public health preparedness and response
Colorado Responds to“ Perfect Storm” of Challenges
by Tyler Wolford, MS, senior specialist, Laboratory Response Network and Larry Sater, MS, BT / CT coordinator and security officer, Colorado Department of Public Health and Environment, Laboratory Services Division
While CDPHE LSD was testing additional tuberculosis samples, specimens started to arrive for suspected human cases of plague and tularemia. The first suspected sample was confirmed by CDPHE LSD to be positive for plague, and specimens from people in contact with that patient arrived at the laboratory. After contacting several sample submitters, the laboratory learned that one hospital had over one hundred exposures of staff, patients and visitors. It also learned that the patient with plague was not in isolation until Yersinia pestis was identified at the laboratory. Soon after, unrelated samples began to pour in for suspected cases of tularemia.
Colorado Department of Public Health and Environment Laboratory Services Division
The US Laboratory Response Network( LRN) is well known for its rapid assay deployment, accurate laboratory test results and highly skilled staff that respond to biological and chemical threats. In addition to testing synthetic biothreat agents such as anthrax, LRN laboratories also respond to high-risk biothreats occurring naturally in the environment. The Colorado Department of Public Health and Environment( CDPHE) Laboratory Services Division( LSD), an LRN member laboratory, recently found itself at the center of a“ perfect storm,” when a combination of weather, sample surges, a select agent inspection and emergency laboratory down time challenged the laboratory and staff to respond.
Weather + Damaged Facilities + Equipment Failure = Increased BSL-3 Testing
In September 2013, a cold front over Colorado merged with warm humid air from the south resulting in substantial rain and catastrophic flooding to Colorado and neighboring states for over six months. During the flooding, a neighboring state’ s LRN biosafety level 3( BSL-3) laboratory was damaged, so CDPHE LSD stepped in to do tuberculosis testing and serve as backup for select agent testing. A few weeks after testing began, a biosafety cabinet in the CDPHE LSD tuberculosis laboratory broke down and all BSL-3 testing duties were moved to the CDPHE LSD LRN laboratory.
And then an FSAP Inspection
At the same time, the Federal Select Agent Program( FSAP) inspection team arrived to perform a triennial renewal inspection for the laboratory’ s select agent certificate. CDPHE LSD persevered, balancing the surge of tularemia and plague testing with the needs of the FSAP inspection team. By the end of 2014, a total of eight confirmed human cases of plague occurred in Colorado. The average yearly total for the entire US is five cases and the last confirmed human case in Colorado was in 2011. An additional sixty-eight human cases of tularemia were confirmed when, on average, Colorado only experiences between three and four per year.
Readiness for the Unanticipated
The CDPHE LSD did an outstanding job performing laboratory testing during its perfect storm. The combination of cross-trained staff, advanced facilities and equipment redundancy were cornerstones of the rapid and effective response. Coordination with the Centers for Disease Control in Fort Collins, Colorado State University Veterinary School and sentinel clinical laboratories also aided in the response. As the events at CDPHE LSD show, it is imperative that LRN laboratories remain prepared to respond to both intentional and inadvertent threats, especially in unanticipated circumstances.
After contacting several sample submitters, the laboratory learned that one hospital had over one hundred [ plague ] exposures of staff, patients and visitors.
Water … Vegetation … Wildlife = Yersinia pestis and Francisella tularensis
Colorado also began experiencing increased snow packs and rain in the early part of 2014. This caused a surge of vegetation and increased numbers of small wildlife in the US Midwest during the spring and summer months. With the increase in wildlife came increased production of Yersinia pestis and Francisella tularensis, the causative agents of plague and tularemia respectively. Both plague and tularemia are transmitted from infected animals to humans via fleas, ticks and mosquitos.
Laboratory analysts Justin Nucci( left) and Greg Waidmann( right) perform Laboratory Response Network( LRN) testing in a Division Select Agent and Toxin( DSAT) registered Biosafety Level-3 laboratory at the Colorado Department of Public Health and Environment during an emergency response
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