Where are they Now? APHL/CDC Emerging Infectious Disease Fellow Looks Back

Apr 10 2014 :: Published in Workforce & Professional Development

By Laura Siegel, Specialist, NCPHLL

It’s fellowship season at APHL! Last month we received over 315 applications for the 2014-2015 class of EID fellows. As the review committee evaluates this year’s applicants, let’s take a look back and see what members of last year’s class are up to.
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“It boggled my mind that there are invisible little creatures that can infect you. The fact that you can’t even see them with the naked eye – and they’re crawling all over you, is fascinating,” said Kayleigh Jennings, PulseNet Specialist and Biological Scientist III, at the Florida Department of Health- Bureau of Public Health Laboratories in Tampa, Florida.

By the time Kayleigh hit middle school, she knew she was interested with science, and ever since that first microbiology lesson, her interest never faltered.

Where are they Now? Looking Back at Class of the 18 EID Fellowship: Kayleigh Jennings | www.aphlblog.org

Kayleigh attended the Ohio State University where she majored in Microbiology and minored in Public Health. In her third year at school, she worked at a research facility alongside Michelle Landes, a student who had just received her acceptance into Class 17 of the Emerging Infectious Diseases Fellowship Program. Michelle discussed the program with Kayleigh and encouraged her to apply for Class 18. Kayleigh was so excited about the opportunity she completed the application nearly a year before it was due.

Ten months later, she packed up her life into her small sedan and made the trek from Ohio to sunny Florida to start her dream job as an EID fellow.  Florida was high on Kayleigh’s list not just for its sunny weather, but because her host laboratory, the Florida Department of Health, allowed her to rotate through all the various departments within the lab. This flexibility led her to discover what she enjoyed doing most – working with Salmonella outbreak surveillance using pulsed-field gel electrophoresis (PFGE) and PulseNet – the Centers for Disease Control and Prevention’s national network connecting cases of foodborne illness to detect outbreaks.

“Analyzing Salmonella – I felt like I was doing something important,” said Kayleigh. “It’s gratifying — I’ve seen a series of DNA patterns that are exactly the same, which means they could be a cluster contributing to an outbreak.  I’ve had times where I’ve had to make a phone call to the epidemiologist, and say ‘You should take a look at this…”

One day Kayleigh was glad she didn’t have to make that call; the day she came across one of the most virulent Salmonella strains she had ever seen.

“An 18 year old boy originally from Nigeria came to a local ER soon after he presented with symptoms, and passed away a few hours later. The medical examiner routinely sends cultures to the Clinical Microbiology Department at the Department of Health for analysis, and it was determined to be an atypical septicemic Salmonella infection.  Since the Salmonella was isolated, the sample was then sent to our PFGE laboratory, and thus landed in my hands.” said Kayleigh.

After running PFGE, uploading the pattern to the appropriate databases, and sending the sample to the CDC for further verification, it was quickly determined that it was a rare strain, not typically endemic to the U.S. Thankfully, this particular strain posed little risk to the rest of the population.

While death from Salmonella is rare, foodborne illnesses are quite common and can make individuals very ill without proper treatment. With more than 48 million people in the US acquiring foodborne illnesses each year, food surveillance systems and the laboratory professionals that support them are critical.

“Foodborne illnesses are not going away anytime soon. If someone is sick, you want to know if that strain is contributing to an outbreak. If there was no PFGE or food safety… an outbreak could be spreading rampant and no one would know.”

Other highlights from Kayleigh’s fellowship include working in a BSL-3 laboratory for the first time, touring the CDC headquarters in Atlanta, GA, and training at the local county health department.

“I never would have had any of these life-changing experiences if not for this fellowship,” she said.

When asked about her future plans, she said, “Will I stay in public health? Definitely — I don’t even know what else I would do,” she joked.  “I enjoy helping, and I like the feeling that what I do matters.

Stay tuned for more posts on past EID fellows!

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APHL Global Health: My Touchstone

Apr 01 2014 :: Published in Global Health

by David Mills, PhD, Director, Scientific Laboratory Division, NM Department of Health

It all began with a late afternoon phone call from my boss, asking if I had any interest in volunteering my time on an APHL project to help public health laboratories in Central America recover from the devastation of Hurricane Mitch. “Sure,” I casually replied, not realizing that my answer was launching me on a journey that, over the next 14 years, would take me to 17 countries on four continents and provide me with some of the most meaningful and rewarding experiences of my professional life.

Looking back, I have to say that I have thoroughly enjoyed the ride. Much of the satisfaction and enjoyment my experiences with the APHL Global Health Program have provided are what I might have anticipated when I first got involved. Philosophically, I had always been a proponent of international assistance and a fan of engineer and inventor, R. Buckminster Fuller, who described the planet as a boat and pointed out the fallacy of the notion that people living in the starboard side of the boat could allow the port-side to sink “without getting their own feet wet, let alone being drowned.” So, international work appealed to me on that level.

APHL Global Health: My Touchstone | www.aphlblog.org

In addition, I have always enjoyed travelling and experiencing different cultures, and my work with the APHL Global Health Program has certainly provided that. And then there was the opportunity for adventures; finding time, after the official work of APHL was finished, to squeeze a day or two for personal activities before returning home, e.g. a safari in Tanzania or a visit to the Forbidden City in China. Other “excitements” were smaller, serendipitous and, perhaps because of that, even more memorable. I will always remember stepping off a small plane near Mt. Kilimanjaro at sunset, catching my first intoxicating whiff of dry grass and faint smoke and being told, “You will never forget that; it is the smell of Africa,” or eating breakfast at sunrise on the edge of a Namibian water hole and spying a troupe of baboons, with babies on their backs, moving through the brush on the far side. Nor will I forget an initially staid and formal evening dinner in a Ukrainian garden that (d)evolved into a boisterous evening of singing, toasting (vodka…) and laughing with new friends after the electricity failed and the gathering continued long into the night by candlelight.

Teaching has also always brought me a great deal of satisfaction—I was a university professor before switching to a public health career—so developing courses and providing training to laboratory professionals for APHL has been extremely enjoyable. I have had the good fortune to be able to share the lessons of my professional experiences (successes and failures) with colleagues in other countries and also to learn from theirs.

But what I never could have anticipated so many years ago and what, more than anything, has kept me coming back again and again to volunteer are the inspiration and humility that that I experience on every single project for Global Health. My day job is terrific—as director of a state public health laboratory, I go to work every day in a new multi-million dollar facility equipped with millions of dollars of analytical instrumentation (and a staff engineer to maintain it) and sophisticated engineering safety systems. Our laboratory is supported by a central team that responds immediately to IT issues, and a courier system that delivers specimens overnight. We have access to federal laboratories for specialty testing and technical support and a national organization, APHL, which provides training and professional support. And yet, with all of these resources, I find that much of my time is spent focusing what is perceived as lacking—budget, staff, competitive salaries, flexible work schedules, new instrumentation, software and so on. These challenges, difficult and ubiquitous, are the reality of management in public health. Over time, however, immersion in these details day after day can make the excitement over the greater purpose of the mission and the people we serve fade and seem very far away, and it is this that keeps me coming back to volunteer.

To periodically leave my day job and travel to a place where smart and talented professionals pursue the mission of the public health laboratory, performing testing similar to that in our own laboratories, but under very difficult conditions, is inspiring. What do I mean by difficult? Difficult is a laboratory performing serology testing when it has electricity irregularly for only 2-4 hours per day. Difficult is washing and reusing latex gloves because of their scarcity. Difficult is performing microscopy in a room with high water stains on the walls a meter off the floor and all of the refrigerators on blocks to keep them above the periodic floodwaters. Difficult is not having a single repair technician in the country to service analytical instruments. Despite these incredible challenges, the people I have worked with in country are enthused, dedicated and optimistic about the work they perform and its importance. Seeing how much they accomplish under these circumstances, I often have thought to myself, “If these people had even half of the resources and support that I have in my laboratory, they would leave me in their dust!”

Quite simply, the international projects are my touchstone. They remind me how fortunate we are, and they re-energize me and rekindle my enthusiasm for my career as a scientist in public service… and after each experience, I return to my laboratory able to do my job better than before I left. Without a doubt, I gave my boss the right answer.

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TB Vanquished by Lab System in the “Malibu of the Midwest”

Mar 24 2014 :: Published in Infectious Diseases

By William Murtaugh, specialist, HIV/TB programs, Infectious Disease, APHL

“Defeat TB: Now and in the Future.”  This was the first theme of World Tuberculosis Day declared by the International Union Against Tuberculosis and Lung Disease (IUATLD) 32 years ago today in 1982, and 100 years after Dr. Robert Koch announced his discovery of the bacteria that cause tuberculosis disease (TB).

Well, the future is March 24, 2014, and TB has not yet been defeated.  But year after year,  and theme after inspiring theme,  the global public health community still proclaims a call to arms, aiming to inspire the world to take up the cause of TB elimination.

TB Vanquished by Lab System in the “Malibu of the Midwest” | www.aphlblog.org

In the United States, the burden of TB is very low relative to many parts of the world. Why then should we be concerned with Mycobacterium tuberculosis, the obligate bacillus demanding our attention today?

It is common to cite TB statistics to emphasize the disease’s impact and the progress toward its elimination. Indeed any TB expert can pull some staggering historical numbers out of his or her pocket.  But reconciling unembellished phrases like “billions infected,” “millions of new cases,” “over a million deaths,” with the experience of those of us average Americans who’s TB “exposure” is limited to news bulletins on World TB Day, is challenging. For us, World TB Day serves as a gentle nudge that the disease is still a threat, and the fight for its elimination continues. Yet while I would be remiss if I did not mention that the United States has seen 21 years of consecutive decline in annual TB cases, I must contend that TB awareness is particularly important here in the United States because of the country’s low TB burden.

Lest we take our progress for granted, repeating the mistakes of the 1980’s and 90’s, it’s important to remember the consequences when the health system falters.  But for the one day, hour or minute that we consider World TB Day, let’s recognize that our progress to date has been achieved through the quiet efforts of a public health system that functions not one day, but all year long.

A TB outbreak in April 2013 exemplifies this point. Along the shores of Lake Michigan sits Sheboygan, WI, a city whose description could be mistaken for a Garrison Keillor monologue “where all the children are above average” and so too are its TB case rates. This Midwestern community learned the hard way that the damaging effects of TB can still be very real.

Prior to 2013, Sheboygan County typically saw fewer than three TB cases per year.  Known as the “Malibu of the Midwest” for its lake surfing competition (the largest in the world in fact), Sheboygan was a place more familiar with the phrase “Hang Ten” than “MDR-TB.”  Then in mid-April, the Sheboygan County Health Department was notified of a suspected TB case that would lead to an outbreak that would engage its resources and generate national media coverage for the remainder of the year.

Before it was over, the outbreak would cross the county and spread through multiple generations of a single family, school children and healthcare workers. It would lead to a case of MDR-TB, 11 additional cases of active pulmonary TB disease and 38 latent (non-symptomatic, non-contagious) TB infections. Over $6 million in state and federal funds ($4.7 million state, $1.4 million federal) would be expended to cover costs associated with outbreak investigation, testing, treatment and prevention measures.

Because TB is uncommon in the US, doctors may not consider it as a potential diagnosis. The first (i.e., index) case in the Sheboygan outbreak sought medical care for symptoms at least eight months before receiving a diagnosis of TB. What should have been a straightforward case – in which a suspected TB patient is diagnosed, treated and transmission prevented – led to eight months of transmissions.

Once TB was finally proposed as a diagnosis, the Wisconsin State Laboratory of Hygiene (WSLH) responded quickly, performing initial screening in two days and confirming diagnosis in less than two weeks. This diagnosis kick-started the TB control system into high gear. The patient was isolated and treated, and contact investigations were initiated to find related cases.

Next the WSLH assessed the standard drug regimen to determine if it would prove effective with this patient. With assistance from the Centers for Disease Control and Prevention (CDC), the lab identified  multi-drug resistant TB (MDR-TB) a category of infection that involves resistance to multiple drug therapies, is more difficult and expensive to treat, and holds a higher risk of death — as the cause of the patient’s illness. Now the concern was, “Had other patients been exposed to MDR-TB in the past eight months?”

More specimens began arriving at the local laboratory near Sheybogan, which quickly exceeded its capacity. With the threat of an MDR-TB outbreak, a solution was needed quickly. Enter the integrated public health laboratory system!  State and local laboratories coordinated with the community hospital in Sheboygan and decided jointly that all specimens from TB suspects would go to the WSLH.

As diagnosis after diagnosis of active pulmonary TB was confirmed, the state TB Control Program wanted to know if all these cases were part of the same outbreak.  While this may seem an obvious “YES!”, not all TB is created equal. Numerous strains of TB are continually in circulation. Without identification of the specific strain, public health officials could not understand the chain of transmission, and without this information, they could not control the outbreak.

Through a CDC initiative designed to strengthen national response to TB outbreaks, state public health laboratory in Michigan performed complex testing to uniquely identify each strain of M. tuberculosis (called genotyping). They determined that the MDR-TB patient was infected with two different strains of TB, one of which was not MDR-TB.  The state laboratories confirmed that other TB strains also belonged to the outbreak. None of these strains, however, were MDR-TB and therefore were more easily treated.

Not bad for a low burden TB setting.

Sheboygan’s story reminds us that TB outbreaks can happen anywhere. Yet if an outbreak does occur in our community we can look with confidence to the response capability of the nation’s public health laboratory system. The impressive response to the outbreak in Sheboygan testifies to the expertise and commitment of  these laboratory professionals. It also epitomizes CDC’s World TB Day theme:  “Find TB. Treat TB. Working together to eliminate TB.”

To learn more about public health laboratories and TB, check out APHL’s TB page. Additional information and resources for World TB Day and related events can be found at CDC’s dedicated website.

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Sochi? So What? Public and Environmental Health at the Winter Olympics

By Michael Heintz, MS, JD, senior specialist, environmental laboratories, APHL

Sochi? So What? Public and Environmental Health at the Winter Olympics | www.aphlblog.org

Hi. I’m Michael and I admit it: I’m a Winter Olympics fanatic. From learning new geography at the Opening Ceremonies, to hoping for that US-Canada hockey game, and seeing the short-track speed skaters hurl themselves in roller-derby-on-ice, I can’t get enough. I’ll even watch a couple hours of curling. I’m all-in for two weeks (well, except ice dancing, but that’s another post).

However, in the midst of the competition and spectacle, the public and environmental health aspects can get lost. With the international locations, huge crowds and new buildings, the footprint of the Olympics can be significant. So where do the Olympics intersect with public and environmental health?

The Centers for Disease Control and Prevention provides basic information if you’re heading to the Games (and more generally for international travel). In addition to routine vaccinations, like chicken pox and your flu shot (which you should already have!), the CDC recommends specific ones for Russia, such as hepatitis-A and others if you are particularly at-risk or heading to remote areas. Visitors should also prepare a travel health kit, including the medications they might need during travel. The CDC even provides a list of Russian phrases to use if you are sick or injured.

Next, one particular aspect of public health at the Games is interaction with the other spectators or athletes. Always remember to wash your hands, wear your seatbelt and generally stay aware of your surroundings. And yes, sexually transmitted infections are a concern at the Olympics. Organizers help the athletes by distributing condoms (150,000 were distributed to athletes at the London Games), but you might be on your own, so be prepared.

Finally, we cannot ignore the environmental impact of the Games. Sochi has an average population of 350,000 people. The 2010 Winter Games in Vancouver attracted an estimated 500,000 visitors plus another 10,000 journalists and 2,700 athletes (not counting security or volunteers). In all, Sochi’s size may double (or more) for the Games. The huge number of people coming to this Black Sea resort town, plus the construction of the new venues and other capacity improvements, will stress Sochi’s environment.

In 1996, the International Olympic Committee added environmental protection as the third pillar of the Olympics. As part of this commitment, Sochi organizers are making efforts to build and conduct the Games in an environmentally responsible manner, including a Green Building recognition program. But with a $50 billion price tag to build and run the events, the environmental impacts include increased construction waste, water shortages, habitat disruption and increased logging. All of these activities increase the amount of pollution in air, soil and water resources. Add the increased demand for drinking and wastewater services, transportation, and curiously, saving last year’s snow, and the overall environmental impact of the Games may be significant. However, we won’t know the full effects until after the Games are over. Looking ahead, the Rio Summer Games have already launched their sustainability program for 2016. Expect future Olympics host-cities to continue concentrating on environmental concerns when preparing for the Games.

While the public and environmental health concerns don’t decrease my appreciation for the spectacle that is the Olympics, including the athlete’s amazing abilities and the two weeks of global good will, it does add context to what goes into making such an event happen. Just another reminder that public and environmental health is part of everything.

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Public Health Laboratory Internship: Keeping an Eye Out for Drug-Resistant Influenza

Jan 14 2014 :: Published in Workforce & Professional Development

By Nikeshan Jeyakumar, PHASE Intern, Laboratories Division of Virology and Immunology, Maryland Department of Health and Mental Hygiene

Public Health Laboratory Internship: Keeping an Eye Out for Drug-Resistant Influenza | www.aphlblog.org

Public health as a discipline derives its importance from its direct positive impact on society. Unlike some fields of study that can remain relevant while being entirely theoretical, public health is entirely dependent on the application of its fundamental principles to real-world situations. Given this reality, the Johns Hopkins Bloomberg School of Public Health (JHSPH) has been taking a forward approach in offering its students a unique opportunity to utilize their education. Now in its tenth year, Public Health Applications for Student Experience (PHASE) internships at JHSPH have enabled students to supplement their education with practical experience. Students can choose from a wide range of internships that span the breadth of public health work and help them develop connections within the greater Baltimore community as well as network with public health professionals. The PHASE internships allow students to enhance their education by taking them out of the classroom and into the field, or in my case, into the Maryland State Public Health Laboratory.

I was a PHASE intern at the Laboratories Division of Virology and Immunology at the Maryland Department of Health and Mental Hygiene in Baltimore from January to June 2013. One of our primary roles as a public health laboratory is to receive samples containing suspected microbial pathogens and conduct diagnostic and surveillance testing in order to characterize such samples. We would then report our results to the submitters, the local government, and to the Centers for Disease Control and Prevention (CDC). As an intern, I was able to participate in a study that evaluated assays for detecting influenza susceptibility to a class of antiviral drugs termed neuraminidase inhibitors. This was part of a larger effort by our laboratory to conduct a surveillance campaign of drug resistance levels in circulating influenza strains during the 2012-2013 flu season. We used an inhibition assay that detects the activity of neuraminidase (NA), a surface protein that facilitates the release of influenza viruses from host cells so that they can travel to other cells and establish new infections. The assay contains a substrate which interacts with influenza NA and quantifies its activity by emitting light in proportion to the amount of activity detected. The quantity of drug required to knock down NA activity to 50% of baseline levels (known as the inhibitory concentration or IC50 value) was then obtained using a CDC-developed computer program that converts the light output data to IC50 values. From this information, we were able to determine the susceptibility of viruses to the three NA inhibitor drugs used in hospitals and clinics worldwide. High levels of NA activity (as measured against standard control levels established by the CDC) in the presence of inhibitor drugs is a strong indicator of resistance.

Seasonal influenza strains are resistant to the entire class of drugs termed adamantanes, which were the first drugs developed against influenza. As a result, doctors really only have three options to cure influenza infections: the inhalable drugs oseltamivir (TamifluTM) and zanamivir (RelenzaTM), and the last-resort intravenous drug peramivir, which is still in investigational stages. The development of widespread resistance to any of these drugs would cripple our ability to treat influenza in clinical settings, so it is essential for us to keep an eye on these viruses and their susceptibility to our pharmaceutical arsenal. One only needs to look at the rise in MRSA and CRE-related fatalities to realize how vulnerable we are as a population to drug-resistant pathogens. Happily, with the flu season coming to a close in May our lab did not detect any phenotypically resistant strains despite only a moderately-effective vaccine and a high number of infections due to a dominant circulating H3N2 strain, which in the past has been responsible for more severe disease outbreaks.

This project has been a wonderful application of my graduate education in microbiology at JHSPH to a real-life public health issue of great importance. It really illustrates the significance of why we have to understand infectious diseases in such detail in order to curb their effects on society. In addition to exposing me to the laboratory aspect of public health, the PHASE internship has also allowed me to network with professionals in the laboratory field and develop a set of connections that will be a tremendous asset in the future. The staff at the Maryland state laboratory is composed of a highly professional group of individuals that work very effectively together in order to carry out their numerous shared responsibilities. The laboratory personnel are particularly well-experienced in clinical virology and are extremely capable and proficient workers when their services are in high demand. This was most evident during the peak of the influenza season in January 2013 when we were inundated with an enormous amount of hospital samples that all had to be confirmed or disconfirmed for influenza infection. Every sample was processed efficiently and in a reasonable timeframe due to the professionalism and hard work of the staff. Dr. Maria Paz Carlos, the chief of the Division of Virology and Immunology, is also very involved in the work of all of the laboratories she manages and is always in constant communication with the rest of the staff and us, the interns. As a result, she has established a collaborative environment in that is extremely conducive to a team-based approach to problem-solving.

I highly encourage anybody attending JHSPH to take full advantage of this unique opportunity offered by the PHASE program. Public health laboratory internships can be a greatly enriching educational experience for students who spend so much time learning concepts and skills in the classroom to actually apply them in a hands-on setting. I would also advocate that other schools of public health collaborate with local and state public health laboratory departments to develop similar programs throughout the country. Engaging public health students and professionals in real-world settings is essential to the proper design and implementation of public health practices and policies from the local to the global scale.

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Public Health Thank You Day: APHL Says Thanks!

Nov 25 2013 :: Published in General

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

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

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

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

- Shari Shea, Director, Food Safety

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

- Susan Bailey, Manager, Customer Support Program

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

- Scott Becker, Executive Director

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

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

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

- Joshua Zulauf, Associate Specialist, Contracts

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

- Jody DeVoll, Director, Strategic Communications

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

- Megan Latshaw, Director, Environmental Health Programs

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

- Chris Mangal, Director, Public Health Preparedness and Response 

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

- Jane Getchell, Senior Director, Public Health Programs

 

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

- Patina Zarcone, Director, Informatics and Institutional Research

 

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

- Caprice Retterer, Associate Specialist, Website

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

- Ruhiyyih Degeberg, Specialist, Newborn Screening and Genetics

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

- Michelle Forman, Senior Specialist, Media

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

- Dare Akingbade, Manager, Food Protection

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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 | www.aphlblog.org

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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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!

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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) | www.aphlblog.org

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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Public Health Preparedness in the Age of Social Media

Sep 03 2013 :: Published in Public Health Preparedness & Response

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

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

One of my earliest childhood memories is of being woken up during nap-time at daycare.  I was about four, and my parents were bringing me home early because a hurricane was approaching the coast.  While I can’t remember now which storm it was (though Hurricane Bob is the most likely), I do remember that my parents kept the radio on for the entire drive home, paying meticulously close attention to the constant stream of weather updates. Even before the age of the smartphone, it was crucial to know what was happening.

That need for timely and accurate information will never change but technology has come a long way since 1991, and thanks to social media we have many more tools available to us to plan for and respond to emergencies.  For laboratories, this means new ways to expand on their Continuity of Operations Plans (COOP) to keep employees and the public safe and well-informed.

Public Health Preparedness in the Age of Social Media | www.aphlblog.org

To share information, many organizations are leveraging existing social media platforms such as Facebook and Twitter.  You might think these services are for bored teens sharing pictures of their lunch, but a quick Facebook search yields hundreds of emergency management groups, and Twitter has even more.  Both platforms are quick and easy ways to push out information such as the status of the local drinking water or whether or not a public health laboratory is diverting samples to other laboratories due to storm damage.  It’s also an opportunity to ask for assistance during emergencies and share information on outbreaks….just search for Cyclospora and you’ll find current news on the number of cases and possible source. I’m far more likely to hear about a major news story from Twitter than from the local television news station, and I know I’m not alone there.

Like most social media sites, these services aren’t reliant on any specific computer and messages can be sent by any laboratory employee with the correct password, making it even easier to communicate.  I admit some of this could be accomplished through text messages as well, but social media messages have a tendency to go viral (meaning people share the messages to different groups of people) that texts can’t match.  When the message concerns issues such as contaminated food or water, the more people that see the information, the better.  Laboratory employees could also use these services to check in when phone lines are tied up, letting supervisors know what their personnel capabilities are in real-time.

There are also a number of mobiles applications (apps) on the market that can assist in planning for and responding to disasters.  The Red Cross is one of the best-known in the business, with a suite of apps that instruct users on how to prepare their homes and workplaces for disasters like tornados, wildfires, and hurricanes. The apps also push out location-specific updates on shelters, weather updates, and other essential information.  Louisiana’s Office of Homeland Security and Emergency Preparedness has another great group of apps called Get a Game Plan, which guides users through making readiness plans for different situations and provides Louisiana-specific information on evacuation zones and shelters, weather alerts, and maps.  Both are accessible from the web for those without smartphones. While these apps are primarily targeted towards families and individuals, it would be relatively easy for a laboratory to include use of these apps in their COOP as a reference point for when certain steps should be taken.  For example, the decision to evacuate or call in extra personnel could take up-to-date information from one of these apps into account.

Good responses to emergencies also require good planning beforehand.  Most laboratories have excellent disaster-response plans in their COOPs, but even the best COOP will be clotheslined if employees aren’t prepared at home.  In addition to the apps above, FEMA’s Ready.gov is a great resource for planning personal disaster readiness, and I’d advise everyone to take a look.  You might be surprised when you realize just how much stuff you’d need to keep your family (and your pets!) safe and comfortable for a few days of shelter-in-place.  We all know how critical public health laboratories are.  In the interests of keeping your laboratory functioning in a disaster, it might be a good idea to have a home-readiness information session at work to be sure that employees are fully equipped to deal with emergencies and keep essential services running.

Of course, no app will protect you if you’re stranded without supplies.  Easy ways to make contact are no substitute for having a readiness kit and a plan in place, and everyone should make the time to ensure they’ll be ready if disaster strikes.  I bet my parents would have loved to have some of these tools back in 1991!

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