Lab Matters Spring 2025 | Page 31

PUBLIC HEALTH PREPAREDNESS AND RESPONSE

By Chris N . Mangal , MPH , senior director , Public Health Preparedness and Response

Colorized transmission electron micrograph of mpox particles ( teal ) found within an infected cell ( brown ), cultured in the laboratory . Image captured and color-enhanced at the NIAID Integrated Research Facility ( IRF ) in Fort Detrick , MD . Photo : NIAID

In 2022 , there was a global outbreak of mpox , a viral disease related to smallpox . To date , there have been over 20,000 cases of mpox globally with approximately 4,000 cases in the United States . There are two clades of the mpox virus : clade I ( with subclades Ia and Ib ) and clade II ( with subclades IIa and IIb ). Both types spread the same way and can be prevented using the same methods . The 2022 – 2023 mpox global outbreak was caused by the clade IIb strain . Fast forward to 2025 , and the US as well as other countries are still responding to mpox cases , with the California Department of Public Health detecting the first known case of clade I mpox in the US in November 2024 .

Well in advance of the 2022 outbreak , US public health laboratories were positioned to detect viruses such as mpox with a test called non-variola orthopoxvirus assay . These laboratories are part of the Laboratory Response Network for Biological Threats Preparedness ( LRN-B ), managed by the US Centers for Disease Control and Prevention ( CDC ). APHL works closely with CDC to support the LRN with training , test development , testing and reporting of results , and workforce development . While the LRN-B was ready for and responded to the 2022 mpox outbreak , CDC also engaged commercial partners to support surge testing . Further , APHL quickly activated its emergency response center ( EOC ) with the goals to :

• Utilize an Incident Management or Command System ( IMS / ICS ) for a coordinated laboratory response and to ensure public health laboratories have timely diagnostics to safely perform tests

• Provide subject matter expertise and technical assistance to members , federal partners and sustaining members

• Facilitate communications among public health laboratories , epidemiologists , health officials , CDC and other partners , serving as a credible resource for the media and the public

• Promote the value of the LRN and the role of public health laboratories in this network

• Utilize APHL ’ s voice to strengthen laboratory partnerships and coordination .

APHL worked with CDC to include automated extraction platforms in the test menu , issued biosafety guidance and encouraged member laboratories to develop new diagnostics to detect the two clades of mpox virus . These laboratories worked closely with each other , the CDC and the US Food and Drug Administration ( FDA ) to seek emergency use authorizations ( EUAs ) and / or register laboratory developed test ( s ) for newly developed tests that provided clade specific identification . Assay development continues among public health laboratories .

APHL has stood down its formal response to mpox but continues its work to strengthen the ability of laboratories to detect this virus . As we look ahead into 2025 , mpox still proves to be a threat to the US and it is imperative to strengthen the LRN , a critical national infrastructure asset , poised to detect and respond to threats . g