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. 

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.

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

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.”

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.

What is Your Laboratory’s Approach to STEC Testing?

by Sharon Shea, MHS, MT(ASCP), director, infectious disease and food safety programs

If you have followed clinical microbiology listservs, attended ASM’s General Meeting or listened to enteric disease talks in the past year, you may have been anticipating the October 16 release of an MMWR Recommendations and Report issue, “Recommendations for Diagnosis of Shiga Toxin-Producing Escherichia coli Infections by Clinical Laboratories.” These guidelines were developed by CDC in collaboration with APHL and a host of clinical, academic and public health partners. The report highlights the importance of prompt and accurate diagnosis of STEC infections for both proper patient treatment and effective public health control. Detailed guidelines for STEC testing in the clinical laboratory are provided, including the recommendation that all stools submitted for routine testing from patients with acute community-acquired diarrhea be simultaneously cultured for O157 STEC and tested with an assay that detects Shiga toxins (to detect non-O157 STEC). Such testing will be a major change in practice for some hospital laboratories and could represent an increase in laboratory costs. Who will bear the cost of this testing? How much of that cost can be reimbursed to the lab?

We in public health need to support our clinical partners as they adopt the new recommendations. Is your laboratory ready to accept isolates and/or broths from laboratories in your state/county? Who will pay for the packaging and shipping? What will you do with those samples once they are received? How can this work be supported at a time of severe cutbacks in public health spending, without additional federal support?

APHL’s STEC work group, in conjunction with state and federal partners, is developing guidelines for receiving and characterizing STEC isolates and specimens in public health laboratories. These companion guidelines will be released in early 2010. Your input on that document or the impact of the new STEC diagnostic recommendations is welcome.

2010 Proposed Federal Budget

President Obama recently unveiled his proposed 2010 federal budget. Unfortunately, it was disappointing to see that the budget generally maintained, but did not increase, the levels of funding for most governmental public health priority programs. The budget for CDC was approximately $6.6 billion, a 0.4% increase from 2009’s budget of approximately $6.3 billion.

A few key laboratory areas did, however, receive greater funding:

▪ FDA funding for food safety was increased. However, there was no sizable increase for CDC activities, most notably PulseNet. To ensure America’s food supply is protected, it’s important that all elements of the food safety infrastructure are adequately funded.
▪ There was a $51 million increase in HIV/AIDS funding, most of which was primarily for point-of-care programs and not for laboratory testing.
▪ It was the third year running that newborne screening activities received dedicated funding.

For more information about the budget, please browse the online document.