Laboratory Surge Response to Pandemic (H1N1) 2009 Outbreak, New York City Metropolitan Area, USA

James M Crawford,Marcella De Geronimo,Robert Stallone,Mary Gerolimatos,Yosef Dlugacz,Fan Zhang,Christine C Ginocchio,Carolyn Sweetapple,Donna M Armellino,Diamanto D Korologos

doi:10.3201/eid1601.091167

Abstract

The North Shore-Long Island Jewish Health System Laboratories serve 15 hospitals and affiliated regional physician practices in the New York City metropolitan area, with virus testing performed at a central reference laboratory. The influenza A pandemic (H1N1) 2009 outbreak began in this area on April 24, 2009, and within weeks respiratory virus testing increased 7.5 times. In response, laboratory and client service workforces were increased, physical plant build-out was completed, testing paradigms were converted from routine screening tests and viral culture to a high-capacity molecular assay for respiratory viruses, laboratory information system interfaces were built, and same-day epidemiologic reports were produced. Daily review by leadership of data from emergency rooms, hospital facilities, and the Health System Laboratories enabled real-time management of unfolding events. The ability of System laboratories to rapidly increase to high-volume comprehensive diagnostics, including influenza A subtyping, provided key epidemiologic information for local and state public health departments.

Highlights

The North Shore–Long Island Jewish Health System Laboratories serve 15 hospitals and affiliated regional physician practices in the New York City metropolitan area, with virus testing performed at a central reference laboratory
The North Shore–Long Island Jewish Health System (NSLIJHS) Central Laboratories serve 15 hospitals and affiliated regional physician practices; virus testing is performed at the Centralized Laboratories in the Clinical Virology Laboratory (CVL)
This plan was tested, beginning Friday evening, April 24, 2009, when 20 students 14–17 years of age with symptoms of an influenza-like illness sought evaluation at the pediatric emergency room of Schneider Children’s Hospital at Long Island Jewish Medical Center, one of the hospitals served by NSLIJHS

Summary

Standard Testing for Respiratory Viruses and Test Capacity

During the normal influenza season, the clinical laboratories of NSLIJHS hospitals perform rapid influenza A+B antigen testing, using either BinaxNOW A+B test (Inverness, Scarborough, MA, USA) or the 3M test. NSLIJHS laboratories routinely encounter a seasonal increase in respiratory virus testing, peaking in mid-tolate February and waning by May. The historic maximum test volume occurred in February 2008, when CVL tested 6,021 samples and clinical laboratories system-wide performed 2,901 rapid influenza tests, for a combined daily average of 308 tests. During April 1–23, 2009, CVL tested 1,955 samples and clinical laboratories system-wide performed 676 rapid influenza tests, for a combined daily average of 119 tests. These volumes were similar to those for preceding years. To accommodate the high volume of R-Mix cultures, CVL reduced the normal test algorithm of screening at 24 hours, 48 hours, and 7 days to a single screening and confirmatory

No tests

Laboratory Information System and Biostatistical Reporting

INFA RAP

Findings

Discussion