Lab Matters Summer 2017 - Page 28

from the bench Florida Responds to the Challenges of Zika Surge Testing By Jessica Brown, Medical Laboratory Scientist III, Bureau of Public Health Laboratories-Jacksonville; Andrew Cannons, PhD, HCLD(ABB), laboratory director, Florida Bureau of Public Health Laboratories- Tampa; Amanda Davis, NT(ABB), MLT(ASCP), Medical Laboratory Scientist III, Florida Bureau of Public Health Laboratories-Jacksonville; Lea Heberlein-Larson, MPH, SM(ASCP), virology administrator, Florida Bureau of Public Health Laboratories; and Marie-Claire Rowlinson, PhD, D(ABMM), assistant laboratory director, Florida Bureau of Public Health Laboratories-Jacksonville The Florida Department of Health’s Bureau of Public Health Laboratories (BPHL) detected the first cases of travel- associated Zika virus infection in Florida in January 2016 and the number of cases steadily increased over the next several months. Approximately seven months later, as many scientists had predicted, the Florida Department of Health (DOH) confirmed the first case of local transmission of Zika in the US when the virus was detected in a Miami-Dade area resident. The BPHL was well-prepared for such an event, having implemented the laboratory-developed tests for Zika (RT-PCR and IgM MAC-ELISA) in BPHL-Jacksonville and BPHL-Tampa in late 2015. However, the detection of locally-acquired Zika cases led to an immediate increase in test volume and some unprecedented challenges. Adapting to Surge Testing The first was triaging of specimens, which proved to be a formidable experience throughout the surge. Since dengue and chikungunya virus–diseases with very similar symptoms to the Zika virus–were circulating in South America, it was essential to have background information such as travel history, pregnancy status and exposure in order to test for the appropriate arboviral diseases. Oftentimes, this information was not supplied or was incomplete, and obtaining it post-sampling was very challenging because direct contact information for the provider was not available. An unfortunate consequence could be that the testing process and the release of test results to providers was delayed. Education to providers was key in improving the submission of appropriate information with samples. Amanda Davis (left) works in the BSC processing samples for Zika testing, while Jessica Brown (right) performs ELISA testing. Photo courtesy of Florida Department of Health, Bureau of Public Health Laboratories 26 LAB MATTERS Summer 2017 Incorrect packaging and shipping of specimens was the second challenge. On average, each patient had at least two specimens (serum and urine) from potentially nine different specimen types. With the overwhelming number of specimens and the lack of experience with this virus, many providers sent the wrong specimen types or shipped them incorrectly. Urine collection cups would often leak during transport requiring technicians unpacking the shipments to use extreme caution. BPHL developed guidance documents in an educational campaign to help health departments, clinics and other agencies understand what sample types to submit, how to package and where to ship. These documents were updated as necessary, for example, following an update to the testing algorithm. BPHL also developed and distributed a frequently asked questions (FAQ) document based on commonly asked and anticipated questions. Following the release of these documents by the Florida virology laboratories and epidemiology department, most urine samples arrived in collection tubes rather than cups, greatly reducing the likelihood of leakage and biorisk. A third challenge was limited testing capacity, involving both instrumentation and personnel. To help alleviate this, BPHL purchased additional equipment which was quickly deployed to augment Zika PCR and ELISA testing capacity. Among the purchases were high-throughput nucleic acid extraction instruments to increase PCR testing capability, plate washers/readers for ELISA testing and other automated instrumentation. Even with equipped laboratories, there was a bottleneck effect with simply not enough staff to triage and test specimens. During PublicHealthLabs @APHL