The recent outbreak of novel Influenza A H1N1 and the subsequent laboratory response have shed light on the work of state and local public health laboratories. But while this rapid response has been grabbing headlines, laboratorians continue work behind the scenes to address a wide range of public health threats.
Through active surveillance, public health laboratories can often detect infections before they become widespread outbreaks. While the media was transfixed by H1N1, the PulseNet system detected a spike in Salmonella serotype Saintpaul infections. Subsequent investigation and testing rapidly identified contaminated alfalfa sprouts as the culprit. Aided by advanced laboratory techniques and improved surveillance, public health laboratories continue to monitor for diseases like E. coli and Salmonella to ensure the safety of our nation’s food.
Public health laboratories are also responsible for screening 97% of newborns in the United States—in the past week alone, government labs have screened close to 80,000 babies for as many as 55 separate conditions. Newborn screening lets clinicians rapidly identify genetic and metabolic disorders, which without prompt treatment may lead to lifelong disability or even death. While many focus on the roll-out of the new influenza assay to states this week, thousands of newborns continue to be tested in the public health laboratory system.
The nation’s public health laboratories provide a diverse range of services to protect the public’s health. Disease diagnosis and surveillance, drug susceptibility testing, newborn screening, chemical exposure and environmental monitoring continue, even while laboratories operate at surge capacity to address the ongoing flu outbreak.
Thursday, May 7, 2009
The importance of electronic messaging
A crucial element in response to a large-scale outbreak, such as the novel H1N1 virus, is rapid reporting of laboratory test results. Lab test results must reach the right people at the right time. Without this information, important public health decisions cannot be made.
Public health labs lack a single, standardized way to exchange laboratory data electronically. Right now, only a handful of state labs can send their H1N1 results electronically to CDC—most rely on some combination of sending spreadsheet attachments through email, uploading results to a secure website, calling in or faxing their results. These limitations apply to CDC as well as public health labs.
Some progress has been made through the Public Health Laboratory Interoperability Project (PHLIP), a joint undertaking by APHL, state public health laboratories and CDC. PHLIP aims to link government labs nationally to provide fluid electronic dialogue among laboratories and CDC. PHLIP's key goal is interoperability—the ability for different types of systems, including computers, networks, operating systems and applications, to work together effectively to exchange information in a useful manner. Essentially, this means systems talking to each other.
Much more needs to be done.
Many federal task forces have identified the need for electronic laboratory reporting; however adequate funding for this activity has not been identified. An expert panel convened by ANSER estimates the cost to develop and maintain electronic laboratory messaging capability at state and local public health labs is at least $200 million in federal funding annually. Without this investment, lab results will continue to be trapped in local, state and federal silos where we cannot protect America's health.
Public health labs lack a single, standardized way to exchange laboratory data electronically. Right now, only a handful of state labs can send their H1N1 results electronically to CDC—most rely on some combination of sending spreadsheet attachments through email, uploading results to a secure website, calling in or faxing their results. These limitations apply to CDC as well as public health labs.
Some progress has been made through the Public Health Laboratory Interoperability Project (PHLIP), a joint undertaking by APHL, state public health laboratories and CDC. PHLIP aims to link government labs nationally to provide fluid electronic dialogue among laboratories and CDC. PHLIP's key goal is interoperability—the ability for different types of systems, including computers, networks, operating systems and applications, to work together effectively to exchange information in a useful manner. Essentially, this means systems talking to each other.
Much more needs to be done.
Many federal task forces have identified the need for electronic laboratory reporting; however adequate funding for this activity has not been identified. An expert panel convened by ANSER estimates the cost to develop and maintain electronic laboratory messaging capability at state and local public health labs is at least $200 million in federal funding annually. Without this investment, lab results will continue to be trapped in local, state and federal silos where we cannot protect America's health.
Tuesday, May 5, 2009
Hardworking Workforce
Over the past year, public health laboratories, their budgets ravaged by state and local cuts, have lost funding for operations, instrumentation and staff. Since January 1, 2008, an APHL survey shows the extent of the damage: labs have lost close to 500 full-time positions out of a total workforce of only 6500, and more losses are anticipated. Entire laboratory programs have been eliminated, because there were simply no funds to sustain them.
Yet, despite a bleak outlook and limited resources, laboratories, when thrust into the latest crisis with the H1N1 outbreak, have responded with skill, ingenuity and grit. In the first week of the outbreak, they subtyped nearly 300 suspect specimens for referral to CDC for final confirmation.
This week public health labs in some 65 locations across the country will assume responsibility for confirmatory (definitive) testing for the novel H1N1 virus, thus accelerating delivery of test results and implementation of disease-control measures. This eases some of the pressure on CDC laboratories but the demand for testing remains intense at the state and local level. Laboratory scientists, administrators, IT specialists and other staff are all racing to keep pace, working late into the night and on weekends.
This level of response isn’t surprising, however. We saw it earlier this year during the Salmonella outbreak when thousands of human and environmental samples poured into PulseNet labs for testing. We saw it in 2008 during the Iowa floods, when laboratorians worked to keep up with the increased demand in water testing. And we saw the same response after hurricanes Ike and Katrina pummeled the Gulf coasts, during the Anthrax attacks in 2002 and following the World Trade Center attack in 2001, to name a few examples.
The staff working flat out in our labs have opted to stay in the field of public health to help people. If money was a primary motivating factor, they would have left long ago! Instead they work to guarantee that emerging diseases and other health threats are detected promptly and that health officials have the information they require to mount an effective response.
It is a testimony to their dedication and hard work that they are continuing testing for other key public health functions—newborn screening, drinking water testing and analysis of foodborne pathogens, for instance—while managing the burgeoning load of H1N1 testing.
Yet, despite a bleak outlook and limited resources, laboratories, when thrust into the latest crisis with the H1N1 outbreak, have responded with skill, ingenuity and grit. In the first week of the outbreak, they subtyped nearly 300 suspect specimens for referral to CDC for final confirmation.
This week public health labs in some 65 locations across the country will assume responsibility for confirmatory (definitive) testing for the novel H1N1 virus, thus accelerating delivery of test results and implementation of disease-control measures. This eases some of the pressure on CDC laboratories but the demand for testing remains intense at the state and local level. Laboratory scientists, administrators, IT specialists and other staff are all racing to keep pace, working late into the night and on weekends.
This level of response isn’t surprising, however. We saw it earlier this year during the Salmonella outbreak when thousands of human and environmental samples poured into PulseNet labs for testing. We saw it in 2008 during the Iowa floods, when laboratorians worked to keep up with the increased demand in water testing. And we saw the same response after hurricanes Ike and Katrina pummeled the Gulf coasts, during the Anthrax attacks in 2002 and following the World Trade Center attack in 2001, to name a few examples.
The staff working flat out in our labs have opted to stay in the field of public health to help people. If money was a primary motivating factor, they would have left long ago! Instead they work to guarantee that emerging diseases and other health threats are detected promptly and that health officials have the information they require to mount an effective response.
It is a testimony to their dedication and hard work that they are continuing testing for other key public health functions—newborn screening, drinking water testing and analysis of foodborne pathogens, for instance—while managing the burgeoning load of H1N1 testing.
Monday, May 4, 2009
Introduction and Welcome
Welcome to the launch of LabLog, the blog for the Association of Public Health Laboratories (APHL), a membership organization of federal, state and local government laboratories that provide testing of public health significance. LabLog will feature posts by APHL staff and members, as well as outside experts. We hope that LabLog will be a valuable source of information on laboratory science and policy, and provide a forum for lively discussions. We strongly encourage questions and comments.
Subscribe to:
Posts (Atom)
Posts
