By Peera Hemarajata, MD, PhD, laboratory technical advisor, Southeast Asia, Global Health International, APHL

Pathogen genomics is not glamorous. There might be a press release when a surveillance report reveals something terrible. But when it shows the threat was contained, that things worked? Silence. And I keep thinking about what that silence actually represents.

Behind that silence is a process most people never see. Samples collected, sequenced, analyzed, interpreted, acted on. Each step done by people who understand that getting it right—and getting it right on time—can change the outcome for entire communities.

When I was at the Los Angeles County Public Health Laboratory, we stood up SARS-CoV-2 genomic surveillance within months and mpox sequencing within weeks. I was so lucky to have worked alongside people who made that possible. Not because the pay was competitive (it wasn’t—clinical labs paid so much more) but because it mattered. I watched colleagues who started their shift at 8:00 am still processing specimens and setting up diagnostic tests at 10:00 pm for pathogens we were still learning about in real time. Their supervisors stayed even later, reporting results and setting things up so the next shift could walk in and hit the ground running. Working under biosafety conditions with agents you don’t fully understand carries a weight that’s hard to describe. You think about exposure. You think about your family. And you show up anyway, because the public depends on you, whether they know it or not.

Public health laboratory work doesn’t trend on Instagram. There’s no influencer moment in setting up a sequencing run at 10:00 pm. The people who do it well are largely invisible to the communities they protect, and most of them prefer it that way.

Now I’m part of a much larger effort to build genomic surveillance capacity across Southeast Asia. The scale is different, but the principle is the same: Train the right people, build the right systems and make sure data gets generated and interpreted well enough that someone can act on it in time.

There’s money in genomics. Oncology, pharmacogenomics, precision medicine. The market figured out how to value sequencing when the return is individual and billable. It’s when genomics is used to protect populations from infectious disease that there’s never a big launch party with shareholders. No ribbon cutting. No product release. Its return doesn’t fit neatly on a dashboard. It shows up in the outbreak that stayed controlled, the resistant organisms caught early and the response that happened while there was still time. The benefit of the return shows up in communities that, if things work properly, never had to know how close they came.

The cost of building these systems is easy to assess. The cost of not having them rarely becomes visible until it’s too late.

Some of the most important returns in public health are written in the things that never got worse. It is important to communicate that to the public.

The post Public Health Laboratory Work May Be Invisible—but It’s Also Indispensable: Perspective From a Public Health Laboratory Professional appeared first on APHL Blog.

By Donna Campisano, specialist, Communications, APHL

Due to their small stature, developing systems and normal play behaviors (e.g., exploring surfaces with their hands and mouths), young children are particularly vulnerable to the health hazards caused by exposure to the dangerous heavy metals and toxic chemicals found in some consumer products and the environment.

In an effort to help families reduce their children’s exposure to these harmful substances, the Minnesota Department of Health (MDH), in partnership with the state’s school districts, local health agencies and tribal nations, launched a biomonitoring program called Healthy Kids Minnesota (HKMN) in 2021. Children 3-to-6 years old can participate in the voluntary program with parental permission.

The program, which receives state as well as federal funding from the US Centers for Disease Control and Prevention (CDC), assesses exposure to a variety of chemicals that can impact health. Those chemicals—which can be found in electronics, plastics, food packaging, personal care products and more—include metals, flame retardants, phthalates, environmental phenols, pesticides and air pollution chemicals.

How Healthy Kids Minnesota Works

The five-year program spends a year assessing children in two regions of the state—one in the Twin Cities metro area and one in greater Minnesota. According to Jessica Nelson, PhD, an epidemiologist with MDH and program director for HKMN, 55-85% of families informed about the program volunteer to participate, and to date over 1,800 children have enrolled.

The program tests a participating child’s urine sample to detect their exposure to over 90 individual chemicals that can cause a host of health concerns—everything from impacting brain and reproductive development to increasing cancer risk. Urine samples are sent to the Minnesota Department of Health – Public Health Laboratory (MDH-PHL) after collection, where the chemicals of interest are isolated and assessed.

“We make it clear from the very beginning that these are not clinical tests,” Nelson said. “For example, we won’t know from the urine test how a child’s health may be impacted. But the families can see how their child compares to other kids from the same area and tested in the same year. And then we give tips on how families can lower their child’s exposures.”

In two different areas of the state, for example, urine from over 50 tested children had high levels of inorganic arsenic (exposure to high levels of inorganic arsenic during brain development has been associated with lower IQ, learning difficulties and behavior problems). Public health officials determined that one cause of the exposure may be frequent consumption of certain types/varieties of rice. Because arsenic is often present in soil and water, rice can take up arsenic in flooded rice paddies during the growing phase

“Rice is a healthy food and important to a lot of cultures,” Nelson noted. “We didn’t tell the families we spoke with to stop eating rice, but we shared information with them on how to reduce their exposure—for instance, recommending white rice over brown, which has less arsenic, and cooking it in extra water.”

What’s next?

As HKMN begins its final year, both Nelson and her team hope the program will continue, and that areas of the state where they’ve already tested kids can be revisited.

“There’s so much value in doing this program in an ongoing way,” Nelson commented. “We’ll be able to track trends across communities, look at changes over time and respond better to concerning exposures. And we’ll be able to take advantage of the amazing capacity we’ve built in our state to do this important work.”

The knowledge the testing provides can inform not only families, but state policy makers as well. Minnesota’s biomonitoring program was established by the 2007 Minnesota Legislature.

“Sharing results with the families in our program is really important,” Nelson said, “but we also look to the bigger picture of providing information for policies and programs that can reduce exposure of the state’s children to harmful environmental chemicals.”

But none of that can happen without adequate, sustained funding.

“Our initial biomonitoring studies started in 2008,” said Carin Huset, PhD, a research scientist in the Chemical Threats and Biomonitoring Unit at the MDH-PHL in St. Paul who is also involved with HKMN. “We were able to do one community study, then another community study. But we didn’t have the support to conduct a big-picture program of this sort. That’s why this CDC funding is so essential. It has enabled us to build the program into what it is now. These are problems we can help solve, but we need the consistent financial support to do it. That’s why it’s been so important to have an opportunity like this.”

The post How One State’s Public Health Laboratory Is Using Biomonitoring to Protect Kids appeared first on APHL Blog.

By Donna Campisano, specialist, Communications, APHL

According to the US Centers for Disease Control and Prevention (CDC), 2 billion people—or one-quarter of the world’s population—may be infected with tuberculosis (TB), a contagious and sometimes deadly infection most often caused by the bacterium Mycobacterium tuberculosis. While the disease is rampant in other parts of the world, the US is not immune. In 2023, there were nearly 10,000 new cases reported in this country, up roughly 16% from 2022.

In recognition of World Tuberculosis Day this March 24, we sat down with Kimberlee Musser, PhD, chief of bacterial disease, Wadsworth Center, New York State Department of Health (NYDOH), and asked her six questions about tackling this ancient disease in a modern world.

What drew you to work in TB testing?

My career in public health started as an APHL Emerging Infectious Diseases postdoc fellow, and for the last 20 years I have been involved in Mycobacterium tuberculosis testing at the Wadsworth Center. At the time when I was asked to take this testing on, molecular diagnostic development was wide open, which was exciting. That, coupled with the reality that molecular diagnostics, if sensitive and specific, could have a major impact on how quickly we could detect the disease and predict drug resistance for Mycobacterium tuberculosis, drew me to this work.

I will also say that contributing to TB diagnostics has been one of the most fulfilling aspects of my public health career. This work takes quite a village, and there are many who have been essential to our success, including CDC and APHL, past and current Wadsworth Center leaders and team members and our New York State and New York City TB Control colleagues.

TB is often thought of as a disease of the past, yet we still have outbreaks in this country today. Why?

We have made some incredible strides in combating TB disease in the US. What was once more than 26,000 cases per year in the 1990s turned to a steady decline until 2020, when closer to 7,000 cases were identified. However, since the COVID-19 pandemic [when cases may have gone undiagnosed and healthcare resources were diverted elsewhere] there has been some ground lost in this fight to eliminate TB. While outbreaks are rare (thanks to the dedicated epidemiologists, laboratorians and others in local, state and national positions focused on TB case finding, treatment and control), there are occasional outbreaks that go undetected.

Can you explain how TB testing is conducted?

Testing for Mycobacterium tuberculosis and members of the Mycobacterium tuberculosis complex (MTBC, a genetically similar group of bacteria that can cause tuberculosis)—as well as the detection of drug resistance—is complicated by the slow growth of these organisms. Our lab at the Wadsworth Center has offered a clinical whole genome sequencing, or WGS, test for use on culture positive samples. This test provides a complete, accurate genome sequence in less than a week that can be analyzed by a bioinformatic pipeline. Ours was developed with our bioinformatician, Pascal Lapierre, working together with our team—Vincent Escuyer, Tanya Halse, Joseph Shea, Michelle Dickinson and myself—to refine the analysis and reporting. While we still need to wait for a culture, this testing saves a great deal of time when it comes to drug susceptibility testing on MTBC culture-positive samples. It is also highly comprehensive, detecting important mutations in the TB genome associated with drug resistance.

We now also have a clinical targeted next generation sequencing test, or tNGS, that provides results on an important set of these mutations directly on the PCR-positive specimen, allowing even more rapid testing. This test was developed and validated by our team and an amazing APHL-CDC Public Health Laboratory Fellow, Shannon Murphy, along with our advanced molecular detection scientist Carol Smith, who is funded through CDC’s Epidemiology and Laboratory Capacity Program. We also have newer tNGS assays in development as well.

How do you think laboratory work such as yours is impacting the surveillance of TB?

By performing WGS for MTBC on all TB cases, we not only utilize the genome for drug susceptibility analysis, but we also utilize the genome to compare to the other 8,000 TB genomes from cases in our database. Weekly, we provide this surveillance analysis of the nearest neighbor genomes from cases that are within 10 mutations (over the 4.4 million base pairs) to our NY State and NY City TB Control epidemiologists to provide rapid TB surveillance data. Importantly, the US has a critically important program focused on WGS of MTBC for national surveillance. Since 2018, CDC has worked with the National TB Molecular Surveillance Center to perform WGS on all US cases with MTBC. New York State also contributes sequence data to this national surveillance program.

What do you wish the average person knew about TB?

That TB disease, although not a major issue in the US, is considered the world’s most deadly infectious disease, causing 1.2 million deaths annually and claiming 3,500 deaths every day. Also critically important is making sure that people with TB are on the most appropriate treatment regimens, and that they stay on the regimen for the full course so that subpopulations of their MTBC infection don’t become drug-resistant and much more difficult and costly to treat.

What do you think the future of this ancient disease is? What advances are being made? Where will we be in 10, 20 years?

I am very hopeful that newer molecular diagnostics that can provide drug-susceptibility testing on specimens (rather than isolates) will be available in many more settings and will lead to better and faster treatment of TB cases. I am also hopeful that newer drugs and drug regimens will continue to be available for TB cases with drug-resistant MTBC, and that these treatments will become available globally to all people with TB in need of these treatments. Maintaining testing and surveillance activities is critically important to combating TB disease and ensuring effective treatments.

The post World Tuberculosis Day Is March 24: 6 Questions for a 20-Year Veteran of TB Testing appeared first on APHL Blog.

By Donna Campisano, specialist, Communications, APHL

Between November 2025 and January 2026, seven people in seven states (as of this writing) became ill with an extensively drug-resistant strain of Salmonella Newport. Three of the people were hospitalized, and the US Centers for Disease Control and Prevention (CDC), which is helping to investigate the outbreak, reports that the true number of people sickened is likely much higher.

All the reported illnesses were traced to certain lots of Rosabella-brand moringa powder capsules. Moringa powder is a dietary supplement rich in nutrients and antioxidants. Another, unrelated, Salmonella outbreak linked to moringa powder sickened 97 people in 32 states from August 2025-January 2026.

While most people recover from a Salmonella infection without antibiotics, those infected with the strain linked to the Rosabella moringa powder would have limited choices if an antibiotic were needed. In addition to being resistant to all first-line and alternative antibiotics used to treat Salmonella infections, CDC notes that because of its genetic makeup, the strain in question may also be resistant to certain antibiotics reserved for severe, extensively drug-resistant infections.

Disease detectives get to work: Inside one state’s investigation

When a resident in East Tennessee became ill last December with gastrointestinal issues, the patient’s health care provider sent a stool sample to a commercial lab for testing. When the sample was identified as having Salmonella bacteria, it was sent to the Tennessee Department of Health Laboratory Services for further characterization.

“Our public health laboratory performed both microbiological and genomic testing to identify the organism suspected to be the cause of the outbreak,” said Randal Fowler, PhD, deputy laboratory director at the Tennessee laboratory. “Our enteric bacteriology team received a bacterial isolate from a commercial laboratory and used MALDI-TOF, a mass spectrometry method, to identify the genus and species of the isolate. Our genomics team performed whole genome sequencing (WGS) on the bacterial isolate to confirm the identification and compare its sequence to other bacterial sequences, helping us link it to other patients’ isolates and environmental samples collected from the outbreak site.”

While the patient didn’t initially report consuming Rosabella-brand moringa powder, when two states linked the powder to their cases, investigators reached back out to the patient who did confirm having taken the supplement.

PulseNet, a CDC-supported national network of public health and food regulatory laboratories that uses WGS to link cases of illness that might indicate an outbreak, was crucial in helping public health professionals connect the Tennessee case to other cases around the country. PulseNet gathers information into a national database that scientists can access to identify bacteria and detect outbreaks by linking bacteria with similar genetic profiles.

“PulseNet identified the cluster of seven Salmonella Newport cases from seven different states on February 9, and states quickly reported patients’ exposures and identified a potential source over the next few days,” added Kelly Orejuela, an epidemiologist with the Tennessee Department of Health. “This quick turnaround helped to identify the product, collaborate with the firm to perform a limited recall and warn consumers of the contamination, which hopefully prevented and stopped additional illnesses.”

Where the case stands now

Ambrosia Brands LLC, the manufacturer of Rosabella-brand moringa powder capsules, has recalled certain lots of the product.

But the case isn’t closed.

The CDC’s National Antimicrobial Monitoring System for Enteric Bacteria (NARMS), a US public health surveillance system that tracks antimicrobial resistance in foodborne and other intestinal bacteria, is alerted when sequencing data indicates bacteria may be resistant to antibiotics. And because the bacteria in the moringa powder outbreak had rare and concerning antibiotic-resistant genes, further testing is currently being conducted.

Based on WGS analysis, CDC reports that all seven patient samples had predicted resistance or nonsusceptibility to multiple antibiotics, including all commonly recommended for the treatment of Salmonella infection: amoxicillin-clavulanic acid, ampicillin, azithromycin, cefoxitin, ceftiofur, ceftriaxone, chloramphenicol, ciprofloxacin, gentamicin, hygromycin, kanamycin, meropenem, streptomycin, sulfisoxazole, and tetracycline. Six of the seven samples had predicted resistance to trimethoprim-sulfamethoxazole; one sample had predicted resistance to colistin. Clinicians can still treat patients with a Salmonella infection resistant to antibiotics, but their choices are severely limited.

What was interesting about the bacteria, said Louise Francois Watkins, MD, medical officer with CDC’s NARMS team, was that it carried the New Delhi metallo-beta-lactamase 1 (NDM-1) gene, which is rarely seen in Salmonella. This gene is associated with resistance to carbapenem antibiotics, considered to be “last resort” antibiotics. “In 30 years of surveillance,” Watkins said, “we’ve only seen this gene in Salmonella a handful of times.”

NARMS is now conducting “long-read” sequencing on the bacteria to see where the drug-resistant genes are located within the genome. This can help determine how likely the Salmonella bacteria can spread resistance to related types of bacteria present in the body or the environment.

Scientists aren’t exactly sure how this Salmonella strain acquired such extensive drug resistance, but overuse of antibiotics may play a role in resistance in general. “Any type of antibiotic use, whether it’s in people, animals or agriculture, drives the bacteria to hold on to resistant genes,” Watkins explained. “And that shifts the balance, allowing resistant strains to take hold and others to die off.”

Adequate funding is essential for quick detections and responses

Detecting and responding to disease outbreaks quickly is key to reducing illnesses and saving lives. And that’s why investing in public health laboratories and their vital work is so crucial.

“Traditional microbiological testing can identify the type of bacteria, but WGS can determine whether bacterial isolates are related enough to be from the same source,” Fowler said. “That level of genomic detail is what allows public health officials to link patients to a common source and take action. Sustained funding is critical because both areas of the Tennessee laboratory that contributed to this outbreak investigation—bacteriology and genomics—require specialized equipment, lab supplies and highly trained scientists. It is an ongoing investment, but the benefits are faster outbreak detection and fewer illnesses in our communities.”

This blog post is part of a series honoring PulseNet’s 30th anniversary. Find more stories about the importance of PulseNet here.

The post How Public Health Laboratories and Federal Partners Uncovered a Multistate Outbreak of Dangerous Salmonella Infections appeared first on APHL Blog.

By Donna Campisano, specialist, Communications, APHL

In the first few months of 2023, six people in Washington State were sickened with the bacteria Listeria monocytogenes (L. mono), which can be found in food, water, soil and animals. Three people ultimately died from infection with the bacteria, which tends to hit pregnant people, adults over 65 and/or those with weakened immune systems the hardest.

When the first patient fell ill in February, a specimen was sent to the Washington Public Health Laboratories, where  scientists quickly confirmed the presence of L. mono and then performed whole genome sequencing (WGS) to analyze the organism’s specific DNA.

“We confirmed the L. mono identification by plating the submitted isolate to agar plates and then utilizing biochemical tests and MALDI-ToF as confirmatory steps,” explained Anna Pickett, microbiology supervisor at the Washington State Department of Health who was involved in the investigation. “Most hospitals/clinics can correctly identify L. mono, but we could characterize these bugs thoroughly. Once confirmed, the patient isolates are routed to WGS.”

Those WGS results are then uploaded to PulseNet, a national network of public health and food regulatory laboratories that uses WGS to look at an organism’s unique DNA fingerprint. Public health professionals can access the PulseNet database and look for similarities between specimens, with the aim of linking cases and identifying causes.

PulseNet proves pivotal

In June, there was a second case. That patient’s isolate clustered via PulseNet with the L. mono isolated from the resident in February.

 “These two isolates were indistinguishable from one another,” Pickett explained. “Given the relative rarity of L. mono infections, we designated these two isolates a Washington State cluster code and began the interview process.”

While investigators interviewed patients looking for common denominators—for example, eating at the same restaurants or consuming the same food—cases grew.

“Several patients had underlying health conditions such as cancer and autoimmune diseases,” Pickett said. “By early July, we identified a potential link to a common hospital in Tacoma, and the Food & Shellfish Bacteriology Laboratory performed testing of environmental swabs and food products from the hospital café kitchen. But … we did not detect any Listeria spp. from those swabs/food items.”

A month later, two more cases were detected, bringing the total to six. One patient mentioned having a milkshake from the Tacoma location of Frugals, a local fast-food restaurant chain. This prompted investigators to re-interview surviving patients and/or their family members, some of whom indicated they had consumed milkshakes from the same establishment.

“In early August, the Tacoma-Pierce County Health Department collected environmental swabs from both milkshake machines at Frugals Tacoma, as well as multiple flavors of milkshakes from the two machines,” Pickett noted. “They also collected an unopen bag of milkshake mix. These samples were then tested by the Food & Shellfish Bacteriology Laboratory. We recovered L. mono from all swabs and processed milkshake flavors within the machines. We did not detect L. mono in the unopened bag of milkshake mix. After isolating the L. mono from these products/swabs, we performed WGS. All recovered isolates matched the six patient isolates via PulseNet.”

The cluster was first identified on June 9, 2023. By August 17, matches from the Frugals L. mono isolates were confirmed. “L. mono can take slightly longer to produce symptoms,” Pickett acknowledged, “as the onset time for this disorder is far longer than other enteric bugs (Salmonella, E. coli, etc.).”

After being exposed to L. mono, it can take days or even several weeks for symptoms to appear.

The public health response

Once investigators were able to pinpoint the source of the infection, county officials worked with Frugals to stop selling milkshakes at all its locations.

Additional testing found that the issue was limited to just the Tacoma Frugals restaurant. That establishment removed the impacted machines (thought to be contaminated through improper cleaning) and purchased new ones. Staff at all restaurants operated by Frugals received training on proper cleaning protocol. “After identifying the source, no other cases were linked to this outbreak,” Pickett said.

PulseNet works to connect the dots

Pickett said PulseNet—largely supported by critical funding from the US Centers for Disease Control and Prevention—was “invaluable” in detecting the outbreak.

“In addition to allowing us to connect the first two cases, PulseNet assisted us in identifying every related patient, enabling us to cast a wide net in finding what was causing the infections,” Pickett commented. “Further, once we did identify a potential source, we were able to confirm our suspicions quickly and definitively. Without PulseNet, it would have been extremely challenging to recognize the outbreak quickly. We may have identified a problem once more cases rolled through, but being able to link a case from February to one in June and then immediately investigate saved precious time and, potentially, lives.”

This blog post is part of a series honoring PulseNet’s 30th anniversary. Find more stories about the importance of PulseNet here.

The post In 2023, a Growing—and Deadly—Outbreak of Listeria Was Reported in Washington State. How PulseNet Helped Lead Investigators to the Cause appeared first on APHL Blog.

By Donna Campisano, specialist, Communications, APHL

This flu season has been an intense one.

The US Centers for Disease Control and Prevention (CDC) estimates there have been at least 25 million illnesses, 330,000 hospitalizations and 20,000 deaths from flu so far this season.

And we’re still weeks away from late spring, when flu cases typically drop off.

What’s behind this active flu season? Experts point to the emergence of a new variant of influenza A(H3N2) known as subclade K.

What is subclade K?

Flu viruses constantly change over time—something scientists call “drifts” and “shifts.”

Small changes are known as antigenic drifts. Although the mutations change the virus, it can resemble other ones, which means the body may be able to recognize it and mount an effective immune response. When the change is significant and abrupt (called an antigenic shift), an entire new subtype of the virus—one most people will have little to no immunity against—can result.

CDC reports that subclade K is the result of an antigenic drift of influenza A(H3N2) that includes a number of significant mutations as compared with the vaccine strain.

Detecting flu variants like subclade K

Influenza viruses are classified based on their genetic and structural characteristics, which can be determined with routine diagnostic tests.

Tests that detect influenza, such as real-time PCR tests, are designed to detect a portion of the influenza genome that does not mutate readily, but is relatively stable, explained Jennifer Laplante, assistant director of the influenza group, Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health.

This first line of testing can determine whether an influenza virus is present in a patient sample, and if it’s an influenza A or an influenza B virus. Often this is done at a primary care clinic or urgent care. Some laboratories conduct further testing on influenza A viruses to characterize for subtype H1 or H3, which are the seasonal subtypes that typically infect humans. Once an influenza virus is detected, many public health laboratories will sequence a portion of the virus or the entire genome.

“This sequence is compared to other virus sequences, enabling us to see how different or similar the recently detected viruses are to each other and to those that have been detected in the past,” Laplante said. “When we sequence the virus, we can see the whole genetic code of the virus and track how it changes over time.”

How public health laboratories prepare for an active flu season

Given last year’s severe flu season, public health laboratories like the one in Wisconsin prepared far in advance for another challenging season.

“Our laboratory spent the summer validating higher‑throughput testing platforms and methods to meet any surge in testing,” said Erika Hanson, virology surveillance coordinator at the Wisconsin State Laboratory of Hygiene. “We focused on approaches that would expand our testing capacity while also providing flexibility in the event of reagent or supply shortages.”

To identify emerging strains, Hanson said her lab, like other public health laboratories, follows the CDC-APHL Influenza Virologic Surveillance Right Size Roadmap, which describes how much influenza testing is needed.

“Only a strategically selected subset of specimens must be fully characterized each season,” Hanson noted. “This approach can optimize surveillance data while reducing the overall burden and cost of testing. In Wisconsin, our influenza surveillance strategy already accounted for detecting variant strains in the population and did not require modification to identify the subclade K variant.”

Why flu surveillance is important—for now and later

Influenza is a highly mutable virus, and testing of specimens is the only way to determine which strains and subtypes are circulating. That information isn’t just essential for the detection of novel influenza viruses; it’s also essential for calculating the most accurate formula for next year’s flu vaccine.

“Subclade K was first identified in the US during the summer of 2025, after the influenza vaccine formulation for the 2025-26 season had already been chosen,” explained Hanson, who noted vaccine strains are selected up to nine months before the flu season begins. Because of this, the influenza A(H3N2) strain included in the vaccine is not a very good antigenic ‘match’ to subclade K. Additionally, this subclade had not previously circulated in the US, meaning the population had little existing immunity. Both its early-season introduction and its relative novelty likely contributed to its rapid spread this season.”

But flu testing doesn’t—and shouldn’t—stop after vaccine selection.

“If we detect a new virus or a surge in the spread of a virus that wasn’t chosen for the vaccine, there still may be time to make changes,” Laplante said. “Even if it’s too late to change the vaccine, we can continue to collect information that can inform public health policymakers or physicians on how to treat the virus now.”

Because subtyping of flu strains doesn’t directly impact patient care, the costs can’t be billed to insurance or passed on to the patient. That makes adequate funding of public health laboratories and the essential influenza testing they do critically important.

“The public health surveillance system exists to do battle with infectious microbes that can cause a great deal of death and sickness,” Michael Pentella, PhD, director of the Iowa State Hygienic Laboratory, emphasized. “Just like our military, public health workers need to be ready at a moment’s notice to defend and protect our communities. The public health workforce must be trained and ready for immediate action—our health and our lives depend on it. And just like our military, public health has to be funded so it is ready. We have seen a good number of emerging infectious agents in the last 50 years, from Legionella to HIV to Ebola to SARS-CoV-2. In each case, it has been the public health laboratory on the front line that has responded and protected people from getting sick. If we do our job, no one sees or hears about us. But we are here every day, doing everything we can to keep our communities healthy.”

The post This Year’s Flu Season Has Largely Been Driven by a New Subclade. How Public Health Laboratories Have Responded appeared first on APHL Blog.

By Donna Campisano, specialist, Communications, APHL

APHL is turning 75, and Carol Clark, the organization’s chief operating officer, has been with the organization for 29 of those years—years when APHL’s mission and membership have grown by leaps and bounds.  

What did APHL look like in 1997 when Carol started? Why did she choose to make it home for almost three decades? Where does she see the organization headed in the future? 

We sat down with Carol to ask all that and more. Read on to learn more about her experiences as APHL’s longest-tenured employee! 

What was your first day on the job like? 

The onboarding process was not nearly as robust as it is today! I remember someone giving me my benefits package and a bunch of forms that I was supposed to sign and return. And I’m 99% sure no one took me to lunch. Instead, we all ate in this small conference room. Initially, people were wary of me because they were distrustful of my boss. But eventually they got to know me for me—and six months later Scott [Becker, APHL’s current CEO] joined the organization.   

What do you remember about your early days at APHL? 

I started on January 13, 1997, and I was hired as the controller. The old controller had left, we had no CEO and we were in the midst of a programmatic audit review by the US Centers for Disease Control and Prevention. It looked like at the end of the fiscal year we were going to have about a $300,000 deficit. Red flags were flying everywhere, and I was questioning my decision. We also didn’t have voicemail, and the computer network only really worked for the two accounting department computers. Even late last century, voicemail and networked computers were standard for nonprofits. We had email, but no one used it. There were about 10 people in the office and when we communicated with each other, we wrote memos on letterhead, printed them, copied them and then put them into each person’s mail slot. Seriously! I had come from an organization that had 20,000 members and a 2,000-person annual conference. So this definitely felt strange. But then Scott [Becker] came on board and things started to change. He began using email and I was like, finally! 

What roles have you held at APHL? 

I like to say I grew up with APHL. As the organization grew, I took on more and more roles. In addition to controller, I was the associate executive director (AED) for finance and administration (F&A). During that time, I was responsible for accounting, human resources, membership, facilities and information technology. Then I was promoted to chief operating officer. I’ve held that position for over 20 years. Over the years, the operations area has grown and matured. In addition to the responsibilities that I had as AED for F&A, legal and compliance, marketing, communications, grants management and information solutions were added to my portfolio. I now also work closely with our informatics and global health programs and with Scott and the board on organizational strategic initiatives. You ask me what roles I had, and honestly, I can’t remember all my titles. But I was always controller. That I remember for sure! 

What attracted you to APHL? 

There had been a lot of upheaval at my old job, and it became clear to me that I was not going to have the sort of career path I had hoped for there. What initially attracted me to APHL was they were offering me a job that I knew I could do—and at the time, it was a fairly niche skill. The job seemed interesting and it fit within my skillset.  

What’s kept you at APHL for 29 years? 

I had only planned to stay at APHL for five years and then go on to my next big challenge, but when you look at APHL and our work, there’s always the next big challenge. In 2001, there was 9/11 and the anthrax attacks, which brought a focus on public health laboratories and a lot of growth to the organization. And then later in the decade, there was H1N1. Then there was a period when things were stable, and that’s when I had young kids and it was important to me to be with a family-friendly organization like APHL. So, it just made sense to stay. During this “quiet time” I was also working with our global health program to establish and formalize our overseas offices and work. And then, of course, there was COVID-19. There was never a long period of boredom. There was never a period when I scratched my head and said why am I still here? Also, APHL is a great organization, with amazing people, awesome members and a supportive environment. Why would I want to leave all that? 

What is your favorite thing about APHL? 

That’s like asking me which child I love the most! I think the thing I like the most is the people, and by that, I mean the staff and the members. I think public health professionals are drawn to this type of work almost as a calling. They have a desire to give back and do more, and I think that permeates throughout the organization. I really enjoy that mission and being a part of something bigger than myself. 

What do you think APHL will look like in the future? 

We’re navigating some really tough times right now, but I think we will come out of it stronger. We have the opportunity right now to reinvent ourselves, to really think about the things that are important to us and how we can accomplish them. The organization is resilient. We’ve dealt with adversity before and I think we’ll get through this and thrive. That’s my prediction, and that’s what I want for us. 

The post APHL Is 75! We Take a Look Back—and Forward—With the Organization’s Longest-Tenured Employee  appeared first on APHL Blog.

By Donna Campisano, specialist, Communications, APHL

In 1993, more than 700 people were sickened (and four died) after eating at a fast-food restaurant chain. It took investigators 39 days to determine that the illnesses were connected and more than a month to find the thing that was making people sick: hamburgers contaminated with E. coli.

Food safety experts and other scientists knew there had to be a faster way to detect and link outbreaks. They determined that if public health laboratories could each conduct the same kind of DNA analysis on bacteria—and then share the data—dots could be connected and outbreaks could be identified sooner.

And so, PulseNet was born.

Launched in 1996, PulseNet, developed in partnership with APHL, US Centers for Disease Control and Prevention (CDC), other federal partners and four state public health labs, is a national laboratory network that analyzes a pathogen’s unique DNA fingerprint to detect and connect outbreaks. PulseNet uses whole genome sequencing to sequence bacterial cultures that have been isolated from human, animal, food and environmental samples. The resulting data are published to a national database known as PulseNet 2.0. Microbiologists and epidemiologists from around the country can access the database and determine if there are similarities that indicate cases are related and even share a common source of infection.

PulseNet enables investigators to identify eight illness-causing pathogens—from Campylobacter to Vibrio parahaemolyticus—and pinpoint outbreak clusters in near real-time. Investigations that used to take weeks, for example, can now take only days. That quick turnaround time is essential to saving lives.

CDC reports that in the 30 years since PulseNet has been in action, over 1 billion pounds of contaminated food have been recalled and an estimated 270,000 foodborne illnesses associated with three common illness-causing bacteria—Salmonella, E. coli and Listeria—have been prevented. Scientists are constantly working to advance laboratory and data analysis tools used to investigate foodborne and other outbreaks. By developing new technologies such as PulseNet 2.0, the newly implemented data analysis platform, PulseNet continues to enhance its ability to detect and prevent additional illnesses.

In celebration of PulseNet’s milestone birthday, we rounded up stories illustrating the tremendous impact the network has had on disease surveillance and outbreak detection. Read on to learn how each one underscores PulseNet’s vital contribution to human, animal and environmental health.

• What Happens When Food Makes You Sick? The Crucial Role of Public Health Laboratories
• From Report to Recall: Meet the Professionals Behind a Foodborne Illness Investigation
• Honoring World Food Safety Day: How Science Keeps You Safe
• Building Collaboration in Asia Through PulseNet International
• PulseNet 2.0: The Future of Genomic Surveillance for Foodborne Outbreaks
• Building Partnerships & Strengthening Workforce Development within Asia-Pacific
• Strengthening Surveillance: A Training Model for the Next Generation of PulseNet Laboratory Experts
• In Puerto Rico, a new molecular bacteriology lab allows better control of foodborne outbreaks
• PulseNet key to solving 2010 E. coli outbreak linked to lettuce
• PulseNet helps Washington public health solve the largest Salmonella outbreak in recent history
• Random dog food sample proved critical in solving human illness outbreak
• Stopping Listeria required an arsenal of tools and an army of experts
• Utah raw milk outbreak was difficult – but not impossible – to stop
• Virginia: PFGE and whole genome sequencing show Salmonella outbreak who’s boss
• 20 years of PulseNet: Preventing thousands of illnesses and saving millions of dollars
• What is PulseNet?

The post Celebrating 30 Years of PulseNet: How It Detects Disease—and Saves Lives appeared first on APHL Blog.

By Donna Campisano, specialist, Communications, APHL

2025 was the worst year for measles in the US since 1992.

According to the US Centers for Disease Control and Prevention (CDC), at the close of 2025 there were more than 2,250 confirmed cases of measles in the country. Compare that to 285 in 2024 and 59 in 2023.

And that’s just what was reported.

Officials suspect many more cases circulated around the country but because some patients did not seek medical care, they weren’t part of the official count. In Texas, for example, where there were 762 confirmed cases last year, experts estimate another 200-300 people were infected but not counted.

Measles is a viral infection characterized by a rash, fever, cough and runny nose. It’s particularly dangerous in children younger than five and is so contagious, CDC reports that nine out of 10 unprotected people will become infected with the virus if they are in contact with someone who has it. Three people died from measles in 2025.

On the precipice

In 2000, measles was officially eliminated in the US. A disease is considered eliminated when it is no longer spreading within the country.

But 49 measles outbreaks (defined as three or more related cases) were reported around the country last year, stretching from Alabama to Alaska, Vermont to Virginia, South Carolina to South Dakota. And 89% of 2025’s measles cases were associated with outbreaks.

These numbers indicate that measles is on the rise within the country, putting the US at serious risk of losing its elimination status—something that recently occurred in Canada.

What’s needed to prevent more cases? Public health professionals point to increased detection, more timely outbreak response and the use of medical interventions that can prevent viruses from taking hold.

Playing a key role are the public health laboratories that identify and track diseases like measles. Their testing gives clinicians the crucial information they need to make appropriate diagnoses so patients can receive the kind of prompt treatment that saves lives and curtails outbreaks. Their testing also contributes to understanding measles transmission, a requirement to understanding the linkage between different outbreaks or new introductions of the virus.

How have some states and their public health laboratories responded to measles outbreaks in the last year? We take a look back.

Texas

Texas had the unwelcome distinction of being home to the largest measles outbreak in the country last year. There were 762 confirmed cases reported between January and August (when the outbreak was declared over), with most of those cases located in the western portion of the state where close-knit communities with low vaccination rates live.

And the first case that started it all had public health officials puzzled.

The patient reported no recent travel, meaning the infection had to come from within the community. What’s more, genotyping identified the strain as D8, a strain recently seen in Canada and Mexico, but—at least at the time—not often seen in the US.

“We don’t know how this person picked up this strain,” said Grace Kubin, PhD, deputy commissioner/laboratory director, Public Health Laboratory Division, Texas Department of State Health Services. “But members of the community that this person belongs to travel back and forth between Mexico and Canada, where they tend to have family and friends. We’re trying to work with Canada to do sequencing related to this strain to see if there’s a link.”

Given the contagiousness of measles, it’s no surprise that cases began exploding. But luckily, said Kubin, because of previous measles outbreaks in the state, Texas was prepared to handle the influx of testing.

“We had PCR tests, which are rapid tests that can detect active infections,” Kubin explained. One problem, though: The PCR throughput was low, allowing for the processing of only about 22 samples per PCR run.

“When the outbreak really started spiraling, we had two PCR machines validated for the measles test,” Kubin noted, “and we had staff who had to manually extract the nucleic acid. We had to switch gears and work on automated extraction methods and validate two more PCR machines for measles testing to keep up with the volume.” The lab also acquired a high throughput instrument, which could process 800 tests a day “pretty easily,” said Kubin.

By early spring, the Texas state public health laboratory as well as CDC-supported Laboratory Response Network (LRN) labs across the state were handling a large volume of measles tests. (LRN laboratories respond to biological and chemical threats as well as other public health emergencies.) Samples originally were being sent to Minnesota, one of four APHL/CDC Vaccine Preventable Disease (VPD) Reference Centers, for genotyping but by April, Kubin said, labs in Texas were able to take the job over.

“I think we had a couple of cases that were related to international travel, so they weren’t classified as part of this outbreak,” Kubin stated, “but almost all the other samples were D8 strains. We’re also comparing our samples to the outbreak in Utah, and those strains are also D8.” Despite being the same strain, Kubin noted that when the phylogenetic trees (the evolutionary history between a set of species) are examined, the samples are different, indicating that the Utah outbreak is unrelated to the one in Texas.

The Texas outbreak was declared over in mid-August, thanks to increased health messaging, pop-up vaccine clinics and webinars educating health care workers—many of whom had never seen a measles rash in person—on the signs and symptoms of the infection.

“This was a collaborative and massive response, and I really can’t give enough kudos to the local public health officials in the hot spot areas,” Kubin said. “Responding to this outbreak is a perfect example of what public health laboratories do—we perform tests that may not be available to other labs, and we will keep performing these tests as long as it’s vital to public health action.”

Utah

There have been more than 200 confirmed measles cases in Utah since its current outbreak began last year. And 55 of those cases were diagnosed in the last few weeks alone.

When the state’s outbreak started last summer, the Utah Public Health Laboratory (UPHL) didn’t have a nucleic acid PCR test available, said Alessandro Rossi, PhD, CLIA director and infectious diseases chief scientist at UPHL. Until the state’s testing could be ramped up, specimens from patients suspected of having measles were sent to the VPD Reference Center in California, commercial labs and the Arizona State Public Health Laboratory.

“Eventually, we were able to validate a multiplex PCR test on Panther Fusion, which is based on two tests developed by CDC and other public health groups,” Rossi said. “The test can detect both wild type [naturally occurring, nonvaccine viral strains] and the vaccine strain.”

To understand where the virus was spreading—often before patients even noticed symptoms—UPHL started wastewater surveillance later in the summer. Currently, it monitors 35 community wastewater systems across Utah, covering approximately 85% of the state’s population.

“Utah has regions with notably low vaccination coverage, increasing the risk of community spread,” said German Pinas, PhD, manager of Water Microbiology and Wastewater Surveillance at the Utah Public Health Laboratory. “Additionally, our somewhat geographic proximity to Texas—where the first major outbreak occurred—added urgency and reinforced the value of an early, population-level detection system.”

Pinas explained that the wastewater surveillance uses the highly sensitive droplet-digital PCR test to quantify the measles viral load in a wastewater sample. “We also perform sequencing for viral strain and sub-strain identification, which helps determine if cases are related to the current outbreak,” he noted. “While the initial epicenter of the outbreak was in southwest Utah, we’re now detecting cases emerging in northern and central regions as well. The statewide coverage allows us to track spread beyond the original hotspot.”

South Carolina

South Carolina is still in the midst of its measles outbreak, which began last October. Since the first person was diagnosed, cases have exploded. As of late January, there have been 789 cases—and counting. Nearly 100 were reported in just three days in early January.

The outbreak is centered in Spartanburg County, in the state’s northwest region. While some of the cases seem to have spread via travel or were acquired from the close contact of a known case, others have no known source, indicating the virus—whether diagnosed or not—is circulating in the community.

In response to the outbreak, the public health laboratory in South Carolina has cross-trained additional staff to ensure adequate testing capacity.

“The virology unit, which is responsible for outbreak-related viral testing, has always practiced broad cross-training to maximize response capacity,” said Cory Weaver, PhD, South Carolina Public Health Laboratory (SC PHL) section director – Virology, Serology & Advanced Molecular. “All team members are trained to perform critical testing for outbreak responses. During the outbreak, virology staff have worked extensively with clinicians and state epidemiologists to provide specimen collection supplies and advise proper collection methods. The lab has developed simple, single-page guidance documents to assist field epidemiology staff in specimen collection.”

Leaning on the expertise of both state and federal partners has also been key, Weaver noted. For example, samples have been sent to CDC and Wadsworth Center (which serves as South Carolina’s VPD Reference Center) for genotyping using Sanger sequencing.

“While genotyping does not allow for tracing the source and transmission routes of the virus for specific cases,” Weaver added, “it does provide important information about the specific strain circulating in South Carolina.”

Public health officials in the state have also called on the skills of their counterparts in Colorado and Utah. The SC PHL is collaborating with the UPHL to perform whole genome sequencing (WGS) on clinical samples while South Carolina builds its in-house sequencing capacity. According to Weaver, WGS will provide deeper insights into strain circulation patterns and contribute to improved national measles surveillance.

The SC PHL is also working with the Colorado Laboratory Services Division, a National Wastewater Surveillance System Center of Excellence, for wastewater monitoring. The Colorado PHL provided technical assistance as South Carolina implemented routine measles wastewater surveillance. Now, South Carolina is sending positive wastewater samples to Colorado for genotyping and WGS.

“The support from CDC and our colleagues across the country has been invaluable to our response,” Weaver said.

Despite its efforts, South Carolina’s measles outbreak is far from over. Public health officials predict the outbreak will last into the spring—at least.

“We expect many more cases in the area because of low vaccination coverage,” said State Epidemiologist Linda Bell, MD. “The department is working to contain the outbreak to its current center of Spartanburg County and prevent the spread to other parts of South Carolina and other states. Measles is highly infectious and spread elsewhere is possible because vaccination coverage in some areas isn’t high enough for herd immunity.”

Even as South Carolina battles its current outbreak, it prepares for future ones by building automated, high-throughput methods for measles RT-PCR testing and expanding in-house viral sequencing capability with a focus on rapid response to new pathogens. “This will provide more timely, robust genomic data for future outbreaks,” Weaver said.

The importance of adequate funding

PHLs—like those highlighted here—receive crucial funding through CDC’s Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Cooperative Agreement. ELC funding strengthens the ability of PHLs to rapidly detect and respond to disease outbreaks, including these measles outbreaks.

It’s funding that gives these laboratories the ability to secure the additional testing supplies and instrumentation needed to handle the influx of specimens an outbreak brings. It also gives them the financial ability to properly maintain that instrumentation, train staff on its usage (and hire additional personnel if needed), contract with courier services and keep data reporting systems up to date through flexible cross-cutting funding lines. All of this adds up to faster diagnosis, faster treatment and a faster end to an outbreak.

And as important as detection is, so is response.

In addition to securing supplies and ensuring a properly trained workforce, ELC funding enables public health professionals to devise and disseminate important public health messaging while also performing community outreach, informing people about how the disease is spread and how it can be prevented. When funding is cut—or worse yet, lost—disease detection takes longer, outbreaks grow and lives that otherwise could have been saved are lost.

The post Measles 2025: A Retrospective on a Record-Breaking Year appeared first on APHL Blog.

By Donna Campisano, specialist, Communications, APHL

APHL.org, the organization’s website, first launched roughly 30 years ago. In those three decades, there have been a few overhauls, but nothing like the extensive redesign now poised to make its debut. It’s the website’s first redesign in 10 years, 10 years marked by significant growth in APHL membership, a worldwide pandemic, dizzying advances in laboratory science and new creative developments in the world of web design.  

To determine how to make a new website better, the core redesign work group, led by APHL’s Madeline Rooney, senior specialist, Communications, embarked on a two-year assessment period. Members, partners and staff were surveyed, interviewed and invited to test new aspects of the website to judge its usefulness.

“We aren’t just moving from one website to another,” Rooney emphasized. “It has been completely rethought and redesigned. Every change was made with a purpose and was based on data from users. For example, we asked members how they look for data and how they’d like to see things organized, and what names make sense. The redesign was very intentional and has users in mind.”

The newly revamped APHL.org is scheduled to launch in early spring, just in time for APHL’s 75^th anniversary celebrations. We sat down with Rooney to ask what she’s most excited about in the new website. Here’s what she had to say:

1. A user-friendly interface

One of the biggest critiques of the old website was that it was difficult to find information, Rooney said. “Users felt strongly that we have really good information, but it was hard to find. Some of the material is restricted, and people were confused about how to get access. Or sometimes you couldn’t see information unless you were logged in. So, a lot of what we did with the new website was renaming and reorganizing things to make it easier to find information.” And a huge help, said Rooney, will be a very capable search function. Type “tuberculosis,” for example, into the search bar and everything pertaining to that subject—trainings, videos, webinars, publications, blog posts, etc.—will show up. “Even if you have no idea where the information you’re looking for lives on the website, you’ll still be able to find it,” Rooney commented.

2. Increased visibility for publications/communications

Looking for APHL blog posts or Lab Matters articles? The new website will have an APHL Publications header, allowing you to navigate to all blog posts and Lab Matters articles. “Right now, we only highlight a couple of key blog posts or podcasts on the website and the feature article from the current Lab Matters,” Rooney said. “But the new website will make all these publications searchable. We’re really excited to increase the visibility of these communication platforms.”

3. Easier to read copy, easier to find resources

The new website will lean heavily into text divided by headers, subheads and bullets—all with the goal of making information easy to find and scan. Additional information, such as a resource’s description, will expand with a click, keeping the page uncluttered yet still helpful. Another prominent feature? Enhanced navigation within the pages. Every page will have both an “On This Page” list of headers and links to “Related Pages” in the sidebar. “The ‘On This Page’ list is like a table of contents,” Rooney noted. “It will give users an overview of the page’s topics and allow you to jump deep into the content without having to scroll through the whole page.”

4. A better mobile experience

Copy and images won’t simply shrink when viewing the website on the smaller screen of a phone or tablet. Everything will automatically realign and readjust to the screen’s size, so viewing will be fluid.

5. A more vibrant, friendlier look

One of the aims of the new website was to make it warm and welcoming—and you’ll notice that in the choice of images, graphics and color palette. “It will still look very much on-brand,” Rooney said. “But with an interesting format. There will be a lot more images, a wider use of colors and everything will look very friendly and engaging. We are first and foremost a community, and we want our website to reflect that feeling.”

The post APHL’s New Website Launches Soon. Here Are 5 Things We’re Excited About! appeared first on APHL Blog.