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Testing for MERS-CoV: The Indiana Lab’s Story

May 08 2014 :: Published in Infectious Diseases, Member News

By Lixia Liu, Deputy Director, Indiana State Department of Health Laboratories

Stephanie Dearth is a cheerful young supervisor with blond hair and black-framed eye glasses.  This was her third week as the supervisor of the virology laboratory at the Indiana State Department of Health Laboratories (ISDHL). When she arrived at work on Wednesday, April 30, she felt lighter as she had submitted her portion of a grant application the day before. She thought she might be able to catch up on her many tasks that had been put on hold. She took a sip of her coffee and walked to the laboratory.

Stephanie put her things away and went to her desk inside the laboratory. Between responding to her emails, discussing training plans for the new hire in her area and preparing for an upcoming CLIA inspection, the day went by quickly. She finally sat down at her desk after many trips to the lab bench; the voicemail light was blinking on her phone.

Testing for MERS-CoV: The Indiana Lab’s Story | www.aphlblog.org

Stephanie listened to the message. It was from Community Hospital in Munster requesting MERS-CoV testing. Recognizing the urgency of the request, she returned the call immediately and then sent an email to alert the ISDH respiratory epidemiologist about the request. Within an hour, the epidemiologist authorized the MERS-CoV test request from Community Hospital and held a teleconference with the ISDH (laboratory and epidemiology), CDC and the hospital. The specimens were scheduled to be delivered to the laboratory for testing the next morning.

When she told me the news I had goose bumps. I realized this may be the first MERS-CoV case in the United States. The weight of the situation was also felt by Dr. Omar Perez, the director of clinical microbiology. Stephanie, Omar and I stayed after the teleconference and discussed the plan for the next day.  Although the MERS-CoV assay was in place, the last MERS-CoV run was performed more than a year ago when the assay was first validated. To be cautious, the team decided to use BSL-3 practice for the entire process. We also agreed that the most experienced senior microbiologist, Jamie Yeadon-Fagbohun, would be the best choice to run the test. Jamie, who was known for her high quality work, had over five years of experience at the ISDHL. She worked on the response to the H1N1 pandemic, the discovery of novel H3N2v and many other high-profile outbreak investigations. She had worked under pressure before, but nothing like this.

The next morning I updated Dr. Judith Lovchik, ISDH assistant commissioner of public health protection and laboratory services, on the testing plan and discussed the testing approaches.  Meanwhile on the clinical microbiology floor, Stephanie, Omar and Jamie were detailing the testing plan.  The same conclusion was reached by all: time was of the essence in this situation.

Immediately after the arrival of a nasopharyngeal swab and serum sample from the patient, Jamie took the specimens to the bioterrorism suite where she gowned-up, put on the respirator and began processing the specimens. She wiped all the surfaces that the specimens might come into contact with and took every precaution to prevent potential carryover. Around noon Jamie resurfaced from the BT suite, her face reddened by the pressurization in the lab and her respirator.

By 3:00 that afternoon, the test runs were completed. Despite the increased anticipation of the nation’s first possible MERS-CoV case, Jamie was not expecting positive results.  “There is no way this would happen in Indiana. After all, Indiana is only a fly-over state,” Jamie thought to herself. After carefully reviewing the test results, Stephanie and Omar came to my office. I knew the results just by the looks on their faces. They told me that the serum sample was positive for all three genetic markers detected by the screening and confirmatory tests. As much as I was prepared for a positive result, I was still shocked to hear it. I immediately called Dr. Lovchik and broke the news to her.  She was equally shocked.

The perceived pressure earlier in the day turned into real pressure that was building with every thought of the potential impact. The lab team – Jamie, Stephanie, Omar and I – met again to review the testing details such as how the samples were arranged in the run, where the controls were situated, etc. With all possible errors ruled out, the team was confident in the results and ready to share the news with the rest of the nation.

As planned, the nasopharyngeal swab and serum sample were shipped to the CDC lab on Thursday for final confirmation of the MERS-CoV results on Friday morning.

The ISDH, Community Hospital and various CDC teams reconvened to plan the response actions based on the public health lab’s test results. The response plan would be executed as soon as CDC’s confirmatory test results were made available, which was scheduled to occur around 1:30 pm on Friday.

First thing on Friday morning the lab team met to discuss the action plan for a potential surge in testing once CDC confirmed results from the first case. Each team member was assigned a task: ordering reagents and supplies, requesting laboratory information management system (LIMS) modifications for easier sample submission, identifying microbiologists from other areas for surge capacity, and others.

Testing for MERS-CoV: The Indiana Lab’s Story | www.aphlblog.org

By noon, planning slowed, and the lab team had time to comprehend what the ISDH lab’s MERS-CoV results meant. But would the results be confirmed by CDC? The wait felt like eternity. I read every email that came across my computer screen. An email from CDC with the subject line “Confirmation” finally arrived at 1:43 pm. I felt like I was about to hear a courtroom verdict. I took a deep breath and continued to read the email: “CDC confirms Indiana MERS-CoV on 5/2/2014 at 1:30 pm.”

”WE DID IT!” I shouted with great relief. I couldn’t wait to share the news with the rest of the team. While it was not good news to hear that MERS-CoV had made its way into the US, it was extremely validating to know that our team quickly and successfully accomplished the task at hand. I was very proud of my colleagues.

After the detection of the first MERS-CoV case on May 1, the ISDH laboratory brought in two additional microbiologists, Stephanie Dalenberg and Brian Pope, to help with testing. During two consecutive 13-hour days, ISDH lab microbiologists, supervisors and directors tested a total of 124 specimens from all of the patient’s direct contacts, including health care workers and household contacts. All contacts continue to be observed, and there have been no additional cases to date.

The ISDH laboratory staff’s quick response, safe testing and accurate results were critical to detecting and containing MERS-CoV. Once again, our national laboratory first responders had quietly and effectively done their job to protect the public’s health.

Top Photo: Jamie Yeadon-Fagbohun in the BSL-3 laboratory

Bottom Photo (from left to right): Dr. Lixia Liu, Dr. Omar Perez, Stephanie Dalenberg, Stephanie Dearth, Jamie Yeadon-Fagbohun, Brian Pope, and Dr. Judith Lovchik 

Photo credit: Indiana State Department of Health Laboratories staff

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Big Changes for the District of Columbia Public Health Laboratory

Jul 17 2013 :: Published in Member News, Public Health Preparedness & Response

By Kara MacKeil, associate specialist, Public Health Preparedness and Response, APHL

According to recent census estimates, Washington DC has a population of 632,323 people. On a workday, however, there are at least 800,000 additional people in the city due to commuters who live in Maryland and Virginia. Add all of the tourists visiting the nation’s capital, and daytime DC is a city of more than 1 million people. Although only roughly 100 square miles, daytime DC has more people than Vermont (626,011), Wyoming (576,412), Alaska (731,449), South Dakota (833,354), or North Dakota (699,628), and is about equal with Rhode Island (1,050,292) and Montana (1,005,141).

Big Changes for the District of Columbia Public Health Laboratory | www.aphblog.org

In public health terms, this means a greater emphasis on emergency preparedness and response in addition to the everyday management of core public health laboratory functions, such as testing for sexually transmitted infections, foodborne illness and more. For the past few years, the DC Public Health Laboratory has dealt with everything that came its way while working out of a small temporary facility. Fortunately, in the fall of 2012, the staff moved into a larger, brand-new, state-of-the-art laboratory.

Part of the reason for this move is that the public health laboratory has been transferred from the Department of Health to the newly created Department of Forensic Sciences. The new facility, located in the heart of DC not far from the Capitol, also houses sections of the police department, the Chief Medical Examiner, and other agencies within the mayor’s office. The main motivation for the move is that the old lab space was just too small to meet the testing demands of a public health laboratory serving more than a million people.

The APHL public health preparedness and response team toured the new facility last May with Dr. Alpha Diallo, deputy director, DC Public Health Laboratory, and other senior members of the DC laboratory. The APHL team had visited the facility once before, during construction in the summer of 2012, and were very impressed with the finished facility.  The building is LEED Gold-Certified, meaning construction materials and furnishings are sustainably produced; appliances, computers and other machines were chosen for conservative energy use; and there’s a focus on conscientious use of resources. One of the most visible features of the LEED principle is the bank of cantilevered window shades on the exterior of the building, covering the glass wall that exposes workstations on most of the floors, including the public health laboratory. These dark glass shades are controlled by sensors that open or close them depending on available sunlight, conserving heat and energy and helping to maintain a steady temperature inside the building.  LEED building techniques are becoming very popular in laboratory construction, as they save significant amounts of funding and resources over the long term and create beautiful, highly functional working environments.

Now that the move is complete, laboratory leadership is well positioned to improve their capabilities and increase their staff, taking best advantage of the new space. There are high hopes that the improved facilities will attract lots of new talent and student interns.

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British Invasion – My Career in Public Health

Apr 23 2013 :: Published in Member News, Public Health Preparedness & Response

By Andrew C. Cannons, Ph.D., HCLD (ABB), Laboratory Director, Florida Bureau of Public Health Laboratories, Tampa

“What do you want to be when you grow up?” In England, students have to make these decisions early on, and at 14 my answer was a doctor or a chef. If you asked me back then what public health was I would have said “the health of the public!”

Andrew Cannons as a child

I was not to become a doctor, due to poor study habits as a child and I did not become a chef (except in my own kitchen), but I did get to university where I acquired a good tutelage in Eastern culture at the city of Bradford –known more for its excellent authentic curries and high volume of pubs than education. Four years later, I graduated with a degree in applied biology. I had a thirst for research, but no acquaintance yet with public health.

Having discovered I was good at research I stayed on at the University of Bradford to complete my Ph.D. in biochemistry, and followed that with a four-year post-doctorate at the University of Wales in Swansea where I also picked up a Welsh accent. I was trying to determine what I wanted to do, and quite frankly I drew a blank. As luck would have it, I soon met one of my field’s most world-renowned scientists at a conference in Spain.  He offered me a three-year post-doc opportunity in his lab at the University of South Florida (USF) in Tampa. I was excited, flattered and thrilled at the offer. And guess what… USF has a college of public health! I was getting closer to where I wanted to go without knowing it.

I had a blast for the first two years I was at USF, so much so that I wanted to stay. After a lot of work and a lot of payments to an immigration lawyer, I received my green card. But I was not really sure that research was my true vocation anymore. I had been an assistant professor in biology for five years and proved to be a good teacher, but it wasn’t fulfilling enough. During this time I met the assistant director of the Florida State Public Health Laboratory in Tampa. He was doing his Ph.D., and asked me to be on his dissertation committee. We became good friends and I started to find out more about public health, albeit at a very superficial level.

The turning point for my career in public health came one October morning. It was 5:00 AM on October 6th, 2001, three days after the index anthrax case was identified in Boca Raton and I received this message –“Can you help us at the public health lab? We are expecting an onslaught!”  No kidding.  By 6:00 PM that day we had processed 40 suspicious samples for Bacillus anthracis. I was tired and hungry, but more importantly, I was hooked. This was important, meaningful, critical work. Sign me up! Not so easy as there had to be a job.

Andrew Cannons -- adult

The following year I was asked if I had considered a career in public health, and specifically about directing a state public health laboratory. I had the Ph.D., the administration skills, and a research background. I just lacked some (a lot!) public health knowledge, and there was the small issue of a Florida Clinical License. So I spent the next eight years directing the research lab, volunteering in the public health lab, studying and building up my clinical licensure one level at a time. I also joined the Association of Public Health Laboratories (APHL) as an individual member and applied for and became a member of the Emergency Preparedness and Response Committee (now the Public Health Preparedness and Response Committee).  This was a really smart thing to do.  It was such an eye opener to understanding more about public health laboratories, the Laboratory Response Network (LRN) and a host of other partners as well as their operations! This was a tremendous education and learning experience for me. Joining APHL became crucial to honing my public health knowledge and skills. In addition to serving on the Public Health Preparedness and Response Committee, various sub-committees and participating in the national meetings, in 2010 I was given the chance to be a member of the APHL Emerging Leaders Cohort III, which seeks to engage APHL members who will play a crucial role in sustaining future leadership in the public health laboratory system. This was a tremendous opportunity to 1) network and share operational experiences with other emerging leaders; 2) enhance my professional development; and 3) collaborate to deliver a product that promoted public health laboratory science.

In 2011 I became qualified as a High-Complexity Clinical Laboratory Director through the American Board of Bioanalysis (ABB) and received my Florida Clinical Laboratory Director License. I was ready, and in April 2012 I assumed the position of Laboratory Director, Bureau of Laboratories (now Bureau of Public Health Laboratories), Tampa.  I acquired a great facility and a wonderful group of dedicated, hardworking and loyal staff, which has made this move so much easier and more fulfilling.

Since transitioning to a director of a major public health laboratory, I have worked on large-scale national events such as the Republic National Convention.  As a 14-year-old boy, I never thought I would end up partnering with the US Secret Service, the Federal Bureau of Investigation, the Department of Homeland Security, and the Centers for Disease Control and Prevention to protect the public’s health from all sorts of threats. Public health was the perfect career choice for me even though it took several forks in the road for me to get here.

Through it all, I’ve held to the motto: Keep Calm and Carry On!

 

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Not Even Sandy Could Stop Newborn Screening in New Jersey

By Scott Shone, Program Manager, Newborn Screening Laboratory, New Jersey Department of Health

This storm was one of the most intense experiences I have faced.  The damage inland was substantial. The destruction along the Jersey Shore was catastrophic.  Entire towns were obliterated and may not return for a very long time.  The places of my childhood memories in Seaside, Point Pleasant, Ocean City, and Long Beach Island are gone…wiped off  the face of our great State.  I will never be able to take my 19 month old son to these places and say “this is where daddy used to play when he was your age.” Very sad.

My staff and I are very, very lucky. Many were without power, a few lost trees, and some lost siding, but no major losses and, most importantly, no loss of life.

The laboratory took a minor hit when solar panels blew off our roof and smashed into the skylights in our atrium (see photo). Otherwise, our backup systems performed exceptionally and the newborn screening laboratory remained 100% functional throughout the storm.

Glass atrium damaged by Superstorm Sandy

I am proud to say that the NJ Newborn Screening Laboratory is operating with no delays and no backlog thanks to the remarkable dedication and hard work of our staff, and intense collaboration/coordination between multiple state agencies, local government entities, advocacy groups, birthing centers and UPS. The Follow-up Program is only catching up on paperwork associated with all the specimens we tested during the storm.

It all comes down to one thing: We were prepared.  All of the Newborn Screening Laboratory staff are weather essential.  Thus, even when the State is closed, I can call staff into work.  Additionally, in the NJ Department of Health, the Public Health Laboratory is in the same Division as our Emergency Preparedness group; therefore, they are well aware of the significance of the Newborn Screening Program.  As we have been developing our continuity of operations plan (COOP) and preparing for our NYMAC (New York-Mid-Atlantic Consortium for Genetics and Newborn Screening Services) sponsored specimen exchange drill with NY, we have met routinely with NJ State Police and the Office of Emergency Management to increase our name recognition should an event like this happen. Finally, we have an excellent relationship with our UPS representative and she has been an advocate for us within her company.  In fact, the Newborn Screening Laboratory has our own address in the UPS system so that the sorting center can separate our packages as we are open even if the State, including the other public health labs, is closed.

On Saturday before Sandy hit, I had additional staff come in to perform as many assays as possible and to complete data entry.  This ensured we went into the storm week without a backlog.  On Monday, as the storm approached, Governor Christie closed the State offices and UPS suspended all services. However, we had staff come in early to finish up Saturday’s work. Further, because our UPS center understood the importance of newborn screening, they delivered Monday’s specimens despite being “closed”.

Including me, 19 of 34 newborn screening lab staff made it in on Monday… a truly heroic effort.  We were able to get every specimen accessioned, punched and assays started.  While I sent most staff home by 2:00, a few of us left at 4:00, about three hours before landfall.  The drive home was wicked as my car’s transmission actually shifted up and down with the 50-60 mph head-winds.

From home, I coordinated with our Department’s Deputy Commissioner and Health Command Center (HCC) to determine if we could establish alternate specimen pickups for Tuesday and Wednesday knowing UPS would be closed. NJ has regional Medical Coordination Centers (MCC), and it was decided that hospitals would transport their newborn screening specimens to one of three MCCs (Newark, New Brunswick, or Camden) and New Jersey State Police, who are some of the best in law enforcement in this country, would retrieve the specimens and transport to the laboratory. In addition, the New Jersey Hospital Association (NJHA) offered to make contact with all of the hospitals to notify them of the alternate plan.

The storm hit late Monday and most of us lost power at home. With the State closed on Tuesday and no specimens to test thanks to our work on Monday and closure of UPS, I told staff to stay home.  That said, my Quality Assurance supervisor, Donna McCourt, and I headed in around 10:30am on Tuesday and the NJHA notified all of the birthing centers to transport newborn screening specimens to their region’s MCC by 2:00pm. The State Police was scheduled to pick up the specimens at 4:00pm and transport to the laboratory so we contacted the six staff members who lived closest to the lab and they all offered to come in to help accession, punch and start running the specimens.

Newborn baby

That night we received 412 specimens from 21 of our state’s birthing hospitals. It was a lower turnout than we expected for a Tuesday. We discovered that the NJHA had notified the hospital emergency coordinators of the plan but not all hospital emergency contacts notified their nurseries/laboratories. This is something we will work on in the after-action process. My staff and I accessioned, punched and started what assays we could before leaving around 10:00pm.

On Wednesday, despite the State closure, all newborn screening staff were asked to report; I had 32 of 34 staff in the lab that day (one who didn’t make it relies on public transportation which wasn’t running and the other one is 86 years old and was staying with her daughter out-of-town).  I spoke to our UPS representative early in the morning and learned that UPS would deliver to the laboratory, but pickups throughout the state were spotty.  Thus, we continued with the MCC plan from Tuesday; however, I had newborn screening lab staff contact every nursery/laboratory rather than relying on the NJHA to make notification.  The Follow-up Program building was closed so they had three of their staff come to the laboratory to work. That afternoon, the State Police delivered 576 specimens from 40 hospitals.  This was much closer to what we expected.  Staff remained to accession, punch and start assays.  Our Capitol Post Office was closed and the Program’s mail was backing up.  Our Lab and Follow-up Medical Directors, Drs. Evan Cadoff and Lori Garg, took the 500+ envelopes to a local Post Office and paid out-of-pocket (reimbursement is coming!) to get our mail out.  Staff left around 5:00pm.

On Thursday, the State officially reopened and things began to return to normal.  UPS had restored service to all hospitals except 14, which were all in the North and Central regions. The Newark MCC had UPS service so rather than sending the State Police, who are needed for other tasks, we had the MCC gather all northern specimens and ship to us for delivery today. The New Brunswick MCC did not have UPS service so we sent a courier to retrieve the specimens from Central Jersey.  Testing progressed normally and all results continued to flow out on time. Our Capitol Post Office remained closed so staff took our reports to another USPS location and used a Department credit card to pay for postage.

Today things in the lab are almost normal.  Follow-up is still catching up on paperwork.  Our Capitol Post Office has reopened and clearly the acute crisis is resolving since I have time to write our story.

We maintained testing everyday through the storm and aftermath, and we reported out all results in our required time frames, including calling critical results.  In the end, during one of the worst natural disasters on record in this State, the screening of newborns for life-threatening conditions continued uninterrupted.  There will be a lot of post-event reviews performed and I look forward to improving our emergency system.  In the meantime, please keep New Jersey in your thoughts as much of our State will take weeks or even months to return to a new normal.

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Life Outside of the Lab

Nov 08 2012 :: Published in General, Member News

Scientists have serious jobs — we don’t have to tell you that, though. What do you do to unwind at the end of the day? On the weekends when you’re not investigating the latest outbreak? We want to know more about you. Show us the easygoing side of scientists!

Send us a fun photo and clever caption of your life outside of work (e.g., your latest vacation, playing with your pets, or enjoying your favorite hobby). Photos will be featured in the digital edition of Lab Matters Magazine in a new section highlighting public health laboratorians!

Photo & Video Sharing by SmugMug

 

To be considered for the upcoming Fall Issue, submit your photo/caption to this address, by Tuesday, November 13th.   Submissions after that date will be considered for future issues.  Please include your name, job title and affiliation in the email along with the photo and caption.

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System Built for Responding to Bioterrorism Confirms Plague in Colorado Girl

Sep 13 2012 :: Published in Member News, Public Health Preparedness & Response

By Larry Sater, MS BT/CT Coordinator, Colorado Department of Public Health & Environment Laboratory Services Division

When the Laboratory Response Network (LRN) was established in 1999, the goal was to establish accurate, rapid testing methods to confirm or rule out dangerous bacteria, viruses and toxins that bioterrorists might unleash on the American public.  However, those same laboratory tools and trained staff do not sit idle waiting for a bioterrorist threat. A great success of the LRN is the day-to-day use of these resources in detecting the presence of select agents in people, pets, livestock and food during everyday life.  If you do not believe me, speak with a seven-year-old Colorado girl and her parents.

Colorado Bioterrorism Lab

Each year, and especially during the summer, the Colorado Department of Public Health & Environment Laboratory Services Division (CDPHE) laboratory is busy testing for West Nile Virus, rabies, plague and other diseases in both clinical and environmental samples.  On August 27, 2012, the lab received another one of these calls, but this one was very different.  A seven-year-old girl was critically ill and determination of the cause of her illness was critical to quickly proceed with appropriate treatment.  A courier from Presbyterian/St. Luke’s Rocky Mountain Hospital for Children delivered the specimens to the state laboratory just before noon on that day.

This was the story: While at a Colorado campground, the little girl found a dead squirrel and insisted on giving it a proper burial.  In the process, it is suspected that fleas containing the plague bacteria left the squirrel carcass and contacted the girl, inflicting several bites. The child soon became ill with a fever of 107 and required airlifting to St. Luke’s.  There, an alert physician checked both symptoms and the literature, concluding bubonic plague was a possible culprit.

The hospital collected specimens for culture and could not rule out the presence of Yersinia pestis, the bacteria causing plague.  At this point, the Laboratory Services Division was contacted and specimens collected from the girl were sent to us for confirmation testing.

Before the LRN, bacteria had to be grown in a culture for at least 1-2 days before the organism could be detected and colonies sampled for testing. However, thanks to rapid technologies adopted by LRN laboratories, the DNA for the plague bacteria was detected and identified within 2 hours of receipt of the specimens using a method called polymerase chain reaction (PCR).  A second rapid test, direct fluoroimmunoassay (DFA) which uses the antibody to the suspected bacteria, confirmed the presence of Yersinia pestis.

Thus within hours, the cause of the girl’s life-threatening illness had been identified as a presumptive positive and a confirmation test conducted that supported the physician’s suspicions.  Samples of the specimens were cultured overnight with microscopic observation of the organisms. Other tests confirmed the presence of the agent and the fact that it was still alive.

Earlier that month, two human cases of brucellosis were confirmed by the CDPHE laboratory, as well as several cases of plague in rabbits discovered in communities across Colorado.

Such specimens come in routinely to the CDPHE laboratory—all part of a day’s work for the staff.  While the LRN Network was established to rapidly confirm the presence of biological and chemical agents that could be employed in a terrorist attack, it has offered a bonus to the American public, protecting them from naturally-occurring health threats every day of the year.

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APHL Gets a Visit

Aug 14 2012 :: Published in Member News, Public Health Preparedness & Response

By Kara MacKeil, Senior Technician, Public Health Preparedness and Response

Even in an essential, exciting field like public health, summertime in the office can seem a little…slow.  You might be doing exactly the same things that filled your days in February, but when the sun is out and the temperatures are rising, it does start feel like the rest of the world is at the beach.  Even with our awesome new summer dress code, APHL’s offices are no stranger to the summer funk. So as you can imagine, we were very excited to shake up our routine with a special visit from the District of Columbia  (DC) Public Health Laboratory and their two summer interns!

Faheem Muhammed (left) and David Martin (right)

Faheem Muhammed (left in the photo), a rising senior at South Carolina State University, and David Martin (right in the photo), a recent graduate of Augusta State University, came to the APHL offices last month with the DC laboratory’s Microbiology Supervisor, Dr. Morris Blaylock.  Both interns were placed with the DC public health lab for the summer as a part of Project: IMHOTEP, a highly competitive program run by the Public Health Sciences Institute of Morehouse College.  Project: IMHOTEP is a ten week summer course that places minority students interested in working in public health with experts in the field.  Students spend two weeks in an intensive introductory course at Morehouse, and then travel to their respective placements for the remaining eight weeks.  At the conclusion of the program, each participant is required to put forward an oral presentation on their work and a written manuscript appropriate for publication.

The interns who visited APHL are nearing the end of their projects, and both have had a busy summer.  Faheem has been studying methods to trace arsenic in food under Dr. Tracie Willis, the DC public health lab’s Chemistry Supervisor.  Faheem is also interested in clinical virology and the potential to work “behind the scenes” in public health. David has spent the summer investigating alternative uses for multiplex PCR under Dr. Blaylock.  He is interested in public health in a laboratory setting, but is also considering the physician’s assistance track.

I’m sorry to say many of us here at APHL don’t get the chance to speak with potential future public health laboratorians very often.  It isn’t for lack of interest though, so when we reached out to the various APHL programs to see who would like to participate in this visit we had no problem filling the schedule.  The day started with a meeting with APHL Executive Director, Scott Becker, who gave an overview of APHL and its mission, and moved on to discussions with various other programs.  Staff members from Public Health Systems, Global Health, Public Policy, and Public Health Preparedness and Response explained in more detailed terms what their program is responsible for and how their work impacts laboratories and the greater world of public health.  APHL staff also provided lots of information on professional development opportunities and encouraged the interns to explore fellowships and other openings. Overall, APHL was very happy for the chance to meet both Faheem and David, and we wish them all the best in their careers! Visit our website for more information on careers in public health laboratories.

 

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The Louisiana State Public Health Laboratory Staff Define Resilient

Mar 15 2012 :: Published in General, Member News

By Linette Granen, Director, Membership and Marketing

Ventilation system in the inductively coupled plasma room A few weeks ago, Scott Becker, APHL’s executive director, and I visited the Louisiana public health lab outside of New Orleans and had a very interesting tour of their facility.  I have one word for those people—resilient.  Their building in downtown New Orleans was completely shut down in 2005 following Hurricane Katrina.  Right now, they are in a converted mental health clinic which in itself has caused a lot of interesting problems.  The current building has been rigged (by the assistant director, Catherine Evans) to accommodate some of the laboratory’s instrumentation.  The ventilation system in the photo of the ICM room is some of Catherine’s handy work! Steve Martin, the lab director, says that they have purchased a lot from a local hardware store.  At any moment, one of the myriad of air conditioning units is usually down.  In the molecular lab, there is no ceiling, thanks to rain damage. When it rains, it actually rains into the room.  Often employees have to mop before they can test.

A new lab is in the process of being built.  As you can imagine, the employees are extremely excited about their new building!  This move is joyful, but it’s sobering too, since the lab will be located about 100 miles from its current location (inland in Baton Rouge—away from flooding).  Many of the employees are at or near retirement age and will not move with the lab.  Here is what is going to happen:

  • The old Louisiana Department of Environmental Quality lab (DEQ; closed down a few years ago) will become the environmental and chemical lab for the public health laboratory; a new building housing the biological testing is being built.
  • The DEQ lab building is not very old, so the facilities there are perfect to house the public health lab equipment and supplies.
  • The location of the new lab is on the Capital grounds so security will be provided by the Capital police.  There will be a fence around the entire property.
  • There will be ample space for receipt of specimens, one floor with totally flexible bench space, and an open airy concept to the new building.

I used to work at the Louisiana public health lab.  As you can imagine, it was bittersweet to see the people I used to work with; we reminisced about the days before and after Katrina. That’s why I can tell you that you would have to see this to believe it!  The staff here has withstood such great tribulations and continues to carry on knowing that their mission – protecting the public’s health – is more important than anything!

As we talked to Catherine, she told us that the public health lab is still doing post-oil spill testing of the seafood that is coming from the Gulf (BP is paying for that testing).  She has a great system set up for screening and has yet to find a positive for PAHs.  As we talked about this, she mentioned that she was filmed doing these tests for MSNBC, and Jeff Corwin actually came into her lab with a film crew.

At the end of last year, there was an article in the Baton Rouge newspaper, The Advocate, regarding the new lab.  Catherine told us that the construction is ahead of schedule (how often do you hear that?) and that they are scheduled to move in March 2013.  Another interesting thing – when I was hired to work at the state public health lab in 1994, the lab director at that time (Dr. Henry Bradford) told me that we would be in a new building in about 2 years.  Of course, that didn’t happen, but the architectural firm that did the plans for that first iteration of the building is the same one that did the plans for the new building.  The head architect on the project, who was a staff architect on the proposed building in 1993, is excited to finally see this project to fruition!

Having been housed in the Louisiana State Public Health Lab from 1994 until 2005, I know very well the difficulties we all faced in the original building where asbestos remediation was under way on our floor immediately before Katrina hit.  Since then, the lab has faced many challenges including Hurricane Katrina.  The people who work in the Louisiana State Public Health Lab are resilient, to say the least.  I can’t wait to see their new facility in Baton Rouge!

 

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And the winner is… APHL Award nominations now open

Feb 14 2012 :: Published in Annual Meeting, Member News

By Linette Granen, Director of Membership and Marketing, APHL

Last night I watched the Grammy Awards presentations and I noticed that the Oscars will be on TV later this month.  What a thrill it must be to be honored with an award that symbolizes recognition of the quality of your work by your peers!  I looked up the definition of recognition and it is an “acknowledgment of achievement, service, merit, etc.”  Synonyms were listed as “notice” and “acceptance.”  Sounds nice!

Wouldn’t it be great if we could acknowledge achievement in laboratory science?  Or in public health laboratory science?   Or recognize colleagues that demonstrate creativity and support for solving the challenges that face public health laboratories?

And the answer is: yes, it would be great and we can!

Lifetime Achievement Award Winner 2011 -- Dr. Norman A. Crouch, PhD

APHL is seeking nominations now for its annual awards.  The awards recognize outstanding achievements in laboratory science, creative approaches being made to solve today’s public health challenges, and exemplary support of laboratories that protect and monitor the public’s health.  I have been with APHL for over 18 years now, so I personally know quite a few of the past recipients. They are amazing people, and I know that there are more individuals like them out there deserving of recognition.   Nominate a colleague today for one of the six awards that are available.  It only takes a short time to submit a nomination that provides the recognition many of your colleagues so aptly deserve!  The deadline for nominations is March 5, 2012.   Click here to access the awards and the nomination forms.

In April we will celebrate National Medical Laboratory Professionals Week.  Currently, the Advance magazines for medical laboratory professionals and for administrators of the laboratory are seeking nominations for their annual Laboratory of the Year and Laboratory Professional of the Year awards.  Although there are prizes for the winners and runners-up, the real prize is recognition by the laboratory community of excellence in laboratory practice.  Could an APHL member laboratory or someone who works in a member laboratory be nominated?  Absolutely!!  After all, APHL is one of the thirteen laboratory professional associations sponsoring the week.  The deadline for award nominations is Friday February 24, 2012.  You can nominate a laboratory professional here.  Nominate your public health laboratory here.

So as I watch the award shows on TV, I think of the many ways to recognize the heroes in our lives, and it extends beyond those recognized for excellence in the arts.  It extends to the many public health laboratory heroes I’ve known throughout my life.

After Hurricane Katrina in 2005, I saw first-hand the heroes of the public health labs who lost everything and were still willing to assist in carrying equipment down 125 steps to a truck so that it wouldn’t get destroyed in a mold-infested building.  I heard the concern in the voices when I notified them that I had received newborn screening specimens at my house since mail service was totally disrupted following the hurricane.  I saw and commiserated with those heroes of the Louisiana State Public Health Laboratory following Hurricane Katrina whose stories are yet to be written.

I know that there are so many like them in all of the APHL member laboratories.  Recognize them this year and acknowledge their achievements with a nomination for one of the APHL Awards.  Please!  And the winner will be all of us!

 

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Hawaii’s Unique Public Health Challenges: Rat Lungworm

Jan 25 2012 :: Published in Infectious Diseases, Member News

By Caitlin Saucier, CDC/APHL Emerging Infectious Diseases Laboratory Training FellowState Laboratories Division, Hawaii Department of Health

One of the best perks of living in a tropical climate is having access to fresh produce year-round. However, a rare disease called rat lungworm has recently gained the attention of the medical community in Hawaii and elsewhere, and may make you think twice before you chop up a head of lettuce from your home garden.

You probably have never heard of rat lungworm disease, which is caused by a parasite, Angiostrongylus cantonensis. This tiny worm lives in southeastern Asia, the Pacific Islands (including Hawaii), Louisiana, Australia, Africa and the Caribbean. Although the parasite appears widespread in nature, fortunately the disease is rare with fewer than 3,000 cases reported worldwide since 1945. In Hawaii, 9 cases were reported in 2011 and a particularly severe case was documented in 2009.

Angiostrongylus cantonensis

Adult worms live in the pulmonary (lung) arteries of rats. Rats that are infected pass the parasitic larvae in their feces. When snails and slugs eat the feces, the larvae grow into the infective stage in their bodies. Humans become infected by eating raw or undercooked snails, slugs, shrimp, crabs, or frogs that contain the larvae. In western diets, this usually happens accidentally; small slugs or snails that feed on produce escape washing and are consumed. It’s easier than you might think to miss a small creature hiding out in the folds of a leafy vegetable. Once consumed by a human, the larvae cannot finish their lifecycle and bury themselves in the tissue of the nervous system, including the brain. This causes the body to mount an immune response that eventually kills the invaders. However, this response causes inflammation and swelling of the protective covering of the brain and the spinal cord, a condition known as meningitis. Common symptoms of meningitis include stiff neck, headache, a low-grade fever, pain or tingling in the skin, nausea, and vomiting. Eosinophilic meningitis (a form of meningitis characterized by eosinophils, a type of white blood cell) suggests rat lungworm disease because parasites are potent stimulators of this cellular immune reaction. The disease usually clears up on its own without medical intervention; however, in severe cases it can cause coma, brain damage, and even death. Diagnosis of the disease can be difficult and is usually based on the patient’s food history.

The State Laboratories Division of the Hawaii Department of Health is collaborating with the Centers for Disease Control and Prevention to establish performance characteristics of real-time PCR (a technique that allows a targeted DNA sequence to be amplified and quantified at the same time) to detect rat lungworm in patients. It is hoped that this assay may improve diagnostics inHawaiiand elsewhere. Treatment is non-specific and usually includes reducing central nervous system pressure, medications that reduce the body’s inflammatory response and pain management.

Fortunately, there are common-sense precautions that can prevent transmission of the disease. If you are in an area where this parasite is found, don’t eat raw or undercooked snails, slugs, frogs, shrimp, or prawns, as tempting as they may be. Always carefully wash fresh produce, and discard any that has damaged skin as this can indicate the presence of slugs or snails. The next time you are traveling go ahead and enjoy the local treats, but know the exposure risks and keep in mind that simple preventative measures can prevent a devastating disease from harming you and your companions.

Part of a series — Read Part 1: Hawaii’s Unique Public Health Challenges

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