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 |

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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5 most unexpected and unique partnerships forged through the Zika response

Top 5 most unexpected and unique partnerships forged through the Zika response |

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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PLOS Update

In 2009, we launched PLOS Currents as an experimental platform for rapid communication of non-standard publications. A few communities embraced the experiment enthusiastically from the start, and the contributions of researchers who volunteered as editors

Responding to Emerging and Zoonotic Infectious Disease Threats in 2017

Montage of photos. From left: a photo of different raw foods, including salmon, fruits and vegetables. A photo of a boy taking an oral vaccine. A photo of bacteria growing in petri dish.

Photo of Rima F. Khabbaz, MD, Director, National Center for Emerging and Zoonotic Infectious Diseases
Rima F. Khabbaz, MD, Director, National Center for Emerging and Zoonotic Infectious Diseases

The fungal superbug Candida auris causes serious and often fatal infections. It can strike people in the places where they seek care—hospitals and other healthcare facilities. In early 2016, we knew about outbreaks of C. auris infections on multiple continents, but we were not sure whether C. auris was in the United States. Fast forward to 2017: C. auris is a priority for public health workers in the United States, and CDC, along with state and local health departments, has tracked more than 200 cases of C. auris infection in the country. Our experts have worked with healthcare facilities across the nation to implement infection control measures and stop transmission.

The progress to track and prevent C. auris is just one example of the important work experts from CDC’s National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) tackled in 2017. Some of the other highlights from the NCEZID 2017 Accomplishments report are described below.

A tremendous year for public health

Summarizing last year’s major efforts was a difficult task. The numbers alone depict a tremendous year for public health. Here are just a few examples.  CDC sequenced nearly 45,000 DNA samples by using Advanced Molecular Detection (AMD) technologies. The agency identified more than 1,100 illnesses that were associated with backyard flocks—the highest number ever recorded by CDC in a single year. And the Antibiotic Resistance Lab Network performed more than 12,000 tests to contain the spread of resistant infections, just to name a few accomplishments.

Tracking new and evolving threatsCDC’s National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) focuses on emerging diseases and diseases spread between animals and people. Our experts work around the clock to identify, track, control and prevent some of the deadliest diseases on the planet. This work includes tracking diseases across the globe and at home, developing innovations, investigating disease outbreaks in extreme conditions, and helping experts prepare for infectious disease threats.

Every day we are learning more about antibiotic resistance, which continues to be among the biggest health concerns in our country. In 2017, CDC took several important steps to combat antibiotic resistance, including rolling out a containment strategy to slow the spread of drug-resistant diseases in healthcare facilities—starting with a single case—and supporting 25 innovators through a CDC pilot project to develop solutions to antibiotic resistance crises.

Understanding the impact

We are also learning more about Zika virus. Zika was often in the headlines in 2016 and 2017, and the mosquito-borne virus continues to be a threat, especially for pregnant women and their fetuses. Last year, CDC experts shed light on a lesser-known effect of Zika virus infection: a link with Guillain-Barré syndrome (GBS), an uncommon illness of the nervous system. In 2017, CDC and partners conducted the first case-control study in the Americas that showed evidence linking Zika virus infection and GBS. This was just one of many vector-borne diseases CDC tackled in 2017.

Responding to new outbreaks

As we continued to work on lingering threats like antibiotic resistance and Zika, CDC also responded to new outbreaks in 2017, both at home and abroad. In the United States, we saw a range of illnesses connected to food products—from Salmonella infections linked to papayas to an Escherichia coli outbreak from soy nut butter. For the first time, scientists linked an outbreak of Seoul virus infections to pet rats in the United States, and AMD lab techniques proved critical in tracing this and other outbreaks. CDC scientists traveled across the globe in 2017 to investigate a myriad of outbreaks, including an outbreak of anthrax infections in animals in Namibia that posed a threat to human health. Experts helped respond to yellow fever outbreaks in countries including Brazil, and we continue that work today as the yellow fever outbreak in Brazil has expanded over the past two years and could affect US travelers.

Like CDC’s response to yellow fever outbreaks, much of last year’s work continues in 2018. We are closely tracking emerging infections like C. auris, continuing to study the effects of unusual diseases like Zika, and investigating and containing outbreaks of infections caused by a wide range of microbes such as Salmonella bacteria, monkeypox virus, and hemorrhagic fever viruses.

Want to learn more? Read the full NCEZID 2017 Accomplishments report, and follow NCEZID on Twitter @CDC_NCEZID.

Pursuing Preprints, Preventing Pandemics: How pre-peer-review posting can accelerate outbreak science | PLOS Research News

0000-0002-8715-2896 Preprints – scientific papers posted online prior to peer review – offer opportunities to share and discuss research rapidly and openly, and Michael Johansson, infectious disease expert and founder of the nonprofit Outbreak Science,

Evaluating Communication Campaigns

Black man holding belly of his pregnant wife making heart. Pregnant woman and loving husband hugging tummy at home. Heart of hands by multiethnic couple on pregnant belly.

Health communication and marketing campaigns that promote positive behavior change are a cornerstone of public health and behavioral science. Designing and implementing quality campaigns on a tight budget and in an urgent timeframe is a challenge that most health communication professionals share. Research and evaluation are critical for a successful campaign. CDC is using leading research and evaluation methods to develop quality campaigns, while keeping costs low and sticking to tight timelines.

A great example is CDC’s design and implementation of The Domestic Readiness Initiative on Zika Virus Disease, also Domestic Zika Campaign: By the Numbers. Since its launch in early summer 2016, the campaign has generated over 350 million impressions and nearly 555,000 clicks across search, social, and display in the United States. In Puerto Rico, the campaign got over 10 million impressions, and 26,000 clicks on a range of media buys that covered the entire island.known as the Domestic Zika Campaign. This bilingual digital campaign sought to increase Zika awareness among the general population and expectant parents in the United States and its territories. Campaign messages were also developed to change knowledge and attitudes regarding Zika transmission, beliefs about the risks of Zika, and the perceived ability (self-efficacy) to protect oneself against Zika.

CDC identified several methods to get tailored messaging to our target audiences. Based on the work for this campaign, there are 10 methods that can help you reduce costs and improve the efficacy of your communication or health marketing campaign.

Formative Research

  1. Use “mixed” methods or alternative approaches. When feasible, mixed assessment techniques can enhance and complement different types of data collection. Your budget may not allow you to conduct in-depth formative research, but you can use one primary research or evaluation method and then supplement with other methods that are less costly. For example, conducting qualitative focus groups might not account for all of your audience segments, but you could perform a literature search to complement your qualitative data. Additionally, when circumstances dictate, sometimes substituting one evaluation activity for another may be just as effective (or close to it). During the Domestic Zika Campaign we used “triad” interviews, which only involved three participants, when we did not have the time or the budget to conduct a full suite of focus groups, and this was supplemented with previous survey data on closely related topics.
  2. Invest in market data. Public, non-proprietary market data, such as data from the US Census, PEW, and Gallup, allow you to get to know your audience at no cost. Outside marketing firms may also be willing to share “older” proprietary data that may be from a year or two ago at little or no cost. During the Domestic Zika Campaign, secondary data donated from Annenberg surveys(?) were key to our analysis of each of our target demographics’ media habits and informed the mass media and digital media strategies and plans. The cost is your time in building relationships with like-minded partners and analyzing the data for a specific purpose.
  3. Identify alternative data. When traditional surveying of knowledge, attitudes, and behaviors is not feasible, sometimes you can use alternative data (usually less expensive). During the Domestic Zika Campaign, we did not have sufficient time to get approval for our survey from the Office of Management and Budget (OMB) and field a traditional campaign evaluation survey. Instead, to meet our tight timeline, we acquired data about our audiences’ insecticide purchasing behavior in the stores where our advertisements had been placed, and compared them to similar product purchasing data from stores that did not display our advertisements. Building partnerships with organizations who have data, even from related issues, that can offer insights to you is a great long-term investment in both implementing and evaluating programs—especially when we have a shared commitment to protecting people from diseases.

Monitoring & EvaluationDigital Media in an Emergency. During a public health emergency or disease outbreak, even a small number of strategically placed, paid digital media spots can deliver messages to those who need them most. This type of message can often be placed within 24 – 48 hours. During the Zika response, CDC developed and executed behavioral intent studies using data collected by Google Health and Nielsen to study the effect of media exposure on audiences’ intent to take action to protect themselves from Zika. • We monitored exposure to digital campaign banners on the Google Display Network and compared those exposures to an increase in internet search for specific Zika-related terms. • We employed channel-targeted messaging, which helped to amplify CDC’s weekly Zika theme content on Facebook to reach audiences beyond the people who were already following the CDC page. This cost-efficient strategy extended the reach of posts to tens of thousands more people within the specific geographic areas.

  1. Take advantage of social media analytics. Social media platforms like Facebook, Twitter, Instagram, and Google AdWords allow you to target specific geographic areas and have built-in analytics tools that the user has access to at no additional cost. The Domestic Zika Campaign used data analytics to look at the performance of specific advertisements and the corresponding click-through rate to Zika-related campaign websites. Using social media platforms as a primary channel for the campaign allowed for more precise audience targeting, rapid message modifications, and real-time metrics. Using the data, we developed tailored advertisements that engaged key audiences and encouraged them to take preventive actions. For example, one of our treatments, the “carousel advertisement format” on Facebook, had the highest engagement with our target audience and provided a platform to communicate in-depth information about actions people could take to prevent Zika infection. Most organizations have access to someone who specializes in web analytics who can offer their insight.
  2. Conduct A/B testing. A/B testing is a way to compare two versions of something to figure out which performs better. A/B testing is used to assess different options of campaign messages or creative concepts in real time and measures which one people actually use more among different channels, such as Facebook and Twitter. The Domestic Zika Campaign tested messages and materials on a number of social and digital platforms to determine which channels our audience preferred. For example, we conducted an A/B test of an existing “Cover Your Body and Use Repellent” advertisement against two new advertisements that presented the “Cover” and “Repellent” content as two separate messages. We conducted a qualitative analysis of user comments on the advertisements and found that users had a negative reaction to the “Cover” action step given the high temperatures in areas with risk of Zika.
  3. Refresh your materials. Build in regular measurements to track and observe public response and evaluate public complacency towards your campaign to avoid a decrease in behavioral change outcomes. This can occur for two reasons: 1. Message fatigue, when the attention of your target audience is reduced because they have had repeated exposures to the campaign messages; or 2. Risk fatigue, when your audience no longer receives or responds to messages about the health threat.  You can refresh and adjust your campaign messages without creating new messages from scratch. During the second phase of the Domestic Zika Campaign we revised materials that were targeted towards men by adding images of males with their pregnant partners because we were informed by both women and men that they had become complacent about behaviors men could perform to protect both themselves and their partners from Zika virus infection and transmission.

General Rules of Thumb

  1. Do not reinvent the wheel. Know what is available in your organization.  Do you have existing contracts in place to purchase things quickly.  If you have to get permissions to do research, do you have processes in place to navigate them efficiently? As a federal agency, anytime we want to ask more than 9 people a question, we have to get approval from the Office of Management and Budget, which typically takes many months. Knowing this, CDC set up a process called the Health Message Testing System, which is generic request set up in advance with OMB that programs can use to quickly get permission to test a specific message with a specific audience. These approvals can be obtained in days instead of months.
  2. Track current events. Scan and track prominent news and social media. Be aware of current events and issues that arise over the course of your campaign. The news media will cover what is timely, and you can take advantage of this coverage to enhance your campaign efforts. During the initial phase of the Domestic Zika Campaign, the proposed use of the chemical pesticide Naled in Puerto Rico created a controversy for public health and government officials on the island. Tracking the controversy allowed us to address this issue by adding a media relations effort to the campaign and provided more opportunities to disseminate the most effective prevention messages.
  3. Partner with influential bloggers. Influential bloggers can help enhance and further disseminate your campaign messages, increasing the reach to and saturation of your target audience. One of the main goals of the Domestic Zika Campaign was to amplify CDC’s Zika prevention messages. We worked with a well-known television news celebrity who was pregnant and chose not to attend the summer Olympics in Rio de Janeiro, Brazil. We pitched the story to mom and parenting bloggers and packaged it with CDC-branded messaging and the opportunity for an interview with a CDC subject matter expert. The cost of working with a blogger can vary, and you need to vet them carefully, but there can be great benefits by partnering with someone who is a natural fit for your cause and/or message content AND who is already reaching your target audience.
  4. Welcome donated media. Opportunities may arise for you to take advantage of “value-added” or donated media, which can help extend your communication efforts and increase the number of measurement points to evaluate. If you purchase a large number of services, the outside vendor might be willing to add additional advertising or other activities so the campaign will not incur any additional costs. For instance, we acquired donated time for the public service announcements developed by the Domestic Zika Campaign to run in movie theaters in Puerto Rico.

Do you have any other suggestions to improve the quality and timeliness of health marketing and communication campaigns on a budget? Please leave a comment below.

Fred Fridinger is a Senior Health Communications Specialist in the Office of the Associate Director for Communication (OADC). During his 22- year career at CDC, he has worked on various campaigns and communication efforts, including those addressing moderate physical activity and healthy eating, genetics, chronic fatigue syndrome, and Zika prevention. In his current position, he oversees the market research function for OADC, which involves the Porter Novelli Styles and Nielsen Scarborough syndicated data bases.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

Responding to Emergencies One Behavior at a Time

A group of Ebola response volunteers in Nigeria.

To improve the health and safety of people in the United States and around the world, we have to influence and change behaviors. It can be difficult to try new things, or stop old things as behaviors range from simple to complex, but one way to consider behavior change is to think of any change as a passive or active choice.

Public health practitioners must think about interventions in terms of the behaviors they are asking people to adopt, stop or continue. What would encourage someone to change what they are currently doing? Before you can influence someone’s behavior or change their choices about a behavior (risky or protective) you need to know how their judgments and decisions are made about that behavior in the first place.

Behaviors are rooted in traditions

During the Ebola response behavior change was critical to prevent people from getting sick and ultimately stop a disease threat. In the wake of the outbreak, communities in West Africa were encouraged to give up or change their traditional burial practices. Some of these longstanding rituals, like washing the body, proved dangerous because the virus can live on the skin of a victim after death. Communicators developed public health messaging to help change social norms and customs for burials. It was important to understand behavioral science and anthropology in order to communicate about safe burial practices in a way that would make people choose to change a behavior that was ingrained in their culture.

Behaviors are rooted in social 7 Things to Consider When Communicating About Health. Trust: Will people trust the information? Who is the best source to put the information out? Information: What information is necessary, and how will people find it? How much is enough, or too much? Motivation: How relevant is the information to the people we’re trying to reach? Environment: What are the conditions that surround and affect the audience? Capacity: What is people’s ability to act on the information? Are there barriers? Perception: What will the audience think about the information? What will inspire them to act on it? Response: How will people respond? What can we do to stay engaged with them and give them support as they take action?norms

The 2016 Zika virus outbreak is the first time in more than 50 years that a virus has been linked to serious birth defects. Due to the impact of Zika virus infection during pregnancy, social norms and perceptions around provider visits had to be addressed to alleviate concerns about the cost of screening. Clinicians were educated about the risks associated with Zika virus, how to prevent infections, and reporting suspected cases to their state, local, or territorial health departments and women were offered free clinical services, education, and access to Zika prevention kits.

Behaviors are rooted in beliefs

The fight to eradicate polio teaches us the importance of beliefs in behavior change during a response to a public health threat. Creating an effective polio vaccine was only the first step in the effort to eradicate polio. Of course an effective vaccine was necessary to prevent polio virus infections, but getting communities to accept the vaccine was equally important. Public health practitioners created messages that build on cognitive, developmental, and social psychology to persuade parents to bring their children into clinics to get vaccinated.

Behaviors inform preparedness and response

Responding to emergencies effectively requires combined expertise in many fields, including behavioral science. Epidemiology, for example, allows us to understand how many people have a disease and characterize the disease, while behavioral science identifies the role of human behavior and psychosocial factors. Behavioral science expertise can identify methods to communicate and design campaigns to change behavior that are culturally and socially acceptable.

It is important that we maintain humility when we try to understand why people do or think what they do. We often assume that we understand human behavior, but we must remain open-minded when working with people from all different backgrounds and cultures. Who’s to say that what our culture considers right and true necessarily translates to the same belief systems elsewhere? Thus public health ethics is also an important consideration when suggesting behavioral change interventions. When we are in situations that are particularly dangerous or stressful, our assumptions about other people’s behavior can lead to recommendations or actions that seem counterintuitive or wrong to them. Careful application of behavioral science is critical to any mission that seeks to improve public health and safety, here and around the world.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

New Lab Matters: Sharing the value of public health laboratories

New Lab Matters: Sharing the value of public health laboratories |

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:

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NCBI’s Virus Variation Resource Enhancements Include Standardized Search Criteria

NCBI’s Virus Variation resource makes it easy to find genome and protein sequences for a number of viruses – no more stumbling through multiple synonyms to find what you need. Now you can search using standardized biological criteria and intuitive … Continue reading

Sensitive CRISPR diagnostics using RNA targeting CRISPR enzyme

0000-0002-8715-28960000-0003-0319-5416 I was recently involved in a collaboration between the Zhang and Collins labs at MIT to use the RNA-targeting CRISPR protein Cas13a/C2c2 to detect either DNA or RNA from pathogens. By combining the use of Cas13a/C2c2