florida bureau of public health laboratories 2013 annual report

2013 ANNUAL REPORT

FLORIDA DEPARTMENT OF HEALTH

BUREAU OF PUBLIC HEALTH LABORATORIES

ContentsHurricane Season Ready or Not, Here it Comes!, 3

Changes to the Environmental Chemistry LaboratoryDepartment, 4

Newborn Screening Enrolls in the MolecularAssessment Program, 4

BPHL: An Important Part of the Laboratory ResponseNetwork, 4

Healthiest Weight Florida, 5

BPHL Enhances Salmonella Testing, 6

2013 BPHL Timeline, 8

Dengue Outbreak in Florida, 10

The BPHL Environmental Laboratory CertificationProgram Contracts with Staff Assessors, 11

Brucellosis: Acquired from a Blood Transfusion, 12

Rabies—The Facts You Need to Know, 12

The Speaker for Beaker, 14

Publications, Grants, Boards & Committees, 15

National Meetings & Presentations, 16

Service Acknowledgements, 17

About the Front CoverCLOCKWISE FROM TOP LEFT: Jeremy Racicot works in

the microbiology section; Dr. Marek Pawlowicz

works in the molecular epidemiology section and

performs Pulse-Field Gel Electrophoresis (PFGE) and

“fingerprint” analysis; Dr. Paul Fiorella works in the

molecular epidemiology section and performs PFGE

and fingerprint analysis; Lylah Seaton and Justin

Hubsmith, from the virology department, working in

the biological safety cabinet; Jennifer Camacho in

the serology department doing testing for STDs; and

Thomasina Fields, who worked in laboratory

support, unexpectedly passed away in October

2013—she had worked for the Department for 33

years, and was a part of our family and is greatly

missed.

BPHL Acknowledges theAnnual Report CommitteeContributors: Dr. Andy Cannons, Mary Cook,

Susanne Crowe, Dr. Rick France, Dr. Leah Gillis, Bill

Nakashima and Dr. Marie-Claire Rowlinson

Review: Dr. Carina Blackmore and Jerry Donham

Administration: Diane Gunnell

Photography: Phil Lee and Bob Sullivan

Design: Georgia Murphy

FLORIDA DEPARTMENT OF HEALTH 2013 BPHL ANNUAL REPORT 1

Contributingto Florida’sHealth,LEAN(er)Laboratories& HealthierEmployees!

Greetings! We are very pleased to present the Bureau of Public HealthLaboratories 2013 Annual Report! In 2013, the Bureau of Public HealthLaboratories (BPHL) continued to “contribute to a healthier Florida byproviding diagnostic screening, monitoring, reference, research andemergency public health laboratory services” including:

nPerforming newborn screening tests

nPerforming testing for a local outbreak of Dengue Virus

nPerforming testing on samples from food-borne outbreaks

nPerforming testing of suspect biological threat samples at all fourlaboratories

nPerforming rabies testing at all four laboratories

In 2013, the BPHL continued to work towards improving the quality andefficiency of services by utilizing LEAN principles and enrolling in theMolecular Assessment Program for Newborn Screening. The BPHLEnvironmental Laboratory Certification Program began contracting withvendors to perform environmental laboratory assessments. The BPHLsupported the Department of Health’s Healthiest Weight Florida Initiative byimplementing a program that encourages employees to walk their way tobetter health and their healthiest weight.

We are grateful for the hard work and dedication of the BPHL staff who arecommitted to promoting and protecting the health of all Floridians and welook forward to the opportunity to continue to serve Florida’s citizens in2014!

Susanne CroweInterim Chief, Bureau of Public Health Laboratories

Our Mission: To contribute to a healthierFlorida by providing diagnosticscreening, monitoring, reference,research and emergency public healthservices.

The Department’s BPHL is a network of four laboratorieslocated in Jacksonville, Miami, Pensacola and Tampa.State government agencies in Florida, such as theDepartment, work hard to prepare for events that couldimpact their ability to provide services. In fact, emergency

planning is so important that it is mandated by law. Chapter 252,Florida Statues, mandates that all agencies have a plan in place tomanage operations and provide mission essential services duringdisasters, emergency situations and other unforeseen circumstances.These plans are called Continuity of Operations Plans (COOP).

Most of you are probably familiar with the concept of emergencyplanning. The two main objectives of emergency planning are savinglives and saving property. The COOP planning goes beyond emergency

planning and includes settingpriorities, identifying essentialfunctions and having a plan in placeso that the organization can continueto accomplish the critical parts ofits mission in any situation. Themost critical services an organizationprovide are termed Mission EssentialFunctions (MEF). While all servicesprovided by the BPHL are of publichealth importance, not all servicesare considered “urgent” or “critical.”

The MEFs performed by the BPHL include testing for rabies andbiological threat agents.

An advantage of COOP planning is that it forces leadership andstaff to think about the “what ifs.” From the disastrous “what if ourlaboratory is devastated by a hurricane” to the more mundane

“what if we cannot conduct testing because of a busted water mainpipe.” During an event, some employees might not be able to makeit to the laboratory to perform their duties. Key leadership decisionswill still need to be made and critical positions covered so that thelaboratory can accomplish the MEFs. By design, the COOP alsoincorporates plans for Delegation of Authority and Orders ofSuccession. A COOP identifies who is in charge during an eventand identifies staff that can perform testing during COOP emergencies.The COOP provides a roadmap for staff to follow during an eventto ensure that critical public health laboratory services are providedto Florida’s citizens without interruption.

WHAT IF A CATASTROPHIC EVENT DAMAGED A LABORATORY TOTHE POINT IT WAS NOT OPERATIONAL? The geographical distributionof Florida’s public health laboratories ensures continuity of testingservices in situations when one of the laboratories is unable toconduct testing for any reason. These redundancies in testingcapabilities are vital to the sustainability of critical public healthtesting during natural disasters and other emergencies.

2 FLORIDA DEPARTMENT OF HEALTH 2013 BPHL ANNUAL REPORT

QUICK FACT Mission Essential Functions (MEFs) are the most critical

services that are provided by an organization. As part of the Continuity

of Operations Plan (COOP) process it is important for organizations to

know what their MEFs are. At the Bureau of Public Health

Laboratories (BPHL) we consider the most urgent testing functions,

such as rabies testing or testing for agents of bioterrorism as MEFs

because this testing can have great public health implications and rapid,

accurate testing is essential.

HURRICANE SEASONReady or Not, Here it Comes!

It was an unimaginable event; two hurricanes were

heading straight toward Florida the same week! Whether

you blame it on global warming or a freak of nature, the

reality was Florida’s public health laboratories needed to

be prepared!

Dr. Andy Cannons and Dr. Rick France review the BPHL-Tampa COOPmanual during the 2013 Statewide Hurricane Exercise.

IN 1986, THE FLORIDA LEGISLATURE

ESTABLISHED THE INLAND PROTECTION

TRUST FUND TO PROVIDE FUNDING FOR

CLEANUP OF PETROLEUM-

CONTAMINATED SITES. As part of thisprogram, the Department’s BPHLEnvironmental Chemistry Laboratory(ECL) performed testing ofenvironmental samples for this andother cleanup programs. Since 2009there have been legislative changesmade to the trust fund and this inturn has meant a reduction in thescope of the testing required tosupport these programs and thedesignation of who will perform thelaboratory testing.

On July 1st 2013, some of thetesting that had previously beenperformed by the BPHL wastransferred to the FloridaDepartment of EnvironmentalProtection laboratory includinganalytical and data collection for thefollowing program sites: petroleumcleanup; dry-cleaning solventcleanup; waste cleanup; and select

non-petroleum or non-point source contaminated sites for the WaterSupply Restoration. However, under the delegation of primacy fromthe Environmental Protection Agency (EPA), the BPHL continues to bethe principal state laboratory for testing under the Safe DrinkingWater Act. In 2013, the BPHL ECL tested almost 13,000 samples.

Changes to theEnvironmental

Chemistry LaboratoryDepartment

Once your COOP is in place,you cannot be sure that theplan will work. A crucial stepin the COOP process is testingthe plan. The best way to test aCOOP is with implementation.The two hurricanes convergingon Florida described above—they weren’t real but part of anexercise. All four of the BPHLlaboratories participated withthe Division of EmergencyPreparedness and CommunitySupport in this year’s May 2013Statewide Hurricane Exercise.This exercise provided the BPHLan opportunity to activate ourCOOP and identify strengthsand areas that needed improve-ment. In the exercise scenario,

the hurricanes significantlydamaged each of the labora-tories as they passed through;first Tampa, then Pensacola,followed by Miami, and finallyJacksonville. As a strength, weidentified that the BPHL labora-tories are able to resume testingof MEFs they provide for publichealth safety within 12 hoursafter activation of the COOP.Our laboratory network wasidentified as another strength.An area for improvement wasthe lack of contingency plansin the event that key resourcesare not available for rabies andtuberculosis testing.

BPHL IS PREPARED With the 2013 Statewide Hurricane Exercise wefound out that our COOP needed some minor revision; but, overallwe were more than prepared. How about you? Are you ready?

PREPAREDBPHL

12-HOUR MEF RESPONSE

MEFs

PENSACOLAJACKSONVILLE

MIAMI

TAMPA

BIOTERRORISMAGENTS

RABIES

CONTINUITY

QUICK FACT The environmental chemistry lab sent out kits to

homeowners in Hernando County to test for arsenic in urine of

homeowners with drinking water wells potentially contaminated with

the chemical. This project was funded by the Centers for Disease

Control and Prevention. The BPHL worked with the Environmental

Public Health Tracking Program in the Bureau of Epidemiology and DOH-

Hernando, to collect and analyze 250 samples for arsenic.


IN JANUARY 2013, THE DEPARTMENT’S BPHL-JACKSONVILLE hosted a sitevisit from representatives from the Association of Public HealthLaboratories (APHL) and the Centers for Disease Control andPrevention(CDC). This was part of an APHL/CDC-funded MolecularAssessment Program (MAP). The CDC’s Newborn Screening andMolecular Biology Branch, in co-operation with APHL, conductsonsite visits designed to assess the molecular program of statenewborn screening programs. The team supports qualityimprovement of current molecular testing capabilities and assistswith the development and implementation of new molecular testsfor newborn screening.

During the visit, APHL/CDC assessed the workflow andprocedures for cystic fibrosis and severe combined immunedeficiency (SCID) testing at the BPHL and providedrecommendations for improvement and future activities. In addition to providing recommendations,

MAP also supported sending one of the newborn screening managersto the Michigan Department of Community Health, NewbornScreening Laboratory for training in deoxyribonucleic acid (DNA)testing for SCID in August 2013. Training covered preparing abnormalcontrol samples and how to properly review assays. This collaborationand exchange of best practices is very beneficial for state public healthlaboratories.

NEWBORN SCREENING ENROLLS INTHE MOLECULAR ASSESSMENT PROGRAM (MAP)

QUICK FACT The Newborn Screening staff attended the APHL 2013 Joint Meeting of the Newborn

Screening and Genetic Testing Symposium and the International Society for Neonatal Screening in Atlanta,

Georgia on May 5th–10th, 2013. This meeting was in celebration of 50 years of newborn screening and was

attended by more than 600 individuals from 37 countries.


Dr. Ming Chan, the retired bureauchief of BPHL, now consults forthe Newborn Screening Program.

BPHL : An Important Part of the Laboratory Response NetworkThe BPHL-JacksonvilleBiological DefenseLaboratory In 2001, theDepartment’s BPHLbiological defenselaboratory in Jacksonvillewas the first laboratory inthe nation to positivelyidentify Bacillus anthracis(the causative agent ofanthrax) from a clinicalsample during the post911 bio-terror attack. TheLaboratory Response Network (LRN) (anintegrated network of local, state andinternational laboratories capable of quickresponse to biological threats and otherhigh priority public health emergencies),had been formed only a few years earlier

but BPHL was prepared.The laboratory’s ability toidentify bioterrorismagents was pivotal inaiding the response oflocal, state and federalauthorities during thisincident, which impactedthe entire nation. Sincethat time, the BPHL hasremained a highly activeand effective member ofthe LRN. Occasionally, the

laboratory’s role may extend beyondsample analysis. For example in 2013,results for samples tested by BPHL-Jacksonville and testimony from laboratorypersonnel assisted federal prosecutors inconvicting a Florida resident for

“threatened use of a weapon of massdestruction” after the individual mailedanthrax threat letters to multiplegovernment agencies.

Pensacola BSL-3 Laboratory Re-Opens Alsoin 2013, the BPHL achieved its goal of re-opening the Bio-Safety Level-3 (BSL-3)laboratory in Pensacola. The BSL-3laboratory is a high level containmentfacility where manipulation and testing ofhazardous infectious agents can be donesafely to ensure that laboratory personnelor members of the community are notexposed. Reestablishment of thislaboratory permitted BPHL-Pensacola toreactivate membership in the LRN andresume its ability to respond to biologicalthreats. As a LRN biological reference

laboratory the BPHL-Pensacola worksclosely with public health officials, lawenforcement and the FBI Weapons of MassDestruction Directorate and supports theseagencies by testing suspicious substancesfor the presence of high priority pathogenssuch as B. anthracis and Yersinia pestis (thecausative agent of the plague). Pensacolajoins BPHL’s other LRN biological referencelabs located in Jacksonville, Miami andTampa adding additional testing capacity,lending support for law enforcement cases,helping direct public health investigationsand effectively providing medical andemergency first responders laboratorysupport within four hours.

Pensacola

Tampa

Jacksonville

Miami

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PROUD TO BEHEALTH NUTS!

PROUD TO BEHEALTH NUTS!In spring 2013, through theHealthiest Weight Floridainitiative, the Department’sBPHL provided screeningsof the HBO documentary The

Weight of the Nation to employees.Watching the documentary, peoplereally became aware of themagnitude of the problem andseeing the negative physical impactof carrying extra weight literallytipped the scales for many. Theywanted to make a change and needed a program that would supportthem. Bonnie Hardy, HIV Incidence and Resistance SurveillanceLaboratory Liaison, BPHL-Jacksonville, took on the challenge. Shetook the materials that had been distributed by Tallahassee andadapted them for the laboratory, thus developing a personalizedweight loss program. Eleven people signed on to program, whichmeant modifying eating habits and incorporating exercise into thedaily routine over a ten-week period. There were weekly weigh-insand lots of cheering and recognition. Two memos were emailedevery week to the participants, who were fondly called the HealthNuts, with helpful information and links to new websites thatmight support them in their endeavor.

At the end of the 10 weeks, a grand finale was organized torecognize the biggest loser and to congratulate the entire group.Overall the group lost three percent of their combined weight—agreat accomplishment! Every person received a certificate inrecognition of their participation and the person who lost thelargest percent of their body weight won a pedometer, an AmericanHeart Association Cook Book, and a $50 Visa card.

THE 10,000 STEP CHALLENGEThose who were involved in thefirst program wanted to continueand others at the laboratory whohad heard about this endeavorwanted to get involved and wereanxious to know what would behappening next. That’s whenBonnie developed Healthy Livingby Design: The 10,000 StepChallenge. This program, whichstarted in 2013 and will continue

in 2014, encourages healthy eating and exercise centered oncompleting 10,000 steps a day. The concept of 10,000 steps a dayoriginated in Japan in the 1960s but is now a popular componentof maintaining healthy weight and weight loss programs aroundthe world. In addition to the BPHL, the challenge was promoted toother entities of the Department and includes participants fromthe Division of Emergency Preparedness and Community Support,Bureau of Vital Statistics and the DOH-Brevard County. The StateEmployees Credit Union (SECU) is also a participant. The challengehas each group compete with one another for the most total stepsbut ultimately the goal is to walk as a team. Walking as a teamchanges the way one walks. It provides support, direction andvalidation. Walking as a team builds new friendships and walkingas a team is the best gift that you can give yourself.

If you are interested in taking part with the Department’s BPHL,Division of Emergency Preparedness and Community Support,Bureau of Vital Statistics, the State Employees Credit Union andothers contact Bonnie Hardy at [email protected] or 904-885-2016.

The vision of the FloridaDepartment of Healthis to be the HealthiestState in the Nation andin January 2013 theDepartment launchedthe Healthiest WeightFlorida initiative. Thiscollaborative effortbetween public andprivate entities bringstogether state and localagencies, businesses,non-profitorganizations andcommunities all withthe same goal ofencouraging Florida’sresidents to leadhealthy, active lives. Itis estimated that in theyear 2030 nearly 60percent of Floridianswill be obese, with thesame proportion ofchildren obese by thetime they graduatefrom high school. Thehope is that thisinitiative can bend theweight curve by fivepercent by the year2017 and stem theobesity epidemic.

HEALTHY LIVING BY DESIGN


mailto:[email protected]

The Salmonella bacteria are found in theintestinal tract of humans and other animalsincluding birds and reptiles. Transmission to

humans is usually through eating food such asbeef, poultry, milk or eggs that have beencontaminated with animal feces containingSalmonella. However, any food item can becontaminated as exemplified by the 2013Salmonella multi-state outbreaks that were linkedto the following foods: tahini sesame paste,cucumbers, chicken and ground beef. Cookingfood does kill the Salmonella but food can also becontaminated by an infected person (i.e., foodhandler) who has not washed their hands properlyafter using the restroom. In addition, Salmonellacan cause infection through direct contact with ananimal or pet. This is especially true of reptilesand chicks that are a particular risk for childrenwho play with and touch them or theirenvironment.

In the state of Florida there are at least 6,000reported cases of salmonellosis every year with apeak in the summer/fall months. Figure 1 showsthe number of cases of Salmonella reported to theFlorida Department of Health by month for 2013,compared to the monthly average over the last 5

years. In September, Florida sees a peak of about800 cases.

Salmonella is a reportable disease in the stateof Florida which means that health care providersmust report persons who are diagnosed withSalmonella (cases) to the Department. TheDepartment is able to follow up with cases todetermine a source for the illness. Health careinstitutions send Salmonella isolates from theirpatients (usually isolated from patient stool) to apublic health laboratory for testing. The resultscan be helpful in determining transmission,source of outbreaks and ultimately preventingfurther cases.

The Department’s BPHL performs laboratorytesting of Salmonella bacterial isolates as part ofthe PulseNet program. As Kayleigh Jenningsreported in the 2012 BPHL annual report,PulseNet is a national program, headquartered atthe CDC in Atlanta, Georgia. The PulseNetprogram has been operational since 1996 to helpdetect and define foodborne outbreaks throughlaboratory testing. The PulseNet program relieson laboratories in each state to test isolates ofSalmonella (and other foodborne bacteria such asE. coli and Listeria) to determine whether isolates

The Centers for Disease Control and Prevention (CDC) reports that each year,approximately 1 in 6 people in the U.S. becomes sick from eating contaminatedfood. Salmonella is the leading cause, with estimates of more than a million casesof infection, 23,000 hospitalizations, 450 deaths and $365 million in direct medicalcosts every year. Persons infected with Salmonella typically exhibit fever, diarrheaand abdominal cramps lasting 4–7 days. Fortunately, Salmonella infection isusually self-limited and generally does not require treatment. However, in certainpopulations (e.g., infants, elderly, immune-compromised or those with underlyinghealth conditions) infection can be more severe resulting in hospitalization andsometimes death.

1,000,000 CASES OF INFECTION

23,000 HOSPITALIZATIONS450 DEATHS

$365 MILLIONIN DIRECT

MEDICAL COSTS

SALMONELLA

BPHL Enhances Salmonella Testing

every year, more than


are related. There are many different types ofSalmonella so isolates initially are “serotyped” tocharacterize the organism based on immunologicreactivity. Common serotypes in the U.S. areTyphimurium and Enteritidis. This information can beuseful for epidemiological classification, outbreakinvestigations and sometimes the serotype correlateswith disease presentation (e.g. Salmonella Typhi causesTyphoid fever). However, further analysis of isolates isusually needed to determine how closely relatedisolates are and whether they are likely to be from thesame source. This additional analysis is performed by amethod called Pulsed-Field Gel Electrophoresis(PFGE). The PFGE technique extracts deoxyribonucleicacid (DNA) from the isolated organism and cuts theDNA into pieces at certain locations. The small piecesof DNA are then separated on a gel based on size.Looking at the pattern, or‘”fingerprint” of DNA pieces on thegel helps the laboratory scientistdetermine whether two isolates arepotentially related to one another.The fingerprints are also uploadedto the PulseNet National Databasefor comparison with fingerprints ofSalmonella isolates from patientstested in other states. Thus anisolate in Florida can be matched toan isolate in another state and thisis how multi-state outbreaks can beidentified, often before a commonsource for the infection has been

determined. For example, in 2013, there was anoutbreak of Multidrug-Resistant SalmonellaHeidelberg linked to chicken. This multistate outbreakaffected 29 states with 634 cases. This outbreak wasdetected through PFGE analysis that identified acluster of Salmonella isolates in California with a rarePFGE pattern.

Testing for Salmonella is very important forsurveillance and prevention of disease but there arechallenges associated with testing. In Florida,laboratories that identify Salmonella are not requiredby law to send Salmonella isolates to the state publichealth laboratory for further testing. Therefore, BPHLis not able to test an isolate from all of theapproximately 6,000 cases seen in the state each year.Typically, BPHL receives about 1,500 isolates.

In 2013, BPHL worked on several approaches to

improve testing for Salmonella, starting withincreasing the number of isolates that BPHL receives.BPHL-Tampa reached out to a local commerciallaboratory and asked them to submit all of theirisolates. The commercial laboratory startedsubmitting isolates in April 2013 and submits up to40 a week. Overall, BPHL is now receiving nearly2,500 isolates on cases in Florida which is an increaseof 1,000 isolates. This additional workload requiredhiring more staff, purchasing equipment and fundingfor supplies to support the increase in testing.Secondly, BPHL implemented a new test forperforming serotyping of isolates. This new methodinvolves molecular analysis and is a much more rapidtest than the traditional serotyping method which wasvery labor intensive and required very specificreagents and technical skills. Because of theimplementation of this new test, the BPHL is now ableto serotype all of the isolates received. This testingprovides more complete information to theepidemiologists who are investigating cases and willimprove surveillance and prevention of disease.

Ultimately we would like to receive an isolate fromevery case in Florida. In addition, we will continue toimprove and expand testing methods as new methodsbecome available. In the near future we expect to see“next-generation sequencing” (another molecularmethod for analysis) coming to our laboratories.

PHOTOS LEFT TO RIGHT: Medical Laboratory Scientist Matthew Schimenti, performs the molecular serotyping assay fordetermining Salmonella serotype. This new method has greatly improved our capacity to perform serotyping and inaddition, we are able to determine the serotype in a timelier manner.

The microbiology department identifies certain enteric bacteria by growing them on tubes containing different media.Based on how the bacteria metabolize various biochemicals in the media, the media changes color. For example,Salmonella Typhimurium reduces sulfur in the media which produces hydrogen sulfide gas which reacts with iron in themedia forming iron sulfide which appears black (second tube from left).

Salmonella: Month of Occurrence in FloridaAnnual to 5-Year Comparison

Nu

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er

of C

ase

s

0

100

300

500

700

900

Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.

2013 Previous 5-Year Average

QUICK FACT Salmonella is a reportable disease in the

state of Florida which means that health care providers

must report persons who are diagnosed with Salmonella

(cases) to the Department.


JANUARYNew

TB TestThe BPHL-Jacksonville TBlaboratory implementeda new method forMycobacterium tuberculosiscomplex drug susceptibilitytesting. Results from thismethod are reported asminimal inhibitoryconcentrations (MIC) forthe drugs. Since this is anew format, the Florida TBphysician’s network isworking to ensure thereports are understood byproviders.

FEBRUARYSmoothies

Can Be Rough!A food sample (fruitsmoothie) was associatedwith a food-borne outbreakin Polk County. The BPHL-Tampa laboratoryidentified Bacillus cereus inthe food using a rapid PCRtest that was confirmed byculture.

MARCHIs It ReallyAnthrax?

A specimen from a patientwith a facial skin lesionsuspicious of cutaneousanthrax was isolated as abeta-hemolytic Bacillusspecies. BPHL-JacksonvilleBT laboratory used real-time PCR to determinethe isolate containedB. anthracis DNA. However,conventional testing ruledout B. anthracis and theisolate was identified asBacillus cereus. The CDCconfirmed the isolate asB. cereus and did indeedharbor B. anthracis toxingenes. Previous reportshave identified someB. cereus strains causinganthrax-like disease inpatients.

APRILH1N1

Still AroundThe BPHL-Miamilaboratory received aspecimen from DadeCounty Medical Examiner(ME) for pediatric deathrelated to Influenza A(H1N1). BPHL receivedseveral ME specimensbetween March and Aprilmostly for H1N1 testing.

MAYCastor Beans Are

Poisonous The BPHL-Jacksonvillechemical threat (CT)laboratory performedtesting for ricinine on apatient who had ingestedcastor beans. A urinespecimen on the patientwas delivered from ahospital in Alachua County,by courier, the evening ofMay 3rd. The CT laboratoryanalyzed the specimenovernight and detectedricinine despite it being 6days after ingestion. Ricinis a naturally occurringpoison found in castorbeans.

JUNEWedded

Bliss?The BPHL-Jacksonvillelaboratory participated in afood investigation fromLeon County. Thirty-eightof sixty-five weddingattendees (attack rate =58%) had symptoms offood-borne illness. Thelaboratory isolated Bacilluscereus from the food sample(tacos) which were servedat the wedding.

2013BPHLTIMELINE


JULYGet Tick(ed)

Off!Ehrlichia chaffeensis wasconfirmed by the BPHL-Jacksonville laboratory in aWakulla County residentwith a history of a tick bite.Ehrlichiosis disease iscaused when Ehrlichiabacteria are transmitted inthe bite of an infected tick.Symptoms include fever,headaches, fatigue andmuscle aches. Ehrlichiosiscan be treated withantibiotics but preventingtick bites is the bestmeasure against disease.

AUGUSTFatalVibrio

BPHL-Miami laboratoryidentified Vibrio vulnificusfrom a blood culture of aMonroe County patient whodied. Vibrio vulnificus is ahalophilic bacterium (foundin saltwater) that causesinfection whenundercooked seafood isconsumed or when openwounds are exposed towarm saltwater. Vibrioinfections are morecommon in the warmersummer months in coastalareas of Florida.

SEPTEMBERNot AlwaysPlain Sailing

BPHL-Miami laboratoryidentified Plasmodiumfalciparum from a 27 yearold patient who works on acruise ship. Travel historyprovided did not explainthe source of the infectionsince the islands traveled toon the cruise ship named donot have malaria.

OCTOBERFood BorneOutbreak

As part of a food borneoutbreak investigation theBPHL-Jacksonvillelaboratory shipped fiveEscherichia coli O157:H7(shiga-toxin producingE. coli, STEC) isolates to theCDC for specializedsubtyping testing(Multiple-Locus Variable-Number Tandem RepeatAnalysis, MLVA). Havingthe MLVA fingerprint inaddition to the PFGEfingerprint helps furtherdifferentiate strains anddetermine whether they arerelated to the same foodsource.

NOVEMBERNasty

WormsThe BPHL-Miami laboratoryidentified a worm from a 9year old patient as Ascarislumbricoides. The CDCconfirmed the diagnosisfrom images that were sentto their laboratory viaspecialized microscopes andcomputer software.

DECEMBERSCID: Rare But

Treatable!BPHL-Jacksonvillenewborn screening (NBS)laboratory had anabnormal-screen positivecase for severe combinedimmune deficiency (SCID).This was only the secondpresumptive SCID resultthat BPHL detected in theNBS laboratory sincetesting for SCID began inOctober 2012. This is out ofover 200,000 babies born inthe state of Florida eachyear that are testedthrough newbornscreening. The SCID resultwas confirmed by testing atDuke University.

“Whether it’s a food borne illness, possible terrorism agent,tropical infection, tuberculosis or genetic disease—every dayat the lab, there is an interesting public health investigationgoing on.” —Rick France, BPHL-Tampa, assistant laboratory director


Bureau ofPublic Health Laboratories:

Pensacola

Jacksonville

Tampa

Miami

F L O R I D A

Martin County, Florida

fever joint pain

rash

dengue fever ff

According to the Centers for Disease Control and Prevention (CDC) morethan one-third of the world’s population lives in an area where there isrisk of infection with dengue virus. Dengue is a leading cause of illnessand death in the tropics and subtropics. As many as 400 million peopleare infected with dengue every year.

Dengue is caused by infection with any one of four dengue viruses (DENV).Dengue virus is transmitted by mosquitoes and, since there are no vaccines toprevent infection, avoiding bites from mosquitoes is the only effective protectionmeasure. There is no cure for dengue virus but early detection of infection followedby prompt supportive treatment can lower the risk of medical complications anddeath.

At this point you may be thinking that as long as you avoid travelling to dengue

endemic areas, you do not need to worry about dengue. Not true! In 2009–2010,Florida experienced a local outbreak of DENV in Key West for the first time in morethan 70 years. After that outbreak, the state continued to see sporadic cases of localtransmission until another outbreak occurred in Martin County in 2013. In MartinCounty, 21 out of 139 patients with dengue symptoms tested positive for thepresence of the DENV-1 virus and/or antibodies.

As a result of this high number of locally acquired dengue cases, a serosurvey wasconducted to determine the extent of the outbreak. Serosurveys are effectively a testof the sera of a population to determine seroprevalence to, in this case, DENV. Thisserosurvey was conducted through a collaborative effort involving state and localepidemiologists and the BPHL. During a three week period, epidemiologists wentdoor to door and a total of 396 individuals were interviewed and provided serum

Fever. Rash. Joint pain.These symptoms are common to many illnesses, but did you know

they can also be symptoms of dengue fever? And did you know thatdengue virus is endemic in many popular tourist destinations

including the Caribbean?

Dengue Outbreak in Florida


The BPHL EnvironmentalLaboratory CertificationProgram (ELCP) employeda staff of assessors toconduct environmental laboratoryinspections for the approximately350 drinking water andenvironmental testing laboratoriesin the state of Florida and providetheir certifications. AfterSeptember 2013, theseDepartment-certified laboratoriesare required to, at their ownexpense, get inspected by one ormore of the six companiescontracted by BPHL ELCP toperform assessments that meetthe requirements of the NationalEnvironmental LaboratoryAccreditation Program (NELAP) andof the Department’s rules asspecified in the contracts. Underthese contracts the assessmentproviders are responsible for allaspects ofeachassessment,fromscheduling toreporting tocorrectiveaction review.

The BPHLELCP retainsthe responsi-bilities ofapplicationprocessingand proficiency testing reviewalong with contract oversight andregulatory enforcement. Wecontinue to make all certificationdecisions and related compliancedeterminations and remain firmlycommitted to our role as a NELAP-recognized accreditation body.

samples for diagnosticserological testing. Specimenswere forwarded to the BPHLsin Jacksonville and Tampa.Laboratory diagnosis of DENVincluded detection of viral RNAby a FDA-approved CDC-developed real-time reversetranscriptase polymerase chainreaction (RT-PCR) method, anddetection of an immuneresponse to the virus bymeasuring presence of DENVspecific antibodies (IgMantibodies and IgG antibodies,which reflect the early and lateimmune response to the virusinfection, respectively). Allpositive results were confirmedby Plaque ReductionNeutralization Test (PRNT),currently considered the “gold

standard” test for dengue. It isused to determine which of thefour dengue viruses is causing thedisease of interest.

Of the 396 survey participants,seven were positive for DENV-1indicating a previous infectionwith dengue. Of these seven, threeindividuals were symptomatic.Further analysis using geneticsequencing of virus from thepatients testing positive for DENV-1 and DENV-1 virus recoveredfrom one of the infectedserosurvey participants indicated

these were epidemiologically and genetically related to each other,as well as to a number of virus isolates from Venezuela. Thisanalysis also showed that while this strain was the same serotype(DENV-1), it was definitely distinct from the 2009–2010 Key Westvirus.

The testing of these samples at BPHL provided conclusivelinkage between outbreak-associated cases and clearlydistinguished the Martin County outbreak from the Key Westoutbreak. The results of the extensive serosurvey conducted inMartin County also showed that approximately 2 percent of theparticipants surveyed were infected during the outbreak.

No more locally-acquired cases of dengue infection have beenidentified in Martin County since this survey was completed inSeptember 2013. While we cannot definitively say what ended theoutbreak, contributing factors include increased mosquito controlefforts, as well as education provided to residents in the affectedcounties on how to protect themselves against dengue and othermosquito-borne diseases.

The success of this serosurvey was the result of tremendouscollaboration between the bureaus of Epidemiology and PublicHealth Laboratories, the DOH-Martin County and the participationof residents in the affected areas.

While we cannotdefinitively say whatended the outbreak,contributing factorsinclude increasedmosquito-controlefforts, as well aseducation provided toresidents in theaffected counties onhow to protectthemselves againstdengue and othermosquito-bornediseases.


Lylah Seaton, lead arbovirology scientist, and Justin Hubsmith, biological scientist I,testing for the presence of DENV specific antibodies in a specimen.

QUICK FACT BPHL performed nearly 8,000 tests for

mosquito transmitted viruses in 2013.

Dr. Carl Kircher from theEnvironmentalLaboratory CertificationProgram reviews work inthe chemistry lab withchemist Eddie Howell.

SO WHY IS BRUCELLAIMPORTANT? Brucellosis is asystemic zoonosis that can beacquired from contact withinfected animals or animalproducts contaminated withbacteria of the Brucella genus.Brucellosis can manifest as anacute or chronic infection.Acute brucellosis presents as anonspecific, flu-like illness,including symptoms of fever,sweats, headache, back pain,malaise, anorexia and myalgia.The chronic form of brucellosiscan take more than a year todevelop with symptoms thatinclude chronic fatigue,recurrent fevers, depressiveepisodes, joint pain, orchitisand endocarditis. The mostcommonly reported speciesthat cause illness in humansare B. abortus, B. melitensis, andB. suis. Humans appear to bemore resistant to Brucella canis

infections, a Brucella speciescommon in dogs. Althoughtreatment is the sameregardless of the infectingspecies, species-levelidentification can assist indirecting the epidemiologicalinvestigation. Brucella suisinfections, for example, areoften related to contact withferal pigs. Brucella is considereda Select Agent by the Centersfor Disease Control andPrevention (CDC).Identification of these fourspecies should be performed byreference-level LaboratoryResponse Network (LRN)laboratories, which includestate and local public healthlaboratories.

BRUCELLA CAN CAUSEINFECTION IN LABORATORYWORKERS An additionalcomplication with Brucella is

that if aerosolized itcan cause infection inlaboratory workers.Therefore, whenhandling Brucellaspecimens,laboratories shoulduse appropriatepersonal protectiveequipment and

perform procedures in abiological safety cabinet.Brucella is one of the mostcommon causes of laboratory-acquired infections in the U.S.

To determine the source ofthe likely contamination in theblood platelets, DOH-Browardinitiated an epidemiologicalinvestigation. Thisinvestigation involved DOH-Miami-Dade, DOH-PalmBeach, the Department’sBureau of Epidemiology, theCDC, the blood bank, thecommercial referencelaboratory and the patient’shospital. The four contributingdonors of the transfused bloodproduct were identified by theblood bank and BPHL-Miamiprovided laboratory testing inan attempt to identify which ofthe four donors’ blood was thesource. Several tests were doneincluding basic microbiologicalculture methods and molecularmethods such as real-timepolymerase chain reaction(PCR). Testing was performedon a range of specimens fromthe original red blood cell(RBC) units including theEDTA whole blood specimenscollected for donor screening ofinfectious diseases to the bloodculture bottles provided by theblood bank. With the exceptionof the initial growth isolatedfrom the pooled platelet pack,

On April 26, 2013 a unit of pooled plateletswas transfused into a 66 year old male fromMiami-Dade County. Following standard protocol, a

set of blood culture bottles were inoculated with the

pooled blood product to ensure the platelets were free

from contamination. On the morning of April 27, one of the

blood culture bottles was positive for growth. The blood

bank technologist isolated bacteria from the bottle and

sent these to a commercial reference laboratory for

identification. The reference laboratory performed testing

to identify the bacterial isolate during the next few days

and suspected the isolate to be Brucella. On April 30, the

reference laboratory notified the Department’s BPHL-

Miami about the isolate and because the blood product

had already been transfused, the blood bank arranged for

immediate delivery of the isolate to the BPHL-Miami for

testing. The BPHL-Miami quickly identified the isolate as a

presumptive Brucella species by a rapid molecular method,

and later that evening confirmed the species as Brucella

abortus.

Stephen White, BPHL-Miamibioterrorism coordinator, reviewingtest results.

BRUCELLOSIS:


Acquired from a Blood Transfusion

Rabies is responsible for more than 26,000human deaths worldwide each year. Therabies virus is commonly found in wildlifepopulations throughout the U.S. Rabies

infection occurs infrequently in domestic animals,including pets, primarily due to animal controland vaccination programs. Though human rabiescases are rare in the U.S., the almost 100 percentfatality rate of untreated infections makes controlof this disease an ongoing public health priority.Rabies is most commonly spread through a biteor scratch from an infected animal. The lack ofavailability of an ante mortem rabies test for exposedindividuals necessitates public health interventionsincluding the animal testing performed at the BPHL.This animal testing can determine risk to the victimafter they are exposed to a suspect or symptomaticanimal.

During 2013, the BPHL tested 2,339 animalsfor rabies, 104 of which were rabies positive. Asyou can see in the figure adjacent, approximatelytwo thirds of all animals tested were domesticspecies. Cats accounted for greater than 42percent of all animals tested and 8.6 percent ofall positives. Most of the cats tested were feraland can have close contact with wildlife vectorspecies such as raccoons and bats as well, whichmakes them susceptible to contracting rabiesand in turn, transmitting it to humans. Dogsrepresented 24 percent of animals tested forrabies and most were unvaccinated and/or strays.The BPHL typically tests a high number of dogsfor rabies exposures since most human rabiesare the result of dog bites. However, of the 574

dogs tested by BPHL in 2013, only 14were positive for rabies. In 2013, therabies positivity rate was highest amongwildlife species (91.3 percent). Raccoonsand bats, two wildlife species that serveas natural reservoirs for rabies in Floridatogether accounted for 85.6 percent ofthe positive animals tested.

While the last human case of rabiesacquired in the State of Florida occurredin 1948, the number of animal cases

detected in Florida emphasizes the need for theDepartment and other State agencies to remain vigilantwith their ongoing efforts to ensure this deadlyinfection remains a rare occurrence.

RABIES—THE FACTS YOUNEED TO KNOWRABIES IS AN INFECTIOUS VIRAL

DISEASE THAT ATTACKS THE

CENTRAL NERVOUS SYSTEMS OF

WARM-BLOODED ANIMALS,

INCLUDING HUMANS.

BobcatFox

PantherRabbit

SkunkCat BatDog

RodentsHorse

Other

Raccoon

Animals Tested for Rabies in Florida, 2013

Nu

mb

er

of C

ase

s0

200

400

600

800

1,000

1,200

NO RABIES

71 raccoons

TESTED POSITIVE IN FLORIDA:

14 dogs

9 cats

18 bats

71 racoons

18 bats

14 dogs

9 cats

5 rodents

4 other

4 panthers

3 horses

2 skunks

2 foxes

2 bobcats

0 rabbits

2013

Rabies is

responsible

for more than

26,000 human

deaths

worldwide

each year.

all blood donor samples andspecimens tested by cultureand by real-time PCR werenegative. In all, 107 specimensand extraction variations weretested. Nevertheless, one ofthe donors showed evidence ofinfection with B. abortus byserological testing. Theserology result providedpresumptive evidence that thedonor had contributed thecontaminated platelets in theplatelet pack. Recently thisdonor had emigrated fromVenezuela and had anextensive travel historythrough Central and SouthAmerica before relocating toFlorida.

INFECTED DONATED BLOODPRODUCTS This appears to bethe first case of B. abortusinfection detected in donatedblood products within the U.S.Donated blood and theresulting componentscollected in the U.S. undergoextensive and costly testing toensure the safety of thereceiving patient. Because thealgorithm for testing bloodand blood products is onlyestablished for specificinfectious organisms and doesnot include Brucella, and sinceplatelet products are prone toprocedural contamination, thiscase demonstrates the criticalimportance of the sentinellaboratory-referencelaboratory relationship fordetecting agents like Brucella

in donor blood and itsproducts. This relationshipallowed for the rapid detectionand confirmation of B. abortuscontamination of a unit ofpooled platelets transfusedinto a patient. As a result ofthese findings, the patient wasprovided Brucella post-exposure prophylaxis toprevent the development ofbrucellosis disease.

Florida typically ranksamong the top five states inthe U.S. for reportedbrucellosis cases. In 2013,there were nine cases ofbrucellosis reported to theDepartment including onenon-Florida resident. Six ofthe cases were imported fromIsrael, Mexico (two), SaudiArabia, Venezuela orWisconsin and caused byBrucella melitensis (three), B.abortus or were confirmed byserology (two). The threeremaining cases were causedby B. suis. Of these, two casesare thought to have beenacquired in Florida from director indirect contact with feralswine and one possibly fromdogs infected with B. suis.There were also 16 laboratoryexposures associated withcultures from these cases.



Florida Health Values: ICAREInnovation: Has creative solutions and manages resources wisely. Brings in fresh ideas to get the job done.

Collaboration: Uses teamwork to achieve common goals and solve problems. Pulls people together.

Accountability: Performs with integrity and respect. Takes credit for successes and full responsibility for failures.

Responsiveness: Achieves our mission by serving our customers and engaging our partners. Goes the extra mile to keep people happy.

Excellence: Promotes quality outcomes through learning and continuous performance improvement. Shoots for the stars!

The Speaker for BeakerA Recognition &

Rewards Programin Tampa

SPEAKERS FOR BEAKER2013

June: Angela Butler

July: Susan Hefti

August: Linda Raab

September: Marshall Cone

October: Italo Prada

November: Craig Bonner

December: Gail Scilabro

BASIC RULES FOR THESPEAKER FOR BEAKER

PROGRAM

The Speaker keeps Beaker forone month.

The Speaker is allowed to addone item of bling to Beaker.

The bling typically representssomething specific about the

Speaker’s laboratory ordepartment section.

The current Speaker selectsthe next Speaker based on atleast one of the criteria of the

Department’s values.

A new Speaker has to comefrom a different department

or lab section.

The new Speaker isannounced at the next

monthly staff meeting by thecurrent Speaker or delegate.

You may only be the Speakeronce a year.

As the Speaker you may passon the knowledge the Beaker

has bestowed upon you.

To understand the knowledgepassing rule you need to

know a little about Beaker’scharacter. He knows basically

two words—“meep” and“beep”—both of which heconstantly utters as he is

subjected to the whims of Dr.Honeydew.

Angela Butler gladly accepts being recognized as thefirst Speaker for Beaker.

MOST EMPLOYEES APPRECIATE BEING RECOGNIZED. THEY PUT INLONG HOURS AND CONTINUOUSLY GO THE EXTRA MILE FOR US. BUTHOW DO WE ACKNOWLEDGE THEM AND DO IT FAIRLY? At BPHL-Tampa we wanted to implement an easy, sustainable, and most ofall, fun Recognition and Rewards program. To fulfill all of theserequirements, we began a program that incorporates an unusual“token of appreciation” that goes by the name of Beaker.

Beaker is an actual Disney Muppet® character and is portrayedas the lab assistant for Dr. Bunsen Honeydew. Dr. Honeydew andBeaker are cohorts in slapstick skits where Beaker ends up on thewrong side of ill-fated experiments. The Beaker was perfect for ourlaboratory setting where our staff could sympathize with hismisfortunes. We wanted to have a real “token of appreciation” forour Recognition and Rewards program so we purchased a BeakerPlush figure.

The Speaker for Beaker is a way for employees to recognize anoutstanding coworker for contributing to the laboratory andlending a hand when needed.


Work Published in National Scientific Journals& Publications in 2013

Traynor, S., Kearney, G., Olson, D., Hilliard, A., Palcic, J., Pawlowicz,M. “Fish Consumption Patterns and Mercury Exposure LevelsAmong Women of Childbearing Age in Duval County, Florida” J.Environ. Health 2013, 75(6), 8–15.

Bennett B, Hardy B, Fordan S, Haddock-Morilla L, Rowlinson MC,Crowe S. “HIV single staging algorithm: Integration andmaximization of resources by reducing time between HIV diagnosisand treatment.” J Clin Virol. 2013 Dec;58 Suppl 1:e34–7

Bennett B, Neumann D, Fordan S, Villaraza R, Crowe S, Gillis L.“Performance of the new HIV-1/2 Diagnostic Algorithm in Florida’spublic health testing population: A review of the first five monthsof utilization.” J Clin Virol. 2013 Dec;58 Suppl 1:e29–33.

HIV/Viral Hepatitis Subcommittee (significant contribution fromBerry Bennett) “Testing for Hepatitis C Viral Infections: FrequentlyAsked Questions.” Association of Public Health Laboratories(APHL)’s Publication. December 2013.

Carroll, R., Burda, W., Roberts, J., Peak, K., Cannons, A., Shaw, L.“Draft Genome Sequence of Strain CBD-635, a Methicillin-ResistantStaphylococcus aureus USA100 Isolate.” 2013 Genome 1.

Association of PublicHealth Laboratories(APHL)

Informatics Committee:Susanne Crowe

Public Health Preparednessand Response Committee:Phil Lee, Andy Cannons

APHL/LRN OperationalWorkgroup: Phil Lee

HIV/HCV Steering Committee:Berry Bennett

Workforce DevelopmentCommittee: Leah Gillis, AndyCannons

Network of LaboratoryLeadership Alumni (NOLLA):Chair Andy Cannons; membersLeah Gillis, Marie-ClaireRowlinson

Core Competencies Committee:Andy Cannons, Rick France,Leah Gillis

American Society forMicrobiology

Committee on Post-graduateEducational Programs: BoardMember Marie-ClaireRowlinson

FDA Partnership for FoodProtection

Laboratory workgroup: Co-Chair Andy Cannons

The NELAC Institute (TNI)

Board of Directors: Past ChairSteve Arms

TNI Advocacy Committee: ChairSteve Arms

TNI Nominating Committee:Chair Steve Arms

TNI NELAP AccreditationCouncil: Steve Arms

TNI Non-GovernmentalAccreditation Body WorkingGroup: Steve Arms

TNI National EnvironmentalFiled Activities ProgramExecutive Committee: CarlKircher

TNI Laboratory AccreditationSystem Executive Committee:Carl Kircher

TNI Accreditation Body ExpertCommittee: Carl Kircher

International Organization forStandardization

ANSI International ConformityAssessment Committee: CarlKircher

ISO CASCO Technical InterfaceGroup: Carl Kircher

Florida Public HealthAssociation (FPHA)

Member At Large: ExecutiveBoard Member Berry Bennett

Board of Directors: SecondVice President (BoardMember/Co-chair LegislativeCommittee) Rick France

Florida Consortium onHIVB/AIDS Research (FCHAR)

Executive Advisor: BoardMember Berry Bennett

Jacksonville Area MicrobiologySociety

President Berry Bennett; Vice-President Marie-ClaireRowlinson; Secretary BethBurden; Treasurer MatthewSchimenti

Florida State College

MedicalLaboratory/HistotechnologyProgram: Board Member CherylHealan

Medical Laboratory TechnicianAdvisory Committee: BerryBennett

University of South Florida(USF)

USF Institutional BiosafetyCommittee: David Wingfield,Andy Cannons

Florida Department of Health

Leadership Institute: RickFrance, Elesi Quaye[ ]

Grants AwardedMarch 2013: Florida BPHL was awarded funds to support aNeisseria gonorrhoeae (GC) susceptibilities project with APHL/CDC.The project looked at inter-laboratory reproducibility of testing 200GC isolates to antibiotics by the E-test susceptibility method.Florida BPHL was one of eight laboratories awarded funding forthe project.


Mass SpectrometryApplications to theClinical Laboratory(MSACL), February10–14, 2013, San Diego,CA:

“Analysis of LewisiteMetabolites in Urine bySolid Phase Extraction—Positive ElectrosprayIonization—LiquidChromatography—Tandem MassSpectrometry.” Posterpresentation, JasonPalcic.

Public HealthPreparedness Summit,March 2013, Atlanta, GA:

“Preparedness andPolitics in PublicHealth.” Presentation,Andrew Cannons.

APHL 2013 Joint Meetingof the NewbornScreening and GeneticTesting Symposium andthe InternationalSociety for NeonatalScreening in Atlanta, GAMay 5–10:

“Improving Efficiencyand Workflow in FloridaNBS Laboratory.” Posterpresentation, BonifacioDy, Jasmin Torres.

American Society forMicrobiology 2013General Meeting, May18–23, Denver, CO:

“Reflex testing ofMycobacteriumtuberculosis complex(MTBC) NAAT-positivespecimens for detectionof drug resistance torifampin and isoniazidby a rapid line probeassay.” Posterpresentation, Marie-Claire Rowlinson.

“Rapid detection andisolation of E. coliO157:H7 from artificiallycontaminated groundbeef and bean sprouts.”Poster presentation,Tatavarthy A, P.Davenhill, V. Goff, K.Nguyen, A Tapawan, A.Cannons, D. Mccluskey.

Florida Society ofEnvironmental Analysts,May 22–24, Florida:

“Detection andQuantitation or How toMake Something out ofNothing.” Posterpresentation, ELCP Staff.

“The Future ofLaboratory Certificationin Florida.” Posterpresentation, ELCP Staff.

APHL Annual Meeting,June 2–5, Raleigh, NC:

“Development of theMiami Public HealthLaboratory as a Regional

Confirmatory Test Sitefor the National HIVBehavioral Surveillance(NHBS) System” Posterpresentation, Leah D.Gillis.

“Connecting Labs in theDigital Age.” (as part ofthe panel Signals &Trends: What Will PublicHealth Look Like in 10Years?). Presentation,Phil Lee.

“Integration ofDiagnostic and HIVClinical ManagementTesting to MaximizeResources.” Posterpresentation, BonnieHardy.

EnvironmentalMonitoring Conference(NEMC) and The NELACInstitute (TNI), in SanAntonio, TX:

“TNI LaboratoryAccreditation Body.”Session chair, CarlKircher.

“Chemistry Fields ofProficiency Testing (PT)Subcommittee.” Sessionchair, Carl Kircher.

“The Importance ofCompetence in theEnvironmentalMeasurement andMonitoring Community.”Session chair, SteveArms.

8th National Conferenceon Laboratory Aspectsof Tuberculosis, August18–21, San Diego, CA:

“MICs in TuberculosisSusceptibility Testing:Challenges andSolutions forImplementation.”Presentation, Marie-Claire Rowlinson.

“Evaluation of the BDMAX™ instrument forautomation of alaboratory developedtest for detection ofMycobacteriumtuberculosis complex(MTBC) directly from thespecimen.” Posterpresentation, Marie-Claire Rowlinson.

“Retrospective Analysisof Testing AlgorithmUsing MolecularDetection Methods forEarly Identification andTreatment of Multi-DrugResistant Tuberculosis(MDR-TB) Cases”. Posterpresentation, TravisJobe.

American Society forClinical Pathology(ASCP) 1-hour webinar,October 15:

“New Tools for theDiagnosis andAntimicrobialSusceptibility Testing ofMycobacteriumtuberculosis Complex.”

Webinar, Marie-ClaireRowlinson.

Fall Meeting of theFlorida Society ofEnvironmental Analysts,October 23–25, PalmBeach, FL:

“3rd Party Assessors—Key Elements of theProgram—WhatLaboratories Need toKnow.” Panel, SteveArms.

“Meet the New FDOHPrivate Party Assessors.”Panel, Steve Arms.

APHL/CDC InFORM(Integrated FoodborneOutbreak Response andManagement),November 18–21, SanAntonio, TX:

“Evaluation of aMolecular SerotypingAssay for Salmonella: AFlorida Perspective.”Poster presentation,Matthew Schimenti.

Jacksonville AreaMicrobiology Society(JAM) meeting,December 3,Jacksonville, FL:

“Case Study: An Old BugWith A New Trick? YouCannot Be Serious!”Presentation, Phil Lee.

National Meetings & Presentations


BPHL is staffedby a team of

highly qualifiedand dedicated

individuals.In 2013, many

staff wereacknowledged

for their service.

T HANK YOU FOR YOUR SERVICE40 YE AR S

Mary Cook, Miami

35 YE AR S

Berry Bennett, Jacksonville

30 YE AR S

Ron Baker, JacksonvilleWayne Trasente, Jacksonville

25 YE AR S

Aurora Grospe, JacksonvilleSandra McConnell, JacksonvilleStephen Prudencio, Jacksonville

Rhonda Shepard, Jacksonville

20 YE AR S

Karen Chaires, JacksonvilleLeila Filson, JacksonvilleDee Harper, Jacksonville

Clifford Knight, JacksonvilleVirginia Simmons, Jacksonville

David Wingfield, Tampa

15 YE AR S

Neomi Abella-Sanchez, JacksonvilleKeith Garrett, Jacksonville

Lea Heberlein-Larson, TampaWilliam Nakashima, Pensacola

R ET IR EMENT S IN 2013

Lawrence Blackwell, 29 years of serviceRobert Moore, 22 years of serviceCecelia Arms, 22 years of service

www.FloridaHealth.gov

http://www.FloridaHealth.gov

florida bureau of public health laboratories 2013 annual report

Documents