Laboratory Emergency Management Survey

1. Laboratory Emergency Management Survey Canadian Animal Health Laboratorians Network Calgary, AB June 8th, 2010 Maria Spinato, DVM DVSc MBA Vahab Farzan, DVM VMIS PhD

2. Roadmap: Background of lab emergency management Objectives of emergency preparedness survey Survey design and participants Selected results: Successful preparations for laboratory emergencies Challenges and opportunities for enhanced preparedness

3. Canadian Animal Health Surveillance Network CAHSN established ~ 2006 network of federal, provincial and university animal health diagnostic labs linked to Canadian Public Health Lab Network key outputs of CAHSN: surveillance and early warning system for animal disease threats rapid diagnosis in regional lab, confirmed by central reference lab surge capacity to provide a rapid response and post-outbreak recovery surveillance testing http://www.inspection.gc.ca/english/anima/surv/cahsnrcsze.shtml

4. Canadian Animal Health Surveillance Network • Network interoperability based upon: • standardized protocols, equipment and reagents • training and certification of technical analysts (PCR, ELISA) • implementation of Quality Assurance (QA) program • upgrading of biocontainment facilities: CL2+ (FAD) http://www.inspection.gc.ca/english/anima/surv/cahsnrcsze.shtml

5. US National Animal Health Laboratory Network NAHLN formed in 2002 by APHIS/CSREES/AAVLD to provide lab support of routine and emergency animal disease diagnosis: • enhance lab emergency preparedness • respond to FAD and toxicological emergencies, bioterrorism events • protect human health by decreasing risk of zoonotic diseases • network of 62 labs (2010) • http://www.www.aphis.usda.gov/animal_health/nahln

6. Laboratory Emergency Management Survey • Survey objectives: • investigate and provide a benchmark of the current emergency preparedness status of CAHSN university and provincial labs • generate a checklist that can be used to assist in developing a lab emergency response plan

7. Laboratory Emergency Management Survey • Survey questions based upon guidelines developed by the Emergency Preparedness Workgroup of the American Association of Veterinary Laboratory Diagnosticians (AAVLD, 2003) • 52 questions, LimeSurvey electronic format • Invited participants were the 10 provincial/university labs most likely to be responding to FAD outbreak (CAHSN)

8. Edmonton St. John’s CAHSN legend: ■ Partner Laboratories CFIA Laboratories Abbotsford Saskatoon Charlottetown Winnipeg Truro St-Hyacinthe Fredericton Guelph Plum Island, NY Ames, IA Mexico City CAHSN Laboratories

9. Which agencies fund or partially fund the diagnostic laboratory?

10. Does the laboratory retain fee revenue? Operational reliance upon fee-for-service revenue has implications for business continuity and long-term financial viability post-emergency

11. Does the lab have a QA Officer? Lab accreditation or certification 5 labs ISO/IEC 17025 2 labs AAVLD 5 labs other: - CFIA - working towards 17025 Quality Assurance and Accreditation

12. Quality Assurance: Standard Operating Procedures Does the lab have SOPs for:

13. Does the lab have a Biosafety Officer? Containment testing facilities: Level 2 – 10 labs Level 2+ (FAD) – 7 labs Level 3 – 2 labs Containment Facilities and Biosafety

14. How does the lab dispose of large carcasses that are level 3 or FAD pathogen suspects?

15. Is the LIMS linked or accessible to other data management systems? LIMS able to sort outbreak sample subset? Yes – 6 labs No – 4 labs Laboratory Information Management System

16. Method of tracking samples between lab sections? Method of tracking samples referred out to another lab? Laboratory Information Management System

17. Does the lab have an emergency response plan?

18. Does your province have a current Foreign Animal Disease Emergency Support (FADES) plan? Does the FADES plan clearly define the roles and responsibilities of the lab and lab staff? Emergency Response Plans

19. Who has access to specimen reception and administrative offices? Who has access to testing laboratories? (Maintenance and custodial staff: supervised? biosafety training?) Laboratory Access

20. Emergency Contact Information?

21. Human Resources – Surge Capacity How would the lab manage surge testing demand during an outbreak?

22. Human Resources – Business Continuity How would the lab manage business continuity (routine testing) during an outbreak?

23. Unionized staff categories? Directors/Managers – 30% Supervisors/Sections Heads – 60% Technical – 100% Administrative – 90% Pre-existing labour agreements to permit overtime, reassignment or hiring of contractors during an emergency? No – 60% Yes – 40% Human Resources

24. Dr. Grant Maxie California 2002-2003 Exotic NewcastleDisease Outbreak – Surge Testing Demand

25. Have standing purchase orders been negotiated with major suppliers to permit rapid delivery of essential consumables and reagents? Yes – 3 labs No – 7 labs Has the lab identified funding sources to pay for staff and consumables during an emergency? Yes – 4 labs No – 6 labs Surge Testing Demands

26. Participation in FAD Test Exercises

27. Has the lab been involved in a real FAD or suspected FAD incident? Yes – 6 labs No – 4 labs Was a post-incident “lessons learned” session conducted? Yes – 3 labs No – 3 labs (N/A – 4 labs) FAD Incidents and Lessons Learned Sessions

28. Lessons Learned - Critical Issues Lab #1: communication, data handling Lab #2: • on-going communication needed between CFIA and province during outbreak: inclusion in Emergency Operation Centre (EOC) • standardized submission forms and reporting formats for all FAD tests • increase # proficiency panels run by analysts • pre-outbreak training for CFIA and lab staff re: sample collection, labelling and packaging Lab #3: enhanced communications between federal and provincial authorities

29. What does your lab need to effectively manage an emergency such as a FAD outbreak? • level 2+ lab facilities – 3 labs • additional SOPs and ISO/IEC 17025 accreditation – 3 labs • additional trained technical staff – 3 labs • better LIMS and/or sample handling (bar coding) – 3 labs • more FAD simulations, testing of emergency response plan – 2 labs • increased capacity for disposal of infected material – 1 lab • lab would not manage the emergency situation; will provide technical, specialized support as needed – 1 lab

30. Survey Summary:Successful Preparations for FAD Emergency • CAHSN has accelerated the training, certification and equipping of partner labs to meet the demand for surge testing • ≥70% of labs have: • Lab Emergency Response Plan • Biosafety Officer, containment level 2+ (FAD) • QA Officer, SOPs (sample tracking, decon/disinfection) • Technical analysts certified for PCR and ELISA FAD tests

31. Survey Summary: Challenges and Opportunities for Enhanced Preparedness • Communications: interagency liaisons • Improved data management • Enhanced biosecurity (lab access, carcass disposal) • Human resources management (labour relations, staffing needs, overtime) • Financial planning – who pays the bills? • Suppliers • Business continuity planning – managing routine diagnostic cases during the outbreak • Advanced training needs: ICS, FAD lab exercises

32. Emergency Preparedness – FAD Response

33. Business Continuity Lab Emergency Preparedness – All Hazards

34. How Basic Preparedness Prevented the Spread of SARS in Vancouverin 2003 “Coordinated Response to SARS, Vancouver, Canada” Skowronski, D. et al, Emerging Infectious Diseases, Vol. 12 (1), January 2006, 155-158

35. Skowronski, D.M. Emerging Infectious Diseases Vancouver Toronto - Decentralized local health boards, no central public health agency - Patient 0 (son of Hong Kong traveller): remained under general observation in emergency room for 18 hr. - Placed in isolation after 21 hr - Barrier precautions (droplet and contact) instituted 3 days after arrival TO: 247 SARS cases, 43 deaths, $1 B - Central public health coordination: BC Centre for Disease Control (BCCDC) - Periodic monitoring and electronic public health communication: Feb 2003 alert re atypical pneumonia China + H5N1 cases in Hong Kong - Hospital A emergency room: recent infection control audit emphasizing barrier precautions with all acute respiratory infections (preparedness) - Patient 0 from Hong Kong: admitted into negative-pressure isolation room with full respiratory precautions within 2 hr of arrival at hospital A - Vancouver: 5 SARS cases, 0 deaths

36. Skowronski, D.M et al, Emerging Infectious Diseases, Jan 2006 “Chance favors only the prepared mind” Louis Pasteur, 1865

37. Thanks: Dr. Laura Rogers Newfoundland and Labrador Dr. Darcy Shaw Prince Edward Island Dr. Grant Spearman Nova Scotia Dr. Jim Goltz New Brunswick Dr. Lise Robert Quebec Dr. Grant Maxie Ontario Dr. Mark Swendrowski Manitoba Ms. Marilyn Jonas Saskatchewan Dr. Ole Sorensen Alberta Dr. Paul Kitching British Columbia Ms. Joanne Sigfusson, Deputy Director, CAHSN Dr. Grant Maxie, Director AHL, University of Guelph Funded by University of Guelph/OMAFRA Emergency Management Research Program

38. References: Laboratory Exercises, Kris Clothier and Pat Blanchard, 2008 NAHLN Emergency Response Symposium, Greensboro, NC, USA Suggested Laboratory Guidelines for Animal Health Emergency Management, AAVLD Emergency Preparedness Workgroup, November 2004, Developing Laboratory Response Plans, Ron Wilson, NAHLN/AAVLD Laboratory Emergency Management Subcommittee Joint Symposium, October 2006, Minneapolis, MN.