APHL 2020 POSTER ABSTRACTS
ENVIRONMENTAL HEALTH
Comparing Drug Profiles in MNDOSA and EVALI ED Encounters
S . Saravia , J . Peterson , K . Hanson , M . Wogen , M . Lunda , J . Taylor , P . D ’ Heilly , T . Wiens , R . Lynfield , R . Danila , C . Cole and P . Moyer , Minnesota Department of Health , St . Paul , MN
In 2017 , the Minnesota Department of Health ( MDH ) created the Minnesota Drug Overdose and Substance Use Pilot Surveillance Activity ( MNDOSA ) to respond to the misuse of drugs epidemic . This ongoing overdose surveillance system combines the reporting of drug overdoses with enhanced toxicology testing of clinical specimens by the MDH Public Health Laboratory ( PHL ). The analytical testing panel includes 266 drugs or their metabolites , including novel substances . During 2019 , MDH-PHL analyzed 183 MNDOSA-related clinical specimens from 97 emergency department ( ED ) encounters , resulting in the detection of 100 different drugs . Multiple drugs were detected in all specimens , indicating that polysubstance use was prevalent .
Beginning in August 2019 , MDH began investigating the novel outbreak associated with e-cigarette , or vaping product useassociated lung injury ( EVALI ). This investigation involved reviewing medical records , interviewing effected individuals , and obtaining clinical specimens to be analyzed at MDH-PHL . Testing of the clinical specimens was performed utilizing the MNDOSA enhanced toxicology testing platform . MDH-PHL analyzed 73 EVALI-related clinical specimens from 64 ED encounters . Multiple substances were detected in all EVALI cases .
MDH-PHL data shows that the detection pattern between MNDOSA and EVALI encounters are vastly different . MNDOSA specimens on average had 10 drugs detected with the most prevalent being amphetamine ( 67 %), methamphetamine ( 63.9 %), norephedrine ( 54.6 %), THC-COOH ( 36.1 %), and fentanyl ( 28.9 %). Caffeine and cotinine were also present in 96.9 % and 95.9 % of specimens . In comparison , an average of 5 drugs were detected in EVALI specimens , with the most prevalent being THC-COOH ( 81.3 %), followed by acetaminophen ( 53 %), ondansetron ( 39.1 %), and lorazepam ( 26.6 %). Caffeine and cotinine were present in 37.5 % and 50 % of specimens . It should be noted that ondansetron , acetaminophen , and lorazepam may have been administered during treatment prior to sample collection , and may not be related to substance misuse .
The MNDOSA and EVALI data sets reflect the importance of having access to broad clinical sample testing protocols . By leveraging our existing capabilities from MNDOSA , MDH-PHL was able to rapidly respond to EVALI and provide relevant information about an emerging novel outbreak . Providing chemical testing results back to medical professionals proved to be useful in characterizing and understanding the various symptoms and treatment options .
As the burden of drug overdose and substance use continues to increase nationwide , advancing our understanding of the chemicals involved is imperative . Tracking of drug overdoses , substance use clusters , and chemicals related to these incidences will give public health officials a better understanding of the changing drug landscape and allow more informed and faster responses .
Presenter : Jason Peterson , Minnesota Department of Health Public Health Laboratory , Environmental Health Section , St . Paul , MN , jason . d . peterson @ state . mn . us
Assessment of the Instant Pot ® for Suitability in Sterilizing Mobile Laboratory Biohazardous Waste
S . Altmann , B . Karlstrand , M . Mar and L . Gardiner , MRIGlobal , Gaithersburg , MD
Proper disposal of biohazardous waste remains a significant challenge for mobile laboratories , particularly those performing surveillance and / or diagnostics for high consequence pathogens . The identification of portable , low cost solutions for sterilizing biohazardous waste generated by laboratory activities is therefore a priority . A recent publication determined that the commercially available 8-qt Instant Pot ® pressure cooker was capable of inactivating Geobacillus stearothermophilus spores , a commonly used biological indicator ( BI ) for validating steam sterilization . The study was limited , however , in that 1 ) it only tested one of the available pressure cooker sizes , and 2 ) the conditions under which spore inactivation were tested did not accurately replicate how biohazardous waste is typically packaged for inactivation and disposal . We therefore assessed the ability of two different sizes of Instant Pot ® to inactivate G . stearothermophilus spores packaged in different substrates as per the biohazardous waste commonly generated by surveillance and diagnostic activities conducted using mobile laboratories .
Presenter : Brendan Karlstrand , MRIGlobal , Gaithersburg , MD , bkarlstrand @ mriglobal . org
A State Population Study ( NJHANES ) for Surveying Environmental Contaminants in New Jersey
E . Cook , C . H . Yu , E . Bind , S . O ’ Leary , D . Haltmeier , C . D . Riker , L . Zhong , A . Steffens , S . Du , A . Krasley , L . Qiao and Z . Fan , New Jersey Department of Health Public Health and Environmental Laboratories , Ewing , NJ
From 2016 – 2018 , the New Jersey Department of Health ( NJDOH ) conducted a large-scale biomonitoring study for emerging and legacy environmental contaminants throughout NJ . This study measured analytes from three groups , including toxic metals in blood ( n = 3000 ) and urine ( n = 1000 ), per- and polyfluoroalkyl substances ( PFAS ) in serum ( n = 1000 ), and polychlorinated biphenyls in serum ( n = 1000 ). However , since this biomonitoring study utilized convenience sampling by procuring specimens from clinical laboratories and blood banks in NJ , the obtained data are limited in generalizing study results for direct comparison with other population-based studies , such as the National Health and Nutrition Examination Survey ( NHANES ) conducted by the Centers of Disease Control and Prevention ( CDC ).
To fill in knowledge gaps identified in the large-scale biomonitoring study , NJDOH is conducting a population-based surveillance for study-selected environmental contaminants . This new study , called NJ Health and Nutrition Examination Survey ( NJHANES ), will use a multistage , cluster , and probability-based random sampling approach to recruit ~ 500 NJ residents over two years . NJHANES will expand upon the previous study to survey additional analytes , including : 1 ) newly emerging PFAS ( e . g ., GenX ) in serum , 2 ) polybrominated diphenyl ethers ( PBDEs ) in serum , 3 ) organochlorine pesticides ( OCPs ) in serum , 4 ) speciated mercury in blood , 5 ) mercury in urine , 6 ) speciated arsenic in urine , 7 ) volatile organic compound ( VOC ) metabolites in urine , 8 ) polycyclic aromatic hydrocarbon ( PAH ) metabolites in urine , and 9 ) nicotine metabolites in serum . NJHANES will collect health and nutrition-related
Environmental Health