Lab Matters Summer 2019 - Page 57

APHL 2019 POSTER ABSTRACTS tests (CIDTs), specifically GI Panels, have changed the way in which clinical laboratories diagnose patients with foodborne illness. The utilization of GI panels by clinical laboratories has led to increased submissions of stools in Cary-Blair or GN broth to public health laboratories. This has subsequently, required public health laboratories to spend more time recovering isolates from positive stools. Objective: Currently, our laboratory utilizes the Alere Quik Chek EIA (enzyme-linked immunosorbent assays) to detect Shiga toxins. Previous experience in our laboratory has shown that rare Shiga toxin variants may not be detected by commercial EIA kits. This can lead to discrepancies when confirming CIDT submitted stools. To improve our detection of known Shiga toxin variants and streamline our processes related to the handling of CIDT positive stools for (STEC), we sought to evaluate the feasibility of using a modified commercial Shiga toxin PCR assay that could eventually be incorporated into a new screening algorithm utilizing both EIA and PCR. Methods: Two commercially available real-time PCR kits from Thermo Fisher Scientific, currently sold and marketed for food testing were evaluated. The TaqMan™ Verotoxin-producing Escherichia coli VT1/ VT2 Multiplex Assay Beads (Kit 1) and Custom TaqMan™ STX1/ STX2 Assay Beads (Kit 2) both utilized lyophilized reagents. Each kit was evaluated for the ability to detect a characterized panel of 15 Shiga toxin producing E. coli isolates enriched in GN broth which included rare Shiga toxin variants. DNA extraction methods evaluated with each kit included the recommended PrepSEQ kit, as well the modification of using a boil prep. Boil prep was performed using the Biorad T100 Thermal Cycler followed by centrifugation and dilution. PCR was performed using the ABI 7500 Fast real-time PCR instrument. Results: Evaluation results revealed discrepancies in the performance among the two kits. Kit 1 was not able to detect the following Shiga toxin variants (1d, 2e, 2f, and 2g). In comparison, Kit 2 accurately detected all 15 characterized isolates within the panel. Both DNA extraction methods performed equally and did not affect the performance of either kit. Conclusions: Based on the ability of Kit 2 to detect all of the Shiga toxin variants within the panel, it appears as the best candidate to integrate within the proposed screening algorithm for STEC positive CIDT stools. Successful validation of this assay has the potential to streamline our screening of CIDT stools, improve our detection of Shiga toxin variants, and reduce discrepancies when confirming STEC positive CIDT stools. Presenter: Kimberly Starr, CPEP Fellow, University of Washington Medical Center, Seattle, WA, starrkim@uw.edu Trends in Products and Countries Refused from Import into the United States T. Dickerson, K. Yeh and J. Lucas, MRIGlobal The United States imported $2.4 trillion in goods over the course of 2017, with 58% of the imports coming from China, Mexico, Canada, the European Union and Japan. Of this $2.4 trillion, capital goods such as semiconductors and computers contributed $641 billion to the US economy, while consumer goods like food, cell phones, TVs and apparel accounted for $602 billion. Of this $602 billion, $138 billion was attributed to food imports, with the most imported foods being fish and shellfish, meat, dairy, vegetables, PublicHealthLabs @APHL APHL.org fruits, nuts, coffee, tea, spices, grains, candy, sugar, chocolate, cocoa, beverages and liquor. Unfortunately, some of these products come from countries with food regulations different from the United States which in turn increases the risk of foodborne illnesses. Moreover, foodborne illnesses seem to occur more frequently in food categories (eg., meat, fish, fruits and vegetables) that are in higher demand and have a wide range of countries of origin. In fact, the FDA is responsible for monitoring imports from over 300 ports of entry in approximately 150 different countries. However, due to the tremendous volume of imported products and limitations in time, as well as human and financial resources, the FDA physically examines less than 1% of the products awaiting entry; although all imported foods are electronically examined. Thus, the FDA prioritizes whether a food shipment should be imported upon a risk-based prediction algorithm that determines whether the products in question should be inspected in the field or a laboratory. Violations that are most commonly cited for refusal of products into the United States include the detection of pathogens (eg., Salmonella and Listeria) and toxins such as aflatoxins, chemical contamination (eg., pesticides, drug residues or unsafe additives) and other sanitary violations like “filth” or a “decomposed appearance.” Thus, the objective of this study was to assess the literature for trends in products and their exporting countries that have been refused entry into the United States due to the detection of foodborne pathogens. Of the literature reviewed, the greatest number of refusals were associated with Salmonella. Mexico had the greatest number of Salmonella violations for vegetables, fruits, non-chocolate candy and gum, while violations for India were more commonly found in spices, flavors and salts. China, on the other hand, had the greatest number of refusals for fishery and seafood products, vegetables and fruits. Hence, this literature review indicates rigorous international standards should be developed and regularly monitored for. Presenter: Tamar Dickerson, MRIGlobal, Kansas City, MO, tdickerson@mriglobal.org Global Health Evaluation of Laboratory Management Training: A Case Study from Ethiopia K. Lewis 1 , A. Kebede 2 , S. Young 1 , S. Liska-Mills 1 , K. Wainwright 1 , T. Kanter 3 , S. Staley 1 ; 1 Association of Public Health Laboratories, 2 Ethiopian Public Health Institute, 3 Centers for Disease and Control and Prevention-Ethiopia Background: In many developing countries, there is a gap among laboratory managers in their knowledge and capabilities to successfully carry out managerial tasks. Recognizing this, the Association of Public Health Laboratories (APHL) developed and implemented a comprehensive basic training curriculum in 2005 for laboratory managers, the Foundations of Laboratory Leadership and Management (FLLM). In 2018 the FLLM curriculum content was updated. Although a significant increase in training scores from pre- and post-tests implies an acquisition of knowledge and understanding, this does not measure subsequent laboratory improvement, and it can be a challenge to show measurable outcomes of laboratory management training. To address this, mandatory post-training activities for the Summer 2019 LAB MATTERS 55