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.

Lab Capacity Model

The CDC-APHL State Lab Capacity Modeling Analysis model, developed to generate data on laboratory processes over the course of a pandemic, allows for states to refine their pandemic plans based on their individual resources and needs. Information generated from running the model identifies resource gaps and bottlenecks that may occur during a pandemic surge. Further, it allows for optimization of strategies for increasing respective capacities. Data entered into the model can be easily reconfigured, to determine how adding or removing resources affects throughput.

The recent and ongoing 2009 Novel Influenza A H1N1 (swine-like) outbreak offers a real-life scenario with which to assess the predictive value of these models. Compilation of data and of measurement evaluations continues, particularly as this event constantly evolves. Preliminary evidence proves, however, that the bottlenecks predicted by the model have proven to be true. Specifically, North Carolina, with seven confirmed cases and thousands of samples tested, reports that the model proved correct when predicting that the accessioning, extracting, and reporting stages would result in bottlenecks.

The feedback from the state—that the model was correct—is indicative of the fact that such practices are useful and carry value. We anticipate receiving feedback from other states, and are optimistic that this tool can be utilized in the future for more effective planning and capacity assessment purposes.

Flu Appropriation

The House of Representatives pushed through a $350 million appropriation for desperately-needed federal funding for state and local government public health organizations.

This funding will help combat many of the cuts government public health labs have had to make during the current recession. A recent APHL survey found that in 2008 alone, labs laid off or left unfilled almost 430 full-time positions, and expected to see another 230 positions empty in 2009. This proposed budget appropriation will go a long way to restoring vital lab capacity—it is critically important that labs retain and reclaim their highly trained workforce.

Despite severe workforce gaps, in the past few weeks, government labs still managed to test thousands of samples and keep the H1N1 outbreak just that—an outbreak—and not a pandemic. However, we’re not out of the woods yet. While things have certainly quieted down in the media, the H1N1 outbreak underscores the need to strengthen public health surveillance and detection of any novel flu strains that may appear.

Yet, that proposed $350 million in funding may still die—unless the Senate acts quickly and decisively. As it stands now, the full Senate will not begin actively debating the proposed appropriation until next week. If the Senate does not match the House with this funding, public health infrastructure will continue to erode in the wake of continued budget cuts.

Despite Outbreak, Work Continues

The recent outbreak of novel Influenza A H1N1 and the subsequent laboratory response have shed light on the work of state and local public health laboratories. But while this rapid response has been grabbing headlines, laboratorians continue work behind the scenes to address a wide range of public health threats.

Through active surveillance, public health laboratories can often detect infections before they become widespread outbreaks. While the media was transfixed by H1N1, the PulseNet system detected a spike in Salmonella serotype Saintpaul infections. Subsequent investigation and testing rapidly identified contaminated alfalfa sprouts as the culprit. Aided by advanced laboratory techniques and improved surveillance, public health laboratories continue to monitor for diseases like E. coli and Salmonella to ensure the safety of our nation’s food.

Public health laboratories are also responsible for screening 97% of newborns in the United States—in the past week alone, government labs have screened close to 80,000 babies for as many as 55 separate conditions. Newborn screening lets clinicians rapidly identify genetic and metabolic disorders, which without prompt treatment may lead to lifelong disability or even death. While many focus on the roll-out of the new influenza assay to states this week, thousands of newborns continue to be tested in the public health laboratory system.

The nation’s public health laboratories provide a diverse range of services to protect the public’s health. Disease diagnosis and surveillance, drug susceptibility testing, newborn screening, chemical exposure and environmental monitoring continue, even while laboratories operate at surge capacity to address the ongoing flu outbreak.

The importance of electronic messaging

A crucial element in response to a large-scale outbreak, such as the novel H1N1 virus, is rapid reporting of laboratory test results. Lab test results must reach the right people at the right time. Without this information, important public health decisions cannot be made.

Public health labs lack a single, standardized way to exchange laboratory data electronically. Right now, only a handful of state labs can send their H1N1 results electronically to CDC—most rely on some combination of sending spreadsheet attachments through email, uploading results to a secure website, calling in or faxing their results. These limitations apply to CDC as well as public health labs.

Some progress has been made through the Public Health Laboratory Interoperability Project (PHLIP), a joint undertaking by APHL, state public health laboratories and CDC. PHLIP aims to link government labs nationally to provide fluid electronic dialogue among laboratories and CDC. PHLIP's key goal is interoperability—the ability for different types of systems, including computers, networks, operating systems and applications, to work together effectively to exchange information in a useful manner. Essentially, this means systems talking to each other.

Much more needs to be done.

Many federal task forces have identified the need for electronic laboratory reporting; however adequate funding for this activity has not been identified. An expert panel convened by ANSER estimates the cost to develop and maintain electronic laboratory messaging capability at state and local public health labs is at least $200 million in federal funding annually. Without this investment, lab results will continue to be trapped in local, state and federal silos where we cannot protect America's health.

Hardworking Workforce

Over the past year, public health laboratories, their budgets ravaged by state and local cuts, have lost funding for operations, instrumentation and staff. Since January 1, 2008, an APHL survey shows the extent of the damage: labs have lost close to 500 full-time positions out of a total workforce of only 6500, and more losses are anticipated. Entire laboratory programs have been eliminated, because there were simply no funds to sustain them.

Yet, despite a bleak outlook and limited resources, laboratories, when thrust into the latest crisis with the H1N1 outbreak, have responded with skill, ingenuity and grit. In the first week of the outbreak, they subtyped nearly 300 suspect specimens for referral to CDC for final confirmation.

This week public health labs in some 65 locations across the country will assume responsibility for confirmatory (definitive) testing for the novel H1N1 virus, thus accelerating delivery of test results and implementation of disease-control measures. This eases some of the pressure on CDC laboratories but the demand for testing remains intense at the state and local level. Laboratory scientists, administrators, IT specialists and other staff are all racing to keep pace, working late into the night and on weekends.

This level of response isn’t surprising, however. We saw it earlier this year during the Salmonella outbreak when thousands of human and environmental samples poured into PulseNet labs for testing. We saw it in 2008 during the Iowa floods, when laboratorians worked to keep up with the increased demand in water testing. And we saw the same response after hurricanes Ike and Katrina pummeled the Gulf coasts, during the Anthrax attacks in 2002 and following the World Trade Center attack in 2001, to name a few examples.

The staff working flat out in our labs have opted to stay in the field of public health to help people. If money was a primary motivating factor, they would have left long ago! Instead they work to guarantee that emerging diseases and other health threats are detected promptly and that health officials have the information they require to mount an effective response.

It is a testimony to their dedication and hard work that they are continuing testing for other key public health functions—newborn screening, drinking water testing and analysis of foodborne pathogens, for instance—while managing the burgeoning load of H1N1 testing.

Introduction and Welcome

Welcome to the launch of LabLog, the blog for the Association of Public Health Laboratories (APHL), a membership organization of federal, state and local government laboratories that provide testing of public health significance. LabLog will feature posts by APHL staff and members, as well as outside experts. We hope that LabLog will be a valuable source of information on laboratory science and policy, and provide a forum for lively discussions. We strongly encourage questions and comments.