Lab Matters Summer 2018 - Page 71

APHL 2018 Annual Meeting Poster Abstracts Working closely with IDEPC to match response needs with testing capacity allowed us to focus efforts appropriately and minimize turnaround times during overlapping outbreaks. The ability to adjust quickly to changing testing needs allowed rapid follow-up with clinicians and patients, a more efficient public health response, thereby reducing the spread of outbreaks in the community. Presenter: Anna Strain, PhD, Minnesota Department of Health, St. Paul, MN, Phone: 651.201.5035, Email: anna.strain@state.mn.us Evaluation of Laboratory Procedures for Detection of Mycobacterium tuberculosis in Gastric Fluid J. Coffin, E. Tacheny, T. Dickerson, R. Howard and F.A. Hamill, MRIGlobal, Gaithersburg, MD Presenter: Jeanette Coffin, MRIGlobal, Gaithersburg, MD, Phone: 240.361.4006, Email: jcoffin@mriglobal.org Building Social Networks for Sustainable Local Outbreak Response Capabilities D. Dasgupta, G. Olinger and J. Michelotti, MRIGlobal, Inc., Gaithersburg, MD Outbreaks of high consequence and emerging pathogens, such as Brucella and MERS, do not stop at national borders and require international cooperation and aid to those countries with limited PublicHealthLabs @APHL APHL.org Presenter: Julia Michelotti, PhD, MRIGlobal, Inc., Gaithersburg, MD, Phone: 240.361.4001, Email: jmichelotti@mriglobal.org Workflow Analysis of the New Jersey Public Health Mycobacteriology Laboratory D. Woell and T. Kirn, New Jersey Department of Health Public Health and Environmental Laboratory, Ewing, NJ Background: For Mycobacterium tuberculosis (TB) infections, timely identification and rapid detection of drug resistance is critical to ensure proper treatment and infection control measures. Culture is still required for the gold-standard of TB identification and as a slow- growing organism cultures need to be monitored for up to six weeks. Additionally, repeated specimens need to be tested over a period of days or weeks for monitoring of disease progression. With multiple specimens needing to be monitored for such a prolonged time, efficient management of laboratory processes to streamline testing is essential for the timely and accurate identification of TB. Objectives: A workflow analysis of the Mycobacteriology lab in the NJ Public Health and Environmental Laboratory (PHEL) was undertaken to increase timeliness of reporting and decrease testing burden on staff. Methods: A process map of all TB lab workflow was drawn to Summer 2018 LAB MATTERS 69 The global Tuberculosis (TB) epidemic is well documented with additional attention being given to the specific challenges of TB diagnosis in children. Culture for Mycobacterium tuberculosis is important to confirm the diagnosis and determine antibiotic response. Because infants and young children do not expectorate sputum, aspiration or lavage of gastric fluid is the usual procedure for obtaining a pediatric specimen to test for M. tuberculosis. Currently, there is no standard laboratory procedure available in the literature for culture of pediatric gastric fluid specimens. In fact, there is conflicting information presented on the value of neutralizing the acidic fluid prior to culture and/ or analysis on the Cepheid GeneXpert Mtb/Rif assay, the two primary detection methods in many countries. The primary goal of this study, funded by the NIH NIAID contract number HHSN272201700001C for Mycobacterium tuberculosis (Mtb) Quality Assessment Program (TBQA), was to determine the effect of sample neutralization on organism detection and recovery under various conditions, in order to determine the best laboratory procedure for processing gastric fluid. Limit of detection in gastric fluid was also evaluated by live culture. Commercially available simulated gastric fluid was inoculated with M. tuberculosis H37Ra at different concentrations. Samples were either neutralized or not with 8% sodium bicarbonate and processed that day or held under varying environmental conditions before processing following the Association of Public Health Laboratories (APHL) sample processing method. Sample sediments were inoculated in duplicate onto Lowenstein Jensen agar slants and incubated for 6 weeks, checking periodically for growth to compare neutralized vs not neutralized samples under the same conditions. Samples were also analyzed on the Cepheid GeneXpert Mtb/Rif assay. Results will be presented to the NIAID- funded AIDS Clinical Trials group (ACTG) and International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) who are coordinating a large scale clinical trial on household contacts, particularly children, of patients with multi-drug resistant TB. agricultural and human health resources. For many years such cooperation has facilitated efforts to contain outbreaks that may impact public health and security. We have, in a number of instances, been engaged to implement USG-funded science that includes cooperative biological research, activities in biosafety and security and the development and implementation of multi- faceted training strategies in Kazakhstan and West Africa. Such training programs facilitate the ability of host countries to prepare and respond to the next disease outbreak. There are, however, limitations to the existing comprehensive programs. They are not always customized to address the specific circumstances of individual host country laboratories and resource-limited countries are unable to sustain some detection and diagnostic technologies, such as multiplex RT-PCR and next generation sequencing. Our team has developed a Capacity Building Pathway aimed at cost effective training and knowledge acquisition. The system of blended learning, documentation and quality processes that can be co-developed with the host nation culminates in a knowledge transfer process that is adopted, maintained and sustained by the host nation to train future generations. The approach utilizes a web-based platform that will provide a forum for continued communication between the partner country and international contract participants. 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