Archive for the 'Public Health Preparedness & Response' category

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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In US, Massive Effort to Detect and Respond to Ebola Already Underway

By Tyler Wolford, MS, Specialist, Laboratory Response Network, APHL

Our curiosity and fears have been running wild since the 2014 Ebola* outbreak in West Africa hit headlines. Scenes from Outbreak, the 1995 box office hit that focused on a fictional outbreak of an Ebola-like virus in Zaire, begin running through our minds. We need to stray from these dramatizations and focus on the facts. Movies are supposed to build suspense and fear, but real life outbreaks don’t happen like they do in the movies. This isn’t Hollywood.

In US, Massive Effort to Detect and Respond to Ebola Already Underway | www.aphlblog.orgThe most common question on the minds of people around the United States: Are we fighting Ebola well enough to keep it from coming to my community?

The truth with many emerging infectious diseases including Ebola, is that the only way to fight it is to be prepared to respond. In the United States, we’re doing just that.

Although the Ebola-Zaire virus circulating in West Africa has not arrived in the United States, a massive effort is underway to detect and control any isolated cases of the disease should they occur in this country. The Centers for Disease Control and Prevention (CDC), the United States Department of Defense (DoD), pharmaceutical companies, public health laboratories and many more are all working domestically and abroad to minimize the potential threat. The DoD has long been studying Ebola virus and successfully developed a test to detect the Zaire strain. On August 5, 2014, the DoD Ebola detection test received emergency use authorization (EUA) by the Food and Drug Administration (FDA) to be used in this extreme circumstance. (An EUA expedites the FDA approval process for unapproved medical devices that could benefit response efforts when no adequate alternatives exist.) After the EUA was issued, CDC worked quickly to deploy the test to select public health laboratories across the United States. As the supply of test kits increases, CDC will look to expand the number of laboratories qualified to detect the Ebola-Zaire virus.

The public health laboratories receiving the Ebola detection assay are part of the Laboratory Response Network (LRN), a specialized network of laboratories that are capable of responding to biological, chemical, radiological and other emerging threats. This preparedness and response effort is not unique to Ebola. Most recently, the LRN has been leveraged to respond to emerging infectious diseases like Middle East Respiratory Syndrome – Coronavirus. The LRN provides a strong infrastructure of trained personnel, clear communication lines, and advanced technology to launch an effective response to emerging infectious disease.

The race to contain Ebola is on since the World Health Organization (WHO) declared the Ebola outbreak a Public Health Emergency of International Concern (PHEIC) in early August 2014. Moreover, the CDC has activated its Emergency Operations Center at the highest response level to help with the outbreak. As Dr. Tom Frieden, CDC director, said in a press conference this week, “We know how it spreads. We know how to stop it from spreading. The challenge is to do that everywhere that’s needed. In order to do that effectively, speed is key.”

While we all are concerned for the health and safety of the people in the most affected nations, we can find some comfort in knowing that a coordinated effort of qualified scientists, doctors, public health officials and organizations is underway to minimize the threat of outbreak in the US.

*Did you know there are five known strains of Ebola virus? The most dangerous one, Ebola-Zaire, is responsible for the outbreak in West Africa. The virus spreads person to person through direct contact with blood and other bodily fluids; despite what you may have read in fear-mongering articles, the spread of the virus through the air has never been documented. Once inside the host, the virus works by weakening the immune system and starving the host organs to the point of failure.


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MERS-CoV: Why We Are Not Panicking

By Tyler Wolford, Specialist, Laboratory Response NetworkPublic Health Preparedness and Response Program; and Stephanie Chester, Senior Specialist, Influenza Program, Infectious Disease Program, APHL

MERS-CoV: Why We Are Not Panicking | www.aphlblog.orgBy now you have probably heard that CDC has confirmed two cases of Middle East Respiratory Syndrome (MERS-CoV) infection in the US. Both were imported from Saudi Arabia; travelers became sick on their journey and sought care here in the US. This is the kind of stuff that typically gets us, infectious disease and preparedness folks, amped up, reaching for coffee and telling our loved ones we might be working late. We know that MERS-CoV is a serious infection – as of mid-May 2014, there have been 536 laboratory-confirmed cases and 145 deaths of MERS-CoV. However, the laboratory community is accustomed to responding to these situations—and that’s good news for public health. We have written, tested and rewritten preparedness plans, policies and procedures for dealing with novel and/or unexpected events and pathogens. We have dealt with white powders (more times than we can count), influenza A(H3N2)v, re-emerging vaccine preventable diseases and many other threats. In addition, we were given a lengthy (roughly two-year) heads-up with MERS-CoV. And while we know not to expect this luxury every time (we’re looking at you, 2009 H1N1 pandemic), the lead time meant that CDC, public health laboratories, health departments and clinicians were alerted and prepared well before the first US two cases occurred. Efforts by CDC and the public health labs ensured that, when the first cases arrived, they could be rapidly identified so proper precautions and epidemiologic investigations could begin. What are the reasons for our relative calmness despite the arrival of MERS-CoV on our shores? We were – and still are – prepared as the case count mounted on the other side of the Atlantic. Here are the specifics:

  • Planning. MERS-CoV was first reported in 2012 in Saudi Arabia. Once transmission became sustained in the Middle East, public health officials knew it was likely that a case would arrive in the US: we just didn’t know when. We had time to plan our response.
  • An approved test. CDC rapidly developed a real-time reverse transcriptase polymerase chain reaction (rRT-PCR) test which was granted emergency use authorization (EUA) by the FDA on June 5, 2013, and deployed the same month to 44 state public health laboratories and one local public health laboratory.
  • Infrastructure. The Laboratory Response Network (LRN) provided critical infrastructure for rapid distribution of the MERS-CoV test to public health laboratories across the US.
  • Training. Once laboratories received the test, they trained their staff and completed proficiency testing to demonstrate that they were trained and ready to perform testing should the need arise.
  • Experience. With health departments and physicians on alert, over 150 patients with MERS associated symptoms have been tested using the CDC assay. All were found to be negative.  This testing provided valuable opportunities for laboratories to familiarize themselves with the test.
  • Communication. CDC, APHL and other partner organizations have maintained timely communications with states, and others partners to keep everyone abreast of the current situation.
  • Dedication. Our public health labs are full of amazing scientists who are willing to spend countless hours, seven days a week to ensure rapid test results.

So if we aren’t panicking now that we have MERS-CoV cases in the US, what are we doing? We’re sprinting to keep pace with MERS-CoV and so far we have performed well, managing every step in the process with precision.

  • Indiana promptly notified CDC of a presumptive positive MERS-CoV infection and CDC rapidly confirmed this result.
  • CDC and Indiana started epidemiologic investigations and tested samples from close contacts of the infected patient.
  • APHL and CDC began communications immediately after the first case was confirmed.
  • APHL, in collaboration with CDC, held a laboratory alert call on May 6, 2014, to provide state and local public health labs with a situational update and to review laboratory testing guidance.
  • Currently CDC is distributing new proficiency testing panels so labs can refresh their competency on the CDC MERS-CoV test.

MERS-CoV is a serious threat that deserves the highest level of preparedness and attention.  Fortunately for the American public, we in the public health system are poised to handle MERS-CoV and other health threats whenever, wherever and however they enter our country. This is why we aren’t panicking, but it’s also why public health requires steady support.  Pathogens have no regard for budgets, funding cycles or economic trends. They won’t wait, and neither can we.

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USAMRIID: Biodefense from the Cold War to Present Day

Jan 08 2014 :: Published in Public Health Preparedness & Response

By Chris Chadwick, Specialist, Public Health Preparedness and Response, Tyler Wolford, Specialist, LRN, and Kara MacKeil, Associate Specialist, Public Health Preparedness and Response

Many of us in public health have become familiar with the US Army Medical Research Institute of Infectious Diseases (USAMRIID) and its role in scientific research and biodefense. However, what we don’t see in the movies is its long-term and far-reaching involvement in the overall preparedness of our nation.  APHL’s Public Health Preparedness and Response (PHPR) team recently visited USAMRIID at Fort Detrick, MD, as part of the Laboratory Response Network’s (LRN) Operational Workgroup, and we were fortunate to spend some time touring the facilities and learning more about USAMRIID’s history.

USAMRIID: Biodefense from the Cold War to Present Day |

Officially created in 1969 when the existing US Army Medical Unit (USAMU) was renamed, USAMRIID’s stated mission is: “We conduct research on current and emerging biodefense threats, resulting in medical solutions to protect the warfighter.” The benefits of the facility’s research aren’t limited to the armed forces though.  USAMRIID’s work includes vaccine and treatment research, and their scientists offer expert consultation and training for medical personnel. During our tour we also learned that one of the first ever laboratory gloveboxes was put together in the Fort Detrick machine shops in the 1940s.

There are more interesting things than gloveboxes in Fort Detrick and USAMRIID’s history though.  One of the most thought-provoking things we observed on our tour was USAMRIID’s famous Eight Ball, a piece of US history that’s protected under the National Register of Historic Places. This one million liter metal sphere is currently tucked away behind a service building, but at one point it was the epicenter of Operation Whitecoat, the US Cold War biodefense program.  From the 1950s through the ‘70s, researchers developing treatments for biological agents released small amounts of these selected agents into the eight ball, allowed them to disperse, and then exposed volunteers to this contaminated air via specially rigged gas masks.  By treating the volunteers (who signed consent forms) with their newly developed vaccines and therapies, scientists were able to develop effective methods to respond to biological warfare. Whitecoat volunteers were exposed to agents that cause diseases such as rabbit fever (tularemia), Q fever, yellow fever, and plague.

Operation Whitecoat and the eight ball experiments may seem shocking to modern readers, but the volunteers were scrupulously screened and educated on the risks and gory details before agreeing to participate.  They received the best medical attention possible at the time, and they were free to end their participation at any point.  Although work in the eight ball was discontinued in the mid 70s, many still return to USAMRIID for annual get-togethers commemorating their work.

Of course, the work didn’t end with Operation Whitecoat.  National laboratories like USAMRIID are the pinnacle of the Laboratory Response Network (LRN), and are responsible for specialized strain characterizations, bioforensics, and handling highly infectious biological agents. These activities require significant planning and state of the art facilities to ensure the safety and security of scientists and that the right results are obtained.

Although most LRN testing at USAMRIID is done in Biosafety Level 3 (BSL-3) equipped laboratories, it is one of a few laboratories in the United States that has BSL-4 facilities. Biosafety level is the level of biocontainment required to work with specific biological agents based on the risk posed by the agent and the activities required for testing. Each level requires a unique set of safety equipment, facility designs, and practices that reduce the risk of laboratory-acquired infections. BSL-4 laboratories are equipped to handle the most dangerous organisms, such as Marburg, Ebola and Smallpox viruses that are highly infectious and potentially lack countermeasures (prevention and treatment).

The most noticeable difference in BSL-4 laboratories is the use of full-body pressurized suits, often referred to as “space suits.” For reference, imagine the movie scene from E.T. the Extraterrestrial where the space garbed scientists ominously invade a home searching for the alien. These suits are the highest form of personal protective equipment and are required for work in BSL-4 labs. BSL-4 also requires scientists to take chemical showers, enter vacuum rooms, and be exposed to UV light in order to destroy any trace amounts of the organisms after testing.

USAMRIID is a vital resource for definitive testing of emerging high-risk biological threats. For an interesting read, check out The Hot Zone written by Richard Preston, which highlights USAMRIID’s involvement in the 1989 discovery of Reston virus, a mutated strain of Ebola virus that surfaced near the nation’s capital.

USAMRIID is also heavily involved in the training of first responders across the world, including hazardous materials teams and National Guard Civil Support Teams (CSTs), tactical response teams, emergency communications, and others. These trainings have gained significant respect in the public health and public safety communities. In addition to their high quality, the trainings are standardized, so a team from Washington will receive the same training and competencies as a team in Maryland. These courses have also benefitted from partnership with other LRN members over the years, allowing USAMRIID to truly integrate all players involved in a typical threat response. For example, we learned of several instances where public safety (law enforcement and fire) was integrated with one of APHL’s own member laboratories to provide on-scene screening and then confirmatory analysis via the LRN.

USAMRIID’s Field Operations and Training Branch (FO&T) provides two courses to first responders: the Biological Agent Identification and Counterterrorism Training (BAIT) and the Field Identification of Biological Warfare Agents (FIBWA) Course. BAIT provides first responders with one- or two-day realistic bioterrorism scenarios that require an integrated response, emergency communications, rapid decision making, analysis of biological threat agents, and an after action review once the exercise is complete. During APHL’s visit to USAMRIID, we had the opportunity to tour the onsite facilities that FO&T utilizes for these training scenarios. The facilities are actual trailers that have been rigged to serve as mock clandestine laboratories. As part of the scenarios, supposed terrorists have a DIY setup for weaponizing agents (e.g., making anthrax-like powders to stuff into envelopes and packages). To test the first responders, there are clues throughout the trailer (think quirky living arrangements, basic chemistry textbooks, and large plastic containers…the kind of stuff you probably saw in Breaking Bad) that suggest the presence of a clandestine lab. Another scenario involves searching a packed storage unit (a replica from an episode of Hoarders, probably) for suspicious powders; participants especially dislike this one because they’re required to remove and test every piece of equipment even though the powder is rather easy to find. The BAIT program is nationally recognized as a premier course for all first responders, and therefore, FO&T is constantly training a variety of groups from all over.

FO&T’s other course, FIBWA, provides first responders with an intensive four-week syllabus on conducting laboratory operations under field conditions. Participants become very familiar with agent detection assays over the four weeks as they work to extract nucleic acid, perform polymerase chain reaction (PCR), and practice electrochemiluminescence (ECL) to detect threat agents and toxins. FO&T has several mobile laboratories at their disposal, so the trainees must adapt to tighter, more consolidated spaces. FO&T can host the trainings at Ft. Detrick, but the mobile labs do travel well so trainings can come to you.

USAMRIID is truly instrumental in national biodefense history, response, research, and training, and has outstanding resources for APHL’s membership.

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Looking Back at Superstorm Sandy: Preparedness for the Public Health Laboratory

Oct 29 2013 :: Published in Public Health Preparedness & Response

By: Scott Hughes, PhD, Chief of Emergency Preparedness & Response, New York City Public Health Laboratory; and Christopher Chadwick, MS, Specialist, Public Health Preparedness and Response, APHL

Public health laboratories work tirelessly to protect our nation from a multitude of threats—suspicious powders, foreign viruses, and even molasses spills. But how do the laboratories protect themselves in the face of danger? As we mark the one-year anniversary of Superstorm Sandy, we’re reminded exactly how they do so.

Looking Back at Superstorm Sandy: Preparedness for the Public Health Laboratory |

On October 22, 2012, Tropical Depression 18 slowly churned in the southern Caribbean. Despite an inconspicuous start, the tropical depression amped up to become Tropical Storm Sandy and then Hurricane Sandy just two days later. Within a week, Hurricane Sandy marched up the east coast to meet a cold front thus creating Superstorm Sandy, an epic rain, wind, and snow event, which had only ever existed in Hollywood blockbusters. On Monday, October 29th Sandy struck New York City.

While Sandy began its havoc in the Caribbean, the New York City Department of Health and Mental Hygiene ramped up its preparations and activated the Incident Command System on Friday, October 26th.  Would the storm actually hit New York City?  As we now know, the storm was devastating.  Much of Lower Manhattan flooded. Fortunately, the New York City Public Health Laboratory avoided severe damage but only had emergency power in certain areas — a limitation that didn’t stand in the way of performing essential testing.

The lab had work to do despite what was happening around them. On Wednesday, October 31st, just two days after Sandy struck New York City, the laboratory’s bioterrorism staff was sent a suspicious powder for testing, a task that is commonplace for them.  But the circumstances were quite different – this was a challenging Halloween treat for the staff! Despite facing the apocalyptic storm, working with limited power and Internet connectivity, and lacking many staff members who were unable to get to work, the New York City Public Health Laboratory maintained bioterrorism testing as an essential function.  The testing was completed quickly as usual, demonstrating how resilient our public health laboratories are during crises. (Testing showed the powder was negative for potential biothreat agents.)

By November 5, the New York City Public Health Laboratory was fully functional and resumed all testing.

Early decisions were critical for the laboratory to protect itself and its staff. Continuity of Operations Planning (COOP) can be a vital resource for all laboratories when making decisions such as what testing should be maintained, what testing can be shared (e.g., the New York State Department of Health in Albany helped out with tuberculosis testing during Superstorm Sandy), and which staff are essential. Public health laboratories are trained to expect the unexpected, and with the help of COOP, the laboratories continue offering essential public health services, which is a true reward of proper preparedness.

Reminder: Hurricane season lasts until November 30th. Preparedness is a continuous process, so be sure to get a kit, make a plan, be informed, and get involved!

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What Exactly Does the Shutdown Mean for Public Health?

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? |

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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The Hype Surrounding MERS-CoV: Should We Be Worried?

By Tyler Wolford, MS, Specialist, Laboratory Response Network, APHL

If this is your first time seeing a virus up close you probably weren’t aware of their unnerving appearance: their outer membranes fortified with menacing protrusions built for one thing, to get you sick. Of the thousands of viruses known to exist, one in particular has been of interest lately: the Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV). MERS-CoV is a novel coronavirus closely related to the Severe Acute Respiratory Syndrome (SARS) Coronavirus that was responsible for 774 deaths (9.6% fatality) in south China back in 2002 and 2003. Within a few months, SARS had spread to over 37 countries with a final count of over 3000 cases. All coronaviruses present similar symptoms (e.g., fever, cough, and shortness of breath), but unlike SARS, MERS-CoV transmission is not known to transmit person to person, giving some relief to public health officials. However, viruses are known to evolve quickly, causing concern for the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). If MERS-CoV secures a foothold and a source isn’t found, the world could be facing another outbreak eerily similar to that of SARS in the early 2000s.

As of September 25, 2013, the global count for MERS-CoV cases has risen to 130. You may be thinking that doesn’t sound like a big deal considering there are over 6 billion people in the world, which results in one case for every 60 million people. The staggering fact to keep an eye on is the close to 50% case-fatality rate. Furthermore, health officials still aren’t able to narrow down the source of the virus. Several virologists have suggested bats to be a host, noting that bats are carriers of a number of coronaviruses and nucleotide sequencing of bats in the area has shown promising matches to the virus found in patients. However, there is a high chance these positive matches could just be a related coronavirus and not specifically MERS-CoV.

Rest assured that no cases have been reported in the United States…yet. Most have been isolated to the Arabian Peninsula with few reports in Europe associated with people who have recently traveled to those countries on the peninsula. Although there is little you can do to protect yourself, public health organizations are diligently working to prepare in the event that cases present in the United States. Currently, CDC has issued guidance to health care providers who suspect a MERS-CoV infection. The CDC has also implemented polymerase chain reaction (PCR) testing capabilities at their headquarters. Since there were no FDA approved tests at that time, CDC was approved for emergency use authorization (EUA) to perform testing immediately. Since CDC began testing, 46 public health laboratories and four Department of Defense (DOD) laboratories have implemented such testing. The CDC utilized the Laboratory Response Network to efficiently implement testing across the United States. The use of the LRN to respond to emerging public health threats is nothing new – the network was leveraged for responses to anthrax, West Nile virus, H1N1, SARS and other recent threats such as ricin. The WHO and CDC continues to monitor this emerging virus.

For more information of MERS-CoV, please visit the CDC’s MERS-CoV information page.

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Massive Molasses Mess and the Laboratory Response

This month is National Preparedness Month.  Follow APHL on our blogTwitter and Facebook for preparedness information and discussions all month!


By Megan Latshaw, Director, Environmental Health Program, APHL

“It was shocking because the entire bottom is covered with dead fish. Small fish, crabs, mole crabs, eels. Every type of fish that you don’t usually see, but now they’re dead. Now they’re just laying there. Every single thing is dead. We’re talking in the hundreds, thousands. I didn’t see one single living thing underwater.” ~ Roger White, a diver (Massive Molasses Spill Devastates Honolulu Marine Life, NPR)

Massive Molasses Mess and the Laboratory Response) |

We’ve all heard of killing someone with kindness, but who knew that sweetness could deal such destruction? The sweetness comprises almost 250,000 gallons of molasses, spilled into Honolulu harbor on September 9th as it was being loaded into a ship via pipeline.

Because the greatest priority relates to public health, the Hawaii Department of Health is leading the response rather than the US Environmental Protection Agency or the US Coast Guard.

Their State Laboratories Division will be doing bacteria testing (enterococci, clostridium and total).  Since this spill is relatively unprecedented the first two bacterial tests were chosen because 1) Hawaii has a lot of data on them and 2) they are currently used to monitor water quality. Scientists are not sure how the spill will affect these indicators but they theorize that the dead fish and the nutrient-rich liquid could lead to unusual growth in marine algae and harmful bacteria. These data plus some chemistry and physical parameters will help them figure out when things are starting to get back to normal.

Meanwhile, the laboratory expects to run out of supplies for this valuable testing.  They have called upon their peer network to borrow and replace consumables from their labs, on the outside possibility that their suppliers cannot provide them with the necessary materials quickly enough. Such outreach emphasizes the importance of building relationships through networks such as the Laboratory Response Network and the Environmental Response Laboratory Network.

Click the image above for an interview with Hawaii’s public health laboratory director and many of their staff.

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What is the EPA’s Water Security Division?

This month is National Preparedness Month.  Follow APHL on our blogTwitter and Facebook for preparedness information and discussions all month!


By Michael Heintz, MS, JD, Senior Specialist, Environmental Laboratories

What is the EPA’s Water Security Division? |

As we continue our march through preparedness month, did you know there are people devoted to protecting our water infrastructure?

Before you think, “right, it’s the EPA and they use the Clean Water Act.” While you’re partially right, it is a division within the US EPA, you should know this division works exclusively at protecting drinking water and wastewater treatment plants, pipes, and other physical components of the system. The Water Security Division (WSD) works to prevent, detect, respond to and recover from water hazards. These threats can include purposeful contamination of a drinking water system, a natural disaster, or an accident that threatens the water health of a community.

The WSD has four goals to advance the efforts to protect water infrastructure:

1. Sustain protection of public health and the environment;
2. Recognize and reduce risk;
3. Maintain a resilient infrastructure; and
4. Increase communication, outreach and public confidence.

The WSD works with the nearly 160,000 public water systems (PWS—drinking water distribution), and 16,000 publicly owned treatment works (POTWs—wastewater treatment) to help ensure safe and secure distribution of drinking water and collection and treatment of wastewater. All told, public water systems serve nearly 84%, and POTWs service almost 75%, of the US population. The rest are served by private water systems (like wells) and septic systems

The Water Security Division undertakes a number of activities every year to help ensure the safe operation of the nation’s water infrastructure. The WSD provides resources and programs to address critical issues like intentional contamination, contamination detection, mutual aid, vulnerability assessments, emergency response capabilities, communication strategies, and how to monitor incidents and threats. In addition, the WSD developed a number of tools that drinking water and wastewater facilities can use to increase their own preparedness levels.

One particularly active portion of the WSD is the Water Laboratory Alliance (hey, this is a laboratory blog, after all!). This laboratory-specific portion of the WSD provides laboratories with resources to help them respond to a water security threat. Of particular importance, the WLA provides training and exercise opportunities, communication outlets, and tools for emergency response. The WLA Response Plan goes so far as to outline the steps laboratories should undertake when responding to a water emergency.

With all of these resources at their disposal, drinking water and wastewater systems should be well prepared for an emergency scenario. If you have questions about your water systems, you can contact EPA at the Safe Drinking Hotline either via email or at 800-426-4791. Or, review the Hotline Reports to see answers to prior questions. Your individual utilities can also answer specific questions or review the Safe Drinking Water Information System to see what is in your water.

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Leveraging Public Health Laboratory/First Responder Partnerships

Sep 11 2013 :: Published in Public Health Preparedness & Response

This month is National Preparedness Month.  Follow APHL on our blogTwitter and Facebook for preparedness information and discussions all month!



By: Christopher Chadwick, MS, specialist, Public Health Preparedness & Response, APHL

Since the morning of September 11, 2001, the American view on terror has changed drastically, and with that, so has public health preparedness and response. Over this last decade, terrorism has become not only a household word but also a public health priority. As we enter Preparedness Month, we’re reminded of the events 12 years ago that caused public health preparedness and response to focus on both natural disasters and intentional attacks.

The fall of 2001 was a defining time for public health laboratories. It was the anthrax letters mailed to several media outlets and United States Senators that brought this form of bioterrorism in the U.S. to the forefront of national news. Still in its infancy, the Laboratory Response Network (LRN), which was created in 1999 to increase bioterrorism and chemical terrorism response capabilities, established itself as a key force for national security as the anthrax letters circulated. In fact, a Florida LRN laboratory was one of the first to recognize inhalational anthrax from a sick person, thus beginning the influx of human samples and laboratory tests conducted by the LRN. These events highlighted the importance and strength of the LRN, and although it wasn’t a household name, the LRN certainly became a name that the public health world knew and valued.

Testing for anthraxFast-forward to 2013 and public health laboratories have added a variety of gadgets to their utility belts to uphold their public health preparedness and response core function (they actually have 11 core functions total that support all of public health). The laboratories continue testing for anthrax but also other potential bioterrorism and chemical terrorism agents, including the recently infamous ricin toxin. These utility belts contain not only actual gadgets (e.g., advanced diagnostic technologies) but also active partnerships comprised of an intense network of players, including hospital and private laboratories, law enforcement, fire departments, and federal programs.

In 2001, the partnerships between the public health laboratories and first responders (e.g., police, fire, hazardous materials teams) facilitated the anthrax response, and since then, these partnerships have only grown stronger. Daily, states continue to see letters and packages containing suspicious powders. And although these powders are typically of the powdered sugar or baby powder varieties, first responders and public health laboratories continue to respond as rapidly as ever. Who knows when the next suspicious powder with an actual threat will emerge (this year’s ricin letters showed us that this form of terrorism is still quite popular), but what we do know is that the public health laboratory/first responder partnerships will always be leveraged to ensure that the nation’s security is upheld.

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