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

Laboratories Disease Enforce NGHA surveillance regulations Investigate infectious food- Provide lab testing when water- and no other resources vector-borne available diseases Lab tours and Laboratory outreach events competency and training MOUs, networks Continuous and quality collaborations improvement with other labs Applied research from observations during Participate in routine testing strategic planning

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 Response Regulation

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 • Categories of laboratories: Sentinel, Reference, Advanced and National • California Public Health Laboratories participate at Sentinel, Reference and Advanced levels https://emergency.cdc.gov/lrn/

Laboratory Response Network

Laboratory Response Network

Del 2 Norte 1 Siskiyou Modoc 2 California’s 1 2 2 SHASTA Lassen Trinity 2 HUMBOLDT Laboratory 2 2 Tehama Plumas 4 2 Mendocino 2 Glenn Sierra Butte 4 Nevada 3 4 Yuba 4 Lake Placer Colusa Sutter Response 3 4 4 El Dorado Yolo 4 4 SONOMA Napa Alpine SACRA 6 MENTO 3 Amador 5 5 4 6 6 Solano Calaveras 6 Marin Tuolumne 6 5 Contra 5 6 SAN Mono Network San Costa 5 JOAQUIN 6 Francisco 5 Mariposa San Alameda Stanislaus CDPH Mateo 6 SANTA 7 5 Merced Madera CLARA 7 Santa 8 8 7 10 Cruz 8 7 FRESNO San Inyo Benito 7 TULARE 9 Monterey 14 Catchment Areas organized 9 Kings 11 9 SAN 10 around Public Health LUIS Kern OBISPO SAN BERNARDINO Santa 11 Barbara 12 Reference Laboratories Ventura 11 LOS ANGELES 13 10 Riverside ORANGE Long 12 Beach SAN Imperial DIEGO 14 14

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 Novel Influenza A Viruses Zika Virus H5N1

RE‐EMERGING Diseases Shiga toxin producing E. coli (STEC) O157 Mumps 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 1 4 2 3 Sentinel PHLs Reference PHLs

Biosafety levels: Pathogens Pathogen Ability to spread Risk of death or Biosafety Level disability Medium but 2 HIV Low treatable High but treatable 2+ Tuberculosis Medium if diagnosed early High but 3 Measles virus Very high preventable with vaccine Avian influenza 3+ H5N1, SARS corona Medium High virus

BIOSAFETY LEVELS • Biological organisms (viruses, bacteria, fungi, parasites) can cause disease • Biosafety level assigned according to: • Contagiousness • Difficulty to cure Safe Dangerous 1 4 2 3 Sentinel PHLs Reference PHLs

California Laboratory Response Network BSL‐2+ BSL‐3+ 1. Alameda 10. Monterey 1. CDPH* 9. San Joaquin 2. Butte 11. Napa‐Solano‐ 2. (Fresno) 10. San Luis Obispo Yolo‐Marin 3. Contra Costa 3. Humboldt 11. Santa Clara 12. Riverside 4. Imperial 4. Los Angeles* 12. Shasta 13. San Francisco 5. Kern 5. Orange 13. Sonoma 14. San Mateo 6. Kings 6. Sacramento 14. Tulare 15. Santa Barbara 7. Long Beach 7. San Bernardino 16. Ventura 8. Madera 8. San Diego 9. Merced * Advanced‐level laboratories

Biosafety levels: Protective equipment 4 2 3 + wash hands + change clothes + full chemical disinfection

Biosafety levels: Facilities 3 Solid & liquid containment 2 4 Open bench Complete air containment

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 D e l N o rte S isk iyo u M o d o c S h a sta L a ss e n T rin ity H u m b o ld t T e h a m a P lu m a s B u tte M e n d o cin o G le n n S ie rra o C o lu s a P la ce r L a k e Y o lo E lD o ra d o S o n o m a A lp in e N a p a S o la n o M a rin S a n T u o lu m n e C o n tra J o a q u in M o n o C o sta S a nF ra n c isc o A la m e d a M a rip o s a S ta n is la u s S a nM a te o S a n ta M e rc e d C la ra S a n taC ru z F re s n o In y o T u la re M o n te re y K in g s S a nL u is O b is p o K e rn S a nB e rn a rd in o S a n taB a rb a ra L o sA n g e le s V e n tu ra O ra n g e R iv e rsid e National Foodborne Disease Surveillance Im p e ria l S a nD ie g o MeaslesNet & MumpsNet Respiratory (Influenza) PulseNet FoodNet, NoroNet, RabiesNet, WNV/Zika and more

New Technologies • Whole Genome Sequencing (WGS) and Next Generation Sequencing (NGS) • PulseNet, TB, Shigella, Influenza, Norovirus, Measles, Hepatitis A • T echnical consultation for WGS wet lab Serratia outbreak – HAI Investigation applications and data analysis Google images Historical Legionella isolates

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?