Lab Matters Summer 2018 | Page 70

APHL 2018 Annual Meeting Poster Abstracts

Infectious Disease

Sensitivity analyses were performed to validate our model.

Results: Forty-five of 132( 34 %) local and state CDCPs and PHLs responded to the surveys. The model predicted 10,591 epidemiologically-linked measles contacts throughout the state including contacts investigated in California counties without confirmed measles cases. The total local and state public health epidemiologic and laboratory cost in California was $ 3.36 to $ 3.70 million. Local costs are estimated to be $ 2.75 million($ 2.36 – $ 3.27 million): CDCPs, $ 2.64 million($ 2.27 to $ 3.13 million) and $ 108,000($ 90,300 –$ 131,000) for local PHLs. State costs for both laboratory and epidemiological response are estimated to be $ 276,528 –$ 619,145.

Conclusions: California public health responses to measles outbreaks require significant financial resources. However, our overall economic assessment is comparable to previous studies. During the 2014 – 2015 US multi-state measles outbreak, expenditures for contact investigations and local response costs contributed most of the public health expenses across all California counties. Our modeling revealed that population density was a primary driver in determining the epidemiological linked measles contacts. Additionally, our model provides a method that could be used in evaluating cost for future measles outbreaks.

Presenter: John Diaz-Decaro, PhD, Los Angeles County Public Health Laboratories, UCLA Fielding School of Public Health, Los Angeles, CA, Phone: 562.658.1330, Email: jdiazdecaro @ ph. lacounty. gov

Rapid Mycobacterial Identification using Real Time PCR and MALDI-TOF Testing

A. Schooley, J. Vanneste, S. Church, H. Seymour and M. Soehnlen, Michigan Department of Health and Human Services, Lansing, MI

Objective: The primary goal for a Mycobacteriology laboratory in the public health setting is to rule in / out the presence of Mycobacterium tuberculosis complex( MTBC) in clinical specimens and cultures positive for acid-fast bacilli. The Michigan Department of Health and Human Services( MDHHS) goal was to create an algorithm using real time PCR and MALDI-TOF testing platforms that would maintain the turnaround time of the Hologic Mycobacterium Direct( MTD) amplification and HPLC tests.

Study Design: MDHHS began this task by validating a real time PCR test for clinical specimens, both respiratory and non-respiratory sources and broth cultures. Within 24 hours of receipt in the laboratory, a physician will have a result of MTBC DNA Detected or not Detected. Broth cultures are the majority of culture types received at MDHHS for identification, but they have a poor success rate when directly tested with MALDI-TOF. Our algorithm validated testing of these broth cultures with the real time PCR assay to rule in / out MTBC and then utilize the MALDI-TOF platform for final identification. The MALDI-TOF validation for Mycobacterium sp. cultures included cultures grown on solid media and 7H9 broth subcultures of the original culture. The subcultures are tested using MALDI-TOF when they reach an approximate turbidity of a 3.0 McFarland standard, usually 1-4 days after incubation. Acidfast bacilli positive cultures on solid medium are tested directly with MALDI-TOF. All clinical specimens and culture aliquots are heat killed before real time PCR or MALDI-TOF testing is performed. MALDI-TOF testing is performed as per the manufacturer instructions for Mycobacterium sp. from Bruker Daltonics. The real time PCR test is a laboratory developed test, originally designed by the Wadsworth Center, involving a simple extraction procedure followed by DNA detection.

Results: MDHHS has been able to transition from using MTD and HPLC testing without compromising turnaround time or cost.

Conclusions: The current MDHHS algorithm provides the laboratory with cost effective testing, while providing the physician with the most rapid identification possible to aid in patient treatment.

Presenter: Angie Schooley, BSMT, Michigan Department of Health and Human Services, Lansing, MI, Phone: 517.335.9637, Email: schooleya @ michigan. gov

Measles and Mumps and Chickenpox, Oh My! Minnesota’ s Response to Three Overlapping Outbreaks

A. Strain, E. Banerjee, N. Bekele, D. Boxrud, K. Harry, V. Lappi, K. Martin, M. McMahon and B. Nefzger; Minnesota Department of Health, St. Paul, MN

Background: Between April- August 2017, the Minnesota Department of Health( MDH) responded to three concurrent vaccine preventable disease( VPD) outbreaks. We experienced the largest in-state outbreak of measles in 30 years, a large mumps outbreak on college campuses and several small outbreaks of chickenpox( VZV). As a VPD Reference Center( VPD-RC), we also provided testing support for a nationwide mumps outbreak. Due to the generally low demand for VPD testing, lab staff fit these assays into routine testing responsibilities. This low demand is reflected in the equipment platforms, which are optimized for rapid testing of small batches of specimens. These factors became major limitations when faced with a need for large volume testing on small volume platforms during the peak of these three outbreaks.

Response: MDH-PHL, Infectious Disease Epidemiology, Prevention and Control( IDEPC) and local public health partners met daily during the measles outbreak to optimize response efforts. Additional testing staff were trained and staff work schedules adjusted to increase the length of the testing day. Equipment was reserved for outbreak response use, with flexible priority scheduling on additional instruments. Multiple batches were scheduled throughout the day. Measles specimens were prioritized over mumps and VZV. VPD-RC turn-around times were not affected. A Saturday testing schedule was temporarily implemented to address the increased demand and maintain rapid turn-around. The Operations( Ops) unit was delegated to handle communication with submitters. The Ops unit was provided with answers to frequently asked questions to assist with communications.

Results: The MN outbreaks began within three weeks of each other, requiring a rapid expansion of the MN response. MDH-PHL tested 1033 measles specimens, 523 mumps specimens and 176 VZV specimens April through August 2017. Average diagnostic turnaround times were 8 hours, 1.5 days and 2.5 days for measles, mumps and VZV, respectively. One additional staff member was fully trained on measles and mumps testing, resulting in five staff members able to work a rotating testing schedule. The Operations staff were able to respond immediately to submitter questions, reducing the burden on testing personnel.

Conclusions: Rapid response times are key to minimizing the spread of human illness. Measles, mumps and chickenpox are highly contagious, with limited treatment options and can become resource-intensive for public health and for individual families.