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Pulsenet Winter 05 In This Issue • NE Area PN Meeting • Lab Profile: FDA/CVM • Server Training • FAQs • BioNumerics Workshop • Publications and Abstracts • Lab Profile: NC • Welcomes and Farewells VOLUME 4 • ISSUE 1 • WINTER 2005 tured to permit the greatest amount of time were an opportunity for all states within the NORTHEAST AREA for breakout discussions in small groups. region to hear the challenges faced by their Participants from each state were randomly colleagues, as well as to learn about the PULSENET MEETING grouped to allow for more open discussion successful components of the many different Lee Wotherspoon, MPH, PFGE Laboratory, Massachusetts State Laboratory and greater exposure to new ideas. systems presented. The presentations shed Institute, Jamaica Plain, MA At the start of the conference, each state light on the enormous diversity in the activi- The first Northeast Area PulseNet Meeting presented an overview of the foodborne ill- ties surrounding PulseNet in each state. The was held June 22–23, 2004, in Boston, ness surveillance and response systems in Northeast states vary greatly in areas such MA. Hosted by the Massachusetts Pulsed- place within their state. The laboratorians, as funding, dedicated personnel, laborato- Field Gel Electrophoresis (PFGE) Lab and epidemiologists, and directors from each ry resources, and working relationships the National Laboratory Training Network state jointly created these presentations to between laboratory and epidemiology staff. (NLTN), the meeting was attended by lab provide the perspectives of the various par- The breakout sessions following the state directors, epidemiologists, and laboratori- ties involved in foodborne illness surveil- presentations challenged participants to ans from Connecticut, Maine, lance and response. The state presentations (Continued on page 2) Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont, the Centers for Disease Control and LABORATORY PROFILE: FDA/CVM Prevention (CDC), and the Association of Public Health Laboratories (APHL). The meeting was closely modeled after the FOOD AND DRUG ADMINISTRATION/CENTER Midwest Area Meeting hosted by Minnesota in October of 2003. Many of FOR VETERINARY MEDICINE (FDA/CVM) the ideas generated by that meeting were used to develop an agenda that would Shaohua Zhao, DVM, MPVM, Ph.D., Office of Research, Food and Drug decision-making by the CVM. Currently, the allow for multidisciplinary discussions of Administration/Center for Veterinary Medicine, Laurel, MD division is involved in three major pro- improving foodborne disease sur- The Food and Drug grams: the National Antimicrobial veillance in the Northeast and Administration (FDA) Resistance Monitoring System (NARMS); nationwide. Center for Veterinary the National Committee for Clinical The goals of the meeting were Medicine (CVM) Laboratory Standards (NCCLS), focusing on to (1) openly discuss issues affect- joined PulseNet the standardization of antimicrobial suscep- ing identification and response to in 1998. The tibility testing; and PulseNet. There are five foodborne illness within PulseNet PulseNet laborato- microbiologists on the CVM PulseNet team: programs, (2) increase under- ry is located with- Dr. Shaohua Zhao, who oversees the pro- standing of epidemiology and labo- in the Division of gram; Sharon Friedman, who conducts ratory roles and activities within their Animal and Food PFGE analysis and is responsible for moni- public health system, (3) develop strate- Microbiology toring laboratory QA/QC; Sadaf Qaiyumi, gies to increase PulseNet effectiveness (DAFM), Office of who performs PFGE and also works on PCR in identification and response to food- Research in Laurel, and DNA sequence analysis in investigat- borne illness within PulseNet programs, MD. The overall ing the mechanisms of antimicrobial resist- and (4) develop recommendations for mission of the division ance; David Melka, who is responsible for implementing these strategies. is to conduct basic PFGE analysis of all Campylobacter isolat- The meeting was comprised of presen- and applied research on ed from NARMS; and Jason Abbott, who tations and breakout sessions. It was struc- zoonotic pathogens to support regulatory (Continued on page 4) www.cdc.gov/pulsenet 1 News PulseNet Meeting (Continued from page 1) participate in PulseNet-Area conference calls, and have CDC Health to encourage compliance with unfunded mandates. provide a template for how to share data between epi and (5) There is need for improved standardization. Standardized identify the strengths and weaknesses within lab programs (states that have successful programs for protocols are credited with the great success of the their state PulseNet programs. Participants sharing lab and epi data could provide CDC and other states laboratory end of the PulseNet program. Extending this were encouraged to discuss what some states with a template). standardization is recommended to improve the overall pro- were doing well that could be used to address (2) Laboratorians and epidemiologists are still searching for the gram. The participants would like CDC to recommend that problems within other states. The issues raised best algorithm to define a cluster. While most participants state epis use standardized tools and share field-tested and solutions offered covered a wide spectrum expressed a desire for CDC to make clear determinations, questionnaires. We would also like for CDC to improve the of topics. Among the key findings from this some steps were recommended to improve the process. standardization of the PFGE proficiency test. conference were: First, test all available isolates if possible to increase the (6) There is a lack of public awareness and political clout. (1) There is a need for improved Epi-Lab integration. Most par- library of patterns. Also, communicate with epidemiologists With resources being a No. 1 issue in most states, partici- ticipants described frustration with Epi-Lab relations at the before posting to the WebBoard, and involve epis in data pants express a concern that the public and the decision state or national level. Some of the Epi-Lab issues men- analysis; i.e. in determining the significance of a pattern at makers are not well enough aware of the important work tioned were lack of integrated data or ability to share data the state, regional, or national level. done by the PulseNet programs in our states. To help efficiently, one-way communication with no reports coming (3) WebBoard: We need to improve the postings and decrease insure the future of PulseNet, it is recommended that APHL back to the lab, and lack of understanding or appreciation the burden. While the WebBoard is recognized as a great assist public health laboratories in developing and carrying of roles and responsibilities for both laboratorians and epi- tool, many lab staff want better training on use of the out a PulseNet Public Relations Campaign by sending exec- demiologists. Collaborative solutions recommended for WebBoard. Better monitoring of the WebBoard is also rec- utive summaries to commissioners, governors, and legisla- improving Epi-Lab functioning at the state level were: create ommended at the state labs. In order to decrease the bur- tors and using presentations or mailings to increase knowl- a shared, cluster database available to lab and epi staff; den of the many postings, ideas generated at the confer- edge and presence of PulseNet as an essential component use existing tools such as weekly reports; seek IT support; ence such as simpler response fields, tallies, and checkbox- of implementing the mission of public health departments. develop communication strategies at the state level; send es have been recommended to CDC. reports to the lab once epi investigations are closed; devel- (4) There is a need for improved isolate and case report sub- Based on the key findings from the discus- op Epi-Lab working groups; and provide Lab 101 and Epi mission. Both the lab and epi staffs are limited in what sion sessions, the participants from each state 101 trainings, orientations, and shadowing. To improve they can do for foodborne disease surveillance and devised an action plan specifically tailored to PulseNet functioning at the regional and national levels, the response by the submission of isolates and case reports. To address the most important issues in their state. following actions were recommended: designate PulseNet improve submission, the following ideas were recommend- The action plans were presented by each state epidemiologist(s) in each state, combine Epi-X listings with ed: mandate isolate submission by updating requirements, (laboratorians, epidemiologists, and directors) corresponding WebBoard postings, provide and define epi and include a PulseNet and Epi overview on bioterrorism at the close of the meeting to offer a public privileges and responsibilities for PFGE data, have epis education/training offered to hospitals and Local Boards of (Continued on page 4) Susan Hunter, M.S., Foodborne and Diarrheal Diseases PULSENET BIONUMERICS SERVER SETUP WORKSHOP Laboratory Section, Centers for Disease Control and Prevention, Atlanta, GA participant had both a client and a server computer. This made it possible for the students to actually create a server database during the workshop and log on to it from their client database during the exercis- es. Topics covered and exercises performed included: an overview of PulseNet server setup including server scripts; setting up an on-line PulseNet server data-
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