Nancy Maddox 2016-03-21 11:47:43
Ancient Scourges, Modern Solutions While APHL exerted much energy and resources to help contain the Ebola virus in 2015, it did not forget a trio of age-old microbes that continue to pose a threat: influenza, tuberculosis and syphilis. Madison, Wisconsin 43.0667° N, 89.4000° W Infuenza outbreaks have plagued humankind throughout history, sporadically reaching pandemic levels. Between April 12, 2009 and April 10, 2010, for example, H1N1 influenza sickened over 60 million people in the United States, killing an estimated 12,469. While APHL has long supported influenza surveillance throughout the world, a major effort last year centered on Madison, Wisconsin, home of the Wisconsin State Laboratory of Hygiene (WSLH). The project brings contemporary science — in the form of whole genome sequencing (WGS) — to bear on the ancient scourge. WSLH scientists demonstrated proof-of-concept for the molecular technology and began performing WGS on influenza specimens from a third of the country, providing an amazing new level of detail about circulating flu viruses. This information will help experts predict the pathogenicity, ease of transmission and drug resistance of various strains. It will also inform the make-up of the annual influenza vaccine. The WSLH is one of three APHL-supported influenza reference centers. The other two — the state public health laboratories in New York and California — are expected to begin routine WGS for national influenza surveillance in 2016. A second prominent activity in 2015 was a series of four “right-size” influenza workshops — two in Atlanta, GA, and one each at state public health laboratories in Providence, RI, and Taylorsville, UT. These workshops aim to help laboratory scientists optimize their flu surveillance by calculating the number of specimens needed to ensure adequate confidence in surveillance data, as well as detection of novel viral strains. Richmond, California 37.9358° N, 122.3478° W In 1500 BC, tuberculosis was mentioned in the Rig Veda, a collection of Vedic Sanskrit hymns. Referred to as yaksma, in that ancient text, it has since been known as phthisis (Greek origin), scrofula (Latin origin), Pott’s disease (British origin) and consumption. Recent additions to the lexicon include MDR- and XDR-TB, a reflection of the microbe’s growing immunity to the modern pharmacopeia. Yet even though tuberculosis is becoming more drug resistant, in some states test volume is too low to enable public health laboratory scientists to maintain proficiency in TB drug susceptibility testing (DST). Enter the California Department of Public Health Laboratory in Richmond. With APHL support, the laboratory — chosen through a competitive process — has established a TB DST reference center that accepts specimens from 15 states with fewer than 50 cases/year. Also in 2015, the association conducted molecular TB diagnostic trainings at the Texas Department of State Health Services Laboratory in Austin and the Washington Public Health Laboratories in Shoreline. Raleigh, North Carolina 35.7806° N, 78.6389° W Some researchers contend that Christopher Columbus carried the syphilis bacterium, Treponema pallidum, to Europe from the Americas. Others contend that syphilis — the so-called “social disease” — has been in both hemispheres since prehistory. In any case, the bug has caused outbreaks virtually non-stop throughout the modern era — CDC recorded about 20,000 US cases in 2014. Rapid, point-of-care tests promise to help alleviate the burden of syphilis by expanding diagnostic access, especially for hard-to-reach populations. In 2015, APHL supported an evaluation of point-of-care syphilis diagnostics at the North Carolina State Laboratory of Public Health in Raleigh. The study compared the performance of point-of-care assays with the performance of laboratory assays, and also compared the performance of point-of-care assays in the field versus in the laboratory. Scientists found that the point-of-care tests generally perform well, but perform even better when done by trained laboratorians. A publication detailing the study results will be published soon. “Rapid advances in sequencing and bioinformatics are revolutionizing microbiology. CDC is excited to be partnering with APHL and public health laboratories across the country to apply these technologies to benefit the health of all Americans.” Gregory L. Armstrong, MD, director, CDC Office of Advanced Molecular Detection
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