Marriam Anjum

Hailey Lampi
Afrin Pattani
Marlena Taus
Drew Erickson
Period 6
Roles and Responsibilities Research: Public Health Laboratorian
Online Research:
Can you provide examples of infectious disease responses your local/state public health lab
have been actively involved within in recent past?
Pitt Public Health has made major contributions in defining, preventing, and treating some of the
most devastating diseases of the past 60 years. Among the pioneering scientific breakthroughs
made by IDM researchers are:
Prevention of poliovirus with gamma globulin, which helped in the development of
the Salk polio vaccine
Identification of dengue viruses and the hemorrhagic fever caused by them
Discovery of adeno-associated virus
Linking the transmission of cytomegalovirus to infected organs in transplantation
Evidence showing HIV load in the blood is a strong predictor of disease progression
Establishing the Pitt Men's Study, a part of the ongoing, nearly 30-year-old nationwide
Multicenter AIDS Cohort Study on the natural history of HIV infection
LINK: http://www.publichealth.pitt.edu/idm

Can you find official charts or documents showing how the lab works with the
epidemiologists and clinicians/nurses during an outbreak?

Chain of command for this organization flows like this (add chart or brief explanation of
key organizational decision-makers):
Medical laboratory technicians assist physicians in the diagnosis and treatment of diseases by
performing tests on tissue, blood and other body fluids. Medical lab technicians most commonly
work in hospitals or doctors' offices. The tests conducted are chemical analyses of body fluids
such as blood or urine using a microscope or automatic analyzer. These tools help MLTs detect
abnormalities or diseases, using a computer to enter their findings throughout the process. These
chemical analyses are considered to be a core job duty, but MLTs also use mechanical and
electrical devices to ensure their test results conform to specifications.
Medical lab technicians are also tasked with the following:
Setting up, maintaining, calibrating, cleaning and testing the sterility of medical lab
equipment
Preparing solutions or reagents to be combined with samples
Collecting blood, tissue or other samples from patients
Along with these job duties, MLTs could also be responsible for matching blood compatibility
for transfusions, analyzing chemical content of fluids or examining immune system elements.
With sophisticated lab equipment, they search for parasites, bacteria and microorganisms in their
samples.
LINK: http://www.rasmussen.edu/degrees/health-sciences/blog/what-does-a-medical-lab-tech-do/

Does the lab ever provide comments in the media about outbreaks? Or, does the lab
website have other ways it provides information to the public?
A lab can provide public awareness of the outbreak. If the disease or virus is spreading, steps of
public health protection are taken to warn the public of the outbreak or future outbreaks.

Comments to the media are one way that they can spread awareness, but a magazine or blog can
also get mixed up. A lab can issue their own safety precautions, either listed on a website or in a
reliable place for the public to see. Many outbreaks have a five-step plan to go along with them
on how to explain to the public the severity, or just general information of the outbreak.
LINK: https://blogs.cdc.gov/publichealthmatters/2011/09/outbreak-investigation-a-cheat-sheet/

Information Obtained from Expert (Ms. Onischuk):

Which role do you play during an outbreak and what steps do you take?
To provide testing for common disease threats of public health concern. Based on the symptoms
of the suspect patient(s) the epidemiologist may discuss with other professionals or call us to
consult about proper collection and what tests should be ordered. When responding to an
outbreak our section knows what to do based on a written general clinical request form that the
epidemiologist or clinician fills out and sends along with the specimen to our lab.. It is
extremely important that the correct specimen is collected quickly and properly to ensure we can
perform the test appropriately. We have standard operational procedures for each type of
pathogen we test for. We often work with other sections within the lab when there is an
outbreak- for example the virology/serology section tests for virus or antibodies against viruses,
the environmental microbiology section tests food, water, or environmental sources for
infectious agents, and the molecular biology section has state of the art test platforms that can
help all of our sections
What is an example of a case and the steps taken?
For example our section may receive 10 salmonella isolates from a certain area of the state, 8 of
which have the same serotype (Salmonella C1 Norwich) that we identify based on our lab
protocols, the molecular section performs DNA fingerprinting (Pulsed Field Gel
Electrophoresis(PFGE)) and determines 7 of the 8 Salmonella C1 Norwich isolates are an
identical match. We notify the epidemiologist and she interviews all 7 patients who have the
identical Salmonella and determines that they all ate food from a taco truck at the state fair.
Suspect food samples are collected from the truck and sent to the environmental microbiology
section where they test the samples for Salmonella. If they find Salmonella C1 Norwich, they
give the isolate to molecular to run PFGE, if it matches then the source of the outbreak is
discovered
Which other agencies do you work closely with during an outbreak and how do you contact
them?
We rely on clinicians, private laboratories, the public, public health nurses, and our
epidemiologist partners to alert about a possible outbreak, usually by telephone or email.

What improvements could you make to the steps you took?

When we have had situations that need improvement, often the most common cause is
breakdown in communication - the lab was not notified of a suspected outbreak, the lab was
notified too late to do testing, the wrong type of specimen was collected, there was a delay in
receipt at our lab and the specimen is no longer of good quality to perform the test. Depending
on the pathogen suspected, we often have a narrow window of time that the specimen needs to be
collected and delivered to us.
Have you ever contacted the media while investigating an outbreak?
The Department of Health has a Chief Information Officer is responsible for alerting the media.
The info is communicated to our local news, and also directly to veterinarians or clinicians via
publications and Health Alert Network (HAN).
What is the most important aspect of an outbreak investigation?
The most important aspect of successful outbreak investigation is communication. When we
receive a phone call or email, we go into action quickly to help diagnose whatever is the suspect
agent based on the epidemiologist's impressions.
What is the most recent case you have worked on and how was it like working on it?
We recently received a call from one of our state on-call epidemiologists about a suspect
Botulism case at a nearby hospital. In this case, both the patient's clinician and the hospital
epidemiologist notified our state epidemiologist. Most states have a list of notifiable diseases and
conditions that require reporting. Our laboratory does not test for Clostridium botulinum, so we
arranged to receive the specimens (stool, serum, wound material), and send to the CDC for
testing. I emailed the head of the Botulism lab at CDC to let her know specimens were on the
way, so she was able to prepare and test them quickly by PCR, which was followed up with
conventional testing. Rapid PCR results helped with the patient treatment and the epidemiologist
was able to further investigate and discover more cases involving of a small group of heroin
users that were skin popping from a shared needle.
Lisa Onischuk, MPH, MT (ASCP)
General Microbiology Supervisor
New Mexico Dept. of Health,
Scientific Laboratory Division
1101 Camino de Salud, NE
Albuquerque, NM 87101
ph: (505) 383-9128
fax: (505) 383-9121
lisa.onischuk@state.nm.us