infectious diseases
can then quickly locate people who
may have been infected and get ahead
of the outbreak before it spreads.
The rRT-PCR test may be quicker than
serological testing—it detects measles
RNA, as opposed to measles antibodies,
and is less confounding than serology—
but it’s not completely definitive, Strain
said. After conducting rRT-PCR testing
on each of the specimens that come
into the lab, any positive specimens
undergo genotyping to determine if
the patient is infected with a wild-type
measles strain or if the rRT-PCR is simply
picking up on the live attenuated virus
that’s contained in the measles-mumps-
rubella vaccine. Genotyping can also
determine if the case is related to the
larger outbreak. (In addition to its regular
testing responsibilities, the Minnesota
Public Health Lab is partnering with
the US Centers for Disease Control and
Prevention (CDC) and Canadian public
health officials to develop a PCR assay
that’s specific to the vaccine strain
of measles. Such an assay would be
particularly helpful in an outbreak, Strain
said, because technicians could then
forgo the extra step of genotyping.)
“As hard as it’s been in the lab, it’s been
even harder for our epidemiologists—
they’ve had more than 7,000 contacts to
trace and to follow up on,” said Joanne
Bartkus, PhD, director of the Minnesota
PublicHealthLabs
@APHL
replace machines, we can’t train more
people … what we do is very complex.”
Vetter said that most of the lab’s current
surge and response capacity is thanks
to federal public health preparedness
funding as well as funding from CDC’s
Epidemiology and Laboratory Capacity for
Infectious Diseases (ELC) Program, both
of which currently sit on the budgetary
chopping block. On preparedness,
President Trump’s fiscal year 2018
budget proposal calls for cutting CDC’s
emergency preparedness budget by
$136 million—that’s on top of years of
preparedness cuts public health agencies
have already absorbed. The ELC, on the
other hand, is wholly entwined with the
Affordable Care Act’s Prevention and
Public Health Fund, which allocates $40 At the same time the Minnesota Virology/
Immunology Unit was responding to the
measles outbreak, it was also responding
to a mumps outbreak on the University of
Minnesota-Twin Cities campus, providing
surge testing for a mumps outbreak in
Washington state that hit nearly 900
cases earlier this summer, and taking
in and testing about 20 specimens a
week for Zika virus. All of that is in
addition to its more regular duties, like
rabies and West Nile monitoring.
In the wake of the measles outbreak,
Minnesota Health Commissioner Edward
Ehlinger, MD, MSPH, called on state
policymakers to create and support a
public health response contingency fund.
Inside the public health lab’s Virology/Immunology Unit, technicians tracked
the measles outbreak using an rRT-PCR assay, which allows them to detect
the highly contagious virus much quicker than private labs that can perform
serological testing for measles antibodies.
“It’s actually meant quite a lot of
maneuvering,” Strain said, referring to
the logistics of responding to the surge
in measles testing. “In some ways, we
were lucky that it happened in April when
flu season was dying down—otherwise
a number of testing staff trained for
measles testing would have also been
doing flu testing. If the (measles outbreak)
had happened any sooner, it would
have been really hard to keep up.”
From start to finish, the measles assay
takes about five hours, Strain said. Lab
staff can process 10 measles specimens
at a time and up to 30 specimens in
day—though that’s a stretch, she noted.
In comparison, the lab can process up to
150 flu samples in a day and often does.
Public Health Laboratory, in late May.
“It’s been daunting for all of us.”
million in annual ELC funds to state and
local health departments in every state.
Under recent ACA repeal-and-replace
proposals in Congress, the Prevention
and Public Health Fund would disappear.
And while ELC and preparedness
monies don’t categorically support the
Minnesota lab’s vaccine-preventable
disease work, Vetter said the funds have
been essential in ensuring the lab can
quickly scale up its response, regardless
of whether the emergency is vaccine-
preventable or not. In other words, the
Minnesota lab has spent years building
an all-hazards response system that
readies it to face any health threat
that lands at its doorstep. Being able
to sustain that nimbleness, however,
would be at risk if funding declined.
“Our commissioner always says that
data are the coins of public health,”
Bartkus said. “And it’s the public
health lab that creates that data.”
As of late May, Strain said the Minnesota
measles outbreak—which exceeded total
U.S. cases for all of 2016—seemed to be
entering a “tapering phase.” As she said
that, however, she paused—and quickly
added “we all just knocked on wood.” ■
DIGITAL EXTRA:
Read more on the Minnesota measles
outbreak.
“Without that funding, we’d probably
have to choose what we respond to
because we’d run out of people and out
of machines—we just couldn’t keep up,”
Vetter said. “If our funding gets cut, we
can’t maintain our machines, we can’t
APHL.org
Summer 2017 LAB MATTERS
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