Announcement: 20th Anniversary of PulseNet: the National Molecular Subtyping Network for Foodborne Disease Surveillance - United States, 2016.

An Economic Evaluation of PulseNet: A Network for Foodborne Disease Surveillance.

Chapter 4 - Foodborne outbreaks

Surveillance for human Salmonella infections plays a critical role in understanding and controlling foodborne illness due to Salmonella. Along with its public health partners, the Centers for Disease Control and Prevention (CDC) has several surveillance systems that collect information on Salmonella infections in the United States. The National Salmonella Surveillance System, begun in 1962, receives reports of laboratory-confirmed Salmonella infections through state public health laboratories. Salmonella outbreaks are reported by state and local health departments through the Foodborne Disease Outbreak Reporting System, which became a Web-based, electronic system (eFORS) in 2001. PulseNet facilitates the detection of clusters of Salmonella infections through standardized molecular subtyping (DNA "fingerprinting") of isolates and maintenance of "fingerprint" databases. The National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS) monitors antimicrobial resistance in Salmonella by susceptibility testing of every 20th Salmonella isolate received by state and local public health laboratories. FootNet is an active surveillance system that monitors Salmonella infections in sentinel areas, providing population-based estimates of infection rates. Efforts are underway to electronically link all of the Salmonella surveillance systems at CDC to facilitate optimum use of available data and minimize duplication.

The Role of Community Molecular Diagnostics Laboratories in the H1N1 Pandemic

Public Health Laboratories: An Important Ally in Sexually Transmitted Infection Control.

Chapter 13 - Select Agent Regulations

The Laboratory Response Network (LRN) was established by the Centers for Disease Control and Prevention. Today, the LRN is charged with the task of maintaining an integrated network of state and local public health, federal, military, and international laboratories that can respond to bioterrorism, chemical terrorism, and other public health emergencies. The more than 150 laboratories that make up the current LRN are affiliated with federal agencies, military installations, international partners, and state and local public health departments. Laboratories in the network may accept samples from hospitals, clinics, the Federal Bureau of Investigation, other law enforcement groups, emergency medical services, and the military and other agencies. All of the LRN laboratories use the same protocols and validated methods to ensure rapid and certain identification of dangerous biologic agents that cause anthrax, botulism, plague, tularemia, brucellosis, and other illnesses.

In 2011, the University of Michigan's Center of Excellence in Public Health Workforce Studies and the Association of Public Health Laboratories (APHL) assessed the workforce and program capacity in U.S. public health, environmental, and agricultural laboratories. During April-August 2011, APHL sent a web-based questionnaire to 105 public health, environmental, and agricultural laboratory directors comprising all 50 state public health laboratories, 41 local public health laboratories, eight environmental laboratories, and six agricultural laboratories. This report summarizes the results of the assessment, which inquired about laboratory capacity, including total number of laboratorians by occupational classification and self-assessed ability to carry out functions in 19 different laboratory program areas. The majority of laboratorians (74%) possessed a bachelor's degree, associate's degree, or a high school education or equivalency; 59% of all laboratorians were classified as laboratory scientists. The greatest percentage of laboratories reported no, minimal, or partial program capacity in toxicology (45%), agricultural microbiology (54%), agricultural chemistry (50%), and education and training for their employees (51%). Nearly 50% of laboratories anticipated that more than 15% of their workforce would retire, resign, or be released within 5 years, lower than the anticipated retirement eligibility rate of 27% projected for state public health workers. However, APHL and partners in local, state, and federal public health should collaborate to address gaps in laboratory capacity and rebuild the workforce pipeline to ensure an adequate future supply of public health laboratorians.

PulseNet, the National Molecular Subtyping Network for Foodborne Disease Surveillance, was established in 1996 through a collaboration with the Centers for Disease Control and Prevention; the US Department of Agriculture, Food Safety and Inspection Service; the US Food and Drug Administration; 4 state public health laboratories; and the Association of Public Health Laboratories. The network has since expanded to include 83 state, local, and food regulatory public health laboratories. In 2016, PulseNet was estimated to be helping prevent an estimated 270 000 foodborne illnesses annually. PulseNet is undergoing a transformation toward whole-genome sequencing (WGS), which provides better discriminatory power and precision than pulsed-field gel electrophoresis (PFGE). WGS improves the detection of outbreak clusters and could replace many traditional reference identification and characterization methods. This article highlights the contributions made by public health laboratories in transforming PulseNet's surveillance and describes how the transformation is changing local and national surveillance practices. Our data show that WGS is better at identifying clusters than PFGE, especially for clonal organisms such as Salmonella Enteritidis. The need to develop prioritization schemes for cluster follow-up and additional resources for both public health laboratory and epidemiology departments will be critical as PulseNet implements WGS for foodborne disease surveillance in the United States.

Norovirus is the leading cause of endemic and epidemic acute gastroenteritis in the United States (1). New variant strains of norovirus GII.4 emerge every 2-4 years (2-4) and are often associated with increased disease and health care visits (5-7). Since 2009, CDC has obtained epidemiologic data on norovirus outbreaks from state health departments through the National Outbreak Reporting System (NORS) (8) and laboratory data through CaliciNet (9). NORS is a web-based platform for reporting waterborne, foodborne, and enteric disease outbreaks of all etiologies, including norovirus, to CDC. CaliciNet, a nationwide electronic surveillance system of local and state public health and regulatory agency laboratories, collects genetic sequences of norovirus strains associated with gastroenteritis outbreaks. Because these two independent reporting systems contain complementary data, integration of NORS and CaliciNet records could provide valuable public health information about norovirus outbreaks. However, reporting lags and inconsistent identification codes in NORS and CaliciNet records have been an obstacle to developing an integrated surveillance system.

Emerging natural and man-made threats to the health of the nations population require development of a seamless laboratory network to address preventable health risks; this can be achieved only by defining the role of public health laboratories in public and private laboratory service delivery. Establishing defined core functions and capabilities for state public health laboratories will provide a basis for assessing and improving quality laboratory activities. Defining public health laboratory functions in support of public health programs is the beginning of the process of developing performance standards for laboratories, against which state public health laboratories, and eventually local public health and clinical laboratories, will establish and implement best laboratory practices. Public health is changing, and as apart of that change, public health laboratories must advocate for and implement improvements for public health testing and surveillance. These changes are outlined also in the Association of Public Health Laboratories consensus report (Association of Public Health Laboratories. Core functions and capabilities of state public health laboratories: a white paper for use in understanding the role and value of public health laboratories in protecting our nation's health. Washington, DC: Association of Public Health Laboratories, 2000).

Activities and Recommendations by the Association of State and Territorial Public Health Laboratory Directors

In a continuation of the efforts begun in 1985 to promote quality and uniformity in laboratory programs for retrovirus testing, the Association of State and Territorial Public Health Laboratory Directors (ASTPHLD) held the Fourth Consensus Conference on Testing for Human Retroviruses March 7-9, 1989, in Kansas City. The impact of these conferences on retrovirus testing both nationally and internationally continues to grow, as evidenced by the number of states, countries and governmental agencies represented. Forty-six states were represented this year plus the National HIV Reference Laboratory of Australia, the Canadian Health and Welfare Department, the Quebec Public Health Laboratory, the World Health Organization, the American Red Cross, the United States Food and Drug Administration (FDA), the Department of Defense and the Centers for Disease Control (CDC). The 199 conference attendees were from industry, clinical laboratories, blood centers, regulatory agencies, educational institutions and state and local public health laboratories. The success of these conferences is due to the many contributions of a very diverse group of participants. Because all the "players" are represented and participate actively in the consensus process, the recommendations formulated at these conferences serve the

In a continuation of the efforts begun in 1985 to promote quality and uniformity in laboratory programs for retrovirus testing, the Association of State and Territorial Public Health Laboratory Directors (ASTPHLD) held the Fourth Consensus Conference on Testing for Human Retroviruses March 7-9, 1989, in Kansas City. The impact of these conferences on retrovirus testing both nationally and internationally continues to grow, as evidenced by the number of states, countries and governmental agencies represented. Forty-six states were represented this year plus the National HIV Reference Laboratory of Australia, the Canadian Health and Welfare Department, the Quebec Public Health Laboratory, the World Health Organization, the American Red Cross, the United States Food and Drug Administration (FDA), the Department of Defense and the Centers for Disease Control (CDC). The 199 conference attendees were from industry, clinical laboratories, blood centers, regulatory agencies, educational institutions and state and local public health laboratories. The success of these conferences is due to the many contributions of a very diverse group of participants. Because all the players are represented and participate actively in the consensus process, the recommendations formulated at these conferences serve the

The BioWatch program, funded and overseen by the Department of Homeland Security (DHS), has three main elements--sampling, analysis, and response--each coordinated by different agencies. The Environmental Protection Agency maintains the sampling component, the sensors that collect airborne particles. The Centers for Disease Control and Prevention coordinates analysis and laboratory testing of the samples, though testing is actually carried out in state and local public health laboratories. Local jurisdictions are responsible for the public health response to positive findings. The Federal Bureau of Investigation is designated as the lead agency for the law enforcement response if a bioterrorism event is detected. In 2003 DHS deployed the first generation of BioWatch air samplers. The current version of this technology, referred to as Generation 2.0, requires daily manual collection and testing of air filters from each monitor. DHS has also considered newer automated technologies (Generation 2.5 and Generation 3.0) which have the potential to produce results more quickly, at a lower cost, and for a greater number of threat agents. Technologies to Enable Autonomous Detection for BioWatch is the summary of a workshop hosted jointly by the Institute of Medicine and the National Research Council in June 2013 to explore alternative cost-effective systems that would meet the requirements for a BioWatch Generation 3.0 autonomous detection system, or autonomous detector, for aerosolized agents . The workshop discussions and presentations focused on examination of the use of four classes of technologies--nucleic acid signatures, protein signatures, genomic sequencing, and mass spectrometry--that could reach Technology Readiness Level (TRL) 6-plus in which the technology has been validated and is ready to be tested in a relevant environment over three different tiers of temporal timeframes: those technologies that could be TRL 6-plus ready as part of an integrated system by 2016, those that are likely to be ready in the period 2016 to 2020, and those are not likely to be ready until after 2020. Technologies to Enable Autonomous Detection for BioWatch discusses the history of the BioWatch program, the role of public health officials and laboratorians in the interpretation of BioWatch data and the information that is needed from a system for effective decision making, and the current state of the art of four families of technology for the BioWatch program. This report explores how the technologies discussed might be strategically combined or deployed to optimize their contributions to an effective environmental detection capability.