Lab Matters Winter 2018 - Page 4

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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