Lab Matters Summer 2024 | Page 22


Environmental Microbiology Outbreak Response : New Resources to Help Address Critical Needs

By Vaishali Dharmarha , PhD , senior specialist , Environmental Health ; and Sarah Wright , MS , manager , Environmental Laboratories
Environmentally transmitted infectious disease outbreaks are a considerable public health burden . The US Centers for Disease Control and Prevention ( CDC ) estimates that each year 17 major waterborne infectious diseases cause approximately 7.15 million illnesses , 118,000 hospitalizations , 6,630 deaths and $ 3.33 billion in direct healthcare costs . 1 Factors such as climate change , aging water distribution infrastructure , expanded and complex plumbing and industrial water systems , and the rise in the number and type of recreational water areas will potentially increase disease burden by creating conditions conducive to pathogen growth . 1 , 2 Environmental microbiology data are critical to understanding of environmentally transmitted infectious disease outbreaks , particularly for these nascent systems and climate-impacted pathogens . Environmental data help to answer questions such as :
1 . What are the key exposure routes ?
2 . Why did this outbreak occur here ?
3 . Why did it occur now ?
Answers to these questions can provide the rationale for developing effective prevention and mitigation measures .
In collaboration with epidemiologists and other environmental health professionals , state , territorial and local public health laboratories play an essential role in quick and effective environmental microbiology testing related to outbreak responses in their jurisdictions . To increase this capacity across the United States , CDC ’ s Environmental Microbiology and Engineering Laboratory at the Waterborne Disease Prevention Branch has partnered with APHL to build a laboratory community . In November 2023 , the APHL Environmental Microbiology Outbreak Response Community of Practice ( EMOR CoP ) was formed to help the now 127 members from 30 states , four local and
Irrigation water sample collection by dead-end ultrafiltration at a case exposure site in Utah related to an E . coli O157 : H7 outbreak . Photo : BreAnne Osborn / Utah Department of Health
four territorial public health laboratories share best practices .
Evaluating EMOR Capacity and Identifying Gaps
A key function of the community is to evaluate current US EMOR capacity and identify gaps in public health laboratories . Currently , the most common capabilities are routine water testing for generic Escherichia coli , coliforms and other fecal indicator bacteria in compliance with the Safe Drinking Water Act and / or Clean Water Act , as well as food testing in response to common foodborne outbreaks . Non-regulatory water testing for Legionella , Cryptosporidium and cyanobacteria were the next most common capability , but very few laboratories reported capabilities for other outbreak-associated , environmentally transmitted pathogens . Instead , laboratories reported needing to rely on outside resources — such as private or federal laboratories — for response-related environmental testing . For example , jurisdictions collaborated with CDC to conduct environmental investigations , confirm exposures routes and develop prevention strategies . These investigations include :
1 . Testing in response to an E . coli O157 : H7 outbreak associated with pressurized irrigation water in Utah being used for drinking and recreational purposes
2 . A fatal Naegleria fowleri infection in a child associated with playing at a splashpad in Arkansas
3 . A campylobacteriosis outbreak associated with municipal drinking water in Nebraska .
APHL-CDC-Public Health Laboratory Collaboration to Strengthen EMOR
Jurisdictions reported relying on outside laboratories for environmental outbreak sampling and testing capabilities due to several challenges . EMOR funding has been limited , and only recently received through the CDC Epidemiology and Laboratory Capacity cooperative agreement . Further , these funds are only accessible to laboratories affiliated with
Culture plate of the outbreak pathogen E . coli O157 : H7 isolated from an irrigation tap at a case residence in Utah . Photo : Mia Mattioli / CDC
20 LAB MATTERS Summer 2024
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