The secret (and amazing) world of public health laboratories

by Kim Krisberg

Walking around a public health laboratory is seriously cool.

Giant humming machines, rows of test tubes and small, round dishes containing specimens with hard-to-pronounce names, biohazard warnings and emergency shower stations, an egg incubator and liquid nitrogen generator, people in protective gear with bulky white hoods and face shields. Oh, and boxes with severed animal heads inside.

"Everything is just so unusual and every day is different," Dr. Grace Kubin told me as she took me on a tour of the Texas state public health lab in Austin last week.

After years of writing about public health, I finally got the chance to look behind the proverbial curtain, if only for a couple hours. Like the state it serves, the Texas public health lab is huge. It houses nearly 400 staff and processes 6,500 samples and specimens every day. That's 1.5 million every year and means the lab handles the largest volume of testing of any public health lab in the country.

The people's laboratory

After slapping a visitor's badge to my jacket, we start the tour. We're barely a few steps down the first hall when Kubin, who directs the Texas Department of State Health Services' Laboratory Services Section, points to a stack of boxes the lab recently received. Inside are dead animals waiting to be tested for rabies -- "but just the heads," Kubin says. Last year, the lab received about 8,000 specimens for rabies testing, mostly skunks and bats. The lab's diagnostic work helps public health workers in the field decide where to drop millions of rabies vaccine bait packets so they'll have the biggest impact on preventing the spread of wild rabies strains, Kubin explains. Texas health officials recently announced that public health efforts had effectively eliminated canine and fox strains of rabies in the state.

From rabies to babies, I follow Kubin to what she says everyone calls the "punching room." And you can hear why before you get to the door. It sounds like the constant punching of holes being made in paper and that's exactly what it is. The room is filled with staff punching three-millimeter holes in specially made testing paper that has a blood sample from a newborn's heel on it. And considering more than 1,000 babies are born in Texas every day and their blood samples have to be processed as quickly as possible to catch disorders that must be diagnosed and treated quickly to prevent serious problems that's a whole lot of hole punching. In fact, Texas public health laboratorians screen 400,000 newborns for 28 disorders every year. And they do it twice. That's 800,000 specimens a year, making the Texas public health lab the largest newborn screening lab in the world, Kubin says. (Public health newborn screening programs test for conditions such as phenylketonuria, congenital hypothyroidism and galactosemia -- disorders that if not detected early in a newborn's life and promptly treated can lead to severe health complications, developmental disorders and even death.)

After the tiny paper blood samples are sorted and prepared, the testing begins. Twenty of the 28 disorders are tested for using tandem mass spectrometry machines -- what Kubin calls the "work horses" of the newborn screening lab. The noisy machines are constantly churning out data, helping public health workers pinpoint disorders as quickly as possible so they can notify an infant's doctor. The lab's capacity and skill for effective newborn screening are literally saving lives, Kubin says proudly.

I was getting hungry just as we got to the part of the lab that protects our food. As we walked passed workstations, Kubin told me about a listeria outbreak that happened about a year ago and resulted in five deaths. After epidemiologists tracked the outbreak back to chicken salad, the lab began testing its ingredients. The culprit was the celery, Kubin says, which was traced back to a San Antonio produce company with the help of DNA testing done at the public health lab. (To read more on the role of public health labs in safeguarding our food supply, click here and here.)

After food came water -- bottles and bottles and bottles of drinking water waiting to be tested for harmful contaminants. Kubin notes that the public health lab is the only facility in Texas that conducts radiochemical testing for contaminants like uranium.

Complex and invisible work

Near the end of our tour, Kubin invites me inside the State Medical Operations Center, a command center where public health workers prepare for and confront emergencies. The room is framed in large televisions and long tables are set up with different signs, such as "Logistics" and "Dispatchers." Kubin notes the center was activated during the 2009 H1N1 flu outbreak, when the lab received about 8,000 flu-related specimens in a week and a half. The 2009 outbreak was an "all hands on deck" moment, she adds.

Public health labs are critical pieces of the nation's emergency preparedness and response system and after years of investment, training and capacity building, Texas is now home to 10 Laboratory Response Network (LRN) labs capable of responding to a range of emergencies, including chemical and biological terrorism, Kubin says. Such preparedness work means that despite Texas' geographical proportions, "there's a (LRN) lab within three hours of every community in the state," she tells me.

In my short time at the Texas public health lab, I only got a tiny glimpse of the breadth of its work. You'd literally have to spend months exploring a lab this size -- and probably go back to school -- to really appreciate the complexity and just sheer volume of the work it does to stay one step ahead of preventable death, disease and disability as well as respond to emerging threats and disasters.

It's often said that the work of public health is invisible -- in other words, most people don't know what public health does or how it relates to their daily lives. If that's true then the work of public health labs is...well, even more invisible. And that's a problem for a field struggling with unpredictable funding streams -- as Kubin said: "Sustainability is a big issue."

"We're laboratorians," Kubin said. "We quietly do our work, we don't advertise. But at the end of the day, we really can say that we've saved lives."

To learn more about the work of public health labs and what we'll lose if they're not adequately supported, visit the Association of Public Health Laboratories.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for almost a decade.

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