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 .