Lab Matters Spring 2019 - Page 24

INFECTIOUS DISEASES Boots on the Ground: A Lab Perspective on Hepatitis A Virus Outbreak Response by Nicholas Ancona, specialist, HIV, Hepatitis, STD & TB Programs Hepatitis A virus (HAV) is the causative agent of a self-limiting vaccine- preventable liver disease. Since March 2017, outbreaks of HAV have been detected in 18 states nationwide with reported associations with individuals who use drugs, persons experiencing homelessness, and in MSM (men who have sex with men) communities. State and local public health laboratories have been engaged in epidemiological and laboratory response efforts aimed at combatting these outbreaks in conjunction with the CDC Division of Viral Hepatitis (DVH). In recognition of both Hepatitis Awareness Month (May) and Hepatitis Testing Day (May 19), Tracy Basler, molecular scientist, Public Health Services Laboratory, County of San Diego Health & Human Services Agency and Marty Soehnlen, PhD, MPH, director of infectious disease, Michigan Department of Health & Human Services Bureau of Laboratories spoke to APHL about their experiences with Hepatitis A virus (HAV) outbreak response efforts and ongoing work. Advice for Public Health Laboratories Current Responding to HAV Outbreaks Basler suggested that laboratories use the outbreak response as an opportunity to assess existing capabilities and develop realistic goals. San Diego County identified the need to increase technological capacity during the outbreak response and worked with partners to implement a PCR screening assay to supplement existing serologic testing at external laboratories. She emphasized the importance of community partnerships and leveraging those in a way that would ultimately enhance laboratory capabilities. During the outbreak response, Basler and her colleagues built partnerships with multiple entities such as universities, non-profits and other public health laboratories. With the help of these organizations, San Diego County improved their communication with submitters and strengthened their bioinformatics infrastructure. Soehnlen stressed the importance of working with partners to identify methods to streamline PCR and genotyping workflows so large volumes of samples do not overwhelm existing laboratory capabilities. Laboratorians may be interested in inquiring about serologic testing capacity at local hospitals as well as reaching out to CDC DVH with questions about the utility and application of molecular sequencing options. Since HAV is highly virulent and can spread rapidly across state lines, she suggested that laboratories prepare for an influx of a large number of samples and identify mechanisms to address staffing and ensure continuity of day-to-day laboratory operations. Value of Interjurisdictional Collaborations for Public Health Laboratorians Basler was new to public health and was brought in during the outbreak. She was pleased to report how supportive and welcoming public health colleagues Since March 2017, outbreaks of HAV have been detected in 18 states nationwide with reported associations with individuals who use drugs, persons experiencing homelessness, and in MSM (men who have sex with men) communities. State and local public health laboratories have engaged in epidemiological and laboratory response efforts aimed at combatting these outbreaks in conjunction with the CDC Division of Viral Hepatitis (DVH). Hepatitis A 22 LAB MATTERS Spring 2019 PublicHealthLabs @APHL APHL.org