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Kansas Lab Makes Enormous Strides in Lead Screening

Did you know that this week is National Lead Poisoning Prevention Week?  And did you know that elevated lead levels in children can cause decreased/delayed learning and behavioral problems?  According to CDC, 250,000 US children aged 1-5 years have blood lead levels greater than 10 micrograms of lead per deciliter of blood, the level at which CDC recommends public health actions be initiated.  Public health laboratories around the country are testing their state’s children to ensure that necessary actions are taken.

In an effort to test more children, the Kansas Health and Environmental Laboratories began a new project. Their original goal in 2002 was to screen every child at 12 and 24 months of age, but they needed a less traumatic way to collect blood from these toddlers. Using the newborn screening program as a guide, the Kansas lab staff developed a similar method to use filter paper to collect blood spots and analyze them for lead. The filter paper used for the newborn screening program is the same filter paper used for blood lead screening. Other similarities include the ease of specimen collection, transportation and training. The lab developed a new method to test for lead from the dried blood spots and developed a specimen submission form that was easy for nursing staff and others to use in the field.

In 2002 prior to starting the filter paper blood spot screening, the Kansas Public Health Lab analyzed around 3,500 blood lead specimens per year. In 2004 with the new screening in place, the lab increased screening to 14,000 specimens per year.  This is an enormous increase and a huge step forward in helping to identify children at risk of lead poisoning and preventing the harmful effects that lead can cause in children.

Computer Models Can’t Replace Real Testing

By Jennifer Beck Pierson, MPH, Senior Specialist, Environmental Health, APHL

Scientists in Europe are working on a new computer model that would reportedly predict chemical risk. While Europe is years ahead of the US in toxicity research and banning of harmful chemicals, many people remain skeptical about computer models. Historically, models used to predict risk are fraught with errors and unreliable -- characteristics that can only help manufacturers to win approval of new chemicals.

If this new computer model can actually identify hazards in chemicals before they are brought to market, it will provide a much needed solution to an ongoing problem. Animal testing is expensive, time consuming and politically sensitive. Chemical manufacturers do not want to jump through hoops to bring their product to market. 

Unlike Europe, which operates under the precautionary principle, in the US there are few barriers to new chemicals entering the market. US regulations under the Toxic Substances Act (TSCA) are weak at best. In fact, only three chemicals have been regulated under TSCA since it passed in 1976, because of a loophole in the statute relating to unreasonable risk. Even asbestos, a known carcinogen linked to tens of thousands of cases of mesothelioma, has yet to be banned outright.

The proposed computer model may sound like a magic bullet, but it can’t replace testing conducted by experienced toxicologists and other laboratory professionals. What we need is more toxicity research to better understand the effects of chemicals on people.

CDC’s Office of Public Health Preparedness and Response (OPHPR) Releases Their State Preparedness Report

By Tony Barkey, Senior Specialist, Public Health Preparedness and Response, APHL 

On September 21, 2010, CDC’s Office of Public Health Preparedness and Response (OPHPR) released their third preparedness report, Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State. The report highlights success and challenges of preparedness and response efforts taking place at state and local health departments across the nation.

As was reported, states continue to make progress implementing Continuity of Operations Plans (COOP). COOP ensures that vital public institutions, like public health laboratories, continue to function during and after an emergency. Today’s changing threat environment and recent emergencies, including localized acts of nature, accidents, technological emergencies and terrorist attacks, have increased the need for COOP capabilities and plans. All 50 states and DC either have a laboratory- specific COOP, are part of their state’s COOP or are in the process of developing their own plan. As we saw during the novel influenza A H1N1 outbreak, having these preparedness plans in place enabled the quick response that was seen. 

The report also revealed that 49 out of 50 states and DC conducted exercises to assess the competency of sentinel clinical laboratories within their state to rule out potential bioterrorism agents. This demonstrates the outreach from the LRN reference laboratories, funded via the CDC Public Health Emergency Preparedness Cooperative Agreement, to their partners who are often on the front line receiving samples during an emergency.

These positive results come at a time when many states are experiencing difficulties maintaining the workforce necessary for an effective response. 41% faced hiring difficulties and 28% faced retention issues. For those that reported hiring difficulties, 36% identified a lack of funding as a primary reason and another 31% reported hiring freezes. 

APHL staff and members played a prominent role in the publication by providing laboratory- and state- specific data to the report. APHL’s data points, collected from the annual All-Hazards Laboratory Preparedness Survey, were used to describe issues such as workforce shortages, continuity of operations, sentinel clinical outreach and training, emergency communication, and general laboratory testing capability. If you are interested in finding out more, the report can be found here. 

APHL Briefs Experts on Biosecurity in Public Health Laboratories

By Sikha Singh, MHS, Specialist, Laboratory Response Network, APHL 

APHL was invited to participate in the September 16th meeting of the Federal Experts Security Advisory Panel (FESAP) to provide a perspective on how potential changes in biosecurity requirements would impact public health laboratories, especially those in the Laboratory Response Network (LRN). Dr. Michael Pentella, associate director of disease control at the Iowa State Hygienic Laboratory, and Rosemary Humes, APHL’s senior advisor for scientific affairs, spoke to the group.

FESAP was created by the recently signed Executive Order on Optimizing the Security of Biological Select Agents and Toxins in the United States to provide advice to the Secretaries of the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) on Select Agent Program security including:

• The composition and potential reduction of the Biological Select Agents and Toxins (BSAT) list, including the development of “Tier 1 agents,” which pose the greatest risk for intentional misuse 
• Measures to enhance reliability of personnel with access to Tier 1 BSAT 
• Standards for physical and cyber security for facilities possessing Tier 1 BSAT 
• Emerging policy issues relevant to the security of BSAT. 

During the course of their presentation to the panel, Humes and Pentella highlighted the robust biosecurity and biosafety practices implemented within public health laboratories, as well as the distinction between public health laboratories and academic and production laboratories. Public health laboratories perform detection, surveillance and diagnostic testing that provides a front-line of defense against health threats in our nation. Their ability to detect agents of biological terrorism and public health significance plays a significant role in national security, as witnessed by the response of LRN laboratories to the 2001 anthrax events and to daily threat detection in all 50 states. 

Pentella echoed the sentiments expressed in the comments provided by APHL on the current HHS list of select agents and toxins. He commented that existing biosecurity measures have proven successful and that increased biosecurity measures would be burdensome and costly to public health laboratories, impacting their ability to provide immediate testing and response capabilities to potential bioterrorism and other threats of public health significance. Pentella further emphasized the funding issues facing laboratories, particularly in light of economic constraints leading to furloughs and extensive budget cuts. 

In response to the many questions raised by the panel, Pentella and Humes noted that current personnel controls are adequate and are further strengthened by regulatory requirements that specify stringent biosafety and biosecurity controls within public health laboratories. Laboratory directors and responsible officials remain empowered to make decisions necessary to maintain the integrity of their laboratories. 

In a heartening conclusion to the discussion, Dr. Gerald Parker, DVM, PhD, MS, Principal Deputy Assistant Secretary, Office of the Assistant Secretary for Preparedness and Response, HHS stated that, "The LRN is one of best investments we've collectively made in bioterrorism preparedness and response." 

APHL and its members value opportunities to shed light on issues that affect public health laboratories and will continue to promote the role of these laboratories in detecting and responding to bioterrorism, emerging infectious diseases and other public health threats. 

Notes from the President: Strengthening the Relationship Between APHL and EPA

By Dr. Patrick Luedtke, M.D.; President, APHL; Director, Unified State Laboratories, Utah Department of Health

I just returned from a wonderful meeting at the Environmental Protection Agency (EPA) national office in Washington DC with the EPA Deputy Administrator Bob Perciasepe and Phil Metzger (Advisor to the Deputy Administrator). In attendance from APHL were Scott Becker (Executive Director), Peter Kyriacopoulos (Senior Director Public Policy), and Megan Latshaw (Environmental Health Program Director). 

The core discussion revolved around the potential benefits of an EPA Laboratory Office that would serve to coordinate all environmental laboratory-based policy, practice, and program efforts in a cross cutting fashion. Additionally, this office would serve as a single point of contact for laboratory-based communication efforts to external partners. 

A secondary discussion involved the need for a single data standard across EPA. This discussion included sharing knowledge of the challenges governmental environmental laboratories face concerning multiple data systems, as well as the major benefits that would accrue to our national environmental laboratory system should such a single data standard be adopted. 

Most importantly, our conversation enabled us to describe the interaction between State and local governmental environmental laboratories and EPA, and share a vision on how that interaction can evolve and lead to even better health outcomes. All in all, it was deeply gratifying at a professional and personal level to engage in such a collegial and congenial dialogue – a dialogue that I am excited about continuing as the relationship between APHL and EPA matures and strengthens.

CDC Director Thomas Frieden visits Washington State Public Health Laboratories

By Allison Cook, Public Information Officer, Washington State Department of Health and Romesh Gautom, Ph.D., Director, Public Health Laboratories, Washington State Department of Health


The Centers for Disease Control and Prevention Director Dr. Tom Frieden recently made his first visit to a public health laboratory during a stop to our state. It was a great honor. While the CDC is one of our most important partners, it doesn’t happen too often that the director is able to make a stop in Washington. We were very excited to host him.

Public Health Laboratories Director Dr. Romesh Gautom 

shows Dr. Frieden through the Microbiology Section of the lab. 

Dr. Brandon Leader, right, looks on.

As it was Dr. Frieden’s first visit to a state lab since becoming CDC director a little more than a year ago, we were happy to give him a brief tour. He had a lot of questions, especially around our food safety, tuberculosis, and shellfish testing work. We showed him areas where we conduct molecular testing including influenza testing, as well as testing for other communicable diseases. 

Dr. Frieden’s visit to our state Public Health Laboratories was brief, but we were pleased with the opportunity to highlight some of the important work we do to protect the people of Washington.

--
The opinions expressed here represent those of the author and not APHL.

Threat to Prevention and Public Health Fund Defeated

By Peter Kyriacopoulos, Senior Director of Public Policy, APHL

On September 14, the U.S. Senate defeated an attempt to eliminate the funding for the Prevention and Public Health Fund -- created in the Affordable Care Act (ACA), the federal health reform law.

Voting on a procedural matter, the Senate rejected an amendment offered by Senator Mike Johanns of Nebraska that would have used the resources in the Fund as an off-set for a new federal income tax reporting requirement that will be implemented by the Internal Revenue Service in 2012. The vote was especially significant because of the eight vote margin by which it was defeated, even though there was an extremely strong push by the business community that encouraged the Senate to pass the amendment.

The final vote tally can be found here; a letter of support from Secretary Sebelius (Health and Human Services) and Secretary Geithner (Treasury) is here.

The public health community has never come together so quickly and worked together as cohesively as it did in the effort to preserve the Prevention and Public Health Fund. This accomplishment will be easily replicated for any future attempts to reduce or eliminate the Fund and should send a very clear message to those who seek other uses for it: “Hands Off!”

Give Public Health 'Just Credit' for Minimizing Impact of H1N1

The 2009 H1N1 influenza outbreak was officially elevated to pandemic status on June 11, 2009.

Earlier this month, on August 10, 2010, the World Health Organization (WHO) declared it officially over.

What does this mean?

To many people, both the start and end dates seem somewhat arbitrary.  Indeed, there are undoubtedly some who think the outbreak never should have been declared a pandemic at all.  Certainly, there are many local communities seemingly untouched by 2009 H1N1.

As with much in public health, to understand these determinations, it is useful to consider the Big Picture.

Pandemics have three basic defining characteristics:

1. They must involve the emergence of a novel, infectious microbe to which people have had no previous exposure and therefore little to no natural immunity.  In this case, “novel” means that there is not a documented history of the disease having infected people or the disease hasn't infected people in such a long time that it unlikely anyone will have immunity.
   
2. They must be pathogenic; that is, they must have potential to make people sick, and often significantly so.
   
3. Last, but not least, pandemics must involve sustained human-to-human transmission over a large geographic area. (The official WHO criteria for a Phase 6 pandemic—the highest level—requires sustained community level outbreaks in at least two countries in one WHO region, plus at least one other country in another region.) 

The 2009 H1N1 virus handily meets all three criteria. It was clearly a unique influenza subtype with its association with swine-origin viruses. It had significant morbidity and mortality:  almost 1.5 million cases worldwide, including roughly 45,000 laboratory-confirmed US cases; and just over 25,000 deaths worldwide, including 10,837 US deaths. And by the end of the pandemic this month, there had been sustained human-to-human transmission in dozens of countries all over the world. In fact, during the pandemic, 2009 H1N1 crowded out other influenza viruses to become the dominant strain, infecting 20-40% of populations in some areas.

In this post-pandemic period, a significant chunk of the world population has now been exposed to the virus—either directly or through vaccination—and thus has some immunity. Rates of sustained transmission are generally leveling off or falling off. Many countries are reporting a mix of circulating flu viruses. . . . . In other words, 2009 H1N1 is behaving more and more like a seasonal flu virus. In fact, now that it is no longer novel—meaning that it now has a well documented history of having infected people—it should never again qualify as a pandemic virus. But that doesn’t mean it has gone away.

Given the justified concern about a pandemic involving avian influenza, with its 50-60% mortality rate, 2009 H1N1 may, in retrospect, seem mild to some. This is good news, partly a result of effective public health intervention and, as stated by the WHO director-general, partly “pure good luck.”

Pete Shult, PhD, head of the Communicable Disease Division at the Wisconsin State Laboratory of Hygiene and an influenza expert, said that back in April 2009, health authorities had “no clue what was going to happen here.”

He said, “Did the government overreact? No. Absolutely not. I think we should take our just credit. We were able to diagnose [2009 H1N1] quickly. We were able to get vaccine out there. We were able to help the health community respond effectively. I’m not sure in the absence of those efforts this wouldn’t have been a worse pandemic. . . .You always have to plan for the worst case.”

And now that it’s over, what can we expect from 2009 H1N1 in the future?

Said Shult, “We’re in uncharted territory. We’ll see what happens.”

Notes from the President: Preventive Laboratory Services

By Dr. Patrick Luedtke, M.D.; President, APHL; Director, Unified State Laboratories, Utah Department of Health

Notes from the President will be a regular series.

Currently public health laboratories focus on infectious disease. Recently an APHL member and fellow lab director asked me for my thoughts on branching out to testing related to chronic disease prevention. I have given a good deal of thought to how public health labs will or could fit into a new prevention-based health system, which seems to be bounding down the healthcare highway toward us at a high rate of speed.  While I certainly have no solutions, I have no shortage of ideas and concerns.

It seems to me the roles of public health laboratories in a prevention-based health system could be made to fit into four broad categories:

1. Provision of test results

Public health laboratories could begin or continue providing a panel of prevention-based testing that perhaps focuses on CDC director Dr. Thomas Frieden’s “winnable battles.”  Testing could include fasting blood sugars, lipid panels, and others.  Some of APHL’s local laboratory members already perform this testing on a regular basis.  For others, it seems to me adoption of this type of testing would be quite dependent on local/state politics.

2. Prevention-focused research

I envision public health laboratories could play a meaningful role in prevention-focused research.  For example, we are approaching 80 million American adults with hypertension, 95% of whom have no known cause for their high blood pressure.  Additionally, it is well known that high blood levels of calcium and potassium as well as low levels of sodium produce significant decreases in many with high blood pressure. That being said, very little is known about body-burden of select metals/chemicals at birth and the resulting development of hypertension.  The same could be said of other common diseases of public health import.  Therefore, given the public health laboratory’s role in newborn screening (NBS), it is not a stretch to imagine an expansion of the NBS panel to include heavy metals, other select chemicals, etc. with the aim of identifying “at-birth risks” for chronic disease development.  

3. Regulatory systems

It seems to me that traditional public health laboratory roles of oversight in the clinical lab arena will likely not change substantially in the future.  In fact, they may expand as point-of-care testing increases and direct access testing labs proliferate.

4. Health outcomes partnering

I believe public health laboratories have an opportunity to move from the old “program evaluation” and internal “quality improvement initiative” paradigms to become active members in systems that focus predominantly on the final impact an intervention has on patient outcome.  This is an area that clinical medicine is rapidly moving into, and an area I feel that public health laboratories need to seriously study.

-- The opinions expressed here represent those of the author and not APHL.

The Prevention and Public Health Fund is Under Attack

By Peter Kyriacopoulos, Senior Director of Public Policy, APHL

Yesterday I attended a meeting of the lead Congressional staff on health reform who detailed a serious threat to the Prevention and Public Health Fund created by the Affordable Care Act (ACA) – the federal health reform law.

This attack on the fund will come on Tuesday, September 14, 2010 from Senator Mike Johanns who wants to divert the public health fund to pay for continuing to allow small businesses to not accurately report their expenses and income to the Internal Revenue Service. The diversion from the fund would cover the lost federal tax revenue that would result from the accurate reporting currently required by law. Unrelated to any tax reporting issue, Senator Johanns’ amendment also reduces by 2 million the number of people covered by health insurance - which will likely raise premiums for all Americans.

It is wrong to pit the health of Americans and small businesses against each other when there are other ways to cover the cost of reporting business transactions. Senator Johanns’ amendment is bad for the Prevention and Public Health fund – and it would be bad for all Americans who need health coverage or pay for coverage. Senator Bill Nelson from Florida has an alternative that gives reporting relief to small business without attacking prevention fund – so that the fund can do its job and produce improvements in the health of Americans.

Now is the time for the public health community to strongly voice its opposition to the amendment that has been introduced by Senator Johanns.

APHL Assists Haiti to Rebuild Devastated Lab System

On January 12, 2010 tragedy struck in Haiti. A massive earthquake rocked the tiny national, particularly Port-au-Prince, causing damage and destruction that will take years to repair.

One of the buildings severely damaged in the earthquake was the public health laboratory. Deemed unsafe for use, laboratory operations moved to a tent erected outside of L'Hôpital de l'Université d'État d'Haïti (HUEH). Since the earthquake, the number of patients being treated at HUEH has tripled from 14,000 per month to almost 42,000 thus increasing demands for laboratory testing. Due to extremely high temperatures and no air conditioning in the tent, automated testing requiring cooler temperatures, such as hematology and blood chemistry, are being run manually. The result is that the current testing capacity is only 25% of the daily demand.

Following the earthquake, the Centers for Disease Control and Prevention requested and authorized APHL Senior Technical Consultant and Team Leader for the APHL Haiti Field Laboratory Support Team, Dave Doherty, to assist all of the public health network laboratories in Haiti in getting testing services back up and running to support the enormous demands for medical care and treatment

Upon learning of the dire needs in the tent laboratory, Doherty sought out to find an air conditioner that would help keep the tent at the appropriate temperature. Before he knew it, a casual conversation with a Doctors Without Borders volunteer led him to International Relief Solutions (IRS), a Georgia based company that creates modular buildings in areas of need. The APHL Haiti Field Laboratory Support Team led by Doherty provided technical assistance to IRS in planning and design of a new modular laboratory facility to will replace the temporary tent facility.

The 24’ by 36’ modular laboratory will stand next to HUEH. The facility is designed with infrastructure for work benches, heating, ventilation, plumbing and electrical services. With direct hookup to electrical and water supplies, the laboratory building will have the air conditioning necessary to meet the requirements of the many intricate and delicate tests that the laboratory technicians on scene perform routinely. The lab will arrive with the electrical system and plumbing pre-installed allowing for a quick start-to-finish set up of approximately four days.

Better lab facilities will improve testing services and will enable laboratory technologists to get back to work. According to Doherty, “Many well-trained technologists in Haiti are unable to work and provide testing services because of the loss of laboratory facilities to earthquake damage.”

It could be years before the permanent structures are rebuilt; the new modular lab serves as a long term solution. This initiative was a success due to the collaboration of willing and committed partners, each of whom brought essential resources and expertise to assure an effective solution for meeting a critical need in Haiti. Lives will be saved and illnesses treated effectively because of the efforts of APHL, IRS and CDC. Doherty modestly explains, “We were able to come through. APHL has always come through in Haiti.”

National HIV Testing Day, June 27

National HIV Testing Day is observed on June 27 of each year to raise public awareness of the importance of knowing one’s HIV status and to encourage communities, organizations and governments to support HIV testing initiatives. APHL salutes the governmental laboratories that diagnose hard-to-identify HIV infections. The service provided by these public health laboratories protects the health of individuals and the community at large.

Even with the enormous advances over the past several years, traditional HIV tests may not identify individuals in the early stages of HIV infection or who are infected with HIV-2, a less common and slower progressing strain of HIV. Although new laboratory-based methods promise to detect more early infections, detection and diagnosis of HIV-2 remains a concern.

According to Dr. Mike Pentella, associate director of the State Hygienic Laboratory at the University of Iowa, “We have identified two HIV-2 infections in recent years that may have been missed if thorough laboratory testing was not conducted. Public health laboratories, through their ability to identify difficult infections like HIV-2 and acute HIV-1 infections, make a significant contribution to HIV prevention efforts.” Dr. Pentella also serves as the chair of the APHL/CDC HIV Steering Committee.

There currently is no FDA-approved confirmatory test for HIV-2.

“You need an accurate and reliable diagnosis before you can treat someone,” says Dr. Patrick Luedtke, president of APHL’s board of directors and director of the Unified State Laboratory in Utah. “While it is obviously critical to use a reliable testing method for the purposes of patient diagnosis, it is also crucial for monitoring its spread."

APHL commends our members, colleagues and partners who work every day to improve outreach and provide accurate and timely diagnostic testing for the public health community.

NOAA Test Detects Oil Component in Fish and Shellfish

Public health agencies and laboratories have a crucial role to play in the BP oil spill crisis as testers of seafood. Chemical testing ensures that seafood from the Gulf of Mexico is not contaminated by oil and is therefore safe to eat. NOAA’s seafood-testing method is the current gold standard—and sole approved testing method—for reopening waters. The test is able to detect PAH, an oil compound, in both fish and shellfish.

All 50 US states participate in a food-testing network called the Food Emergency Response Network (FERN). NOAA’s test is available to all FERN labs and, as the testing workload expands, FDA will increasingly encourage FERN labs to utilize NOAA’s test. In addition to detecting PAH, labs can assist with baseline testing by comparing pre- and post-spill PAH levels. In performing these chemical analyses, public health labs will be instrumental to the re-opening of fisheries.

Exhibition Anticipation!

The APHL Annual Meeting is only a few days away and the anticipation mounts regarding what the vendors will be displaying in the exhibit hall. There will be 41 exhibitors including 20 APHL sustaining members, and, yes, we will again be sponsoring a raffle in the exhibit hall. Prizes include airline tickets, cash, a DVD on Class II Biological Safety Cabinets, a Kindle, a free registration to the 2011 APHL Annual Meeting and more. The exhibits will run from Sunday, June 6 at 3:30 pm through Monday, June 7 at 4:30 pm. Some exciting items and services will be there including:

• A white paper on Florida/Texas electronic data exchange for surge capacity from LabWare
• The award-winning Abbott Plex ID platform using IBIS technology
• Data management, productivity and compliance solutions from STARLIMS, which has been supporting PHLs around the world for 5 years
• Luminex’s xMAP® open-architecture, multi-analyte technology platform delivering fast and accurate results
• Solutions for sustainable, healthy facilities from HDR/CUH2A
• eReports as part of the Specimen Gate® family of software applications, which are ready-built to meet customers’ needs, and JANUS liquid handling solutions and technology for a cleaner environment and better health from PerkinElmer.

More news to follow, but let’s make a date to meet at the Hilton Netherland Plaza in the Hall of Mirrors to uncover what other exciting discoveries await us in the Exhibit Hall at the APHL Annual Meeting!

 

World Hepatitis Day

 Did you know?  

• Approximately 500 million people around the world are currently infected with chronic hepatitis b or c
• 1 in every 3 individuals will be exposed to hepatitis b or c in their lifetime

Due to the lack of routine screening programs, most hepatitis infected individuals will not receive testing until symptoms of liver disease develop. World Hepatitis Day is an opportunity to raise awareness about this frequently overlooked set of diseases.

 

According to a recent report from the Institute of Medicine (IOM), “Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and Hepatitis C” up to 5.3 million people, or 2% of the US population, are infected with hepatitis B or C. The IOM report attributes the lack of viral hepatitis awareness in the United States to inadequate education and inadequate funding. For example, in 2008 the CDC’s National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention had a budget of almost $1 billion and only 2% of it was allocated to viral hepatitis initiatives. The recommendations put forward in the report frequently site increasing the amount of laboratory testing conducted as a vital step in increasing the awareness of infection status and decreasing transmission rates.

 

In the event that the recommendations from the IOM report are implemented, it is likely that public health laboratories will play a key role in those initiatives. In 2009 APHL surveyed 51 public health laboratories to determine their viral hepatitis testing capabilities and capacities. The survey found that 88% of state public health laboratories (SPHLs) in the US perform or refer some level of hepatitis testing, indicating that SPHLs continue to play an important role in the diagnosis and surveillance of viral hepatitis infection in the United States. However, 58% of responding laboratories reported that the funding they currently receive is not enough to meet hepatitis testing needs in their state.

 

APHL is releasing the full survey report in observance of World Hepatitis Day and would like to recognize our members, colleagues and partners in the public health laboratory system who are working to reduce the burden of viral hepatitis around the world.

 

Approaches to Combating HIV/AIDS

At a recent amFAR (The Foundation for AIDS Research) sponsored Congressional briefing* on AIDS research at NIH, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Disease (NIAID), described what he viewed as the three essential approaches in combating HIV/AIDS: 

• controlling disease progression
• preventing new infections; and
• curing existing infections.

Antiretroviral therapy (ARV) is one of the most potent interventions available in medicine today and can significantly prolong a patient’s life. Continued expansion of ARV therapy, especially in the developing world, is essential to controlling disease progression and improving patient outcomes.

 

For a sustainable response to the pandemic, however, preventing new infections will be crucial. A significant focus of NIH funding supports vaccine development and treatment research (Pre-Exposure Prophylaxis, test & treat programs, and microbicides). Dr. Fauci cited the positive results of a vaccine trial last year as a significant first step towards developing an effective vaccine.

 

In the coming years, NIAID plans to continue investing in vaccine research to build on this preliminary success. The ability to cure existing infections would be an incredible breakthrough, but as Dr. Fauci mentioned, HIV is capable of hiding in the body making a true sterilizing cure very difficult to develop. Research is continuing, though, especially on so-called “functional cures” that wouldn’t completely eliminate the virus from the body but would prevent its proliferation and pathogenesis without the need for additional treatments.

 

While it is clear that a great deal of research funding is directed toward HIV vaccines and cures, NIH is also committed to researching new approaches in testing and treatment. It is estimated that 21% of HIV-infected individuals are unaware of their status. In efforts to expand testing, public health laboratories will continue to play an important role in the public health response to this pandemic.

 

*The briefing was held in collaboration with the offices of Congresswoman Rosa DeLauro (D-CT), Congresswoman Barbara Lee (D-CA), and Congressman Eliot Engel (D-NY). Thank you to those offices for their support.

 

Celebrating National Lab Day

Today marks the very first National Lab Day, an event conceived in 2009 by a grassroots coalition of educators and scientists eager to reinvigorate science, technology, engineering and mathematics (STEM) education for America’s K-12 students. The event earned a stamp of approval from President Obama and was added to his “Educate to Innovate” campaign to combat the nation’s flagging performance in science and math. National Lab Day looks to create a community of students, teachers, professionals and organizations focusing on collaboration to “improve educational outcomes, inspire students to pursue science, technology and engineering careers, improve hands-on laboratory environments in the STEM subjects, and raise student, parent and public awareness of the importance of science and technology to our nation’s future.” Check out the National Lab Day website for more information.

Just as any computer company, alternative energy think tank or NASA department depends on new ideas and innovation from younger generations, public health laboratories also require skilled, innovative thinkers to confront the ever-evolving challenge of keeping American citizens healthy. Public health laboratorians are the behind-the-scenes “disease detectives,” providing the science to confirm food-borne illness outbreaks, emerging infectious diseases, potential chronic illnesses in newborns, and even biological terrorism threats. Despite the importance of the labs, the United States is in the midst of a severe shortage of public health lab workers, and badly needs a steady stream of new laboratorians to enter and innovate in the field.

APHL is committed to assisting the youngest generation to become leaders in the STEM fields, and more specifically, in public health laboratory science. APHL’s Workforce Development department creates continuing education opportunities and leads a fellowship program for the best and brightest studying emerging infectious diseases and environmental health. The National Center for Public Health Laboratory Leadership (NCPHLL) strives to prepare current and future laboratory leaders with the skills critical to public health lab success in the rapidly-evolving field. APHL also participates in the Labs Are Vital education and awareness program, working to promote laboratory science to students and the general public.

National Lab Day is a perfect opportunity for APHL and public health laboratory workers to promote the importance of public health laboratories in their communities and to lead students towards the exciting and vital world of public health. The National Lab Day website has many opportunities for scientists and other professionals to volunteer at schools. There is nothing like hands-on learning and real-life experience from actual laboratorians to excite and inspire kids towards a future in lab science. Who knows, a future laboratory leader may be dissecting his or her first frog today.

National Lab Day Website 

National Lab Day Video

APHL Announces Results of Board Elections

On Friday, May 7, APHL announced the results of the 2010 board of directors elections.  APHL’s board is the legal authority of the association, and administers all of our property, funds and affairs. Being on the board of directors is an enormous responsibility, which is why the association’s elections and nominations processes are so important.  In its monthly calls and quarterly meetings, the board reviews program activities, progress on the annual plan, and committee motions/actions. It also meets with a host of external stakeholders from APHL’s federal partners to corporate members to international delegations. 

On behalf of Secretary Treasurer, David Butcher, we present this year's election results and offer sincere congratulations to the following:

President Elect, 2010-2011, Victor Waddell (AZ)

Member At Large, 2010-2013, Charles Brokopp (WI)

Local Institutional Member Representative, 2010-2013, Mary Sue Kitchen, (Fairfax County, VA)

Thank you to the Nominations Committee, chaired by Past-President Frances Downes, for its work in preparing the slate.  Also, a heart-felt “thanks” goes to the voting members for taking time to participate in the election.  If you have any questions about the process or the results, please contact Shawna Webster or call 240.485.2785. 

New Lab in Iowa Shaping a Healthier Future For All

By Scott Becker, Executive Director, Association of Public Health Laboratories

On Wednesday, May 5, a dedication ceremony was held for the new State Hygienic Laboratory at the University of Iowa. The three-story, 113,900-square-foot facility, which replaces one constructed in 1917, houses the states’ environmental and public health laboratory.

The opening of the state-of-the-art facility marks the culmination of years of work by the lab’s staff who identified the need for a new building, worked tirelessly to secure the funding, and directed design and construction of the enormously complex edifice.

The Hygienic Laboratory is responsible for conducting tests to detect diseases and contaminants in the environment. It also monitors for the presence of diseases and for contaminants in Iowa's waterways and air. In emergencies, such as the Iowa floods of 2009, it serves as the state’s laboratory first responder.

The facility will allow for new collaborations, including those to study interactions between human health and the environment, and to evaluate emerging laboratory technologies that could save lives and money. Who knows? Scientists here could uncover indicators linking infectious and chronic disease or develop methodologies that will revolutionize laboratory diagnostics.

The people of Iowa are the immediate beneficiaries of this state-of-the-art health resource. Yet, because no public health laboratory works in isolation, this new facility actually benefits those of us in the rest of the country as well. Its presence represents another step toward our shared mission--shaping a healthier future for all.

Suspicious Powder Sample Sent to Arizona State Lab for Testing

The Laboratory Response Network (LRN) and its partners maintain an integrated network of laboratories that are fully equipped to respond quickly to acts of chemical or biological terrorism, emerging infectious diseases, natural disasters and other public health threats and emergencies.  The LRN became operational in 1999 and has since performed essential public health services, notably including responding to the Anthrax attacks of 2001. 

Most recently in Phoenix on Tuesday, the State Department of Health (Arizona Bureau of State Laboratory Services, an LRN member laboratory) similarly acted to test a white powder letter addressed to Governor Jan Brewer.  The letter was opened by a staff person in the State Capitol sending the hazmat team scrambling to lockdown the building. 

In situations such as this, the FBI will deliver the suspicious sample to the LRN laboratory.  The LRN lab’s highly trained staff will then run a panel of tests (standardized across the LRN, specific to BioTerrorism and Public Health threats) in a very secure and safe environment to determine if there exists an agent of interest within the suspicious sample.  The testing methodology is robust and redundant, with verification and confirmation tests run for any positive samples.  All data specific to threat samples received and tested by the LRN labs are then reported to CDC as well as to the FBI.

Currently the FBI is awaiting results on the samples in Arizona.

Lab Week Comes to a Close -- A Message from Scott Becker

As National Laboratory Professionals Week comes to a close, APHL is proud to honor all of the public health laboratory professionals who work tirelessly to protect the health and safety of the public. You are each to be commended for the high quality work you deliver day after day-- despite budget cuts, furloughs, staff down-sizing, antiquated facilities and all the other challenges that confront laboratorians in 2010.

So today, raise a purple-gloved hand high in a salute to you and your colleagues. Few people can say that their work saves lives, but you can. I extend my sincere thanks on behalf of the people you serve and the association that is fortunate to represent you.

Scott Becker
Executive Director, APHL

Celebrating Earth Day and Lab Week

Happy Earth Day! This year marks the 40th anniversary of this celebration, a day designed to inspire awareness and appreciation for the Earth's environment. While we have come a long way in improving our environment – no more rivers so contaminated that they regularly are consumed in flame, for example – we still have a long way to go, as evidenced by recent findings of contaminants in dog food, baby bottles, and children’s toys.

Did you know that laboratories are vital to protecting us from harmful contaminants in our environment?

Public health laboratories measure contaminants once they get into our bodies, while environmental laboratories measure contaminants in the environment itself (in the air, water or soil).

To better illustrate the importance of the lab’s role in protecting us from environmental contamination, here is a fictional but realistic scenario:

A group of six young men, all apparently friends, arrive at a local emergency room with similar symptoms: nausea, vomiting, headache, fatigue and weakness. The ER immediately takes blood and urine specimens, sending them to the hospital labs for screening while simultaneously contacting the state Poison Control Center for advice.

Tests indicate cell and tissue decomposition and the Poison Control Center suspects radiation sickness. They recommend calling the state public health lab for guidance. Meanwhile, all of the patients and medical staff who came into contact with these men (receptionists, nurses, and physicians) enter quarantine. The men’s clothing is secured.

The public health lab contacts the local FBI field office, which immediately sends agents, while the Department of Defense’s Civil Support Team begins processing the men’s townhome. A suspicious white powder is found along with documentation on a laptop linking the men to a recent theft totaling over $75M in radiopharmaceuticals. Following confirmation of radioactivity, the scene is evacuated and cordoned off.

Meanwhile, the FBI locates a storage unit rented by one of the men under an assumed name. Upon search of the unit they find more of the white powdery substance as well as containers of paint remover, concentrated sulfuric acid and hydrogen peroxide. In addition, the unit contains laboratory equipment (glassware, distillers, mixers, an ice bath and filters).

Ultimately, the white powder is determined to be Triacetone Triperoxide (TATP), a powerful, highly unstable homemade explosive. Apparently, the men were trying to build a dirty bomb and were exposed to the radioactive pharmaceutical they had stolen.

People who came into contact with these men remain concerned about their potential exposure, so the state public health lab tests their urine. The results reassure the medical staff and the men’s neighbors that they need not worry. The state environmental laboratory tests soil and water samples from around the storage unit and the men’s townhome; much to local policymakers’ relief the results show no reason for concern.*

Thanks to the coordinated response between the hospital, the Poison Control Center, the Civil Support Team, the public health laboratory, the environmental laboratory and the FBI, the terrorist plot was foiled. Public health and safety were protected!

* Note that there is no national program for radioanalytical laboratory preparedness and response. Some states are better able to test for radioactivity than others, some not at all.

For more information on environmental health and laboratories see www.aphl.org/eh

For more information on Earth Day see:

• Top Ten Actions Individuals, Organizations, and Businesses can Take in Reducing Their Contribution to Global Warming
• Commit to taking action or sign up for daily green tips

Laboratory Systems & Standards: Building the Foundation for Quality Testing

In honor of Laboratory Professional Week, APHL would like to highlight some of the activities that it conducts on behalf of members. The Laboratory Systems and Standards (LSS) program works with public health and laboratory partners to build the foundation for quality testing: comprehensive standards and integrated public health laboratory systems.

Vaccine-Preventable Disease Project

As the incidence of Vaccine-Preventable Diseases (VPD) decreases in the US, the capacity and capability of state and local public health laboratories to perform VPD testing has declined, becoming increasingly inconsistent. While some labs are quite proficient in VPD testing, others are eliminating testing altogether. However, timely and accurate diagnosis of VPDs is essential to identify and control outbreaks and to provide the information needed to improve vaccines and vaccination programs. To address gaps in testing capacity for VPDs, APHL was recently awarded funding through the American Recovery and Reinvestment Act of 2009 (ARRA) to provide training programs and quality improvement activities for VPD testing in public health laboratories. The association is partnering with CDC to develop and present these programs.

The first initiative is a series of teleconferences targeted to public health laboratorians. To date, CDC subject matter experts have presented new diagnostic testing methods for several VPDs, including Bordetella pertussis (whooping cough), Streptococcus pneumoniae, measles virus and mumps virus. The mumps educational teleconferences have been especially timely in light of the ongoing mumps outbreak in the northeastern United States. State public health lab staff are being trained in the new mumps assay developed at CDC. Access to this assay will enhance patient diagnosis and epidemiological investigations in participating states.

In response to a recent survey of public health labs’ training needs for VPDs, more trainings and quality improvement activities are planned, including hands-on workshops, proficiency testing exercises and assay comparison studies. By working together on these activities, APHL and CDC look forward to helping public health laboratories to improve their capability to quickly and accurately detect cases of VPDs.

Voluntary Accreditation Program

“Continuous quality improvement” is part of the laboratorian’s credo. Assays and equipment must meet precise quality standard before they can be utilized in the laboratory. Now APHL is developing voluntary standards specific to public health laboratories that will be used to assess the quality of the laboratory itself and specifically its operations and functions. These new standards will not supplant CLIA, but be used as a complement to the federal regulation.

The accreditation program will be voluntary, and will integrate standards from existing domestic and international sources as well as those outlined in the Core Functions of Public Health Laboratories.

Incorporation of the public health laboratory standards will be proposed to the Public Health Accreditation Board (PHAB) for incorporation into their accreditation process. Accreditation will signify that the laboratory has met agreed-upon standards of quality and that it ascribes to them as a measure of its services.

APHL is convening a Think Tank with PHAB at the end of April to discuss how the program should look, be structured, and what elements should be included in such a partnership. Information from the Think Tank will be shared with membership on the APHL web site and through reports in Lab Matters.

Laboratory System Improvement Program (L-SIP) Assessment

To make it easier for labs to find quality improvement and performance-related materials, APHL provides a one-stop-shop for resources to improve the quality of state public health laboratory systems. One of those tools is the Laboratory System Improvement Program (L-SIP) assessment tool. During an L-SIP assessment, representatives of the state public health laboratory system and partners convene to assess the performance of state public health laboratory system. This program provides a user-friendly process, including a performance assessment tool for assessing and establishing a baseline measure of performance.

Most recently, South Dakota has scheduled our Laboratory System Improvement Assessment for April 29th. We have closely followed the recommendations of the APHL L-SIP Assessment Tool User's Guide, a document that walks the coordinators through the assessment preparation process and includes sample materials such as letters to participants and agendas. For this lab and the others who utilize the L-SIP assessment tool, they find that it offers a means for strengthening relationships with public health, clinical and other laboratories and partners that comprise the broader laboratory system, as well as a framework for continuous improvement of public health laboratory systems.

We are looking forward to convening our system partners later this month to discuss our state public health laboratory system and what we can do to improve it.

Rebuilding Haiti’s Labs: Governance, Policies and Systems Before Bricks and Mortar

At a March 31 United Nations special session on rebuilding Haiti, countries responded with pledges of significant funding for the decimated nation; however, funding alone will not rebuild Haiti, and certainly not its battered laboratories.

First, Haitian leaders must find the courage and commitment to confront corruption and inefficiency within their government. Without a fundamental shift from opportunism to public service, donors will not be willing to sustain the long—and costly—process of recovery.

Photo: A typical lab in Port-au-Prince, Haiti

Second, the international donor community must adopt new operational models that are less dependent on the services of ex-patriots. Good models are available. Paul Farmer at Partners in Health and Jean William Pape at GHESKIO/ Weill Cornell Medical College, for example, have shown that impoverished communities with few resources can combat diseases and improve health care. Their approach—like that of APHL's project in Haiti—is to build long-term partnerships with local groups and to help train their doctors and healthcare professionals.

Third, Haiti’s laboratories need to be reconceived and rebuilt as part of an integrated national laboratory network operated under a strong quality management system. A precursor to this is development and implementation of a revised national laboratory policy and strategic plan to guide the orchestration of the necessary resources, including a trained and competent workforce.

Yet the reality at the moment is that there isn’t a comprehensive and forceful Haitian laboratory policy, strategic plan or network, only the commitment of the country’s national laboratory to forge a true laboratory system and support from some non-governmental organizations. How can APHL best support development of a nationwide laboratory system that will serve all of Haiti’s people? We look forward to your comments.

Case Study 1 -- The Response

To follow up on our previous post about Mr Fudd and his family's mysterious illness...

Response:

If the specimen was initially tested in a sentinel clinical laboratory where analyses are unable to rule out a possible Bioterrorism agent (in this case, Yersinia pestis) using standard methods they would immediately refer suspicious isolates and specimens to their collaborating LRN reference laboratory.

Case Investigation:

Upon investigation the Fudd family was attending a family and friends reunion in New Mexico. One of the Fudd family traditions is to organize a wascially wabbit hunt the morning of the reunion, and dine on rabbit stew and other assorted rabbit dishes at that evening’s party.

In humans, Yersina pestis is most often acquired from the bite of infected fleas that feed from animal reservoir such as squirrels, rabbits, and prairie dogs. Although rare, there have been several documented reports of Y. pestis infection from the direct contact of contaminated meat products either through ingestion or inhalation.

Celebrating Lab Week -- Case Study 1

Happy National Medical Laboratory Professionals Week!

As a fun activity during the week several programs at APHL will be posting fun case studies related to the work being done in public health laboratories across the country. Today’s case study comes from Infectious Disease, Food Safety, and Emergency Preparedness.

Case Study

Mr. Fudd presents in the emergency room in Chicago with fever, lethargy, severe pharyngitis, tonsillitis and a striking swelling of his neck. The ER Physician ordered Rapid Streptococcus A Dtesting, gram stain, and respiratory cultures.

Two days following the first patient presentation, three additional Fudd family members present to the same emergency room with similar symptoms.

All patient specimens were sent to the laboratory for ordered laboratory testing. The lab results included the following:

Laboratory Tests --
(Photo: Blood Agar Plate Growth at 48 hours)

• Rapid Streptococcus A: Negative
• Gram Stain: Gram Negative Rods
• Culture incubated at 37C for(24 hours): Pin point colonies on Blood agar Plate and Chocolate agar
• Culture incubated at 37C for (48 hours): Grey, white, translucent colonies on Blood agar Plate and Chocolate agar; Clear White Non Lactose Fermenting colonies on MacConkey agar

Biochemicals --
(Photo: Gram Stain of Culture Isolate)

• Catalase: Positive
• Oxidase: Negative
• Urease: Negative
• Indole: Negative

What would your laboratory do next?

Please include your comments/answers below. APHL is excited to hear what your laboratory would do next!  The response and case investigation will be posted this afternoon.  Stay tuned...

 

Heel-Prick Test Conducted By Labs Ideal for Genetic Disorders

A virus that causes about 20% of hearing losses in newborns has received considerable attention of late in mainstream media. A recent study published in the Journal of the American Medical Association (JAMA), finds that this virus—the cytomegalovirus or “CMV”—can be best detected using existing analytical methods, rather than the one evaluated in the study. [insert reference as footnote], For the immediate future, medical practitioners, laboratory scientists and the families they serve will need to rely on other proven technologies, such as testing a baby’s saliva.

Newborn screening is a complex process that can be confusing even to medical experts. Recently a CBS News segment on the JAMA study reported erroneously that newborn hearing tests are conducted at state public health laboratories. This is incorrect. A baby’s hearing is tested at the hospital within 24-48 hours of birth; that test is not performed by state newborn screening laboratories.

State laboratories do, however, shoulder most of the responsibility for newborn screening in the US. They conduct 97% of the testing for the core panel of 29 congenital disorders recommended by the American College of Medical Genetics (ACMG) and the U.S. Secretary of Health and Human Services Advisory Committee on Heritable Disorders and Genetic Diseases in Newborns and children (ACHDGDNC). Newborn screening by state laboratories protects over 4,000 children a year from the potentially devastating effects of Phenylketonuria (PKU), Medium Chain Acyl-CoA Dehydrogenase deficiency (MCAD), Maple Syrup Urine Disease (MSUD) and other serious disorders that can lead to death or life-long disability. In addition to the 29 ACMG “Core” conditions, the public health laboratory in some states also screens for some of the 25 “Secondary” conditions.

A new testing method would simplify and expedite testing for CMV if the method could be adapted to use the same instrument platforms as used to detect other newborn screening conditions.

Newborn screening starts with a single heel-prick collected at the birthing facility soon after a baby is born. Blood droplets are collected on a filter paper kit, allowed to dry and then sent to the state public health laboratory for testing using specific analytical tools to detect congenital disorders. Methods used by the newborn screening laboratory include fluorometric and colorimetric immunoassays, electrophoresis, high performance liquid chromotography and tandem mass spectrometry (MS/MS).

The introduction of MS/MS revolutionized newborn screening – allowing labs to test for dozens of conditions simultaneously. Currently, not all diseases and conditions can be detected via MS/MS (e.g. biotinidase, galactosemia) but the aim is to detect more disorders using this efficient and effective method to provide more rapid detection of congenital conditions to protect the nation’s children.

National Public Health Week -- APHL Honors Public Health Laboratories

By Mary Shaffran, Senior Director, Public Health Programs, APHL

Along with our partners, the public health laboratories are working to keep communities healthy. Laboratorians work behind the scenes. Public health laboratories serve as the nation’s early warning system for diseases and other health hazards. When health risks emerge or re-emerge, public health laboratories analyze the threat, provide the answers needed to mount an effective response and act to protect the public in collaboration with other decision makers. They protect our health by monitoring continuously for diseases and other health hazards.

Just a few of the things that laboratories are doing every day to make sure that you and your neighbors are healthy: 

- Public health laboratories in every state are the backbone of our nation’s infectious disease surveillance networks. They are analyzing infectious diseases such as influenza to determine if they are changing and reporting this information to public health officials so they can determine effective prevention measures. [More on the Infectious Disease Program]

- More than 11,000 babies are screened daily for potentially life-threatening genetic and congenital disorders.

• Matt and Noelle Bamonte discovered that their seemingly healthy baby boy had PKU, a serious disorder that can cause brain damage if not treated from a very early age. Noelle is certain that without laboratory screening, her little boy would have been vastly different. Now, aside from a strict diet, he lives a normal life! [More of their story]

- Public health laboratorians confirm whether people are infected with sexually transmitted diseases, and confidentially report back the results so that people can be treated and others are not exposed. [More on the Sexually Transmitted Disease Program]

- In order to detect foodborne outbreaks and ultimately keep Americans safe from foodborne disease, public health laboratorians test human specimens and food samples for bacteria such as Salmonella and E. Coli.

• In 2006, the New Mexico public health laboratory pinpointed the exact source of the E. Coli that made its way into spinach and made hundreds of people sick. [More on the E.Coli outbreak]

- Public health laboratorians test environmental, clinical and food samples to determine whether they contain hazardous agents in order to protect Americans from terrorist attacks, and they are able to do this 24/7.

• California scientists are collecting specimens from 2,000 people to test for the presence toxins used in used in industry, agriculture and the home. They’ll use this information to explore such things as the connection between exposure and diseases, and to examine changes in exposure over time and the connection to changing health policies and industry regulations working to reduce exposure. [More on the work in California]

- Public health laboratorians test water samples in flood-ravaged areas to ensure that the water is safe to drink.

• In 2008, severe flooding in Mason City, Iowa caused the closure of the water treatment facility. Residents were advised to boil their water until the system was restored and the water was tested to ensure it was safe to drink. The Hygienic Lab rose to the task and tested the water quickly bringing the treatment operation back online. [More on the floods in Iowa]

We would like to thank our unsung heroes in lab coats for protecting the public’s health – every day.

 

Join APHL and our many partners in celebrating National Public Health Week. For more information, visit http://www.nphw.org/.

 

 

 

 

 

 

 

 

 

Salmonella Outbreak Leads to Heightened Surveillance

As laboratory and epidemiology surveillance systems expand and improve, more foodborne outbreaks are being detected. Additionally, the vehicles responsible have become more diverse. Whereas the classic “church supper” and other point source outbreaks once made headlines, now fresh produce, peanut butter, veggie snacks and even reptiles have been implicated in localized and complex multi-state outbreaks.

New culprits, including ingredients that were overlooked years ago, are now being detected as the source of food contamination. In the past few weeks, public health officials have heightened surveillance for Salmonella in the wake of the recalls of hydrolyzed vegetable protein or HVP. HVP is a flavoring additive that has been widely used in the food industry. It is sometimes referred to on packaging as “natural flavors.” This additive is found in thousands of products ranging from snack foods, ready-to-eat products (hot dogs, for example) soups, sauces and other processed foods. This recall may be the largest to date. (List of recalled foods.) Although no human illness has been associated with the recalls to date, the implicated strain of Salmonella was found at a food flavoring processing plant in Nevada.

APHL continues to support member laboratories on foodborne surveillance networks such as PulseNet. This laboratory-based surveillance system detects clusters of foodborne illnesses by using DNA fingerprinting technology. APHL supports member laboratories in the PulseNet network to improve surveillance though trainings, technical meetings, information dissemination, and grants.

This recall demonstrates the critical importance of the public health laboratory system and the need for maintaining and expanding food safety surveillance networks. By catching contamination more quickly, labs are able to prevent widespread outbreaks of foodborne illnesses; another important way that public health laboratories are keeping you healthy.

Implementation: The Next Step in Health Reform

Last week when President Obama signed the Senate version of the Patient Protection and Affordable Care Act into law, he initiated significant reform of the US health system. The key word here is “initiated,” because the benefits of this far-reaching new law hinge upon its successful implementation.

If governmental public health and its laboratories do not receive adequate funding to underwrite the public health provisions of the Act, then its benefits will be considerably reduced. Specifically, funding from the Prevention and Public Health Fund must be directed to the Centers for Disease Control and Prevention (CDC) for use in support of governmental public health. Anything less will belie the intent and purpose of this landmark legislation.

Key provisions of the health reform law that directly impact public health laboratories include:

• The Prevention and Public Health Fund (Sec. 4002) will fund prevention and wellness activities, including governmental public health, at $500 million beginning in fiscal year 2010 and expanding to $2 billion in 2015. These monies are provided outside of the standard annual appropriations process and in addition to the federal funding already being directed to similar programs. This funding cannot be reduced or redirected, and full disbursement is mandatory within the timeframes specified. APHL is already at work to ensure that a significant portion of fiscal year 2010 funds are directed to governmental public health programs, including those that support laboratories.

• The Public Health Workforce Recruitment and Retention Program (Sec. 5204) provides funding to expand the public health workforce through loan reimbursements and scholarships in exchange for service as a public health professional. This new program is authorized at $195 million in fiscal year 2010.

• Funding for the Epidemiology-Laboratory Capacity (ELC) grant program (Sec.4304) and public health fellowships (Sec. 5314). The ELC program, authorized for the first time, could receive annual funding totaling up to $195 million, with $32 million directed to enhancing laboratory practice and $60 million to improving information systems.

• The Fellowship Training in Public Health adds a section entitled, “Fellowship Training in Applied Public Health Epidemiology, Public Health Laboratory Science, Public Health Informatics, and Expansion of the Epidemic Intelligence Service” to the Public Health Service Act. Under this section, the laboratory fellowship program is authorized at $5 million annually, as is the Public Health Informatics Fellowship program.

World TB Day

By Kelly E. Wroblewski, Manager - HIV, STD, TB, Hepatitis Programs, APHL

Every year approximately 2 million people worldwide die from tuberculosis-related disease. Yet TB prevention and control too often receives scant funding and limited attention from government officials, health professionals and the public.

Observed every March 24 to commemorate the date in 1882 when the bacterium that causes tuberculosis was first discovered, World TB Day affirms the critical role of public health laboratory scientists in controlling and preventing the disease.

Last week the Centers for Disease Control and Prevention released reports indicating that preliminary data shows a 10.6% decrease in reported TB cases in the United States over a one-year period from 2008 to 2009. While many factors, including potential underreporting, could have factored into this decrease, the numbers are still encouraging. Yet public health professionals know we must remain vigilant, for a decline in US funding led to a resurgence of TB cases in the nineties. Moreover, new drug-resistant strains of TB have emerged, making the disease increasingly deadly.

In 2009 APHL members made significant contributions to TB control efforts above and beyond their work in the laboratory. After several years of work by APHL members, the TB self assessment tool, Mycobacteriology: Assessing Your Laboratory, was revised and published in a new electronic format. Additionally, the TB Steering Committee developed and published a document, Core TB Services of Public Health Laboratories, which outlines the role of public health laboratories in TB diagnostics and surveillance.
Now planning is underway for the 6th National Conference on Laboratory Aspects of TB, which will be held in Atlanta, GA, June 21-22, 2010, in conjunction with the National TB Conference.

On this day dedicated to raising awareness of tuberculosis and enhancing prevention and control globally, APHL would like to recognize the members, colleagues and partners who persevere to combat this devastating disease.

CDC Creates New Office of Prevention Through Health Care

By Peter Kyriacopoulos, Director of Public Policy, APHL

The Centers for Disease Control and Prevention (CDC) recently notified Scott Becker, APHL’s Executive Director, about a newly created office: the Office of Prevention Through Health Care (OPTH). This new office will enable CDC to more aggressively and effectively develop and disseminate policies that leverage the health care system to improve health through prevention. According to CDC, OPTH will coordinate health care activities across CDC programs and will lead engagement with external partners on health care issues.

There is no better way to achieve an immediate improvement in health through prevention than increased surveillance and detection of disease outbreaks. State and local laboratories performing tests of public health significance are on the frontline of this activity and are under extreme pressure to continue their exemplary performance because of the staffing reductions that have resulted from budget cuts caused by the economic downturn. Work on food safety, pandemic influenza, and other infectious diseases is imperiled because of these budget cuts.

An infusion of federal support for state and local public health workforce retention would produce an immediate high-value preventive intervention by preserving the much-needed laboratory professionals who are responsible for surveillance and detection on a daily basis. Improved surveillance and detection coupled with expedient delivery of that information through a robust laboratory informatics network would lead to a reduction in the instances of disease and reductions in the number of individuals seeking health care because of disease. It is hard to imagine a smarter engagement with the health system than by reducing the number of people it is struggling to serve. The positive implications for the payers, public and private, of this care are similarly obvious.

The corollary is also true, the path we are travelling with continued losses of state and local laboratory professionals coupled with the antiquated mechanisms for transmitting laboratory test orders and results can only lead to reduced surveillance and detection and increased incidents of disease that causes public and private payers to expend ever increasing amounts on the delivery of health care to increased numbers of people.

Public Health Preparedness Summit: Huge Success

Last month’s Public Health Preparedness Summit in Atlanta was a huge success. The Summit welcomed over 1,800 attendees and continues to provide a unique forum for multiple disciplines of public health to learn from each other how best to promote a culture of public health preparedness across the nation.

This year's Summit included Town Hall Sessions where organizations such as APHL presented on important topics including "The Wild World of Public Health Laboratories: We do More than Testing for Sexually Transmitted Diseases." This session provided attendees with an overview of public health laboratories, their role in testing for novel influenza A H1N1; detecting Salmonella typhimurium in peanut butter and identifying a nationwide outbreak; screening the nation's newborns for genetic disorders and providing continuity of operations during natural disasters, such as Hurricane Katrina; and working with the Laboratory Response Network (LRN) to test hundreds of white powder threat letters sent to governors and embassies.

In addition to presentations on laboratory-specific activities, APHL's preparedness staff, Anthony Barkey and Sikha Singh, led a session on implementing social networking tools as tomorrow's emergency response engine for local departments of health.

One of the keynote presentations was delivered by Ana-Marie Jones, executive director of Collaborating Agencies Responding to Disaster (CARD). She emphasized the importance of simplifying messages and engaging the public as messengers. Jones encouraged public health leaders to use these tough economic times to eliminate failing programs and look at how to leverage successes of existing programs that succeed in generating measurable change.

Closing keynote speaker, Thomas Frieden, MD, MPH, Director, CDC and Administrator, ATSDR, stated that preparedness is a core function for CDC. Frieden reiterated CDC's commitment to strengthen state and local preparedness to better measure, improve and monitor public health capability; strengthen technical assistance; promote collaboration and train the public health workforce.

This conference will continue be one of the few events that bring together all the major players in the preparedness community, from emergency planners and first responders to policy makers and federal agencies. The summit is quickly becoming an event known for bringing new ideas and technology to the forefront, which is a trend that will only help to strengthen the public health community.

Public Health Funding Through PHEP

By Peter Kyriacopoulos, Director of Public Policy, APHL

Strong governmental public health is capable of responding to the full array of diseases and other health threats that can cause harm to the people of this country. Public Health Emergency Preparedness (PHEP) funding offers one avenue of support, and there will certainly be others similarly targeted. PHEP provides funding to public health departments via CDC to build their capacity and capability to respond effectively to infectious disease outbreaks, natural disasters and other public health emergencies, including those that are willfully introduced.

The correct way to assure an effective and efficient governmental public health response to all threats is through dedicated and continuous federal funding. While there is not yet sustained federal funding for public health laboratories, it remains one of APHL's top policy priorities. Both the House and Senate versions of health reform legislation include provisions creating trusts or investment funds that go far to accomplishing this goal. Until they are enacted, governmental public health will be compelled to seek funding from any and all possible sources.

Newborn Screening: Part 2

By Brad Therrell, Ph.D., Professor Dept. of Pediatrics, UTHSCSA Director, National Newborn Screening and Genetics Resource Center (NNSGRC)

Each year 15,000-16,000 newborns are identified with one of the core 29 conditions tested for using newborn screening. Tests are conducted by analyzing dried blood spots in order to prevent serious medical outcomes from certain congenital conditions.

Many states are considering evidence that points to the value of adding more conditions to the recommended core screening panel. The Secretary of Health and Human Services' Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC) recommends additional tests; the most recent is Severe Combined Immunodeficiency Disease (SCID), better known as 'Bubble Boy Disease'. Krabbe Disease, now screened for only in New York, is also being considered as a possible addition. Former Buffalo Bills quarterback Jim Kelly (Hunter's Hope Foundation) is actively seeking expanded newborn screening including the addition of Krabbe Disease which took the life of his son Hunter before newborn screening was available.

There have been inaccurate reports regarding the use of a baby’s DNA obtained from newborn screening. As mentioned previously, the newborn screening specimens are stored as dried blood spots, not as DNA. If DNA extraction is necessary and possible, there is usually a dissent process in place and there are educational materials about newborn screening distributed by every newborn screening program. In fact, the Secretary of Health and Human Services' ACHDNC is already hard at work considering national guidance on the issue of storage and use of dried blood spots.

It is important that everyone has the facts about newborn screening available to them. Regardless of the inaccuracies that exist out there, parents deserve to have factual information on the entire process.


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The opinions expressed here represent those of the author and not APHL.