The Idaho Bureau of Laboratories and Emergency Preparedness Michael Stevenson, Ph.D. IBL Emergency Preparedness Section Manager stevensm@dhw.idaho.gov 208-334-2235 x269 1 October 24, 2013
“I wish you’d learn to put the lid on your petri dish, Harry! We came here today with just four kids but now it looks like we’ve got several million!!”
Objectives • Overview of the Idaho Bureau of Laboratories (IBL) • Overview of the Laboratory Response Network (LRN) • Overview of the Select Agent Program • Emergency Preparedness testing at IBL • How IBL can assist with infection control 3 WEAR NO FOOD PROTECTIVE OR DRINK CLOTHING
The Idaho Bureau of Laboratories As Idaho’s state public health laboratory, IBL provides laboratory services to support the programs within the Department of Health and Welfare, Idaho’s seven Public Health Districts, and other state agencies. Testing Training • Communicable disease agents in • Continuing medical education clinical specimens seminars and telelectures • Contaminants or adulterants in • Formal presentations at water, food, and soils conferences • Biological and chemical threats • State Training Coordinator Inspection Outreach • Clinical and environmental • Maintenance of Idaho Sentinel laboratories Laboratory Network (ISLN) • X-ray and mammography units • Publication/presentation of 4 • Air quality monitoring stations applied public health research • Development/validation of new analytical methods
IBL Statistics • 20,000 square feet laboratory space • Approximately 40 full-time employees • ~ 60,000 samples per year • 72% Microbiology • 26% Environmental • 2% Emergency Preparedness 5
IBL Program Organization Christopher L. Ball, Ph.D., HCLD (ABB) Bureau Chief QA/QC Business Emergency Environmental Laboratory Microbiology Operations Preparedness Analysis Improvement Biological Administration Air Quality Clinical Labs Bacteriology Threat (LRN-B) Data Chemical Molecular Certification X-Ray Epidemiology Management Threat (LRN-C) Myco- Facilities Food Testing Inorganics bacteriology Shipping & Virology- Microbiology Receiving Serology 6 Organics
Emergency Preparedness Section • Michael Stevenson, Ph.D. – Scientist 4, Section Manager • Justin Grant, B.S. – Scientist 2, Chemist • Wendy Loumeau, B.S. – Health Education Specialist, STC • Dan Rousselle, B.A. – Scientist 3, Chemist • Robert Voermans, B.S. – Scientist 3, Microbiologist 7
Anatomy of a Biological Terrorism Event Incident Boise Fire Department, HazMat Region IV Idaho 101 st Civil Support Team First Responders Post Office Biohazard Detection System (BDS) Evidence FBI Unknown powders, anthrax threat letters Testing IBL Emergency LRN Preparedness protocols 8 Section Biosafety Level 3 Conventional methods Rapid methods (BSL3) Laboratory B. anthracis culture Real-time PCR
The Laboratory Response Network CDC Level 3 Level 2 Level 1 LRN-B LRN-C 9 CDC, Atlanta, GA
The Laboratory Response Network • The LRN was established by the Department of Health and Human Services’ CDC in accordance with Presidential Decision Directive 39, which outlined national anti-terrorism policies and assigned specific missions to federal departments and agencies. • The LRN became operational in August 1999 through a collaborative effort involving LRN founding partners, CDC, FBI and APHL. • The LRN is the premier system for identifying, testing and characterizing potential agents of bio- and chemical threats . 10
Laboratory Response Network for Biological Threats (LRN-B) • Typically hospital/clinical laboratories - voluntary • Broadly, all laboratories analyzing or referring specimens that may contain microbial agents or toxins • Rule out or refer to nearest LRN Reference Laboratory if potential 11 select agent
Idaho Sentinel Laboratory Network in the seven Public Health Districts 12
LRN-B Reference Laboratories • Typically are public health laboratories • Receive isolates from Sentinel Laboratories for confirmation • Perform conventional and rapid molecular biological agent testing • Process environmental samples • Receive mandatory LRN proficiency test samples • IBL is Idaho’s LRN-B reference lab Biosafety Level-3 laboratory 13 Registered Select Agent entity
LRN-B National Reference Laboratories • CDC (Atlanta) • USAMRIID (Frederick, MD) • Have highest biosafety level (BSL4) to work with highly dangerous/infectious agents (smallpox, Ebola) • Have advanced methods to further characterize isolates of biological agents, i.e. “microbial forensics” 14
Select Agents Under United States law, select agents are bacteria, toxins, viruses, or fungi which have been declared by the U.S. Department of Health and Human Services or by the U.S. Department of Agriculture to have the potential to pose a severe threat to public health and safety. Cutaneous anthrax Tularemia 15 Bubonic plague
Select Agents Terrorism: Threat letter Environmental Threats: Anthrax Brucellosis 16 Plague Tularemia
Select Agent Program www.selectagents.gov • Centers for Disease Control and Prevention (CDC), Division of Select Agents and Toxins (DSAT) • Animal and Plant Health Inspection Services (APHIS), Agricultural Select Agent Program Code of Federal Regulations (CFR) 17 Title 42 – Public Health Part 73 – Select Agents and Toxins
Select Agent Program • The Select Agent Program is administered by CDC and APHIS, and regulates laboratories that may possess, use, or transfer select agents within the United States . • The Select Agent Program was established to satisfy requirements of the USA PATRIOT Act and the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, which were enacted in the wake of the September 11, 2001 attacks and the subsequent 2001 anthrax attacks. • IBL is a registered entity with the Select Agent Program. • www.selectagents.gov 18
Bacterial Select Agents • Bacillus anthracis • Botulinum neurotoxin producing species of Clostridium • Brucella abortus • Brucella melitensis Burkholderia pseudomallei • Brucella suis • Burkholderia mallei • Burkholderia pseudomallei • Coxiella burnetii • Francisella tularensis • Rickettsia prowazekii 19 Brucella • Yersinia pestis
Viral Select Agents • Crimean-Congo haemorrhagic fever virus • Eastern Equine Encephalitis virus • Ebola virus • Lassa fever virus • Monkeypox virus Ebola virus • South American Haemorrhagic Fever viruses • Tick-borne encephalitis complex (flavi) viruses • Variola major virus (Smallpox virus) • Nipah Virus • Rift Valley Fever Virus 20 Monkeypox virus
Toxin Select Agents • Abrin • Botulinum neurotoxins • Conotoxins Rosary peas abrin • Ricin • Staphylococcal enterotoxins • T-2 toxin • Tetrodotoxin Castor beans ricin 21
Laboratory Response Network for Chemical Threats (LRN-C) Level 3 Level 2 Level 1 62 labs 46 labs 10 labs CDC • Work with hospitals/labs • Level 3 activities • Level 2 activities • Comprehensive CT • Proficient in more CT • Proficient in CT analyses response plan analyses (e.g. mustards) (e.g. cyanide, VOC) • Competency in SCPaS • Conduct CDC research • Surge capacity lab Analytical Capability 22
LRN-C Laboratories Level 1 Labs Level 2 Labs Level 3 Level 3 Labs American Samoa Chicago Guam Micronesia Los Angeles 2004 Marshall Is. N. Mariana Is. New York City Palau Puerto Rico US Virgin Islands Level 2 District of Columbia 23
Chemical Agents - Classes http://emergency.cdc.gov/chemical/ • Pulmonary Agents : Chemicals that • Nerve Agents : Highly poisonous cause severe irritation/swelling of the chemicals that work by preventing the respiratory tract nervous system from working properly • Phosgene (respiratory distress, choking) • Sarin (diarrhea, miosis, bradycardia) • Chlorine, Chlorpicrin, Diphosgene • Soman, Tabun, VX • Blood Agents : Poisons that affect the • Vesicants : Chemicals that bliser the body by being absorbed into the eyes, respirator tract, and skin on blood contact • Hydrogen Cyanide (vertigo, tachycardia) • Sulfur Mustard (itching, yellowish blisters) • Carbon Monoxide, Hydrogen Sulfide • Nitrogen Mustard, Phosgene Oxime • Biotoxins : Poisons that come from • Industrial Chemicals : raw materials to plants or animals convert into thousands of products • Ricin (respiratory distress, fever, coughing) • Metals (mercury, lead, arsenic, cadmium) 24 • Abrin, Strychnine • Volatile Organic Compounds (VOCs)
Chemical Threat Agents Tested at IBL BLOOD URINE • Cyanide • Abrine (abrin marker) • Ricinine (ricin marker) • Toxic Metals (Cd, Hg, Pb) • HNPAA (explosive metabolite) • Volatile Organic Compounds • Tetramine (rat poison) (benzene, carbon tetrachloride, • Metabolic Toxins chloroform, 1,2-dichloroethane, (monochloroacetate, monofluoroacetate) ethylbenzene, styrene, tetrachloroethene, toluene, o-, m- • Organophosphate Nerve Agents and p-xylene) (sarin, soman, cyclohexylsarin, VX, Russian VX) 25 • Toxic Metals (As, Ba, Be, Cd, Pb, Tl, U)
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