APHL Staffer Shares her Career Path with the Next Generation of Public Health Students

Jan 21 2015 :: Published in Workforce & Professional Development

By: Bertina Su, MPH, senior specialist, Laboratory Systems and Standards, APHL

Last fall I was invited back to my alma mater to talk about life after University of Maryland’s (UMD) Master of Public Health (MPH) program. A former classmate was coordinating an informational session for undergraduate students to help them get a sense of where the MPH grads went in their careers; she asked me to participate and I happily accepted both because she is a friend but also because I could have used an event like this when I was finishing my undergrad degree.

APHL Staffer Shares her Career Path with the Next Generation of Public Health Students | www.aphlblog.org

My journey into public health was not something that I planned. I earned a bachelor’s degree from Washington and Lee in chemistry, but as graduation loomed, I still had no idea what I wanted to do with my life after receiving my diploma. Reality was sinking in. My fellow chemistry classmates went into research or continued to medical school, and while those options seemed to be the logical next steps, they were not the right fit for me.

I took a year off after graduation to volunteer at Bread for the City, a non-profit in Washington, DC, that provides food, clothing, medical care, legal and social services residents in need; it was there that I became exposed to the world of public health. I worked in the medical clinic doing mostly administrative work helping with health insurance enrollment and coordinating health education programs. I began to understand what public health was, and that I could use my science education in this field to help people. I spoke with many of the staff about how they found their way into public health, and they all had MPH degrees. It became clear that if I wanted to move my career in this direction, I needed to find an MPH program that worked for me. Before I knew it, I was back in school learning about biostatistics, program evaluation and epidemiology. After completing UMD’s two-year MPH program, I interviewed for a program manager position at APHL, and I have been here ever since.

Fast forward a few years… There I am setting up my information table at UMD’s School of Public Health featuring APHL’s Annual Report, Lab Matters and my own business cards. I even wore my APHL STAPH staff t-shirt. I had the opportunity to speak with several students who asked questions mostly about my MPH experience and responsibilities at APHL. Some were not familiar with either public health laboratories or association work, so it was rewarding to expand their knowledge. I talked about my quality improvement and survey work, but their ears really perked up when I told them that I get to travel and work with people all over the country.

I’d love to see undergraduate public health programs hold more events like this one to give the next round of graduates the opportunity to hear from alumni about their journey into the public health workforce and about other career paths they had not considered. While my path into public health may have been unconventional, I am thankful that I took it. The work has been rewarding, and I hope that my participation will encourage another public health student to pursue an equally fulfilling position.

I encourage you to contact your alma mater to share your knowledge, experience and lessons-learned with public health students. You just might inspire someone to pursue a career in a public health lab.

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Newborn Screening: This Tiny Test is a Big Job That’s Always Improving

Jan 12 2015 :: Published in Newborn Screening and Genetics

By Scott J. Becker, executive director, APHL

Newborn screening saves or improves lives – 12,000 each year, to be specific. Every year over four million babies born in the United States have their heels pricked during the first days of life to check for certain devastating conditions that are not otherwise apparent at birth. The small number of babies who test positive for those conditions may suffer serious and irreversible damage without early detection. Newborn screening enables health professionals to identify and, in most cases, treat those babies allowing them to grow up to live healthy, normal lives. The newborn screening program is one of our nation’s greatest public health achievements, but that doesn’t mean it is perfect.

Newborn Screening: This Tiny Test is a Big Job That’s Always Improving | www.aphlblog.org

Last year a series in the Milwaukee Journal Sentinel drew public attention to some of the areas in which the newborn screening program needed to improve. That story and a recent editorial in USA Today focused on the amount of time between specimen collection, testing and reporting of results. Timeliness is critical for the newborn screening program to be a success, and we acknowledge the valuable contribution these articles have made.

Continual quality improvements – including timeliness – have been and continue to be a priority for public health laboratories, the agencies responsible for identifying and reporting positive newborn screening test results. In fact, APHL recognized the efforts of many state programs during the 2014 Newborn Screening and Genetic Testing Symposium. Many state newborn screening programs have conducted hospital site visits; conducted targeted outreach to lagging performers and publicly recognized top performers; provided hospitals and other specimen submitters with guidelines for collection of specimens; reinforced regulatory requirements; and provided training for use of overnight courier shipping software. Program changes like these in states around the country have significantly improved specimen transit times.

APHL and its members have collaborated with the Department of Health and Human Services Discretionary Advisory Committee on Heritable Disorders in Newborns and Children to develop updated recommendations on timeliness guidelines. These activities occur in tandem with a series of other quality improvement activities including proficiency testing, evaluation of emerging technologies and implementation of quality practices pertaining to screening, confirmation and results reporting.

I am proud of the work state newborn screening programs are doing every day. We do not take the public health laboratories’ role in this life-saving program lightly, and I thank the staff for their dedication to improving it. Our focus is on the babies – it always has been and always will be.

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Say “Thank You, Public Health!”

Nov 20 2014 :: Published in General, Partners

Say "Thank You, Public Health!" | www.aphlblog.org
This year APHL is partnering with Research!America for Public Health Thank You Day! On Monday, November 24th, take the time to thank the many public health professionals who work hard to keep you, your family and your communities healthy. Even though they often work behind the scenes, public health professionals are there protecting you.

We simply cannot say “THANK YOU!” enough to our members, the unsung heroes in lab coats! So we are going to take to our many social networks and say #ThankYouPublicHealth! Add the hashtag on Facebook, Twitter, Pinterest, Instagram or any other network that uses hashtags. Complete the sentence…
Say "Thank You, Public Health!" | www.aphlblog.org

 

#ThankYouPublicHealth for stopping Ebola in its tracks!

#ThankYouPublicHealth for that tiny heel prick that saved my baby’s life! #newbornscreening

 

Or simply add it to a shared article or photo!

If you have space, add the official Public Health Thank You Day hashtag #PHTYD and #APHL. We’ll be watching for posts and will share our favorites! If you would are not active on any of these social networks, leave a comment below and we’ll share for you.

Most importantly, we just ask that you shout it from the virtual rooftops… #THANKYOUPUBLICHEALTH!

Check out Research!America’s website for more great Public Health Thank You Day resources.

 

 

 

 

 

 

 

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Public Health and Freedom: Reflecting on Berlin, AIDS and Ebola

Nov 13 2014 :: Published in General

By Scott J. Becker, executive director, APHL

Twenty-five years ago I was huddled by a radio listening to the BBC broadcaster tell of the fall of the Berlin Wall. As I listened, I became more and more aware of how much Americans take our freedom for granted.

Earlier that same week I moved to Geneva, Switzerland to begin an assignment with the World Health Organization (WHO); not only was it a big move, it was also my first ever trip overseas. I was in a temporary apartment, didn’t speak the language (French), didn’t know anyone and, although very excited, was generally overwhelmed. Meanwhile, only a few hundred miles away, history was being made. I didn’t realize it at the time, but those first few weeks in Geneva helped shape my career and, really, the person I became from that point forward.

Public Health and Freedom: Reflecting on Berlin, AIDS and Ebola | www.aphlblog.org

My assignment at WHO was to coordinate a global conference on integrating HIV/ AIDS into the curriculum of health professional schools across the globe. While healthcare professionals weren’t scared like they were when the disease was first discovered, they really didn’t have much experience with HIV/ AIDS. So my project was to integrate this disease into curricula to teach a new generation of healthcare workers. It was an exciting and difficult challenge not only because of the heavy subject matter at hand or the language which was still unfamiliar to me, but also because I had to navigate the complex bureaucracy of WHO.

When I began this project, the public was just beginning to understand that HIV wasn’t a gay disease or an African disease, but it was a disease that could impact anyone. In fact, we were seeing heterosexual transmission explode in Africa. There was a huge stigma attached to AIDS causing those who were infected to be shunned in public and in the workplace.

As the international conference commenced in Istanbul, Turkey, I felt enormous pride that we were doing something, but it was short lived. One day a man who was HIV positive showed up at the meeting looking for care. Despite being unable to publicize the meeting because of the stigma, this man heard that all these health professionals were coming together in his city to discuss his disease. He was desperate and really had nowhere to turn in his community. He was an outcast and felt like he lost his freedom. The man cried when we told him that it wasn’t really a medical meeting and that we weren’t able to help him directly. My heart broke. I remember going back into the meeting and sharing his story with a colleague from the Turkish health ministry who took down his information and promised to reach out. (I’m fairly certain he did that to placate me, not for real follow up. I’ll never know for sure.)

By that point the Berlin Wall was fully down, people were passing back and forth between East and West Germany, and we were getting glimpses of hope for the future. Back in Geneva, I began to explore the connections between global public health and basic human freedoms. The fall of the wall and my experiences in Istanbul really solidified my desire to be part of improving health for all. It was abundantly clear that good health provided freedom in so many ways. I had found my niche.

I’ve thought a lot about the man in Istanbul recently as I’ve listened to stories about Ebola. Here, too, we have a new and very scary disease. Except that it’s not really new, but new to many in America. The stigma now being associated with Ebola is much like that of AIDS 25 or more years ago. The treatment of returning healthcare workers – heroes, in my mind – is shameful and disappointing. The lack of respect for information shared by scientific and medical experts, people who have studied Ebola for their entire career, is frustrating. And the worst of all, watching public fear escalate and place demands on decision makers is deeply troubling.

Healthcare workers in any region – whether those testing samples in New York City or those treating patients in Sierra Leone – deserve their freedom to move freely until medical experts determine they present a risk to the public. Patients who have recovered from Ebola deserve their freedom as they return to life in good health. And we all deserve freedom from fear, something that is given to me every time I speak with colleagues who understand the intricacies of how Ebola operates and how it can be contained.

My hope for the future is that we as public health professionals, healthcare workers, neighbors and as Americans can move beyond stigma to a better place, one where health is recognized as both a right and a freedom.

*Photo: World Health Organization’s headquarters in Geneva, Switzerland

 

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Biomonitoring and the Public Health Laboratory: Everything You Want to Know

Oct 23 2014 :: Published in Environmental Health

Biomonitoring and the Public Health Laboratory: Everything You Want to Know | www.aphlblog.org

Simply stated, biomonitoring allows public health practitioners to understand whether environmental contaminants are being absorbed into people’s bodies. Given improvements in technology; the capabilities and expertise that now exist in public health laboratories; and the increasing public demand for more information about chemical exposures, biomonitoring is poised to become an integral component of public health practice.

APHL proudly recognizes all of the great work public health laboratories are doing to advance the practice of biomonitoring. We have made it a priority to share these biomonitoring achievements through a variety of channels.

Just in case you missed these great resources and stories, they are here:

Free Webinars

Blog posts and Lab Matters Articles

Fact Sheets

Other resources

Tell us what you think: EH@aphl.org.

 

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Could funding cuts to food safety programs make you sick?

Jul 23 2014 :: Published in Food Safety, Public Policy

By Michelle Forman, senior media specialist, APHL

Could funding cuts to food safety programs make you sick? | www.aphlblog.orgWhen public health works, no one sees it.

That’s a common adage at APHL and is most frequently used when referring to the gross lack of – and ever plummeting – funding for valuable public health programs. But what does it mean? When do we see public health and when does it vanish into the background?

The public health system comprises many areas from healthy eating to smoking cessation to biomonitoring to newborn screening. To answer this question, we’re going to focus on food safety – something that impacts every person in the United States – by following the journey of peanuts as they pass through the food system and into your lunch bag.

(Note: Peanuts were chosen to make a point. They are not inherently risky. As of the original date of this post, there is no current known outbreak associated with peanuts. This journey could feature any food item.)

Our peanuts were grown on a large farm that distributes its harvests for use in many different products.

After being roasted, they are shipped to another facility to be ground into a paste. That paste is then used to make peanut butter for cookies, crackers, ice cream, dog treats and many other products.

In a perfect situation, our peanuts are grown using the safest growing practices; thoroughly roasted to kill pathogens acquired on the farm; processed in facilities that ensure utmost safety and cleanliness in accordance with all food safety guidance provided to them; sent to stores, restaurants and other food service facilities where they will be purchased and consumed by families trusting that they are receiving peanut butter crackers free of Salmonella. Public health has worked in the form of inspectors, guidelines, regulations, sample testing, quality assurance, staff training and public education to ensure that a perfect situation can and will exist most of the time. Although you never saw public health working to prevent you from getting sick, it was there.

Even when all goes right – even when there are not blatant safety oversights along the way – sneaky Salmonella can find its way in. What then?

Our peanuts have picked up Salmonella after roasting (there’s likely no more heating to kill that nasty pathogen) in the processing facility. They are then mixed with more and more peanuts, shipments from other farms, passing through machine after machine, being ground into peanut paste, infecting huge lots of peanuts along the way. Our peanuts are now causing a silent outbreak deep within the processing facility.

The lots of infected peanut paste – soon to be peanut butter – go unsuspected and are sent to the next phase of processing where they will become cookies, crackers, ice cream, dog treats, etc.

Suzy Public loves peanut butter cookies, so she picks up a package during a routine grocery store visit. Two days later, Suzy is very sick.

Vomiting takes a turn to more severe symptoms so Suzy does the right thing and heads to her doctor. In keeping with clinical care guidelines, Suzy’s doctor orders a stool sample which is then sent to a clinical lab where it tests positive for Salmonella. This is obviously important information for Suzy’s doctor who needs to determine the most effective treatment, but it is also important for the public at large, especially for those in her community.

Additional testing at the public health laboratory could link Suzy’s Salmonella to other cases in her area or across the country.

While clinical labs must submit a report alerting epidemiologists of Suzy’s Salmonella, many states don’t require clinical labs to submit isolates (a sample of the Salmonella that made Suzy sick) to the public health lab. The report allows epidemiologists to gather initial exposure information on cases, but identifying potential outbreaks among sporadic cases can be tough without additional information. An isolate allows the public health lab to subtype or get DNA fingerprints from the Salmonella (more on this below), providing greater information and more rapid outbreak detection. So why wouldn’t states require these isolates be submitted? There are likely different reasons for this; one common reason is simply that the states lack resources. Some states can afford to have a courier pick up and deliver those isolates, but not every state is able. It is hard to mandate that the clinical labs handle shipments on their own time and dime. Additionally, some states simply cannot process all of those isolates at their current funding level. Requiring all clinical labs to send those isolates would put an enormous workload on already understaffed public health laboratories.

Once the investigation has been opened, an epidemiologist or public health nurse will contact Suzy Public to begin the investigation to nab the culprit. The first question they will ask Suzy is to list everything she consumed in the week or so prior to getting sick. These interviews allow disease detectives to track patterns in sick individuals’ diets. If everyone ate peanut butter crackers, they can target their investigation.

Could funding cuts to food safety programs make you sick? | www.aphlblog.org

Delays in testing or reporting will delay these disease detectives, and that means Suzy and the others who were made ill may not remember so far back. Even if they do remember and the disease detectives can identify a common food item in their diets, that product may already be off the shelves and in more people’s homes thus exacerbating the outbreak. Additionally, departments of public health face staff shortages that mean overloaded epidemiologists and public health nurses. Their ability to conduct thorough interviews requires ample time – and time is limited when staff are carrying a workload suited for several people.

If that isolate was sent to the public health lab, additional testing is done to confirm Salmonella and to subtype the pathogen. There are over 2,500 subtypes of Salmonella, so the first step in outbreak detection is determining which type has made this individual sick. PFGE testing delves further into the identification of the pathogen by identifying its DNA fingerprint. For example, there could be multiple outbreaks associated with Salmonella Typhimurium at the same time but that doesn’t mean it is the same culprit. Isolating the DNA fingerprints is like a detective pulling fingerprints from a crime scene – when there are multiple offenses committed, fingerprints can link them to the same perpetrator. The DNA fingerprints are then entered into the PulseNet database, a system used to detect clusters nationally. This information is used by epidemiologists to further target their investigation.

But staff shortages in public health laboratories mean not all isolates can be tested, and those that are tested could be delayed. That means less information is making its way into the PulseNet database or it is being entered too late.

Delays or gaps in information make the investigation extremely difficult.

The case of the contaminated peanuts is a complicated one. We know the contaminated peanut butter used to make Suzy’s cookies caused her illness, but identifying those cookies as the source is only the beginning of the investigative process. Was it the flour, sugar, salt, eggs, peanuts, or one or more of the other ingredients that made Suzy sick? And what about the people who were sickened by peanut butter crackers? Or energy bars? Finding the common denominator – and drilling all the way down to where contamination occurred – is very difficult. These complicated investigations can last upwards of a year, but they are being closed without resolution simply because public health departments don’t have the means to keep them open. No resolution means contamination at the processing facility could continue and more people could become ill. It also means the rest of the industry cannot learn from the outbreak and implement changes to improve product safety.

Rapid detection leads to faster recalls of contaminated products. That means fewer people get sick. But our public health system does not have the means to investigate every case of foodborne illness. There are not enough resources to follow up on every cluster.

Without question, more outbreaks would be found if there were sufficient resources to detect and investigate them all. Simply put, funding cuts are ultimately causing more people to get sick.

Advocates continue to work hard to convince decision makers that increasing funding for the public health system is a very good investment in our population. Healthy people are better for every aspect of society. While the advocates are working, public health professionals continue to seek more ways to improve the system with fewer staff and fewer resources. Whole genome sequencing, for example, could provide more information to better understand outbreak clusters, and that could mean less follow up testing which could mean operating with fewer staff. However, implementation of advancements such as whole genome sequencing requires time and money that the system simply does not have.

Every day that you wake up without foodborne illness, thank the public health system. Waking up healthy did not happen without the dedicated men and women working hard to prevent the spread of dangerous bacteria.

When public health works, no one sees it… but it still needs adequate support to continue protecting our health. The disease identification system described above operates on only $40 million annually and is in immediate need of at least an additional $10 million as indicated in the 2015 budget request. To realize significant improvements, CDC funding for food safety should be doubled at a minimum.

Tell Congress that more money is needed for food safety! Follow these two simple steps:

  1. Here is a letter telling Congress that more funding is needed for public health. Complete the information and it will be sent to your elected officials.
  2. Copy the following sentence and paste it into the letter to draw attention to the specific needs for food safety: I am especially concerned with the need for funding to improve our nation’s food safety system. CDC’s food safety office is in immediate need of an additional $10 million as indicated in the 2015 budget request. Without this funding, more Americans will get sick from foodborne illness.

 

 

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APHL 2014 Annual Meeting Day 3 Roundup

Jun 03 2014 :: Published in Annual Meeting

Top Tweets

For more tweets see our Day 3 Storify

 

Top Photos

 

Attendees visit with vendors in the exhibit hall | www.aphlblog.org

2014 APHL Awards Ceremony and Breakfast | www.aphlblog.org

Jeff Moran, Director, Arkansas Public Health Laboratory, Discussing future analytical considerations of legalizing marijuana

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Next Generation Public Health: Can Laboratories Enhance the Value Stream?

Jun 02 2014 :: Published in Annual Meeting

By Glen P. Mays, MPH, PhD, Director, National Coordinating Center for Public Health Services & Systems Research; The University of Kentucky, Lexington

Next Generation Public Health:  Can Laboratories Enhance the Value Stream? | www.aphlblog.org

Dr. Glen Mays will present the Dr. Katherine Kelley Distinguished Lecture on Tuesday, June 3, at the APHL Annual Meeting and Eighth Government Environmental Laboratory Conference in Little Rock, Arkansas. Attendees, please mark your program for this presentation scheduled for 2:00 pm in the Grand Ballroom. Dr. May’s PowerPoint presentation will be available on the APHL conference website as of Wednesday, June 3.

The Affordable Care Act and related state health reform initiatives are triggering diverse and far-reaching changes within the nation’s public health system.  Public health agencies are renegotiating their responsibilities and relationships with other health system stakeholders and to more clearly define their unique contributions to the “value stream” that produces population health.  My upcoming talk at the APHL Annual Meeting will explore strategies for demonstrating and enhancing the value that public health laboratories bring to the task of improving population health.  Here’s a preview of some of the trends and strategies I’ll discuss in my talk.

Next-generation public health places much greater emphasis on the catalytic functions of information acquisition, analysis and dissemination to mobilize and guide the actions of multiple stakeholders in the health system to achieve population health improvement.  Much of the information needed to support successful population health strategies is generated, analyzed and disseminated through the work of public health laboratories.  Counterfactual examples like the recently documented problems with newborn screening highlight the population health risks that can arise when information flows are suboptimal.  The converse is also true – generating the right information at the right time and getting it into the hands of the right decision-makers can fuel population health improvement.  Consequently, public health laboratories must think strategically about the roles that they can play in using their information flows to build, steer and sustain collaborative efforts in population health improvement, including:

  • Increasing the breadth, volume and quality of information generated through laboratory testing, particularly as the demand for testing increases as a result of expansions in health insurance coverage and new technologies for detecting and preventing disease.
  • Helping policymakers and other stakeholders understand the cost/benefit trade-offs associated with new testing technologies and opportunities.
  • Accelerating the timeliness with which information is produced and disseminated through laboratory operations.
  • Developing and testing innovations that improve the transmission and exchange of laboratory information – from specimen collection and transport through the dissemination and communication of test results. These actions include public health laboratory roles in meaningful use of electronic health records and in population-wide health information exchange.
  • Harnessing and harvesting opportunities for scientific research using the information flows that are generated and/or facilitated by public health laboratories, including the creation of specimen bio-banks, disease registries and test result archives.
  • Improving the resilience of the information flows generated by public health laboratories, including ensuring the continuity of testing and information dissemination capabilities during large-scale emergencies and hazardous events.
  • Using real-time laboratory information to better target and tailor public health interventions to the population groups that can benefit most, in keeping with the movement toward “personalized prevention and public health.”

Implementing these types of strategies will require improvements in public health laboratory capacity, which in turn requires an ability to demonstrate the health and economic value of expanded investments in public health laboratory capacity.  This task –articulating the societal return-on-investment (ROI) gained through enhanced laboratory capacity – is a central challenge for laboratory professionals and the public health community writ large.  Analytic techniques such as value stream mapping, information network analysis and value-of-information (VOI) analysis offer extremely powerful ways of valuing the information flows that are generated, processed and disseminated through public health laboratories.  These techniques can be used to show how the work of public health laboratories fuels the many processes involved in producing population health: from surveillance to investigation, prevention, protection, mitigation and resiliency.

Health reform’s push for improved population health requires more, better and faster information.  Public health laboratories are key to realizing this vision, but progress will require demonstrating and enhancing their value added.  I look forward to exploring these strategies in greater detail at the APHL annual meeting.

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Vectors of Change in Public Health Labs: Four Scientists Share their Views

May 31 2014 :: Published in Annual Meeting

The Affordable Care Act, molecular diagnostics, diminishing resources, global climate change: these are a few of the disparate developments shaping the future of public health laboratories in the United States. We asked four laboratory directors – all speakers at the 2014 APHL Annual Meeting – to share their views on the top vectors of change in the public health laboratory community.

Kerry Buchs, MHA, MT(ASCP), Laboratory Operations Director, Philadelphia Public Health Laboratory

Vectors of Change in Public Health Labs: Four Scientists Share their Views  | www.aphlblog.org“Within the next four years, 50% of my technical staff in the laboratory will be retiring. This presents a huge challenge for us to replace these tenured staff members. Fewer students are interested in going into health and science careers so the competition is extremely tough for new graduates in our area.  Fortunately we have several medical technologist training programs in the city.  One of our strategies for filling vacancies is to capture these students during their clinical internship for a rotation within the public health laboratory.  This exposes them to the work we do in public health and how rewarding it can be.”

Daniel Rice, MS, Director, New York State Food Laboratory; Incoming APHL President

“Diminishing resources in terms of staff and funding will continue to have a major impact on the future public health laboratories. Local and state public health laboratories have lost substantial numbers of positions and funding over the last eight years or so. This has had a remarkably negative impact on testing capability and capacity. The concept of regionalization of services is much discussed and appears to be gaining momentum. While this may bring efficiencies from larger volume testing by fewer labs, it also threatens to reduce the labs’ repertoire of testing capabilities. This could have unintended consequences. For example, testing could be delayed when a once routine capability no longer exists, and a sample needs to be shipped to another lab.

Protracted hiring freezes are causing an ever-widening gap between new scientists and seasoned staff. The median age in public health laboratories continues to rise and the number of mid-career scientists is decreasing. This situation is leading to a future, one that is not too far off, when the next wave of retirements will result in a catastrophic loss of institutional knowledge within laboratory programs. There will not be a sufficient number of appropriately trained scientists in the pipeline to fill the void of competent managers and leaders.

Technology is a fundamental driving force shaping public health laboratories. Technological advancements are occurring at such a fast pace that assessing and implementing these new technologies is a real challenge to public health laboratories. It is apparent that technology is shifting public health scientists from historical roles of bench chemist or microbiologist to more instrument- and informatics-based expertise. This is likely to change the physical layout/design of future public health laboratories and the training plan/path for future scientists significantly.

Jill Taylor, PhD, Interim Director, Wadsworth Center

“There are many drivers that will shape our future, not least among them being advanced technologies and big data. However, the thought we need to keep in the front of our minds when we are deciding how to juggle priorities while managing the next public health emergency is that, to serve and protect the public, we need to rely on the best science. Ultimately we will not have served our clients well if our decisions are based on outdated methods. While this will present many fiscal and operational challenges, it is imperative that we find creative solutions to address this need to keep abreast of our fields.

Ultimately, it is all about the people. One of the things that I have always loved about working in public health is seeing the passion, energy and commitment of the scientists and support staff who work in our labs. Nobody wants another emergency but I am sure you can relate to the observation that an emergency is a marvelous time to see everyone pulling together and making the system work. While we are now faced by a myriad of challenges, fiscal, operational and technological, I am confident that our people will continue to embrace change, move forward and find the creative solutions we need.”

John Ridderhof, DrPH, Laboratory Science Officer, CDC/OPHSS/CSELS

“One under-recognized challenge is the need for public health laboratories (PHLs) to implement informatics solutions that will provide them with the capabilities to report directly into the electronic health record (EHR) and receive HL7-based test orders (ETORs).  For now, this may be OK, as many of the referring clinical laboratories are also struggling to be interoperable with EHRs and providers. This ETOR capability is the future, and we should start identifying the required solutions now, knowing this will take support from all sectors to assure PHLs continue to be effective and relevant.

There are many challenges in the way of new technology and bioinformatics capability for PHLs.  In the end, it will still come down to the PHL workforce, since the biggest hurdle is not the instrumentation, but rather the education, training and competencies to use new technologies effectively. Upgrading the workforce will require a concerted effort to both recruit new talent and assure current staff are provided continuing education, mentoring and training to adopt new skills.”

 

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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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