NHANES Laboratory ComponentGeraldine McQuillan, Ph.D., Brenda

Lewis, MPH, David Lacher, MD, Qiyuan Pan, Ph.D., NCHS

Barbara Lindstrom, M.SPH., Westat

Centers for Disease Control and PreventionNational Center for Health Statistics

NHANES Laboratory Component• Specimen collection

• Specimen processing

• Specimen storage

• Specimen shipping

• Specimen testing

• Quality control

• Specimen tracking

• Laboratory QC

Specimens Collected

• Blood

• whole blood

• serum

• plasma

• blood clots

• Urine

• Home tap water

• Lead dust wipes

• Swabs

• nasal

• vaginal

Venipuncture Protocol

Age in Years 1-2 3-5 6-11 12+ Tube Type – Priority 3-mL Lavender 1 1 1 1 5-mL Lavender 1 1 2 3-mL Gray (Morning sessions only)

1

3-mL Blue (40+) 1 3-mL Red 2 7-mL Red 2 15-mL Red 2 4 10-mL Red 1 10-mL EDTA (20+) 1

Blood Collection Procedure• Administering a

questionnaire

• exclusions for hemophilia

• exclusion for chemotherapy (within 4 weeks)

• fasting questions (all 1+)

• fasting • (all SPs age 12 or more

years)• morning - 9 hrs• afternoon or evening -6 hrs.

• Performing venipuncture

• Collecting specimens for special studies

• collecting nasal swab

OP96010

MEC Laboratory

• CBC and differential

• Pregnancy test

• Blood and urine processing

• 290 laboratory assays• 44 vials of blood• 14 vials of urine• 13 other containers (water, swabs,

wipes)

• 28 laboratories

Laboratory Protocol

• Trends

• assays the same or comparable across surveys

• Complement the physical exam

• bone markers

• Bio-measurements (different measurements by age)

• nutrition

• environmental

• infectious disease

• chronic diseases

Nutrition Laboratory Tests

• Iron Status

• Erythrocyte Protoporphyrin

• Iron/TIBC

• Ferritin

• Vitamin Status

• RBC Folate

• Serum Folate/Vitamin B12

• Vitamin A/E/Carotenoids

• Vitamin D

• Homocysteine/methylmalonic acid

Environmental Laboratory Tests

• Lead

• Cadmium

• Blood and urine Mercury

• Pesticides, persistent/non-persistent

• Cotinine

• Urinary Iodine

• Lead Dust

• Volatile organic compounds

Infectious Disease Laboratory Tests

• Hepatitis A, B, C, D, E

• Sexually Transmitted Diseases

• HIV

• HSV-1 and 2

• Chlamydia / Gonorrhea

• Syphilis

• Bacterial vaginosis /Trichomonas

• HPV antigen and antibody

• Measles/Varicella/Rubella

• MRSA

• Toxoplasmosis

Chronic Disease Laboratory Tests

• Diabetes

• Hemoglobin A1c

• Glucose, Insulin and C-peptide

• Heart Disease

• Lipids, Fibrinogen, CRP

• Thyroid Disease

• TSH and Thyroxine

• Kidney Disease

• Urinary microalbumin

• Clinical biochemistry profile - serum creatinine

Other Laboratory Tests

• Bone makers

• Bone Alkaline Phosphatase

• Urinary N-telopeptides

• FSH/LH (females 35-60 yrs.)

• Prostate Disease

• Prostate Specific Antigen (males 40+)

Future Research

• Separate consent and storage

• Serum- Age 6+ years

• Plasma- Age 6+ years

• Urine- Age 6+ years

• DNA- Age 20+ years

Additions to the Laboratory Component-2001

Vaginal Swab Collection (females age 14-49 years)• Bacterial vaginosis (BV)

• Most common cause of vaginal discharge• Not an infection but a change in vaginal

bacteria• Associated with premature labor and delivery• Infections after OB/GYN procedures

• Trichomoniasis• Most common curable STD• No population based data• Causes reproductive health problems in

women• Males rarely have symptoms

NHANES 2001Additional Blood Tests• Syphilis (age 18-49 years)

• Two tests will be done (RPR and EIA)• Measure of recent infection (both tests

positive)• Measure of remote infection (EIA positive)

• Toxoplasma gondii (age 6-49 years)• Foodborne infection • Can cause congenital infections if

pregnant women are infected

NHANES 2001

Additional Tests• Prostate Specific Antigen (males age

40+)• Detects prostate disease/cancer

• Nasal swab collection (ages 1+)• Methicillin-resistant Staph aureus• Assessment of community acquired

bacterial resistance to antibiotics

Additions to the Laboratory Component-2002

Vaginal Swab Collection (females age 14-59 years)• Human papillomavirus (HPV)

• One of the most common sexually transmitted infections in the U.S.

• Cervical infection with certain types of HPV is the strongest risk for cervical cancer.

• No national surveillance system to measure the burden of HPV infections in the U.S.

Blood collection • HPV-16 antibody, males and females ages 14-59 years

• To determine the prevalence of infection in the population

NHANES 2002

Follow-up Addition to Exam• Follow-up of HCV positive individuals

• Phone survey 6 months after ROF sent

• Questions on knowledge and health care received