Lab Matters Fall 2018 - Page 33

MEMBERSHIP • Electronic test ordering and reporting (ETOR): Supported by a grant from the state’s County Medical Services Program, the laboratory was the first California public health laboratory to establish a bidirectional interface with local providers using a health information exchange network for ETOR. The system went live April 1, 2018. Challenges Back row (from l to r): Annayal Yikum, Roy Fuller, Jeremy Corrigan, Paula Moon, and Clara Bolster. Front row (from l to r): Kelsey McMahan, Kylee Hee, Heather Maddox and Jessica Reynolds. Photo: Humboldt PHL come through the laboratory en route to either Sonoma PHL or the state public health laboratory. about $260,000 of federal public health emergency preparedness funding, $82,000 of federal homeland security funding (for the purchase of a GeneXpert testing platform), $220,000 from fee income (which, under California law, cannot exceed the actual cost of service provision) and $773,000 of county public health funds. Success Stories Humboldt PHL performs about 5,000 tests/ year, 3,000 of which are for childhood blood lead testing. Core environmental services include oyster testing; tick speciation; Lyme disease testing for Ixodes pacificus, the western black-legged tick; animal rabies testing; beach water testing; and drinking water testing in state parks within the county and for a slew of local festivals. Molecular tests run the gamut from respiratory pathogens and childhood vaccine preventable diseases to select agents and emerging infectious diseases. Just this year, the laboratory implemented a test for dengue, chikungunya and Zika viruses. • Microbial source tracking: For the past several years, Humboldt County has been home to the #1 “bad beach” in California, according to an annual report card issued by a local, non-profit environmental group. Clam Beach had the highest levels of total and fecal coliforms measured in state coastal waters. With funding from the California State Water Resources Control Board and technical support from Sonoma PHL, Humboldt PHL developed tests to differentiate human fecal contamination from avian, ruminant or canine contamination in beach water. After almost three years of testing, “we found that most of the problem was from birds,” said Corrigan. The state control board will soon make recommendations to mitigate the problem. Corrigan said, “I’m very proud of this work.” To simplify specimen submission, the laboratory runs a courier service for hospitals and clinics within the 50-to-60 square mile area around the local health department, where most residents are clustered. It also provides reference testing and consultation services. Said Corrigan, “If we can’t do the testing, we will find somebody who can and facilitate that testing with information on sample type, holding temperature and proper shipping conditions.” All suspect tuberculosis specimens, for example, • Vibrio testing: Five or six years ago, Humboldt PHL became the first public health laboratory in California to begin molecular testing for V. parahaemolyticus in oysters. Earlier this year, the laboratory was the first in the state to implement the latest version of that test, newly approved by the US Food and Drug Administration’s National Shellfish Sanitation Program. “We can use this test to investigate a human illness related to V. parahaemolyticus from oysters,” said Corrigan. Testing PublicHealthLabs @APHL • Recruitment and retention of microbiologists. “Of all the California laboratories, we’re one of the lower- paying laboratories. I’ve trained five to six microbiologists, and they all end up going someplace else to work.” • “Getting samples to us is sometimes difficult, because our population is so spread out.” Goals • Bring tuberculosis testing in-house by the end of 2018. • Bring on syphilis screening and confirmatory testing by the end of 2018. • Connect local hospitals to the laboratory’s electronic ETOR system. • Conduct another microbial source tracking research project to investigate additional county beaches. n Clara Bolster with a western blacklegged tick specimen which will be tested for Borrelia burgdorferi, the causative agent of Lyme disease. Photo: Humboldt PHL Fall 2018 LAB MATTERS 31