Nancy Maddox 2016-03-21 11:43:25
Stopping the Next Deadly Epidemic Freetown, Sierra Leone 8.4844° N, 13.2344° W “We have prevailed over an evil virus. We persevered and we have overcome,” said Sierra Leone President Ernest Bai Koroma last fall, as hundreds of people reveled in the streets of Freetown, the capital city of this long-struggling West African nation. As reported by the Associated Press, the November 7 festivities marked the official end of the deadly Ebola epidemic here, following two consecutive 21-day Ebola incubation periods with no new cases. This achievement certainly merits celebration — the result of months of effort by individuals and organizations committed to saving lives and instilling hope. APHL was pleased to be able to contribute to the multinational response, making use of its extensive expertise in laboratory practice. As in past emergencies, APHL filled a critical role building reliable testing resources, so patients could be accurately diagnosed and disease surveillance begun. The association’s Freetown-based consultant, Dr. Isatta Wurie, PhD, helped to draft the Ebola Response Laboratory Operational Manual; surveyed the laboratories operating in Sierra Leone to gauge their capabilities, testing capacity and needs; helped launch an Ebola proficiency testing program; and worked with local officials to ensure uninterrupted utility service for the response laboratories. With CDC funding, APHL also began a long-term project to renovate the Sierra Leone Central Public Health Reference Laboratory, which was shuttered in late 2014 due to insufficient biosafety protections for laboratorians and later suffered a collapsed roof. Hanoi, Vietnam 21.0285° N, 105.8542° E New Delhi, India 28.6139° N, 77.2090° E Ironically, the Ebola response ramped up at the same time as the Global Health Security Agenda (GHSA) — a major, international effort to “accelerate progress toward a world safe and secure from infectious disease threats” like Ebola. Given the need for laboratory testing to detect and monitor biosecurity threats, CDC tapped APHL to support key GHSA “acceleration” projects in priority countries in Asia and Africa, from India to Uganda. Last fall, APHL began a series of site visits in these countries to finalize specific project plans. Overall, projects will include activities such as: Documenting the capabilities, testing capacities and relationships among domestic clinical laboratories. What can they test for? How is the national laboratory network configured? How does the national laboratory network interface with international sites? Each in-country assessment will conclude with a list of recommendations from APHL enabling national health ministries to target laboratory spending toward critical needs. Reviewing national laboratory strategic plans and policy documents to ensure a robust link between clinical laboratories and public health epidemiology programs. Absent such a link, laboratory data is under-utilized and disease surveillance suffers. Partnering with local experts, or developing in-country expertise, to certify the efficacy of laboratory biosafety cabinets, a requirement for worker safety. APHL is leveraging the US Laboratory Response Network — founded by CDC, APHL and the Federal Bureau of Investigation — as a model for national laboratory systems in other countries. In 2015, the association shared the model with the African Society for Laboratory Medicine and Vietnam’s Ministry of Health. The association’s GHSA partnerships extend to the US Department of State — which sent GHSA Ambassador Bonnie Jenkins to speak at APHL’s 2015 annual meeting — and to the African Society for Laboratory Medicine (ASLM) — a pan-African, professional association modeled on APHL and based in Addis Ababa, Ethiopia. ASLM worked closely with APHL on its Ebola response in Sierra Leone and will continue to work with the association as it carries out acceleration projects in Africa. Washington, DC 38.9047° N, 77.0164° W In an interconnected world, it is impossible to separate domestic and global biosecurity; dangerous pathogens move about as easily as tainted food or infected travelers or mosquitos. Thus, while strengthening laboratory systems abroad, APHL has also been attending to state and local laboratories in the US to assure laboratory biosafety and public biosecurity. While the Ebola crisis was escalating and outcomes uncertain, APHL provided crucial input to national health officials regarding laboratory needs — especially laboratorians’ request for enhanced biosafety training. CDC subsequently asked the US Congress for supplemental preparedness funding for this and other priorities. Ultimately, federal legislators in Washington, DC, appropriated an Ebola response package of over $5 billion, including $250 million in new public health spending. A total of $105 million went, through the CDC Epidemiology and Laboratory Capacity program, to the 50 state health departments and to health agencies in the six largest US cities and eight US territories or freely associated states (FAS). At the same time, via the Hospital Preparedness Program and Public Health Emergency Preparedness cooperative agreements, CDC awarded $145 million, divided among health departments in the 50 states, four major US metro areas and eight US territories and FAS. The funding comes with the stipulation that “public health agencies must ensure their jurisdictions have the ability to quickly, safely and accurately perform laboratory testing on suspected Ebola virus specimens, as well as manage any surges of specimen testing and analysis.” APHL received a $2.2 million CDC cooperative agreement to provide biosafety/biosecurity expertise and training to the newly funded state and local government laboratories and to develop guidance and tools to assist those laboratories with outreach and biosafety training for the sentinel clinical labs in their jurisdictions. APHL’s newly established Biosafety and Biosecurity Committee — chaired by Michael Pentella, PhD, director of the William A. Hinton State Laboratory Institute — is overseeing this work as well as related policy matters. Already, APHL’s membership has approved a position statement on the need for rigorous biosafety practices, which the committee will be implementing. A big concern, for example, is the safe packaging and shipping of suspect specimens going from clinical laboratories to reference laboratories for confirmatory testing. Among many ongoing activities are development of virtual communities of practice to facilitate information sharing among laboratory biosafety officers and development of an online repository of risk assessment templates and training courses. “Ebola detection hinges on quality laboratory systems, and that is what the Sierra Leone Health Ministry is working to establish with APHL support.” Isatta Wurie, PhD, senior public health laboratory consultant, APHL “I have had a chance to learn about APHL’s expertise in laboratory systems, and I welcome its engagement with the GHSA Nongovernmental Sector Consortium, which is doing such good work to promote global health security.” Ambassador Bonnie Jenkins, US Department of State
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