The Exceptional Public Health Laboratory: Turning Challenges into Opportunities

1. The Exceptional Public Health Laboratory: Turning Challenges into Opportunities Mike Loeffelholz Ph.D. D(ABMM)

2. Outline What is a PHL? Essential services Beyond essential: the exceptional PHL Challenges faced by PHLs Meeting challenges

3. What is a PHL?

4. What is a PHL? Mission Aligned with agency Based on population served “When you’ve seen one public health lab…you’ve seen one public health lab.” Services Analytical and diagnostic testing Education and training Scientific expertise/consultation

5. PHL Services

7. Core Functions of PHLs* Disease prevention, control, surveillance Integrated data management Reference and specialized testing Environmental health and protection Food safety Laboratory improvement and regulation Policy development Emergency response Research Training and education Partnerships and communication *APHL

8. Training and Education Iowa public health laboratory/Univ. Iowa Mentored 2 EID fellows Training of Clin. Microbiology fellow, residents COPH lectures Lab-based practicum for Dept. Epidemiology student Training documents CACLME (Clinical virology) ASCP (Bioterrorism preparedness, HCV) ASM (Sentinel laboratory guideline- Avian influenza)

9. What Makes an Exceptional PHL? People Well-trained Experienced Dedicated, motivated, empowered Service-oriented Leadership recognizes and acknowledges contributions of every employee Facilities Safe Secure Efficient Flexible

10. The Exceptional PHL Quality system Adequately trained and competent staff Complete and up-to-date operating procedures Properly functioning facility and equipment Test systems operating w/i specifications Specimens handled to maintain integrity Test reports are clear and informative

11. Visible partner in the public health organization The Exceptional PHL

12. A Visible Partner in Public Health: Two Extremes Iowa Quarterly IDPH/UHL meetings Conferences, symposia, grants Arkansas Lab solely a provider of analytical services Gradual inclusion at the “table” Laboratory must earn respect

13. The Exceptional PHL Customer service attitude Test result turn-around-time Prompt, courteous, informative response to questions

14. Challenges Health threats “Old” threats remain Foodborne diseases Inherited genetic diseases Influenza (seasonal) Chemical contaminants of water and soil New threats Emerging infectious diseases Pandemic influenza Biological and chemical terrorism

15. Challenges Changing technology New methodologies Molecular Ultra-sensitive detection of analytes Rapid, non-culture methods in private labs Genetic testing Biomonitoring As capabilities increase, to what extent does our obligation to detect & characterize?

16. Challenges Resource constraints Declining state appropriations Increased reliance on grants and contracts Workforce Shortages of laboratory scientists Regulations and certification

17. Vision: A PHL capable of responding to new threats and opportunities

18. Meeting the Challenges Know and engage your customers SHO Epidemiology Agency programs (human & environ health; emergency response) State & federal agencies Clinical/private laboratories Medical community Public Communicate the PHL mission and its achievements

19. Meeting the Challenges Many partners in public health Recognize contribution of private sector

20. Partnerships at Univ. Iowa Dept of Pathology Reference testing; education; training of visiting scientists College of Medicine Collaboration on grants

21. Additional Partnerships APHL Board of Directors Laboratory Systems and Standards Committee Co-Chair of 2005 Emerging Infectious Diseases conference CDC CDC/CSTE Influenza Surveillance Committee- Laboratory Workgroup CDC/APHL Pandemic Influenza Diagnostics Workshop Pertussis Prevention and Control panel Scientists and program directors CLSI (NCCLS) Guidelines on viral culture and molecular methods for infectious diseases Business Advisory panels Media Press releases/feature news stories

22. Partnership of Public and Private Laboratories National Laboratory System CDC/APHL collaboration Goals Formal relationships between private and public health labs Consistent laboratory capacity to protect nation’s health Pilot projects

23. Arkansas Lab Integration Project Establish laboratory advisory committee Develop educational products to increase awareness of PHL and its services Brochure Web site

24. Arkansas Lab Integration Project Measures of effectiveness Increased awareness of lab functions (survey tool) Increased enrollment in Arkansas Laboratory Response Network Increased number of reportable isolates submitted to PHL

25. Meeting the Challenges Sustainable funding Fees? Mission shift from core public health activities towards analytical service Grants and contracts Good management of, outcomes from existing $ Visibility (committees, conferences, literature) Scientific excellence Support innovation and research (non-academic setting)

26. Meeting the Challenges Organizational effectiveness Management accountability Monitoring and measuring performance Excellent, experienced, dedicated employees Think & act nationally/globally More threats are beyond state’s borders (SARS, pandemic flu, melamine in food, lead in toys)

27. Building Science and Capabilities of ADH PHL New laboratory building Established a diagnostic virology laboratory Hired Ph.D. scientists to boost scientific output and credibility Secured grant funding Food safety Public/Private lab integration Applied to host CDC/APHL EID fellow New LIS Molecular diagnostics Chemical terrorism preparedness

28. Research at Iowa Public Health Laboratory

29. PCR Detection of Bordetella pertussis One of first state PHLs to offer PCR for B. pertussis Trained scientists from several labs

30. B. holmesii and Pertussis

31. B. holmesii is Detected in IS481-Based Assays

32. Molecular Basis for Detection of B. holmesii

33. Detection of B. holmesii by IS481 PCR

34. IS481 in B. holmesii

35. How Significant is B. holmesii? <1% (by culture) of NP specimens from Massachusetts pts w/ pertussis (Yih et al. 1995. EID Emerg Infect Dis. 1999. 5:441-3) Not detected (by PCR) in Finnish and Dutch pts w/ pertussis (Antila, M et al. 2006. J Med Microbiol. 2006. 55:1043-51)

36. Vision: Innovative and quality laboratory science driving public health practice and policy

37. Keeping in Sight the Ultimate Goal…

38. People…the Patient AIDS patient in ICU with opportunistic infections Septic, critically ill infant with community acquired meningitis Child with E. coli HUS on life support Patient in intensive care with antibiotic-resistant bacterial infection

39. Vision: Healthy People