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0:03
[MUSIC PLAYING]
0:19
Welcome to the Introduction to Public Health Laboratories course. I work at the Centers for Disease Control and Prevention in the Office of the Associate Director for Science.
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This course covers the following six topics that will help you understand some basic aspects of public health laboratories. Number one, a public health approach. Two, what are public health laboratories? Three, core functions of state public health laboratories. Four, public health laboratory infrastructure. Five, laboratory safety. And the sixth topic is using the results to affect public health.
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After today's session, you will be able to describe the role of public health laboratories, summarize the core functions of state public health laboratories, describe the parts that are common to all public health laboratory system infrastructures, recognize the need for different laboratory levels and safety practices, explain the necessity for communicating with a laboratory when collecting and submitting samples for testing, describe how laboratory results are used to affect public health.
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First we will learn about the public health approach and how it relates to public health core science.
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Let's talk about public health in a broader context. Public health problems are diverse and can include infectious diseases, chronic diseases, emergencies, injuries, environmental health problems, and other health threats. Regardless of the topic, the following four general steps are taken in approaching any public health problem. First, we ask, what is the problem? In public health, we identify the problem by using surveillance systems to monitor health events
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and behaviors occurring among a population. After we have identified the problem, the next question is, what is the cause of the problem? For example, are there factors that might make certain populations more susceptible to disease, such as something in the environment or certain behaviors that people are practicing?
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After we have identified the risk factors related to the problem, we ask, what intervention works to address the problem? We look at what has worked in the past in addressing the same problem, and if a proposed intervention makes sense with our affected population.
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In the last step, we ask, how can we implement the intervention? Given the resources we have and what we know about the affected population, will this work? As we go through this course, you will see different examples of this public health approach at work.
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To implement the public health approach, practitioners use and apply scientific methods. These methods come from a series of core sciences that provide the foundation. These sciences include public health surveillance, which we use to monitor a public health situation. Epidemiology enables us to determine where diseases originate, how or why they move through populations, and how we can prevent them. Public health laboratories support public health
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by performing tests to confirm disease diagnoses. Laboratories also support public health by conducting research and training. As we continue to move from the use of paper documents to electronic health records, public health informatics continues to increase in importance. Informatics deals with the methods for collecting, compiling, and presenting health information. It enables us to use electronic data effectively when addressing a public health situation.
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Prevention effectiveness is closely linked to public health policy. Prevention effectiveness studies provide important economic information for decision makers to help them choose the best option available. Together, these five core sciences can help us protect and promote the public's health by giving public health practitioners the answers they need. Public health is better able to respond to the situation by using contributions from each of these sciences.
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One science alone cannot answer the questions and provide a solution. It is the application of these core sciences taken together. In the second topic, we are going to find out what public health laboratories are and what type of services they provide. This slide has a brief video that provides an overall description of what a Public Health Laboratory, or a PHL, is. [VIDEO PLAYBACK] -Ever wonder who identifies health threats to keep your world safe and healthy?
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It's the laboratorians at public health laboratories across the country. As part of the public health system, these governmental labs work to keep your communities healthy. And they play a bigger role in your life than you may have guessed, starting with newborn screenings that identify dangerous genetic and metabolic disorders that can cause disabilities or even death early enough to treat them. Laboratorians are disease detectives, working tirelessly to prevent outbreaks
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by monitoring communities for pathogens that spread through contact with people or your environment, and testing to protect you from foodborne illnesses. Public health labs test drinking and some recreational water for bacteria, parasites, pesticides, and other harmful substances, all as a part of a coordinated health system effort to have fewer sick people, and ultimately a more comfortable environment to live in. You may not have heard about them, but in one way or another, their work
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has affected your life and that of every American. Learn more about how public health laboratories protect your health at aphl.org.
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[END PLAYBACK] After watching this video, how would you now describe public health laboratories? Public Health Laboratories, or PHLs, serve as the first line of defense to protect the public against diseases and other health hazards. Working in collaboration with other arms of the nation's public health system, PHLs provide clinical diagnostic testing, disease surveillance, advanced skills in laboratory practice.
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The goal of public health laboratories is to protect and improve public health by testing samples, providing expertise, and communicating scientific information. Public health labs support the identification and confirmation of illness during outbreaks. They conduct research for future responses to public health situations. And they provide information that can be used to generate policies and procedures that are related to public health.
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You probably understand the concept of a laboratory, but you might be thinking more about the role that laboratories play in clinical laboratory testing. For example, when you go to your doctor's office for an examination, you might need some routine tests performed, such as cholesterol screening or routine blood work. These types of tests are usually performed in clinical laboratories, where the focus is on the individual patient. Clinical laboratories are often privately owned and operated.
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By comparison, PHLs, or Public Health Labs, focus on diseases and health status of the population groups by performing limited diagnostic testing, reference testing, disease surveillance, and emergency response support. They also perform applied research by using the practical application of science. And they provide training for laboratory personnel.
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Public health labs provide many public health functions, such as screening of all newborn babies for diseases and conditions. In August of 2013, the nation celebrated the 50th anniversary of the first newborn screening tests. These tests were developed to detect conditions among infants immediately after birth, because certain conditions, such as metabolic disorders, can result in serious illness and even death. The testing panel has expanded over the years
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substantially since the first tests were administered. Although newborn screenings vary amongst the different public health laboratories, a common test is for hypothyroidism. This condition occurs when the thyroid gland does not produce adequate amounts of thyroid hormone to meet the body's needs. Hypothyroidism can affect an infant's growth and cause brain damage. However, if this condition is identified through a newborn screening test, the infant can be treated with medication.
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Let's do a quick knowledge check based on what you've learned so far. Which of the following are activities and services performed by public health laboratories? Select all that apply. A, conducting blood tests as part of the ongoing management of a patient's disease. B, testing samples collected during a disease outbreak. C, providing screening for all newborns. And D, training public health laboratory personnel. B, C, and D are all examples of activities and services
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that public health labs provide. Answer A relates to a clinical laboratory that likely performs tests that are part of the medical management of an individual patient with a chronic or an ongoing disease. Which of the following is the best example of what public health laboratories do as opposed to clinical laboratories? A, cholesterol testing. B, diagnostic testing. C, routine blood testing. And D, disease surveillance. The correct answer is D, disease surveillance.
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Now that we have covered what public health labs are, let's learn about the core functions of state public health laboratories, which is the third topic in this course.
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The Association of Public Health Laboratories, or APHL, has established 11 core functions that provide a basis for assessing and improving the quality of laboratory activities being conducted by public health labs. The list demonstrates the variety of functions that are performed by state public health labs or laboratories at the local, regional, and at the national level within a broader public health lab system. Let's take a closer look at these core functions.
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This slide covers core functions 1, 2, and 3. The first function is disease prevention, control, and surveillance. It includes the ability to provide accurate and precise results in a timely manner and serves as the center of expertise. It also provides specialized testing and population surveillance. Reflecting back on the newborn screening example, this function is used for early detection of congenital disorders among newborns. Integrated data management includes the gathering
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and sharing of scientific information that supports public health programs serving the needs of state. An example would include the ability to capture data to detect trends and analyze outbreaks by reviewing the data to detect increases in a specific strain of flu, for example. State public health laboratories serve as the primary reference laboratory for specialized testing. For example, this might include testing for rare but extremely serious diseases, such as those caused by anthrax, plague,
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or other agents of bioterrorism. Certain kinds of tests can be highly complex. They might require special equipment, personnel with specialized training, or exceptional safety practices. Not every clinical laboratory can or should have the ability to run these kinds of tests.
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This slide outlines the core functions 4, 5, and 6. Environmental health and protection refers to the ability to conduct analysis and provide services related to environmental samples, such as testing performed after the 2011 oil spill in the Gulf of Mexico that resulted from an oil rig explosion. Laboratories might also test for toxic chemical, radiologic, or microbiologic contaminants in air, water, and soil, or for contaminants resulting from hazardous waste.
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State public health laboratories are also expected to test and analyze specimens related to food safety. This includes samples from persons, food, or beverages during foodborne illness outbreaks to detect the responsible pathogen. Items such as beef, milk, and ice cream are routinely tested for safety.
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The state public health laboratory takes a leadership role in laboratory regulations by coordinating and promoting quality assurance programs. They also oversee licensure, accreditation, and laboratory certification. State public health labs inspect many of the clinical and private laboratories to ensure that they are in compliance with federal and state regulations regarding the testing of clinical samples. This is crucial for ensuring that test results are accurate.
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We will learn about core functions 7, 8, and 9 in this slide. State public health labs are charged with providing both scientific and managerial leadership in the development of state and federal public health policies and standards of practice. This generates scientific evidence on which to base public health practice, standards, and laws. Public health labs also play a key role in emergency preparedness and response by responding to requests for rapid, timely notification
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and secure messaging of results that are associated with acts of biologic or chemical terrorism or other high-priority public health emergencies. An example of this is the response to the anthrax-tainted letters that were sent through the United States postal mail in October of 2001. The clinical laboratory sent the suspicious isolate to Florida State public health lab, where the identification was quickly confirmed, resulting in an immediate national response.
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Next is public-health-related research. This function can be performed by all public health labs. Public health labs are an essential collaborator for research into new ways to identify diseases, new drugs to fight diseases, and new vaccine to prevent diseases. Many public health labs work with partners to validate new methods before they're implemented in other public health labs.
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Finally, in this slide, we will learn about core functions 10 and 11. State public health labs serve as resources for training and education and are expected to be skilled in the latest procedures and use of equipment. For example, a state public health lab might be the first to receive a newly developed piece of equipment. And they might bring in technicians from other laboratories to teach them how to use the equipment. Developing and strengthening partnerships
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between state, county, city, organization, academia, and private industries is also a core public health lab function. Here, public health labs participate in strategic policy planning and work on maintaining strong communication channels among different types of public health personnel. These laboratories link to national networks and help support the coordination of public health activities. Thinking back to newborn screening program we discussed earlier, what public health lab
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core functions do you think apply to newborn screening tests? Let's do another quick knowledge check. Newborn screenings vary among public health laboratories. However, they all test for which condition? A diabetes. B leukemia. C jaundice. And D, hypothyroidism. The correct answer is D, hypothyroidism. 11 core functions have been established by the Association of Public Health Laboratories, or APHL, to provide a basis for blank and blank the quality of laboratory activities being conducted.
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A, assessing and maintaining. B assessing improving. C maintaining standardizing. And D, improving, standardizing. The correct answer is B, assessing and improving. Now that we know more about the core functions of state public health labs, let's discuss topic number 4, which is the public health laboratory infrastructure. Public health lab systems are a network of federal, state, and local laboratories that work in collaboration with private laboratories, such as clinical and physician
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laboratories. In addition, state and city public health departments were at the forefront of establishing the first public health labs, whereas federal laboratories were not established until 1946. Because the basis of public health authority rests with the states, the state public health lab is considered the central focus of the public health system. Each state or territory's laboratory infrastructure varies on the basis of available resources, the needs within each state, and governance
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in that jurisdiction. Public health labs serve many agencies and perform diverse functions. Therefore, their structure is often based on the availability of resources and the laboratory's functions in the case of an incident or situation. Although this graphic that we're looking at depicts some of the key functions of the infrastructure, each public health system varies and might include additional components or stakeholders, such as first responders and epidemiologists.
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In certain situations, environmental health laboratories operate under the federal government, but the state public health laboratory is part of the state's health department. Some of the key components of state public health labs include environmental laboratories, physician laboratories, clinical laboratories, local public health departments and laboratories, and federal public health laboratories. The public health laboratory infrastructure varies across jurisdictions because of differences
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in funding, grants, associations with universities, and state government affiliations. Communication and interactivity is vital within the infrastructure, because it can affect how quickly and accurately public health lab situations are addressed. For example, a physician laboratory might refer a particular specimen to a clinical reference laboratory. And that laboratory might refer it to a state laboratory. Public health surveillance systems and public health labs
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depend on the referral and reporting by physicians and clinical laboratories. In certain situations, laboratories share their resources across jurisdictions to better fulfill the essential functions. Alternatively, a public health lab might need to work with multiple laboratories to diagnose and implement new diagnostic practices.
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Now let's take a closer look at the public health system infrastructure and its various components. State and territorial labs comprise the first component. Every state and territory has a public health lab. These centralized public health laboratories perform tests on behalf of their jurisdiction and are often part of the state health department or another department within the state. They assist in regulating laboratories within the state by developing new policies and methods for detecting
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and combating disease. Many states also have local or regional laboratories that support public health activities. State public health labs and some local or regional laboratories might have the ability to conduct testing unavailable elsewhere. The second component is comprised of federal labs. Federal public health labs become involved when additional assistance is needed or a widespread public health threat occurs. CDC, the United States Army Medical Research Institute of Infectious Diseases,
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and the Food and Drug Administration are examples of federal agencies that operate public health labs. Federal public health labs perform specialized testing that state and local public health labs are unable to perform, such as identifying certain chemical, toxin, radiologic, and biological substances. They also have responsibility for follow-up on a larger scale. For example, in the case of widespread chemical spill, not only would the local and state public health labs
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and the Environmental Protection personnel respond, but the United States Environmental Protection Agency might be called in to assist with the cleanup and testing. CDC might become involved by assisting with the epidemiologic investigation, and with testing specimens from those persons who were exposed to a particular chemical. Federal public health labs might also help develop new methodologies that can be passed down to state public health
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labs for further testing, research, and implementation. The third component includes environmental laboratories that focus on testing samples for air, food, soil, water, and zoonotic illnesses, zoonotic meaning a disease that normally exists in animals but that can infect humans. As mentioned previously, they might operate within or under a different organization than the state or local health department. Private laboratories comprise the final component.
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Although privately operated, clinical or physician office laboratories are often used to identify the initial cases associated with a given outbreak. In reporting systems and networks, these laboratories refer results and information up the chain to state laboratories. Here's a quick check based on what you've just learned. Which laboratory serves as the center of the public health laboratory system infrastructure?
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The correct answer is B, state public health labs. Here's another knowledge check question. In the event of a salmonellosis outbreak, what role might a federal laboratory perform? A, collect specimens required for testing. B, send specimens to clinical laboratories for confirmation of initial findings. C, confirm cases through testing. And D, provide guidelines and recommendations for testing Salmonella bacteria.
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The correct answer is D, provide guidelines and recommendations for testing Salmonella bacteria. Now that you have been introduced to the public health lab infrastructure, let's take a look at another important aspect, which is laboratory safety. Each laboratory must have key safety principles and procedures in place to minimize the risk to laboratory personnel and others for contamination and exposure to the pathogens that are being tested. Specimen submittal protocols are crucial,
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because each laboratory has its own safety procedures in place for collecting, shipping, labeling, and performing tests. As the risk associated with a sample increases, the level equipment and personnel protective equipment needed also increases. In biologic laboratories, one of four biosafety levels is assigned, with Level 1 being the lowest and Level 4 the highest. Level selection depends on different factors, including how the organisms spread among persons, for example, by air,
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water, or person-to-person contact. As the risks associated with the microbe increases, the assigned level increases. For example, a virus that spreads by air can spread very quickly and easily from person to person, and requires complicated handling in the laboratory. If a vaccine or effective treatment does not exist, a high biosafety level is required. However, an organism that does not cause severe disease only requires a low biosafety level.
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Each laboratory must display signs notifying personnel of the applicable biosafety level that represents how the agent should be handled. Each biosafety level has its own specific containment controls, safety equipment, and required facility construction. Different types of specialized controls and equipment are used to provide barriers between the microbes and the laboratory practitioner, ranging from disposable gloves and face shields to complex biosafety cabinets.
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Overall, laboratory safety is governed by local, state, federal regulations administered by different agencies. The Occupational Safety and Health Administration, or OSHA, has published extensive guidance for minimizing the risks and making laboratories safer. OSHA standards provide rules that protect workers from chemical hazards as well as biological, physical, and safety hazards. Other federal entities issue guidelines and regulations for programmatic testing, such as the Clinical Laboratory
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Improvement Amendments, or CLIA, which are federal regulatory standards that apply to all clinical laboratory safety practices. The USDA, DOJ, EPA, FDA, the CDC, and NIH all have additional guidelines and regulations in place regarding how testing and laboratory practice must be conducted.
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Safe specimen handling and shipment is a crucial part of laboratory practice. All public health labs have specific specimen collection manuals that must be provided to users. Quality standards govern laboratories in terms of specimen collection and shipping. Incorrect collection and shipping can result in the laboratory being unable to perform the requested test, or can cause it to provide invalid results. Because specifications, collection methods, and shipping procedures are based
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on the qualifications of the receiving laboratory and the type of specimens being collected, entities submitting samples for testing need to know the correct protocols to follow. Before sample collection, those entities should know what type of samples to collect, what methods to use for collection of samples, how to store the samples, which laboratory can receive and test the samples, how to pack, label, and ship the samples. Packing and shipping techniques might include refrigeration
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or the use of dry ice where ultra-low temperatures are needed. The importance of correct packaging and shipping cannot be overstated. For example, anthrax samples that are incorrectly packaged and shipped will be rejected, because that places the laboratory personnel at a very high risk for infection. This will delay public health response and impede crucial public health interventions. Before shipping samples, staff should determine if the specimen is appropriate for the designated
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public health lab, identify the correct packing and shipping techniques that need to be used, and ensure that the specimens have correct documentation and labels. After the laboratory completes the testing, the test results are delivered by telephone, US Postal mail, express mail delivery, or email, depending on the laboratory and the urgency of the needed test results. Here's another knowledge check question based on what you've just learned. True or false, safety principles and practices
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are the same for all laboratories. A true. And B, false. The correct answer is B, false. Now that you know more about laboratory safety, we will take a closer look at the last topic, which relates to how laboratory data are used in public health. As noted earlier in the course, communication and collaboration within the public health infrastructure is critical. Electronic Lab Reporting, or ELR, uses automated systems for the rapid reporting
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to health authorities, which can help them quickly identify trends and alert other public health professionals. These reports are used for surveillance and disease intervention, and have many benefits, including improved timeliness, reduction of manual data entry errors, and reports that are more complete. Examples of ELRs include the following, the Laboratory Response Network, or LRN, that focuses on bioterrorism and chemical terrorism response. The Food Emergency Response Network, or FERN,
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integrates the nation's food testing laboratories at the local, state, and federal levels into a network that is able to respond to emergencies involving biologic, chemical, or radiologic contamination of food. PulseNet is a national network of public health and food regulatory agency laboratories maintained by the CDC. PulseNet facilitates early identification of common source outbreaks by comparing the individual DNA fingerprints from certain bacteria identified by public health labs
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and determining if bacteria with matching fingerprints might be associated with a given foodborne outbreak. Communication within this network can help food regulatory agencies. After the public health data from the ELR are collected and disseminated, they can be used to monitor trends and detect changes. For example, increased resistance to antibiotics can be identified, or syndromic surveillance can be used to enhance laboratory and informatics data analysis.
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Data can be used to identify or confirm an outbreak. For example, laboratories perform seasonal testing for the West Nile virus, a virus caused by mosquitoes. Testing is conducted on human specimens and mosquito pools to confirm that an outbreak is occurring or is likely to occur.
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After a laboratory confirmation that a disease is occurring in a community, the public health authorities can take immediate action by issuing guidance and control measures. In the West Nile virus example, authorities might conduct prevention activities, such as communitywide insecticide spraying to eliminate mosquitoes, or broadcasting prevention messages to the public. Laboratory data are also helpful in evaluating and creating public health policy. Again in the case of the West Nile virus,
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one potential policy change might be to require seasonal community mosquito control programs as a matter of course, instead of waiting for the illness to occur each and every year. Public health labs are also used in determining disease history. For example, West Nile virus was first found in the West Nile district of Uganda in 1937. But it did not appear in North America until 1999, when it was first identified in laboratory specimens from both humans and horses.
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Laboratory data can be used to prioritize resource allocation, including funding or personnel. Laboratory results for mosquitoes infected with West Nile virus allows the focusing of mosquito control efforts to specific geographic areas, rather than throughout an entity, city, state, or region. Laboratory data can provide a base for epidemiologic research. This can help guide long-term resource allocation to prevent future West Nile virus outbreaks in a specific region, for example.
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The data can also help identify environmental hazards and exposures. An example would be lab data that indicates if environmental hazards were created as a result of the communitywide insecticide spraying to prevent the spread of West Nile virus. Which of the following describe how public health laboratory data are used to affect public health? A, guide public policy. B, determine disease history. C, detect changes. And D, all of the above. The correct answer is D, all of the above.
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Now that you have completed this course, you should be able to describe the role of public health laboratories, summarize the core functions of state public health laboratories, describe the parts that are common to all public health laboratory system infrastructures, recognize the need for different laboratory levels and safety practices, explain the necessity for communicating with the laboratory when collecting and submitting samples for testing, describe how laboratory results are
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used to affect public health.
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