State Hygienic Laboratory OUR IMPACT. DISEASE CONTROL

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State Hygienic Laboratory OUR IMPACT www.shl.uiowa.

1 State Hygienic Laboratory OUR IMPACT INFECTIOUS DISEASE THREATS BY THE DECADE 1970S LEGIONELLA DISEASE CONTROL STEPS IN AN OUTBREAK INVESTIGATION DETECT A POSSIBLE OUTBREAK FIND CASES IN AN OUTBREAK 1980S MRSA HIV 1990S NIPAH VIRUS WEST NILE VIRUS 2000S MONKEYPOX SARS 2010S ANTIBACTERIAL RESISTANCE EBOLA ,912 IOWA COUNTIES SERVED 2,269 2,314 1,097 2, , , , , , ,122 3, , *Based on fiscal year 2016 numbers Clinical Disease Analyses Performed for Iowa by the State Hygienic Laboratory Fiscal Year 2016 = 90,385* 3 1,110 4,801 1, , , , ,567 13, ,458 1, ,484 28, ,231 36,877 1,196 45, ,507 2, , ,417 6, ,750 2, ,950 3, ,580 14,747 7,477 1,063 1,324 6, ,002 27,481 If cases continue Not finding associations If cases stop GENERATE HYPOTHESES THROUGH INTERVIEWS TEST HYPOTHESES THROUGH ANALYTIC STUDIES AND LABORATORY TESTING SOLVE POINT OF CONTAMINATION AND ORIGINAL SOURCE OF OUTBREAK VEHICLE CONTROL OUTBREAK THROUGH RECALLS, FACILITY IMPROVEMENTS AND INDUSTRY COLLABORATION DECIDE AN OUTBREAK IS OVER RECALL RECALL COMPONENTS OF DISEASE CONTROL SURVEILLANCE RAPID DIAGNOSTICS OUTBREAK INVESTIGATION 24-HOUR RESPONSE NEW TECHNOLOGIES AND METHODS

SURVEILLANCE OUR IMPACT - DISEASE CONTROL The State Hygienic Laboratory identifies the incidence and location of illnesses that affect population health, and does so in partnership with:

Response Network OUTBREAKS The laboratory s Disease Control Division helps limit the spread of illnesses by rapidly identifying pathogens that cause outbreaks.

s public health laboratory, the State Hygienic Laboratory maintains expertise and capacity in many areas of specialized testing.

influenza surveillance Serology Zika virus screening Maternal Screening identification of genetic dispositions NATIONAL LEADERSHIP Our laboratory scientists lead the nation in many areas

2 SURVEILLANCE OUR IMPACT - DISEASE CONTROL The State Hygienic Laboratory identifies the incidence and location of illnesses that affect population health, and does so in partnership with: Iowa Department of Public Health and local health departments The Centers for Disease Control and Prevention Health care facilities across Iowa Laboratory Response Network Food Emergency Response Network OUTBREAKS The laboratory s Disease Control Division helps limit the spread of illnesses by rapidly identifying pathogens that cause outbreaks. Multiple foodborne outbreaks-salmonella, Listeria Mumps primarily in Iowa s Regent universities Noroviruses often in long-term care and child-care facilities SPECIALIZED TESTING As Iowa s public health laboratory, the State Hygienic Laboratory maintains expertise and capacity in many areas of specialized testing. Environmental Microbiology food and water testing and foodborne outbreaks Microbiology statewide antimicrobial resistance monitoring, rabies testing, foodborne pathogen testing Molecular influenza surveillance Serology Zika virus screening Maternal Screening identification of genetic dispositions NATIONAL LEADERSHIP Our laboratory scientists lead the nation in many areas of public health. Organism genotyping (Mycobacterium, Salmonella, Shigella, E. coli) Detecting Cryptoporidium and Cyclospora Laboratory Response Network (LRN) and Food Emergency Response Network (FERN) responses Advanced methods to detect pathogens at the molecular level

COLI BSL2 PATHOGENS SUCH AS HIV AND STAPH INFECTIONS EMERGENCY BY THE

Hospitals EMS Providers Health Care Coalitions Sentinel Laboratories

DANGEROUS MICROBES SUCH AS EBOLA NATIONAL & GLOBAL HEALTH COMMUNITIES

3 State Hygienic Laboratory OUR IMPACT Biosafety Levels for Testing BSL1 LOW-RISK MICROBES SUCH AS E. COLI BSL2 PATHOGENS SUCH AS HIV AND STAPH INFECTIONS EMERGENCY BY THE NUMBERS Counties and Local Public Health Agencies Hospitals EMS Providers Health Care Coalitions Sentinel Laboratories HazMat Teams BSL3 HIGHLY INFECTIOUS PATHOGENS SUCH AS ZIKA BSL4 DANGEROUS MICROBES SUCH AS EBOLA NATIONAL & GLOBAL HEALTH COMMUNITIES PATIENTS PARTNERS 10 COMPONENTS OF EMERGENCY PARTNERING TRAINING RESPONSIVENESS DETECTING THREATS DISASTER

OUR IMPACT - EMERGENCY NETWORK A network of teams that specialize in preparedness and response work together to determine if an unknown agent or infectious disease poses

Teams include: State Hygienic Laboratory Homeland Security and FBI Fire Departments and HazMat Teams 71st Civil Support Team Iowa State Patrol Local law enforcement

and shipping training Specimen collection training Field identification of threats training EVENTS Threats to public health and safety can happen anywhere including in

Some recent events include: Castor beans Osage Unknown substance Eastern Iowa Airport Pesticide drift Marion Cyanide powder Centerville Credible threat letter Oskaloosa

4 OUR IMPACT - EMERGENCY NETWORK A network of teams that specialize in preparedness and response work together to determine if an unknown agent or infectious disease poses a health risk to Iowans. Teams include: State Hygienic Laboratory Homeland Security and FBI Fire Departments and HazMat Teams 71st Civil Support Team Iowa State Patrol Local law enforcement agencies The State Hygienic Laboratory provides highly specialized training for partners with Bioterrorism laboratory workshop Full-scale exercises and drills Packaging and shipping training Specimen collection training Field identification of threats training EVENTS Threats to public health and safety can happen anywhere including in the small towns and facilities in Iowa. Some recent events include: Castor beans Osage Unknown substance Eastern Iowa Airport Pesticide drift Marion Cyanide powder Centerville Credible threat letter Oskaloosa RESPONSE The State Hygienic Laboratory is on-call around the clock, 365 days a year to identify biological, chemical and radiological threats to Iowans. It responds with Some of the most highly trained laboratory response staff in the state Testing of highly infectious agents Biosafety level 3 laboratories Statewide courier for routine and urgent sample transport Tier 1 select agent registration extra physical security and personnel reliability requirements

5 State Hygienic Laboratory OUR IMPACT ENVIRONMENTAL HEALTH AIR QUALITY Statewide monitoring network at 29 sites WATER QUALITY Lakes, rivers, streams, impoundments (more than 200 waterways), recreational water and private wells FOOD SAFETY Food Emergency Response Network and Rapid Response Team TOXIN ASSESSMENT AND RISK MANAGEMENT Contamination evaluation and quantification NUCLEAR State and regional service IOWA COUNTIES SERVED , ,582 1, Environmental Health Analyses Performed for Iowa by the State Hygienic Laboratory Fiscal Year 2016 = 145,714* 447 2, , ,640 1, ,671 2,147 39, ,240 3, , , , , , , , , ,807 MAKING A DIFFERENCE IN IOWA SAFEGUARDING HUMAN AND ANIMAL HEALTH PREVENTING HEALTH ISSUES SUCH AS: RESPIRATORY NEUROLOGICAL FOODBORNE ILLNESSES CANCER SKIN CONDITIONS WATER AND LAND PRESERVATION ECOSYSTEM DIVERSITY PROTECTION TOXIN DETECTION CLEAN AIR NUCLEAR SAFE WATER FOOD EMERGENCY RESPONSE SOIL QUALITY

OUR IMPACT - ENVIRONMENTAL HEALTH AMBIENT AIR QUALITY Collects data from more than 100 monitors at 29 sites in 16 Iowa counties to

LIMNOLOGY Collects and analyzes samples of surface water, wastewater and groundwater throughout Iowa.

Among the many toxins that limnologists monitor are lead, mercury, pesticides and arsenic.

air, food, milk, urine and foliage. Radionuclides can be harmful to human health if inhaled or ingested.

ENVIRONMENTAL CONTAMINATION Assesses for the toxic chemicals and elements in the environment that are threats to human and animal health.

6 OUR IMPACT - ENVIRONMENTAL HEALTH AMBIENT AIR QUALITY Collects data from more than 100 monitors at 29 sites in 16 Iowa counties to monitor air quality. Poor air quality may affect the health of those with respiratory conditions, the elderly and the very young. LIMNOLOGY Collects and analyzes samples of surface water, wastewater and groundwater throughout Iowa. Limnologists examine the physical, chemical and biological characteristics of aquatic systems and their watersheds. Among the many toxins that limnologists monitor are lead, mercury, pesticides and arsenic. RADIOCHEMISTRY Primarily performs analyses of water and soil to determine radioactivity concentrations, but also is capable of analyzing air, food, milk, urine and foliage. Radionuclides can be harmful to human health if inhaled or ingested. The section maintains preparedness for any radiation emergency response incidents. ENVIRONMENTAL CONTAMINATION Assesses for the toxic chemicals and elements in the environment that are threats to human and animal health. The Hygienic Laboratory analyzes air, soil, water, vegetation and food for potentially toxic organic compounds, such as plasticizers, pesticides, pharmaceuticals and industrial chemicals. It also measures minerals and metals in the occupational and natural environment, some of which are harmful to health even with minimal exposure.

2013 MILWAUKEE JOURNAL SENTINEL IDENTIFIES IOWA & DELAWARE AS MODEL PROGRAMS 1992 SHL BEGINS SCREENING FOR NORTH DAKOTA NEWBORNS 2006 COURIER PROGRAM BEGINS FOR DAILY COLLECTION OF SPECIMENS 2013

7 State Hygienic Laboratory OUR IMPACT IOWA NEWBORN SCREENING PROGRAM Timeline of Events 1966 IOWA BEGINS NEWBORN SCREENING 2005 SHL PROVIDES SCREENING FOR LOUISIANA AFTER HURRICANE 2007 SHL BEGINS SCREENING FOR SOUTH DAKOTA NEWBORNS 2013 MILWAUKEE JOURNAL SENTINEL IDENTIFIES IOWA & DELAWARE AS MODEL PROGRAMS 1992 SHL BEGINS SCREENING FOR NORTH DAKOTA NEWBORNS 2006 COURIER PROGRAM BEGINS FOR DAILY COLLECTION OF SPECIMENS 2013 NATIONAL 50 TH ANNIVERSARY OF NEWBORN SCREENING 2016 IOWA NEWBORN SCREENING PROGRAM CELEBRATES ITS 50 TH ANNIVERSARY BABIES SCREENED - FY , *Includes 2 that are not assigned to a county. Based on mother s zip code , , , , , NEWBORN SCREENING BY THE NUMBERS* Babies born in U.S. who are saved or have health improved Conditions detected Iowa babies screened North Dakota babies screened South Dakota babies screened Analyses performed for Iowa , ,079 Babies Screened by County F Y ,000 1,000-3,000 >3,000 12, ,509 13,734 13, ,660 *Based on fiscal year 2016 numbers COMPONENTS OF NEWBORN SCREENING SAVING LIVES 7 DAYS A WEEK STATEWIDE COURIER SCREEN FROM 5 DROPS OF BLOOD BIRTHING FACILITIES AND MIDWIVES

OUR IMPACT - NEWBORN SCREENING Since 1966, hundreds of Iowa babies have been helped through early detection of inherited conditions that, if left undetected and untreated, can have devastating health

In their own words, parents describe the impact of the Iowa Newborn Screening Program. THE FAMILY CIRCLE Brody (top, left) and Brooke were born with biotinidase deficiency.

We feel fortunate that our children are healthy, active and can live a normal life like any other child. We are grateful we know how to keep our children healthy.

genetic disorder was added to the program. There are no words to express how grateful I am [for newborn screening]. My son probably wouldn t be with us today without it. YAY!

8 OUR IMPACT - NEWBORN SCREENING Since 1966, hundreds of Iowa babies have been helped through early detection of inherited conditions that, if left undetected and untreated, can have devastating health effects. The Iowa Newborn Screening Program works 365 days a year, to ensure that these conditions are identified so lifesaving treatments can be provided and babies can thrive. In their own words, parents describe the impact of the Iowa Newborn Screening Program. THE FAMILY CIRCLE Brody (top, left) and Brooke were born with biotinidase deficiency. Biotin is used in the body to breakdown fats, proteins and carbohydrates. If left untreated, this serious condition can cause coma or death. We feel fortunate that our children are healthy, active and can live a normal life like any other child. We are grateful we know how to keep our children healthy. JUST IN TIME Zach was the first baby in Iowa identified through the Newborn Screening Program with MCAD (medium chain acyl-coa dehydrogenase) deficiency just one month after screening for the rare genetic disorder was added to the program. There are no words to express how grateful I am [for newborn screening]. My son probably wouldn t be with us today without it. YAY! FOR NEWBORN SCREENING Payton (left), Max and Garrett were diagnosed with classic galactosemia in which the body is unable to properly digest galactose, a sugar found in all foods that contain milk. Babies who do not receive prompt treatment may die within the first few weeks of life. All are doing an outstanding job in school and are happy, healthy kids. FOUR IOWA As infants, these four brothers (circling the group) were diagnosed with Phenylketonuria or PKU. It was the first condition in the nation that was detected when newborn screening began in the 1960s. If left untreated, PKU can cause permanent brain damage. Everyone is doing great. We are blessed!

Association of Public Health Laboratories

STATEMENT BY DR. Peter A. Shult ON BEHALF OF THE ASSOCIATION OF PUBLIC HEALTH LABORATORIES DIRECTOR OF THE COMMUNICABLE DISEASES DIVISION OF THE WISCONSIN STATE LABORATORY OF HYGIENE ON Beyond the Checklist: