Laboratory Response to the 2009 H1N1 Event

Texas Department of State Health Services

Laboratory Services Section

Grace Kubin, Ph.D.

Vanessa Telles, MPH

Emergency Preparedness Branch

Outline

Anatomy of a response – Surge! How big and how bad Surveillance mode – What does that

mean? Specimen collection, packaging and

shipment

Laboratory Response Network (LRN) Flu Pilot = Statewide Surge

LRN laboratories around Texas participated in flu pilot project for 2008-2009 season

Split specimens – LRN performed PCR testing for seasonal influenza and remaining specimen sent to DSHS Austin laboratory for culture

Laboratory Response Network (LRN) Flu Pilot = Statewide Surge

Regular Flu Season

Approximately 22 specimens tested per day

2 technical staff performing PCR Between 1000 to 1500 specimens

received the entire season (between the months of October through May)

H1N1 Response:Calling all specimens

Received between 1000 to 1500 specimens per day early in the event

Ramping Up in 9 days:

Staffing: Increased from 2 to 25 trained laboratory

staff Contracted 15 temporary laboratory

employees 66 non-technical laboratory staff to

support the response

Ramping Up:Equipment

Equipment 4 ABI 7500 FAST instruments

1 upgraded instrument in virology area 1 instrument in Biothreat area 2 on loan from manufacturer

1 Luminex instrument on loan

Ramping Up:Specimen Throughput

One ABI instrument: 2 trained staff 22 specimens per day (regular 8 hour

day) 4 ABI instruments:

20 trained staff 252 specimens per shift

One “shift” 14.5 hours

Ramping Up:Specimen Throughput

One Luminex instrument: 6 trained staff 90-360 specimens per shift

One “shift” 10-14 hours

Samples Received during H1N1

DSHS Austin Total: 13,500 specimens (running tally through

July 8th)

Texas Total: Over 38,000 specimens (running tally

through July 8th)

H1N1 Flu Surveillance (Resulted)

0

20

40

60

80

100

120

Date Collected

Per

cen

t

H1N1 Pos H1N1 Neg Seasonal Flu Linear (H1N1 Pos )

Overall H1N1Results

For all specimens tested at DSHS: Percent Positive for H1N1: 21.1%

Percent Negative for Flu A: 74.9%

The Purpose of H1N1 Surveillance

to detect the distribution and spread of the virus

to detect new variants of the virus and to assist in outbreak

investigations

Surveillance Specimen Criteria Draft only – not yet approved

Patients hospitalized for 48 hours or greater and the following symptoms: Fever > 37.8ºC (100ºF) and cough and/or sore throat

plus one or both of the following conditions: severe illness with lower respiratory tract infections

or pneumonia OR certain atypical presentation in children, adults >

64 years of age, and immunocompromised individuals

Patients who have died with influenza-like illness and have no other known cause of death (ante mortem specimens only)

Pregnant patients with influenza-like illness

Surveillance Specimen Criteria Draft only – not yet approved

Individuals with influenza-like illness who are part of a critical public health investigation as identified by the DSHS Health Service Region (HSR), DSHS Infectious Disease Control Unit (IDCU) or local health department and communicated by the HSR or IDCU to the state laboratory.

Providers who are participants in the DSHS viral

culture/PCR surveillance system as designated by the DSHS Infectious Disease Control Unit (IDCU); only enrolled providers will be allowed to submit specimens.

Surveillance Specimen Criteria Draft only – not yet approved

Specimens not meeting one of these criteria should be submitted to a reference laboratory.

Reference laboratories performing H1N1 testing: Quest Diagnostics Texas Children’s Hospital (Houston) List of laboratories will be posted to the

DSHS website

Proper Specimen Collection: Swabs

Swabs accepted for testing: Sterile, polyester fiber tipped swabs with

a plastic shaft Either Dacron or Rayon swabs

Swabs not accepted for testing: No cotton tipped or wooden shaft swabs No swabs that contain calcium alginate Genprobe testing swabs are

unacceptable

Acceptable Specimens

Nasopharyngeal swabs Nasopharyngeal aspirates Nasal swabs Throat swabs Dual nasopharyngeal / throat swabs

Proper Specimen Collection:Media

Do not use expired media Be sure to check expiration date

Store properly according to package insert

Place swabbed specimens in media

Specimen Handling

Transport specimens to the laboratory as soon as possible

Preferably ship the same day of collection

If collected on a Friday, a holiday, or the weekend, store at -70°C and ship on Monday or the following business day

Shipping

If specimens will be shipped the same day of collection Store specimens at 4°C Ship using cold packs

If specimens will be stored for > 2 days after the date of collection Store specimens at -70°C Ship on dry ice

Overview:Why will my sample be rejected?

Use the wrong swab for collection Use expired media Stored at wrong temperature Specimen received at ambient

temperature Sample spilled; broken collection tube Incomplete information on submission

form or tube

Questions?

Grace KubinGrace.Kubin@DSHS.state.tx.us