With a Little Help from My FriendsWith a Little Help from My Friends: Update on Surveillance and...
Transcript of With a Little Help from My FriendsWith a Little Help from My Friends: Update on Surveillance and...
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With a Little Help from My Friends:
Update on Surveillance and Diagnostics at WSLH
Alana Sterkel, PhD, D(ABMM), SM(ASCP)CM
Assistant Director
Communicable Disease Division
Wisconsin State Laboratory of Hygiene [email protected]
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
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Who is Here Today?
A) Laboratorian
B) Administrator
C) Public Health
D) Infection Prevention
E) Other
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Public Health Laboratory Core Functions
• Reference & Specialized Testing • Disease Prevention, Control & Surveillance • Emergency (Outbreak) Response • Partnerships & Communication • Integrated Data Management • Training & Education • Food Safety • PH-Related Research • Policy Development • Laboratory Improvement & Regulation • Environmental Health & Protection
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Reference Center
Mycobacteriology (WMLN Conference, Oct. 8th)
Virology (Virology Conference)
Antibiotic Resistance (AR Lab Network)
Bacterial Identification and Characterization
Serotyping, sequencing, toxin detection, AST
STDs, Arboviruses
Parasitology
Select Agent Testing
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
Reference Manual- http://www.slh.wisc.edu/wslhApps/RefMan/wslhSearch.php
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Training and Education
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
WCLN Conferences and Webinars
AR Lab Network fellows
Bioinformatics fellow
Micro Director (CPEP) fellows
UW Medical Students
UWHC Pathology Residents
UWHC Infectious Disease Fellows
UW-LAX Microbiology Masters students
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Laboratory Surveillance Programs in Wisconsin
Antimicrobial Resistance (AR Lab Network)
Wisconsin Enteric Pathogens (WEPS)
PulseNet, NARMS, CryptoNet, CaliciNet
Invasive Bacterial Surveillance (IBLS)
Vectorborne Diseases
Vaccine Preventable Diseases (VPD)
Influenza and Respiratory Diseases (NIRC)
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ANTIBIOTIC RESISTANCE
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Regional ARLN Lab
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Gonorrhea Resistance
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WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
Gonorrhea Incidence The Rate of Gonorrhea is Increasing Now More Common in Men than Women
7,925 in WI 2018
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WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
Gonorrhea Incidence Most Disease is in MSM Massive increase in MSM rate in past 6 years
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Gonorrhea Cases Reported Wisconsin, by Quarter Apr 2014- Mar 2018
14-Q2
14-Q3
14-Q4
15-Q1
15-Q2
15-Q3
15-Q4
16-Q1
16-Q2
16-Q3
16-Q4
17-Q1
17-Q2
17-Q3
17-Q4
18-Q1
Southeast 688 766 709 632 887 1233 1308 1288 1191 1233 1351 1329 1239 1462 1558 1266
Other 258 329 313 327 281 360 318 336 314 325 348 350 414 497 556 532
0
200
400
600
800
1,000
1,200
1,400
1,600
# G
C C
ase
s
Year-Qtr • Data should be considered presumptive; numbers of cases may differ from previously published or final reports. • Data courtesy of John Pfister
Southeast Region
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Strep. pneumoniae Invasive Isolates
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
https://www.cdc.gov/pneumococcal/surveillance.html
2018 WI Data
PPVS23 Vaccine
PCV13 Vaccine
Serotype #
3 4
7C/(7B/40) 1
10A 1
12F/(12A/44/46) 1
13 1
14 1
15A/15F 2
15B/15C 3
19A 2
19F 2
21 1
22F/22A 2
23A 4
23B 6
33F/33A/37 5
35B 2
38/25F 1
Unable to serotype 1
Total 40
518 Cases reported in WI, 2018
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S. pneumoniae Antibiotic Susceptibility
2010 2011 2012 2017 2018
MENINGITIS Interpretation
Penicillin 76.0 77.5 79.0 77.2 75.9
Ceftriaxone 92.5 98.3 95.7 90.5 93.1
NON-MENINGITIS Interpretation
Penicillin 93.2 94.1 96.3 90.7 97.0
Ceftriaxone 96.3 98.3 98.2 98.9 97.3
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ENTERIC DISEASES
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WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
PFGE
NGS
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Bacterial Enteric Disease
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
US Rates 1996-2014
31 WI, 2018
1039 WI, 2018
1705 WI, 2018
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Salmonella
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All Salmonella 2016 Enteritidis 2016
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Salmonella
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
Num
ber
posi
tive
NGS
1039 Cases reported in WI, 2018
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Shigella
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
Shigella in the US 1970-2016
129 cases in WI, 2018
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Shigella + STEC in WI 2017-2019
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WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
STEC
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STEC in the US 1996-2016
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565 cases in WI, 2018
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WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
Num
ber
posi
tive
E. coli
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Campylobacter
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
1705 Cases reported in WI, 2018
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Campylobacter jejuni in US (NARMS)
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
Ciprofloxacin Resistance 28%
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Cryptosporidium (CryptoNet)
862 reported in 2018
95% C. parvum/hominis
Validating Genotyping
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Cyclospora
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319 Cases reported in WI, 2018
Basil
Salad Mix
Veggie trays
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Norovirus (CaliciNet)
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Sapovirus
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Astrovirus
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July 2004- Aug 2019
Jan 2014- June 2019
Rotavirus Rota Positives 2004-2019
(Antigen + PCR)
No.
Posi
tives
No.
Posi
tives
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VACCINE PREVENTABLE DISEASES
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The Vaccine Process
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90% coverage
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Mumps in the US 1968-2011
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US 1985-2011
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WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
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WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
2000-2018
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Mumps in WI
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28 Cases reported in WI, 2018
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Rubella
Endemic rubella was declared eliminated in the US in 2004
Still endemic in other parts of the world
Requires continued vaccination in the US
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
0 Cases reported in WI, 2018
2018
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Varicella Zoster
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US Shingles Rates
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Varicella Zoster
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300 Cases reported in WI, 2018
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Diphtheria
No toxin producing strains cultured in US since 1996
Still endemic in other countries but decreasing
Discontinued at WSLH
5 year review: 4 tests/yr, no positives
Testing still available at the CDC
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
0 Cases reported in WI, 2018
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Pertussis in the US
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
1922-2015
1990-2015
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Pertussis cases in the US, 2019
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Pertussis in WI
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
Bordetella Positive by PCR Jan 2014-Sept. 2019
697 Cases reported in WI, 2018
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VECTORBORNE DISEASES
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Vectorborne Diseases
Disease 2018 Cases
Babesiosis 64
Ehlichiosis/Anaplasmosis 517
Jamestown Canyon virus 22
La Crosse virus 0
Lyme 1883
Malaria 16
Powassan 3
Rocky Mountain spotted fever 29
West Nile virus 33
Zika 0
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
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Vectorborne Diseases
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
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Anaplasmosis
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
Ehrlichiosis
US Disease Rates 2000-2017
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Lyme Disease
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
2017
New CDC guidance allowing a second EIA instead of Western Blot for confirmation
2018
https://www.cdc.gov/mmwr/volumes/68/wr/mm6832a4.htm
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Lyme Disease
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
Lyme Season in US
US 1997-2017
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RESPIRATORY VIRUSES
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NIRC National Influenza Reference Center
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Influenza Surveillance
Providing situational awareness:
When season begins/ends
types/subtypes/strains of influenza circulating
when and where circulating
clinical severity
community impact
age groups targeted
# tests performed/positivity rate
reliability of diagnostic methods
Detecting novel or reassortant viruses
Informing vaccine strain selection by CDC
Detecting and monitoring antiviral resistance
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Influenza
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0
900
1800
2700
3600
4500
0
400
800
1200
1600
2000
No. T
est
ed
No. P
osi
tive
Number of Specimens Tested and Positive for Influenza by PCR at Wisconsin Laboratories
No. Positive for Influenza A No. Positive for Influenza A (H3)
No. Positive for Influenza B No. Positive for influenza A (H1-Pandemic)
No. Positive for influenza A (H3N2)v No. Tested for Influenza
0
1300
2600
3900
5200
6500
0
500
1000
1500
2000
2500
No. T
est
ed
No. P
osi
tive
Number of Specimens Tested and Positive for Influenza by PCR at Wisconsin Laboratories
No. Positive for Influenza A No. Positive for Influenza A (H3)
No. Positive for Influenza B No. Positive for influenza A (H1-Pandemic)
No. Positive for influenza A (H3N2)v No. Tested for Influenza
0
900
1800
2700
3600
4500
0
400
800
1200
1600
2000
No
. T
este
d
No
. P
osit
ive
Number of Specimens Tested and Positive for Influenza by PCR at Wisconsin Laboratories
No. Positive for Influenza A No. Positive for Influenza A (H3)
No. Positive for Influenza B No. Positive for influenza A (H1-Pandemic)
No. Positive for influenza A (H3N2)v No. Tested for Influenza
Influenza Positives by PCR, 4 Years
2018-2019
2017-2018
2016-2017
2015-2016
6243 Influenza-associate hospitalizations in WI, 2018
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Influenza Peaks, 24 years
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
2018-2019 Ʌ
2017-2018 Ʌ
2016-2017 Ʌ
2015-2016 Ʌ
2014-2015 Ʌ
2013-2014 Ʌ
2012-2013 Ʌ
2011-2012 Ʌ
2010-2011 Ʌ
2009-2010 Ʌ
2008-2009 Ʌ Ʌ
2007-2008 Ʌ
2006-2007 Ʌ
2005-2006 Ʌ
2004-2005 Ʌ
2003-2004 Ʌ
2002-2003 Ʌ
2001-2002 Ʌ
2000-2001 Ʌ
1999-2000 Ʌ
1998-1999 Ʌ
1997-1998 Ʌ
1996-1997 Ʌ
1995-1996 Ʌ
Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July
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RSV
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Human Metapneumovirus
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Coronavirus
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
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Rhinovirus
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Parainfluenza
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
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Laboratory Response Network Emergency Laboratory Response and Coordination
Select Agent Testing
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
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Clinical Laboratory Role in Public Health
Critical element in Public Health surveillance
Report notifiable diseases to local public health
Wisconsin Disease Surveillance System (WEDDS)
Form 4151
Support state surveillance
Isolates
Specimen
Data
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
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Benefits of Reporting
Recognition of outbreaks
Tracking drug resistance
Evaluation of vaccine efficacy
Inform on future vaccines
Focus resources to areas that need it most
Trend data
Help Doctors diagnose patients
Optimize your resources for testing
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Reporting
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
http://www.slh.wisc.edu/wcln-surveillance/surveillance/
http://www.surveygizmo.com/s3/389222/Wisconsin-Laboratory-Surveillance-Reporting
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Reporting
It is no longer necessary for you to report to the National Respiratory and Enteric Virus Surveillance System (NRVESS). The WSLH is now reporting this data to NREVSS directly for all labs.
If you have questions or problems reporting test data by either the web-based system or the fax system, please email us at [email protected] or call Mary Wedig at 608-224-4274.
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Resources CDC
https://www.cdc.gov/pneumococcal/surveillance.html
https://www.cdc.gov/widgets/diseaseandconditions/data-maps.html?deliveryName=DM6448
https://www.cdc.gov/vaccines/pubs/surv-manual/chpt01-dip.html
https://wwwn.cdc.gov/narmsnow/
https://www.cdc.gov/mmwr/volumes/65/rr/rr6502a1.htm
DHS
https://www.dhs.wisconsin.gov/publications/p01792-9-2019.pdf
WSLH
http://www.slh.wisc.edu/wcln-surveillance/surveillance/
WISCONSIN STATE LABORATORY OF HYGIENE - UNIVERSITY OF WISCONSIN
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Thank You!