Laboratory Provides Crucial Services During Calm, Calamity

Last year, Houston, like the rest of the country, agonized over the possibility of receiving mail cross-contaminated with anthrax or coming across an ominous powdery substance meant as a bioterroristic attack.

The weeks immediately after the first cases of anthrax infection surfaced one year ago, proved one of the most hectic and demanding time periods ever for the Houston Department of Health and Human Services' Laboratory. The lab, located in the Texas Medical Center, ultimately tested more than 500 samples for anthrax spores from the numerous suspicious items submitted by law-enforcement agencies and the city's Hazardous Materials Response Team.

The facility continued the routine microbiological testing that the health department and numerous other medical institutions depend upon to deliver the region's health care, and at the same time, stepped up to take care of a situation that put a significant strain on its resources - and those of many other laboratories nationwide.

"We now have experience that will be extremely helpful in the unfortunate event we ever have a real anthrax case," said Vern Juchau, Ph.D., laboratory services bureau chief for the past 11 years.

The lab from time to time still receives suspicious items and the total number of samples tested reached 657 last month.

Bioterrorism experts believe the agents that terrorists most likely will try to manipulate into a biological weapon are anthrax and, to a lesser degree, the smallpox virus, long feared because of its ease of transmission and higher fatality rate.

Despite the large quantities of suspicious items - everything from talc, sand and flour to moldy bread - submitted to the lab, staff members were able to speedily provide test results on objects deemed a possible threat. The fast turnaround in ascertaining the likelihood of the presence of anthrax enabled the department to quickly reassure the local community of its safety.

Ruling out an anthrax case required that the lab perform three tests on each of the samples. The sequence involved a gram stain, spore stain and culture test, resulting in a grueling overtime schedule for microbiologists and other lab staff.

No battery of tests ever detected any anthrax locally. Nationwide, five people died and 13 others developed anthrax infections after the mailing of contaminated letters to high-ranking government officials and news media personalities following the Sept. 11 attacks on the United States.

The lab serves as a regional laboratory for a 16-county area, but during the anthrax scare the state asked that for bioterrorism purposes, the facility handle testing for 28 southeast Texas counties. Approximately half of the samples tested originated outside of Houston.

The lab is one of six in the state considered regional laboratories, because of their capacity to handle sophisticated testing such as typing, or grouping organisms in order to distinguish different strains, isolating viruses, serving as a reference laboratory capable of identifying tuberculosis bacteria and tuberculosis-like organisms, and performing antibody susceptibility tests and tests most hospital laboratories are unable to accommodate.

Laboratories are usually classified as Level A, B, C, or D. Level A laboratories are those typically found in community hospitals and are able to perform initial testing on all clinical specimens, usually blood or some other body fluid. Public health laboratories are usually Level B; they are valuable for confirming or refuting preliminary test results and perform antimicrobial susceptibility tests on bacteria and viruses. Level C laboratories, which are reference facilities and usually large public health laboratories, can perform more rapid identification tests. Level D laboratories are designed to perform the most sophisticated tests and are located in federal facilities such as the Centers for Disease Control and Prevention.

The TMC-based lab is a Level B facility, and forms part of the CDC's laboratory response network. Local hospitals can submit specimens for more definitive identification. However, it can also perform almost every test conducted at state laboratories, designated as Level C.

The lab is a recipient of grant-funded projects that are helping the area with bioterrorism preparedness. Among them is a $58,000 grant that helped secure a microbiologist and equipment to develop protocols and procedures for testing biological agents as well as perform actual bioterrorism testing. The funding is part of a larger grant awarded to the state by the CDC.

A second grant, awarded by the Department of Justice, made it possible for the lab to obtain high-tech equipment able to perform routine testing in addition to detecting agents that terrorists might use during a chemical attack.

Last month, the department received a $694,000 grant from the CDC to hire additional lab staff, create a bioterrorism section within the facility, pay for upgrades to the building and purchase additional equipment and supplies. The grant will also help lab staff train personnel from clinical labs in 17 area counties on bioterrorism preparedness.

"We will teach them what to look for, how to recognize an agent and the appropriate way to sent it to us," Juchau said.

While the anthrax scare underscored the fact that Houston's safety is closely linked to the lab's advanced capabilities, the facility also serves a crucial area resource on a daily basis. It functions as a reference laboratory for local hospitals and health care providers needing specific molecular identification of organisms.

"Most hospitals don't have the capacity to identify a virus," Juchau said. "If they do, they can only detect a virus presence and place it in a general category. They send it to us to confirm the results and establish a more definitive identification."

Local laboratory testing saves money for the community since sending specimens to commercial labs in other parts of the country would be much more costly, Juchau said. Even some local commercial laboratories refer their testing to the lab.

The lab, from an epidemiological point of view, also needs health care organizations to submit their specimens so it can assist the department in tracking and stopping the spread of disease. During outbreaks of foodborne illnesses such as salmonella, shigella or pathogenic E. Coli, for example, the lab is able to isolate disease-implicated bacteria detected in different cases and link them to a common food source.

Linking the bacteria is feasible through equipment that allows the lab to analyze the organisms at the genetic level. Essentially, the equipment detects patterns in bacteria and stores the information in an electronic database of DNA fingerprints. The lab is only the third city-affiliated facility in the country awarded the technology through a grant from the CDC, which normally reserves the tool for state health departments.

Routine testing at the lab for the various programs provided by the department's health centers includes blood chemistry, hematology, rubella, blood typing to detect Rh factor and other maternity problems and detection of sexually transmitted diseases, hepatitis and tuberculosis. Examples of tests conducted for environmental health programs include analysis of potable and environmental water, dairy products, food and lead testing in humans and the environment.

"We provide the means for early detection of agents in the community," Juchau said. "We provide the means for tracking the source of those agents. And finally, we aid in the diagnosis for the treatment."

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©2006 Texas Medical Center

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