The 2018-2019 Wisconsin State Laboratory of Hygiene Annual Report is now online at https://indd.adobe.com/view/0f146d2e-4a2d-437b-9173-8e4117ba7bda. There is a PDF version at https://www.slh.wisc.edu/news/publications/.

From helping determine the size of Wisconsin’s opioid crisis to tracking the spread of antibiotic resistant organisms across the Midwest to housing the “international gold standard” for air pollution monitoring, the scientists and staff of the WSLH exemplify the Wisconsin Idea and have “Forward” encoded in our DNA.

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A two-tier testing method for Congenital Adrenal Hyperplasia (CAH) developed at the Wisconsin State Laboratory of Hygiene (WSLH) Newborn Screening Laboratory is reducing anxiety for families by increasing the specificity of test results.

CAH is a potentially life-threatening endocrine disorder with the majority of cases caused by a defect in the enzyme 21-hydroxylase. This defect creates an overproduction of the hormone androstenedione, leading to ambiguous genitalia in females. It also causes decreased production of the hormones aldosterone and cortisol, which can cause an electrolyte imbalance leading to a “salt wasting crisis” and resulting in shock and death within the first week of a baby’s life if left untreated.

The WSLH began newborn screening testing for CAH in 1993 using an immune assay test that measures the concentration of an analyte through use of an antibody and fluorescent tag. However, the antibody may also bind to other analytes causing cross-reactivity, resulting in false positive results (i.e., the test results say the baby has the disorder when they really don’t). The chance for false positive results increases even more for babies that are stressed, such as those in a neonatal intensive care unit, because their cortisol and other steroid levels are already elevated.

In 2016, 428 babies in Wisconsin had abnormal CAH screening results based on this 1^st tier immune assay test according to Dr. Patrice Held, WSLH Newborn Screening Co-Director and UW assistant professor of pediatrics. Of those 428 babies, only five were confirmed to have the disorder.

“These are typical statistics for not only Wisconsin, but for all states that perform just the 1^st tier screening test for CAH using an immune assay,” Held said.

In 2017, WSLH Newborn Screening Advanced Chemist Eric Bialk began developing a 2^nd tier test that would be run if the 1^st tier test result is abnormal. This 2^nd tier test measures five different steroids instead of just one and is performed using more sensitive technology – LC/MS-MS.

When the additional test went live in March 2018, Wisconsin became one of just a few states to implement a 2^nd tier test for CAH.

“We wanted to implement a 2^nd tier test to increase the specificity of the screening in order to decrease the number of false positives,” Held explained. “The 2^nd tier test is performed on the same sample we receive for the initial newborn screen so we don’t need to contact the baby’s physician to collect another specimen, prematurely raising anxiety before knowing whether there is an increased likelihood for disease.”

According to Held, in the first six months since the 2^nd tier test was implemented, 245 babies had abnormal results from the 1^st tier CAH screen. After the 2^nd tier test was performed, that number dropped to 16. Ultimately, three babies were confirmed to have the disorder. The 2^nd tier test reduced the false positive rate by 93%.

“Implementing the 2^nd tier test means our lab staff only had to contact 16 babies’ doctors about abnormal test results rather than 245,” Held said. “That’s a decrease in our staff time, a decrease in the time primary care physicians need to spend following up on the abnormal results, and, most importantly a decrease in stress for families who didn’t need to worry.”

In October, Held and Bialk won the Best Poster Award at the International Society for Neonatal Screening Conference for their description of the validation process of the 2^nd tier test.

At the Wisconsin State Laboratory of Hygiene, we strive to keep our prices low.  We understand how rate increases may impact your business operations.  From time to time, it becomes necessary for us to increase our prices to keep our not-for-profit laboratory financially stable.  Effective January 1, 2019, we will increase some of our prices.  We want to thank you for your understanding, and we look forward to serving you in the years to come. If you have any questions or concerns, please do not hesitate to contact WSLH Chief Financial Officer Kevin Karbowski at kevin.karbowski@slh.wisc.edu or  (608) 265-4511.

Please note the following changes to the Wisconsin State Laboratory of Hygiene’s operations due to the observance of the Christmas and New Year’s holidays.

The table below lists the hours of operations for our Clinical Specimen Receiving department. We will have staffing to accept clinical specimens at both our 2601 Agriculture Drive and our 465 Henry Mall facilities.

As always, if you have an off-hours emergency, please call the WSLH Emergency Pager at 608-263-3280.

 

Earlier this year, patients began arriving in Chicago emergency rooms with unexplained bleeding. A link was made to the use of synthetic marijuana products, and the discovery of brodifacoum – a powerful anticoagulant and rat poison – was found to be the cause. This outbreak soon spread to Wisconsin and other states. In response, WSLH chemists developed a test to quantify brodifacoum in patients and added new information for diagnosis and patient management.

In this webinar, WSLH Chemical Response Coordinator Noel Stanton explains the history of the outbreak, the characteristics of this chemical exposure, and the unique role the WSLH is playing in the response.

Listen to the webinar: https://slhstream2.ad.slh.wisc.edu/Mediasite/Play/35e5ce9959ce494b9fb05d30442be8aa1d

2018 marks the 100th anniversary of the devastating 1918 influenza pandemic that killed tens of millions worldwide. To commemorate the centennial, UW’s Wednesday Nite @ the Lab (WN@TL) hosted a series of talks this fall looking back at various aspects of the 1918 pandemic and looking forward into the future. WSLH Communicable Disease Division Director Dr. Pete Shult co-presented one of the talks.

100+ Years of Influenza Research at UW – https://www.youtube.com/watch?v=RhBhfxylPFs
Bernard Easterday, Yoshihiro Kawaoka and Chris Olsen of the University of Wisconsin School of Veterinary Medicine share 100+ years of influenza research at the University of Wisconsin

Influenza: It’s Not Only About Pandemics – https://www.youtube.com/watch?v=MKOqwv7J-dg
Pete Shult (WSLH Communicable Disease Division) and Tom Haupt (WI Division of Public Health) describe how 10 decades of wrangling with the antigenic drift, the antigenic shift, and the host-hopping of the flu virus have challenged public health agencies to invent and refine strategies to manage seasonal influenza and other emerging viruses.

UW and Madison and the Influenza Epidemic of 1918 – https://www.youtube.com/watch?v=ZrkHq6A6DWs
Steve Oreck of the UW-Madison Department of History explores how the SATC (Student Army Training Corps) for World War I impacted the UW campus and Madison when the flu arrived just in time for fall semester 1918.

Cytotechnology Certificate Program Director Kaitlin Sundling, MD, PhD, won the American Society of Cytopathology Foundation’s “Shark Tank” Young Investigator Grant competition with her pitch – “Development of a Deep Learning Image Analysis System for Improved Cytology Screening.”

From a large field of applicants, proposals from 12 semifinalists were evaluated and 3 young researchers were chosen to present in front of the society at its annual meeting in November.

Kaitlin was awarded a two-year $50,000 grant to be used toward her research creating a machine learning prescreening algorithm for cytology.

In this video, Kaitlin preps for competition and explains her research idea — https://vimeo.com/297367355

Summary from the Occupational Safety and Health Administration (OSHA)

The Occupational Safety and Health Administration (OSHA) published a working paper showing that the agency’s On-Site Consultation Program generates national economic benefits of approximately $1.3 billion per year.

The OSHA On-Site Consultation Program offers no-cost and confidential occupational safety and health services to small and medium-sized businesses in all 50 states, the District of Columbia, and several U.S. territories with priority given to high-hazard worksites. (In Wisconsin, the WisCon program is part of the WSLH’s Occupational Safety and Health Division.)

On-Site Consultation services are separate from enforcement and do not result in penalties or citations. Consultants from local agencies or universities work with employers to identify workplace hazards, provide advice for compliance with OSHA standards, and assist in establishing and improving safety and health programs.

OSHA routinely performs rigorous economic analysis of agency regulations.  OSHA economists performed a similar analysis of On-Site Consultation, based on established economic principles and widely recognized values, such as the Value of a Statistical Injury (VSI).

The economists considered three distinct models for determining the economic contributions of On-Site Consultation:

• A one-time, one-year safety and health management program;
• A Hazard-reduction exercise; and
• An OSHA enforcement inspection.

Ultimately, the agency determined that a one-time, one-year safety and health management program most closely aligns with the services provided by the On-Site Consultation Program. Using conservative estimates based on the avoidance of OSHA recordable injuries and illnesses (not including fatalities prevented or prevention of delayed-onset illnesses) and looking at benefits to employers, workers’ compensation systems, and the workers themselves, OSHA developed the following breakdown of the benefits the OSHA On-Site Consultation Program provides to the national economy.

Annual Benefits of the OSC Program*

Covered Workers	1,260,932
Estimated Injuries per Year	37,828
Injuries Prevented by OSC Program Visits	9,457
Value of Avoided Injury per Injury	$77,000
Workers’ Compensation Cost per Injury	$30,526
Benefits to Workers from Avoided Injuries	$728,188,374
Benefits to the Workers’ Compensation System from Reduced Claims	$288,684,134
Benefits to Employers from Avoided Indirect Costs	$317,552,547
Total	$1,334,425,056

*Totals may not sum due to rounding

For the full paper, please see:  https://www.osha.gov/dcsp/smallbusiness/2018_Benefits_OSHA_On-Site_Consultation_Program_Economic_Analysis.pdf

The Wisconsin State Laboratory of Hygiene will be closed on Thursday, November 22, for the Thanksgiving holiday.

Our Specimen Receiving departments will observe the following hours of operation for the Thanksgiving holiday:

 

 

 

Stories about people being hospitalized for and even dying from severe bleeding after using synthetic cannabinoids have filled the news since March 2018.

The responsible agent was determined to be brodifacoum, a powerful anticoagulant. The Wisconsin State Laboratory of Hygiene (WSLH) Chemical Response Program developed and implemented a quantitative test method for brodifacoum in blood, which is being used to diagnose and guide treatment length for patients.

The WSLH’s and Indiana State Department of Health laboratory’s involvement in these cases is featured in the Summer 2018 issue of the Association of Public Health Laboratories Lab Matters magazine – https://view.joomag.com/lab-matters-summer-2018/0966891001535548469/p16?short

Latest information on cases – Wisconsin Department of Health Services – https://www.dhs.wisconsin.gov/chemical/synthetic-cannabinoids.htm

The WSLH Chemical Emergency Response Team received an award from the Centers for Disease Control and Prevention’s national Laboratory Response Network (LRN) for their rapid response to the ongoing brodifacoum exposures – https://www.slh.wisc.edu/accolades-for-wslhs-chemical-emergency-response-team/