INFECTIOUS DISEASES
Boots on the Ground:
A Lab Perspective on Hepatitis A Virus Outbreak Response
by Nicholas Ancona, specialist, HIV, Hepatitis, STD & TB Programs
Hepatitis A virus (HAV) is the causative
agent of a self-limiting vaccine-
preventable liver disease. Since March
2017, outbreaks of HAV have been
detected in 18 states nationwide with
reported associations with individuals
who use drugs, persons experiencing
homelessness, and in MSM (men who
have sex with men) communities. State
and local public health laboratories
have been engaged in epidemiological
and laboratory response efforts aimed
at combatting these outbreaks in
conjunction with the CDC Division of
Viral Hepatitis (DVH). In recognition of
both Hepatitis Awareness Month (May)
and Hepatitis Testing Day (May 19), Tracy
Basler, molecular scientist, Public Health
Services Laboratory, County of San Diego
Health & Human Services Agency and
Marty Soehnlen, PhD, MPH, director of
infectious disease, Michigan Department
of Health & Human Services Bureau
of Laboratories spoke to APHL about
their experiences with Hepatitis A virus
(HAV) outbreak response efforts and
ongoing work.
Advice for Public Health
Laboratories Current Responding
to HAV Outbreaks
Basler suggested that laboratories use the
outbreak response as an opportunity to
assess existing capabilities and develop
realistic goals. San Diego County identified
the need to increase technological
capacity during the outbreak response
and worked with partners to implement
a PCR screening assay to supplement
existing serologic testing at external
laboratories. She emphasized the
importance of community partnerships
and leveraging those in a way that
would ultimately enhance laboratory
capabilities. During the outbreak
response, Basler and her colleagues built
partnerships with multiple entities such
as universities, non-profits and other
public health laboratories. With the
help of these organizations, San Diego
County improved their communication
with submitters and strengthened their
bioinformatics infrastructure.
Soehnlen stressed the importance
of working with partners to identify
methods to streamline PCR and
genotyping workflows so large volumes
of samples do not overwhelm existing
laboratory capabilities. Laboratorians may
be interested in inquiring about serologic
testing capacity at local hospitals as
well as reaching out to CDC DVH with
questions about the utility and application
of molecular sequencing options. Since
HAV is highly virulent and can spread
rapidly across state lines, she suggested
that laboratories prepare for an influx of
a large number of samples and identify
mechanisms to address staffing and
ensure continuity of day-to-day laboratory
operations.
Value of Interjurisdictional
Collaborations for Public Health
Laboratorians
Basler was new to public health and
was brought in during the outbreak. She
was pleased to report how supportive
and welcoming public health colleagues
Since March 2017, outbreaks of
HAV have been detected in 18
states nationwide with reported
associations with individuals who
use drugs, persons experiencing
homelessness, and in MSM
(men who have sex with men)
communities. State and local public
health laboratories have engaged
in epidemiological and laboratory
response efforts aimed at combatting
these outbreaks in conjunction
with the CDC Division of Viral
Hepatitis (DVH).
Hepatitis A
22
LAB MATTERS Spring 2019
PublicHealthLabs
@APHL
APHL.org