Continuing Medical Education Course Handout FY 18 EpiTech

Continuing Medical Education Course Handout FY 18 Epi-Tech Surveillance Training U. S. Army Public Health Center UNCLASSIFIED 1

Continuing Medical Education Course Handout U. S. Army Public Health Center UNCLASSIFIED 2

Continuing Medical Education Course Handout U. S. Army Public Health Center UNCLASSIFIED 3

ANNOUNCEMENT n To Register for the Monthly Disease Surveillance Trainings: Contact your Service Surveillance HUB to receive monthly updates and reminders 2. Log-on or Request log-on ID/password: https: //tiny. army. mil/r/z. B 8 A/CME 3. Register at: https: //tiny. army. mil/r/MEHs. S/Epi. Tech. FY 18 1. n Confirm attendance: Please enter your full name/email into the DCS chat box to the right or email your Service hub n You will receive a confirmation email within 48 hours with your attendance record; if you do not receive this email, please contact your Service hub n Integrity – Service – Excellence

Integrity - Service - Excellence Laboratory Testing: Education and Interpretation Victoria Holbrook, MPH Epidemiologist Epidemiology Consult Service (USAFSAM/PHR) 1 st Lt Cedric Walters Operations Chief, Immunodiagnostics Epidemiology Lab Service (USAFSAM/PHE) Distribution D: Do. D and Do. D Contractors Only Integrity – Service – Excellence

Learning Objectives n Describe lab test types commonly seen in the 2017 Reportable Medical Events (RME) Guidelines to improve reporting. n Understand the basic science behind common lab tests seen during disease surveillance to improve reporting accuracy. n Interpret lab test results found during surveillance activities to improve reporting accuracy. Integrity – Service – Excellence

What can be tested? n Sterile samples Blood/Serum n Pleural (joint) fluid n Cerebrospinal fluid (CSF) n n Non-Sterile samples n n n Stool Urine Tissue Sputum (saliva) Nasopharyngeal (nose/mouth/throat) Integrity – Service – Excellence

Most Common Test Types Antigen n Antibody n PCR n Culture n Vocabulary note: Assay = Test Integrity – Service – Excellence

Antigen and Antibody Tests Also collectively called immunoassays n For most infections there are both antibody and antigen tests n n n Have to pay attention to the lab results! Common test types: EIA (ELISA) n IFA/DFA n Western Blot (Ab only) n Antibody Titer (Ab only) n Integrity – Service – Excellence

Antigens and Antigen Tests n Antigens – Typically proteins on the surface of viral, bacterial, parasitic, or fungal cells; can also be chemicals produced by the infecting microorganism n Antigen (Ag) Tests Identify the presence of a known antigen in a sample n Typically used with acute infections n Results are positive or negative n Integrity – Service – Excellence

Antibodies and Antibody Tests n Antibodies – Proteins produced by the immune system; are specific to a particular antigen n Antibody (Ab) Tests Identify the presence of a known antibody in a sample n Used with acute or chronic infections n Results are positive or negative n n Can be quantitative Also called immunoglobulin (Ig) n Two most important antibody classes: Ig. M and Ig. G n Integrity – Service – Excellence

Antibodies n Ig. M Antibody n Ig. G Antibody Produced first in response to infection n Marker of current infection n Detectable for up to 6 months after infection Produced later in response to infection n Marker of long-term immunity n From vaccination or disease n Integrity – Service n – Excellence

Antigen/Antibody Tests n Antibody/antigens are a matched pair n n An antibody is like a lock with a specific antigen key Antibody tests use an antigen to see if antibodies are present n Antigen tests use an antibody to see if antigens are present Antibody Antigens The top assay would be positive; the bottom assay would be negative Integrity – Service – Excellence

Results and Interpretation n For EIA, IFA, or DFA results will indicate if the test was: Antigen or antibody n Antibody Ig. M or Ig. G n Antigen Antibody Ig. M Integrity – Service – Excellence Ig. G

Sinlge Antibody Titer n Titer is a serial dilution of a patient sample (serum) diluted with saline or water n n Goal: Find how much antibody is in a sample A higher titer means more antibodies in the sample Integrity – Service – Excellence

Results and Interpretation Serial Dilution: 1: 8 1: 16 1: 32 1: 64 1: 128 Integrity – Starting point 1 - fold serial dilution 2 - fold serial dilution 3 - fold serial dilution 4 - fold serial dilution Service – Excellence

Results and Interpretation n AHLTA antibody titer result: Integrity – Service – Excellence

Paired Antibody Titer n Sometimes antibody titers are tested in pairs called “acute and convalescent sera” or “paired sera”: Acute titer, taken first n Convalescent titer, taken 2 -4 weeks later n Convalescent sample Acute sample Integrity – Service – Excellence

Results and Interpretation n For a positive “ 4 -fold rise in antibody titer” the convalescent serum must be positive at 4 dilutions more than the acute serum result n Example scenario: Is this a 4 -fold increase? Acute: Convalescent: Integrity – Service – Excellence

Results and Interpretation 1 We’re looking for a 4 -fold increase when compared to the FIRST titer n 2 5 4 3 + + + - 1/16 1/32 1/64 1/128 1/256 1/512 1/1024 Yes. The convalescent titer is actually 5 -fold higher than the acute titer. Integrity – Service – Excellence

PCR n PCR – Polymerase chain reaction n n Detects the presence or absence of organism-specific DNA (or RNA) “Bio. Fire GI Film Array” sound familiar? Integrity – Service – Excellence

Results and Interpretation n Results are positive or negative: n AHLTA results may say RT-PCR n NAAT n DNA n RNA n Integrity – Service – Excellence

Results and Interpretation n PCR proves there is genetic material, but it does not necessarily prove that the organism is alive and actively causing infection n A positive PCR for Shiga-toxin producing (STEC) E. coli is not reportable under the RME Guidelines for this reason Integrity – Service – Excellence

Culture n n Culture refers to “culturing” or growing an organism on, typically, a petri dish n Takes several days to grow most organisms n Physicians could run multiple tests at the same time to get quicker results Also sometimes called “isolation” Integrity – Service – Excellence

Results and Interpretation n Results are positive or negative; the organism grows or doesn’t n Culture is typically the “gold standard” n n Proof the organism is present AND alive If other tests are inconclusive, culture results usually trump all other tests Integrity – Service – Excellence

Contact Information n Army: APHC – Disease Epidemiology Division Aberdeen Proving Ground – MD COMM: (410) 436 -7605 DSN: 584 -7605 usarmy. apg. medcom-aphc. mbx. disease-epidemiologyprogram 13@mail. mil n Navy: NMCPHC Preventive Medicine Programs and Policy Support Department COMM: (757) 953 -0700; DSN: (312) 377 -0700 Email: usn. hampton-roads. navmcpubhlthcenpors. list. nmcphc-threatassess@mail. mil Contact your cognizant NEPMU 2: COMM: (757) 950 -6600; DSN: (312) 377 -6600 Email: usn. hampton-roads. navhospporsva. list. nepmu 2 norfolk- threatassess@mail. mil NEPMU 5: COMM: (619) 556 -7070; DSN (312) 526 -7070 Email: usn. san-diego. navenpvntmedufive. list. nepmu 5 -health-surveillance@mail. mil NEPMU 6: COMM: (808) 471 -0237; DSN: (315) 471 -0237 Email: usn. jbphh. navenpvntmedusixhi. list. nepmu 6@mail. mil NEPMU 7: COMM (int): 011 -34 -956 -82 -2230 (local): 727 -2230; DSN: 94 -314 -727 -2230 Email: NEPMU 7@eu. navy. mil n Air Force: Contact your MAJCOM PH or USAFSAM/PHR USAFSAM / PHR / Epidemiology Consult Service Wright-Patterson AFB, Ohio COMM: (937) 938 -3207 DSN: 798 -3207 usafsam. phrepiservic@us. af. mil Integrity – Service – Excellence