A Publication of the Maryland Department of Health and Mental Hygiene

The Laboratories Administration—Maryland’s State Laboratory

state and local The Department of public health laboratories in Homeland a near-final state in early Security’s 2003.8 It is managed and BioWatch Program funded at the federal level Swift detection of by the Department of aerosolized Homeland Security, with biological agents state and local public health during agencies responsible for biological attack on-the-ground management of laboratory Photo 1: Author Kenneth Okogi (left) with co-worker Ron Yahil working at Introduction the ABI-7500 Real-time PCR instrument. Photo: Georgia Corso activities and response to positive findings. The The mailing of -containing letters airborne particles. State public health federal government provides the funding subsequent to the attacks of September laboratories coordinate the laboratory for BioWatch; however it is locally 11, 2001 heightened concerns about acts testing and analysis of the samples, operated in about 30 cities to provide of and increased interest in using reagents provided by the Centers routine environmental screening and to developing ways to detect biological for Disease Control and Prevention support the security of large scale, threats as quickly as possible. In 2003, (CDC). State and local public health and national events such as parades, sporting the newly created Department of safety agencies are responsible for the events, political conventions, and Homeland Security (DHS) introduced response to laboratory findings. The inaugurations. the BioWatch Program. The program’s Federal Bureau of Investigation (FBI) is objective is to swiftly detect specific (Continued on page 2) biological agents that could be released BioWatch has three main components: in aerosolized form during a biological Sampling, analysis, and response. Each attack. The BioWatch Program was component is overseen by different developed by the Department of Energy agencies; the EPA and its contractors and the Environmental Protection maintain the sampling component, September 2010 Agency (EPA) and was delivered to specifically the sensors that collect Volume 14, Number 9 Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • December 2008 • Vol. 12, No. 12 Page 1 (Continued from page 1) The BioWatch System The Department of Homeland Security’s BioWatch Program The BioWatch Program is operated by a team comprised of field operators, designated as the lead agency for the law laboratory scientists (including those enforcement response if a bioterrorism located here at the Laboratories event is suspected. Administration) and public health and safety officials from city, state, and The detection of pathogenic species in federal organizations. This coordinated open environments, such as air and team is responsible for deploying air water supplies, is critical. Early sampling devices at classified sites in PRODUCTION MANAGER detection enables public health several metropolitan areas, and collect- authorities to take the proper actions ing daily samples. These samples are Georgia Corso such as containing human-to-human sent daily to public health laboratories, transmission of an infectious agent, including the Laboratories Administra- EDITORIAL BOARD reducing the number of victims of an tion, where scientists extract, test, and outbreak, and provide timely treatment analyze these samples using advanced Jack DeBoy, Dr. P. H. for those who have been infected. The polymerase chain reaction (PCR) Prince Kassim, Ph.D. onset of symptoms resulting from instruments and report laboratory results Fizza Majid, Ph.D. human exposure to a threat agent often daily via an integrated data management occurs after several days and usually is system. The BioWatch system generates Robert Myers, Ph.D. not easily distinguished from more a signal known as a BioWatch Actionable Jafar Razeq, Ph.D. common ailments. Nevertheless, the Result (BAR) when testing confirms the Jim Svrjcek, B.A. human immune response may provide presence of genetic material consistent Michael Wajda, M.S., J.D. the only other means of pathogen with one of the biological agents that are detection available. The need to rapidly monitored by the system. Chengru Zhu, Ph.D. and reliably detect biological agents in the environment is especially acute due Instance of a LABORATORIES ADMINISTRATION to both their lethality and prior use by BioWatch Actionable Result terrorist groups against civilians.1 Director An incident of a BAR was reported on Jack DeBoy, Dr.P.H. BioWatch forms one component of a October 9, 2003 in , Texas. The more comprehensive interagency Houston Department of Health and

Deputy Director surveillance system designed to identify Human Services reported detecting low for Scientific Programs and respond to outbreaks in an agent- levels of Francisella tularensis, the Robert Myers, Ph.D. specific manner. This system, known as bacterium that causes . the National Bio-surveillance Integration According to a press release, positive System (NBIS) remains under constant results were detected on three Deputy Director 2 for Administrative and development. NBIS seeks to combine consecutive days, with negative results 4 Regulatory Programs urban aerosol monitoring data obtained on subsequent days. The response to the Michael Wajda, M.S., J.D. from BioWatch with information from positive result was a modest one with several other sources, including medical precautionary measures taken by the surveillance programs such as the local and state public health agencies. TECHNICAL QUESTIONS BioSense Program managed by the CDC These included increasing surveillance and veterinary surveillance conducted by for human illness, additional environ- 3 Questions concerning the U. S. Department of Agriculture. mental sampling and testing, and technical content of this newsletter The objective of this integration is to assessment of activities in the area that may be referred to quickly identify abnormal levels of may have caused the sensors to pick up Dr. Jack DeBoy at 410-767-6100 infectious agents resulting from a natural the organism. There were no indications event or a bioterrorism attack, in order to that this signal was the result of an facilitate an appropriate public health intentional pathogen release. These response. For example, during the findings likely reflected natural The Critical Link is published monthly emergence of the 2009 H1N1 influenza "background" levels of the organism in by the staff of the Laboratories Administration outbreak, BioWatch scientists at the the environment, and authorities chose Department of Health & Mental Hygiene DHMH Laboratories Administration to enhance surveillance rather than 201 W. Preston Street played an integral role in assisting the distribute antibiotics in the affected 5 Baltimore, Maryland 21201 Molecular Biology Division. community. (Phone 410-767-6909) (Continued on page 3)

Page 2 Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • September 2010 • Vol. 14, No. 9 (Continued from page 2) BioWatch and The Department of Laboratory Response Homeland Security’s Network BioWatch Program The BioWatch Program and BioWatch the CDC-sponsored Partners in Laboratory Response Preparedness Network (LRN) share common goals in providing BioWatch has initiated and laboratory support for developed collaborative detecting a bioterrorism relationships with state and event, and both are deployed local public health, in state and local public laboratory, law enforcement, health laboratories. The and environmental health LRN was developed by the agencies to strengthen our CDC, FBI, and state and nation’s overall local health agencies, with preparedness.6 Some of the the first set of test methods key partners that play developed prior to the pivotal roles to ensure the anthrax mailings of 2001. program’s success include: The LRN is managed and funded at the federal level by the Department of Health • The DHS provides and Human Services funding and through the CDC, and, in a management for the fashion similar to the program. BioWatch Program, state and local public health • State, city, and county agencies are responsible for public health agencies on-the-ground management Photo 2: Laboratory scientists are part of a team responsible for deploying air of network assets and that locally own and sampling devices at classified sites in metropolitan areas, and collecting samples sent daily to public health laboratories. Scientists extract, test, and response to positive operate the BioWatch 9 analyze these samples using advanced PCR instruments. Photo: Georgia Corso findings. The LRN has the Program. benefit of a longer history as a civilian public health • The CDC oversees the Laboratory The Relationship Between program, during which time policies, Response Network where BioWatch and Public Health procedures, and protocols have matured. collected samples are analyzed, and acts as a liaison with state and BioWatch and infectious disease The BioWatch Program shares some local public health departments. surveillance through the public health operational similarities with the LRN, and health care systems are complemen- but there may be areas in which • The EPA assists in sampling tary. However, BioWatch has the simultaneous operation of the two activities in response to a BAR. potential to provide a more timely alert systems might prove difficult. Both than the public health systems due to the systems would likely be in significant • The Federal Bureau of Investiga- quick turnaround time in reporting use during a bioterrorism event, and tion provides threat assessment results. Also, the testing is focused on handling large influxes of both and is the lead law enforcement only select biological agents, unlike the BioWatch and environmental samples wide range of infectious agents tested in and investigative agency. might cause competition for limited the public health systems, in addition to resources. Conflict might arise in areas providing early warning of a biological • The Lawrence Livermore National including prioritizing samples for testing attack. The BioWatch Program also (triage), referral testing, and data Laboratory provides technical assists local public health authorities in management.10 On the other hand, close support, including the develop- the detection of forensic evidence on the involvement of BioWatch operation and ment and assessment of new source, nature, and extent of biological 6 testing with the public health community technologies and protocols. attack to aid law enforcement in may prove to be of benefit in the case of 7 identifying the perpetrators. (Continued on page 4)

Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • September 2010 • Vol. 14, No. 9 Page 3 (Continued from page 3) References The Department of Homeland Security’s FDA Awards BioWatch Program 1. Benjamin Brodsky. 2007 .“The Next Generation of Sensor Technology for the Laboratories an actual attack. In a fact sheet released BioWatch Program.” Monterey Institute for International Studies, September. at the signing of the FY2004 Homeland Administration Security appropriations bill, the White 2. Kimothy Smith. 2006. Testimony before the House noted that the BioWatch Program US House of Representatives, Committee on Funding for New and the LRN are both early-detection Homeland Security, Creating a Nationwide th programs for bioterrorism, and “that Integrated Network, 109 Radiological Food Congress., 2nd session., May 11. federal partners are working with state and local officials to implement an 3. Office of Inspector General, Department of Safety Program effective consequence management plan Homeland Security. 2007. Better Management that incorporates the BioWatch Needed for the National Bio-surveillance The Laboratories Administration is the system”.11 Integration System Program, (Department of proud recipient this week of an award of Homeland Security, Washington D.C., July), $1.25 million ($250k/year over five OIG-07-61. years) from the Food and Drug Future Goals 4. Houston Department of Health and Human Administration, Food Emergency Just like other programs of this Services, 2003. Officials Following Up on Response Network. The award is to magnitude, improvements can be made. Bacteria Detection Press Release. Oct.9. improve food safety and security by participating in radiological defense Improvements to existing technologies, 5. processes, and relationships will Eric Berger. 2003. Houston Chronicle, enhancement activities, by performing "Suspicious Bacteria Detected: Security continue to be important factors as the Monitors Spot Germ; Discounted," selected radiological analyses in the BioWatch Program evolves. Some of the October 10, p. A27. event of terrorist activities affecting future goals include: foods or food products, and by initiating, 6. Office of Health Affairs, U.S. Department of in conjunction with the DHMH Office of • Enhancing detection coverage by Homeland Security, Washington, D.C., March Food Protection and Consumer Health 2009. adding more outdoor and indoor Services, a radiological food monitoring collectors and to support 7. Office of Inspector General, Department of program. This cooperative agreement additional jurisdictions. Homeland Security, Washington, D.C., January comes with funding for two positions. 2007. Establishing a radiological food surveillance program in Maryland has • Improving current sample 8. Judith Miller 2003. The New York Times, been pursued by the DHMH for nearly collection technologies. "U.S. Deploying Monitor System For Germ 10 years. Peril," January 22, p. A1. • Developing methods for more 9. Leslie Tengelson, et al. 2002. "Coordinated rapid detection and greater cost Response to Reports of Possible Anthrax efficiencies. Contamination, Idaho," Emerging Infectious The services and facilities of the Diseases, 8(10):pp. 1-7. Maryland Department of Health and

• Maximizing coordination and Mental Hygiene (DHMH) are operated 10. Higgins, J.A., et al. 2001 "A Field on a non-discriminatory basis. This collaboration with other detection Investigation of Bacillus anthracis policy prohibits discrimination on the programs. Contamination of U.S. Department of basis of age; ancestry; color; creed; Agriculture and Other Washington, D.C. marital status; mental or physical • Developing automated tools to Buildings During the Anthrax Attack of disability; national origin; race; religious October 2001," Applied and Environmental affiliation, belief, or opinion; sex; or identify released biological agents sexual orientation and plies to the 6 Microbiology, 69(1): pp. 593-599. to support response operations. provisions of employment and granting 11. Executive Office of the President, The White of advantages, privileges and accommodations. • Improving information sharing House. 2003. "FY2004 Budget Fact Sheet," October 1. The Department, in compliance with and situational awareness. the Americans with Disabilities Act, 12. IOM. 2009. BioWatch and Public Health ensures that qualified individuals with • Providing support for clinical case Surveillance: Evaluating Systems for the Early disabilities are given an opportunity to recognition and reporting by Detection of Biological Threats. The National participate in and benefit from DHMH health care providers.12 Academies, Report Brief, December. services, programs, benefits, and employment opportunities. This article was written by Kenneth Okogi.

Page 4 Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • September 2010 • Vol. 14, No. 9 SALMONELLA F 2 2 OUT OF STATE M 60 1 BALTIMORE CITY F 2 1 OUT OF STATE F 51 1 MONTGOMERY M 37 1 OUT OF STATE F 5 1 MONTGOMERY M 36 1 OUT OF STATE M 2 1 PRINCE GEORGE'S M 29 1 OUT OF STATE M 0 1 PRINCE GEORGE'S M 28 1 OUT OF STATE F 83 1 WASHINGTON M 2 1 OUT OF STATE SALMONELLA SER. 4,12:I:- M 2 1 OUT OF STATE M 0 1 BALTIMORE CITY M 0 1 OUT OF STATE F 14 1 BALTIMORE CITY F 0 1 PRINCE GEORGE'S SALMONELLA SER. 4,5,12:I:- M 46 1 PRINCE GEORGE'S M 57 1 CALVERT M 77 1 WICOMICO F 36 1 FREDERICK SALMONELLA SER. INFANTIS Reported by the U 4 1 OUT OF STATE F 7 1 BALTIMORE CITY F 4 2 OUT OF STATE SALMONELLA SER. JAVIANA Laboratories Administration M 47 1 PRINCE GEORGE'S F 0 1 BALTIMORE covering results from the month of F 61 1 TALBOT F 0 1 WICOMICO SALMONELLA SER. 6,7:M,T:- SALMONELLA SER. MIAMI JulyJuly 20102010 U 0 1 MONTGOMERY M 22 1 PRINCE GEORGE'S F 43 1 OUT OF STATE SALMONELLA SER. MUENSTER ENTERIC BACTERIOLOGY SALMONELLA SER. ALBANY F 51 1 OUT OF STATE F 88 1 MONTGOMERY SALMONELLA SER. NEWPORT GENUS SEROVAR SALMONELLA SER. BARDO U 0 1 ANNE ARUNDEL SEX AGE # JURISDICTION F 61 1 CARROLL M 43 1 CHARLES SALMONELLA SER. BERTA F 9 1 OUT OF STATE CAMPYLOBACTER JEJUNI U 0 1 BALTIMORE M 2 1 TALBOT U 27 1 ANNE ARUNDEL U 10 1 BALTIMORE SALMONELLA SER. SAINTPAUL F 50 1 BALTIMORE M 68 1 OUT OF STATE M 2 1 OUT OF STATE F 20 1 BALTIMORE SALMONELLA SER. ENTERITIDIS F 84 1 WICOMICO F 16 1 BALTIMORE F 60 1 BALTIMORE SALMONELLA SER. TYPHI F 8 1 BALTIMORE F 54 1 BALTIMORE M 29 1 MONTGOMERY M 0 1 BALTIMORE F 6 1 BALTIMORE M 1 1 MONTGOMERY M 62 1 BALTIMORE F 2 1 BALTIMORE M 1 3 OUT OF STATE M 58 1 BALTIMORE M 60 1 BALTIMORE SALMONELLA SER. TYPHIMURIUM M 49 1 BALTIMORE M 32 1 BALTIMORE F 52 1 CALVERT M 38 1 BALTIMORE M 15 1 BALTIMORE M 41 1 KENT M 30 1 BALTIMORE M 9 1 BALTIMORE F 18 1 WASHINGTON M 12 1 BALTIMORE M 6 1 BALTIMORE M 2 1 WASHINGTON M 10 1 BALTIMORE M 2 1 BALTIMORE SALMONELLA SER. UNTYPEABLE F 58 1 BALTIMORE CITY U 69 1 BALTIMORE CITY F 0 1 TALBOT F 87 1 KENT U 58 1 BALTIMORE CITY SHIGELLA FLEXNERI F 55 1 KENT U 50 1 BALTIMORE CITY M 9 1 ANNE ARUNDEL F 62 1 MONTGOMERY U 38 1 BALTIMORE CITY F 24 1 BALTIMORE CITY M 17 1 MONTGOMERY U 20 1 BALTIMORE CITY M 9 1 OUT OF STATE U 41 1 OUT OF STATE U 8 1 BALTIMORE CITY U 0 1 PRINCE GEORGE'S U 26 1 OUT OF STATE F 72 1 BALTIMORE CITY U 45 1 PRINCE GEORGE'S U 25 1 OUT OF STATE F 61 1 BALTIMORE CITY SHIGELLA FLEXNERI II:3,4 U 17 1 OUT OF STATE F 50 1 BALTIMORE CITY M 41 1 MONTGOMERY U 7 1 OUT OF STATE F 38 1 BALTIMORE CITY M 22 1 OUT OF STATE U 1 1 OUT OF STATE M 58 1 BALTIMORE CITY SHIGELLA SONNEI F 50 1 OUT OF STATE M 51 1 BALTIMORE CITY M 0 1 BALTIMORE CITY F 49 1 OUT OF STATE M 46 1 BALTIMORE CITY M 23 1 BALTIMORE CITY F 38 1 OUT OF STATE M 29 1 BALTIMORE CITY M 5 1 FREDERICK M 0 1 OUT OF STATE M 0 2 BALTIMORE CITY M 70 1 MONTGOMERY M 48 1 OUT OF STATE M 0 2 BALTIMORE CITY M 1 1 OUT OF STATE M 46 1 OUT OF STATE M 16 1 CARROLL M 0 1 OUT OF STATE M 32 1 OUT OF STATE F 34 2 CECIL F 58 1 WASHINGTON M 27 3 OUT OF STATE U 67 1 OUT OF STATE VIBRIO PARAHAEMOLYTICUS M 4 1 OUT OF STATE U 41 1 OUT OF STATE M 76 1 BALTIMORE CITY M 2 1 OUT OF STATE U 28 1 OUT OF STATE M 61 1 CALVERT F 74 1 TALBOT U 2 1 OUT OF STATE VIBRIO VULNIFICUS , SEROTYPE 0157:H7 F 68 1 OUT OF STATE M 45 1 CHARLES F 40 1 ANNE ARUNDEL F 65 2 OUT OF STATE YERSINIA ENTEROCOLITICA U 6 1 CECIL F 46 1 OUT OF STATE U 23 1 BALTIMORE M 28 2 OUT OF STATE F 40 1 OUT OF STATE F 42 1 WASHINGTON F 25 1 OUT OF STATE TOTAL 158 F 25 1 OUT OF STATE

Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • September 2010 • Vol. 14, No. 9 Page 5 ISOLATES - REFERENCE STAPHYLOCOCCUS, M 2 CECIL COAGULASE NEGATIVE F 6 CHARLES GENUS SPECIES BLOOD 1 BALTIMORE CITY M 5 CHARLES F 1 DORCHESTER SOURCE # JURISDICTION WOUND 1 CARROLL M 2 DORCHESTER WOUND 1 FREDERICK LABIA 1 PRINCE GEORGE'S F 4 FREDERICK KLEBSIELLA PNEUMONIAE M 2 FREDERICK STREPTOCOCCUS, ALPHA-HEMOLYTIC URINE 1 CHARLES F 1 GARRETT MOUTH 1 TALBOT WOUND 3 CHARLES F 11 HARFORD MORAXELLA SPECIES STREPTOCOCCUS, M 7 HARFORD BLOOD 1 ANNE ARUNDEL BETA HEMOLYTIC GROUP B F 3 HOWARD BLOOD 1 BALTIMORE CITY M 5 HOWARD TOTAL 5 CSF 2 BALTIMORE CITY F 9 MONTGOMERY LUNG 1 BALTIMORE CITY M 6 MONTGOMERY VAGINAL 1 MONTGOMERY F 50 PRINCE GEORGE'S VAGINAL 3 PRINCE GEORGE'S M 64 PRINCE GEORGE'S VAGINAL 9 PRINCE GEORGE'S U 1 PRINCE GEORGE'S ISOLATES - MISCELLANEOUS STREPTOCOCCUS, VIRIDANS GROUP F 2 QUEEN ANNE'S BLOOD 2 BALTIMORE CITY F 1 SAINT MARY'S GENUS SPECIES F 4 SOMERSET SOURCE # JURISDICTION TOTAL 58 M 3 SOMERSET F 2 TALBOT

M 1 TALBOT ACHROMOBACTER SPECIES F 1 WASHINGTON SPUTUM 1 WASHINGTON M 1 WASHINGTON ACTINOMYCES MEYERI SEXUALLY TRANSMITTED DISEASES F 17 WICOMICO BLOOD 1 BALTIMORE CITY GENUS SPECIES M 8 WICOMICO CLOSTRIDIUM SPECIES SEX # JURISDICTION U 1 WICOMICO BLOOD 1 BALTIMORE CITY F 3 WORCESTER CORYNEBACTERIUM SPECIES SYPHILIS SEROLOGY M 3 WORCESTER BLOOD 1 BALTIMORE CITY F 1 ANNE ARUNDEL WOUND 1 PRINCE GEORGE'S M 1 ANNE ARUNDEL TOTAL 347 ENTEROBACTER AEROGENES F 3 BALTIMORE BLOOD 1 BALTIMORE CITY M 5 BALTIMORE NEISSERIA GONORRHOEAE ENTEROCOCCUS FAECALIS F 14 BALTIMORE CITY M 1 ALLEGANY F 1 ANNE ARUNDEL VAGINAL 1 PRINCE GEORGE'S M 32 BALTIMORE CITY F 2 BALTIMORE ESCHERICHIA COLI U 4 BALTIMORE CITY M 4 BALTIMORE BLOOD 3 BALTIMORE CITY M 1 CECIL M 1 CHARLES M 1 CALVERT VAGINAL 2 MONTGOMERY F 2 DORCHESTER VAGINAL 1 PRINCE GEORGE'S M 3 HARFORD F 5 MONTGOMERY F 1 HARFORD KLEBSIELLA PNEUMONIAE M 5 MONTGOMERY M 1 HARFORD ARM 1 MONTGOMERY F 10 PRINCE GEORGE'S M 2 HOWARD MORGANELLA MORGANII M 27 PRINCE GEORGE'S F 1 MONTGOMERY WOUND 1 CARROLL M 1 WASHINGTON M 4 MONTGOMERY PROTEUS MIRABILIS U 1 WICOMICO F 13 PRINCE GEORGE'S BLOOD 1 BALTIMORE CITY M 18 PRINCE GEORGE'S SPUTUM 2 WASHINGTON TOTAL 114 F 5 WICOMICO PSEUDOMONAS AERUGINOSA M 3 WICOMICO BLOOD 1 BALTIMORE CITY CHLAMYDIA TRACHOMATIS F 1 WORCESTER

SPUTUM 1 CARROLL F 3 ALLEGANY TOTAL 60 SALMONELLA ENTERITIDIS M 2 ALLEGANY BLOOD 1 BALTIMORE CITY F 26 ANNE ARUNDEL STAPHYLOCOCCUS AUREUS M 7 ANNE ARUNDEL F 24 BALTIMORE WOUND 1 ANNE ARUNDEL M 10 BALTIMORE BLOOD 2 BALTIMORE CITY MYCOBACTERIOLOGY F 11 BALTIMORE CITY WOUND 1 BALTIMORE CITY M 23 BALTIMORE CITY ISOLATE NASAL 2 CARROLL U 1 BALTIMORE CITY SEX AGE # JURISDICTION WOUND 1 CARROLL F 5 CALVERT WOUND 1 CARROLL M 3 CALVERT MYCOBACTERIUM AVIUM COMPLEX VAGINAL 1 PRINCE GEORGE'S U 1 CALVERT F 57 1 ANNE ARUNDEL WOUND 2 PRINCE GEORGE'S F 2 CARROLL F 74 1 ANNE ARUNDEL NASAL 2 WASHINGTON M 2 CARROLL F 32 1 BALTIMORE F 1 CECIL

Page 6 Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • September 2010 • Vol. 14, No. 9 F 72 1 BALTIMORE M 47 1 OUT OF STATE MYCOBACTERIUM F 83 3 BALTIMORE M 66 1 OUT OF STATE SUSCEPTIBILITY RESULTS M 51 1 BALTIMORE MYCOBACTERIUM M 63 3 BALTIMORE TUBERCULOSIS COMPLEX 19 ISOLATES IDENTIFIED M 66 2 BALTIMORE F 50 4 ANNE ARUNDEL 4 DRUG RESISTANT STRAINS FOUND M 75 1 BALTIMORE M 52 2 ANNE ARUNDEL M 81 1 BALTIMORE F 28 1 BALTIMORE # JURISDICTION DRUG(S) F 23 1 BALTIMORE CITY F 29 5 BALTIMORE F 47 1 BALTIMORE CITY F 30 1 BALTIMORE 1 BALTIMORE CITY ISONIAZID B F 52 1 BALTIMORE CITY M 24 1 BALTIMORE 1 PRINCE GEORGE'S PYRAZINAMIDE F 53 2 BALTIMORE CITY M 20 1 BALTIMORE CITY 1 MONTGOMERY ISONIAZID M 44 2 BALTIMORE CITY M 60 1 BALTIMORE CITY 1 FREDERICK STREPTOMYCIN M 47 1 BALTIMORE CITY M 79 2 CHARLES A M 62 3 BALTIMORE CITY F 39 2 HOWARD TWO ISOLATES FROM THE SAME PATIENT B PROBABLE FOR M. BOVIS M 66 1 BALTIMORE CITY M 42 2 HOWARD C MEETS CASE DEFINITION OF M 60 1 CARROLL M 45 1 HOWARD MULTI-DRUG TUBERCULOSIS (MDRTB)

F 77 1 FREDERICK F 19 3 MONTGOMERY Mycobacterium tuberculosis complex consists of: F 84 1 FREDERICK F 85 1 MONTGOMERY M. tuberculosis M. africanum F 87 2 FREDERICK M 57 8 MONTGOMERY M. bovis M. microti F 51 1 MONTGOMERY M 68 1 MONTGOMERY M. bovis, BCG M. canettii M 47 1 MONTGOMERY M 77 1 MONTGOMERY F 77 1 OUT OF STATE M 66 1 OUT OF STATE M 48 1 PRINCE GEORGE'S M 79 1 OUT OF STATE M 69 1 PRINCE GEORGE'S F 22 1 PRINCE GEORGE'S FOOD PROTECTION M 53 1 TALBOT F 38 1 PRINCE GEORGE'S TOTALS M 34 1 WASHINGTON M 48 1 PRINCE GEORGE'S FOOD F 63 1 WICOMICO MYCOBACTERIUM XENOPI NUMBER OF SAMPLES 41 M 80 1 WICOMICO F 65 1 BALTIMORE NOTABLE PATHOGENS: MYCOBACTERIUM FORTUITUM COMPLEX M 68 3 BALTIMORE F 58 1 BALTIMORE CITY SCOTOCHROMOGENIC MYCOBACTERIA CAMPYLOBACTER SP. 0 F 84 1 FREDERICK M 27 1 PRINCE GEORGE'S CLOSTRIDIUM DIFFICILE 0 F 33 1 HOWARD ENTEROCOCCUS 0 M 66 2 OUT OF STATE TOTAL 133 E. COLI 0 M 79 1 OUT OF STATE E. FAECALIS 0 M 27 1 PRINCE GEORGE'S LISTERIA SP. 0 F 65 1 WICOMICO MRSA 0 MYCOBACTERIUM GORDONAE M 70 1 ANNE ARUNDEL PARASITOLOGY SALMONELLA SP. 0 M 27 1 BALTIMORE VRE 0 M 49 1 BALTIMORE GENUS/SPECIES M 75 1 BALTIMORE # JURISDICTION CRABMEAT F 62 1 FREDERICK NUMBER OF SAMPLES 6 M 63 1 HARFORD ENDOLIMAX NANA EXCEEDING STANDARDS1 0 F 33 1 HOWARD 2 PRINCE GEORGE'S NOTABLE PATHOGENS: M 45 1 HOWARD 2 MONTGOMERY LISTERIA INNOCUA 0 M 55 1 HOWARD 1 PRINCE GEORGE'S F 51 1 MONTGOMERY 2 MONTGOMERY M 28 1 MONTGOMERY 1 MONTGOMERY SHELLFISH F 57 1 PRINCE GEORGE'S ENTAMOEBA COLI NUMBER OF SAMPLES 3 F 84 1 PRINCE GEORGE'S 1 PRINCE GEORGE'S EXCEEDING STANDARDS2 0 F 89 1 PRINCE GEORGE'S 1 MONTGOMERY F 71 1 WICOMICO 2 PRINCE GEORGE'S TOTAL STANDARDS EXCEEDED 0 MYCOBACTERIUM KANSASII 1 WASHINGTON M 75 2 BALTIMORE 2 MONTGOMERY M 68 3 BALTIMORE CITY ENTAMOEBA HARTMANNI SHELLFISH GROWING WATERS F 77 1 OUT OF STATE 3 ANNE ARUNDEL NUMBER OF SAMPLES 358 MYCOBACTERIUM TUBERCULOSIS ENTEROBIUS VERMICULARIS F 29 1 BALTIMORE 1 MONTGOMERY M 72 1 BALTIMORE 1 WASHINGTON TOTAL NUMBER OF SAMPLES 408 M 12 1 BALTIMORE CITY GIARDIA LAMBLIA M 20 1 BALTIMORE CITY 1 FREDERICK M 47 1 BALTIMORE CITY 3 MONTGOMERY STANDARDS F 39 1 HOWARD 1 PRINCE GEORGE'S F 19 1 MONTGOMERY 1 HOWARD 1CRABMEAT FRESH M 57 1 MONTGOMERY HOOKWORM ESCHERICHIA COLI AT < 36 MPN/100 GRAMS U 18 1 OUT OF STATE 1 MONTGOMERY F 25 1 OUT OF STATE STANDARD PLATE COUNT AT < 100 IODAMOEBA BÜTSCHLII M 22 1 OUT OF STATE 2 PRINCE GEORGE'S 2 M 43 1 OUT OF STATE 1 PRINCE GEORGE'S SHELLFISH M 45 1 OUT OF STATE FECAL COLIFORMS AT < 230 MPN/100 GRAMS M 46 1 OUT OF STATE TOTAL 30 STANDARD PLATE COUNT AT < 500,000 PER GRAM

Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • September 2010 • Vol. 14, No. 9 Page 7 WATER MICROBIOLOGY F 26 1 PRINCE GEORGE'S 33 2 WASHINGTON F 34 1 PRINCE GEORGE'S 10 0 WICOMICO F 36 2 PRINCE GEORGE'S # TESTED # NON-COMPLIANT M 40 1 PRINCE GEORGE'S SUBTOTAL COMMUNITY 0 0 F 19 1 SOMERSET 962 119 U 18 1 TALBOT NON-COMMUNITY 497 123 F 31 1 WASHINGTON TOTALS

F 18 1 WICOMICO 2,646 136 TOTAL 497 123 F 28 1 WICOMICO INFLUENZA A(H1/N1) NOVEL A F 14 1 BALTIMORE CITY VIRUS

ISOLATE TOTAL 55 RABIES

SEX AGE # JURISDICTION SOURCE # JURISDICTION

PARAINFLUENZA VIRUS 3 BAT 1 ANNE ARUNDEL F 79 1 FREDERICK VIRAL HEPATITIS 1 BALTIMORE CITY TOTAL 1 ORGANISM 1 FREDERICK # SPECIMENS 1 HOWARD # POSITIVES 4 MONTGOMERY 1 PRINCE GEORGE'S JURISDICTION VIRAL POLYMERASE 1 TALBOT CAT 1 BALTIMORE CHAIN REACTION (PCR) HEPATITIS B 1 HARFORD 63 1 ALLEGANY 1 WORCESTER ISOLATE 120 3 ANNE ARUNDEL SEX AGE # JURISDICTION FOX 1 PRINCE GEORGE'S 49 0 BALTIMORE 1 SAINT MARY'S 401 6 BALTIMORE CITY HERPES SIMPLEX VIRUS TYPE 1 1 WICOMICO 14 0 CALVERT F 19 1 BALTIMORE CITY 2 WORCESTER 18 0 CARROLL F 30 1 BALTIMORE CITY RACCOON 1 BALTIMORE 125 1 CECIL F 21 2 CARROLL 1 CHARLES F 18 1 CECIL 8 0 CHARLES 2 FREDERICK U 19 1 HARFORD 30 0 FREDERICK 2 GARRETT F 24 2 PRINCE GEORGE'S 16 0 GARRETT 1 MONTGOMERY F 26 1 PRINCE GEORGE'S 75 1 HARFORD 1 PRINCE GEORGE'S 1 SOMERSET HERPES SIMPLEX VIRUS TYPE 2 20 1 HOWARD 1 TALBOT F 20 1 ANNE ARUNDEL 4 0 KENT 1 WICOMICO F 27 1 ANNE ARUNDEL 321 0 MONTGOMERY 2 WORCESTER F 39 1 BALTIMORE 319 4 PRINCE GEORGE'S

U 0 1 BALTIMORE CITY 3 0 SAINT MARY'S TOTAL U 24 1 BALTIMORE CITY 1 0 SOMERSET POSITIVES 31 4 0 TALBOT U 32 1 BALTIMORE CITY 1 0 UNKNOWN F 0 2 BALTIMORE CITY TOTAL 37 0 WASHINGTON F 13 1 BALTIMORE CITY SPECIMENS 518 F 17 1 BALTIMORE CITY 55 0 WICOMICO F 22 1 BALTIMORE CITY F 24 1 BALTIMORE CITY SUBTOTAL F 25 1 BALTIMORE CITY 1,684 17 CHLAMYDIOPHILIA PSITTACI F 29 1 BALTIMORE CITY (CHLAMYDIA) F 43 1 BALTIMORE CITY HEPATITIS C M 18 1 BALTIMORE CITY 53 11 ALLEGANY REPORTED QUARTERLY M 23 1 BALTIMORE CITY 130 22 ANNE ARUNDEL NO REPORT THIS MONTH M 24 1 BALTIMORE CITY 56 8 BALTIMORE M 28 2 BALTIMORE CITY 213 44 BALTIMORE CITY M 29 1 BALTIMORE CITY 13 1 CALVERT CD4 FLOW CYTOMETRY WORKLOAD

M 32 1 BALTIMORE CITY 23 1 CARROLL M 49 1 BALTIMORE CITY REPORTED QUARTERLY 85 13 CECIL NO REPORT THIS MONTH U 53 1 BALTIMORE CITY 10 0 CHARLES F 38 1 CALVERT 1 0 DORCHESTER F 35 1 CECIL 31 1 FREDERICK BLOOD LEAD F 20 1 HARFORD 17 0 GARRETT MARYLAND M 29 1 HARFORD 31 3 HARFORD F 26 1 MONTGOMERY I <10 35 12 1 HOWARD F 28 1 MONTGOMERY IIA 10-14 0 5 2 KENT F 29 1 MONTGOMERY IIB 15-19 0 62 2 MONTGOMERY M 32 1 MONTGOMERY 170 8 PRINCE GEORGE'S III 20-44 0 M 45 1 MONTGOMERY IV 45-69 0 F 21 1 PRINCE GEORGE'S 2 0 SAINT MARY'S V >69 0 F 25 1 PRINCE GEORGE'S 1 0 SOMERSET 4 0 TALBOT TOTAL 35

Page 8 Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • September 2010 • Vol. 14, No. 9 NEWBORN & CHILDHOOD SCREENING ENVIRONMENTAL CHEMISTRY COMPLIANT COMPLIANT

PRESUMPTIVE POSITIVES # TESTED SAMPLE # NON- TYPES DISORDERS # PHENYLKETONURIA (PKU) 2 MAPLE SYRUP URINE DISEASE (MSUD) 1 HOMOCYSTINURIA 8 ASBESTOS TYROSINEMIA 2 AIR 0 0 ARGININEMIA 0 BULK 0 4 CITRULLINEMIA 1 AIR QUALITY

GALACTOSEMIA 1 PM 2.5 0 915 BIOTINIDASE DEFICIENCY 14 RADIATION HYPOTHYROIDISM 85 AIR/CHARCOAL FILTERS 0 64 HEMOGLOBIN -DISEASE 15 MILK 0 3 HEMOGLOBIN -BENIGN 497 WIPES 0 39 CONGENITAL ADRENAL HYPERPLASIA (CAH) 33 RAW WATER 0 3 CYSTIC FIBROSIS 2 VEGETATION 0 0 FATTY ACID OXIDATIONS 8 OTHER 0 2 ORGANIC ACIDEMIAS 6 DRINKING WATER ACYLCARNITINE - BORDERLINE 10 METALS ACYLCARNITINE - OTHERS 0 COMMUNITY 15 39 MONTHLY TOTALS NON-COMMUNITY 8 16 # OF SPECIMENS SCREENED 13,038 PRIVATE WELLS 23 156 NUMBER OF TESTS 824,285 PESTICIDES & PCBs % UNSATISFACTORY SPECIMENS 1.5 COMMUNITY 0 20 2010 YEAR-TO-DATE CONFIRMED CASES NON-COMMUNITY 0 8 CONDITIONS # CONFIRMED PRIVATE WELLS 0 0 MEDIUM CHAIN ACYL-CoA DEHYDROGENASE DEFICIENCY (MCAD) 2 VOLATILE ORGANIC COMPOUNDS SHORT CHAIN ACYL-CoA DEHYDROGENASE DEFICIENCY (SCAD) 7 COMMUNITY 1 78 ELEVATED FORMIMINOGLUTAMIC ACID (FIGLU) 1 NON-COMMUNITY 0 50 3-METHYLCROTONYL-COA CARBOXYLASE DEFICIENCY (3-MCC) 3 PRIVATE WELLS 0 58 GLUTARIC ACIDURIA TYPE 1 (GA-1) 1 RADIATION GALACTOSE EPIMERASE DEFICIENCY 1 COMMUNITY 1 22 GALACTOSEMIA - VARIANT -DG 3 NON-COMMUNITY 0 10 GALACTOSEMIA - UNKNOWN VARIANT 1 PRIVATE WELLS 1 16 CONGENITAL ADRENAL HYPERPLASIA-SALT WASTING 2 INORGANICS CONGENITAL ADRENAL HYPERPLASIA-UNCLASSIFIED 1 COMMUNITY 1 49 HYPOTHYROIDISM - PRIMARY 16 NON-COMMUNITY 8 71 OTHER HYPOTHYROIDISM 9 PRIVATE WELLS 1 129 TBG DEFICIENCY 5 FOOD CHEMISTRY SICKLE CELL DISEASE -SS 30 SUSPECTED 0 12 SICKLE CELL DISEASE -SC 19 TAMPERING SICKLE CELL DISEASE -S BETA THALASSEMIA 3 MICROSCOPIC FILTH 0 3

SICKLE CELL DISEASE-SV 1 LABELING 0 0 SICKLE CELL TRAIT 1 SURVEILLANCE 0 11 HEMOGLOBIN VARIANT 1 CHEMICAL 0 0 CYSTIC FIBROSIS 4 CONTAMINATION CFTR-RELATED METABOLIC SYNDROME (CRMS) 1 TRANSIENT TYROSINEMIA 5 TOTAL 59 1,778

Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • September 2010 • Vol. 14, No. 9 Page 9 VIRAL LOAD SPECIMENS HIV ANTIBODY SCREENING SPECIMENS SPECIMENS TOTALS TOTALS 10 10 POSITIVE POSITIVE POSITIVE POSITIVE TOTAL <10 >10 % EIA % WB # EIA # EIA # WB 3 4 —10 —10 HIV-1 RNA COPIES/ML SUBMITTER 3 5

4 5

CORRECTIONAL INSTITUTIONS 181 2 1.10% 1 50.00% ALLEGANY 13 0 2 0 15 FAMILY PLANNING 158 1 0.63% 0 0.00% (NON-GOVERNMENT) CARROLL 0 1 0 0 1 HEALTH CENTERS 345 31 8.99% 31 100.00% (NON-GOVERNMENT) FREDERICK 2 1 0 0 3 HLTH DEPT, NON-STD, FAMILY PLAN 408 0 0.00% 0 0.00%

MONTGOMERY 80 6 4 2 92 HLTH DEPT, NON-STD, OB/GYN 82 0 0.00% 0 0.00%

HLTH DEPT, NON-STD, OTHER 567 40 7.05% 38 95.00% PRINCE GEORGE'S 126 14 21 7 168 HLTH DEPT, STD CLINICS 947 7 0.74% 7 100.00%

SOMERSET 0 1 0 0 1 HOSPITAL, OTHER 98 10 10.20% 10 100.00%

HOSPITAL, PUBLIC 21 0 0.00% 0 0.00% WASHINGTON 2 2 1 0 5 JUVENILE SERVICES 70 1 1.43% 1 100.00%

WICOMICO 0 0 2 2 4 LABORATORIES (NON-HOSPITAL) 347 16 4.61% 6 37.50%

PEDIATRIC - CHILD HEALTH 10 0 0.00% 0 0.00% SUBTOTALS 223 25 30 11 289 PRIVATE PHYSICIANS 7 2 28.57% 1 50.00% DEPT. OF 15 4 0 1 20 CORRECTIONS PRIVATE STUDENT HEALTH CNTRS 23 0 0.00% 0 0.00% PUBLIC STUDENT HEALTH CENTERS 223 3 1.35% 1 33.33% TOTALS 238 29 30 12 309

TOTALS 3,487 113 3.24% 96 84.96%

MAILING LABEL LABEL MAILING

Baltimore, Maryland 21201 21201 Maryland Baltimore,

201 West Preston Street Street Preston West 201

Department of Health & Mental Hygiene Hygiene Mental & Health of Department

J. Mehsen Joseph Public Health Laboratory Laboratory Health Public Joseph Mehsen J.

c/o Georgia Corso, Room L-15 L-15 Room Corso, Georgia c/o Critical Link Link Critical

Page 10 Critical Link • www.dhmh.state.md.us/labs/html/critical-link.html • December 2008 • Vol. 12, No. 12