president’ s & executive director’ s message
2017-18 Flu Season Tests Emergency Response System
The 2017-18 influenza season is but a shadow of the infamous 1918 outbreak, whose centennial is discussed in our feature. Yet, this season has been bad enough. At this writing, CDC reports that hospitalizations for influenza-like illnesses are at the highest levels since tracking began in 2010, and 48 states are reporting widespread influenza activity, signifying that the season still hasn’ t reached its peak.
Yet, as always, the availability of laboratory data gives public health and healthcare personnel a window into the outbreak that they would not otherwise have. The Rhode Island Department of Health( RIDOH), for example, has an influenza surveillance scheme based on a network of strategically placed sentinel healthcare providers, several based at university health centers. The state also conducts outbreak investigations in congregate living sites, such as nursing homes and college dormitories, which are required to report instances of influenza and to submit specimens to the state laboratory for testing. With sentinel physician surveillance and monitoring of outbreaks, the virus’ s spread has been well documented. For example, cases started picking up in Rhode Island last December, earlier than the previous three flu seasons. After holiday vacations ended the first week of January, which might have impacted the number of cases counted in state, the epidemic curve skyrocketed.
Rhode Island’ s surveillance data— and data from every US state and territory— feeds into CDC’ s national surveillance map. The fact that CDC is able to collect such data in near-real time is a success story in itself, and one in which APHL has been pleased to play a role. Thanks to the association’ s Right Sizing project, public health laboratories can determine just how many specimens and laboratory test results need to be collected for epidemiologists to paint a picture of what the virus is doing on local and national scales. Much of the influenza data CDC receives comes to the agency through the APHL Informatics Messaging Services platform— AIMS. Both of these tools, the Right Size calculator and AIMS, are the result of years of collaboration with public health partners.
Of course, the utility of the laboratory extends beyond testing of surveillance and outbreak specimens. This flu season, the RIDOH State Laboratory has received many specimens from hospital laboratories identified as unsubtypable, a red flag in public health since unsubtypable is potentially indicative of a novel influenza strain. Upon testing with the standardized CDC protocols the state laboratory employs, however, almost all of these specimens have subtyped to H3N2, this season’ s predominant strain. Why the discrepancy? The issue boils down to the varied sensitivity and specificity of tests performed on a collection of different platforms that may have unproven accuracy when it comes to subtyping influenza strains.
Public health laboratories’ rigor, highly trained staff, standardized protocols and focus on high-specificity, high-sensitivity tests clearly adds value. And, since the US Food and Drug Administration has disallowed the use of at least two rapid influenza test kits this season, there is even greater reliance on laboratory testing.
With the addition of advanced molecular platforms, many public health laboratories now have the ability to identify respiratory viruses other than influenza that may be circulating in the local population, and to disseminate that information to physicians so they know what’ s out there. That knowledge helps to inform physicians and their patients when influenza is ruled out.
Yet, as critical as laboratory testing is, we realize it is but a piece of the public health emergency response system. Every influenza season is a test of that system. And this season has clearly strained it, with Tamiflu shortages and jam-packed emergency departments. The current issue of Time magazine, for example, features a photo of overflow hospital patients being housed in tents in parking lots. These gaps must be addressed.
While influenza is a timely topic— and we hope you have gotten your vaccination— there is a lot more to read in this issue of Lab Matters. To name just a few, APHL’ s Global Health field team met in Johannesburg last December for a week of training and strategic planning; the association’ s former class of emerging leaders is set to roll out e-learning modules on budgeting and resource management; and Puerto Rico laboratorians are working diligently to restore essential testing services in the wake of Hurricane Maria. We hope you will check it out. n
2 LAB MATTERS Winter 2018
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