APHL 2019 POSTER ABSTRACTS
the most common K. pneumoniae sequence type. Among E. coli
ST131 isolates, 48 (92.3%) isolates were resistant to ciprofloxacin
or levofloxacin, 27 (51.9%) were resistant to trimethoprim-
sulfamethoxazole, and 23 (44.2%) were resistant to tobramycin,
gentamicin, or amikacin.
Conclusions: The phenotypic case definition worked well for targeted
surveillance of ESBL-producing Klebsiella and E. coli. ESBL genes of
the blaCTX-M type were most abundant. Additionally, clone ST131
represents a significant concern given the significant proportion of
ESBL-producing E. coli with this sequence type and the associated
resistance to multiple antibiotic classes in addition to β-lactams.
Presenter: Davina Campbell, Centers for Disease Control and
Prevention, Atlanta, GA, [email protected]
of this unique A(H1N1)v virus supports the recommendation that
testing for seasonal influenza viruses and monitoring for human
infections with novel influenza A viruses should continue year-round
and that public health authorities should consider novel influenza
virus infections when persons with influenza-like illness have a
history of swine or poultry exposure.
Presenter: Peter Cook, Bioinformatics Fellow, Centers for Disease
Control and Prevention, Atlanta, GA, [email protected]
50-State Legal Epidemiology Assessment of State Disease
Reporting Laws Requiring Clinical Laboratory Specimen
Submission to Health Departments
R. Hulkower, Centers for Disease Control and Prevention
Detection and Characterization of an Influenza A(H1N1)
pdm09 Virus Isolated from a Human Following Direct
Exposure to Influenza Virus Infected Swine
Human-to-swine transmission (reverse zoonosis) of seasonal
influenza viruses has led to sustained circulation of human-
like influenza viruses in swine in the United States. While these
viruses evolve and eventually become adapted in swine, nascent
reverse zoonoses can result in virus detections that are difficult to
distinguish as ‘swine-origin’ or ‘human-origin’ due to the genetic
similarity of viruses circulating in both hosts. Herein, we report the
first identification of a zoonotic infection with an A(H1N1)pdm09
virus derived from a swine host. In October 2017, a patient with no
underlying medical conditions developed an influenza-like illness.
Real-time RT-PCR testing of a nasopharyngeal specimen indicated
infection with a seasonal influenza A(H1N1)pdm09 virus. However,
viral genome sequence analysis suggested an influenza A(H1N1)
variant (A(H1N1)v) virus. Phylogenetic analysis of each viral gene
segment revealed the virus was a reassortant containing PB2, PB1,
NP and NS genes derived from the triple reassortant internal gene
(TRIG) cassette commonly found in swine influenza viruses, but
with HA, NA, PA and M genes closely related to seasonal A(H1N1)
pdm09 viruses. The patient reported direct exposure to swine in
the week preceding illness onset, and swine from the premises
tested positive for influenza virus. Subsequently, the virus isolates
obtained from both the patient and a pig had an identical genotype.
While the origin of the virus collected from the patient was resolved
by sequence comparison of the variant virus to available swine
influenza virus genomes, future cases may not be as readily
discernable if 1) reassortment does not result in acquisition of
well-defined swine influenza virus gene segments and 2) if related
swine influenza virus genomic sequences are not available.
Therefore, we have identified swine-associated sequence fragments
using a k-mer based algorithm comparing swine-associated and
human-associated groups of A(H1N1)pdm09 virus genomes that
we hypothesize can differentiate between human- and swine-origin
influenza viruses. Preliminary results indicate that the identification
of single nucleotide polymorphisms in virus sequence fragments can
differentiate between influenza virus species-origin. Identification
58
LAB MATTERS Summer 2019
Presenter: Rachel Hulkower, Centers for Disease Control and
Prevention, Atlanta, GA, [email protected]
PublicHealthLabs
@APHL
APHL.org
P. Cook 1 , 2 , J. Jones 1 , R. Kondor 1 , N. Zanders 1 , T. Stark 1 , J. Benfer 3 , S.
Scott 4 , A. Janas-Martindale 5 , J. Barnes 1 , S. Lindstrom 1 , L. Blanton 1 ,
J. Schiltz 5 , D. Wentworth 1 , T. Davis 1 ; 1 Centers for Disease Control
and Prevention, 2 Association of Public Health Laboratories, 3 State
Hygienic Laboratory, University of Iowa, 4 Wisconsin State Laboratory
of Hygiene, 5 National Veterinary Services Laboratory
Public health surveillance of potential and emerging infectious
disease outbreaks relies on consistent reporting of notifiable
conditions (“disease reporting”) from health care and clinical
settings to public health agencies. All states and DC have laws
requiring health care providers, facilities, and laboratories to report
suspected or confirmed cases of specific infectious diseases to
their state or local health department. These laws often include
additional isolate or other clinical material submission requirements
for laboratories. Public health agencies rely on the submission of
isolates from clinical laboratories to track pathogen information,
such as serotype, subtype, virulence, and antibiotic resistance,
to monitor trends, detect, and respond to outbreaks. With the
increasing development and use in clinical settings of culture-
independent diagnostic tests (CIDT), which do not produce an
isolate, there is growing concern that the supply of isolates to health
departments will be depleted, hindering public health surveillance
activities. Researchers studied strategies to maintain the supply
of isolates for public health laboratories, including encouraging
reflex culture via test kit inserts and updating state disease
reporting laws. We examined state disease reporting laws requiring
clinical laboratory submissions to health departments to identify
characteristics of the legal language that could facilitate isolate
submission. The study included 51 jurisdictions (50 states and
DC), 47 of which have disease reporting laws that expressly require
clinical laboratory submissions to health departments. Of those
jurisdictions, 9 have laws with language specifically addressing what
should be submitted if the laboratory has used a non-culture or
rapid testing method (CIDT) to make a diagnosis. PHLP researchers
also identified four features of law that could facilitate isolate
recovery for health departments. Those features are: 1) clear
language establishing routine mandatory submission of isolates or
other clinical materials; 2) clear language/definition of the materials
to be submitted (e.g., “isolate,” “specimen” or “clinical material”);
3) a list of alternative materials to submit if the preferred isolate
is not available; and 4) clear language addressing what should be
submitted if the laboratory has used a non-culture/rapid testing
method. We then classified each state’s disease reporting laws
according to its representation of one or more of these features. The
results of this study can be used to identify and propose generalized
solutions to potential gaps in jurisdictions’ disease reporting laws
to maintain isolate or clinical material submissions to health
departments.