APHL 2019 POSTER ABSTRACTS
Improving Crisis and Emerging Threat Responses in Public
Health Laboratories Evaluation of MERS-CoV Testing Capability Among US
Laboratory Response Network Laboratories
R. Aubert 1 , E. Bind 2 , M. Bonifas 3 , C. Charlton 4 , C. Courtney 5 , N.
Hull 6 , M. Johnson 7 , R. McNall 1 , C. Perkins 8 , C. Sloma 9 , S. Staley 10 , A.
Strain 11 , T. Wolford 10 , R. Razzaque 12 ; 1 Centers for Disease Control
and Prevention, 2 New Jersey Department of Health, 3 Michigan
Department of Health and Human Services, 4 Provincial Laboratory
for Public Health, 5 Washington, DC Public Health Laboratory,
6
Wyoming Public Health Laboratory, 7 Kentucky Division of
Laboratory Services, 8 Los Angeles County Public Health Laboratory,
9
Texas Department of State Health Services, 10 Association of Public
Health Laboratories, 11 Minnesota Department of Health, 12 Oregon
State Public Health Laboratory B. Whitaker, D. Erdman, E. Schneider, N. DeGroote, S. Sakthivel,
X. Lu, L. Lowe, P. Syribeys and S. Lindstrom, Centers for Disease
Control and Prevention
Background: Public health laboratories (PHLs) and public health
associated institutional laboratories (PHAIs) are facing an increasing
number of threats that negatively affect the ability of laboratories
to provide uninterrupted services. To ensure an undiminished
standard for public health and safety, it is imperative that PHLs and
PHAIs have the capability and capacity to prepare for and respond
to threats through improved collaboration and resource gathering.
Cohort 11 of APHL’s Emerging Leader Program aims to provide
accessible, user-friendly, and relevant information to utilize for
improving emergency response and crisis management.
Methods: In the fall of 2018, APHL’s Emerging Leaders Program
Cohort 11 includes a diverse group of fifteen public health
professionals, including representatives from US state and local
PHLs, the Centers for Disease Control and Prevention, Public
Health Canada, and APHL. The topic of public health preparedness
and emergency response was selected by Cohort 11 as an unmet
need with overarching relevance, and an issue that aligned with
APHL’s strategic priorities. The cohort determined that a publication
identifying gaps and lessons learned in crisis response would
provide information to both public health professionals and policy
makers. The cohort will collate the knowledge and experiences
shared by subject-matter experts to convey these lessons into a
document and summary fact sheet. To enhance existing resources,
Cohort 11 is also facilitating a round-table discussion of this topic at
the APHL Annual Meeting.
Results: Cohort 11 will create a document which highlights
challenges for the PHLs in responding to crisis and emerging
threats, including biological, chemical, natural disasters, and
technological issues. Challenges may involve personnel, resources,
tests systems, monitoring, reporting, and communication during the
response. Through consultations with experts, the document will not
only address the gaps in the preparedness program, but will also
provide a thoughtful and detailed summary of our findings which
will be useful for state public health laboratory leaders and policy
makers, the federal government laboratories, and for PHLs globally.
Background: In 2012 a novel coronavirus was identified as
the cause of Middle East Respiratory Syndrome (MERS-CoV).
The Centers for Disease Control and Prevention (CDC) rapidly
developed and deployed diagnostic real-time RT-PCR (rRT-PCR)
assays under U.S. Food and Drug Administration (FDA) Emergency
Use Authorization (EUA). Diagnostic assay kits were deployed to
laboratories belonging to the CDC Laboratory Response Network
(LRN) that include U.S. public health laboratories (US PHLs) and
Department of Defense laboratories that have been qualified to
perform testing on patients under investigation (PUIs) for MERS-CoV.
CDC has assessed those testing capabilities by conducting annual
performance evaluations of any US PHL receiving the CDC Novel
Coronavirus 2012 Real-Time RT-PCR Assay (MERS-CoV assay).
Methods: In order to evaluate the performance of US PHLs
performing the CDC MERS-CoV assay, CDC developed a MERS-
CoV External Quality Assessment (EQA) panel comprised of mock
respiratory specimens covering a range of strong to weak positive
samples. Mock specimens were manufactured by serially diluting a
gamma radiation inactivated MERS-CoV virus isolate in commercial
viral transport media (VTM) along with clean, uninfected A549
human cells. Single-blinded EQA panels were shipped to qualified
LRN laboratories and processed as clinical respiratory specimens
and tested by the CDC MERS-CoV assay. Results were reported
back to CDC for confidential grading where a passing performance
consisted of correct qualitative results and cycle threshold (Ct)
values within 2 standard deviations of internal values replicated by
CDC.
Results and Conclusions: Initial evaluation in 2013 showed 84%
of LRN labs passed the EQA panel on the first try. Through ongoing
technical laboratory support, performance improved to 88% in
2014, 94% in 2015, 96% in 2016 and 100% in 2017-2018. CDC
was able to determine several areas of improvement such as
specimen processing, reagent preparation and data analysis issues.
In total, 16 performance issues were identified from 2013-2016
among 15 individual laboratories. From 2013-2018, qualified LRN
labs have tested over 1300 PUIs for MERS-CoV infection. Notably, 2
patients in 2014 tested positive for MERS-CoV which were found to
be imported from Saudi Arabia. Currently there are 57 qualified LRN
laboratories in the U.S. capable of performing MERS-CoV diagnostic
testing using the CDC MERS-CoV assay.
Presenter: Brett Whitaker, Centers for Disease Control and
Prevention, Atlanta, GA, [email protected]
Conclusion: To build a stronger public health network, we must
establish effective communication and coordinated response within
the PHLs during the crisis events as well as establish efficient
public communication strategy. APHL Cohort 11 will provide a
document and forum to assist this priority by sharing knowledge
across laboratories and providing information, which can be used to
prepare for emerging public health threats.
Presenter: Rafia Razzaque, Oregon State Public Health Laboratory,
[email protected]
PublicHealthLabs
@APHL
APHL.org
Summer 2019 LAB MATTERS
77