The Laboratorian - Volume 3, Issue 2

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The Laboratorian - Volume 3, Issue 2
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October 2011 - Volume 3, Issue 2

Article Index

- Rabies Laboratory
- Influenza Surveillance
- Safe Drinking Water
- Remote Data Systems
- Handwashing

Editorial

grace

Who is the new Laboratory Director?

Several staff members have come up to say that no one knows who I am. In response, here is some background. I came to Austin in 1985 to attend The University of Texas at Austin. (You just thought you got rid of a Longhorn as Laboratory Director when Dr. Neill left, but you are stuck with another one. Hook ‘em!) After receiving my bachelor’s degree, I worked at a local biotech company until I made my way back to UT to work in an academic lab. Funding was cut, so I decided to go to graduate school at (where else?) UT.

After graduation, it was time to get a real job and there was an opening at our laboratory in the Molecular Biology area. In the spring of 2004, I became part of the DSHS Laboratory family. My job was to perform pulsed-field gel electrophoresis and upload the analyzed data into PulseNet—a nationwide database used to compare DNA patterns for a variety of bacteria that cause food borne illnesses. At the time, my sphere of co-workers was isolated to the fourth floor.

In 2005, my sphere expanded when I joined the Emergency Preparedness Branch as a Program Supervisor for the Texas Laboratory Response Network (LRN). If you are not familiar with the LRN, they provide emergency response for public health threats such as testing white powders for anthrax and human specimens for toxic substances like cyanide. In 2007, Marianne Garcia retired as the Emergency Preparedness Branch Manager and I was chosen to be her replacement. In this position, I was fortunate to be involved in many different projects that allowed me to interact with many folks from all over the laboratory:  Specimen Acquisition, Microbiological Sciences, Environmental Sciences, Biochemistry and Genetics, and Lab Reporting.

When Eldridge “Hutch” Hutcheson retired as the Laboratory Operations Unit Manager last year, I was again fortunate to be chosen as his replacement. A short time later we learned that we would also be losing Dr. Susan U. Neill. I again found myself moving to a new office; this time it was the Laboratory Director’s office.

Now you know how I got here. I look forward to learning more about all of you, particularly those who I have not yet had the privilege of working with.

by Grace Kubin, PhD

The Rabies Laboratory: Never a Dull Day

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With 8,000-10,000 specimens received per year, work in the DSHS Rabies Laboratory is never dull. However, some days are more interesting than others. Laboratorians will always remember receiving a tiger head for testing. Most specimens submitted are dogs and cats. In order of decreasing appearance in the Laboratory, bats come next, followed by skunks and just about everything else, including cows, horses, squirrels, armadillos, and raccoons. All mammals are accepted for testing, but everyone takes notice when the specimen is a zebra, gazelle, wildebeest, or nilgai. Most specimens are submitted by animal control officers and police departments, but anyone can request rabies testing, as long as specimen submission guidelines are followed.

 

The Rabies Lab primarily uses Fluorescent Antibody testing. In this process, the team makes touch impression slides of brain tissue, stains the slides with Anti-Rabies antibody that has a fluorescent tag, and views the result under a microscope. If there is rabies virus present, it fluoresces. All positive specimens are typed for
epidemiological purposes using a panel of monoclonal antibodies—10 for terrestrial strains and 19 for bat strains. The major terrestrial rabies strain is the South Central Skunk. (The Texas Fox and Domestic Dog/Coyote rabies strains were eradicated in Texas using typing information.) Bat rabies strains are as varied as the types of bats. Any typing problems and confirmation are handled through a variety of testing methods, as appropriate: PCR/Sequencing, cell culture, and mouse inoculation. Results are reported quickly, often within the same day but no longer than 30 hours, unless there is a weekend involved.

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Roughly 10 percent of all animals test positive for the rabies virus, but the number varies by species: about 50 percent of skunks test positive and about 15 percent of bats test positive. Terrestrial animals are most likely to test positive for rabies in spring and early summer; however, bats are more likely to test positive in late August though October. This year, approximately 200 more positive specimens have been received when compared with the previous two years, making 2011 an extremely busy year for the Rabies team.

Positive rabies results are also reported to Zoonosis Control personnel who play an important role in preventing outbreaks. For example, one puppy in a litter tested positive for rabies. A littermate had already been given to an unknown man in the parking lot of a convenience store. Zoonosis stepped in to track down the man; his new puppy tested negative for rabies. In response to many positive bats found at schools, Zoonosis staff created an annual K-8 school poster contest. The children are given information about avoiding contact with wild animals, especially bats, and are encouraged to create a poster about rabies. Prizes are given for the best posters. (Despite the high incidence of rabies in bats, they are beneficial animals.)

Rabies is a preventable viral disease of mammals. It can be transmitted through the bite of a rabid animal or via exposure to the saliva of an infected animal, which can get inside a person’s body through open cuts, scratches, or wounds or through the mucous membranes in the mouth, eyes, or nose. For further information about rabies, please refer to the CDC Rabies web site. Detailed statistics can be found on the Rabies Surveillance in Texas web site. More information about rabies testing is available via the DSHS Rabies Laboratory web site.

by Jimi Ripley-Black

 

Influenza Incidence Surveillance Project: Preventing the Next Pandemic

currentFlu

The deadly 1918 “Spanish” flu circulated silently in the United States for four months before anyone noticed it. As frightening as that sounds, given what we now know about the strain of influenza that killed up to 50 million people worldwide, improved surveillance now means that we are better prepared to respond to new flu strains by quickly implementing testing, information dissemination, and vaccines. That is why the DSHS Laboratory is working on a national surveillance project with the DSHS Emerging and Acute Infectious Disease Branch. This project will monitor the age-specific incidence of medically attended influenza-like illness (ILI) and influenza-associated influenza-like illness.

Benefits of the Influenza Incidence Surveillance Project (IISP) also include: 1) a standardized method to collect data on patient visits and to collect patient specimens for influenza surveillance; 2) expanded testing to include other etiologic agents of ILI, besides influenza, allowing understanding of the percentage of ILI that is due to influenza versus other respiratory viruses; and 3) a picture of how ILI is impacting patient visits for each age group.

The IISP is a collaborative effort of the Council of State and Territorial Epidemiologists (CSTE) and the Centers for Disease Control and Prevention (CDC) to determine locality-specific weekly incidence of influenza-like illness (ILI), laboratory confirmed influenza, and other respiratory viruses among persons seeking medical care for ILI. More specifically, the project will determine: a) the incidence of medically attended ILI, b) the incidence of laboratory-confirmed influenza in health care seeking populations, and c) the etiologic agents among patients with ILI.

Texas is one of 12 participating sites for the IISP and has been conducting surveillance activities since July 31, 2011 through July 28, 2012. As a collaborative effort, the project requires active participation by those involved. IISP participants prepare an initial patient panel, report ILI and weekly patient visit totals per age group, and collect and submit specimens on the first 10 patients with ILI seen each week. The Emerging and Acute Infectious Disease Branch coordinates the project, provides required training, prepares surveillance summaries, and follows up with a provider if these reports are not received.

The Laboratory handles the shipment of specimen collection supplies and specimen testing and does PCR testing for influenza A and B. Specimens that test positive for influenza A will be subtyped for A (H1), A(H3), and 2009 A(H1N1). Specimens that are negative for influenza will be tested using a respiratory panel designed to detect rhinovirus, adenovirus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), and parainfluenza viruses 1-3.

The IISP is currently underway. In the last couple of months, the Emerging and Acute Infectious Disease Branch has been training the new participants and determining the best approach to share the laboratory results.  They have also been working with the Laboratory to send out supplies to participating providers and set up contracts with local health departments to assist with provider follow-up. The first IISP surveillance report was received on August 9 and the first specimen on August 25.

by Jan Adversario

Texas Drinking Water Watch: Ensuring Drinking Water Safety

 

A large portion of the Environmental group’s workload consists of testing drinking water, following the protocols of the Safe Drinking Water Act (SDWA). Annually, the group processes more than 36,000 samples from over 4,000 different public water systems. Samples are analyzed to monitor levels of radiation, harmful bacteria, metals, pesticides, petroleum products, disinfection by-products, and other contaminants.

The data generated by these analyses is then electronically delivered to the Texas Commission on Environmental Quality (TCEQ). TCEQ is charged with ensuring water system compliance, so they contract with the DSHS Laboratory to have these analyses performed. The resulting data is used to confirm the quality of drinking water and to determine whether more frequent monitoring is required to ensure consumer safety. If levels of contaminants exceed certain specified limits, a water system may be found in violation of the SDWA, which means that they are required to notify their customers and take corrective actions.

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All of the drinking water data generated by the lab is considered public information. To increase its accessibility, the TCEQ has set up a website: Texas Drinking Water Watch. Once at the website, search for a water provider using its water system name or facility number. This information can be found on the consumer’s water bill. It is also possible to search by activity status, county, water system type, and source water type. A customer can then access a wealth of knowledge about a specific water provider, including any violations that a system may have had and whether or not they have returned to compliance. Historical results for specific contaminants can also be found.

The Texas Drinking Water Watch web site provides a convenient one-stop shop for comprehensive information about drinking water suppliers. A large portion of the available data is a result of the hard work and dedication of Laboratory analysts.

by Andrew Vinyard


Remote Data Systems: An Overview of Online Results Reporting

The DSHS Laboratory offers online access to test results through its Remote Data Systems. The benefits/advantages of using these applications include:

  • Providing submitters faster and easier access to test result reports
  • Minimizing the impact on costs by reducing the number of recollections and retests due to unsatisfactory specimens
  • Improving the quality of data received by the Laboratory
  • Providing the ability to track specimens
  • Eliminating hand entry of large number of fields

Depending on the type of specimen submitted, submitters access the different systems outlined below.

Clinical Chemistry (Copia) – Texas Health Steps submissions

  • Tests available are blood lead, total hemoglobin, hemoglobin electrophoresis (hemoglobin types), syphilis (RPR), glucose, lipid profile, cholesterol and HDL.
  • Submitters are able to enter patient demographic information, order testing, and view/print test results via the web.

Newborn Screening (Neometrics)

  • For all newborn screening submissions.
  • Submitters are able to enter patient demographics and view/print test results via the web.
  • Submitters can also set up direct two-way data transfer systems via HL7 messages.

Public Health (PHLIMS/LabWare)

  • Supports all Microbiological Sciences public health testing.
  • Links laboratories that perform Bio Threat (BT) testing, making up the Texas Laboratory Response Network (LRN).
  • Allows for increased use of HL7 messaging for communication with other entities, such as the CDC and the Florida Department of Health laboratory through the Public Health Information Network (PHIN).

Microbiology (Results-Web Portal)

  • Tests include tuberculosis, HIV/STD, rubella, flu, rabies, serology, virology, molecular, parasitology, clinical bacteriology, and consumer microbiology.

Each authorized user must complete and submit a Remote Data Systems web application, which consists of a Facility Security Agreement and a Web User Access Agreement, to obtain an account on one or more of the available Remote Data Systems applications.

For additional information, please visit our Remote Data Systems web site, send an email to LabInfo@dshs.state.tx.us, or call 1-888-963-7111, ext. 6030 (toll free).

 

Fighting Infection Through Handwashing

For many families, August meant the beginning of the school year and, with it, the germ season. The most effective way to fight infections is also the most simple: handwashing. Good handwashing techniques have been trivialized for hundreds of years. Historical epidemics that can be directly associated to poor hand washing include the 1854 London Cholera Epidemic or The 1906 “Typhoid Mary” Epidemic.

 

Even today, we take handwashing for granted. The Centers for Disease Control and Prevention (CDC) reports that nosocomial or hospital-acquired infections account for “2,400,000+ nosocomial infections in the US alone. They are estimated to directly cause 30,000 deaths and contribute to another 70,000 deaths each year.

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Nosocomial infections cost over $2,300 per incident and $4.5 billion annually in extended care and treatment.” All of these infections and deaths are directly related to poor handwashing hygiene.

The relationship between handwashing and the prevention of disease is not a new concept. In 1847, Dr. Ignaz Philipp Semmelweis investigated high mortality rates among the maternity patients in his hospital located in Vienna, Austria. His published findings traced death back to a single cause: lack of cleanliness by the student physicians treating the patients. However, the medical community rejected his conclusions. At the time, bloodletting was the most popular way to treat a disease. Dr. Semmelweis was ostracized by the medical community. Not until Louis Pasteur, who published his germ theory 48 years later, were Dr. Semmelweis’ ideas accepted.

So why are illness and death still being spread by the lack of good handwashing techniques? Handwashing is a self-monitored activity and there are barriers related to effective observance of hand washing. According to an article on "Preventing Infection Through Handwashing," these barriers are “education, level of awareness, the development of an aseptic conscience, lack of motivation, lack of facilities such as access to sinks, soap, antibacterial detergents, and time.”

The CDC offers these simple educational instructions on when, and how to properly wash your hands.

When should you wash your hands?

  • Before, during, and after preparing food
  • Before eating food
  • After using the toilet
  • After changing diapers or cleaning up a child who has used the toilet
  • Before and after caring for someone who is sick
  • After blowing your nose, coughing, or sneezing
  • After touching an animal or animal waste
  • After touching garbage
  • Before and after treating a cut or wound

What is the right way to wash your hands?

  • Wet your hands with clean running water (warm or cold) and apply soap.
  • Rub your hands together to make a lather and scrub them well; be sure to scrub the backs of your hands, between your fingers, and under your nails.
  • Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.
  • Rinse your hands well under running water.
  • Dry your hands using a clean towel or air dry.
  • In public restrooms, if available, turn off water with a towel.
  • Also in a public restroom, if available, use a clean towel when opening the door to leave; if unavailable, minimally use clean hands.

How should you use hand sanitizer? (Hand sanitizers are not effective when hands are visibly dirty.)

  • Apply the product to the palm of one hand.
  • Rub your hands together.
  • Rub the product over all surfaces of your hands and fingers until your hands are dry

by Cindy Crouch

 

Note: External links to other sites are intended to be informational and do not have the endorsement of the Texas Department of State Health Services. These sites may not be accessible to people with disabilities. 

 

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THE LABORATORIAN
October 2011, Volume Three, Issue Two
(Publication #E14-13156)
Published by DSHS Laboratory Services Section
PO Box 149347, MC 1947
Austin, TX 78714

512 458 7318
888 963 7111, ext 7318 Toll Free
email The Laboratorian

 

LABORATORY DIRECTOR
Grace Kubin, PhD
512 458 7318
email Grace

NEWSLETTER EDITOR
Jimi Ripley-Black
512 458 7318, ext 6505
email Jimi

Last updated October 18, 2012