testing.

“It was game-changing in terms of how we were able to respond,” said Shult of the shift to RT-PCR. “The results were reliable and the turnaround time was remarkably quicker. …If we had received 400 specimens in a day (like we did in the H1N1 pandemic) and we were still depending on viral culture, we’d have been immediately behind.”

To further illustrate how far flu surveillance has come, Shult noted that only about 15 years ago — before the influxes of federal pandemic and preparedness funds — a flu season as severe as the 2017-2018 one would have significantly strained the lab’s capacities. Instead, Shult said the Wisconsin lab was “able to take on a season like the past one more or less in stride.”

Like his colleague in New Hampshire, Shult is concerned about sufficient federal funding to both preserve the country’s investment in flu surveillance and response and ready the system for the future.

“We’ve had a lot of funding to build this capability and capacity, and slightly less funding to maintain it,” he said. “We have staff to pay and train, we have equipment that ages out and needs maintenance … there are considerable ongoing costs.”

Shult’s laboratory wish list? Enough funding to keep getting better and faster at chasing the flu.

“My wish is having enough dollars to maintain what we’ve built and keep on top of new technologies that will help us respond even quicker,” he said. “Right now, if we were to face a severe pandemic, we’d be stressed but we’d still be in the game. But if funding were severely cut? Then we’d be in trouble.”

 

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New Lab Matters: Time to welcome the next generation of public health laboratory scientists

New Lab Matters: Time to welcome the next generation of public health laboratory scientists | www.APHLblog.org

The Bureau of Labor Statistics estimates that 12,000 new laboratory professionals are needed each year to meet consumer demand. At the same time, while automation has eliminated some less-skilled laboratory jobs, the growing sophistication of public health laboratory analyses has generated demand for scientists with highly specialized training. As our feature article shows, laboratories are recruiting new talent for the “hidden profession” by taking a hard look into what they really want, and how they want to work.

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.

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Lab Culture: Introducing PKU Life Podcast with Kevin Alexander

Introducing: PKU Life Podcast with Kevin Alexander | www.APHLblog.org

Fifty-five years ago, newborn screening was born. At the time, though, that little heel prick was performed to screen for only one condition: phenylketonuria (PKU). Without early intervention, babies born with PKU faced severe cognitive, behavioral and other neurological disorders. The advent of PKU newborn screening allowed health care providers and families to make critical changes to a baby’s diet to prevent those consequences.

TIntroducing: PKU Life Podcast with Kevin Alexander | www.APHLblog.orgoday, December 3, is PKU Awareness Day. It’s hard to say where newborn screening would be without that first PKU test. And 55 years later, it’s hard to say where newborn screening would be without the families and individuals living with PKU who have shared their stories to convey the value of this simple test. One of those individuals is Kevin Alexander.

Kevin has been a leader in the PKU community simply by sharing his story and his experiences living with PKU. He has spoken at conferences and events around the world, created a video documentary about his life, served as a leader and friend to others living with PKU, and now he shares his voice in a new podcast.

For this PKU Awareness Day, we are sharing Kevin’s podcast, PKU Life Podcast with Kevin Alexander. We are so appreciative of Kevin’s willingness to both share with and listen to those in the newborn screening community. Kevin, thank you for your leadership, friendship and generosity!

Listen here or subscribe wherever you listen to podcasts:

 Links:

PKU Life Podcast with Kevin Alexander – Facebook

PKU Life Podcast with Kevin Alexander – Instagram

PKU Life Podcast with Kevin Alexander – Twitter

APHL’s Newborn Screening Program

APHL blog posts about PKU

PKU Awareness Day

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5 most unexpected and unique partnerships forged through the Zika response

Top 5 most unexpected and unique partnerships forged through the Zika response | www.APHLblog.org

By Kelly Wroblewski, director, infectious disease, APHL

While the US public health system has been through a number of infectious disease responses in the last decade, the Zika response was unique in both its duration and complexity. For more than 20 months (January 22, 2016 – September 29, 2017), CDC’s Emergency Operations Center was activated to respond to the US’s largest Zika virus outbreak. State and local public health departments began their responses as early as November 2015 and continue to respond today. Through the uncertainty, public health built relationships with new partners and found opportunities for unique collaborations with old partners.

APHL explores the journey in detail in our new book, A Complex Virus, A Coordinated Response: Public Health Laboratories Battle Zika. For APHL and public health laboratories, five unique and unexpected partnerships forged during the Zika response proved critical to progress on this journey. Learn about them below:

1. Vector Control

Vector control is, of course, a time-honored, if underappreciated, public health partner; after all, CDC was established in the 1940s in response to malaria. The Zika response reinvigorated those relationships as public health laboratories and vector control programs worked together on the best methods and approaches for vector surveillance (i.e., testing vectors to see if the pathogen is present) and insecticide resistance testing (testing insects to determine which sprays will be most effective). Once local transmission occurred in Florida and Texas, vector control relied on public health laboratory test results to focus mosquito control efforts on the areas where transmission was most likely to occur.

2. Maternal and Child Health and OB/GYNs

While public health laboratories may connect with maternal and child health departments for other types of testing like newborn screening, it is unusual for these groups of public health professionals to work together in response to an emerging infectious disease. Many OB/GYNs treating patients concerned about their risk of Zika infection and exposure were used to working with clinical and commercial laboratories for prenatal testing, but had never ordered a test at a public health lab. Public health labs across the country worked with their maternal and child health counterparts to ensure they had the most up-to -date information on accessing testing, knew how to correctly complete test request forms and could interpret test results to pass along to appropriate healthcare providers.

3. Commercial Laboratories

At public health laboratories, Zika testing represented a massive increase in workload. Beyond demand from patients worried about their exposure, there were multiple new tests to validate, different tests required for different patient populations and often a single specimen from which multiple laboratories needed to conduct multiple tests. In April 2016, commercial laboratories began performing Zika testing, thus distributing some of the specimen volume, taking some of the load off public health labs and offering OB/GYNs access to testing from laboratories with whom they had established relationships.

4. The Zika Coalition (So. Many. Partners.)

This group, led by the March of Dimes, was comprised of more than 70 member organizations committed to the health and wellbeing of US children and families. It was established in response to Congress’ delay in approving the Obama Administration’s emergency request for funding to respond to the Zika crisis in the US. The request was made in in February of 2016 and was not approved by Congress until that September. The Zika Coalition visited congressional offices, wrote letters and testified before the Senate Appropriations Committee advocating for and applying pressure to ensure public health got the funding necessary to respond.

5. CDC, FDA and CMS – Tri-agency Taskforce for Emergency Diagnostics

Although partnerships with the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS) are neither unique nor unexpected during an infectious disease emergency response, the Zika response did change their nature with the establishment of the Tri-agency Taskforce for Emergency Diagnostics. Throughout the 20 month response, as we learned more about how the Zika virus behaved, APHL worked with these agencies to ensure that laboratories had access to the best possible tests through the emergency use authorization (EUA) process (FDA’s role), guidance on how to use those tests (CDC’s role) and assurance that the tests were being implemented in compliance with quality testing standards (CMS’s role). This taskforce remains intact for future responses.

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