Health Alert Network (HAN)

Providing Health Alerts, Health Advisories, Updates, and Info Service Messages to State and Local Health Officers, Public Information Officers, Epidemiologists and HAN Coordinators as well as Clinician organizations.

February 22, 2011 - Best Practices for Health Care Professionals on the Use of Polymerase Chain Reaction (PCR) for Diagnosing Pertussis
The following Health Alert Network (HAN) message was distributed on February 16, 2011 to health care providers to improve consistency and reliability of pertussis diagnosis (whooping cough) by nucleic acid amplification technology. This HAN message is being shared as a LOCS advisory with the laboratory community, including state, county and local public health laboratories, for enhancing situational awareness and to facilitate communication across the health care spectrum.  For the .pdf version click here.

October 19, 2010 - Questions and Answers following the distribution of the CDC Dear Colleague Letter on August 18, 2010
The Centers for Disease Control and Prevention (CDC) sent a message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv to address issues raised as a result of the CDC Dear Colleague letter from Dr. Kevin Fenton, Director, CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, dated August 16, 2010 and distributed on August 18, 2010.

The letter from Dr. Fenton conveyed CDC concerns regarding the reporting practices adopted by some laboratories using commercially available chlamydia and gonorrhea nucleic acid amplification tests when low positive specimens were routinely retested. The letter requested that Laboratory Directors review their procedures and affirm appropriate reporting of disparate test results by following manufacturers’ instructions and the most recent guidance provided by CDC (2002). Furthermore, laboratories were advised to notify their users of any results from the past two years that were reported as “negative” after routine retesting under conditions highlighted by the letter.

The Question and Answer document, linked here, developed in consultation with the Association of Public Health Laboratories (APHL), the Food and Drug Administration (FDA), and the Centers for Medicaid & Medicare Services (CMS), is intended to clarify the intent of the letter distributed in August and the actions Laboratory Directors should take when interpreting and reporting results of these nucleic acid amplification tests for chlamydia and gonorrhea.

August 18, 2010 – CT/GC testing of "low positives" using NAATs
The Centers for Disease Control and Prevention (CDC) sent a message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv regarding CT/GC testing of "low positives" using NAATs. The National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases and Tuberculosis (NCHHSTP) of the Centers for Disease Control and Prevention advises laboratory directors that supervise the performance and reporting of Chlamydia trachomatis and Neisseria gonorrhoeaenucleic acid amplification tests (NAATs) to review and ensure manufacturer’s instructions are being followed on interpretation and reporting of “low-positive” results.  A MMWR article is in preparation and will be published in the coming weeks, providing additional information on this topic.

Please click on the following link for a letter from Dr. Kevin Fenton, Director of NCHHSTP, CDC: http://wwwn.cdc.gov:80/dls/locs/ViewUploadedDocument.aspx?DLS_Upload_Files_id=542

May 14, 2010 - Potential for Q Fever Infection Among Travelers Returning from Iraq and the Netherlands
The Centers for Disease Control and Prevention (CDC) sent a Health Advisory message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv regarding the potential for Q fever infection among travelers returning from Iraq and the Netherlands.  The Advisory provides information and recommendations on appropriate laboratory testing to physicians seeing patients -  particularly military personnel or civilian contractors who have an illness consistent with Q fever and have traveled to Iraq or the Netherlands in the 30 days prior to illness onset. This health advisory provides useful recommendations on diagnostic testing strategy and patient sampling in suspected cases of Q Fever. 

To read the Health Advisory, go to http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00313      

Q    Q fever is a nationally notifiable disease. A completed CDC Q fever Case Report Form should be submitted to the state health department for all probable and confirmed Q fever cases.  (http://www.cdc.gov/ncidod/dvrd/qfever/case_rep_fm.pdf).  The patient’s history of travel should be clearly noted on the case submission form.  Additional information about Q fever is available at: http://www.bt.cdc.gov/agent/qfever/clinicians/index.asp

May 11, 2010 – CDC Reminds Clinical Laboratories and Healthcare Preventionists of their Role in the Search and Containment of Vanocomycin-Resistant Staphylococcus aureus (VRSA)
The Centers for Disease Control and Prevention (CDC) sent a message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv to remind clinical laboratories and healthcare preventionists of their role in the search and containment of Vanocomycin-Resistant Staphylococcus aureus (VRSA).  This serves as a reminder about the important role of clinical laboratories in the diagnosis of VRSA cases to ensure prompt recognition, isolation, and management by infection control personnel.  This is an important opportunity for all laboratories to revisit their step-by-step problems-solving procedures or algorithm for detecting VRSA that is specific to their laboratory.  A sample algorithm is available at http://www.cdc.gov/ncidod/dhqp/ar_visavrsa_algo.htmland highlights the recommended testing methodologies for detecting VRSA and actions based on testing results. 

Please read the complete CDC Advisory at http://www.cdc.gov/ncidod/dhqp/ar_vrsa_labUpdate.html

April 27, 2010 – Potential for Dengue Infection Among Relief Workers Returning from Haiti
The Centers for Disease Control and Prevention (CDC) sent a Health Advisory message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv regarding the Potential for Dengue Infection Among Relief Workers Returning from Haiti.  CDC has received reports of dengue fever among relief workers returning from Haiti, where the disease is endemic. Health-care providers in the United States should consider dengue in the differential diagnosis of febrile illness in any person who has recently been in Haiti or other countries where dengue is being transmitted, and are encouraged to submit samples to state health departments (available from AZ, CA, CT, FL, NY, PR, and TX) or the CDC for proper laboratory testing. In US areas with Aedes mosquitoes present, infected travelers may also present a risk for local spread of dengue virus(es).  To read the CDC Health Advisory, go to http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00312

January 20, 2010 – CDC Update on Haiti CrisisThe Centers for Disease Control and Prevention (CDC) sent the message below to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv to provide an update on the Haiti Crisis: 

Dear CDC Partner, the January 12 earthquake in Haiti has resulted in a huge response effort involving our global, domestic, government, and non-government partners. CDC has already deployed staff to assist in the effort and anticipates many more will be working in Haiti over the coming months. Your organization may also be actively engaged in the response, or may become involved over time. The health and safety of the Haitian people is the focus the response efforts. In order for that to be achieved, relief workers from our own staff and volunteers from our organizations must also be protected from injury and illness. CDC has developed a fact sheet "Guidance for Relief Workers and Others Traveling to Haiti for Earthquake Response" that describes steps that relief workers can take before, during, and after a trip to Haiti to stay healthy and avoid injury. This document can be downloaded at http://wwwnc.cdc.gov/travel/content/news-announcements/relief-workers-haiti.aspx and as a Microsoft Word document at http://wwwn.cdc.gov:80/dls/locs/ViewUploadedDocument.aspx?DLS_Upload_Files_id=538

CDC's Earthquake Webpages include many other resources for responders, and are being updated frequently. We hope you will visit http://emergency.cdc.gov/disasters/earthquakes/

October 16, 2009 – Recommendations for Diagnosis of Shiga Toxin--Producing Escherichia coli Infections by Clinical Laboratories
The Centers for Disease Control and Prevention (CDC) sent a message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv regarding Recommendations for Diagnosis of Shiga Toxin-Producing Escherichia coli Infections by Clinical Laboratories, published in the Morbidity and Mortality Weekly Report Recommendations & Reports (October 16, 2009 / 58(RR12);1-14).  The recommendations provide comprehensive and detailed recommendations for Shiga toxin—producing Escherichia coli (STEC) testing by clinical laboratories, including the recommendation that all stools submitted for routine testing from patients with acute community-acquired diarrhea (regardless of patient age, season of the year, or presence or absence of blood in the stool) be simultaneously cultured for E. coli O157:H7 (O157 STEC) and tested with an assay that detects Shiga toxins to detect non-O157 STEC. The report also includes detailed procedures for specimen selection, handling, and transport; a review of culture and nonculture tests for STEC detection; and clinical considerations and recommendations for management of patients with STEC infection. Improving the diagnostic accuracy of STEC infection by clinical laboratories should ensure prompt diagnosis and treatment of these infections in patients and increase detection of STEC outbreaks in the community. The recommendations are available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5812a1.htm

October 15, 2009 – CDC Updated Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel The Centers for Disease Control and Prevention (CDC) sent a message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv regarding its Updated Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, including Protection of Healthcare Personnel and two related Questions and Answers (Q&A) documents.  The updated interim guidance is intended for healthcare personnel, including clinical laboratorians and others who may have direct contact with patients or contaminated material.  The interim guidance describes a hierarchy of controls to prevent influenza transmission through elimination of potential exposures, engineering controls, administrative controls and personal protective equipment (PPE).  The information contained in the interim guidance document and accompanying Q&A* applies uniquely to the special circumstances of the current 2009 H1N1 pandemic during the fall and winter of 2009-2010, and will be updated as new information becomes available during the course of this influenza season.

Updated Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, including Protection of Healthcare Personnel

* Questions and Answers about CDC’s Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel

Questions and Answers Regarding Respiratory Protection For Preventing 2009 H1N1 Influenza Among Healthcare Personnel are intended to supplement the updated interim guidance document by providing additional information to assist healthcare facilities in optimizing implementation of recommended respiratory protection practices in the context of shortages of respiratory protection equipment.

October 9, 2009 – CDC Interim Guidance for Influenza Surveillance: Prioritizing RT-PCR Testing in Laboratories
The Centers for Disease Control and Prevention (CDC) sent a message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv regarding its Interim Guidance for Influenza Surveillance: Prioritizing RT-PCR Testing in Laboratories. This interim guidance describes the prioritization of patient samples to be tested by rRT-PCR for SURVEILLANCE purposes* and is intended for state and local health departments, hospitals, and clinicians participating in influenza surveillance activities.

*Prioritization of patient samples to be tested by rRT-PCR for SURVEILLANCE

  • Patients presenting to healthcare providers participating in the US Outpatient Influenza-like Illness Surveillance Network (ILINet) who meet the surveillance case definition of influenza-like illness (ILI**).
  • Hospitalized patients for whom influenza infection is clinically suspected despite a negative result on a rapid influenza diagnostic test.
  • Patients whose deaths are believed to be influenza-associated
  • Other patient samples may be tested according to state and local regulations or guidance.  Please check with your Public Health Laboratory.

** see interim guidance for ILI definition

To access the Interim Guidance for Influenza Surveillance: Prioritizing RT-PCR Testing in Laboratories, go to http://www.cdc.gov/h1n1flu/screening.htm

IMPORTANT NOTE: This document does not contain recommendations for the prioritization of patient samples sent for clinical testing, which can be found under a separate guidance, Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season, available at http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm

October 2, 2009 – CDC Interim Recommendations for Clinical Use of Influenza Diagnostic Testing During the 2009-10 Influenza Season
The Centers for Disease Control and Prevention (CDC) sent a message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv regarding its Interim Recommendations for Clinical Use of Influenza Diagnostic Testing During the 2009-10 Influenza Season, and testing-related Q&A documents for both health care providers and the public. Although the recommendations are intended to inform clinician testing decisions, it is important for laboratorians to be aware of testing-related information directed to clinical partners.  Laboratories may also find the testing-related Q&A documents beneficial in responding to questions from clinical partners and from patients.

With respect to the interim recommendations for clinical use of influenza diagnostic testing, it should be noted under “Information on Specimen Collection and Storage” that clinicians are advised to consult with the laboratory regarding available testing options for lower respiratory specimens.  Laboratories may wish to remind their clinicians of specific specimen/swab requirements for each type of available influenza diagnostic test.  Laboratories are reminded to consult the test kit manufacturer’s instructions (package insert) to verify the types of specimens for which a particular test system has been validated.  Another source for identifying acceptable specimen types for a given test system is the searchable CLIA database, which can be found on the Food and Drug Administration’s web site (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCLIA/search.cfm). Use of a non-approved specimen type constitutes off-label use and requires the laboratory to comply with applicable CLIA regulations (§493.1253 Standard: Establishment and verification of performance specifications; http://wwwn.cdc.gov/clia/regs/toc.aspx). 

Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season

Questions & Answers: Interim Recommendations for Clinical Use of Influenza Diagnostic Testing During the 2009-2010 Influenza Season - For Health Care Providers

Questions & Answers: Influenza Diagnostic Testing During the 2009-2010 Flu Season - For the Public

August 21, 2009 – MMWR on Use of Influenza A (H1N1) 2009 Monovalent Vaccine, Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009.
The Centers for Disease Control and Prevention (CDC) sent a message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv regarding the early release of a Morbidity and Mortality Weekly Report article, "Use of Influenza A (H1N1) 2009 Monovalent Vaccine, Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009."

This article includes important information that applies to laboratory workers who handle infectious materials; these individuals would fall into one of the five initial target groups for vaccination efforts.  The groups identified in the MMWR article include pregnant women, persons who live with or provide care for infants aged <6 months="" health-care="" and="" emergency="" medical="" services="" personnel="" b="">(including laboratory workers who handle infectious materials), children and young adults aged 6 months--24 years, and persons aged 25--64 years who have medical conditions that put them at higher risk for influenza-related complications.  Other highlights of the recommendations include establishment of priority for a subset of persons within the initial target groups in the event that initial vaccine availability is unable to meet demand and guidance on use of vaccine in other adult population groups as vaccine availability increases.  The MMWR article is available at http://www.cdc.govmmwr/preview/mmwrhtml/rr58e0821a1.htm

Vaccination and health-care providers should be alert to announcements and additional information from state and local health departments and CDC concerning vaccination against novel influenza A (H1N1) virus infection. Additional information is available from state and local health departments and from CDC's influenza website (http://www.cdc.gov/flu).

August 17, 2009 - Publication of HIV Testing Algorithms: a Status Report
The Centers for Disease Control and Prevention (CDC) sent a message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv regarding a "Notice To Readers" that was published in the August 7, 2009, Morbidity and Mortality Weekly Report on "Publication of HIV Testing Algorithms: a Status Report."  The status report does not contain formal guidelines or recommendations but reviews the supporting evidence and limitations regarding the proposed algorithms, and the additional data needed to substantiate each of them.  The report is intended to solicit performance data from laboratories to validate the proposed algorithms and feedback regarding operational parameters associated with the algorithms.

The full report, executive summary and schematics of the various algorithms are available on the Association of Public Health Laboratories (APHL) website at http://www.aphl.org/hiv/statusreport and http://hivtestingconference.org.  Inquiries, comments, and descriptions of pertinent performance data should be directed to APHL via e-mail at hiv.algorithm@aphl.org.

The August 7 MMWR Notice is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5830a4.htm

August 14, 2009 – CDC Interim Biosafety Guidance for All Individuals Handling Clinical Specimens or Isolates Containing 2009-H1N1 Influenza A Virus (Novel H1N1), as well as Vaccine Strains
The Centers for Disease Control and Prevention’s (CDC) Laboratory Outreach and Communication System (LOCS) sent a message to laboratorians regarding the revised Interim Biosafety Guidance for All Individuals Handling Clinical Specimens or Isolates Containing 2009-H1N1 Influenza A Virus (Novel H1N1), as well as Vaccine Strains.  This guidance is for all individuals who may perform diagnostic and research activities including rapid diagnostic testing at the point of care with 2009-H1N1 influenza A virus (Novel H1N1).

The revised document includes the following changes:

  • Revisions concerning required PPE and engineering and work practice controls are included as follows: 
  1. For those performing rapid immunoassay tests for influenza, splash protection is required.
  2. For those performing more complex procedures (e.g., direct or indirect fluorescent antibody tests [DFA, IFA], culture, molecular assays), a Class II biosafety cabinet (BSC) in a biosafety level-2 (BSL-2) laboratory is required. Biosafety level-3 (BSL-3) practices are no longer required for viral isolation.
  • Updated nomenclature for the virus, now referred to as 2009-H1N1 Influenza A Virus (Novel H1N1), is incorporated throughout the guidance

Link to guidance: http://www.cdc.gov/h1n1flu/guidelines_labworkers.htm

August 6, 2009 - Evaluation of Rapid Influenza Diagnostic Tests for Detection of Novel Influenza A (H1N1) Virus – United States, 2009
The Centers for Disease Control and Prevention’s Laboratory Outreach and Communication System (LOCS) sent a message to laboratorians regarding the August 7 publication of a Morbidity and Mortality Weekly Report article, “Evaluation of Rapid Influenza Diagnostic Tests for Detection of Novel Influenza A (H1N1) Virus – United States, 2009.”  The article describes the performance of three commercially available rapid influenza diagnostic tests (RIDTs) compared to real-time RT-PCR for their ability to detect the novel influenza A (H1N1) virus in respiratory specimens.  Overall sensitivity for the novel influenza A (H1N1) virus ranged from 40-69%, meaning these infections may not be detected by RIDTs, especially if the amount of virus in a specimen is low.  For this reason, decisions regarding treatment and further testing among patients with negative results from RIDT should be based upon clinician suspicion, underlying medical conditions, severity of illness, and risk for complications in those persons suspected of having the novel influenza A (H1N1) virus infection.

Link to MMWR: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5830a2.htm?s_cid=mm5830a2_e

July 29, 2009 – CDC Interim Guidance for the Detection of Novel Influenza A Virus Using Rapid Influenza Diagnostic Tests
The Centers for Disease Control and Prevention’s Laboratory Outreach and Communication System (LOCS) sent a message to laboratorians regarding its revised Interim Guidance for the Detection of Novel Influenza A Virus Using Rapid Influenza Diagnostic Tests.  The document supersedes the guidance document, Use of Rapid Influenza Diagnostic Tests for Patients with Influenza-like Illness during the Novel H1N1 Influenza Virus (Swine Flu) Outbreak, previously posted on CDC’s website on May 2, 2009.

The new interim guidance provides an overview of the sensitivities of rapid influenza diagnostic tests (RIDT) in detecting influenza A (H1N1) virus in order to help guide the reporting and interpretation of test results.  This guidance is intended primarily for all individuals who may be processing or performing rapid influenza diagnostic testing on respiratory specimens from patients with suspected influenza A (H1N1) virus infection, including those in clinical practice settings.  An Example of a Statement to Accompany Rapid Influenza Diagnostic Test Results and an algorithm to assist in the interpretation of RIDT results during periods when influenza viruses are circulating in the community are contained in this interim guidance. Guidance will be updated as needed based on new data.

Link to guidance: http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm

July 24, 2009 – FDA Issues EUA for Focus Diagnostics Influenza H1N1 (2009) RT-PCR Test
The Centers for Disease Control and Prevention’s Laboratory Outreach and Communication System (LOCS) sent a message to laboratorians regarding a press release issued by the Food and Drug Administration (FDA) about the issuance of Emergency Use Authorization (EUA) for the Focus Diagnostics Influenza H1N1 (2009) Real-Time Reverse Transcription Polymerase Chain Reaction (RT-PCR) diagnostic test.  The Focus RT-PCR is the third diagnostic test authorized under an EUA by the FDA since the public health emergency involving the 2009 H1N1 influenza virus was declared on April 26, 2009.

The EUA allows Focus Diagnostics to distribute the test to laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high complexity tests. This test is not typically utilized in a doctor's office; it is a complex laboratory test performed in an environment that has the necessary equipment. These tests are intended for use in the detection of the 2009 H1N1 influenza virus in patients with symptoms of respiratory infection. To read the press release, go to http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm173543.htm

July 2, 2009 – Transmission and Pathogenesis of Swine-Origin 2009 A(H1N1) Influenza Viruses in Ferrets and Mice
The Centers for Disease Control and Prevention’s Laboratory Outreach and Communication System (LOCS) sent a message to laboratorians to provide a link to the manuscript, "Transmission and Pathogenesis of Swine-Origin 2009 A(H1N1) Influenza Viruses in Ferrets and Mice," that was published online, July 2, 2009, in Science.  Results from these animal studies indicate that close contact is the most efficient means of transmission of this H1N1 virus. They further suggest an increased potential for lower respiratory and intestinal tract involvement with this infection.  Similarly, human cases to date have indicated that a significant proportion of individuals infected with the H1N1 virus have exhibited gastrointestinal distress and vomiting. http://wwwn.cdc.gov:80/DLS/LOCS/ViewUploadedDocument.aspx?DLS_Upload_Files_id=520 (manuscript)

April 28, 2009 - CDC Interim Guidance on Specimen Collection and Processing for Patients with Suspected Swine Influenza A (H1N1) Virus Infection
On April 28, the Centers for Disease Control and Prevention (CDC) sent a message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv regarding CDC's interim guidance, “Specimen Collection and Processing for Patients with Suspected Swine Influenza A (H1N1) Virus Infection.” The guidance is available on CDC’s website at http://www.cdc.gov/swineflu/specimencollection.htm

April 24, 2007 - Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory Workers
The Center for Disease Control and Prevention (CDC) sent a message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv regarding CDC's interim laboratory guidance, "Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory Workers."  The guidance is available on CDC’s website at http://www.cdc.gov/swineflu/guidelines_labworkers.htm .

February 5, 2009 – MMWR on Haemophilus influenzae Type B
The Center for Disease Control and Prevention (CDC) sent a message to laboratorians via the Laboratory Outreach Communication System (LOCS) listserv regarding a recent report published in the Morbidity and Mortality Weekly Report (MMWR) on Haemophilus influenzae Type B. Ongoing laboratory-based surveillance from the Active Bacterial Core surveillance system detected Haemophilus influenzae in five young children in Minnesota (2008).CDC reminds laboratorians that Haemophilus influenzae invasive, is a nationally reportable disease (http://jama.ama-assn.org/cgi/reprint/282/2/164.pdf) and has become a rare cause of invasive disease in the U.S. following implementation of the Hib vaccination program in the 1990s. According to current CDC recommendations, laboratories should perform serotype testing of all invasive H. influenzae isolates in children younger than 5 years of age. Confirmation of serotype is also encouraged for invasive H. influenzae cases in other age groups, particularly children aged 5 to 14 years (CDC’s VPD Surveillance Manual, Chapter 2: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt02-hib.htm). Surveillance information monitors disease burden and determines vaccine failure vs. failure to vaccinate. Laboratories should review their state and local policies regarding serotyping, reporting criteria, and isolate submission. A contact list of State Public Health Laboratories can be downloaded at: http://www.aphl.org/aphlprograms/ep/Documents/EPrep110707_SPHL_contact_list.pdf. To read the MMWR report, go to (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5803a4.htm?s_cid=mm5803a4_e). 

December 19, 2008 - CDC Health Advisory on Use of Influenza Antiviral Medications in the Setting of Oseltamivir Resistance among Circulating Influenza A (H1N1) Viruses, 2008-09 Influenza Season
On December 19, the Centers for Disease Control and Prevention (CDC) issued a Health Advisory that was distributed through the Health Alert Network (HAN) regarding its Interim Recommendations for the Use of Influenza Antiviral Medications in the Setting of Oseltamivir Resistance among Circulating Influenza A (H1N1) Viruses for the 2008-09 Influenza Season. According to the advisory, preliminary data from a limited number of states indicate that the prevalence of influenza A (H1N1) virus strains resistant to the antiviral medication oseltamivir is high. Therefore, CDC is issuing interim recommendations for antiviral treatment and chemoprophylaxis of influenza during the 2008-09 influenza season. When influenza A (H1N1) virus infection or exposure is suspected, zanamivir or a combination of oseltamivir and rimantadine are more appropriate options than oseltamivir alone. Local influenza surveillance data and laboratory testing can help with physician decision-making regarding the choice of antiviral agents for their patients.  To read the Health Advisory, go to http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00279

October 17, 2008 - CDC Issues Health Advisory on False-positive Results with a Commercially-Available West Nile Virus IgM ELISA Kit The Centers for Disease Control and Prevention (CDC) issued a Health Advisory that was distributed through the Health Alert Network (HAN) on October 14, 2008 regarding False-positive Results with a Commercially-Available West Nile Virus IgM ELISA Kit. This notice serves as an important reminder for clinical laboratories to send specimens that test positive for West Nile virus IgM antibodies based on a commercially-available kit to a public health laboratory for confirmatory testing. To read the CDC Health Advisory, go to http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00278.

August 22, 2008 - CDC Issues Health Update on Rabies Vaccine Supply

The Centers for Disease Control and Prevention (CDC) issued a Health Update regarding the limited supply of rabies vaccine which may affect the near-term availability of vaccine for rabies post-exposure prophylaxis (PEP). Because of limited existing supplies, the CDC strongly recommends that health care providers, state and local public health authorities, animal control officials, and the public take immediate steps to ensure appropriate use of human rabies biologics.  To read the CDC Health Update, go to http://www.cdc.gov/rabies/news/2008_22Aug_CliniciansUpdate.html

April 4, 2008 - CDC Health Advisory on Measles Outbreaks in the United States
The Centers for Disease Control and Prevention (CDC) sent a Health Advisory regarding measles outbreaks in the United States. Suspected measles cases should be reported immediately to your state or local health department (http://www.aphl.org/about_aphl/about_phl/member_laboratory_listing/Pages/default.aspx), and serologic and virologic specimens (serum and throat or nasopharyngeal swabs) should be obtained for measles virus detection and genotyping. Laboratory testing should be conducted in the most expeditious manner possible. In addition, laboratorians should note that transmission risks can be minimized by ensuring that all healthcare personnel have evidence of measles immunity and that appropriate infection control practices are followed.

Please note the Health Advisory contains recommendations for vaccination of health care personnel. Laboratorians should consider these recommendations in assessing the risk of exposure.

To read the CDC Health Advisory, “Measles outbreaks in the United States: Public health preparedness, control and response in healthcare settings and the community” go to http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00273 

March 4, 2008 - CDC Health Advisory on Ricin
The Centers for Disease Control and Prevention (CDC) sent a Health Advisory regarding preliminary results of environmental testing at laboratories in Nevada that tested positive for ricin. The CDC is working collaboratively with the Southern Nevada Health District's Environmental Health Division, the FBI, and other public health and law enforcement agencies to investigate a case of possible ricin exposure in Las Vegas. Ricin is a potent biologic toxin that is derived from castor beans.

Private and commercial laboratories with questions concerning specimen collection, handling, storage, or shipping should contact their state public health laboratory's chemical terrorism coordinator, available through their respective state public health laboratory (http://www.aphl.org/about_aphl/about_phl/member_laboratory_listing/Pages/default.aspx). Ricin or its exposure marker, ricinine, should only be tested by Laboratory Response Network (LRN) laboratories with validated methods. State public health laboratories, or the CDC Directors Emergency Operations Center (DEOC) can provide appropriate advice on testing issues. The CDC LRN site (http://www.bt.cdc.gov/lrn/) has information on both the chemical and biological LRN, including important sample collection information.

To read the CDC Health Advisory on Ricin, go to http://emergency.cdc.gov/agent/ricin/han_022008.asp

January 30, 2008 - Influenza-Associated Pediatric Mortality and Staphylococcus aureus co-infection
The Centers for Disease Control and Prevention (CDC) sent an official CDC Health Advisory requesting that states report all cases of influenza-related pediatric mortality during the 2007-2008 influenza season. The health advisory contains updated information about influenza and bacterial co-infections in children and provides interim testing and treatment recommendations. As stated in the advisory, clinicians, health care providers, and medical examiners are being asked to contact their local or state health department as soon as possible when deaths among children associated with laboratory-confirmed influenza are identified. Note that for this purpose "laboratory-confirmed" means a positive result with any test for influenza, including rapid and/or waived tests.

Clinical laboratories should be aware of possible requests from local or state health departments for S. aureus isolates from pediatric influenza patients in whom co-infection was noted. Because it is possible that cultures could be discarded before a request from local or state health departments is communicated to the laboratory, it is important for clinical laboratories to maintain S. aureus isolates from sterile sites/sputum/endotrachial cultures for future requests. Please read the CDC Health Advisory at
http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00268 >

January 18, 2008 - Update: Potential Exposures to Attenuated Vaccine Strain Brucella abortus RB51 During a Laboratory Proficiency Test - United States and Canada, 2007
The Morbidity and Mortality Weekly Report (MMWR) recently published "Update: Potential Exposures to Attenuated Vaccine Strain Brucella abortus RB51 During a Laboratory Proficiency Test - United States and Canada, 2007 (Vol. 57 / No. 2). The notice is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5702a2.htm?s_cid=mm5702a2_e

December 21, 2007- Potential Exposure to Attenuated Vaccine Strain Brucella abortus RB51 During a Laboratory Proficiency Test 
The Morbidity and Mortality Weekly Report (MMWR) recently published "Notice to Readers: Potential Exposure to Attenuated Vaccine Strain Brucella abortus RB51 During a Laboratory Proficiency Test -- United States, 2007 (56(50);1320-1321). The notice is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5650a5.htm?s_cid=mm5650a5_e

May 17, 2007 - Influenza-Associated Pediatric Mortality and the Increase of Staphylococcus aureus Co-infection
The Centers for Disease Control and Prevention (CDC) sent an official CDC Health Advisory requesting that states report all cases of influenza-related pediatric mortality from the 2006-2007 influenza season. Specifically, clinicians, clinical agencies and medical examiners are being asked to notify their local or state health department as soon as possible, when deaths among children due to laboratory-confirmed influenza are identified. Clinical laboratories should be aware of possible requests from local or state health departments for S. aureus isolates from pediatric influenza patients in whom co-infection was noted. Because it is possible that cultures could be discarded before a request from local or state health departments is communicated to the laboratory, it is important for clinical laboratories to maintain S. aureus isolates from sterile sites/sputum/endotrachial cultures for future requests. Read the CDC Health Advisory

April 16, 2007 - Addition of Novel Influenza A Virus Infections to the National Notifiable Disease Surveillance System
The Morbidity and Mortality Weekly Report (MMWR) recently published "Notice to Readers: Addition of Novel Influenza A Virus Infections to the National Notifiable Diseases Surveillance System, 2007 Vol 56, No MM13;307." Additional information concerning the National Notifiable Disease Surveillance System is available at http://www.cdc.gov/epo/dphsi/nndsshis.htm and http://www.cdc.gov/epo/dphsi/phs/infdis.htm. Due to state-to-state variability in notification requirements, private and commercial laboratories should obtain information about notifiable diseases for each state by contacting the appropriate state and territorial public health laboratory or through the state epidemiologist.

October 4, 2006 - “Importance of Culture Confirmation of Shiga Toxin producing Escherichia coli infection as Illustrated by Outbreaks of Gastroenteritis" [Morbidity and Mortality Weekly Report, September 29, 2006 / 55(38);1042-1045]
Clinical diagnostic laboratories should strongly consider including STEC O157 in their routine bacterial enteric panel (with Salmonella, Shigella, and Campylobacter spp.). If bacterial culture for STEC O157 is not performed in parallel with EIA, Stx-positive broths should be inoculated to a selective isolation medium, such as SMAC agar, and any resulting sorbitol-negative colonies should be tested with O157 antiserum or latex reagent. All confirmed and presumptive STEC O157 isolates and Stx-positive broths that do not yield STEC O157 should be forwarded to a public health laboratory as soon as possible for confirmatory testing and further genetic characterization. STEC O157 isolates should be confirmed, characterized, and tested by PFGE, and the pattern promptly entered into the PulseNet database. At the public health laboratory, the broth should be subcultured to selective agar and a representative sample of sorbitol positive and negative colonies tested by Stx EIA or PCR for stx1 and stx2 genes. Non-O157 STEC isolates can be tested using commercial antisera for the most common non-O157 STEC serogroups (O26, O45, O103, O111, O121, and O145) and should be sent to the CDC E. coli Reference Laboratory for complete serotyping and further genetic characterization, including PFGE.

September 17, 2006 - Multiple States Investigating a Large Outbreak of E. coli O157:H7 Infections
E. coli O157:H7 cases should be reported rapidly to the appropriate local and state public health officials, and isolates should be forwarded to state public health laboratories for rapid PFGE analysis. Private and commercial laboratories with questions about this outbreak should contact their state public health laboratory (state laboratory listing).

July 5, 2006 - The National Immunization Program has updated its website to include important laboratory diagnosis information concerning mumps specimen collection, storage and testing (note - scroll down to Information for Healthcare Professionals).

March 13, 2006 - Department of Health and Human Services Pandemic Planning Update

February 24, 2006 - Influenza Vaccination of Health-Care Personnel Recommendations of the Healthcare Infection Control Practices Advisory Committee and the Advisory Committee on Immunzation Practices

February 3, 2006 - Press Release on H5 Assay

January 24, 2006 - Summary Report: What Labs Need to Know About Their Role in Influenza Testing

January 18, 2006 - ACIP Childhood HBV Prevention Recommendations

November, 2005 - HHS Pandemic Flu Plan, Supplement 2 - Summary of Roles and Responsibilities for Public Health and Clinical Laboratories in Laboratory Diagnostics

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