MEMBERSHIP
After a “two-week retirement” in 2007,
Beebe relocated to the West Coast and
assumed the directorship of the County of
San Luis Obispo PHL.
Staff
The laboratory’s 11 employees
include Beebe, seven public health
microbiologists, one lab technician and
two medical billers.
Other services of note include
parasitology testing, blood lead testing
and rabies testing on animals.
Revenue
The bulk of the laboratory’s $2.2 million
annual budget, about $1.2 million (54%),
comes from medical or other fees. About
$350,000 (16%) comes from grants, and the
remainder (30%) from county coffers.
Testing
The PHL performs about 38,000 tests
per year, with the lion’s share looking
for sexually transmitted pathogens,
such as HIV, chlamydia and gonorrhea.
Other high-volume tests are influenza
(anywhere from 250 to 1,000 tests/year)
and TB, using the QuantiFERON ® -TB Gold
Plus assay, GeneXpert amplification test
and traditional culture.
PublicHealthLabs
@APHL
On the environmental side, the PHL
tests both drinking water and ambient,
recreational water from the nearby Pacific
Ocean and local lakes and streams. It
also supports area shellfish growers by
providing the testing needed to assure the
quality of shellfish that have undergone
depuration—a process in which the
animals are flushed with free-flowing,
pure water for about 48 hours to remove
bacterial contaminants and physical
impurities.
Successes
Wherever possible, the laboratory favors
molecular methods. Beebe said, “We’re
using whole genome sequencing (WGS)
to help us identify everything that’s
coming through the door: bacteria,
mycobacteria, soon fungi and yeasts,
maybe eventually viruses. The newly
expanded molecular PCR menu now runs
17 tests, including a respiratory disease
panel, gastrointestinal disease panel and
discrete tests for everything from measles
virus to norovirus to herpes simplex virus
Types 1 and 2. The county laboratory uses
a California state PCR assay to test for
enterovirus, one strain of which, D68, is
thought to be a causative agent of acute
flaccid myelitis.
Now that the laboratory is performing
WGS for the principle enteric pathogens,
Salmonella and Shiga toxin-producing
E. coli, Beebe is considering joining
PulseNet, the national foodborne
disease surveillance network. Already,
the PHL is a member of the Laboratory
Response Network for Biological Threat
Preparedness (LRN-B), tasked with testing
unknown samples for select agents like
anthrax and plague. “It’s not high-volume
work,” said Beebe, “but there’s a lot of
pressure with every test.”
Beebe said, “The success story here
has been our transformation from a
conventional laboratory to a molecular
laboratory, while still maintaining
conventional techniques.” One example
of this transformation is the PHL’s use
of molecular amplification testing for
measles and mumps—a test unavailable
in local private sector labs. The PHL’s
ability to produce high-quality, vaccine-
preventable disease results within three to
four hours of specimen receipt prompted
praise from the county health officer
Penny Borenstein, MD, who refers to
Beebe’s shop as “that gem of a lab.”
Other successes include onboarding
whole genome sequencing with help from
Colorado bioinformatician Logan Fink—”a
tremendous accomplishment for us”—
and detecting a “swine flu” influenza A
(H1N2) outbreak at the county’s Midstate
Fair in 2018.
APHL.org
The success story here
has been our transformation
from a conventional laboratory
to a molecular laboratory, while
still maintaining conventional
techniques.”
James Beebe, PhD, D(ABMM)
Challenges
• To continue to meet public health
needs in the midst of technological
change while “partnering, not
competing,” with private reference
laboratories.
• Expanding the laboratory’s electronic
pathways. Currently, the PHL conducts
one-way electronic laboratory reporting
to both the state department of health
and CDC, conducts bi-directional
electronic test ordering and results
reporting (ETOR) with a few major
customers, and participates in the
local health information exchange.
Beebe is currently trying to establish
bi-directional ETOR with two local
hospitals, but, he said, “to get to the
hospital decision-makers is probably
the biggest challenge I’ve faced here.”
Goal
• “To keep changing with the times.”
For example, the PHL was recently
awarded the contract to screen county
jail inmates for HIV and hepatitis C
virus. “We haven’t done hep C antibody
testing for probably 15 years, so now
we have to bring it up again. We have
to be flexible and quick enough to be
prepared for whatever comes our way....
We’ve written that story again and
again—figuring out how to meet public
health needs without a lot of resources.
The future looks about like that.” n
Fall 2019 LAB MATTERS
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