Disease Detection: Laboratories on the front lines

You can’t respond to threats if you don’t know what they are, which is one reason that laboratories play such an important role in public health. Public health laboratories have helped detect all kinds of threats to the public’s health; including anthrax, monkey pox, novel flu viruses, and foodborne disease outbreaks caused by germs like listeria. Since 1999, CDC, the Federal Bureau of Investigation (FBI), and the Association of Public Health Laboratories (APHL) have been working together to support the Laboratory Response Network (LRN). The LRN is a network of 160 domestic and international laboratories that work around the clock to provide rapid testing of biological and chemical threat agents and support for other public health emergencies.  They use standardized tests so results from one laboratory mean the same thing as results from another laboratory within the network.

The LRN’s mission to respond to public health emergencies was tested in the summer of 2011, when a 61-year-old retiree from Florida was diagnosed with anthrax. The man was on a 3-week vacation with his wife visiting the national parks of Wyoming, Montana, and the Dakotas when he came down with a rare and extremely deadly type of anthrax infection that experts believe he picked up from natural sources while on his road trip.

In August 2011, shortly after arriving at a friend’s home in Minnesota, he became seriously ill and was hospitalized. LRN training and partnership between the local hospital and the Minnesota Department of Health led to quick suspicion of Bacillis anthracis, the organism that causes anthrax, and a clinical sample was sent from the hospital to the state laboratory for analysis. The Minnesota Department of Health used LRN methods to confirm that the patient had inhalational anthrax, which has a death rate as high as 90% when left untreated.

It was a terrifying diagnosis. But thanks to plenty of planning and a strong infrastructure, appropriate treatment of the patient began promptly.  CDC was asked to provide assistance with the medical care, including the provision of a specialized treatment—anthrax immunoglobulin.  These combined efforts to treat the patient were successful, and he recovered.

Public health experts concluded the patient’s illness was caused by anthrax germs that exist naturally in the environment, but the exact source of the infection was not identified.  The patient had exposure to soil and animal remains during his travel.  CDC and the Minnesota Department of Health also worked with the FBI early in the investigation and determined that this case was not the result of bioterrorism.

This is just one instance of the LRN at work. The LRN was also crucial during responses to anthrax in 2001, SARS in 2003, and monkey pox in 2003.  In addition, the public health infrastructure built to sustain the LRN was key to the 2009 H1N1 response. Thanks to all the LRN member laboratories, the staff at CDC and key partners such as the Association of Public Health Laboratories, FBI, Department of Defense, and Department of Homeland Security for making this network the success it is.