Usually in winter it’s Wisconsinites who head south for warmer weather. But in early February, it was two nurses from Puerto Rico’s newborn screening program who headed north to brave the cold and learn from the WSLH newborn screening staff.

Ledith Resto Melendez and Zulley Peńaloza Medina spent the first week of February learning about our newborn screening testing processes. Puerto Rico’s newborn screening program, which is affiliated with the University Pediatric Hospital in San Juan, received a NewSTEPS grant from the Association of Public Health Laboratories to implement Severe Combined Immunodeficiency (SCID) screening. They started testing for SCID in August 2015.

In 2008, Wisconsin became the first place in the world to routinely screen newborns for SCID. Babies with the disorder are born without a functioning immune system. Our newborn screening lab has served as a training center for many state and some international newborn screening programs that want to implement SCID testing. WSLH Newborn Screening Laboratory Co-Director Dr. Mei Baker has also traveled many miles consulting with labs on SCID testing implementation.

Even though Puerto Rico only began SCID testing months ago, Ledith and Zulley wanted to visit the WSLH NBS lab soon after implementation for quality assurance purposes.

“We want to review our processes with Wisconsin to make sure we are doing things well and see if there are any changes we need to make,” Ledith explained.

And since they were here, they decided to learn all they could about the testing processes for the other 43 disorders screened for in the WSLH NBS lab.

“We have had an opportunity to see every step for every test, from punching blood spots to data entry to testing to results reporting to follow-up,” Ledith said. “We’ve seen every piece of equipment and talked with all the staff.”

“The staff have been very helpful,” Zulley added.

The Puerto Rico newborn screening program screens about 34,000 babies annually for 29 disorders. About 20-25 babies a year will test positive for one of the disorders. There are about 30 staff members who work in the program, which combines testing, short and long-term follow-up activities and genetic counseling.

Ledith and Zulley hope this trip is just a first visit in what will become a long-term collaboration.

“The staff have been great and Mei is a wonderful teacher,” Ledith said. “The people here really love what they’re doing.”

WSLH Toxicologist Kayla Neuman is presenting study data on the effect of synthetic cannabinoids on driving at the American Academy of Forensic Sciences annual conference on February 25, 2016.

Here’s an abstract of her presentation –

 

Synthetic Cannabinoids in Drivers: Clinical and Psychophysical Indications of Intoxication

Kayla M. Neuman, M.S., Wisconsin State Laboratory of Hygiene – Forensic Toxicology Section

Synthetic Cannabinoids, also known as “fake pot”, K2, and spice are growing in popularity amongst drivers in Wisconsin. Specialized evaluations performed by Drug Recognition Experts (DRE) to identify drugged driving impairment were examined. The data collected was used to determine the likely symptoms caused by these types of substances.

The Wisconsin State Laboratory of Hygiene (WSLH) with the cooperation of the WI Department of Transportation’s Bureau of Transportation Safety (BOTS), outsourced samples to other laboratories to test for synthetic cannabinoids. A total of 118 cases were sent out between March 2010 and May 2015, with 24 cases having all information required for the data collection. Of the 24 cases examined, 20 were male subject and 4 were female subjects. There were a total of 11 different types of synthetic cannabinoids found in these 24 blood specimens and negative results for the rest of the alcohol and drug testing. Examination of the police reports revealed that impaired drivers were commonly identified by poor driving and traffic crashes (71%).

Based on the DRE evaluations, the subjects consistently had poor balance and coordination (54%), bloodshot eyes (67%), droopy eyelids (54%), and were unable to cross their eyes (75%). These symptoms are also common with impairment seen by those who use cannabis. Impairment was also noticeable by the subjects speaking slowly and swaying while trying to balance during two of the tests used. However, the body’s responses (pulse rate, blood pressure, body temperature, pupil size, pupil reaction to light, and muscle tone) to synthetic cannabinoids were within normal DRE ranges for the majority of cases. There were a few cases that displayed specific indications of intoxication that were not within normal ranges including dilated pupils (46%), watery eyes (42%), uncontrollable shaking (21%), elevated pulse (42%), and elevated blood pressure (21%). This may be due to the specific type of synthetic cannabinoid used, the person’s body chemistry, or the amount of time between driving and the DRE evaluation. Overall, driver performance on DRE evaluations indicated that synthetic cannabinoids caused significant physical impairment and do impair a person’s ability to drive a car.

Abstract will be presented during the American Academy of Forensic Sciences annual conference in Las Vegas, NV, February 25, 2016.

(Information current as of 02/16/2017)

 

For individuals that meet Centers for Disease Control and Prevention (CDC) travel or exposure criteria, fee-exempt testing Zika virus testing is available at the Wisconsin State Laboratory of Hygiene (WSLH) upon approval by a Wisconsin Division of Public Health (DPH) epidemiologist. The most common Zika virus tests approved are the Zika virus IgM antibody assay on serum, the Arbovirus PCR Panel (Zika, Dengue and Chikungunya viruses) on serum, and the Zika virus PCR on urine.

 

The following information is for Wisconsin clinical and hospital laboratories.

 

Diagnostic Testing:

• If a physician suspects a case of Zika virus and would like testing performed, please contact the WI Department of Health Services (WDHS) Communicable Disease Epidemiology Section (phone: 608-267-9003). Once WDHS approves testing, they will provide your laboratory with a form that must be completed and accompany the specimen. For more information – https://www.dhs.wisconsin.gov/zika/lab-testing.htm

• For individuals that meet Centers for Disease Control and Prevention (CDC) travel or exposure criteria, fee-exempt testing Zika virus testing is available at the Wisconsin State Laboratory of Hygiene (WSLH) upon approval by a Wisconsin Division of Public Health (DPH) epidemiologist. The most common Zika virus tests approved are the Zika virus IgM antibody assay on serum, the Arbovirus PCR Panel (Zika, Dengue and Chikungunya viruses) on serum, and the Zika virus PCR on urine. NOTE: Specimens testing positive or equivocal for Zika virus IgM will still need to be forwarded to the CDC for confirmatory plaque-reduction neutralization (PRNT) testing because of the significant cross-reactivity between Zika and other Flaviviruses in the MAC ELISA assay. Also, requests for IgM testing for dengue and chikungunya viruses will continue to be sent to CDC.

• Specimen – Instructions for specimen collection and submission are provided at time of testing approval by WDHS.

• Transport – Specimens approved for testing by WDHS may be transported to the WSLH by calling Statmedex for pick-up. Specimens should be triple packaged as a Category B Biological Substance.

• Fee for Service Testing – No fee-for-service testing is being offered at this time. ALL Zika virus test requests must be approved by WDHS by calling 608-267-9003.

Reporting:

Zika virus has been added to the list of notifiable diseases/conditions. The WSLH will report any confirmed cases of Zika virus to WDHS.

 

Resources:

For information on Zika virus infection:

WI Department of Health Services: https://www.dhs.wisconsin.gov/zika/index.htm

CDC: http://www.cdc.gov/zika/index.html

Pan American Health Organization (PAHO): http://www.paho.org/hq/index.php?option=com_content&view=article&id=11585&Itemid=41688&lang=en

 

It sounds like something out of a late-night horror movie — thick green muck spreading across a lake and disrupting the drinking water supply for 400,000+ people. But it wasn’t Hollywood — it was Lake Erie and Toledo, OH in summer 2014.

That harmful algal bloom (HAB) and others are discussed in the ET&C Focus article “Are harmful algal blooms becoming the greatest inland water quality threat to public health and aquatic ecosystems?” published in the January 2016 issue of Environmental Toxicology and Chemistry. The article is co-authored by Wisconsin State Laboratory of Hygiene Environmental Toxicologist Dawn Perkins.

While the authors don’t have an exact answer to their question yet, they do outline the challenges ahead and the information that is still needed to ensure the story has a happy Hollywood ending.

From the article –

 

A pilot project at the Wisconsin State Laboratory of Hygiene (WSLH) to perform Whole Genome Sequencing on influenza viruses received the Excellence in Domestic Partnering Award from the National Center for Immunization and Respiratory Diseases (NCIRD) at the Centers for Disease Control and Prevention (CDC).

The WSLH is in the first year of a 3-year project funded by the CDC to pilot Next Generation Whole Genome Sequencing of influenza viruses submitted for surveillance from Wisconsin and other states.

The WSLH is the first state public health laboratory in the country to collaborate with the CDC on this cutting-edge technology. The WSLH has been 1 of 3 CDC-designated National  Influenza Surveillance Reference Centers since 2009.

Genetic characterization of influenza viruses is important both for monitoring genetic drift (how the virus may be changing) and for selecting the virus strains to include in influenza vaccines. Next Generation Sequencing (NGS) in state public health laboratories could potentially shave months off the vaccine development process.

“This is a big recognition at CDC,” said Dr. Peter Shult, director of the WSLH Communicable Disease Division and Emergency Response. “I am very  proud of the hard work of our staff, especially (microbiologists) Tonya Danz and Rich Griesser, (electronic laboratory reporting coordinator) Mary Wedig, and our WSLH IT staff. This type of public health work is what the WSLH is all about.”

 

Previous Stories about the Project

Building a Better Flu Vaccine
Getting CLARITY on Whole Genome Sequencing

According to estimates from the U.S Bureau of Labor Statistics’ Survey of Occupational Injuries and Illnesses (SOII), Wisconsin’s overall incidence rate of nonfatal occupational injuries and illnesses remained unchanged, at 4.0 cases per 100 equivalent full-time workers in 2014.

Nationally, the total injury and illness case rate per 100 full-time workers fell from 3.5 in 2013 to 3.4 in 2014. In surrounding Midwestern states (IA, IL, IN, MI, MN, NE, OH), Iowa had the highest total recordable case rate of 4.4 cases per 100 full-time workers while Ohio had the lowest rate of 2.9 cases.

SOII is the largest work injury data collection conducted nationwide. The Wisconsin SOII program collects data from a representative sample of 6,000 establishments in both the private and public sector.

Key Findings for Wisconsin:

• Private industry total incident rates fell slightly from 4.0 in 2013 down to 3.9 cases per 100 workers in 2014, while state and local government rates rose from 4.5 in 2013 to 4.7 in 2014.
• There were an estimated 86,300 total injuries and illnesses in Wisconsin workers with 25,300 (29%) requiring time off due to injury.  The number of cases with time off due to injury is up from the estimated 23,200 in 2013.
• Across all industries, Wisconsin workers averaged 7 days off due to injury.
• The leading nature of injury that required time off work in the private sector was sprains, strains and tears at 37.8% of lost time injuries. Soreness and pain was the second leading cause, at 16.3% of lost time cases.
• Establishments with between 50 to 249 employees had the highest rate of workers who had time off due to injury at 4.7 cases per 100 full-time workers. Employers with between 11 to 49 employees were second-highest, with a rate of 4.1 cases per 100 full-time workers.

The Wisconsin State Laboratory of Hygiene, a part of the University of Wisconsin-Madison, is the state’s public, environmental and occupational health laboratory. The WSLH’s Bureau of Labor Statistics/Occupational Safety and Health Statistics Unit have a cooperative agreement with the U.S. Bureau of Labor Statistics to conduct their annual Survey of Occupational Injuries and Illnesses and Census of Fatal Occupational Injuries in Wisconsin.

For more information about nonfatal work injuries in Wisconsin, go to www.slh.wisc.edu/bls.

The Wisconsin Mycobacteriology Laboratory Network (WMLN) held its annual meeting on November 4, 2015.

The WMLN is an ongoing collaboration of all 31 laboratories in Wisconsin that perform some level of testing for TB, to share expertise and data critical to the state’s TB control efforts, and to improve TB testing quality overall in Wisconsin.

WMLN activities are coordinated by the Wisconsin State Laboratory of Hygiene and support statewide TB control efforts by the Wisconsin Department of Health Services’ Wisconsin Tuberculosis Program.

 

2015 WMLN Conference presentations

Lt. Dee Dee Downie spoke to WSLH staff recently about the challenges and successes of her 2 deployments to Liberia to battle the Ebola virus.

Lt. Downie is a commissioned officer in the U.S. Public Health Service and serves as the CDC Public Health Advisor to the Wisconsin Department of Health Services’ Office of Preparedness and Emergency Health Care.

Webcast (1 hour long)

The Wisconsin State Laboratory of Hygiene (WSLH) has been chosen by the Centers for Disease Control and Prevention (CDC) to be 1 of 3 National Influenza Surveillance Reference Centers for the next 5 years (2015 – 2020).

The WSLH, along with the state public health laboratories in California and New York, will provide influenza virus isolation, neuraminidase inhibition (i.e. anti-viral medication resistance) and whole genome sequencing testing services.

Test result data will be used by CDC to speed influenza vaccine development and better understand what influenza viruses are circulating and how they may be changing.

The WSLH will provide testing for Wisconsin and 21 other states.

Since 2009, the WSLH has served as a CDC virus isolation project partner looking for antigenic shift and drift in influenza viruses. This latest project builds upon that partnership.

The WSLH’s contract with CDC to serve as a national Vaccine Preventable Disease (VPD) Reference Center also has been renewed for another 5 years. The WSLH provides routine testing capacity for measles, mumps, rubella and other vaccine-preventable diseases for other public health laboratories as well as surge capacity for CDC in case of a large-scale outbreak.

The WSLH is not only performing viral and bacterial VPD testing for Wisconsin and 17 other state and local public health laboratories across the country, it is also the only VPD Reference Center providing test performance evaluation panels to public health laboratories so that they can assure the quality of their testing.

The work WSLH scientists perform with both reference centers enhances our surveillance and outbreak response capabilities to support Wisconsin’s public health system and the health of Wisconsinites.

About 7:00 AM Monday through Saturday, chemists and support staff working in the Wisconsin State Laboratory of Hygiene (WSLH) Newborn Screening Laboratory gather round a table and open envelopes containing precious samples from the state’s newest residents – dried blood spot specimens collected from babies born within the previous couple of days.

The blood spots are sent to multiple stations in the laboratory where they are tested for 44 rare, serious disorders that, if not treated quickly, can lead to severe health problems and sometimes even death. Out of the 65,000 babies born in Wisconsin annually, about 135 will have one of the disorders.

For lab staff, these blood spots represent real-life babies. But rarely do they get to meet the actual people whose lives they have so profoundly affected.

Earlier this month they got their chance.

In celebration of Newborn Screening Awareness Month, two people living with PKU – one of the 44 disorders on the newborn screening panel – visited the WSLH Newborn Screening Laboratory.

PKU is a metabolic disorder that requires a lifelong, low-protein, low-phenylalanine diet to avert irreversible brain damage from the accumulation of phenylalanine in the body. People living with PKU drink liquid supplements and/or take pills to obtain needed nutrients for proper growth and development.

Joelle Odor was the first baby to test positive for PKU after newborn screening was consolidated at the WSLH in 1978. She told staff of her challenges staying on the restrictive PKU diet when she reached her teens and how changes in the formulation of supplements have allowed her to get back “on diet”.

Logan Schrimpf is only 3 months old so his parents Kristi and David did the talking for him.

Logan is the Schrimpf’s first baby and his PKU diagnosis has required some additional adjustments for the new parents. David recounted the emotional roller coaster he and Kristi were on the first few weeks of Logan’s life, including how important it was to learn the results of follow-up tests that monitored whether dietary changes were lowering Logan’s phenylalanine levels.

At 3 months, Logan is doing great and the Schrimpf’s are adapting to life with a child who has PKU.

Because diet and supplemental formula are crucial to managing PKU, two dietitians from the University of Wisconsin-Madison’s Waisman Center metabolic disorders clinic also spoke to the lab staff. Nikki Drilias and Therese Breunig brought along samples of some of the different formula options for staff to taste.

Joelle, Kristi, David and Logan also toured the newborn screening lab learning how the chemists detect the disorders in the dried blood spots.

For everyone involved the event was a chance to learn more about the people behind the lab results.