Microbiology for Public Health:
The Role of Medical
Laboratories
Judy Isaac-Renton MD
Director BCCDC Laboratory
Services, PHSA Laboratories
BCSLS, April 2008
Objectives
1.
2.
3.
4.
5.
To describe the different microbiology disciplines
To outline Core Functions of public health labs,
outlining some Why, What and Who’s
To list provincial, national and international public
health partners
To describe how all microbiology labs collaborate
in the public health network
To let you know what BCCDC and what BCCDC
Laboratory Services does (your provincial public
health reference microbiology labs)
Network Example 1: Reference
Late Friday afternoon
Physician (Respirologist) from IHA
On Call Medical Microbiologist
58 yr old female in ICU, ventilated
Fever, CXR findings, risk factors
Network Example 1: Reference
Later Friday afternoon, team convened
CAP? (Bacteriology Program staff)
Viral? (Virology Program staff)
Hantavirus? (ZEP Program staff, NML)
24/7 specialized expertise
Create knowledge/information (labs
impact >80% medical decisions)
LD?
Hanta?
Network Example 2: Public Health
Testing in front-line microbiology labs,
hospitals and community labs
143 cases of disease due to E. coli O157
42 persons hospitalized: bloody diarrhea
Children on dialysis: No deaths
Public health galvanized, intervenes
Isolates from front-line microbiology
labs, to provincial public health labs
(BCCDC)
E. coli
Network Example 2: Public Health
Environmental Health Officer Sleuthing
E.coli O157:H7 Outbreak Epi-Curve
E. coli
n=135
18
Secondary
16
Primary
Number of Cases Reported
14
12
PFGE
8
6
4
2
Onset Date
Epidemiologists Analysing
8-Dec
4-Dec
30-Nov
26-Nov
22-Nov
18-Nov
14-Nov
10-Nov
6-Nov
2-Nov
29-Oct
25-Oct
21-Oct
17-Oct
13-Oct
9-Oct
5-Oct
1-Oct
27-Sep
0
23-Sep
All Labs Testing
BCCDC Labs Sleuthing
10
Network Example 2: Public Health
Front-line labs do patient testing (patient
focused)
Public health ref labs (e.g., BCCDC labs) do
reference clinical and environmental
microbiology testing (focus on specialty
tests, link environmental with clinical and
population health)
Both create information, Quality Assure it,
interpret it, connect with health care workers
Information shared with public health
workers in HA, Epi, CPHLN PulseNet
WWW
Network Example 2: Public Health
Provincial public health labs, member of
Canadian Public Health Network (CPHLN)
Link to National Micro Labs and PulseNet
To USA CDC Labs and PulseNet
To Labs world-wide and “PulseNets”
For both patients and populations
Interventions with prevention, a focus
Legislated framework
WWW
NML
Future Sites
Current PH Sites
Health Canada Sites
CDC
CDC
Microbiology Disciplines Include:
(From Largest Microbes to Smallest)
Parasitology: worms are large
Mycology: fungi are also large
Giant tapeworm
Aspergillus
Microbiology Disciplines Include:
Bacteriology: bacteria are smaller (light
microscope)
Virology: smallest (seen using an
electron microscope, not a light
microscope)
Bacillus
Virus
Microbiology - Other
Some, such as prions, break all the rules
Communicable diseases (CDs) are the main
focus of PH reference labs
All CDs are caused by infectious agents but not
all infections are considered CDs
Core Functions for
Public Health Microbiology
Laboratories & Networks
Ten Core Functions for public health
laboratory system
CPHLN considers these a minimum
requirement for optimal service on
behalf of our communities
http://www.cphln.ca/CPHLN/src/public_publications.php
Core Functions
1.
Communicable disease surveillance, prevention
and control
2. Outbreak and emergency response to
communicable diseases
3. Environmental health and food safety
4. Reference testing, specialized screening and
diagnostic testing
5. Biosafety, containment, and biohazard response
6. Integrated communicable disease data
management
7. Public health policy development and evaluation
8. Laboratory Quality Assurance
9. Training and education of health care workers
10. Public health related research and development
Surveillance & Outbreak
Response Core Function
Systematic data collection &
interpretation of clinical and lab info
Multidisciplinary team needed
Labs in community, hospitals, public
health all report to local public health
Public health analyses and responds
HUS
Surveillance & Outbreak
Response Core Function
Why?
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CDs, one important PH function
Ongoing watchfulness
C. gattii
Microbes impact quickly and widely
Microbes know no borders, change quickly
New patterns, novel pathogens, new tests
Alert for early diagnosis, intervention and
prevention
Surveillance & Outbreak
Response Core Function
What?
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Reportable Communicable Diseases (RCDs) from
clinicians and labs (BC legislation)
Unusual observations (BC legislation)
Sentinel systems (respiratory, environmental)
Who?
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All microbiology labs to public health in HA
BCCDC Epid works on inter-jurisdictional issues
PH labs works with HA PH, Epi and CPHLN
Bioterrorism & Emergency
Response Core Function
Why?
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Bioterrorism world-wide (purposeful
release of infections agents)
Special events and natural events
Planning, capacity and response
Expertise, leaders and facilities
Environmental Microbiology
Core Function
Why?
 Specialized public health practice of
microbiology (very different than clinical)
 Surveillance (upstream) and outbreak
response
 Bioterrorism (global food chain)
 Natural emergencies (Fraser Freshet)
 Planning, capacity and response
 Expertise, leaders and facilities
Environmental Microbiology
Core Function
Who?
 Private and public labs
PHO approved for DW
 Public health audits
 Investigation of waterborne outbreaks
 BCCDC leaders in
Quality Assurance
(EWQA)
Environmental Microbiology
Core Function
Who?
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Networks with CFIA, Health
Canada
Investigation of foodborne
outbreaks from schools,
restaurants, facilities etc
Food poisoning
investigations
Public health food
surveillance testing
Integrated Data Management
Core Function
Who?
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Linking clinical and environmental testing
Lots of Information Management changes
(in BC, it’s PHIP, PLIS)
Impacts of this change
Networks key
WWW
Research & Training
Core Function
 Faculty and staff carry out public health
research and training
 New knowledge about communicable
diseases (CDs)
 When novel pathogens appear, critical
skills (capacity)
 Need to keep abreast of rapidly
advancing technologies
 Many educational/training activities
How Do PH Labs Core Functions
Relate to Our Labs Work?
1.
Other Core Functions
Some Core Functions
Day-to-Day Work
?
Communicable disease
surveillance, prevention and
control
2. Outbreak and emergency response
to communicable diseases
3. Environmental health and food
safety;
4. Reference testing, specialized
screening and diagnostic testing
5. Biosafety, biocontainment, ER
6. Integrated communicable disease
data management
7. Public health policy development
and evaluation
8. Laboratory Quality Assurance
9. Training and education of health
care and public health workers
10. Public health related research and
development.
Partners in Public Health
Local Medical Health Officers, CD
Nurses, Environmental Health Officers
Epidemiology, STIC, TBC, EH
All health care workers
Provincial Health Officer
Ministry of Health
Partners in Public Health
Lab Network?
Community and hospital microbiology
labs: front line partners
PH Labs: reference and specialty labs
Share basics
Focus, hence roles, differ but work on
Communicable Diseases together
Satellite public health labs
National Public Health
Lab Network
International
(WHO, CampyNet etc)
Overview of BCCDC
 British Columbia’s Centre of
Excellence for the prevention,
detection and control of
communicable diseases (CDs)
 Affiliated with University of
British Columbia
 Partners with the province’s
public health workers in all
Health Authorities as well as with
MOH
 Provides support and tools to
respond to emergencies,
outbreaks and unusual events
related to communicable
diseases (CDs)
BCCDC Divisions
 Environmental Health
 Epidemiology
 Hepatitis Services
 Laboratory Services
 STI/AIDS Control
 TB Control
 Vaccine & Pharmacy
BCCDC Laboratory Services,
PHSA Laboratories
Programs:
Bacteriology & Mycology
Biosafety Biocontainment
Central Processing Receiving
Environmental Microbiology
Parasitology
Quality
TB/Mycobacteriology
Translational Research
Virology
Zoonotic Emerging Pathogens
Bacteriology & Mycology
Program
Program Head: Linda Hoang
Section Head: Ana Pacaggnella
Team: 30 staff
Research:
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Linda Hoang, MD, DTM&H, FRCPC
Program Head
Clinical Assistant Professor
Dept of Path & Lab Medicine
University of British Columbia
Email: linda.hoang@bccdc.ca
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Emerging pathogens
Healthcare acquired infections
New and unusual bugs
International medicine
Bacterial BT agents
Bacteriology & Mycology Program
 Reference tests for bacteria with
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new molecular assays (PCR, 16S)
Identification and typing of
isolates to detect, monitor and
control outbreaks
Linked electronically with all
other public health labs to
assess PFGE patterns
Examine specimens for fungal
systemic infections (deep
mycoses)
Diagnosis of sexually transmitted
diseases such as Chlamydia
trachomatis, GC, and other CDs
by nucleic acid testing, PCR.
Biosafety Biohazard
Containment
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BCCDC Labs Biosafety Biohazard Containment
Program (TDG, WHMIS, CL3, ERAP, BRAT..)
Program Head Biosafety Officer: Neil Chin
Containment Level 3 Suites on 3 floors
Bioterrorism & Emergency Response Team for labs
Links with Emergency management at HA, provincial
and national levels (Bi-Ex Field exercise)
Environmental Microbiology
Judy Isaac-Renton, MD, DPH, FRCPC
Director, BCCDC Laboratory Services
Professor
Dept Path & Lab Medicine,
University of British Columbia
Email: judy.isaac-renton@bccdc.ca
Program Head:
Judy Isaac-Renton
Section Head: Joe Fung
Research:
 Water Microbiology
 Norovirus
DNA`Sequencing
 Botulism
 Giardiasis
 Microbial Source
Tracking
Environmental Microbiology
 Detection of protozoan
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parasites (Giardia,
Cryptosporidium),in water
Developing PCR tests for
specific pathogens
Test drinking, pool, beach
water samples
Investigation of foodborne or
waterborne outbreaks
Leaders in Provincial Health
Officer program (EWQA)
Food poisoning investigations
Norovirus RT-PCR and DNA
sequencing
Photo courtesy University
of Alberta, Public Health
TB Mycobacteriology Program
Patrick K.C. Tang, MD, PhD,
FRCPC
Clinical Assistant Professor
Dept Path & Lab Medicine
University of British Columbia
Email: patrick.tang@bccdc.ca
Program Head: Patrick Tang
Section Heads: Mabel Rodrigues
Staff: 20
Research:
 Molecular diagnostics
 Microarrays and
bioinformatics
 Discovery of novel
infectious agents
Mycobacteriology/TB Program
 Prepare smears (acid-fast stains,
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fluorescent) for diagnosis of TB
Liquid culture (automated
process) and solid culture on
Lowenstein Jensen media Identification of all Mycobacterium
species
Detect M.tb directly on smear
positive sediments by molecular
methodology
Biochemical identification and
drug sensitivities in CL3
Fingerprinting by RFLP and PCR
VTRU to evaluate clusters of
infection
Parasitology Program
 Examination of samples for
parasites of medical importance
 Examination for intestinal
parasites from SAF preserved
stools (concentration, stained
smears)
 Outbreak investigation and
surveillance
 Examination for Blood/Tissue
parasites such as malaria,
Acanthamoeba and Leishmania
 Specialized procedures
(cultures, Baermann)
 Tick identification
 Mosquito surveillance for West
Nile virus monitoring
Translational Research in
Microbiology
 Development and adaptation of
molecular diagnostic methods for
use in all laboratories
 DNA sequence identification of all
organisms
 Compilation of sequence databanks
available to outside laboratories
 Rigorous program for monitoring
Molecular Quality Control
 Education and training in new
molecular methods
 Network for public health:
technology transfer