PUBLIC HEALTH PREPAREDNESS AND RESPONSE
Public Health System Recovery in Full Swing:
Hurricane Response in Puerto Rico and the US Virgin Islands
by Jill Sutton, associate specialist, Crisis Response
Following back-to-back hurricanes in
2017, public health laboratories and
other programs within the Puerto Rico
Department of Health (PRDH) and the
US Virgin Islands Department of Health
(USVIDOH) entered into response and
recovery mode. Nearly 19 months later,
both jurisdictions are continuing to
restore public health infrastructure that
is vital for detecting and responding to
health threats.
With the help of external partners such
as APHL, the US Centers for Disease
Control and Prevention (CDC) and other
non-governmental organizations, both
jurisdictions’ public health laboratories
have been able to:
The PRDOH Bacteriology Molecular Lab minor repairs completion marks the beginning of genomic sequencing for outbreak
identification and for the detection of bacterial special pathogens in Puerto Rico
1. Implement a temporary specimen
transport system to restore specimen
testing capacity.
2. Address procurement needs to replace
or repair equipment, reagents and
other supplies needed to ensure public
health operations and services have the
capacity to support local public health
needs.
3. Assess and respond to critical health
infrastructure damage.
4. Scale up staffing to support gaps
in workforce needed to maintain
laboratory operations and services.
Repairing the Critical Infrastructure
Needed to Support Quality
Laboratory Systems
PRDH recognized that in order to mitigate
the impact of future public health
emergencies—especially hurricanes—
their laboratory network must scale up
their capabilities and capacity to support
both immediate and long-term public
health testing needs. With coordination
and collaboration from external partners,
PRDH prioritized implementing whole
genome sequencing (WGS) within the
bacteriology/molecular laboratory to
improve testing capacity for infectious
diseases. However, prior to implementing
PublicHealthLabs
@APHL
this technology, structural damage that
occurred to the lab in San Juan had to
be addressed. Repairs on the molecular
laboratory began in January 2019 and are
expected to be complete by the end of
May 2019.
Another priority project to further
support catastrophic readiness is the
implementation of a laboratory quality
management system. This project
has been initiated across all PRDH
laboratories to harmonize and strengthen
key operations such as biosafety and
biosecurity, information management,
equipment maintenance, procurement
tracking and continual workforce training.
USVIDOH – Health Information
Management and Exchange
to Address Data Access and
Exchange
Ensuring rapid and secure exchange
of laboratory data is a priority at the
USVIDOH. During a disaster situation,
lives depend on the ability to use public
health laboratory data to inform public
health decisions. With support from APHL
and CDC, the USVIDOH public health
laboratory plans to enhance their current
laboratory information management
APHL.org
system (LIMS) and move from off-site
hosting to on-site. The purpose of
transitioning to an on-site hosting
environment is to eliminate potential
issues with internet infrastructure should
it be interrupted during a natural disaster.
With the infrastructure in place to support
data storage on-site, access to laboratory
data during a public health crisis will not
be delayed.
After the 2017 hurricanes, patients and
healthcare providers had limited access to
medical records. In addition to enhancing
their existing LIMS system, USVIDOH
is prioritizing the development and
implementation of a universal repository
for health data that not only public health
officials and laboratorians will have
access to, but also healthcare providers
and patients. Access to information such
as vaccination records, health screenings,
laboratory results and treatment status
of a patient’s pre-existing condition can
drastically improve the medical response
and minimize the operational impact in
USVI. n
Spring 2019 LAB MATTERS
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