Lab Matters Fall 2024 | Page 31

INFECTIOUS DISEASES

By Ismael Rodríguez Rodríguez , laboratory operations manager , Puerto Rico Public Health Laboratory and Anne M . Gaynor , PhD , deputy director , Infectious Diseases

From right to left : Julio Valentín Román , Ismael Rodríguez , Ricardo Mendoza Cabassa , Ramon Flores Ramos and Denisse Padilla Medina . Photo : PR PHL

In Puerto Rico , the word “ dengue ” is not exotic or unknown — it is an endemic virus that causes large outbreaks in cycles approximately every three to seven years . Since the most recent large outbreak occurred in 2012 – 2013 , a large outbreak was overdue for the island . In March 2024 , the Puerto Rico Department of Health ( PRDH ) declared a public health emergency and , in June 2024 , the US Centers for Disease Control and Prevention ( CDC ) released a Health Alert Network ( HAN ) Advisory warning of increased risk of dengue virus ( DENV ) infections in the United States because of increased global incidence , record-breaking numbers of cases in the Americas and the increasing number of cases in Puerto Rico .

Public health surveillance of arboviruses — DENV in particular — is a critical and ongoing public health activity within the PRDH . Weather events such as el Niño and increased hurricane activity can heavily influence vectorborne diseases such as dengue , making arboviral surveillance critical prior to and immediately following an event . With ongoing concern for increasing hurricane activity and the known impacts from Hurricane Maria , the PRDH has been reviewing its existing systems and is working to enhance arbovirus-specific diagnostic testing capacity . Historically , arboviral testing was performed by the Biological and Chemical Emergencies Laboratory ( BCEL ), which focuses on testing for emergency response and preparedness for PRDH . To create more efficiency in the system , PRDH leadership was interested in transitioning testing from BCEL to the Infectious Diseases section of the public health laboratory , which handles more routine surveillance and testing . In 2023 , APHL was able to add support to this effort through a number of activities .

When APHL started supporting the work , efforts were already underway at the public health laboratory with some minor renovations to the molecular laboratory , including relocation of some office spaces , installation of benchtops and new air conditioning units as well as procurement of necessary equipment . The public health laboratory , with the support of CDC ’ s Division of Vector- Borne Diseases , Dengue Branch ( based in San Juan , PR and funding through the Epidemiology and Laboratory Capacity Program ( ELC ), had also begun purchasing equipment , identifying staffing needs to create and hire new positions , working through testing algorithms and establishing ordering and reporting mechanisms . In December 2023 , APHL staff and consultants were able to perform a site visit to meet laboratory staff , PRDH staff and partners , and tour the facility along with completing a survey tool for arbovirus disease testing . APHL also hosted a one-day meeting with all relevant partners to discuss in detail testing algorithms , test ordering and results and think through processes and systems . The meeting helped to identify positive progress toward the transition as well as identify some gaps where additional technical and financial support might be helpful .

By early spring the public health laboratory was validating equipment and staff were gaining familiarity with the methods through trainings with CDC and BCEL . Updating the laboratory

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