Lab Matters Spring 2023 | Page 17

FEATURE

People check in to get a vaccination at a walk-up mpox vaccination site at Barnsdall Art Park in Hollywood , CA . Photo : Brian van der Brug / Los Angeles Times via Getty Images

Department of Public Health . “ Then we had a lot of communication with both CDC and APHL almost on a weekly basis in the very beginning , where the network would host these calls and people could call in to ask questions .”

Those LRN meetings with the CDC and other laboratory directors facilitated discussion on how to make testing more efficient , increase capacity and speed up turnaround times . When the outbreak happened , mpox already had an approved test ready for use . However , the test was manual , which slowed down testing especially as suspected cases increased .

It ’ s fine when you have one sample , but when you ’ ve got hundreds of samples … It was taking our team , for 10 to 20 samples , between an hour and an hour and a half to just put in the results and the data for each sample .”

Jocelyn R . Hauser , PhD , D ( ABMM )

“ With input from public health laboratories , APHL worked with CDC to look at additional extraction platforms , specifically automated extraction platforms ,” says Chris Mangal , MPH , APHL ’ s director of Public Health Preparedness and Response . “ We saw an acceleration in how CDC evaluated automated extraction platforms , submitted performance data to the US Food and Drug Administration ( FDA ) and secured approval for laboratories to use automated extraction . The addition of automated extraction platforms was an important aspect of the mpox response to help laboratories handle testing surge .”

CDC also engaged commercial laboratories that had higher throughput testing , thereby increasing testing capacity .

How the LRN Should Modernize

The connectivity of the LRN helped bring about changes to the mpox outbreak as public health laboratories continued to learn what worked best and shared that information with each other , with CDC and APHL input . But it also illuminated cracks in the system that experts say need to be addressed for future outbreaks .

Mpox was a known pathogen and already had an approved test in place , albeit a manual one . While initially it had to be tested in a biosafety level-3 ( BSL-3 ) suite — based on how contagious and deadly smallpox is — that was later changed to BSL-2 , which opened up testing and personnel capacity . But how will the LRN respond to a larger outbreak , a more contagious and deadlier pathogen or an unknown pathogen ? Or now , a very familiar one : SARS-CoV-2 , the coronavirus that causes COVID-19 , which has killed more than 6 million people globally .

One of the first tests of the LRN was the 2001 anthrax attacks , where laboratories not only had to respond initially but had to surge up as they were inundated with samples of all types of white powder that people feared were anthrax . In 2003 , the LRN responded to a small outbreak of mpox , then SARS . Later there were ricin and tularemia scares , followed by H1N1 flu in 2009 . The LRN was activated in all these outbreaks . Yet the LRN was never activated during the COVID-19 pandemic .