Lab Matters Winter 2017 - Page 16

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
LAB MATTERS Winter 2017
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