1The Nebraska Public Health Laboratory:Biosecurity Preparedness and Meeting Other Public Health NeedsSteven Hinrichs, M.D., DirectorPete Iwen, Ph.D, Associate DirectorPaul Fey, Ph.D. Associate DirectorTony Sambol, M.A., Assistant DirectorThe Nebraska Public Health Laboratory is a cooperative partnership with the Nebraska Department of Health and Human Services, the University of 2,yNebraska Medical Center, the Nebraska Medical Center.Origins of UNMC project, est. 1997Goals: To provide public health related laboratory testing within existing facilities for: STD’s Epidemiology supportAntibiotic resistance3Antibiotic resistance Emerging infectious diseases To develop an electronic reporting system for lab tests- ELIRT Partnerships: DHHS, NMC and UNMC2Mission Statement:“Dedicated to protecting the 4pghealth and safety of Nebraskans through diagnostic laboratory science, technology, and education.”Focus of LaboratoriesDifferences“Provide information for decision making”Clinical LaboratoryClinical Laboratory--The Nebraska The Nebraska Medical CenterMedical CenterDiagnostic testingDiagnostic testingNebraska Public Health Nebraska Public Health LaboratoryLaboratory Some diagnostic testingSome diagnostic testingReference testingReference testing5Diagnostic testingDiagnostic testing Some reference testingSome reference testing Medical managementMedical management Focus =Focus = IndividualsIndividualsReference testingReference testing Surveillance and Surveillance and monitoringmonitoring Focus =Focus = PopulationsPopulationsIntegrated NetworkIdentifying Public Health Threats637CDC’s Laboratory Response Network (LRN)8National LaboratoriesNational laboratories, including those operated by the CDC, areLRN cont.9those operated by the CDC, are responsible for specialized strain characterizations, bioforensics, select agent activity, and handling highly infectious biological agents and toxic chemicals.4Reference LaboratoriesReference laboratories - responsible for investigation and/or referral of specimens --are made up of more than 100 state and local public LRN cont.10health, military, federal, and international laboratories. Lab types include veterinary, agriculture, food and water testing laboratories. In addition to laboratories located in the U.S., facilities located in Australia, Canada, and the United Kingdom serve as reference laboratories abroad.Sentinel LaboratoriesSentinel laboratories provide routine diagnostic services, rule-out and referral steps in the identification processLRN cont.11identification process. Although these laboratories may not be equipped to perform the same tests as LRN reference laboratories, they can test samples to determine whether those samples should be shipped toreference or national laboratories for further testing.125NPHL Capability-Biosecurity andSpecial Pathogens Special Pathogens Laboratoriesest. 1999NPHL Specialized Sections:Laboratory preparedness for14 Biological  Chemical  RadiologicalNPHL Specialized Sections• Special Pathogens & Biosecurity Labs• Emerging infectious diseases• Monkey pox• SARS-Coronavirus• Avian Influenza A H5N1Filltl ibbit f15•Francisellatularensis-rabbit fever• Mumps• Reference and specialized testing • Salmonella spp. serotyping• Histoplasma capsulatum• E. coli O157:H7• Influenza Virus-isolate typing (H3 & H1)• West Nile Virus616NPHL Biosecurity Laboratory17CDC Category “A” Testing CapabilityAgent DiseaseBacillus anthracis AnthraxFrancisella tularensisRabbit fever18Francisella tularensisRabbit fever Yersinia pestis Plague C. botulinum toxin BotulismVariola Major Smallpox* * NPHL is 1 of 26 CDC approved labs in USA7CDC Category “B” Testing CapabilityAgent DiseaseBrucella spp. BrucellosisBurkholderia mallei GlandersBurkholderia pseudomallei MelioidosisCoxiella burnetii Q FeverRicinToxic Syndromes19RicinToxic Syndromes WEE EncephalitisEEE and VEE* EncephalitisClostridium perfringens* IntoxicationChlamydia psittaci PsittacosisStaph Enterotoxin B Toxic SyndromesSalmonella spp. Salmonellosis E. coli O157:H7 Hemolytic Uremic Syn.* Pending technology transfer from CDCAgents of BioterrorismBacillus anthracisYersinia pestisBrucella spp.Francisella tularensis2001: Anthrax82002-2003SmallpoxSpring 2003:Tested specimens for SARS-associatedCoronavirus9“Monkeypox sickens 20 people in USA”“Exotic virus thought to haveJune 9,2003; USA Todaythought to have been spread by pet prairie dogs… exposed to a sick Gambian rat”“infected prairie dogs sold to people in 15 states”-including NEBird Flu- Could it happen here?1002/13/2004 State Epidemiologists notified of a suspected case  Travel history to Thailand; person visited bird show Returned to Nebraska, became ill several days laterAvian Influenza H5ae NPHL received specimen- performed following tests which were all negative: Rapid Flu A & B tests (Neg) PCR tests for Flu A,B (generic) & H5 (specific) Rapid shell vial assay (BSL-3 lab) Traditional cell culture (BSL-3 lab) NPHL Specialized Sections:Laboratory preparedness for29for Biological  Chemical  RadiologicalJuly 20033011LRN Chemical Testing Capability:Level 3Level 2Level 1Level 362 labsLevel 248 labsLevel 110 labsCDC1 lab•Level 1+2+3 Activities •Mustards•Nerve Agents•Level 2+3 Activities•Cyanide•Toxic Metals•Competency inCollection &Shipment ofClinical Samples•Comprehensive Response PlanLRN Chemical Lab Preparedness:1999Level 1 Labs (5)No Capacity (45)32LRN Chemical Lab Preparedness: 20053312Lab Preparedness Supplies Stockpiles CDC 5000 Patients NPHL  300 Patients MOU with local supplier 1000 P ti t3 mL or larger Lavender (EDTA)Sterile Urine ContainersMultiple Sample Needles Collection Tube HoldersLatex Free Tourniquets3 mL or larger Green (Sodium or Lithium Heparin) or Gray Tubes (Sodium Fluoride/Potassium Oxalate)341000 Patients  NLN Level-B laboratories (13) 100 Patients Scottsbluff, North Platte, Kearney, Grand Island, Lincoln, Norfolk Other Hospitals 100 PatientsLatex Free TourniquetsAlcohol Prep PadsCotton BallsAdhesive BandagesSpecimen Bags (Ziploc)3 Gallon Sharps Container1 Gallon BleachWaterless Hand CleanerLatex Free Exam GlovesNPHL Specialized Sections:Laboratory preparedness for35 Biological  Chemical  Radiological36133738NPHL Specialized Sections• Special Pathogens &