Edward Telles, Princeton University Eastern Sociological Society February 28, 2015.
Laboratory Response to the 2009 H1N1 Event Texas Department of State Health Services Laboratory...
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Transcript of Laboratory Response to the 2009 H1N1 Event Texas Department of State Health Services Laboratory...
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 [email protected]