The Tenacity of Tuberculosis: MDR-TB

Mar 24 2015 :: Published in Infectious Diseases

By William A. Murtaugh, MPH, Specialist, TB Program, APHL

“Suddenly she stopped, clutched her throat and a wave of crimson blood ran down her breast… It rendered her even more ethereal.” ~ Edgar Allan Poe describes his wife dying of tuberculosis.

Disturbing, sensational and oddly romanticized — these were the days of tuberculosis past. So what has become of its future?

The Tenacity of TB: How multi-drug resistant tuberculosis will determine global progress in TB elimination | www.APHLblog.org

While recent news stories about en vogue infectious diseases are no less sensational, TB has certainly lost its status at the water cooler. It is far from having the mystique of a zombie apocalypse; it’s not wrapped up in a passionate human rights movement like HIV/AIDS; it doesn’t have the exotic novelty of Ebola; and it hardly provokes the Thought Police like vaccine preventable diseases. With a low burden of disease in the US and case rates continuing to decline annually, TB has all but faded from public consciousness.

But what TB has lost in zeitgeist influence, it has made up for in tenacity. For every major advancement in treatment and control, M. tuberculosis has capitalized on weaknesses and dared the public health system to rest on its laurels. As a result, the US, a country with relatively robust TB control programs, has not achieved TB elimination. Globally, large disparities in resources and infrastructure remain and TB is the second largest cause of mortality of any single pathogen behind HIV.

In the US, TB often persists in marginalized and invisible populations such as homeless or foreign-born communities. With few exceptions, cases of TB are still reported by every state. Occasionally, rare outbreaks breach the imaginary safety bubble of larger communities. It is vital to recognize that our current system is neither infallible nor exclusive of the global TB fight. The TB of today poses a challenge that could take the hot air from the lungs of the most bumptious pathogen pundit. That threat, and this year’s topic for World TB Day, is multi-drug resistant tuberculosis (MDR-TB).

Multi-drug resistant tuberculosis is defined as active disease from infection by M. tuberculosis strains that are resistant to at least rifampin and isoniazid, two of the four drugs in first line drug therapy (collectively and colloquially known by the acronym “RIPE”). The reasons that TB strains develop drug resistance are complicated and derive from a variety of biological and man-made influences. The major concern with MDR-TB is that it renders inadequate an already limited number of drugs, with only prolonged, less effective and more toxic treatment options remaining.

The story of MDR-TB has its roots right here on, or rather in, our soil. Streptomycin, the first drug to treat TB, is an antibiotic produced by bacteria found in the soil, and is a Nobel Prize winning discovery by Selman Waksman of Rutgers University. While blindingly obvious, drug resistance can’t develop without one key component…drugs. But drug resistant TB was unheard of prior to the discovery of streptomycin in 1943. Not to be outdone, M. tuberculosis showed that it could quickly develop resistance. Through the next 20 years this TB tit-for-tat went on with each newly developed drug until a regimen of combination therapy, the RIPE panel of drugs, provided the TKO and is still the primary arsenal used today. This drug regimen was lengthy with harsh side effects, but it was nonetheless effective. US case rates began to decline through the 1970s. However, the silver bullet of antituberculosis drug discovery was a silver lining that encircled a menacing storm cloud of emerging drug resistant TB.

Optimism in new treatment regimens gave way to the reality that global scale-up of effective treatment programs was a long term investment and expensive. Funders wanted the most bang for their buck, and TB didn’t fit the bill. Consequently, global political will eroded and only wealthy countries, like the US, made significant strides toward TB elimination. Low resource, high burden countries faced limited access to antituberculosis drug supplies and deficient healthcare infrastructure. This contributed to the improper use of drugs that consequently encouraged the emergence of resistant TB strains and subsequent outbreaks of multi-drug resistant TB. These factors led to treatment failure and widespread transmission, and paved a road for outbreaks of multi-drug resistant TB.

Not until the 1990s, when TB remained the single largest cause of death from an infectious disease, were advances made in public health economics that supported investment in TB treatment efforts. The World Health Organization implemented a strategy that is the foundation of today’s approach: Directly Observed Therapy short-course (DOTS). DOTS strategy, as the name indicates, involves a high level of accountability for treatment adherence. Unfortunately, drug resistant strains of M. tuberculosis cannot be determined through direct observation or even under a microscope. MDR-TB patients were failed by the original DOTS strategy because it did not include a significant laboratory component to detect drug resistance. This weakness, coupled with comorbidity associated with a mounting HIV epidemic, gave rise to numerous MDR-TB outbreaks here in the US.

Traditional methods for TB drug susceptibility testing in the laboratory greatly improve the ability to properly treat and control MDR-TB, but require weeks of precious time and expertise. This often limits their utility. The Centers for Disease Control and Prevention Division of TB Elimination, in conjunction with APHL and state and local public health laboratory systems in the US, continue to play an important role in maintaining expertise amid overall declining rates of TB. Great strides have been made in the past decade in development and implementation of technologies that can inform treatment decisions within 24 hours and in greater detail than was ever thought possible.

With a bolster to the domestic diagnostic infrastructure, MDR-TB cases are able to be detected and remain rare (95 cases in 2013). But MDR-TB is showing little sign of significant decrease and, as of 2013, nearly 90% of cases were foreign-born. While barely registering in headlines, MDR-TB is nevertheless the next major obstacle to tuberculosis control. Its path will determine global progress toward TB elimination.

Check out APHL’s webinars related to TB:

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University of Oregon outbreak highlights collaboration between public health and clinical care

Mar 12 2015 :: Published in Infectious Diseases

By Michelle Forman, senior specialist, media, APHL

University of Oregon outbreak highlights collaboration between public health and clinical care | www.APHLblog.org

In mid-January, a University of Oregon student was diagnosed with Neisseria meningitidis serogroup B, a rare but serious disease. Within one month, three additional students were diagnosed with the same disease, one of whom died. “I was the first assistant on that autopsy,” said Patrick F. Luedtke MD, MPH, senior public health officer and medical director of the Lane County Department of Health & Human Services Community & Behavioral Health clinics. (He’s also a past APHL president.) “The bacteria were everywhere. Neisseria meningitidis takes over the body and wins every battle.”

College campuses like the University of Oregon are perfect breeding grounds for meningococcal disease. Young adults ages 16-21 have higher rates than others, and it is transmitted through close or lengthy contact such as living in close quarters or kissing. So, yeah… meningococcal disease can make its way across a college campus if it isn’t stopped quickly. In fact, there were similar outbreaks at Princeton University and at University of California, Santa Barbara in 2013.

Meningococcal disease is rare, but if a person gets it they are likely to become very sick. Once it is suspected, clinical laboratories can do a test to confirm meningococcal disease and doctors can quickly begin antibiotic treatment. (Oftentimes prophylactic antibiotic treatment is given anyone who had close contact with the sick individual.) But even with quick and proper treatment, approximately 20% of people will have long-term disabilities and 10-15% of people die. The best way to prevent severe illness is to prevent illness all together – decrease the number of people who can get meningococcal disease in the first place – with vaccines. Here’s the kicker, though… Kids in the US receive a quadrivalent meningococcal vaccine at age 11. However, that vaccine only protects kids from serogroup A, C, Y or W-135. What about B, the serogroup found at the University of Oregon?

In October 2014, the FDA approved the first ever N. meningitidis serogroup B vaccine for use in people 10-25 years of age as a three-dose series. In January 2015, the FDA approved another N. meningitidis serogroup B vaccine for use in the same age group as a two-dose series. Neither vaccine has been recommended for routine use yet, but it has been recommended for controlling outbreaks like the one at the University of Oregon. In order to implement a massive campaign to vaccinate all 22,000 students, CDC needed to know that there had been at least three confirmed serogroup B cases within a three month period. The clinical test that confirmed meningococcal disease in each of the four patients wasn’t enough, though. Not only are clinical laboratories often without the capabilities to serotype meningococcal disease, the serogroup doesn’t affect clinical care. Whether the meningococcal disease was serogroup A, B, C, Y or W-135 didn’t change how they cared for the sick individuals. Further testing was needed to show that all four cases had the exact same strain of serogroup B meningococcal disease.

That was a task for the Oregon State Public Health Laboratory; in an outbreak, it is the public health laboratory’s role to show cases are truly linked. As each case was determined to be meningococcal disease, the public health laboratory was contacted and serotyping began. While the public health lab’s confirmation that the patients were sick with group B meningococcal disease was enough information for CDC to green-light the vaccination effort, the Oregon State Public Health Laboratory dug even deeper. With Neisseria meningitidis cases such as the ones at the university, the Oregon state lab routinely uses pulsed-field gel electrophoresis (PFGE) to isolate the DNA fingerprint of each strain to show that everyone got the disease from the same source. That information could help epidemiologists identify the index case. “Using PFGE to fingerprint meningococcus is considered very risky, and it is very expensive, so many laboratories don’t do it,” explained Robert Vega, general microbiology manager at the Oregon state lab. “The risk associated with this is very real to us. Our staff is vaccinated against groups A, B, C, Y and W-135; we are well equipped and I have highly proficient staff.”

Once it was confirmed that the cases were group B meningococcal disease, CDC approved the Lane County Health Department and the University of Oregon to implement a massive effort to quickly vaccinate 22,000 students. The vaccination effort began on March 2 and within one week over 10,000 students had received the first dose of the vaccination. “We still have more students to reach, but we are working hard to make sure everyone is vaccinated,” said Dr. Luedtke. Quick treatment from clinical care providers and fast, accurate testing by the public health lab will hopefully mean that this is the beginning of the end of this outbreak.

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APHL Coaching Initiative Spans Continents

Feb 24 2015 :: Published in Workforce & Professional Development

By Michelle M. Forman, senior specialist, media, APHL

Andy Cannons was a member of APHL’s Emerging Leaders Program (ELP) Cohort III in 2011, an intensive year-long leadership development program for promising public health laboratory scientists. “It was a great program that gave me the tools I needed to become a better leader,” Andy shared. Once the program ended, he and his colleagues moved from the ELP program to the Network of Laboratory Leadership Alumni (NOLLA) where they could continue networking and seeking professional development opportunities.

APHL Coaching Initiative Spans Continents | www.aphlblog.org

In 2014, the ELP program went global with its first cohort in Lesotho. As part of this new endeavor, NOLLA members in the US were invited to serve as coaches for program participants in Lesotho. Andy was one of those coaches. “I was hesitant at first – unsure of what I had to offer – but I agreed,” said Andy. “The general idea was that I would be paired with someone and would support them in working through day-to-day challenges faced in their laboratory.”

Andy was paired with Mokenyakenya Matoko, a national laboratory information systems officer in the Lesotho Ministry of Health. Despite some problems with video connection during their first Skype meeting, they were able to get to know each other a bit. “We discussed our backgrounds; how we got to where we are in our careers; our personality traits and leadership skills; and most importantly what Mokenyakenya was expecting from me as a coach,” explained Andy. “Thirty minutes into the meeting I concluded that Mokenyakenya and I were going to have a really good coaching experience.”

The two men met monthly via Skype, exchanging support and guidance. Mokenyakenya has worked on his communication skills, something he felt needed improvement. “Other important attribute that I have improved on is be myself. Though I am an introvert, I was advised try to take some leadership in most activities,” said Mokenyakenya. “I have learned that being an introvert it does not necessarily mean being shy and waiting for other people to comment. Rather I should try to participate in the process, give ideas.”

In December 2014 something unexpected happened. Andy and Mokenyakenya both travelled to South Africa for the African Society for Laboratory Medicine (ASLM) conference, however neither knew the other would be there. As Andy presented on laboratory tools to stop Ebola, Mokenyakenya sat in the audience and recognized his coach. “It was an incredible surprise to be able to meet Mokenyakenya in person and spend time talking while we were in South Africa,” said Andy.

After the conference, their regular meetings continued. “Dr. Andrew had played a major role in terms of discovering new habits and potential in me, most importantly self-confidence,” said Mokenyakenya of his experience.

Andy has also thoroughly enjoyed the experience as a coach. “I have learned more about myself; I’ve become more confident and understanding; and I’ve learned to think and adapt quickly. I am also hopefully making a positive and constructive difference in someone else’s life. The icing on the cake is that coaching Mokenyakenya has led to a friendship that I hope will last for years. That’s priceless!”

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From The Lorax to the Laboratory

by Vanessa Burrowes, APHL-CDC Emerging Infectious Diseases Laboratory Fellow, North Carolina State Laboratory of Public Health

When I was a kid, I was pretty curious about everything around me. If I wasn’t asking a million questions to increasingly exasperated adults or devouring an adventure book series like The Boxcar Children, you could usually find me outside playing in the dirt getting scraped up and loving every minute of it. While those explorations certainly led me to science in an indirect way, it was Dr. Seuss who led me straight there.

From The Lorax to the Laboratory | www.aphlblog.org

On a dreary rainy day when I was four years old, my preschool teacher sat several of us down to watch a movie in the hopes of abating our restlessness. I sat there with my peers for my first viewing of the original version of Dr. Seuss’s The Lorax. I returned home that evening filled with a horrific fear of the future. I dreaded that, like the world of the Lorax, my world too would someday become grey, poisoned and hopeless, full of Humming Fish walking out of lakes and brown Bar-ba-loots gloomily dragging their feet away to escape such a heavily polluted place. The Once-ler’s profound advice that, “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not,” triggered a driving sense of responsibility within me at a very young age. From that day forward, I decided to dedicate my life to protecting the environment and the health of those living in it with the hope of preventing such a dreadful event from happening. Even at four years old, The Lorax definitely gave me perspective on the role I could play during my time on earth.

Many years later as I started thinking about possible careers, my parents tried to push me, their oldest child, into pursuing medical school. They were both immigrants from families with no prior science background and worked hard throughout their lives to become chemists. My mother wanted both of her daughters to pursue science careers and take advantage of the growing field of opportunities the U.S. had to offer female scientists, especially if there was the chance for us to become financially independent which seemed most tangible in medicine. I respected my mom’s feminist ideology and followed through by shadowing in the oncology unit at Aultman Hospital in Canton, Ohio for about three months during high school. Try as I might, I didn’t enjoy working under flickering fluorescent lights, racing back and forth between nurses to help aid dying patients, or viewing various body fluids being projected everywhere. Maybe I picked the wrong unit to begin exploring medical careers, but I knew from that experience that while I was still very interested in science, I ultimately wanted to find a much more controlled environment where I could do my best to help prevent people from getting to that terminal stage of disease in the first place.

As college approached, I was feeling a bit lost. While I definitely still felt a love of science, I also toyed with the idea of being a lawyer or a judge and even started looking into political science degree programs. This all stemmed from my short-lived, very “successful” role as a sharp-witted, intelligent prosecuting attorney (complete with a sweet drawn-on mustache) in a 5th grade play. I loved the thrill of the investigative work, probing through clues until arriving at some semblance of an answer. But was it a good career choice for me?

It wasn’t until later that I realized that I could have it all.

During the summer of 2007 I was selected as one of 30 students from around Ohio to attend the REAL (Regents Environmental Academy for Learning) Summer Science Program at Bowling Green State University. I gained an overview of basic concepts of biology, chemistry, pollution and toxicology, but my favorite workshop was on epidemiology, my first exposure to public health. We were given a fictional case study where 15 out of 20 kindergarten students had contracted an unknown bacterial illness after visiting a local zoo. To uncover the cause for the outbreak, we reviewed hospital files, patient records and poured through interview transcripts. By investigating all of these factors, we were able to pinpoint the strain and source of the ingested bacteria. The thrill of the detective work involved in solving this case, as well as insight into the interconnected dynamics of disease transmission, ignited my interest in pursuing public health as a career. It seemed to feed all of my interests: science, detective work and a strong desire to help improve our world.

I’m currently an APHL/CDC Emerging Infectious Diseases (EID) Laboratory fellow working at the North Carolina State Laboratory of Public Health (NCSLPH). This fellowship has given me several opportunities to communicate my findings from various projects and ideas with public health leaders and stakeholders from the North Carolina Department of Health and Human Services.

One of the coolest moments of my fellowship so far may have been when I was unexpectedly put in charge of leading a research and development (R&D) meeting with NCSLPH’s research collaborative company, bioMérieux, during a site visit to their headquarters in Durham, NC. As I was en route to their building, I learned that my boss couldn’t make it with me. After talking myself through an initial bout of nervousness, I realized that I was confident that I knew what parts of our procedures needed to be improved and was able to advise them on troubleshooting issues that had arisen during our experiments. Not only did the staff astutely listen and actively ask for my input, but they also took all of my advice into consideration. When I received the final version of the protocol, I noticed that many of my suggestions were incorporated. For the first time in my life, I felt that people were finally asking me for constructive input and respecting my contributions to a given project.

But, I have to be very honest. Without question, the ultimate moment of my EID fellowship so far was when I finally fulfilled a lifelong dream of wearing the full personal protective equipment (PPE) necessary to work in a BSL-3 suite. I donned the PAPR, Tyvek suit, booties… the works! All the movies, TV shows and news clips showing people wearing these suits make them look like the ultimate scientist superheroes (and smartest villains for the shameless Breaking Bad fan in me). Now I pretty much work full-time in this superhero scientist suit. As part of the project I mentioned before, I’m working with Brucella spp (highly pathogenic, #1 cause for laboratory acquired infections) to submit protein spectral data to bioMérieux to build their MALDI-TOF Vitek MS database for BSL3 pathogens. While the PPE does allow me to feel like a scuba diver exploring the unknown depths of the microbiological ocean, it still takes me a long time to physically get into the thing so the magic has worn off a bit. I look more like the Michelin tire mascot on most days, but I still feel like a scientific superhero inside! I hope I can make this my uniform to wear while riding into a future public health battle!

I like to think that the work I’m doing as an EID fellow has a significant impact on protecting the public (even though it doesn’t include that awesome mustache from my time as a prosecutor). I still have my whole career ahead of me and who knows what’s in store. I’m not worried about that right now; I’m too busy having the time of my life.

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APHL Staffer Shares her Career Path with the Next Generation of Public Health Students

Jan 21 2015 :: Published in Workforce & Professional Development

By: Bertina Su, MPH, senior specialist, Laboratory Systems and Standards, APHL

Last fall I was invited back to my alma mater to talk about life after University of Maryland’s (UMD) Master of Public Health (MPH) program. A former classmate was coordinating an informational session for undergraduate students to help them get a sense of where the MPH grads went in their careers; she asked me to participate and I happily accepted both because she is a friend but also because I could have used an event like this when I was finishing my undergrad degree.

APHL Staffer Shares her Career Path with the Next Generation of Public Health Students | www.aphlblog.org

My journey into public health was not something that I planned. I earned a bachelor’s degree from Washington and Lee in chemistry, but as graduation loomed, I still had no idea what I wanted to do with my life after receiving my diploma. Reality was sinking in. My fellow chemistry classmates went into research or continued to medical school, and while those options seemed to be the logical next steps, they were not the right fit for me.

I took a year off after graduation to volunteer at Bread for the City, a non-profit in Washington, DC, that provides food, clothing, medical care, legal and social services residents in need; it was there that I became exposed to the world of public health. I worked in the medical clinic doing mostly administrative work helping with health insurance enrollment and coordinating health education programs. I began to understand what public health was, and that I could use my science education in this field to help people. I spoke with many of the staff about how they found their way into public health, and they all had MPH degrees. It became clear that if I wanted to move my career in this direction, I needed to find an MPH program that worked for me. Before I knew it, I was back in school learning about biostatistics, program evaluation and epidemiology. After completing UMD’s two-year MPH program, I interviewed for a program manager position at APHL, and I have been here ever since.

Fast forward a few years… There I am setting up my information table at UMD’s School of Public Health featuring APHL’s Annual Report, Lab Matters and my own business cards. I even wore my APHL STAPH staff t-shirt. I had the opportunity to speak with several students who asked questions mostly about my MPH experience and responsibilities at APHL. Some were not familiar with either public health laboratories or association work, so it was rewarding to expand their knowledge. I talked about my quality improvement and survey work, but their ears really perked up when I told them that I get to travel and work with people all over the country.

I’d love to see undergraduate public health programs hold more events like this one to give the next round of graduates the opportunity to hear from alumni about their journey into the public health workforce and about other career paths they had not considered. While my path into public health may have been unconventional, I am thankful that I took it. The work has been rewarding, and I hope that my participation will encourage another public health student to pursue an equally fulfilling position.

I encourage you to contact your alma mater to share your knowledge, experience and lessons-learned with public health students. You just might inspire someone to pursue a career in a public health lab.

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Newborn Screening: This Tiny Test is a Big Job That’s Always Improving

Jan 12 2015 :: Published in Newborn Screening and Genetics

By Scott J. Becker, executive director, APHL

Newborn screening saves or improves lives – 12,000 each year, to be specific. Every year over four million babies born in the United States have their heels pricked during the first days of life to check for certain devastating conditions that are not otherwise apparent at birth. The small number of babies who test positive for those conditions may suffer serious and irreversible damage without early detection. Newborn screening enables health professionals to identify and, in most cases, treat those babies allowing them to grow up to live healthy, normal lives. The newborn screening program is one of our nation’s greatest public health achievements, but that doesn’t mean it is perfect.

Newborn Screening: This Tiny Test is a Big Job That’s Always Improving | www.aphlblog.org

Last year a series in the Milwaukee Journal Sentinel drew public attention to some of the areas in which the newborn screening program needed to improve. That story and a recent editorial in USA Today focused on the amount of time between specimen collection, testing and reporting of results. Timeliness is critical for the newborn screening program to be a success, and we acknowledge the valuable contribution these articles have made.

Continual quality improvements – including timeliness – have been and continue to be a priority for public health laboratories, the agencies responsible for identifying and reporting positive newborn screening test results. In fact, APHL recognized the efforts of many state programs during the 2014 Newborn Screening and Genetic Testing Symposium. Many state newborn screening programs have conducted hospital site visits; conducted targeted outreach to lagging performers and publicly recognized top performers; provided hospitals and other specimen submitters with guidelines for collection of specimens; reinforced regulatory requirements; and provided training for use of overnight courier shipping software. Program changes like these in states around the country have significantly improved specimen transit times.

APHL and its members have collaborated with the Department of Health and Human Services Discretionary Advisory Committee on Heritable Disorders in Newborns and Children to develop updated recommendations on timeliness guidelines. These activities occur in tandem with a series of other quality improvement activities including proficiency testing, evaluation of emerging technologies and implementation of quality practices pertaining to screening, confirmation and results reporting.

I am proud of the work state newborn screening programs are doing every day. We do not take the public health laboratories’ role in this life-saving program lightly, and I thank the staff for their dedication to improving it. Our focus is on the babies – it always has been and always will be.

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APHL’s Top 10 Blog Posts of 2014

Dec 18 2014 :: Published in General

Wow, this has been quite a year for public health. Vaccine preventable disease outbreaks, MERS-CoV, chikungunya, EV-D68, and Ebola on top of the usual critical food safety, environmental health, preparedness and global health work being done by our members tested every system across the board. While I feel it is safe to say that no one wanted to face these issues for a multitude of reasons, we were beyond pleased to see public health laboratories face and respond to the many challenges of the year. As we hear from our members often, “It’s all in a day’s work.”

These are the blog posts that brought in the highest number of readers this year. Thank you to the APHL staff and members who wrote and contributed to these stories; and thank you to the many readers who keep coming back.

APHL's Top 10 Blog Posts of 2014 | www.aphlblog.org10. Safe Drinking Water Act has Been Protecting You for 40 Years – This year was the 40th anniversary of the Safe Drinking Water Act, the first national standard for public drinking water protections. Raise a glass of clean water with us! Cheers!

9. Where are They Now? APHL/CDC Emerging Infectious Disease Fellow Looks Back – Kayleigh Jennings, a former APHL/CDC Emerging Infectious Disease Fellow, shares some of the highlights of her fellowship experience. “I never would have had any of these life-changing experiences if not for this fellowship.”

8. MERS-CoV: Why We Are Not Panicking – Following the confirmation of two MERS-CoV cases in the US, the public began to worry that the outbreak could spread here. Some of APHL’s Infectious Disease program staff and Public Health Preparedness and Response program staff explained why they weren’t panicking. As they say in this blog post, “…We in the public health system are poised to handle MERS-CoV and other health threats whenever, wherever and however they enter our country.”

7. Could funding cuts to food safety programs make you sick? – We followed the journey of a hypothetical batch of peanuts from farm to table, so to speak. Along the way our peanuts became contaminated with Salmonella. But as funding cuts have deeply impacted food safety programs, would the contamination be detected early enough to prevent an outbreak? Or at least to stop an outbreak from spreading further?

6. USAMRIID: Biodefense from the Cold War to Present Day – Our Public Health Preparedness and Response program staff visited the US Army Medical Research Institute of Infectious Diseases (USAMRIID) and shared some of what they learned about its history and the fascinating work done in their laboratories. At the time, we didn’t know that USAMRIID would be thrown into the public eye as the Ebola story unfolded.

5. Dylan Coleman Has a Story to Warm Your Heart – Thanks to newborn screening, Dylan Coleman had a simple non-invasive test that detected critical congenital heart disease (CCHD). Without this test, Dylan may not have survived. He was the first baby born in Maryland to be diagnosed with a heart defect as a result of this newly added test.

4. In US, Massive Effort to Detect and Respond to Ebola Already Underway – Just a few weeks before the first Ebola case was identified in the US, this blog post outlined how public health laboratories were preparing just in case. By the end of the month we all learned that this preparedness effort would be tested and ultimately shown to be successful.

3. Food Safety Funding Cuts in Action – Two days after our blog post on food safety funding cuts (see #7 above) went live, it became obvious that our hypothetical situation was playing out in real life with a stone-fruit recall. Testing performed in Australia found Listeria on stone fruit distributed from a company in California. A similar program in the US was cut from the budget on December 31, 2012; had this program still been in place, the contaminated fruit may have been identified and intercepted long before arriving in Australia.

2. Enterovirus D68 Testing, Surveillance and Prevention: What We’re Telling Our Friends – As there were more and more reports of Enterovirus D68 infections in kids, parents started to worry. APHL’s Infectious Disease program staff tried to address concerns and assure people that the clinical and public health communities could handle this outbreak.

The most read blog post for 2014…

1. Testing for MERS-CoV: The Indiana Lab’s Story – The staff at the Indiana State Department of Health Laboratories were kind enough to write about their encounter with MERS-CoV. They were the first laboratory in the US to have a positive MERS case. Thanks to effective preparedness efforts and highly qualified staff, they were able to quickly and safely obtain accurate results. This is public health!

 

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TIME’s 2014 Person of the Year: Recognizing the Ebola Fighting Laboratorians

Dec 12 2014 :: Published in Public Health Preparedness & Response

By Chris N. Mangal, MPH, director, Public Health Preparedness and Response, APHL

TIME's 2014 Person of the Year: Recognizing the Ebola Fighting Laboratorians  | www.aphlblog.orgThis year saw the deadliest outbreak of Ebola in West Africa, specifically in Sierra Leone, Liberia and Guinea. The West African people, their governments and numerous international organizations have been on the frontline fighting to contain this outbreak and stop the transmission chain. We agree with TIME magazine’s choice to name The Ebola Fighters as their Person of the Year. The many doctors, nurses, ambulance drivers, researchers, volunteers, survivors and so many others who continue to work tirelessly to heal the sick, protect the healthy and contain this outbreak deserve the world’s applause. Of course, we at APHL especially want to recognize the laboratorians who are a vital part of these Ebola response teams at home and abroad. They work diligently to process thousands of samples and quickly determine whether or not an individual is infected with the deadly virus, utilizing safe laboratory practices to do so.

While domestically the public health laboratories authorized to perform the Ebola detection test have continued to state this is all in a day’s work for them, the significance of this test does not go unnoticed. As samples from suspect cases are rushed to public health laboratories, ample precautions have been taken to protect and reassure those outside of the laboratory of their continued safety. Tests are performed quickly and carefully to ensure the fastest possible turn-around and accurate results. Those results help doctors and other medical professionals determine the next steps in patient care; help researchers to develop targeted countermeasures such as vaccines and antiviral medications; and if positive, allow epidemiologists to begin contact tracing to contain the spread or, if negative, offer assurance to the public that the suspect case is negative. Thanks to swift testing in West Africa and in the US, we have seen many patients recover after early and appropriate treatment – in fact, many health professionals are now referring to Ebola Virus Disease as treatable.

Public health laboratorians join the long list of Ebola fighters worthy of being called Person of the Year. They have not turned away from their responsibility of protecting the population. The Ebola fighters will likely not rest over the holidays – they will continue to battle Ebola and protect the public’s health. For that, we are grateful.

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Say “Thank You, Public Health!”

Nov 20 2014 :: Published in General, Partners

Say "Thank You, Public Health!" | www.aphlblog.org
This year APHL is partnering with Research!America for Public Health Thank You Day! On Monday, November 24th, take the time to thank the many public health professionals who work hard to keep you, your family and your communities healthy. Even though they often work behind the scenes, public health professionals are there protecting you.

We simply cannot say “THANK YOU!” enough to our members, the unsung heroes in lab coats! So we are going to take to our many social networks and say #ThankYouPublicHealth! Add the hashtag on Facebook, Twitter, Pinterest, Instagram or any other network that uses hashtags. Complete the sentence…
Say "Thank You, Public Health!" | www.aphlblog.org

 

#ThankYouPublicHealth for stopping Ebola in its tracks!

#ThankYouPublicHealth for that tiny heel prick that saved my baby’s life! #newbornscreening

 

Or simply add it to a shared article or photo!

If you have space, add the official Public Health Thank You Day hashtag #PHTYD and #APHL. We’ll be watching for posts and will share our favorites! If you would are not active on any of these social networks, leave a comment below and we’ll share for you.

Most importantly, we just ask that you shout it from the virtual rooftops… #THANKYOUPUBLICHEALTH!

Check out Research!America’s website for more great Public Health Thank You Day resources.

 

 

 

 

 

 

 

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Public Health and Freedom: Reflecting on Berlin, AIDS and Ebola

Nov 13 2014 :: Published in General

By Scott J. Becker, executive director, APHL

Twenty-five years ago I was huddled by a radio listening to the BBC broadcaster tell of the fall of the Berlin Wall. As I listened, I became more and more aware of how much Americans take our freedom for granted.

Earlier that same week I moved to Geneva, Switzerland to begin an assignment with the World Health Organization (WHO); not only was it a big move, it was also my first ever trip overseas. I was in a temporary apartment, didn’t speak the language (French), didn’t know anyone and, although very excited, was generally overwhelmed. Meanwhile, only a few hundred miles away, history was being made. I didn’t realize it at the time, but those first few weeks in Geneva helped shape my career and, really, the person I became from that point forward.

Public Health and Freedom: Reflecting on Berlin, AIDS and Ebola | www.aphlblog.org

My assignment at WHO was to coordinate a global conference on integrating HIV/ AIDS into the curriculum of health professional schools across the globe. While healthcare professionals weren’t scared like they were when the disease was first discovered, they really didn’t have much experience with HIV/ AIDS. So my project was to integrate this disease into curricula to teach a new generation of healthcare workers. It was an exciting and difficult challenge not only because of the heavy subject matter at hand or the language which was still unfamiliar to me, but also because I had to navigate the complex bureaucracy of WHO.

When I began this project, the public was just beginning to understand that HIV wasn’t a gay disease or an African disease, but it was a disease that could impact anyone. In fact, we were seeing heterosexual transmission explode in Africa. There was a huge stigma attached to AIDS causing those who were infected to be shunned in public and in the workplace.

As the international conference commenced in Istanbul, Turkey, I felt enormous pride that we were doing something, but it was short lived. One day a man who was HIV positive showed up at the meeting looking for care. Despite being unable to publicize the meeting because of the stigma, this man heard that all these health professionals were coming together in his city to discuss his disease. He was desperate and really had nowhere to turn in his community. He was an outcast and felt like he lost his freedom. The man cried when we told him that it wasn’t really a medical meeting and that we weren’t able to help him directly. My heart broke. I remember going back into the meeting and sharing his story with a colleague from the Turkish health ministry who took down his information and promised to reach out. (I’m fairly certain he did that to placate me, not for real follow up. I’ll never know for sure.)

By that point the Berlin Wall was fully down, people were passing back and forth between East and West Germany, and we were getting glimpses of hope for the future. Back in Geneva, I began to explore the connections between global public health and basic human freedoms. The fall of the wall and my experiences in Istanbul really solidified my desire to be part of improving health for all. It was abundantly clear that good health provided freedom in so many ways. I had found my niche.

I’ve thought a lot about the man in Istanbul recently as I’ve listened to stories about Ebola. Here, too, we have a new and very scary disease. Except that it’s not really new, but new to many in America. The stigma now being associated with Ebola is much like that of AIDS 25 or more years ago. The treatment of returning healthcare workers – heroes, in my mind – is shameful and disappointing. The lack of respect for information shared by scientific and medical experts, people who have studied Ebola for their entire career, is frustrating. And the worst of all, watching public fear escalate and place demands on decision makers is deeply troubling.

Healthcare workers in any region – whether those testing samples in New York City or those treating patients in Sierra Leone – deserve their freedom to move freely until medical experts determine they present a risk to the public. Patients who have recovered from Ebola deserve their freedom as they return to life in good health. And we all deserve freedom from fear, something that is given to me every time I speak with colleagues who understand the intricacies of how Ebola operates and how it can be contained.

My hope for the future is that we as public health professionals, healthcare workers, neighbors and as Americans can move beyond stigma to a better place, one where health is recognized as both a right and a freedom.

*Photo: World Health Organization’s headquarters in Geneva, Switzerland

 

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