Improving Capacity for Public Health Laboratories in California - - PowerPoint PPT Presentation

Improving Capacity for Public Health Laboratories in California

CHEAC Annual Meeting October 9, 2019

Continuous quality improvement Applied research from

• bservations during

routine testing Laboratory competency and training Provide lab testing when no other resources available Enforce NGHA regulations Participate in strategic planning Disease surveillance Lab tours and

• utreach events

Investigate infectious food- water- and vector-borne diseases MOUs, networks and collaborations with other labs

Laboratories

The California Public Health Laboratory Response Network and its role in Public Health Infrastructure

Katya Ledin, PhD MPH, HCLD(ABB) California Department of Public Health Infectious Diseases Laboratory Branch

Research Public Health Labs Clinical Regulation

Response

Public HealthLaboratories

• Focused on health of population (notindividual clinical

treatment)

• Test human, animal and environmental samples
• T

est for reportable diseases, emergingdiseases and outbreaks

• Often have tests not available in commercial laboratories; can

develop new tests asneeded

• Required to follow clinical and environmental testing

regulations, employ licensedpersonnel, and pass regulatory inspections

Laboratory ResponseNetwork

• National laboratory network to detect

biological, chemical and radiological threats and emerging pathogens

https://emergency.cdc.gov/lrn/

• Categories of laboratories: Sentinel,

Reference, Advanced and National

• California Public Health Laboratories

participate at Sentinel, Reference and Advanced levels

Laboratory Response Network

Laboratory Response Network

CDPH

1 1 2 2 2 2 2 2 2 2 2 3 3 3 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 7 7 7 7 7 8 8 8 10 9 9 9 10 10 11 11 11 12 13 12 14 14

California’s Laboratory Response Network

14 Catchment Areas organized around Public Health Reference Laboratories

California’s Laboratory Response Network

• Tier 1 Advanced State Public Health Lab – CDPH
• Advanced Local Public Health Lab – LA
• Reference Local Public Health Labs – 12
• Sentinel Local Public Health Labs – 16

EMERGING Diseases

Candida auris CRE/MDROs

H5N1

Novel Influenza A Viruses

Zika Virus

RE‐EMERGING Diseases

Mumps Shiga toxin producing

• E. coli (STEC) O157

Acute Flaccid Myelitis

Diseases – continuing threats

Tuberculosis (TB)

Multi‐Drug Resistant (MDR) TB Extremely Drug Resistant (XDR) TB

BIOSAFETY LEVELS

• Biological organisms (viruses, bacteria,

fungi, parasites) can cause disease

• Biosafety level assigned according to:
• Contagiousness
• Difficulty to cure

Safe Dangerous

2 3 4 1

Sentinel PHLs Reference PHLs

Biosafety levels: Pathogens

Pathogen Ability to spread Risk of death or disability Biosafety Level HIV Low Medium but treatable

2

Tuberculosis Medium High but treatable if diagnosed early

2+

Measles virus Very high High but preventable with vaccine

3

Avian influenza H5N1, SARS corona virus Medium High

3+

BIOSAFETY LEVELS

• Biological organisms (viruses, bacteria,

fungi, parasites) can cause disease

• Biosafety level assigned according to:
• Contagiousness
• Difficulty to cure

Safe Dangerous

2 3 4 1

Sentinel PHLs Reference PHLs

California Laboratory Response Network BSL‐2+

1. Alameda 2. Butte 3. Contra Costa 4. Imperial 5. Kern 6. Kings 7. Long Beach 8. Madera 9. Merced

• 10. Monterey
• 11. Napa‐Solano‐

Yolo‐Marin

• 12. Riverside
• 13. San Francisco
• 14. San Mateo
• 15. Santa Barbara
• 16. Ventura

BSL‐3+

1. CDPH* 2. (Fresno) 3. Humboldt 4. Los Angeles* 5. Orange 6. Sacramento 7. San Bernardino 8. San Diego 9. San Joaquin

• 10. San Luis Obispo
• 11. Santa Clara
• 12. Shasta
• 13. Sonoma
• 14. Tulare

* Advanced‐level laboratories

Biosafety levels: Protective equipment

2 3 4

+ wash hands + change clothes + full chemical disinfection

Biosafety levels: Facilities

2

Open bench Solid & liquid containment Complete air containment

3 4

Laboratory Response Network (LRN) protects Biosafety & Biosecurity

• Maintain specialized

facilities and lab tests

• Train personnel
• Practice with exercises

and proficiency tests

• Provide training and

guidance for hospital and clinical laboratories

California’s Laboratory Response Network

• Tier 1 Advanced State Public Health Lab – CDPH
• Advanced Reference Public Health Lab – LA
• Reference Local Public Health Labs – 12
• Sentinel Local Public Health Labs – 16

California’s PHL Networks

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National Foodborne Disease Surveillance

MeaslesNet & MumpsNet Respiratory (Influenza) PulseNet

FoodNet, NoroNet, RabiesNet, WNV/Zika and more

• Whole Genome Sequencing (WGS) and

Next Generation Sequencing (NGS)

• PulseNet, TB, Shigella, Influenza, Norovirus,

Measles, Hepatitis A

• T

echnical consultation for WGS wet lab applications and data analysis

New Technologies

Serratia outbreak – HAI Investigation Historical Legionella isolates

Google images

LRN Infrastructure: Best Practices

• Network for disease surveillance and outbreak detection
• Standardized methods & equipment through regularly updated lab

protocols and communications with Sentinel and Reference PHLs

• Functional redundancy
• Communication and collaborations among different jurisdictions
• Resource for guidance and training
• Relationships with local clinical labs
• Relationships with first responders
• Important for PHLs to be involved in preparedness exercises and

Homeland Security drills to maintain communication and contacts

Frequently asked questions

• How many BSL‐4 labs are there in California?
• None
• Only 14 Advanced BSL‐3 laboratories in the US
• Can we borrow a BSL‐3 lab in an emergency?
• Unless everything is exactly the same, would need days‐weeks to

start testing

• Clinical regulations (CLIA) require test validation, equipment

verification and personnel competency for any changes

Questions?