Slide Department of Medical Microbiology and Immunology by nikeborome

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									      Response to Public Health Emergencies:
      The Role of Public Health and
      Laboratories

      MM&I 554

      November 30, 2010



WISCONSIN STATE
LABORATORY OF HYGIENE                          1
  Response to Public Health Emergencies:
  The Role of Public Health and Laboratories

You should be able to discuss:
• The expansion of the number of partners participating in
  response to a public health emergency and what led to this
  expansion
• The key laboratory elements of the Laboratory Response
  Network (LRN) for bioterrorism
• What is meant by an “All Hazards” preparedness and
  response philosophy when dealing with public health threats
• Non-traditional laboratory response capabilities that can be
  deployed during public health or environmental emergencies
• Current challenges in laboratory response to public health
  threats
    WISCONSIN STATE
    LABORATORY OF HYGIENE
                                                            2
               Emerging Infectious Diseases
              Not really About “Emergency Response”
                                    Targets
                                    • Surveillance and
                                      Response
                                    • Applied Research
                                    • Infrastructure and
                                      Training
                                    • Prevention and Control
                                    The Outcomes:
                                    • Raised awareness of public
                                      health deficiencies
                                    • We understood what needed
                                      to be done; however,
                                      minimal funding to do it

http://www.cdc.gov/ncidod/diseases/eid/index.htm
      WISCONSIN STATE
      LABORATORY OF HYGIENE
                                                               3
Traditional Federal Partners in Public Health


                          CDC




                    EPA            FDA




                          USDA
  WISCONSIN STATE
  LABORATORY OF HYGIENE
                                                4
Traditional State Partners in Public Health
The WSLH Serves Them All

                               WSLH


   State Health
                                            DNR
       Dept.




                Local Health
                                      Clinicians
                  Depts.
 WISCONSIN STATE
 LABORATORY OF HYGIENE
                                                   5
                         BIOTERRORISM

 The intentional or threatened use of
  microorganisms or biologic toxins to
 kill or incapacitate people, animals or
                  crops.


                Everything you want to know:
                        www.bt.cdc.gov
WISCONSIN STATE
LABORATORY OF HYGIENE
                                               6
                         MMWR
             Recommendations and Reports
            April 21, 2000 /Vol. 49 / No. RR-4

  Biological and Chemical Terrorism:
   Strategic Plan for Preparedness
             and Response

  Recommendations of the CDC Strategic
         Planning Workgroup



WISCONSIN STATE
LABORATORY OF HYGIENE
                                                 7
   Development of Advanced Testing Capability
   Bioterrorism Agents

• Category A Agents            • Category B Agents
   Anthrax (Bacillus             Brucellosis (Brucella)
    anthracis)                   – Epsilon toxin of C. perfringens
   Botulism (Clostridium         Food Threats (e.g., Salmonella, E.
    botulinum toxin)               coli O157:H7, Shigella)
   Plague (Yersinia pestis)      Glanders (Burkholderia mallei)
                                  Melioidosis (B. pseudomallei)
   Smallpox (variola major)     – Psittacosis (Chlamydia psittaci)
   Tularemia (Francisella        Q Fever (Coxiella burnetii)
    tularensis)                   Ricin toxin from castor beans
  – Viral hemorrhagic fevers     – Typhus fever (R. prowazekii)
    (e.g., Ebola, Marburg,        Viral encephalitis (e.g., VEE, EEE)
    Lassa)                        Staphylococcal enterotoxin B
                                 Water threats
    WISCONSIN STATE
    LABORATORY OF HYGIENE
                                                                 8
Overt vs. Covert Events
Recognition


                        Overt Event


Responder                Public Health   Health Care
Community                 Community      Community


                        Covert Event

WISCONSIN STATE
LABORATORY OF HYGIENE
                                                       9
Federal Partners in Emergency
Preparedness and Response

 • DHHS                      •   USPIS
    – CDC (PH response)      •   Secret Service
 • EPA                       •   Treasury
 • USDA                      •   NSC
 • FDA                       •   SBCCOM
 • DHS                       •   USAMRIID
 • FBI (Crisis Mgmt)         •   OEP
 • FEMA (Consequence Mgmt)
 • DOD
 • DOJ
WISCONSIN STATE
LABORATORY OF HYGIENE
                                                  10
State Partners in Emergency
Preparedness and Response

•   WI Division of Public Health
•   Local health departments
•   DNR - Environmental concerns
•   Health care providers
•   Public Health Laboratories – The WSLH
•   DATCP - Food chain/agricultural issues
•   WVDL – Animal issues
•   WEM; Local emergency management agencies
•   FBI
•   Local law enforcement
•   Fire/HAZMAT
•   Local clinical laboratories
WISCONSIN STATE
LABORATORY OF HYGIENE
                                               11
      The National Lab Response Network
          (LRN) for Bioterrorism

 Coordination by the CDC
 Comprised of public and private labs
 Timely and accurate diagnostic testing
     Consensus protocols using CDC-approved methods
 Site-appropriate testing
     Secure reference testing protocols and reagents
 Timely and secure results reporting
     NEDSS and HIPAA compliant
 Linkage with local, state and federal agencies
 Central role for the state public health
  laboratory
WISCONSIN STATE
LABORATORY OF HYGIENE
                                                        12
The Laboratory Response Network(LRN)
A Model for Networking and Emergency Response
                          • National Labs - CDC &
                            USAMRIID
                          • Reference Labs - State &
                            local PHLs, state agency
                            labs
                          • Sentinel Labs - Community
                            clinical hospital labs
An integrated network of state & local public health,
clinical, federal, military, & international laboratories to
respond to bioterrorism, chemical terrorism and other
public health emergencies.
  WISCONSIN STATE
  LABORATORY OF HYGIENE
                                                               13
           RESPONSE TO PUBLIC HEALTH THREATS


     • Bioterrorist (BT) events are
       unnaturally occurring emerging
       infectious diseases (EIDs)
     • Laboratory capacity and capability
       and epidemiologic surveillance
       needed for recognition of BT
       events are the same as for
       naturally occurring EIDs – “All
       Hazards”
WISCONSIN STATE
LABORATORY OF HYGIENE
                                               14
CDC Program Announcement 99051
Public Health Preparedness & Response to Bioterrorism
EMERGENCY SUPPLEMENTAL: 2002-2009
 CDC Focus Areas: 2002-06
• Preparedness Planning and
  Readiness Assessment
• Surveillance & Epidemiology
  Capacity                           CDC Goals: 2006-10
• Laboratory Capacity - Biological
                                     • Prevent
• Laboratory Capacity - Chemical
• Health Alert Network               • Detect/Report
• Communication and Health           • Investigate
  Information Dissemination          • Control
• Education and Training             • Recover
    WISCONSIN STATE
    LABORATORY OF HYGIENE
                                                   15
Why is the WSLH the Lead
in Emergency Laboratory Response?

• Statutory authority within the state
• Historical precedence
   – PHLs are reference labs within the state
   – PHLs serve as state’s laboratory liaison to CDC
     and EPA
   – State PHL provides link between local
     laboratories and CDC /federal agencies
• Experience with biological agents of public health
  concern, with outbreak investigations and
  supporting response to environmental emergencies
WISCONSIN STATE
LABORATORY OF HYGIENE
                                                 16
WSLH Microbiological Testing Capability
Non-BT Agents (“All-Hazards”)


  Real-Time PCR at WSLH
  – SARS
  – Monkeypox
  – Herpes Simplex
  – Enterovirus
  – Influenza A & B; “Avian” Influenza; 2009 H1N1
  – Respiratory pathogens battery
  – Norovirus, astrovirus, rotavirus
  – Bacterial, parasitic enteric pathogens
  – Pertussis, mumps, measles, varicella
  WISCONSIN STATE
  LABORATORY OF HYGIENE
                                                17
     Chemical Laboratory Response Network
                     2010
                                Level 3 Labs
                                Level 2 Labs
Level 3:
American Samoa                  Level 1 Labs
Chicago
Guam
Micronesia
Marshall Is.
N. Mariana Is.
New York City
Palau
Puerto Rico
US Virgin Islands

Level 2:
District of
Columbia
Los Angeles
   WISCONSIN STATE
   LABORATORY OF HYGIENE
                                               18
The Chemical Laboratory Response Network
                             WSLH is a Level 1
                             Laboratory




WISCONSIN STATE
LABORATORY OF HYGIENE
                                                 19
  WSLH Emergency Laboratory Response
   “All Hazards” Analytical Capabilities



                        All Hazards
             Clinical   •Biological     Environmental
            Response    •Chemical         Response
                        •Radiological




WISCONSIN STATE
LABORATORY OF HYGIENE
                                                        20
The Wisconsin Clinical Laboratory Network
                                          Douglas                         Bayfield

                                                                                         Ashland
                                                                                                          Iron



                                                                                                                                       Vilas
                                                  Washburn              Sawyer
                                      Burnett
                                                                                                        Price
                                                                                                                            Oneida                                  Forest     Florence


                                          Barron                 Rusk
                            Polk                                                                                                                                                          Marinette

                                                                                                                             Lincoln

                                                                                               Taylor
                                                                                                                                                       Langlade                Oconto
                                                                  Chippewa
                          St. Croix       Dunn


                                                                                                                           Marathon                                 Menominee
                                                                                         Clark

                         Pierce                              Eau Claire                                                                                       Shawano

                                                                                                                                                                                                                     Door
                                          Pepin
                                                                                                                   Wood                  Portage              Waupaca
                                                Buffalo                                                                                                                                                        Kewaunee
                                                                 Trempealeau                                                                                                  Outagamie
                                                                                   Jackson

                                                                                                                                                                                                 Brown
                                                                                                                                                                                                         Manitowoc
                                                                                                                 Juneau          Adams Waushara                         Winnebago
                                                                                      Monroe

                                                                                                                                                                                             Calumet
                                                                    LaCrosse                                                                   Marquette
                                                                                                                                                                        Fond du Lac
                                                                                                                                                                                                  Sheboygan

                                                                          Vernon                                                                              Green Lake
                                                                                                                          Sauk                 Columbia            Dodge
                                                                                                 Richland
                                                                                                                                                                                          Washington Ozaukee
                                                                            Crawford



WCLN Sentinel Labs                                                                                               Iowa
                                                                                                                                               Dane
                                                                                                                                                                  Jefferson           Waukesha
                                                                                                                                                                                                       Milwaukee

                                                                                       Grant

WCLN Reference Labs                                                                                       LaFayette
                                                                                                                                  Green
                                                                                                                                                           Rock               Walworth       Racine



                                                                                                                                                                                               Kenosha


 WISCONSIN STATE
 LABORATORY OF HYGIENE
                                                                                                                                                                                                                            21
  What REAL Difference Does the
  WCLN Make?
Powders SARS Monkeypox Pertussis Influenza Mumps E.coli Salmonella Measles 2009
  2001 2003    2003     2003-05 2004-07     2006 2006     2007      2008 H1N1




Capabilities Developed:
 Enhanced PHL testing capabilities                Shipper repositories
 WSLH 24/7 Emergency Response                     Specimen courier
 Emergency Response guidelines                    Messaging
 Surge capacity for PHLs                          Training for clinical labs
 Rapid reporting                                  Response exercises
 Collaboration/Communication                      Lab-based surveillance
   with other labs
 Testing and shipping exercises

      WISCONSIN STATE
      LABORATORY OF HYGIENE
                                                                           22
Beyond the LRN


Emergency Laboratory Response
Beyond the Traditional Laboratory




WISCONSIN STATE
LABORATORY OF HYGIENE
                                    23
    Emergency Laboratory Response Beyond
    the Traditional Laboratory
    Rapid POC Diagnostic Testing Sites
• Influenza as an example                   Douglas


• Surveyed 1,996 labs POLs,                                 Bayfield


  clinics and LTCF                              Washburn
                                                              Sawyer
                                                                                Ashland            Iron
                                                                                                                 Vilas


   – 1257 (63%) returned       Burnett

                                 Polk                      Rusk
                                                                                          Price
                                                                                                             Oneida
                                                                                                                                                  Florence




• Responses:                                  Barron                               Taylor
                                                                                                             Lincoln

                                                                                                                                Langlade
                                                                                                                                               Forest

                                                                                                                                                  Oconto
                                                                                                                                                           Marinette




   – Perform rapid influenza
                                            Dunn           Chippewa

                                St. Croix                                                                                                  Menominee
                                                                             Clark
                                                                                                          Marathon

      tests:                   Pierce

                                            Pepin
                                                        Eau Claire
                                                                                                                      Portage
                                                                                                                                     Shawano
                                                                                                                                     Waupaca
                                                                                                                                                                             Door
                                                                                                    Wood

        367 (30%)                             Buffalo


                                                                           Jackson
                                                                                                                                                 Outagamie

                                                                                                                                                                Brown
                                                                                                                                                                        Kewaunee




   – Considering performing
                                                        Trempealeau                               Juneau                                                           Manitowoc
                                                                           Monroe                                        Waushara
                                                                                                             Adams
                                                             La Crosse                                                                                       Calumet
                                                                                                                                            Winnebago
                                                                                                                         Marquette
      rapid influenza tests:                                      Vernon
                                                                                                                                Green Lake Fond du Lac
                                                                                                                                                                 Sheboygan


                                                                                                                         Columbia
        76 (6%)                                                      Crawford
                                                                                     Richland
                                                                                                          Sauk


                                                                                                                                               Dodge
                                                                                                                                                                 Ozaukee




   – Perform rapid influenza                                                Grant
                                                                                                   Iowa
                                                                                                                         Dane
                                                                                                                                                           Washington




      tests year-round:                                                                     Lafayette
                                                                                                                 Green
                                                                                                                                 Rock
                                                                                                                                        Jefferson

                                                                                                                                                Walworth
                                                                                                                                                        Waukesha Milwaukee
                                                                                                                                                             Racine


        318/464 (69%)                                                                                                                                         Kenosha



     WISCONSIN STATE
     LABORATORY OF HYGIENE
                                                                                                                                                                               24
Emergency Laboratory Response Beyond
the Traditional Laboratory
Biohazard Detection System-USPIS
                        • USPS program
                        • Anthrax detection
                        • Continuous air sample
                          collection from “pinch points”
                        • Automated PCR
                        • Once per hour
                        • All major processing facilities




WISCONSIN STATE
LABORATORY OF HYGIENE
                                                       25
Emergency Laboratory Response Beyond
the Traditional Laboratory
BioWatch-EPA/CDC
•   Air filters on EPA air quality monitors
•   Located in most major US cities
•   Tested daily by Lab Response Network laboratories
•   PCR for anthrax, plague, smallpox and tularemia




WISCONSIN STATE
LABORATORY OF HYGIENE
                                                        26
Emergency Laboratory Response Beyond
the Traditional Laboratory
BioShield-BARDA

                        • BioShield One:
                           – $5.6B over 10 years for vaccine
                             and pharmaceutical R&D for the
                             Strategic National Stockpile
                           – Participation issues

                        • BioShield Two:
                           – Created BARDA: Biomedical
                             Advanced R&D Agency, $1B
                             budget
                           – Provides additional protections
                             and guarantees to participants


WISCONSIN STATE
LABORATORY OF HYGIENE
                                                               27
  Emergency Laboratory Response Beyond the
  Traditional Laboratory
  National Guard Civil Support Teams (WMD)
• WI’s 54th CST (WMD)
• Field identification of CBRNE
  agents following intentional
  release
• On alert 24/7/365
   – Federally funded, state
     controlled
   – Activated by Governor
• Employs a mobile analytical
  lab with full suite of biological,
  chemical and radiological
  detection equipment
• Coordination with WSLH

   WISCONSIN STATE
   LABORATORY OF HYGIENE
                                         28
 Emergency Laboratory Response Beyond
 the Traditional Laboratory
 HAZMAT
• Civilian response to non-
  intentional chemical,
  radiological, nuclear
  events (e.g. spills,
  accidental releases,
  result of fire, etc.)
• Primary response,
  detection, containment
• Has became a player in
  acts of terrorism

  WISCONSIN STATE
  LABORATORY OF HYGIENE
                                        29
Emergency Laboratory Response Capabilities
An expanding list of partners


        State             WSLH
     Agency Labs
     DATCP(FERN)                     Clinical Labs
     WVDL(NAHLN)
     WI Crime Lab


   Federal Agencies
  FBI(HMRU), USSS,                   HAZMAT
        USPIS       National Guard
                    54th CST WMD
  WISCONSIN STATE
  LABORATORY OF HYGIENE
                                                     30
 LABORATORY NETWORK RESPONSE TO PUBLIC
            HEALTH THREATS
                         Current Challenges
• Maintaining partnerships/communications
• New environmental sensing technologies
  – Understanding the technologies and limitations
   – Coordination with laboratory
• Rapid kit tests for BT and other EID agents
   – Understanding the limitations
   – Lab testing in the hands of the non-laboratorian
• Threats to water and food : the challenges in
  detection and interpretation
• “Fast tracking” diagnostic methods in the lab
• Biosafety and biosecurity
• Sustainability
 WISCONSIN STATE
 LABORATORY OF HYGIENE
                                                        31

								
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