FEATURE
LRN RESPONSE TIMELINE
ESTABLISHED
SUDDEN ACUTE RESPIRATORY SYNDROME ( SARS )
H1N1
FUKUSHIMA
EBOLA PFAS
ARSENIC
-ALASKA-
ZIKA
MPOX
1999
2001
2003
2005
2009
2010
2011
2012
2014
2015
2016
2017
2022
ANTHRAX
HURRICANE KATRINA
SULFUR MUSTARD -MASSACHUSETTS-
MIDDLE EASTERN RESPIRATORY SYNDROME CORONAVIRUS ( MERS-COV )
RADIOLOGIC CONTAMINATION
TOXIC METAL EXPOSURE
-COLORADO-
-WASHINGTON-
A week later , Hauser was on a Zoom call with
CDC ’ s Laboratory Response Network ( LRN ) when her state epidemiologist emailed her that DC had a suspected mpox case . Another one came in later that night , a few days before Memorial Day .
“ It was essentially the holiday weekend that jump-started our response ,” Hauser says . “ From there , it became like a snowball of getting requests and having positive samples within the next two weeks . And then it kept snowballing with more samples .”
When mpox hit the United States last year , CDC activated the LRN , allowing for a coordinated response , standardized testing and information-sharing among laboratories . The mpox experience across the US highlighted the power of the LRN , but it also showcased its weaknesses — offering lessons in ways the network must modernize .
“ The LRN is an underutilized resource that needs to be reimagined in terms of the world of today — and the world of today is that we ’ re going to have more frequent introductions to infectious diseases ,” says Jill Taylor , PhD , APHL senior advisor for scientific affairs .
The Creation and Benefits of the LRN
The LRN was established in 1999 by APHL , CDC and the Federal Bureau of Investigation as a network of laboratories that could prepare for and respond to bioterrorism . Today ’ s LRN has two components : the LRN for Chemical Threats Preparedness ( LRN-C ) and the LRN for Biological Threats Preparedness ( LRN-B ). The LRN-B uses a tiered structure of thousands of clinical laboratories that serve as sentinels , ruling out and referring threats to reference laboratories . There are approximately 120 reference laboratory members , representing all 50 state public health laboratories plus some local public health , military , veterinary , agriculture , food , water and international laboratories . These reference laboratories detect and characterize biological threats such as anthrax and mpox .
Another tier of the LRN-B is comprised of national laboratories such as those at CDC and Department of Defense . These laboratories perform additional characterization as well as assay development .
The LRN was also created in a world before the 9 / 11 terrorist attacks , a world without social media and a world with a blossoming internet that ordinary people were still discovering . In 1999 , information did not travel so fast — and so widely — as it does in 2023 . There have been massive advancements in technology over the past 20 years , along with new epidemics and emerging diseases that stress laboratories ’ capabilities . The LRN finds itself stretched at times and is ripe for modernization , experts say . But CDC will need to push for and lead that modernization , and it will likely need more money to do so .
“ Funding spikes with an outbreak and then it goes away ,” Hughes says . “ That ’ s always something that is foremost in our minds — preparing for the next outbreak when there isn ’ t an outbreak . It ’ s very hard to justify that from a funding point of view , but it needs to be done . You need to have a response-ready team .”
During the 2022 mpox outbreak , being a part of the LRN meant laboratories could access assays and reagents from CDC and be a part of a constant communication network about how to respond to the outbreak . While mpox is not designated as a Select Agent , it is on the LRN list of tests , mostly to differentiate it from its cousin , the more dangerous and ( almost ) eradicated smallpox .
“ We had the assay already available , and the LRN supplied us with our reagents to do the testing ,” says Nicole M . Green , PhD , D ( ABMM ), director of public health laboratories at the
Los Angeles County
14 LAB MATTERS Spring 2023