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.
Showing posts with label infectious diseases. Show all posts
Showing posts with label infectious diseases. Show all posts
Monday, April 19, 2010
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.
Laboratory Tests --
(Photo: Blood Agar Plate Growth at 48 hours)
Biochemicals --
(Photo: Gram Stain of Culture Isolate)
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...
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
(Photo: Gram Stain of Culture Isolate)
- Catalase: Positive
- Oxidase: Negative
- Urease: Negative
- Indole: Negative
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...
Thursday, April 8, 2010
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.
- 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.
- 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.
Join APHL and our many partners in celebrating National Public Health Week. For more information, visit http://www.nphw.org/.
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]
- 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]
- 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]
- 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.
Monday, November 2, 2009
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.
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.
Thursday, September 3, 2009
Cross-Border Influenza Preparedness
by Chris Mangal, director of emergency preparedness and response
On August 31-September 1, 2009, in Winnipeg, Canada, APHL's leadership and infectious disease, preparedness and global health staff met with key officials from the Canadian Public Health Laboratory Network (CPHLN) to discuss collaborative activities, such as lessons learned from the recent H1N1 outbreak and planning for a tri-national cross-border preparedness summit. In addition, APHL staff toured the Emergency Operations Center of the National Microbiology Laboratory and learned about their Incident Command Structure used to respond to infectious disease outbreaks.
Following the meeting with CPHLN, APHL staff (Scott Becker, Mary Shaffran, Chris Mangal and Natalia Machuca) attended the first conference of its kind in Canada, “Severe H1N1 Disease: Preventing Cases, Reducing Mortality,” organized by the Public Health Agency of Canada (PHAC).
Dr. Graham Tipples from PHAC served as the Master of Ceremonies, welcoming key public health officials, including the Honorable Leona Aglukkaq, Canada's Minister of Health. The minister noted that this conference was the first of its kind to bring together clinicians, laboratorians and key public policy officials. She mentioned that the conference will help Canada to better prepare for and respond to the upcoming influenza season. The minister also mentioned that continued monitoring and surveillance for H1N1 along with consistent collaborations, information exchange and strong partnerships will be vital to keep the population healthy and prevent and manage the spread of H1N1.
The Manitoba Minister of Health, the Honorable Theresa Oswald, welcomed participants to Winnipeg, but stated, “I really wish you weren't here." This statement is a reflection of the growing concerns about the upcoming flu season and the potential for H1N1 to be more widespread, affecting the general population and overwhelming the healthcare systems globally.
Dr. David Butler-Jones, chief public health officer, PHAC, addressed the dilemma of managing and measuring H1N1. He noted that "you can't manage what you don't measure," but also mentioned that the fluidity of H1N1 cases makes it difficult to measure and as such public health officials must be creative in responding to this pandemic.
Dr. Frank Plummer, chief science advisor, PHAC, further explained the objectives of the conference, noting that he hopes participants leave with a better understanding of epidemiology and severity of the disease, clinical care and management issues, intensive care unit challenges and strategies to manage H1N1 cases. He also encouraged further connections among hospitals, infection control and public health.
Dr. Charles Penn, Global Influenza Programme, World Health Organization (WHO) addressed the current status of the pandemic and WHO efforts to facilitate communications globally, mobilize resources and provide access to vaccines and antivirals. Several additional sessions, including in-depth discussions on modeling scenarios, provided participants with more information on Canada's efforts to prepare for and respond to H1N1.
APHL will continue our collaboration with Canada and look to build stronger linkages with Mexico to ensure that there are robust laboratory systems in place to detect and respond to infectious disease outbreaks globally.
On August 31-September 1, 2009, in Winnipeg, Canada, APHL's leadership and infectious disease, preparedness and global health staff met with key officials from the Canadian Public Health Laboratory Network (CPHLN) to discuss collaborative activities, such as lessons learned from the recent H1N1 outbreak and planning for a tri-national cross-border preparedness summit. In addition, APHL staff toured the Emergency Operations Center of the National Microbiology Laboratory and learned about their Incident Command Structure used to respond to infectious disease outbreaks.
Following the meeting with CPHLN, APHL staff (Scott Becker, Mary Shaffran, Chris Mangal and Natalia Machuca) attended the first conference of its kind in Canada, “Severe H1N1 Disease: Preventing Cases, Reducing Mortality,” organized by the Public Health Agency of Canada (PHAC).
Dr. Graham Tipples from PHAC served as the Master of Ceremonies, welcoming key public health officials, including the Honorable Leona Aglukkaq, Canada's Minister of Health. The minister noted that this conference was the first of its kind to bring together clinicians, laboratorians and key public policy officials. She mentioned that the conference will help Canada to better prepare for and respond to the upcoming influenza season. The minister also mentioned that continued monitoring and surveillance for H1N1 along with consistent collaborations, information exchange and strong partnerships will be vital to keep the population healthy and prevent and manage the spread of H1N1.
The Manitoba Minister of Health, the Honorable Theresa Oswald, welcomed participants to Winnipeg, but stated, “I really wish you weren't here." This statement is a reflection of the growing concerns about the upcoming flu season and the potential for H1N1 to be more widespread, affecting the general population and overwhelming the healthcare systems globally.
Dr. David Butler-Jones, chief public health officer, PHAC, addressed the dilemma of managing and measuring H1N1. He noted that "you can't manage what you don't measure," but also mentioned that the fluidity of H1N1 cases makes it difficult to measure and as such public health officials must be creative in responding to this pandemic.
Dr. Frank Plummer, chief science advisor, PHAC, further explained the objectives of the conference, noting that he hopes participants leave with a better understanding of epidemiology and severity of the disease, clinical care and management issues, intensive care unit challenges and strategies to manage H1N1 cases. He also encouraged further connections among hospitals, infection control and public health.
Dr. Charles Penn, Global Influenza Programme, World Health Organization (WHO) addressed the current status of the pandemic and WHO efforts to facilitate communications globally, mobilize resources and provide access to vaccines and antivirals. Several additional sessions, including in-depth discussions on modeling scenarios, provided participants with more information on Canada's efforts to prepare for and respond to H1N1.
APHL will continue our collaboration with Canada and look to build stronger linkages with Mexico to ensure that there are robust laboratory systems in place to detect and respond to infectious disease outbreaks globally.
Wednesday, July 1, 2009
HIV Testing & Public Health Laboratories
According to a CDC estimate, close to 250,000 Americans are unknowingly infected with HIV. CDC recommends HIV screening as part of routine patient care for all people between the ages of 13 and 64. Yet despite improvements in care, social stigma and lack of awareness still prevent many from receiving tests for HIV.
Rapid detection of new HIV infections and successful linkage of HIV-positive patients into care are crucial factors in breaking the transmission cycle. In an effort to improve outreach and access to testing, CDC is targeting resources to high-risk communities. But while community outreach is integral part of the fight against HIV, fast and accurate laboratory diagnostics also plays an important role.
Public health laboratories support HIV treatment and prevention initiatives in multiple ways. They not only provide timely diagnostic tests, but many also conduct surveillance for drug resistance and offer tests for patient care and disease management. Public health laboratories implement advanced testing technologies as they become available to detect infections earlier and confirm infections more accurately.
The observance of National HIV Testing Day this past Saturday highlights the role of community outreach and increased testing in fighting the HIV epidemic. But behind the scenes, the daily work of public health laboratories plays an essential role in the speedy diagnosis of infection and the vigilant surveillance of disease.
Rapid detection of new HIV infections and successful linkage of HIV-positive patients into care are crucial factors in breaking the transmission cycle. In an effort to improve outreach and access to testing, CDC is targeting resources to high-risk communities. But while community outreach is integral part of the fight against HIV, fast and accurate laboratory diagnostics also plays an important role.
Public health laboratories support HIV treatment and prevention initiatives in multiple ways. They not only provide timely diagnostic tests, but many also conduct surveillance for drug resistance and offer tests for patient care and disease management. Public health laboratories implement advanced testing technologies as they become available to detect infections earlier and confirm infections more accurately.
The observance of National HIV Testing Day this past Saturday highlights the role of community outreach and increased testing in fighting the HIV epidemic. But behind the scenes, the daily work of public health laboratories plays an essential role in the speedy diagnosis of infection and the vigilant surveillance of disease.
Wednesday, May 20, 2009
APHL Corporate Partners Assist Lab Community During Outbreak
APHL has a long history of collaboration with corporations associated with laboratory and public health practice. Corporate partners have sponsored events at our conferences, assisted with training programs for the clinical laboratory community and included us in initiatives to build the under-staffed laboratory workforce. Since APHL established its sustaining membership program in 2005, corporate support for member laboratories has been enthusiastic. We are pleased to have 24 companies as current members.
With the emergence of the novel Influenza A (H1N1) virus, several sustaining members have stepped up to assist member laboratories in ramping up capacity to identify and characterize the virus. One, Applied Biosystems, made contributions long before the virus made its appearance in the United States.
In 2008 Applied Biosystems collaborated with CDC to bring the 7500Fast PCR platform to FDA for clearance with the CDC 5-target influenza assay, which detects circulating strains and the H5N1 virus. Fortunately, APHL had trained public health laboratories on use of the platform and panel prior to the emergence of H1N1, but unfortunately, some did not have the required instruments. Enter Applied Biosystems. The company worked tirelessly to ship and set up equipment 24/7 in labs across the country while providing around the clock technical assistance via phone. To complement this fine work, BioSearch Technologies—whose Black Hole Quencher dye label is used for the probe technology in both the CDC 5-target influenza and novel H1N1 assay—increased production to meet international demands for the test reagents.
Another sustaining member, Luminex, assisted and continues to assist member laboratories that have requested its viral influenza panel and equipment for rule-out of the presence of novel H1N1. Again, the company has worked hard to provide support and technical assistance to aid labs in obtaining equipment and reagents.
Finally, when APHL needed assistance in publicizing the hard work of public health laboratories during this event, we reached out to Fleishman Hillard, a respected national public relations firm with whom we had worked on the Labs Are Vital campaign (www.labsarevital.com). They offered to help us pro bono and have provided insightful advice and much needed support to APHL’s Communications staff.
We are a proud to be a part of this remarkable, extended public health community. The challenges we faced during this outbreak would have been much greater without the support of our corporate partners. We salute you for your efforts and extend our sincere thanks.
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