Public Health Laboratories Respond to Flu Outbreak

With regard to pandemic influenza, public health laboratories recognized the importance of planning a long time ago. Proactive preparations, and help from the Association of Public Health Laboratories (APHL) and the Centers for Disease Control and Prevention (CDC), mean that laboratories are responding efficiently and effectively to the novel H1N1 flu outbreak.

The novel H1N1 diagnostic kits -- developed and deployed by CDC in only 10 days -- were delivered to more than 60 state and local public health laboratories this past weekend. After validation, these labs will conduct most of the confirmatory testing, which previously had been handled only by CDC. Such a step not only means that results will take less time, but also that disease control measures can be put into place faster.

Demand for testing is overwhelming; one jurisdiction reported a backlog of 3,500 specimens, with 1,000 coming in daily, and capacity to test only 200 per day. However, public health laboratories anticipated such a surge and so they developed response plans, participated in trainings and simulation exercises, and formed networks in which they could easily ask each other for assistance.

Simply planning for a pandemic, though, is not sufficient, since plans often gather dust waiting to be implemented and because gaps are usually not identified until the plan is exercised. Recognizing this, the APHL, the CDC and Booz Allen Hamilton conducted a pandemic influenza simulation exercise in August 2008.

"One state called to tell me that, exactly as the model predicted, the spots where they needed the most help were with specimen accessioning and result reporting," said Rosemary Humes, senior advisor for scientific affairs at APHL. "Because we identified potential problem areas in advance, the public health laboratory has been able to respond much more rapidly."

Through daily conference calls and emails, APHL and CDC provide the public health laboratories with a forum for updates and technical assistance. Laboratorians from 36 states just completed APHL training on CDC's influenza testing protocol during the first two weeks of April. An impromptu training for other staff is scheduled to take place this week.

Manufacturers of the equipment used to detect the flu virus play a vital role in the current response, providing technical support and troubleshooting issues. In 2008, through an agreement with CDC, APHL procured service contracts for the instrumentation in the states. Vendors are also important partners since demand for the reagents used in the flu test have increased exponentially.

Many public health laboratories still communicate results via fax. APHL and CDC have been working with several states to develop standardized electronic reporting. The first results ever sent electronically to CDC were from influenza tests. Much work remains to be done on this project, but the future payout means that public health laboratories should be even better prepared for the next event, no matter what it might be.

Source: Association of Public Health Laboratories