Lab Matters Fall 2019 | Page 20

SPECIAL SECTION: THE LABORATORY RESPONSE NETWORK Ready or Not: 20 Years of Chemical Threat Preparedness by Amy D. Watson, PhD, Emergency Response Branch, National Center for Environmental Health, Department of Laboratory Services, US Centers for Disease Control and Prevention and Jennifer N. Liebreich, MPH, manager, Environmental Health In 1999, the US Centers for Disease Control and Prevention (CDC) funded four state public health laboratories to expand laboratory capacity to prepare for a potential national terrorism event involving chemical agents such as sarin gas and sulfur mustards. In the years that followed, other local and state public health departments identified the need for similar response capabilities in their own jurisdictions. In 2002, APHL convened a 50-state meeting—now called the “Ready or Not” meeting—to assess the nation’s readiness for chemical threats. APHL brought together key stakeholders from state and local public health laboratories, CDC, DoD, the US Environmental Protection Agency (EPA) and FBI to identify target areas for improving national chemical threat preparedness: • Create a national laboratory network • Expand national analytical laboratory testing capabilities and capacity • Develop standardized protocols for emergency response • Strengthen partnerships. During the meeting, state and local laboratories volunteered to become a part of what is now known as the Laboratory Response Network for Chemical Threat Preparedness (LRN-C). Today, LRN-C laboratories are in all 50 states, three major US cities and Puerto Rico. Currently, 84% of Americans live within 100 miles of an LRN-C laboratory, increasing national preparedness for high-threat chemical agents. Originally designed for CDC surge capacity during large-scale chemical terrorism events, today’s LRN-C serves a crucial role in local chemical responses across the country. Over the last 20 years, LRN-C labs have responded to public health situations related to arsenic in private wells in Alaska, toxic metals in local rivers in Colorado, per-and polyfluoroalkyl substances in drinking water in upstate 18 LAB MATTERS Fall 2019 The LRN-C in-person meetings allow CDC to provide critical communications regarding new technical approaches for addressing emerging chemical threats such as those observed in the current U.S. opioids crisis.” Dr. Rudolph C. Johnson, CDC/Emergency Response Branch New York, and the ongoing lead crisis in Flint, Michigan. These agile testing capabilities can all be attributed to the strong partnership between CDC and APHL. An Agile Network, A Sharing Network The APHL and CDC cooperative agreement partnership has been integral to the growth and support of the LRN-C. Retaining a competent, well-trained workforce has always been a challenge because of high employee turnover rates in the local public health sector. This is especially true for LRN-C laboratories, which employ highly specialized, sophisticated methodology for identifying chemical threat exposures in human samples. When LRN-C mass spectrometers were approaching the end of their service life in 2018, APHL worked with equipment vendors to ensure comparable equipment configurations and pricing were made available to member laboratories. LRN-C laboratories also receive support for research, vendor traineeships, equipment maintenance contracts and travel to LRN-C meetings through the cooperative agreement. APHL facilitates the LRN-C Biannual Technical Meetings held in the fall and spring of each year to provide LRN-C laboratories with programmatic updates Chemical Threat Agents Found in Synthetic Marijuana (2018) Following six suspected cases of synthetic marijuana poisonings, the Wisconsin LRN-C Level 1 laboratory began developing a method to detect the anticoagulant brodifacoum. Brodifacoum is described as a “super- warfarin” and was originally designed to be used as a rodent poison. As new cases emerged daily, CDC’s Emergency Response Branch, Division of Laboratory Sciences provided the state lab with internal standard to assist with the method development. Within a couple of weeks, the Wisconsin lab was able to develop and validate a quantitative brodifacoum method in blood specimens. At the close of the Spring 2018 outbreak, more than 200 hospital cases in over 10 states were reported. from CDC, technical training and guidance on laboratory response planning. The meetings enable LRN-C laboratories to network and build relationships and share best practices for partnership engagement with local preparedness and response stakeholders such as Weapons of Mass Destruction (WMD) coordinators, senior health officials and civil support teams. Thanks to APHL’s continued support for these meetings, the LRN-C Biannual Technical Meetings have observed increasing record attendance each year. n Through our LRN-C relationship with CDC, we were able to rapidly obtain the materials needed for this important national response.” Noel Stanton, Wisconsin State Laboratory of Hygiene PublicHealthLabs @APHL APHL.org