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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.org 10. 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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Say “Thank You, Public Health!”

Nov 20 2014 :: Published in General, Partners

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.

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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APHL’s Top 10 Blog Posts of 2013

Dec 19 2013 :: Published in General

APHL had an exciting year! Here are the ten blog posts that attracted the most readers this year. As you’ll see, there’s a big focus on newborn screening thanks to our 50^th Anniversary campaign. We’d like to offer a special thanks to the many families who shared these inspirational stories!

APHL's Top 10 Blog Posts of 2013 | www.aphlblog.org

10. Proof of the Value of Newborn Screening at Every Milestone – Joe is an adorable blue-eyed dimpled little boy who loves math. But after learning their perfect new baby had PKU, Joe’s parents worried. A doctor assured them, “He can have the greatest life.” And he has.

9. Screening Scores Big for These Minnesota Twins – Sam and Grace were both born with PKU. Their parents were saddened to think of all the exciting food-related things they might not get to do – no hot dogs at ballgames or ice cream cones in the summertime. Eventually they came to appreciate the diagnosis and understand what missing this important information might have meant. “We are so lucky and fortunate that our children were born in a time and place where a simple test saved their lives,” said their mother, Becca.

8. Anthrax in Minnesota? The Laboratory Response Network Springs into Action – After a several-week long road trip, a man became severely ill. What was causing the illness and how many people might he have infected along the way? The Minnesota lab jumped into action and solved this public health mystery.

7. Two Siblings Born With Isovaleric Acidemia: One Caught by Newborn Screening, One Wasn’t – The Monaco family’s experience is a perfect example of why newborn screening is so critical. One of their children was born at a time when his disease was not on their state’s screening panel; another one of their children was born at a time when her disease, the same as her brother’s, was on their state’s screening panel. Their outcomes are dramatically different, all because of newborn screening.

6. No Story Is the Best Story – Honey emailed us to share photos of her daughter, Maren, during our 50 Years of Saving Babies’ Lives campaign. She mentioned that Maren has a condition that was detected by newborn screening, and because of this early detection they were never a family in crisis and do not have a scary, dramatic story. Her story – or lack thereof – struck many of us at APHL.

5. A Pediatrician’s Quick Thinking Saved Maggie Grace – Maggie seemed like a typical newborn to her first-time-parents. As they all prepared to leave the hospital, something happened and Maggie was sent to the NICU. Luckily, her pediatrician had the foresight to contact the state public health lab and have Maggie’s newborn screening results rushed. That decision may have saved her life.

4. What Exactly Does the Shutdown Mean for Public Health? – The federal government shutdown had sweeping impacts across the nation. But what did it mean for the many critical federal public health programs? Luckily state and local programs were still hard at work, but they were missing an integral part of the public health system.

3. PKU Hasn’t Stopped Elisa From Living Her Dreams – Elisa was born with PKU; fortunately for her it was detected by newborn screening at birth. Now an adult, Elisa has traveled the world, gotten married and had a baby of her own. “PKU can’t stop you from living your dreams… I’m excited for life.”

2. On the Verge of a Coma, Baby Carter’s Life was Saved – Carter was born just before Thanksgiving. As his parents prepared to host family for the holiday, they got a call that his newborn screening results were abnormal. Carter has Maple Syrup Urine Disease (MSUD), and, within those first days of life, was literally hours from slipping into what could’ve been a damaging coma. Now Carter is a typical rambunctious tot who keeps his family very busy!

The most read blog post of 2013… It’s a tie!

1. Federal Public Health Programs and Employees are Essential Despite Label – During the federal government shutdown, employees were referred to as “essential” and “nonessential” as a designation of who was furloughed and who was required to work. As APHL’s executive director, Scott Becker, pointed out, ALL public health workers were essential whether furloughed or not.

1. Tap Water vs. Bottled Water – Do you drink tap or bottled water? One of APHL’s environmental health staffers explained why bottled water many not be any better than tap. It might have you thinking twice about buying that expensive bottle of water!

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Are Girls Being Nipped in the STEM?

Dec 11 2013 :: Published in General, Workforce & Professional Development

By Rohini G. Sandesara, APHL/CDC Training Fellow, Centers for Disease Control and Prevention, NCEZID, DVBD, Dengue Branch, Molecular Diagnostics and Research Laboratory

On October 1, 2013 the US federal government shut down and with it hundreds of thousands of people were not allowed to work by law, including myself. As a result, I spent an obscene amount of time on the internet reading about almost everything. Something that caught my attention were a few websites talking about Ada Lovelace because a day to celebrate her was approaching. I was happy to see her getting some publicity and wanted to see her being recognized for two things: 1) she was an intelligent woman and 2) she was the first computer programmer EVER. Unfortunately, her day came and went and I was sorely disappointed in the minimal exposure she got; I had to dig into women-focused websites to find blurbs about her.

During this time I also noticed a lot of articles about federal departments that were forced to close. I saw a fair amount of light being shed on the sciences and how these agencies were handling the shutdown. Even the research being done in Antarctica got a decent amount of coverage. There were stories of what was going to happen to the animals used in the research that had come to a halt, the inability of NIH to accept new patients into clinical trials, the CDC unable to do proper influenza surveillance right at the start of flu season, the FDA not being able to inspect imported food… the list goes on. So on October 15, 2013, an internationally recognized day to celebrate Ada Lovelace, I was surprised that more people did not take advantage of these circumstances to advocate for the STEM fields at all, let alone women specifically by using Lovelace as an example. On the one hand there was a lot of talk about what these shuttered federal agencies do, yet on the other hand, a great opportunity to encourage investment, time and support for these fields was passed by.

As a female scientist, I would love to increase the number of women in these crucial fields of study by using opportunities that are already available. The internet makes the world a very small place and there is no reason not to use it to advocate for women in these areas. Missed opportunities like Ada Lovelace Day are rampant and inexcusable. Companies and organizations with wide nets cast all over the world through marketing and consumerism have the best resources to encourage girls from a young age to pursue the STEM fields, but they choose not to.

LEGO regularly has a computer engineer whose bio reads “In his spare time, he programs his own video games, catches up on the latest posts in his favorite web forums, and hangs out with his pet robo-cat.” They now also have a female scientist who will “…spend all night in her lab analyzing how to connect bricks of different sizes and shapes…” Neither of these character descriptions help to dispel stereotypes of people on these career paths. This alone is enough to push young girls away from STEM fields, because they may identify being a scientist with not having a life outside of lab or a computer programmer as someone who is socially isolated. TV shows and movies also advocate for this thinking by showcasing the idea that scientists’ work is the focus of their lives. This could not be further from the truth. There are plenty of scientists who exhibit just as much passion for their work as they do for hobbies and interests outside of work.

We need to expose the public to real people in these fields by getting the word out there about who they are, what they do and why they do it. UNESCO recently formed a scientific advisory board consisting of scientists from all over the world to help influence policy. A solid 50% of them are women; however, neither the formation of this board nor the gender makeup of it was widely circulated in the media. This should have been news-worthy because it is important for people to see the positions these women have and show what scientists actually do rather than the fictional representations that are often projected on us.

Without understanding of what STEM fields entail, it is no surprise that there a skill shortage is forecast in many of these sectors. Without the active dissolution of stereotypes in these fields, we are knowingly pushing away brilliant minds and studies show they tend to be female. (See these studies: 1, 2, and 3.) There is no one type of person that goes on to study physics, become a biomedical engineer, develop software or build robots. Many different people pursue these fields; that is why we see progress in them.

Ada Lovelace was a pioneer for women and kickstarted the technology saturated world we use every day without a second thought. Her day of recognition coincided with a time when people were becoming more knowledgeable about STEM fields, yet her accomplishments were not leveraged to their fullest potential. We should be using the opportunities we have at our fingertips to advance knowledge about STEM fields so that we do not give the wrong impression of what goes on inside these worlds. These are the fields that directly influence our daily lives without most of us even knowing how.

About Ronini: Through a fellowship run by the Association of Public Health Laboratories (APHL), I am currently working in the Molecular Diagnostics and Research Laboratory in the Dengue Branch of the Centers for Disease Control and Prevention (CDC). I am passionate about scientific research, cutting edge technology, photography, expanding my culinary skills and travelling. Living in Puerto Rico for this fellowship is also exposing me to much more island life than growing up in New Jersey ever did, and I can’t really complain about that!

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Public Health Thank You Day: APHL Says Thanks!

Nov 25 2013 :: Published in General

Today is Public Health Thank You Day (#PHTD)! APHL has so much to be thankful for — mostly, we want to say thanks to our members, partners and staff for their hard work protecting the public’s health every day. We are grateful to be part of this community!

Public Health Thank You Day: APHL Says Thanks! | www.aphlblog.org

Some APHL staff members have put together messages saying what they are thankful for this #PHTD…

I’m always thankful for the dedicated APHL members who give so much of their time and expertise to improving public health nationally, even when they have so much to focus on in their own cities and states. This year, I am particularly thankful for the opportunity to fully vaccinate my infant twins; the efforts of Luminex to launch a new technology without harming public health; the dedication of friends working logistics routes in the Philippines to help those affected by Typhoon Haiyan; and anything being done to maintain a functioning and effective federal government – open for the business of improving and saving lives.

- Shari Shea, Director, Food Safety

I am thankful for a Customer Support Team that is kind, enthusiastic and dedicated to helping APHL members!

- Susan Bailey, Manager, Customer Support Program

I’m thankful for all the dedicated, hardworking people in public health who keep me, my family, and my community safe and healthy. I am thankful for clean air, clean water, good soil that my CSA can grow my veggies, and mostly for healthy babies.

- Scott Becker, Executive Director

I am thankful for all of the students who have discovered science can be a life-long passion. It is exciting to learn that the younger generations are finding laboratory science can be an excellent career to serve the needs of their family, friends and the public at large. I am thankful for all of those working to promote laboratory science as a career that impacts the health of the public. Kudos to those who work behind the scenes to keep us safe and healthy!

- Cathy Johnson, Manager, Leadership and Management Curriculum, National Center for Public Health Laboratory Leadership

I am thankful that I get to support all of the wonderful programs that make a difference in people’s lives both here and all over the world.

- Joshua Zulauf, Associate Specialist, Contracts

My thanks to public health labs for saving me from influenza’s fever, aches and pains. They keep me healthy by helping to identify the circulating strains included in each year’s flu vaccine.

- Jody DeVoll, Director, Strategic Communications

I’m thankful for working in a field that is helping to make the world a better place; full of dedicated, smart, caring people; so reliant on science, yet so connected to the people; and always open to learning and new directions.

- Megan Latshaw, Director, Environmental Health Programs

Thank you to all of our staff, members and consultants for the great work they do both domestically and internationally. In a recent trip to Vietnam, I was reminded of how APHL’s work is far reaching. It was inspiring to see how laboratory information management systems are changing the way laboratories here in the US and in countries such as Vietnam and Guyana protect the public’s health.

- Chris Mangal, Director, Public Health Preparedness and Response

I just spent a few days with my grandson – a healthy, happy, and very rambunctious 5 year old. I am thankful for all the public health programs that work to keep him healthy – newborn screening assuring that if he had been born with any heritable diseases they would have been detected and treated early; immunizations protecting him from hepatitis, pertussis, measles, mumps, rubella, rotavirus and more; environmental health looking out for the air he breathes and the water he drinks; food safety and nutrition (together with his parents) watching out that the food he eats is not only nutritious, but free of disease causing bacteria. Kids are all so precious.

- Jane Getchell, Senior Director, Public Health Programs

I am thankful for having the opportunity to work with so many inspiring, dedicated public health professionals that work tirelessly to help keep the whole world healthy both in mind and body!

- Patina Zarcone, Director, Informatics and Institutional Research

I am thankful for all the lab techs pipetting away to check for our safety every day. Public health never stops and I am grateful for those who work around the clock. Others’ wellbeing is their constant calling, public health professionals are so ballin’. THANK YOU!

- Caprice Retterer, Associate Specialist, Website

I’m thankful for cold weather, sunny days and public parks for running. Staying healthy through the holidays!

- Ruhiyyih Degeberg, Specialist, Newborn Screening and Genetics

I’m thankful for vaccinations that keep my family safe from serious diseases and for newborn screening programs that save babies’ lives every day.

- Michelle Forman, Senior Specialist, Media

I’m thankful for all public health initiatives geared towards ensuring an integrated food safety system.

- Dare Akingbade, Manager, Food Protection

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What Exactly Does the Shutdown Mean for Public Health?

Oct 04 2013 :: Published in Food Safety, General, Infectious Diseases, Laboratory Systems and Standards, Newborn Screening and Genetics, Public Health Preparedness & Response, Public Policy

As we face day three of the federal government shutdown, we are hearing more about the deeply felt impact on our federal partners. While we can be grateful that local and state public health agencies are still hard at work, the federal portion of the continuum is minimally staffed and operating a bare-minimum of essential programs that ensure the public’s health and safety. Below are some of the negative effects we are hearing from the Centers for Disease Control and Prevention (CDC), the United States Department of Agriculture (USDA), the Food and Drug Administration (FDA), and the Department of Health and Human Services (HHS).

What Exactly Does the Shutdown Mean for Public Health? | www.aphlblog.org

Reference Testing Services Will be Delayed or Absent

CDC provides highly specialized reference testing for rare pathogens and for rare instances of drug resistance. Although CDC will maintain many of these services, the number of staff performing these tests will be greatly reduced. The result will be a delay in delivery of potentially lifesaving test results.

For example, the Division of Tuberculosis Elimination performs sequencing to detect mutations associated with drug resistance to rapidly identify persons with drug resistant TB. It is the only laboratory in the country that is currently utilizes this method (which provides a high level of detail) for public health investigations. Delayed results will lead to delays in delivering optimal treatment to patients and mounting an appropriate public health response.

National Disease Surveillance Will Be Weakened

CDC collects data on infectious diseases from all 50 states, local jurisdictions and territories. The compiled data tracks how diseases are spreading and helps scientists to identify multi-state outbreaks. One of the best examples of this function is influenza surveillance. Flu season is upon us; CDC monitors the flu virus strains that are circulating nationally, keeps track of any resistance to drugs, and determines how well this season’s flu shot will work against circulating strains, and sends national alerts to public health professionals when things look out of the ordinary. It shares the data generated from this activity with state and local health departments, providing them with a “big picture” view of flu activity across the country. Armed with this information, they can prepare effectively for potential outbreaks in their area. But a prolonged government shutdown will reduce the clarity of the big picture view, since less data will be collected.

CDC Support of Local Outbreak Response will be Limited

CDC services like advanced testing and consultation to state and local public health programs facing cases or outbreaks of relatively rare diseases. Because these diseases are so rare, many jurisdictions rely heavily on subject matter expertise at CDC for advice and information when responding. Although CDC’s skeleton crew of staff will do its best to assist, state and local public health departments will be largely on their own when it comes to responding to outbreaks of relatively rare diseases like measles or mumps.

Food Safety Will be Negatively Impacted – More People Could Get Sick

If you and others who ate the same food become ill from certain types of foodborne bacteria, you may never know the cause of your illness, as CDC will not be analyzing all of the data submitted, and FDA and USDA will not be following up on those leads to track the source of the illness. These are necessary steps to ensuring fewer people get sick.
CDC will delay assessing the proficiency of state and local laboratories that participate in PulseNet. This bi-annual assessment may be pushed back for several weeks, even if the shutdown only lasts several days.
State and local scientists who want to begin submitting DNA fingerprints to PulseNet will not be allowed to, as CDC certification of new PulseNet participants will be on hold.
In normal operating status, state and local food regulators do not have enough resources to properly inspect all retail food establishments and restaurants. With federal inspection personnel on furlough, even fewer establishments will be inspected to make sure that they are following the regulations.
CDC’s IT staff have been furloughed. PulseNet IT staff are not present to aid public health laboratories if they are unable to connect or submit data to the national databases. If the system fails, national outbreak detection could come to a halt. If communication list-serves fail, there are few remaining staff with the know-how to repair these critical national communication tools.

Select Agent Program Has a Delayed Response

Due to the absence of either an FY 2014 appropriation or a Continuing Resolution for HHS and USDA, the Federal Select Agent Program, which oversees the possession, use and transfer of biological select agents and toxins that have the potential to pose a severe threat to public, animal or plant health or to animal or plant products, is not fully staffed and thus unable to provide timely regulatory compliance support to state and local entities. These regulatory gaps could have serious implications for safety and security.

Laboratory Response Network Anticipates Delays

Because the CDC is operating with minimal staff throughout, the Laboratory Response Network, which is the nation’s premier system for responding to potential bioterrorism, chemical terrorism and other public health emergencies, is down to just a few staff with anticipated delays in responding to requests for assistance from state and local public health laboratories and no support for daily reagent shipments.

The larger impact is the lack of federal support for state and local public health. While these state and local agencies continue to conduct routine surveillance and monitor the nation’s health, they rely on their federal counterparts to provide the big picture of disease spread, potential releases of biological threats as well as scientific guidance and methodologies to detect novel threats, like the MERS-coronavirus.

Newborn Screening Laboratory Quality Assessment Delayed

Closing CDC has delayed the fourth quarter assessment of newborn screening laboratory quality. If the delay is extended, then these laboratories will not be able to rely on the assistance of CDC to maintain their compliance with Clinical Laboratory Improvement Amendments, the federal law known as CLIA. Newborn screening depends upon high complexity laboratory operations that are governed by the requirements of CLIA, which include an independent external review to provide quality assurance – and is provided by CDC in the case of newborn screening.

The shutdown will force newborn screening laboratories to seek out non-traditional sources for external review, establish a working relationship with them – possibly at some expense, and pursue activities to meet the CLIA quality assurance requirements. This will not only be inefficient, cumbersome and potentially costly, it will also result in a greater degree of uncertainty because it has never been done.

As CDC’s website details, “The Newborn Screening and Molecular Biology Branch, Division of Laboratory Sciences, operates the Newborn Screening Quality Assurance Program (NSQAP). NSQAP is a voluntary, non-regulatory program to help state health departments and their laboratories maintain and enhance the quality of test results. The program is operated in partnership with APHL. The program provides services to more than 85 domestic newborn screening laboratories, 31 manufacturers of diagnostic products, and laboratories in 67 countries. NSQAP has been the only comprehensive source of essential quality assurance services for dried-blood spot testing for more than 33 years.”

The shutdown will add an unnecessary burden and additional complexity to one of the most successful public health programs in the United States.

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Federal Public Health Programs and Employees are Essential Despite Label

Oct 02 2013 :: Published in Food Safety, General, Infectious Diseases, Public Policy

By Scott J. Becker, executive director, APHL

It is day two of the federal government shutdown.

Every day, before I leave for work, I walk our family dog around the neighborhood. The weather is beautiful today, just as it has been for the last couple weeks. What’s different about today, however, is that my neighborhood is full of cars on the street and people milling about. It just dawned on me that I live in a nonessential neighborhood. My neighbors are government employees.

Federal Public Health Programs and Employees are Essential Despite Label | www.aphlblog.org

APHL is headquartered in Montgomery County, Maryland, an ethnically and socioeconomically diverse area; our school system is known for being one of the top in the nation but today it’s known for having children from 70,000 families whose family members’ jobs are considered nonessential and are now furloughed. Among those furloughed are the security guards who check IDs at the National Institutes of Health (NIH); our nation’s top scientists who are looking for cures for childhood cancer; the researchers doing work on influenza viruses; the food service workers who are usually hard at work by now helping to feed the many employees at the National Institute of Science and Technology (NIST); and the Maternal and Child health specialist at the Health Resources and Services Administration (HRSA) who supports the newborn screening programs in our public health labs.

Despite being given a “nonessential” label, they are all essential to us.

Public health is a local, state and federal continuum where all parts work together to ensure we have a healthy American populace. The public health system can’t work very well – or, I should say, doesn’t work very well – when one part of the system simply isn’t engaged. That’s the situation we face today on the second day of the federal government shutdown. Local public health is still hard at work, state public health is still hard at work, but the federal portion of public health is minimally staffed. If the local or state systems need technical assistance or laboratory support, they are largely on their own.

The federal portion of the continuum is essential. In some ways you can think of it as the glue that holds the system together. Public health laboratories and epidemiologists are busy tracking down disease outbreaks all the time. They do a great job in their local or state jurisdictions detecting diseases and other pathogens that can harm us. But it is the role of the federal government – the Centers for Disease Control and Prevention (CDC), in this case – to come up with a national picture of disease outbreaks. It’s the job of the CDC to knit together the mystery of how outbreaks unfold across the country, all with the goal of stopping them as soon as possible so that lives can be saved.

Take a foodborne outbreak for example. On any given day CDC is reviewing up to 30 (and sometimes more) clusters of foodborne illness across the country. We have an incredible system called PulseNet, which is essentially a DNA fingerprinting system for bacteria that cause foodborne outbreaks. It’s those DNA patterns that are uploaded to a large database at CDC. It is then CDC’s role to review that data and to look for matching patterns across the country so that multistate outbreaks can be detected, the product pulled from market, the outbreak stopped and people can regain their health. What I just described isn’t only CDC’s role, it also involves the FDA. It’s their responsibility to test products that have been implicated in outbreaks and ensure they are pulled from the market. But because of the shutdown, only a skeleton crew of CDC disease investigators and FDA investigators and regulatory specialists are at work.

It’s also the beginning of the annual flu season. Public health laboratories around the country are busy collecting specimens and analyzing them to determine what influenza strains are circulating. That information is then shared with CDC so they can do their job of reviewing the information nationally to determine where flu outbreaks are occurring. But because of the government shutdown there is no one at CDC able to review these reports. That means we are likely to see influenza reported in each state but we will not see a national picture. While that’s not devastating in the short run, if we go a few weeks or longer we will miss out on seeing what’s happening with influenza this year which will impact our knowledge base on what strains might be put into the flu vaccine for next year potentially compromising the health – and possibly lives – of many.

I could go on and on but my point is really that public health remains an enterprise; as I said above, it is a local, state and federal continuum. The federal role in public health is essential. It is the part that holds together the other pieces and we are less safe when the federal contributions to public health are missing in action.

Congress must act soon; public servants deserve better and the American public deserves better.

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On World AIDS Day, Do Your Part: Get Tested!

Nov 30 2012 :: Published in General, Infectious Diseases

Since the first case of what came to be known as “Acquired Immune Deficiency Syndrome” (AIDS) was reported in 1981, the disease has spread across the world in a pandemic that has killed 30 million people and infected 34 million more. World AIDS Day recognizes the strides made in the fight against the HIV virus, and the work still to be done to address gaps in access to testing, treatment and care.

Here in the US, the Centers for Disease Control and Prevention (CDC) estimates that approximately 1,000,000 people are living with HIV, with approximately 50,000 more added each year. Sadly, over one-quarter (26%) of the new infections are in young people between the ages of 13 and 24. Most of these adolescents and young adults (60%) are not aware of their infection status, according to CDC’s recent Vital Signs report.

What can you do to curb the pandemic, and also protect yourself and those you love? Get tested! CDC recommends that everyone should be screened who does not know his or her HIV status.

Yes, it’s daunting to confront disease of any type, much less AIDS, but knowledge is your best protection. Early treatment of HIV infection prolongs life and prevents transmission, and for the vast majority who are not infected, testing brings peace of mind.

What’s more, it’s never been easier to get tested. Clinics offer rapid tests that provide preliminary results on-site. Over-the-counter tests, approved by the Federal Drug Administration in July, are now available at pharmacies for at-home testing. To ensure the accuracy of these tests, initial positive results are confirmed at public health, clinical and commercial laboratories.

Do you know your HIV status? If not, do your part on this World AIDS Day, and get tested. You can find the closest testing center by entering your zip code at CDC’s testing resources site.

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