Anthrax in Minnesota? The Laboratory Response Network Springs Into Action

Mar 05 2013 :: Published in Public Health Preparedness & Response

By Kara MacKeil, Associate Specialist, Public Health Preparedness and Response, APHL

Picture a small rural hospital in northern Minnesota.  A man walks into the emergency room late in the afternoon complaining of flu-like symptoms. He’s admitted and at first seems stable, but rapidly deteriorates.  As he is transported by helicopter to a larger hospital for advanced treatment, his condition plummets en route and survival seems increasingly unlikely.  The backstory: The man was three weeks into a road trip and could have passed this fast-acting, apparently lethal bug on to any number of people.  Sounds like the script pitch for Contagion 2, right?  Mystery illness in Minnesota, I can see it now.*

But while it sounds like a script pitch, this actually happened in the fall of 2011, with Bacillus anthracis, as the causative agent of anthrax, as the starring villain.  There was one very important change to the storyline though.  Thanks to the efforts of the laboratorians at Lake Region Healthcare in Fergus Falls, Minnesota, and the Minnesota Department of Health Laboratory Response Network (LRN) staff, the mystery bug was identified in time to provide treatment, and the patient is alive and well today. Maureen Sullivan of the Minnesota Public Health Laboratory told us the story of the legwork that went in on the laboratory side, and it would definitely make for a pretty good movie!

First, a word on the LRN.  The LRN was developed in 1999 by the Centers for Disease Control, APHL, the Federal Bureau of Investigation (FBI) and the Department of Defense.  Today, there are two main arms of the LRN: chemical and biological threats preparedness and response (LRN-C and LRN-B), which provide a strong, unified system of laboratories that can respond to any threat.  There are standard protocols for everything, and regular trainings to keep everyone up-to-speed. In the LRN-B, Sentinel Level laboratories like the Lake Region Healthcare Laboratory can rely on reference laboratories such as the Minnesota Public Health Laboratory, and the Minnesota Public Health Laboratory, in turn, can call on resources within the CDC. Further, the Minnesota Public Health Laboratory can leverage partnerships with the local law enforcement, FBI and the National Guard Civil Support Team.  From the first culture to the final treatment, the Minnesota anthrax case was a perfect illustration of what dedicated laboratory and first responder professionals can do with the strength of the LRN behind them.

Testing for anthrax

Back to our story.  The patient in question was a 61-year-old Florida man who had been driving through the northern plains states for the past few weeks with his wife, taking in your standard tourist attractions and enjoying the scenery. (Can’t you picture the opening montage of our movie?)  He had a previous history of pneumonitis and had been exposed to Agent Orange in the Vietnam War, but was otherwise healthy.  When he arrived at Lake Region Healthcare on a Thursday afternoon, there wasn’t anything to suggest that he might be infected with a deadly biological agent, so the hospital began its standard protocol for flu-like symptoms and sent blood cultures to the laboratory.  These cultures were examined that Friday morning and, after finding all four to be positive, the laboratory technician followed LRN sentinel protocols and plated all four to watch for growth.  Normally samples like these would have been checked again at about noon on Saturday, but the laboratory technician was suspicious and made a point to look at them again later Friday afternoon.  Cue the ominous music and enter the Minnesota Public Health Laboratory, an LRN Reference Lab, at camera left, because those plates had growth!

Realizing what she might have on her hands, the sentinel laboratory technician made a call to the MN public health lab to let them know what was happening, and then personally packaged the samples and drove them to the delivery drop box to ensure they would arrive at the state laboratory the next day. Thanks to her diligence, the plated samples arrived at the state laboratory about 24 hours early, at 11 AM Saturday morning, and Sullivan says when the on-call molecular biologist opened the box, “she looked at the colonies, closed it right up, went and called her husband and said ‘I think I might be here for a while.’”

Sullivan got the call with positive results for B. anthracis spores at 2:30 PM that afternoon (while on a family vacation, I might add) and started making phone calls.  The submitting hospital had to be notified so treatment could begin as soon as possible, but positive anthrax findings don’t stop with identification.  Because anthrax is so dangerous, the Minnesota LRN-B’s next task was to determine whether this patient was deliberately infected.  This is the point in our script where the military enters, in the form of the National Guard’s 55th Civil Support Team (CST).  The Minnesota laboratory conducts regular trainings in conjunction with the 55th CST, and they have a great working relationship. In conjunction with the National Institute for Occupational Safety and Health (NIOSH), the 55th CST and two representatives from the Minnesota laboratory (Sullivan included) spent a day combing over the patients rental car, removing anything that might give them a clue as to where the spores had come from.  Altogether they collected over 50 samples, including the patient’s boots and a set of deer antlers.  While none of the samples collected from the car tested positive, Sullivan notes, “It was a very good collaboration with the CST team and with our partners at CDC to put the environmental sample plan together.”

Testing for anthrax

Meanwhile, the patient’s condition had deteriorated.  On Sunday, he was loaded into a medevac helicopter and sent south to a larger hospital for treatment. Despite a nail-biting collapse en route, doctors were able to stabilize him, and the following day a team from the CDC administered emergency treatment.  It’s important to note that this treatment would not have happened without the positive B. anthracis identification from the Minnesota State Public Health Laboratory. That treatment, coupled with the early changes to the patient’s antibiotic regimen after the positive identification, is likely the reason the patient recovered completely.

Like any good movie, this story leaves a few questions behind.  First, where did the anthrax come from? While the movie version of this story would probably end with some hint at nefarious origins in order to create a sequel, the truth is it was probably a complete coincidence.  Anthrax is found naturally in all seven continents and lies dormant in soil for hundreds of years.  The spores can reactivate when they are kicked up and inhaled, commonly by grazing animals.  Our patient had spent some time on his road trip collecting rocks from riverbeds, and at one point drove past a large herd of grazing buffalo.  It’s probable that he inhaled some spores (and it would only take one) in one of these locations, but we will truly never know. You may also be wondering why the patient’s wife didn’t get sick, despite being in all the same places and presumably getting the same exposures.  It’s possible that the patient’s history of lung problems might have made him more susceptible, but again, there is no way to know.  She may have just been very lucky.

Despite these questions, the reality remains that without the smooth functioning of the LRN-B, this could have been a very different story.  But thanks to the dedication of a wide variety of people, the patient was on the road to recovery a mere four days after the initial blood cultures were drawn.  “I think what this really showed us was that all of the efforts we’ve put forth for our training really have made a difference,” says Sullivan. “All of those things really came together and we had a very successful response.”

In conclusion, Contagion 2: LRN in Action.  Get the popcorn!

*Speaking of Contagion, my friends in Minnesota would probably like me to point out that this case study does an awesome job of refuting the movie Contagion’s very unflattering portrayal of Minnesota public health and emergency response systems.  Despite what Steven Soderbergh may have you believe, when trouble arrives in real life, Minnesota is on its game!

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Laboratory Response Network: Texas Style

Feb 21 2013 :: Published in Public Health Preparedness & Response

By Kara MacKeil, Associate Specialist, Public Health Preparedness and Response, APHL

Dallas County Police

When was the last time you went on an evening hayride at a meeting, or had homemade barbecue brisket for dinner? If you’re part of the Texas Laboratory Response Network (LRN), it wasn’t that long ago.

Everything really is bigger in Texas, and the Texas slice of the LRN is no exception. Texas has ten member laboratories at the Reference Level, and those labs work extensively with organizations such as the Texas State Chemist, the Brooke Army Medical Center, and the Federal Bureau of Investigation (FBI). This makes for a large, varied network of people and, while conference calls have their place, once a year or so the Texas Department of State Health Services (TX-DSHS) convenes these laboratories and other partners for an in-person meeting. It’s a great chance for the laboratories to address issues specific to Texas, share successes and problems, and build relationships for a stronger network. I was lucky enough to be invited to observe the meeting this year, along with two other APHL staff members, Chris Mangal, director of public health preparedness and response (PHPR), and Peter Kyriacopoulos, senior director of public policy.

Texans being Texans, this meeting doesn’t take place at some sterile airport hotel.  As you might guess from the aforementioned hayrides and barbecue, this meeting was held at a dude ranch, specifically the Mayan Ranch of Bandera, TX. Far from being distracting, the relative isolation of the ranch completely cuts out the usual attrition to local tourist spots. And unlike meetings in big cities, the cost is low and there’s only one place (and time) for meals and limited activities for your evenings, so you end up spending a lot more time with your fellow attendees than you might otherwise.  It’s all Texas laboratory talk, all the time, and the end result is a lot more brainstorming than you often get at large meetings.

Packaging & Shipping Training

Like any state, the laboratories of Texas have some unique challenges and it was interesting to learn more about them.  One issue that never occurred to me as a native New Englander was fertilizer control.  Texas is a big agricultural state so there are plenty of farmers who need fertilizer for their soil, but it can also be used for bomb-making. To prevent this, the Texas State Chemist’s office has put some very strict controls in place to limit who can buy this fertilizer and in what quantities. Only certain dealers are allowed to sell it, and when they encounter any customer who seems suspicious, they can call the Chemist’s office to get a second opinion. Incidentally, the Texas State Chemist is authorized to make arrests.

Another benefit to this meeting was that some of the lesser-known laboratories and agencies were able to re-introduce themselves to the rest of the network and emphasize the services and help they’re able to offer. In addition to the Texas State Chemist, we saw some great presentations from the Chemical Threat Laboratory for the Texas Department of State Health Services, as well as presenters from the nearby Brooke Army Medical Center, the National Guard 6th Civil Support Team, and Texas-office FBI Weapons of Mass Destruction Coordinator. Turnover can be high in public health, so reminders like this are valuable to maintain current information and contacts.

Key takeaways from this meeting:

  • The LRN is strong across Texas with the Austin laboratory being a central resource
  • The LRN does more than terrorism preparedness – laboratories are actively engaged in influenza surveillance and other routine public health activities
  • Inexpensive in-person meetings in isolated locations are great ways to network
  • And things really are bigger in Texas!

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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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Presenting APHL’s New Animated Video!

Oct 31 2012 :: Published in General

What is a public health laboratory? Hopefully this will help answer that question. If you cannot see the video below, click here.

Thanks to Digital Bard for their hard work on this video!

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Bio-Buzz Words and CDC’s Select Agents Program

Oct 25 2012 :: Published in Public Health Preparedness & Response

By Christopher Chadwick, MS, Specialist, Public Health Preparedness and Response, APHL

In the bio world, scientists throw around several words that tend to confuse people: biosafety, biosecurity, biodefense and bioterrorism.   What do these buzz words mean?

Bioterrorism and biodefense are probably the terms with the most straightforward definitions.

  • Bioterrorism: the unlawful or threatened use of certain microbes or toxins (“BT agents”) to harm or scare people
  • Biodefense: the measures taken to prevent, detect, respond to and recover from harm or damage caused by BT agents.  Biodefense measures include surveillance systems or networks for detection, such as the Laboratory Response Network (LRN), and medical countermeasures for response and recovery, such as vaccines and antimicrobials.

The laboratories are vital in the detection and characterization of potential BT agents, but what protects the laboratories and the laboratorians from exposure to the agents or from accidentally releasing them to the public? Biosafety and biosecurity!

  • Biosafety: the policies, practices, safeguards, and equipment that protect laboratorians, the environment, and the public from the accidental exposure to BT agents. Essential to biosafety is the Biosafety in Microbiological and Biomedical Laboratories (BMBL) guidance document, a voluntary guide to standard practices, safety equipment, facility structure (e.g., biosafety levels 1-4).
  • Biosecurity: the protection, control and accountability for agents to prevent misuse or intentional release.

CDC’s Select Agent Program

Chris Chadwick's Halloween pumpkin -- yes, he *really* made this

Recently, biosecurity has been a hot topic among the laboratories with the release of the final rule of the Select Agents Regulation by the Department of Health and Human Services Centers for Disease Control and Prevention. The Select Agents Regulation, more formally known as the Rules for Possession, Use, and Transfer of Select Agents and Toxins or 42 CFR Part 73, provides biosecurity guidance on a specific list of agents and toxins, including the popular BT agents anthrax, botulism, plague and smallpox, in order to implement provisions of the Public Health Security and Bioterrorism Preparedness and Response Act of 2002.

On October 5, 2012, the final rule was published with a variety of revisions that were met with support and criticism by the public health laboratory community. The most notable revision is the establishment of 11 Tier 1 agents that pose the greatest risk of misuse and potential for mass casualties (e.g., anthrax, botulism, Ebola). With this new designation, laboratories that handle these agents must develop additional facility safeguards and personnel reliability to ensure biosecurity, thus putting a financial burden on the laboratories. Physical safeguards include establishing an intrusion detection system and three security barriers that would delay someone attempting to reach the agents, while IT safeguards include additional information security to protect against viruses and spyware that may compromise confidential records.

Revisions to the actual list of select agents include the addition of the SARS, Lujo, and Chapere viruses; the removal of 11 agents and toxins; and the retention of Bacillus anthracis (aka, anthrax) Pasteur strain (but not as a Tier 1 agent). Public health labs were quite happy to learn that LRN member laboratories can use exempt attenuated strains of some agents for proficiency tests and that Coccidioides immitis, a soil fungus endemic in the southwestern United States, was removed from the list.

The revisions to the Select Agents Regulation are a great reminder that biosecurity and biosafety efforts are always changing in the laboratory. Technologies are shifting, the workforce is evolving, and new infectious diseases are emerging so these efforts to maintain biosecurity and biosafety are becoming even more important. With that, in the spirit of Halloween, the Public Health Laboratory Division at the Minnesota Department of Health says: Don’t Be a Zombie, Follow Safe Laboratory Practices!

 

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Nothing New: Sequestration Poses Serious Risk to Public Health

Oct 23 2012 :: Published in General, Public Policy

By Peter Kyriacopoulos, Senior Director of Public Policy, APHL

Congress’ frustration over its inability to effectively manage federal spending and the impact of that spending on the deficit is nothing new. The concept of imposing an automatic across-the-board spending cut once spending exceeded specific caps is nothing new. Designing this sequestration or automatic cut mechanism in such a way to encourage Congress to make appropriate decisions by providing an option that was deemed to be so objectionable that Congress would never let it occur is nothing new. Sequestration was part of the Balanced Budget and Emergency Deficit Control Act of 1985 – 26 years before the enactment of the Budget Control Act (BCA) of 2011. That law was primarily the product of three U.S. Senators: Phil Gramm, Warren Rudman and Ernest Hollings and is often referred to as Gramm-Rudman-Hollings.

Capitol Dome

In its most recent guise, as a condition for increasing the federal debt ceiling in 2011, Congress and the President agreed on the mechanics of the BCA which resurrected the Gramm-Rudman-Hollings concepts of spending caps and automatic cuts. The approaching January 2, 2013 deadline is generating considerable interest in the automatic cuts that begin on that date. One thing new included in the BCA is the creation of a special Congressional committee that was directed to produce legislation that would further reduce the federal debt by $1.2 trillion, or automatic cuts of the same amount would occur.

The BCA automatic cuts were designed to be so punitive and unacceptable that Congress would take definitive action to prevent them from ever happening – nothing new. The special Congressional committee was not able to reach agreement and produce an alternative proposal which has led to the likely imposition of the automatic cuts on January 2.

Because of this increased interest in the automatic cuts, most have forgotten the almost $1 trillion in federal spending reductions between 2012 and 2022 that are already being implemented through the spending caps included in the BCA. These caps reduced federal spending $62 billion in fiscal year 2013 and have created downward spending pressure on all federal agencies, including the Centers for Disease Control and Prevention (CDC) which supports the state and local governmental public health laboratories.

Beyond the current impact of the caps, the automatic cuts in federal spending will cause spending in fiscal year 2013 to be reduced by an additional $110 billion. These automatic cuts, will cause a $31 billion cut in domestic programs – like those operated by CDC – in fiscal year 2013 starting on January 2. There are many numbers being used to measure the size of this spending reduction, and it is not unreasonable to presume they will amount to a 10% reduction.

A reduction of this size in CDC’s funding for the governmental public health laboratory system will hit direct support for the system through the Epidemiology and Laboratory Capacity (ELC) program and through the Public Health Emergency Preparedness (PHEP) cooperative agreement; combined, these programs provide in excess of $100 million annually in direct laboratory support and a reduction on the order of $10 million will dramatically reduce the surveillance and detection capability of the laboratory system. This is before determining the amount of indirect spending by CDC on behalf of the laboratory system, which will likely be very similar.

A possible silver lining could be the timing of the PHEP and ELC grant awards, as both awards are scheduled for release later in the 2013 calendar year – conceivably giving Congress sufficient time to produce an alternative that stops the automatic cuts.

The ELC and PHEP grants are not the sole source of CDC’s direct and indirect work with the governmental public health laboratory system which includes collaborative work on newborn screening, environmental health, tuberculosis and HIV/AIDS. All of this work improves the public’s health and leads to better individual health outcomes and reduced health care expenditures by both public sector and private sector payers. It is unconscionable that the activities of CDC and its state and local governmental health laboratory partners is put being put at risk while Congress attempts to craft a solution to the size of the federal deficit. It is also reminiscent of another piece of history involving fiddles and Rome – nothing new.

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Improving Outbreak Response with FoodCORE: an Introduction to Food Safety Success Stories

Oct 11 2012 :: Published in Food Safety

By Jessica A. Monmaney, Senior Technician, Food Safety and Infectious Diseases, APHL

A few months ago, you may have heard about an ongoing and growing Salmonella outbreak. By the end of the outbreak, there were 425 people sick across 28 states, and 55 people hospitalized. However, without the quick action by the states and cities involved, many more people could have become ill. In large part due to CDC’s Foodborne Diseases Centers for Outbreak Response Enhancement (FoodCORE) program, the outbreak’s cause was identified as scraped raw frozen tuna and further illnesses were prevented.

FoodCORE is a program that started in 2009 and is currently made up of 7 centers: Connecticut, New York City, Ohio, South Carolina, Tennessee, Wisconsin and Utah. FoodCORE finds solutions to outbreaks more rapidly through a system of comprehensive interviews, prompt DNA fingerprinting of pathogens and efficient information sharing among partners. Interviews with sick individuals regarding recent food consumption allow FoodCORE centers to identify potentially contaminated products, fingerprint the DNA of the bacteria and combine information to determine what made people sick.

PulseNet Logo

At the 16th Annual PulseNet and 8th Annual OutbreakNet Update Conference, the FoodCORE team provided crucial input/participation throughout numerous facets of the conference as a whole, and collaborated for a member networking session and an open session. The following people deserve a round of applause for their efforts leading up to, and throughout, the conference: Jennifer Mitchell, Julia Hall and Kim Quinn as General Session moderators; Katie Garmin, Marilee O’Connor and Jenni Wagner as Regional Breakout Session Facilitators; Heather Hanson, HaeNa Waechter, Jeannette Dill, Amy Woron, Katie Garmin, Tim Monson and David Young as speakers and poster presenters; and all of the FoodCORE members who took the time to engage PulseNet and OutbreakNet partners during the Sunrise Sessions and the Q&A portions of the General Sessions.

The FoodCORE Members Networking Session was attended by over 40 people, including staff from FoodCORE centers, as well as partners from CDC’s Outbreak Response and Prevention Branch, leadership and sites from FDA’s Rapid Response Team (RRT), APHL and the Public Health Agency of Canada. Center participants met in small groups to discuss center-specific future goals and upcoming projects. Attendees successfully concluded the meeting in agreement on team-wide projects and goals, such as improving the process of reporting metrics and the development of model practices documentation.

An open session on the first day of the conference provided over 70 conference attendees with the opportunity to become more familiar with FoodCORE and the lessons learned while resolving outbreaks that lead to success stories. In addition to the raw scraped tuna outbreak, the Ohio state lab created an innovative way to provide information on norovirus infection and protection through social media, New York City used their a “Team Salmonella” to solve an outbreak of Salmonella related to kosher chicken livers, and Utah utilized FoodCORE resources to resolve an outbreak of Salmonella in queso fresco that had stumped state public health officials for two years. For more details on these outbreaks – including interviews with staff at FoodCORE centers from the frontlines of these success stories – please stay tuned for the upcoming fall issue of APHL’s Lab Matters!

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What We’re Reading — A Month of Blog Posts

Sep 27 2012 :: Published in What We're Reading

National Preparedness Month and Newborn Screening Awareness Month

As you probably know, this month has been both National Preparedness Month and Newborn Screening Awareness Month.  And as you may have noticed, our blog has been BLOWING UP (don’t worry, we were prepared) with fantastic posts honoring each of those months.  Just in case you missed any of these great stories, here is a rundown of posts by APHL staff, members and partners:

National Preparedness Month:

My Path To Public Health Preparedness and Response by Christopher Chadwick, MS, Senior Specialist, Public Health Preparedness and Response, APHL

System Built for Responding to Bioterrorism Confirms Plague in Colorado Girl by Larry Sater, MS BT/CT Coordinator, Colorado Department of Public Health & Environment Laboratory Services Division

National Preparedness Month and Serendipity by Jim Garrow, Guest Blogger, Operations and Logistics Manager for the Bioterrorism and Public Health Preparedness Program at the Philadelphia Department of Public Health

Newborn Screening Awareness Month:

It’s all about the babies by Pat Blake, Strategic Communications Director, State Hygienic Laboratory at the University of Iowa

Happy Birthday to Ary — 10 years of Living With Sickle Cell by Michelle Forman, Senior Media Specialist, APHL

Raising Baby Caroline: Life With PKU by Michelle Forman, Senior Media Specialist, APHL

Breathing a Sigh of Relief Thanks to Newborn Screening by Elizabeth Jones, MPH, Specialist, Newborn Screening and Genetics, APHL

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National Preparedness Month and Serendipity

Sep 18 2012 :: Published in Public Health Preparedness & Response

By Jim Garrow, Guest Blogger

Jim is the Operations and Logistics Manager for the Bioterrorism and Public Health Preparedness Program at the Philadelphia Department of Public Health. He developed PDPH’s first social media accounts and continues to coordinate and advise on all social media use within the Department. Jim spends his free time writing about social media use in emergencies on the Face of the Matter blog, hanging out with his family and watching zombie movies.

Jim Garrow

I know this is a lab blog. Most of you have either a history with Bunsen burners or can whip up something mean on one of those, um, spinning things you guys use. (Obviously, I have neither qualification.)

So, what the heck am I doing here on a lab blog during National Preparedness Month? What knowledge could an emergency risk communicator, blogger and disaster planner possibly impart to an august group of blog readers such as yourself? Nothing about labs, that’s for sure. If I have one thing to give, that’d be a different perspective.

Every once in a while, those of us that work in preparedness hear a wizened old emergency manager say, “Never exchange business cards in a disaster.” Basically, meet all of your colleagues before you need to know them. Most of us interpret that to mean meeting those in our respective fields: PIOs meet PIOs, lab workers meet lab workers. And that’s a good practice, but during this National Preparedness Month, I say we should think bigger.

Earlier this year, I tried to scrimp and scrounge for money to travel to Seattle. I wanted to travel to the APHL Annual Meeting. Work wouldn’t pay for it because I’m not a lab guy, what could I possibly learn?

Here’s the thing, I have no idea what I’d learn, maybe nothing. But what an amazing opportunity to learn more about things I never had the chance to learn about. What a once-in-a-lifetime chance to meet the best and the brightest in a cutting edge, science-focused field. What a chance for serendipity, for kismet, for luck.

And isn’t that really the goal? To meet all of our potential colleagues; people we may never have the opportunity to work with, except for y’know, when the big one hits. To be exposed to ideas great and wide and varied and unusual and, to borrow a trite phrase, out-of-the-box. To learn something that, while it wouldn’t directly relate to our work, will allow us to see things in a new light, or from a new angle.

So I ask you, dear reader, when did you last let serendipity guide you? When did you last put yourself in an unusual situation with a high probability of learning something you’d never considered? When was the last time you tried something just to try it?

Why not try something like that during this National Preparedness Month? Why not collaborate beyond your comfort zone? Exchange those business cards today.

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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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