Biological Agents

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Laboratory Response Network Elizabeth A.
Macias, Ph.D., D(ABMM) Gatekeeper, Air Force LRN
Laboratories Air Force Institute for Operational
Health Epidemiological Surveillance Division
(AFIOH/SDE) Brooks City-Base, TX
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What is the Laboratory Response Network ?
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Laboratory Response Network (LRN)

• Established in 1999 by the Centers for Disease
  Control and Prevention (CDC)
• Integrated network of laboratories state and
  local public health, hospital, military,
  veterinary, and international
• Respond quickly to biological and chemical
  terrorism, as well as emerging infectious
  diseases and other public health threats

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LRN Structure
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LRN Structure Sentinel Laboratories
If you perform routine diagnostic Microbiology
cultures, then you are a Sentinel
laboratory. Minimum requirements

- Follow BSL-2 guidelines - Plate cultures on
blood and chocolate agar - Microscopy capability
(Gram stains, wet mounts)
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LRN Structure Sentinel Laboratories

• Perform testing on clinical specimens, not
  environmental samples
• Presumptive testing - protocols on American
  Society for Microbiology (ASM) website
  http//www.asm.org/Policy/index.asp?bid6342

• Recognize, rule-out, and refer to Reference or
  National laboratories for further testing

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LRN Structure
Basic Sentinel Clinical Laboratory
Advanced Sentinel Clinical Laboratory
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Basic Sentinel Clinical Laboratory

• 1. Certified under CLIP/CLIA for the applicable
  subspecialty within the specialty of Microbiology
• Inspected by CMS-approved accreditation
  organization (i.e., CAP)
• Policies/procedures for referral of specimens to
  an Advanced Sentinel Lab
• Policies/procedures for direct referral of
  suspicious specimens or isolates to the nearest
  LRN Reference Lab

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Advanced Sentinel Clinical Laboratory

• First three same as for Basic Sentinel Labs
• 1. Certified under CLIP/CLIA for the applicable
  subspecialty within the specialty of Microbiology
• Inspected by CMS-approved accreditation
  organization (i.e., CAP)
• Policies/procedures for direct referral of
  suspicious specimens or isolates to the nearest
  LRN Reference Lab

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Advanced Sentinel Clinical Laboratory
Additionally 4. Have a Class II or higher
certified Biological Safety Cabinet 5. Comply
with BSL-2 practices AND 6. Policies for
additional respiratory protection 7. Use LRN
Sentinel Level Clinical Guidelines from the ASM
Website
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Advanced Sentinel Clinical Laboratory
8. Personnel trained and demonstrate competency
in LRN Sentinel Level Clinical Microbiology
Guidelines 9. Personnel trained and certified
in Packing and Shipping of Infectious Substances
Guidelines 10. Procedures to track and account
for decontamination of laboratory biological waste
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Advanced Sentinel Clinical Laboratory
It is further highly recommended
11. Microbiology laboratory operates under
negative pressure (applies only to new
construction or remodeling) 12. On-site terminal
decontamination capability, e.g., autoclaving,
for disposal of wastes categorized as BSL-3 or
Select Agent
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LRN Sentinel Labs
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LRN Sentinel Labs
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Laboratory Response Network (LRN)
USAF LRN Policies
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Laboratory Response Network (LRN)
May 2001 HQ/USAF SG mandated all AF medical
laboratories support homeland defense by
participating in the LRN In support of the
national laboratory response network and homeland
defense, all AF medical laboratories will
participate, at a minimum, at Level A New
terminology Sentinel.
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Laboratory Response Network (LRN)

• August 2007 - National Laboratory Response
  Network Policy Letter
• Discusses Basic and Advanced Sentinel labs
• AFMS laboratories will have the CDC technical
  protocols, notification procedures, and
  procedures to properly ship clinical samples in
  place by 1 October 2007

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Air Force Laboratory Response Network Sentinel
Laboratories
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USAF LRN Basic Sentinel Labs
(CCLM Classification)
Los Angeles Maxwell McChord Misawa Peterson Pope R
amstein Randolph Schriever Clinic Upwood Vance Whi
teman
Ellsworth Geilenkirchen Goodfellow Grand
Forks Hickam Holloman Hurlburt Field Incirlik Kirt
land Kunsan Lajes Laughlin
Andersen Aviano Beale Bolling Brooks CB
(Clinic) Buckley Cannon Charleston Columbus Crough
ton Edwards Eielson
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USAF LRN Advanced Labs
(CCLM Classification)
Osan Patrick Robins Scott Seymour
Johnson Shaw Sheppard Tinker Travis Tyndall USAFA
Vandenburg Wright-Patterson Yokota
Keesler Lakenheath Langley Little
Rock Luke MacDill Malmstrom McConnell McGuire Mino
t Moody Mountain Home Nellis Offutt
Altus Andrews Barksdale Bitburg
(Spangdahlem) Davis Monthan Dover
Dyess Eglin Elmendorf Fairchild F.E.
Warren Hanscom Hill Kadena
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State-Based Sentinel Lab Activities
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State-Based Sentinel Lab Activities
FY2006 Public Health Emergency Preparedness
Cooperative Agreement managed by the CDC Each of
the grantees (50 state PH labs plus PH labs in
DC, NYC, LA County, and Chicago) must accomplish
critical tasks in exchange for direct funding
received through the cooperative agreement
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State-Based Sentinel Lab Activities
Most of their activities focus on the
capabilities and capacity in their own lab A
small percentage of these critical tasks and
performance measures surround LRN sentinel lab
activities, including the following
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State-Based Sentinel Lab Activities

• Maintain a database of all sentinel (biological)
  labs in the jurisdiction using the CDC-endorsed
  definition that includes

• POC Information
• Biosafety Level
• Certification status
• Capability to rule-out Category A and B
  bioterrorism agents
• Contact information for the reference labs used
  by these sentinel labs

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State-Based Sentinel Lab Activities

• Test the ability of the sentinel laboratories to
  send specimens to a confirmatory LRN lab on
  nights, weekends, and holidays

• Ensure all laboratory staff know how to contact
  the next level LRN lab
• Have properly trained staff for packaging and
  shipping (i.e., current biosafety training and
  IATA certification)

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State-Based Sentinel Lab Activities

• Increase the exchange of laboratory testing
  orders and results

• Timely reporting of results from LRN confirmatory
  lab back to the submitting sentinel lab and
  reporting to CDC as appropriate
• Linkage of results to public health

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Tri-Service LRN Initiative
CDC/LRN

DoD Gatekeeper COL Dan Harms
US Army Bill Nauschuetz
USAF Elizabeth Macias
USN CDR Sharon West
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Summary of LRN Benefits
What does the LRN offer to the Department of
Defense and to the Nation?

• True Network
• Standardized testing, procedures and reagents (no
  cost for oligos, Abs)
• Proficiency testing
• Administrative materials Safety SOP, chain of
  custody forms, FBI contacts, vaccination
  information, etc.

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Missions of LRN
BW agents
Non-BT Missions of LRN

• SARS Testing
• Vaccinia testing for smallpox vaccination
  adverse effects
• Monkeypox testing
• Avian Influenza

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Questions?

• Elizabeth A. Macias, Ph.D., D(ABMM)
• Laboratory Director
• Air Force Institute for Operational Health,
• Epidemiological Surveillance Division
  (AFIOH/SDE)
• 2730 Louis Bauer Drive
• Brooks City-Base, TX 78235-5132
• COMM 210.536.1271
• DSN 240.1271
• Email elizabeth.macias_at_brooks.af.mil