24May / 2023

Ebola detection and testing rapidly expands in Uganda and US

A presentation slide showing the location of the 2022 Sudan ebolavirus outbreak. The speaker is shown to the right.

Ebola detection and testing rapidly expands in Uganda and US

By Melanie Padgett Powers, writer

A partnership between Uganda and US public health professionals was instrumental in responding to the 2022 Ebola outbreak in Africa. Furthermore, lessons learned from that response helped update guidance on how the US would respond to suspected Ebola cases arriving on US shores.

Ebola is a highly transmissible disease with a mortality rate of 50 to 90 percent without treatment. When people hear “Ebola,” it’s usually referring to the Zaire ebolavirus, explained Trevor Shoemaker, PhD, MPH, at the 2023 APHL Annual Conference May 23 session, “Preparedness and Response Domestically and Abroad—the 2022 Ebola Outbreak” in Sacramento, CA. Shoemaker is team lead, epidemiology, surveillance, clinical and health education, Viral Special Pathogens Branch, US Centers for Disease Control and Prevention (CDC).

The Zaire virus has been responsible for the majority of Ebola outbreaks in recent years and is one of four ebolaviruses known to cause human infection. However, when Ebola broke out in Uganda in September 2022, it was the Sudan ebolavirus.

For the past 12 years, the CDC has been supporting Uganda’s Viral Hemorrhagic Fever (VHF) Surveillance System. “But we’ve been engaged in Uganda ever since the first Sudan virus outbreak detected in the year 2000,” Shoemaker said. For the VHF program, the CDC assisted Uganda’s Ministry of Health, through the Uganda Virus Research Institute, to establish a laboratory to perform in-country diagnostics and enhance the epidemiological and clinical surveillance in the country.

“Most of the things we helped implement were to improve reporting capability, improve the laboratory capacity, detect incident cases very rapidly and report those to the national level so they could take action,” Shoemaker said. “We improved the capability to respond, so this would be quick outbreak investigation and containment.”

They also trained Ugandan health workers on how to properly don personal protective equipment, take a blood specimen for testing, fill out the case report form and safely ship samples to the national laboratory.

The program, which has tested over 20,000 clinical samples, has greatly increased the detection of VHF outbreaks in Uganda and the region, Shoemaker said. Since the program began, it has detected more outbreaks than in the previous 10 years. “It has also reduced the time between initial report of suspected outbreaks and laboratory confirmation by quite a number of days,” he said. The laboratory can provide results within six to 12 hours of receiving the sample and can do confirmatory testing within 24 hours.

In the 2022 Ebola outbreak, there were 164 total cases in nine Ugandan districts, with 77 deaths, which is a 47 percent case fatality rate.

Ebola preparation in the US

Although the risk of Ebola being imported to the US last year was considered low, Shoemaker said, the CDC activated its emergency response structure. CDC Ebola Response Teams were ready to travel to states if needed. CDC updated its guidance for health care workers in the US for suspected Ebola cases. The APHL Biosafety and Biosecurity Committee also updated its Ebola guidance, which was from 2015.

In the US, the CDC oversees the Laboratory Response Network (LRN), a system of approximately 120 US laboratories—including all 50 state public health laboratories—that detect and respond to biological threats.

Before the 2022 Uganda Ebola outbreak, only eight LRN laboratories had the capability to test for the Sudan ebolavirus. Within a month, that was expanded to 27 LRN laboratories, as well as 10 regional emerging special pathogen treatment centers, Shoemaker said. Now, there are 34 laboratories able to test for Sudan virus (as well as the Marburg virus, another severe viral hemorrhagic fever).

To test for the Sudan ebolavirus, the LRN laboratories use the commercial product BioFire FilmArray and the Warrior Panel, which was approved by the US Food and Drug Administration in 2017. CDC uses a real-time reverse transcription–polymerase chain reaction (RT-PCR) assay, similar to what many LRN laboratories already have to test for the Zaire virus. The CDC’s Sudan test is currently undergoing approval to send out to LRN laboratories.

In 2022 in the US, the CDC had clinical consultations for 35 ill returning travelers from the outbreak region and performed tests on three people. All were negative. Compare that to January 2017 to December 2021, Shoemaker said, when there were seven Ebola virus outbreaks and the US performed testing on only nine ill travelers.

Melanie Padgett Powers is a freelance writer and editor specializing in health care and public health.

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03Apr / 2023

Visit to New York’s Wadsworth Center reignites APHL staffer’s passion for lab science

Photo of Rana Rahmat, APHL staff person, standing in front of the David Axelrod Institute of the New York State Wadsworth Center.

By Rana Rahmat, specialist, Laboratory Response Network, APHL

After the public health emergencies of the last several years, it would be quite easy for anyone in this field, particularly laboratory scientists, to find themselves jaded about the field. As someone who worked in a laboratory for years and felt that stress, I thought I was beyond the excitement of seeing public health laboratory work.

I was wrong. And I’ve never been happier for it.

As part of APHL’s Public Health Preparedness and Response team, new team members visit one of our member public health laboratories to see, experience and learn about how the laboratories operate and the different types of work they do. How can we help support their mission if we don’t understand what they do, how they do it and why they do it? As the Laboratory Response Network (LRN) specialist, I’ve mostly worked with the bioterrorism units at public health laboratories with very little exposure to other departments. I didn’t even have a general knowledge of the types of work other parts of the lab did, nor did I know or understand the work. Visiting a public health laboratory was the perfect opportunity to change that.

For my visit, I had the opportunity to visit the New York State Department of Health Wadsworth Center for a few days to tour and spend time with staff members. In those few days I transformed from the jaded scientist back to the young kid who thought science was so awesome and wanted to know everything about how the tests and instruments worked. At Wadsworth, I was in the perfect place to feed that reignited curiosity.

My first day was spent with the biodefense team who I work with the most as that section performs the laboratory’s LRN functions. One mock test later – shortened from its usual eight hour run time, of course – and the previously intimidating number of steps on the protocols didn’t seem so daunting anymore. The morning concluded with a tour of the biosafety level 3 (BSL-3) space, which is relatively small for the sheer number of instruments it needs to house most of which are quite large.

My second day was cold and wet, but inside the lab I was happily overwhelmed with the amount of dedication I saw from every staff person. The morning started with a meeting at the Biggs Laboratory at Empire State Plaza with Dr. Patrick Parsons. What followed was a two-hour tour of the facility, exploring from room to room and hearing about all the incredible work done at this lab. The immense volume of testing was impressive and learning how it impacted aspects of everyday life and helped during crisis situations was something I never really considered until that day.

The afternoon was spent at the Griffin Laboratory, home of the Arbovirus and Rabies Laboratories. It was incredible to walk through the various lab spaces and see all the different stages of work while hearing about the research, routine surveillance and the constant new challenges they face. I didn’t even mind seeing the mosquitos feeding…even though it was right after lunch!

My second stop at the Griffin Laboratory was the Rabies Laboratory. It was definitely not a space for the squeamish! Hearing about the volume and types of specimens they process, and how much team effort it takes to efficiently run the lab was astounding. I hadn’t yet toured any lab spaces with active tests until I walked into the rabies specimen processing room. Right there in a biosafety cabinet was the head of an animal that had recently been processed for testing. It was just there for me to see and examine if I was willing to get close enough with proper PPE. There was no way I was going to say no to that regardless of the little time that had passed since lunch! Before I could even wrap my head around what I was doing, three more boxes were brought in and I again felt like a child thinking, “this is SO cool!” Dr. Davis then showed me microscope slides of positive and negative specimens that were prepared for me. They were beautiful, the bright green and red hues reminiscent of Christmas. That day ended with a tour of the animal biosafety level 3 (ABSL-3) space on site, which showcased a great deal of innovative systems developed for research.

The last day of the visit was at the David Axelrod Institute, visiting more departments to learn about their work, and to learn how they all come together to function as one public health lab. Each person and each department reaffirmed that it takes a lot of effort to run every aspect of the public health laboratory. I saw that every department is unique and vital to the mission, and that there is an overwhelming amount of work to be done every day.

One thing I saw in every individual I met was that regardless of their site, department or how long they have worked at Wadsworth, they all shared an incredible amount of passion for their work. The joy they felt in doing the research, performing the testing and sharing the innovation their jobs was palpable despite how tiring it must have been with COVID-19, mpox and the many other public health events of the last several years.

Visiting Wadsworth didn’t just give me insight into how public health laboratories work, it also reminded me that laboratory science is still just as exciting to me as ever. It helped me realize that no matter how world-weary we get, how hard public health work is sometimes, it is work that’s worth doing. As for me? Who knows if I’ll ever go back to working in a lab, but it’s comforting to know that the spark of joy still exists.

There are quite a few people to whom I owe a great deal of gratitude for making this visit as incredible as it was: Christina Egan for approving it, Michael Perry for organizing every meeting and showing me the different locations, and Alex and Dominic from the biodefense team for showing me around the laboratory on the first day. I’d also like to give a massive thank you to the following people for taking time out of their day to speak with me: Patrick Parsons, Alex Ciota, April Davis, Corey Bennett, Lisa Mingle, Kara Mitchell, Bill Lee, Bill Wolfgang, Kim Musser, Sudha Chaturvedi, Vincent Escuyer, Meghan Fuschino, Linda Styler and Monica Parker. Thank you, thank you, thank you all for making this an unforgettable experience.

(Note: Though I wish I had more photos to commemorate this trip, I was so enraptured by the experience that I didn’t think to take pictures at any of the sites. I spent my time entirely focused on absorbing every detail around me, but sadly not on camera.)

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31Oct / 2022

Lab Culture ep. 31: Past, Present and Future of Biosafety

From left to right: Jill Power, Christina Egan, Carrie Anglewicz and Andrew Cannons

Today’s show is a conversation between four past winners of APHL’s Leadership in Biosafety and Biosecurity Award. Jill Power, Christina Egan, Carrie Anglewicz and Andrew Cannons (from left to right in the photo above) share their thoughts on the past, present and future of biosafety in public health laboratories.

Listen here or wherever you get your podcasts:

Andrew C. Cannons, PhD
Laboratory Director
Bureau of Public Health Laboratories –Tampa
Florida Department of Health

Jill J. Power, MS
Deputy Director
New Hampshire Public Health Laboratories
New Hampshire Department of Health and Human Services

Carrie Anglewicz, MS
Biosafety Officer, Laboratory Outreach
Bureau of Laboratories
Michigan Department of Health and Human Services

Christina Egan, PhD
Deputy Director, Division of Infectious Diseases
Chief, Biodefense and Mycology Laboratories
Wadsworth Center
New York State Department of Health

Links:

Leadership in Biosafety and Biosecurity Award
Strengthening Lab Biosafety & Biosecurity
APHL Blog posts about biosafety

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21Sep / 2022

Public Health Emergency Preparedness (PHEP) funding program marks 20 years

Photo of three individuals wearing yellow personal protective equipment (PPE).

By Jill Sutton, specialist, Emergency Preparedness and Response, APHL

This year marks the 20th anniversary of the CDC Public Health Emergency Preparedness (PHEP) Cooperative Agreement, a program that was developed in 2002 to strengthen preparedness capabilities in public health departments across the US.

Public health preparedness today can be attributed to developments in policy and funding since the September 11, 2001 terrorist attacks and the anthrax attacks that followed shortly after. Over the last 20 years, public health preparedness has evolved from a bioterrorism focus to an all-hazards approach, a framework that focuses on how we prepare and respond to a wide range of public health threats like infectious diseases and natural disasters as well as biological, chemical, nuclear and radiological events.

What is PHEP?

Since 2002, the PHEP program has been a critical source of funding, guidance and technical assistance for state, local and territorial public health departments. Thanks to PHEP, health departments are able to support preparedness and response activities and strengthen their preparedness capabilities so they are ready when public health emergencies strike.

At the local level, public health departments invest their PHEP funds to:

Enhance preparedness infrastructure,
Conduct trainings and exercises,
Hire dedicated preparedness staff,
Establish and maintain systems that enable the early detection of public health threats like monkeypox or COVID-19,
Quickly acquire emergency supplies and equipment, and
Rapidly share public health data to inform response needs.

As a result of these investments, communities are more prepared for public health emergencies than they were 20 years ago, but there’s still more that needs to be done. Federal preparedness funding has declined over the last 20 years, forcing PHEP recipients to cut positions, preparedness trainings and exercises, and equipment needs from their budgets. This has caused public health departments to be unable to expand or maintain their preparedness capabilities. A lack of sustainable funding directly impacts the capacity of state, local and territorial health departments to prepare for and respond to public health threats that arise in the communities they serve.

As we also celebrate National Preparedness Month, we honor the 20th anniversary of PHEP and all that it has helped our nation accomplish. Whether we are facing a pandemic or not, we need to remain prepared for the next public health emergency. It is our sincere hope that funding for PHEP will rise to ensure our nation’s public health system is prepared for the next emerging threat.

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30Jul / 2020

The importance of sustained federal funding for public health

Erik Riesdorf of Wisconsin prepares specimens for testing in the laboratory

By Stephanie Barahona, associate specialist, Public Health Preparedness and Response, APHL and Sam Abrams, specialist, Public Health Preparedness and Response, APHL

As hospitals across the country work to manage a constant influx of COVID-19 patients, their partners in public health are addressing critical community and statewide testing needs. While both the healthcare and public health systems are responding to the pandemic, their approach is different: healthcare systems focus on providing individual patient care while public health supports an entire population’s health. In this response, and like many before, the role of the public health laboratory in detecting and responding to threats has never been more critical. But public health laboratories are often only funded when there is a crisis such as Ebola, Zika, vaping and now COVID-19. This approach to federally fund laboratories while in emergency mode leaves the nation vulnerable.

Preparedness funding 101

Although public health laboratories receive funding support from their state and local governments, the federal government provides the majority of their preparedness and response funding. Via the Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases Cooperative Agreement (ELC) and the Public Health Emergency Preparedness Cooperative Agreement (PHEP), the US Centers for Disease Control and Prevention (CDC) is the primary funder of state, local and territorial public health laboratories. For 25 years, the ELC has been a source of significant financial support that enables public health laboratories to conduct surveillance and respond to vector-borne diseases, food and waterborne diseases and other emerging threats such as pandemic influenza and COVID-19. In Fiscal Year 19 (FY19), which represents August 1, 2019, to July 31, 2020, total ELC funding was approximately $231 million, of which 43% went to public health laboratories to support testing and surveillance needs.

On an annual basis, approximately 90% of funding for public health preparedness and response efforts come from PHEP. Following the anthrax attacks of 2001, total PHEP funding to public health agencies peaked in 2003 at $970 million (unadjusted)—a year in which public health laboratories received $167.7 million for biological and chemical preparedness. Over the years, this funding has decreased considerably. In FY 2019 (July 1, 2019, to June 30, 2020), PHEP funding totaled $620 million. This was similar to 2018 when the jurisdictions received $620 million, of which public health laboratories received $81.5 million (Figure 1).

Figure 1: PHEP Funding to Public Health Laboratories, 1999-2018 (in millions $)

Funding has continued to lag for ELC and PHEP, creating challenges for laboratories to remain adequately prepared. ELC-recipient public health laboratories remain underfunded by 70% in personnel support while laboratory equipment and supplies, which are critical for detecting infectious diseases, face a shortage of 60%. Over 39% of ELC funding requests for health information systems went unfunded in FY19, resulting in $29 million less than health departments needed to sustain syndromic surveillance, electronic laboratory reporting and other systems necessary to track patient cases and limit the disease burden. Cuts to PHEP funding impacted preparedness activities as well. Up to half of state public health laboratories faced cuts over the past few years, resulting in the inability to expand capabilities for new assays and tests and hiring necessary staff.

Staying ahead of emerging threats

Funding shortages are most evident during a public health crisis. The federal government has largely responded to public health emergencies through just-in-time supplemental funding. The 2014 Ebola virus epidemic exposed significant gaps in US operational readiness to respond to a threat of its kind. Congress responded with millions of dollars, of which $110 million went to state, local and territorial health departments via the ELC. Approximately $21 million of these funds were provided to public health laboratories over a three-year period (extended in most cases to four years) to enhance biosafety and biosecurity, infection control and other urgent gaps. By enhancing outreach efforts, public health laboratories were able to engage clinical laboratorians and provide guidance on risk assessments, appropriate use of personal protective equipment, decontamination and other biosafety issues.

When the funding ended in 2018, many public health laboratories were forced to reduce biosafety staff and diminish outreach efforts. This presented challenges to recruiting and maintaining qualified staff as many worried about a subsequent loss of funds. The emergence of Zika proved similar to Ebola, with CDC issuing $97 million in supplemental funding via the ELC.

Response to COVID-19 is no different. Congress is appropriating billions of dollars and public health agencies now face a surge of funds at the height of a pandemic:

At the beginning of the response, CDC redirected funds from its internal activities to state, local and territorial health departments via the Crisis Response Cooperative Agreement.
An initial $10 million was distributed to select jurisdictions through the ELC.
On March 5, the president signed the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (PL 116-123). This act provided funding to prevent, prepare for and respond to COVID-19. By March 16, CDC via the Public Health Crisis Response Cooperative Agreement awarded $569.8 million to 65 jurisdictions. On April 6, another $160 million was awarded to 34 jurisdictions. This included 27 jurisdictions with high COVID-19 case counts or evidence of rapidly accelerating case counts and seven US territories and freely associated states with unique COVID-19 response challenges.
In addition, the Coronavirus Aid, Relief and Economic Security (CARES) Act, provided billions in supplemental funding, with a total of $631 million awarded via the ELC to state, local and territorial health agencies to increase testing capability and capacity, improve surveillance and additional efforts necessary for the US to successfully combat COVID-19.

Finding long-term solutions

While these additional funding sources are a welcome relief to underfunded public health systems, they do not provide a long-term solution for combating new threats. With each response, public health is behind—they have no ability to be ready to respond to novel and large-scale threats. This lag limits the ability for public health laboratories to quickly ramp up testing capacity needed to stay ahead.

Consistent and sustainable federal funding for public health laboratories is key to stay ahead of threats. Such funding provides:

A warm base where laboratories are poised to quickly and safely respond, which encompasses highly trained laboratory scientists, biosafety professionals and other support personnel; high-throughput equipment and electronic data messaging tools; and communication systems and agreements in place with other laboratories such as commercial laboratories.
The opportunity for scientists to validate and verify equipment and assays, ensuring timely, accurate results and sustained confidence in quality laboratory testing.
Reagents and other laboratory supplies, including personal protective equipment, so that laboratorians can appropriately and safely perform testing and provide ample capacity within their jurisdictions.
A national laboratory system comprised of private and public laboratories working side by side to protect the public’s health.

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27Mar / 2020

Coronavirus stimulus provides key investments in public health

FOR IMMEDIATE RELEASE

Silver Spring, MD, March 27, 2020 — The emergency aid package passed by Congress today makes key investments in public health, according to the Association of Public Health Laboratories (APHL). The measure, designed to bolster US response to the coronavirus (COVID-19), includes a tenfold increase to improve the management of public health data and a substantial boost in funding for state and local health departments, including public health laboratories.

“Public health department and laboratory staff have been on the front lines helping to protect our communities from this novel disease threat. They are over-burdened and short on critical supplies,” said Scott Becker, CEO of APHL. “This stimulus package provides important funding that will help strengthen our nation’s response to the pandemic and other pressing health challenges.”

The measure includes $500 million for the Centers for Disease Control and Prevention (CDC) to improve the management of public health data. This funding will help develop and deploy data and analytics that scale rapidly in emergencies, provide predictive capacity to identify emerging threats, ensure two-way information flow and more to better detect and monitor disease threats.

The bill also provides $1.5 billion to CDC to fund state and local health departments and their laboratories, in addition to the $950 million already provided for these activities in the first supplemental funding package. It will strengthen these critical agencies to enable them to respond nimbly to public health emergencies, including COVID-19.

“If we’ve learned anything during the first months of our COVID-19 response it’s that monitoring, testing for and tracking disease and preparing our communities for health threats are absolutely essential functions and must not be taken for granted,” said Becker. “This stimulus package includes long-overdue funding to help protect us against COVID-19 and other potential health threats.

“We look forward to the president enacting this measure and to our continued work with the administration and Congress to ensure adequate and sustained funding to protect public health.”

APHL also joined partners in issuing a statement applauding members of Congress for providing $500 million for the Data Modernization Initiative at the Centers for Disease Control and Prevention (CDC) that will transform public health data systems and save lives.

Contact: Michelle Forman at 240.485.2793 or michelle.forman@aphl.org

# # #

The Association of Public Health Laboratories (APHL) works to strengthen laboratory systems serving the public’s health in the U.S. and globally. APHL’s member laboratories protect the public’s health by monitoring and detecting infectious and foodborne diseases, environmental contaminants, terrorist agents, genetic disorders in newborns and other diverse health threats. Learn more at www.aphl.org.

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13Mar / 2020

APHL CEO to his kids: We will get through this. Now go wash your hands.

By Scott J. Becker, CEO, APHL

I’m a dad to two girls – one in high school and one in college – both of whom are home as their schools respond to the COVID-19 outbreak. They asked me to share some info with their friends and I thought it would be helpful for other kids wondering about the same things.

—

I wanted to provide a little reality check for all of you who are now experiencing this major disruption to your lives. Yeah, it sucks. No way around that. I want to try to help by providing you with some context and terminology so you can make good decisions and full understand what’s happening right now.

What is COVID-19? It’s the disease caused by SARS-CoV-2, which is the official name of this new coronavirus. (Virologists worldwide would be furious if I didn’t mention that!) I’ll refer to it as COVID-19, much easier to say (use #COVID19).

First off, this week the World Health Organization (WHO) in Geneva announced that COVID-19 is officially a pandemic and that there are over 118,000 cases worldwide. A pandemic is simply the global (multiple regions of the world) spread of a new disease that is easy to pass from person to person in an efficient and sustained way. Nothing new there, right? We’ve seen this disease spread over the last few months, first in Asia and then in other spots around the world such as Italy, Iran, Seattle, etc. An epidemic, on the other hand, is the spread of a disease within a specific community. Think of a measles or mumps outbreak on a college campus, or a foodborne outbreak associated with contaminated sprouts (just don’t eat sprouts, they are notorious for making people sick). You have also heard about the transmission on cruise ships. I think of cruise ships as “floating petri dishes” on a good day. In this instance, having thousands of people on cruise ships at the outset of an epidemic or pandemic was also a pretty efficient mechanism to further circulate the virus.

So what can you do? First, recognize that this situation is serious. We have had very few pandemics in the past 100 years! Also remember that our healthcare and public health systems are much better than they were way back then. We will get through this.

What are we trying to do now? Put simply, we are trying to use important public health tactics to flatten the epidemic curve for COVID-19. The “epi curve” is what we see as case counts go up and then eventually come down. We are trying to buy ourselves time to reduce the curve of illness. Another way to say it is that we are trying to break the chain of transmission.

There are many ways to help yourself and your community (friends, family, especially older people). I was embedded with CDC earlier this week, I have worked closely with my colleagues there throughout this outbreak just as I have for my entire career. The site I linked to above (here it is again) is accurate and extremely helpful. Please, please, please read it.

Handwashing is one of the best ways to protect yourself and your family from getting sick. Wash your hands often with soap and water for at least 20 seconds (scrub for 20 seconds!), especially after blowing your nose, coughing or sneezing; going to the bathroom; and before eating or preparing food. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. In my experience, soap and water are easier to find right now than hand sanitizer and it works better anyway.

Please clean your cell phone. Really. That’s another place where viruses love to hang out.

Stop touching your face. Much harder to do than it sounds.

Social distancing – yeah, this might mean that you won’t be going to concerts and other events for a while. Good thing you all are so good at staying connected over social media, etc. Remember, this isn’t only about you – it’s about everyone. You don’t want to be the vector that infects a whole bunch of vulnerable people! That’s why many nursing homes around the nation aren’t allowing in any visitors.

Okay, so it feels like it really sucks to be you right now. Major disruption in your lives, online classes (hopefully that will work out okay), no large gatherings, etc. In reality, it sucks to be all of us right now. This is why public health matters – it’s the health of the public, all of us, that really matters. And here it comes: we’re all in this together. This too shall pass. My wife and I have known many of you since you were little. You are all resilient. You will learn from this and come out stronger on the other side. And maybe some of you will go into the public health field (at least think about it)!

Stay well and stop touching your face. Now go wash your hands.

Scott

@scottjbecker @aphl

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24Jan / 2020

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.

Update (Jan 31, 2020): Media Statement on Novel Coronavirus Public Health Emergency Declaration from APHL Executive Director Scott Becker

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

What is an Emerging Infectious Disease?

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29Oct / 2019

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.

The post Humboldt County Public Health Lab was ready for ricin thanks to LRN appeared first on APHL Lab Blog.

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17Oct / 2019

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

Stefan Saravia and Maureen Sullivan at the Minnesota Public Health Laboratory

This year marks 20 years since the inception of the Laboratory Response Network (LRN). Founded by APHL, CDC and the FBI, the LRN exists to protect the public from biological and chemical threats. How did the LRN get its start? And how has it evolved over the past 20 years? This episode of Lab Culture features an interview with two public health laboratory scientists and LRN experts.

Listen here or wherever you get your podcasts:

Maureen “Moe” Sullivan
Emergency Preparedness and Response Laboratory Supervisor
Public Health Laboratory, Minnesota Department of Health

Stefan Saravia
Biomonitoring and Emerging Contaminants Unit Supervisor
Public Health Laboratory, Minnesota Department of Health

Links:

Minnesota Laboratory Emergency Preparedness
About the Laboratory Response Network (APHL.org)
The Laboratory Response Network Partners in Preparedness (CDC.gov)
What is biomonitoring? (Video)
“Pine County man charged with government center threats, more” (StarTribune)

The post Lab Culture Ep. 20: 20 Years of the Laboratory Response Network appeared first on APHL Lab Blog.