Lab Matters Summer 2019 - Page 60

APHL 2019 POSTER ABSTRACTS the most common K. pneumoniae sequence type. Among E. coli ST131 isolates, 48 (92.3%) isolates were resistant to ciprofloxacin or levofloxacin, 27 (51.9%) were resistant to trimethoprim- sulfamethoxazole, and 23 (44.2%) were resistant to tobramycin, gentamicin, or amikacin. Conclusions: The phenotypic case definition worked well for targeted surveillance of ESBL-producing Klebsiella and E. coli. ESBL genes of the blaCTX-M type were most abundant. Additionally, clone ST131 represents a significant concern given the significant proportion of ESBL-producing E. coli with this sequence type and the associated resistance to multiple antibiotic classes in addition to β-lactams. Presenter: Davina Campbell, Centers for Disease Control and Prevention, Atlanta, GA, xew9@cdc.gov of this unique A(H1N1)v virus supports the recommendation that testing for seasonal influenza viruses and monitoring for human infections with novel influenza A viruses should continue year-round and that public health authorities should consider novel influenza virus infections when persons with influenza-like illness have a history of swine or poultry exposure. Presenter: Peter Cook, Bioinformatics Fellow, Centers for Disease Control and Prevention, Atlanta, GA, pcook@cdc.gov 50-State Legal Epidemiology Assessment of State Disease Reporting Laws Requiring Clinical Laboratory Specimen Submission to Health Departments R. Hulkower, Centers for Disease Control and Prevention Detection and Characterization of an Influenza A(H1N1) pdm09 Virus Isolated from a Human Following Direct Exposure to Influenza Virus Infected Swine Human-to-swine transmission (reverse zoonosis) of seasonal influenza viruses has led to sustained circulation of human- like influenza viruses in swine in the United States. While these viruses evolve and eventually become adapted in swine, nascent reverse zoonoses can result in virus detections that are difficult to distinguish as ‘swine-origin’ or ‘human-origin’ due to the genetic similarity of viruses circulating in both hosts. Herein, we report the first identification of a zoonotic infection with an A(H1N1)pdm09 virus derived from a swine host. In October 2017, a patient with no underlying medical conditions developed an influenza-like illness. Real-time RT-PCR testing of a nasopharyngeal specimen indicated infection with a seasonal influenza A(H1N1)pdm09 virus. However, viral genome sequence analysis suggested an influenza A(H1N1) variant (A(H1N1)v) virus. Phylogenetic analysis of each viral gene segment revealed the virus was a reassortant containing PB2, PB1, NP and NS genes derived from the triple reassortant internal gene (TRIG) cassette commonly found in swine influenza viruses, but with HA, NA, PA and M genes closely related to seasonal A(H1N1) pdm09 viruses. The patient reported direct exposure to swine in the week preceding illness onset, and swine from the premises tested positive for influenza virus. Subsequently, the virus isolates obtained from both the patient and a pig had an identical genotype. While the origin of the virus collected from the patient was resolved by sequence comparison of the variant virus to available swine influenza virus genomes, future cases may not be as readily discernable if 1) reassortment does not result in acquisition of well-defined swine influenza virus gene segments and 2) if related swine influenza virus genomic sequences are not available. Therefore, we have identified swine-associated sequence fragments using a k-mer based algorithm comparing swine-associated and human-associated groups of A(H1N1)pdm09 virus genomes that we hypothesize can differentiate between human- and swine-origin influenza viruses. Preliminary results indicate that the identification of single nucleotide polymorphisms in virus sequence fragments can differentiate between influenza virus species-origin. Identification 58 LAB MATTERS Summer 2019 Presenter: Rachel Hulkower, Centers for Disease Control and Prevention, Atlanta, GA, hzo2@cdc.gov PublicHealthLabs @APHL APHL.org P. Cook 1 , 2 , J. Jones 1 , R. Kondor 1 , N. Zanders 1 , T. Stark 1 , J. Benfer 3 , S. Scott 4 , A. Janas-Martindale 5 , J. Barnes 1 , S. Lindstrom 1 , L. Blanton 1 , J. Schiltz 5 , D. Wentworth 1 , T. Davis 1 ; 1 Centers for Disease Control and Prevention, 2 Association of Public Health Laboratories, 3 State Hygienic Laboratory, University of Iowa, 4 Wisconsin State Laboratory of Hygiene, 5 National Veterinary Services Laboratory Public health surveillance of potential and emerging infectious disease outbreaks relies on consistent reporting of notifiable conditions (“disease reporting”) from health care and clinical settings to public health agencies. All states and DC have laws requiring health care providers, facilities, and laboratories to report suspected or confirmed cases of specific infectious diseases to their state or local health department. These laws often include additional isolate or other clinical material submission requirements for laboratories. Public health agencies rely on the submission of isolates from clinical laboratories to track pathogen information, such as serotype, subtype, virulence, and antibiotic resistance, to monitor trends, detect, and respond to outbreaks. With the increasing development and use in clinical settings of culture- independent diagnostic tests (CIDT), which do not produce an isolate, there is growing concern that the supply of isolates to health departments will be depleted, hindering public health surveillance activities. Researchers studied strategies to maintain the supply of isolates for public health laboratories, including encouraging reflex culture via test kit inserts and updating state disease reporting laws. We examined state disease reporting laws requiring clinical laboratory submissions to health departments to identify characteristics of the legal language that could facilitate isolate submission. The study included 51 jurisdictions (50 states and DC), 47 of which have disease reporting laws that expressly require clinical laboratory submissions to health departments. Of those jurisdictions, 9 have laws with language specifically addressing what should be submitted if the laboratory has used a non-culture or rapid testing method (CIDT) to make a diagnosis. PHLP researchers also identified four features of law that could facilitate isolate recovery for health departments. Those features are: 1) clear language establishing routine mandatory submission of isolates or other clinical materials; 2) clear language/definition of the materials to be submitted (e.g., “isolate,” “specimen” or “clinical material”); 3) a list of alternative materials to submit if the preferred isolate is not available; and 4) clear language addressing what should be submitted if the laboratory has used a non-culture/rapid testing method. We then classified each state’s disease reporting laws according to its representation of one or more of these features. The results of this study can be used to identify and propose generalized solutions to potential gaps in jurisdictions’ disease reporting laws to maintain isolate or clinical material submissions to health departments.