Programs in Review
The first NEB dinner-lecture of the year, co-sponsored with the Massachusetts Department of Public Heath (MDPH), was held at the Best Western TLC Hotel in Waltham on December 3, 2002. Over thirty people attended the meeting. Ralph Timperi, Assistant Commissioner, MDPH and Director of the State Laboratory Institute (SLI) in Boston, MA spoke on The Role of Clinical Microbiology Laboratories and Bioterrorism. He pointed out that clinical laboratories are a key in the early detection and prevention of biological threats; they are as important as is the astute infectious disease physician, who recognizes and responds to unusual clusters of symptoms.
L to R: Jaclynne Laxon, PhD, Past-President, NEB,
Barbara Werner PhD and Alfred DeMaria, Jr., MD
Dr. Werner described the influenza virus as an enveloped, segmented RNA virus (orthomyxovirus). The three influenza types (A,B,C) are based on characteristics of NP and M protein; type A infects humans, pigs, and birds etc., while B and C primarily infect humans. Influenza A is divided into subtypes based on the surface glycoproteins, hemaglutinin (HA), of which there are fifteen antigenic types and neuraminidase (NA) of which there are nine antigenic types.
HA agglutinates RBC's in tissue culture, and neutralizing antibodies against it are important for immunity. Both HA and NA are involved in virus penetration/ attachment to cells.
Dr. Werner also described viral nomenclature: A/Beijing/32/92 (H3N2) indicates type/geographic origin/strain number/year of isolation/virus subtype. She reminded us that there are many variants of A (H3N2), which are antigenically related but not identical. Epidemic influenza results when new strains of the virus gradually evolve by point mutations in HA/NA surface proteins or both, errors in RNA polymerase transcription, and selection for strains that encounter the least resistance (antigenic drift). Pre-existing antibody cannot neutralize a new strain. Pandemic influenza, on the other hand, is caused by a reassortment of influenza A subtypes (antigenic shift) or by abrupt changes in HA or NA surface proteins, which can occur when cells are infected with two strains of virus. This results in a new virus containing novel HA and/or NA, which is immunologically distinct from previously circulating strains. Based on 15 HA subtypes and 9 NA subtypes, 7100 different combinations can occur.
Dr. Werner then spoke of avian influenza H5N1 (AI, fowl plague), which was first described in poultry in Italy in 1878; strains range from avirulent to highly virulent. All subtypes occur in birds, especially in the reservoir maintained in migratory waterfowl, which makes AI a worldwide problem. From waterfowl the virus can easily infect many susceptible domestic birds then travel to domestic pigs, and other animals, resulting in viral reassortment and new strains. Hence the concern about the current avian influenza strain that is spreading across Asia that has already caused a number of human deaths.
Dr. DeMaria described the clinical aspects of influenza. The virus is stable in aerosols and is transmitted and spread by coughing, sneezing, etc. It attaches to and enters columnar epithelial cells, replicates, and causes cell death, which may trigger pro-inflammatory cytokine response, with resulting tissue damage, fever, and systemic illness. The balance of viral replication and host response is critical; virulent viruses resist antiviral effects of cytokines. The incubation period for influenza is about 4 days, with symptoms lasting for 3-7 days. The entire respiratory tract may be involved, causing fever, chills, malaise, myalgias, cough, sore throat and headache. The virus can be detected up to 24 hours before onset of symptoms and is shed for 2-8 days after onset of the disease; viral shedding in children can persist for weeks. In general, more severe symptoms, i.e., seizures and death, occur more commonly in both the very young and very old. Some complications of influenza are pneumonia (primary and secondary bacterial), myocarditis, meningitis, Reye syndrome, myositis and myoglobinuria. Therefore immunization in the young and old is strongly encouraged. Dr. DeMaria mentioned that antivirals, such as Amantidine and Rimantadine, which prevent vital entry into cells, must be taken 24-48 hours after onset of symptoms. Other antivirals such as the nucleic acid inhibitors Zanamivir (Relenza) and Oseltamivir (Tamiflu) are also somewhat helpful. The evolving "universal" approach to respiratory infection control is respiratory hygiene (source control), i.e. use of masks, private rooms, personal protective equipment for staff, etc. and "cough etiquette" for patients with respiratory tract infections/cough, i.e. mouth/nose covered, hand hygiene, masks in waiting areas, etc.
Dr. Werner explained that viral culture is the gold standard for diagnosing influenza. Conventional cell culture takes 5-10 days, while the shell vial assay takes 2 days. Direct immunofluorescence is subjective, with variable sensitivity and specificity. Molecular methods were of limited availability until recently. Serology, on the other hand is retrospec-tive, since acute and convalescent specimens are needed. Rapid EIA and EIA-like tests are available, but are less sensitive and specific. She added that nasal mist vaccine may replicate in cell cultures and yield a positive result in rapid tests up to 3 weeks post immunization. Dr. Werner then showed a photograph of cells infected with influenza virus (stained using monoclonal antibody and immuno-fluorescence), and described how typing and subtyping are done using hemagglutination inhibition. She mentioned that as of 2/10/04, 226 specimens for influenza testing were received at the Massachusetts State Laboratory. There were 121 isolates of influenza H3N2; 1 isolate of H1N1; 1 of influenza B, SIC; 1 of influenza B, HK; 1 adenovirus; 1 mixed parainfluenza 3 and influenza A; 9 cultures were pending, and 1 was unsatisfactory. She then described nine commercial rapid diagnostic tests for influenza, the specimen types required for each, and specimen storage temperatures; she described rapid EIA and "EIA-Like" Tests and the antigen detected, and showed test performance (per manufacturer claims), which varied from 58-100% (CDC studies show a range of 67-96%). She added that test performance depends on the type of specimen used, with nasopharyngeal cultures giving better results. Dr. Werner described the CDC's recommended test algorithm for suspect avian influenza cases: if a specimen is positive for flu A (based upon clinical and epidemiologic data), specimens should be sent for further testing to the state public health laboratory or another laboratory with BSL3+ facilities.
Influenza is one of the leading causes of vaccine-preventable deaths, continued Dr. DeMaria. Nationally, there are 36,000 excess deaths annually, with 90% in people > 65 years. In Massachusetts an estimated >800 residents die from complications such as pneumonia, with an estimated 2600 residents hospitalized annually. Therefore vaccination against the disease is very important. The efficacy of the inactivated virus vaccine varies by batch, age group and underlying illness and there are at least fifteen antigenic variants of influenza A (H3N2). The duration of immunity is < one year. In the elderly, vaccination reduces the risk of hospitalization for heart disease, cerebrovascular disease, pneumonia and influenza, and in general reduces the risk of death from all causes. Adverse reactions to the vaccine include anaphylactic reaction to egg protein, thimerosol, latex, and any other component of the vaccine, and temporary moderate to severe illness with or without fever, local reaction occur in 10-64%, fever and malaise occur in <1%, and severe allergic and neurological reactions are rare. The inactivated vaccine is 70-90% effective in healthy young adults, and is 80% effective in preventing deaths in long term care patients.
The live attenuated influenza vaccine, developed in Russia, is administered as a nasal spray. The cold-adapted restricted replication vaccine is recommend-ed for healthy people 5-49 years old. Among the contraindications for this vaccine are allergy to eggs, history of immunodeficiency, asthma or reactive airway disease, pregnancy, and underlying conditions that increase risk for complications from influenza. The risk of transmission of the virus from recipient to immunocompromised persons is unknown, and the vaccine is not recommended for health care workers or household contacts of people who are immunocompromised.
The 2003-04 flu season was the earliest since 1976, the predominant circulating strain being A/Fujian/411/2002 (H3N2), which caused a "moderately severe" season in Australia and New Zealand. This strain is a drift from the vaccine strain A/Panama/2007/99 (H3N2), which, along with A/New Caledonia/20/99-like (H1N1) and B/Hong-Kong/330/2001-like strains comprise the 2003-04 influenza vaccine. Therefore the current vaccine offers some cross-protection against the A/Fujian-like viruses and does reduce the severity of the disease. Dr. DeMaria stressed that the benefit of vaccination is that is keeps people healthier and " A vaccine not given is 100% ineffective!" He is concerned about those people we are not reaching, such as younger people with high-risk medical conditions, health care workers, racial and ethnic minorities, and others, such as the >65 age group.
Massachusetts traditionally buys half of the vaccine used in the state, and this vaccine is targeted for those at high risk for morbidity and mortality. The vaccine is distributed to local health depart-ments, long-term care facilities, community health centers and private practitioners. However the state budget is currently down, the cost of vaccine has doubled since 2001, and the supply is limited, as there are currently only two manufacturers.
Dr. DeMaria added that a given influenza strain lasts about two years worldwide. The key to pandemic strains is antigenic shift and reassortment, as Dr. Werner previously mentioned. People and animals live closely together in Asian countries, allowing ample opportunity for viral recombination, therefore pandemic strains generally have originated there. Since the virus is new, everyone is susceptible. He then spoke of the 1918 pandemic, in which 20-40 million people died worldwide between September 1918 and April 1919, including many healthy young adults. Deaths were most likely due to cytokine response, overwhelming fever and other reactions to the virus. During the 1957 Asian Flu season (H2N2) 68,900 Americans died, and in the 1968 Hong Kong Flu season (H3N2) 33,800 died. The 1976 "Swine Flu" (H1N1) was compared to the 1918 flu, but did not spread from Fort Dix, NJ. The Hong Kong Flu 1997, occurred when avian influenza A (H5N1) was transmitted from chickens to humans, not person-to person, and resulted in 18 human cases and 6 deaths.
Avian influenza is of great concern recently, with outbreaks reported in Asia and in chicken flocks in the United States, but with a different strain (H7-subtype) than found in the Asian outbreaks. The in-cubation period is 3-14 days, it is 100% contagious, and produces respiratory symptoms and egg drop. Strains with low pathogenicity have a low mortality rate, animals may be asymptomatic and recover in 3 weeks, while strains with high pathogenicity may produce >95% mortality within 24 hours. Outbreaks have occurred among pigs (1979, 1992, 1998, 2003), horses, harbor seals (1979, 1982-83, 1992) and whales (1985). Humans are commonly infected with H1, H2 and H3, but also with other strains, such as in 1997 (Hong Kong H5N1), 1999 (China H5N1), 2003 (Hong Kong H5N1 and Netherlands H7N7).
To date there has been no documented human-human transmission of the highly pathogenic avian influenza A (H5N1) virus circulating in Asia, but fourteen human cases and 11 deaths have been confirmed in Vietnam and Thailand, with additional cases possibly occurring in China. Reassortment of genetic material between the currently circulating human influenza virus A (H1N1) or A (H3N2) and avian influenza A (H5N1) could lead to the emergence of a virus with greater infectiousness, and trigger a global pandemic.
Dr. DeMaria summarized statistics of the current the influenza season. He believes there is a great need for emergency contingency planning both statewide and nationally. The next influenza pandemic could strike with little warning, with outbreaks occurring simultaneously throughout the US. It should be noted that it takes 4-6 months to produce a vaccine and it takes one egg to prepare one dose of vaccine. In MA, with a population of greater than 6 million, there could be an estimated two million clinically ill people, with 26,000 hospitalizations and 6,000 deaths, and a disruption of critical community services if such a new strain occurred. In MA, sentinel providers keep track of the number of cases of influenza reported, which are then reported nationwide by state and territorial epidemiologists.
Attendees were referred to the MDPH Web Site: www.state.ma.us/dph, Influenza Information, for additional information about influenza. (click on the egg!).
Editors Note: 2/3/04. The MDPH has just released a statewide bulletin to all Health Care Providers, Public Health Professionals, Hospital Epidemiol-ogists, Chiefs of Emergency Medicine and Influenza Sentinel Providers regarding Enhanced Surveillance for Influenza A (H5N1) and Severe Acute Respiratory Syndrome (SARS).
Speakers at Career Night included Ms. Barbara Mullin, Worldwide Marketing Manager-Cell Culture Products, Corning Life Sciences; Ms. Elaine Palome, Director of Employment, ArQule, Inc.; Dr. Victoria Knight, Microbiology Department, Cetek, Corp.; Dr. Julia D'Arezzo, Supervisory Microbiologist (retired), VA Medical Center, Providence, RI; and Dr. Patrick Regan, Supervisory Microbiologist, Winchester, MA. Dr. Pistole commented that each of the speakers brought his/her unique background and perspective with their presentations complimenting each other's. Good feedback was received from students about the event, which may become an annual one. Career Night was supported through funding from the NEB-ASM.
The Wednesday evening dinner-lecture, Forensic Product Testing: Augmenting Micro-biology in the Investigation of Food Terrorism, was given by Carl. M. Selavka, PhD, D-ABC, Director, Crime Laboratory System, Massachusetts State Police, Sudbury, MA. National focus on food terrorism has increased since 11 Sept-ember 2001 and Dr. Selavka gave examples of the many chemical and physical agents that threaten the safety of food products and pharmaceuticals. He described the systematic examination of these products using various analytical means to augment those of the microbiologist.
(L to R) Robert Murray of NY, Carl Selavka, PhD, and Susan Case, PhD
Among a number of well-attended symposia were the following. In Women's Health Issues, Sylvie Ratelle, MD, MPH, from the Massachusetts Department of Public Health, spoke on the biology, pathogenesis, diagnosis and epidemiology of HPV, it's link with cervical cancer, and implications for clinical management. Lydia Shrier, MD, MPH, of Harvard Medical School/Children's Hospital, Boston, reviewed the biology, pathophysiology, clinical manifestations and sequelae of Chlamydia trachomatis infections, and Dana Dunne, MD, FACP, of the Yale University school of Medicine/New Haven Health Department, gave an overview of recent research on pathogenesis of bacterial shifts that cause cervical vaginosis and spoke on the latest diagnostics and treatments available.
The number of attendees at the workshop on Dematiaceous Fungi, with presenters Andrew Onderdonk, PhD and Akhtari Alam, MS, of Brigham & Women's Hospital, exceeded the number expected. Participants were instructed in biosafety considerations in mycology, performance of direct microscopy on mycology specimens, and utilization of trouble-shooting factors involved in the identification of dematiaceous mold.
The clinical symposium Practical Guidelines for Laboratory Testing presented by Paul Schrecken-berger, PhD, of the University of Illinois Medical Center at Chicago, provided the attendees with practical guidelines for the testing and working up of respiratory, stool, CSF and urine cultures, also blood cultures, catheter tips, genital and wound cultures.
Resistance is Futile, Yeah, Right! also drew a large audience, as Stephen Brecher, PhD, of the VA Boston Healthcare System, updated the participants on drug resistance in staphylococci, enterococci and S. pneumoniae. Paul Schreckenberger, PhD, of the University of Illinois Medical Center at Chicago, reviewed antibiotic resistance in gram negative bacteria, and Karen Mills, BS, MT(ASCP)SM, from AB Biodisk, NA, spoke on Etest Gradient Technology for MIC and ART.
In Arthropod Identification, Roger LeBrun, PhD, of the University of Rhode Island, introduced the participants to arthropods and reviewed the identification of those of medical and veterinary importance in Northeastern U.S. Sheldon Campbell, MD, PhD, Yale University School of Medicine/West Haven VA Medical Center, spoke on the tick-borne diseases of New England (lyme, Erlichia, and tularemia, including epidemiology, clinical features, diagnosis and therapy), and concluded in a most unique manner - with guitar and song!
Sheldon Campbell, MD and Jaclynne Laxon, PhD
The Massachusetts Biotechnology Council co-sponsored a full-day program on Drug Development that complemented programs contributed by the other Region I Branches. These included an Indoor Air Quality symposium co-sponsored by the Connecticut Valley Branch, a Molecular Pathogenesis symposium co-sponsored by the Eastern New York Branch, and a Mycobacteriology Roundtable co-sponsored by the New York City Branch.
Sarah Zimmerman and Stephen Brecher, PhD
Boston Harbor Tour: Marcia Walsh, PhD (L), and Michael Labare, PhD (C, rear) of West Point, with his students
Gregory Reppucci, NEB Council, and his students from North Shore Community College
Kerri Zeller, Meridian Bioscience and Friends
Jane Costello (L), Dennis Swirsky (R), Gen-Probe
LuAnn Basciano, Appropriate Technical Resources
Susan Schrier and Wendy Marchetti, Remel, Inc.
Grace Thorne, Cubist Pharmaceuticals and Sarabelle Madoff
Janet Lane and Bruce Terry, Hardy Bioscience
Kris Schulz and Joanne Johnson, Becton Dickinson
From: ASM News, Volume 70, Number 1, 2004
On 31 October 2003, the Northeast Branch of ASM hosted a program entitled "Measured Response to Bioterrorism: A Biological Terrorism Tabletop Exercise and Expert Panel Discussion" as part of the 38th Annual Meeting of ASM Region I Branches. In addition to meeting participants in Boston, MA, audiences at the Thomas Jefferson University Hospital Medical Center in Philadelphia, PA and the Hospital Council of Western Pennsylvania in Warrendale participated via interactive video broadcast. The program was also accessible over the Internet.
Co-sponsored by the Eastern Pennsylvania Branch of ASM, Harvard Center for Public Health Preparedness, Massachusetts Department of Health (Bureau of Communicable Disease Control, Bureau of Laboratories and Environmental Science), Pennsylvania Department of Health Bureau of Laboratories, University of Pittsburgh Center for Public Health Preparedness, and the National Laboratory Training Network, the expert panel spoke from the Boston Marriott-Quincy in Massachusetts. The expert panel was made of distinguished experts in medicine, public health, public safety, government, and biodefense strategy, practice, and science.
The program addressed the challenges of coordinating a strategic response to a specific bioterrorism event through a scenario-driven expert panel discussion and tabletop exercise. The tabletop exercise template utilized during the development of the program was authored by the United States Department of Homeland Security, Office of Domestic Preparedness. In the exercise, events of a bioterrorism event were revealed one piece at a time chronologically until final resolution. Intermittent breaks allowed for questions to be asked of the expert panel.
Clinicians, microbiologists, infectious disease practitioners, board-of-health members, first responders, and other health professionals were invited to participate. For clinical microbiologists, however, the Eastern Pennsylvania and Northeast Branches saw this exercise as an especially good opportunity. Unlike other workshops focused only on laboratory procedures and safety, this program addressed the need for microbiologists to become familiar with other non-microbiology groups and agencies that would be involved in response to a bioterrorism event. Through the interactive nature of the exercise, participants learned how to field a broader-based response to such an event.
Approximately 320 individuals participated in the program at the three locations. Donald Jungkind, past-president of the Eastern Pennsylvania Branch and program facilitator, noted, "We met many other people that would not normally come to a microbiology meeting. We had representatives from the FBI, various health department agencies, first responders, emergency room personnel, and hospital administrators. At this meeting the attendees were urged to consider joining ASM and their local ASM Branches. We also made them aware of the websites that would allow them to check for other ASM events, even if they were not active in microbiology and chose not to join the organization." The videoconference format worked well for this event. "We also learned that high-speed Internet connections giving live, real-time connection between three major cities would allow multidimensional programs of high quality," said Jungkind.
Garry Greer, Northeast Branch President and meeting organizer, noted "As Branch President, I felt we would have been remiss to have a meeting that did not include a bioterrorism component. The partnership with the university Centers for Public Health Preparedness seemed logical. Once our Branch had the support of National ASM, it became easy to garner and coordinate support from organizations and panel members. We feel that the meeting was a huge success and a learning experience for all involved."
Membership News
Please check the mailing label on future announcements and Newsletters for your membership expiration date and any corrections that need to be made. We have created a membership database in order to send items of interest more easily and rapidly by e-mail, therefore don't forget to include your e-mail address. Please notify Irene H. George, Secretary, of any changes at (617) 983-6602.
Membership in the national branch automatically makes you a member of the local branch in some organizations, but this is NOT the case in the ASM. You may be both a National Member and a NEB member, but you have to join each individually. The Northeast Branch membership currently has 209 paid members, which includes:
| Emeritus | 23 |
| Honorary | 4 |
| Students | 14 |
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Visit Our Web Site!!
The NEB has established a home page on the World Wide Web. All current events and the Newsletter are available here. Visit us via the ASM Home Page:
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Membership
Full membership in the American Society for Microbiology was reduced to $49 in 2001 and journal purchase as part of your membership is no longer necessary. This should make it much easier for those who are not actively involved in laboratory research and do not need personal copies of the journal, to justify membership.
ASM membership applications may be obtained through the Northeast Branch both at our meetings and by contacting the NEB Secretary.
Council Elections
President: Gregory V. Reppucci (1 year)
Treasurer: Jo-Ann T. Rosol-Donoghue (3 years)
Local Councilor: Mary Nicholson (2 years).
Offices will become effective July 1, 2004.
NEB Officers - 2004-05
Standing (L to R): Mary Nicholson, Jaclynne Laxon, Gregory Reppucci, Irene George, Garry Greer, Harvey George.
Seated (L to R): Marcia Walsh, Emy Thomas, Jo-Ann Rosol-Donoghue, Paulette Howarth
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Future Meetings
National:
28-31 March 2004
Safeguarding the National Supply from Farm to Table. Key Bridge Marriott Hotel, Arlington (Rosslyn), Virginia Society for Industrial Micro- biology. For information see: www.simhq.org.
21-23 May 2004
ASM Conference fir Undergraduate Educators (ASMCUE), at Xavier University of Louisiana in New Orleans
23-27 May 2004
ASM 104rd General Meeting, New Orleans, LA
30 October-2 November 2004
44th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Washington, DC.
Local:
14-15 April, 2004
18th Regional Conference and Exposition, CSI Boxboro:Clinical Science Investigators. The Clinical Laboratory Management Association, American Association for Clinical Chemistry (AACC), and CLAS. At the Holiday Inn, Boxborough, MA. Michael T. Bourke, PhD speaks on "Forensic Aspects of DNA Analysis". For more information visit: www.nerce.org.
26 April, 2004
Coding and Reimbursement in Microbiology: Tips for Getting Credit and Getting Paid. ASM Foundation Speaker Vickie S. Baselski, PhD.
Professor, Dept. of Pathology, University of Tennessee Health Science Center, Memphis, TN. At: State Laboratory Institute, Jamaica Plain, MA. Contact: Emy Thomas, 508-650-7310.
For the above national ASM meetings contact: Meetings Dept., American Society for Microbiology, 1752 N Street, NW, Washington, DC 20036. Tel: 202-942-9248. See www.asmusa.org.
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