Lab Matters - Winter 2013

SWEET HOME ALABAMA: ADPH BUREAU OF CLINICAL LABORATORIES FINDS ITS FOOTING

Alabama is a state in flux. The inspiration for that 1934 jazz standard, “Stars Fell on Alabama,” it’s languid climate, diverse flora and sandy Gulf Coast beaches make it one
of the most romantic states in the US. With the second largest
inland waterway system in the country, and a land area that is
two-thirds forest, it has rightly been called “Alabama the Beautiful.”
averages 60,000 births per year. Since the state performs two screens
per infant, its NBS program tests almost 120,000 dried blood spot
specimens annually. Massingale would like to ramp up the program
further, by adding severe combined immunodeficiency, but inad-
equate space and personnel have hampered those efforts.

Yet, the “Heart of Dixie” is less laid back than in the past. The state still values its natural charms and large poultry and cotton farms, but is increasingly focused on high-tech progress. It is home to the Marshall Space Flight Center and its educational SPACE CAMP®, Maxwell Air Force Base, the US Army Redstone Arsenal and a number of automotive production facilities, from Hyundai to Mercedes-Benz. There are also golf courses galore along the Robert Trent Jones Golf Trail, loft apartments in downtown Montgomery and a new 220,000-square-foot convention center in Birmingham.

The next largest volume of the lab’s workload is STD testing. Alabama has 67 counties and, said Massingale, “most specimens come from county health departments.” The ABCL uses Gen-Probe’s Aptima® assays for gonorrhea and chlamydia testing for genital and non-genital sites, and recently began using this method to detect Trichomonas vaginalis. It uses Bio-Rad’s GS HIV Combo Ag/Ab EIA for diagnosis of HIV- 1 and HIV- 2, and Gen-Probe’s Aptima® HIV- 1 RNA Qualitative Kit for confirmation of HIV- 1 infection. It also has adopted an enzyme immunoassay for syphilis screening.

“From top to bottom, we have interesting things to attract people from all over the world,” said Sharon Massingale, PhD, HCLD/ CC(ABB), director of the Alabama Department of Public Health (ADPH) public health laboratory (PHL).

Massingale, a native Alabaman, is focused on high-tech progress too. Despite fiscal challenges, she said, “I want us to be a leader in PHL science.” Massingale came to the laboratory in 1999 after raising two children and earning a doctorate in microbiology from Auburn University “at the ripe age of 40.” She had already earned a bachelor’s degree from Alabama A&M University in Huntsville and a master’s degree from Tuskegee University, where she also taught. Without clinical experience, however, Massingale began her career as an entry-level microbiologist and rose through the ranks.

In addition to the usual broad range of clinical services found in state PHLs—including nucleic acid amplification testing for tuberculosis—the ABCL performs 16S DNA sequencing, shellfish testing, and recreational water analysis of Gulf Coast beaches and spot surveillance of retail milk for sterility. It is one of few PHLs offering mycology services and continues to analyze seafood for contamination resulting from the 2010 BP oil spill.

The laboratory’s influenza testing program was enhanced just in time for the 2009 H1N1 pandemic. Fortunately, Alabama was part of a 2008 APHL-funded, RAND Corporation study assessing national influenza laboratory preparedness. Among other things, the final report noted the need for an additional PCR platform in Alabama. Massingale, then a supervisor, arranged to purchase the instrument and also sent a staff member to CDC for its latest rRT-PCR flu panel training.

That experience gave her valuable insight to the laboratory’s needs. Before assuming the top post, she launched the state’s West Nile virus clinical testing program, set up the molecular laboratory and played a critical role preparing the lab for the 2009 H1N1 pandemic.

These advanced measures served the state well when the first cases of H1N1 influenza were detected in March 2009. With APHL assistance, the ABCL was able to expedite its order for the PCR platform and to simultaneously purchase two additional instruments. Because of this increased testing capacity, the ABCL tested all submitted specimens without external surge support.

As its name suggests, the Alabama Bureau of Clinical Laboratories (ABCL), specializes in clinical analytical services. Two other state labs—in the Alabama Department of Environmental Management (ADEM) and Alabama Department of Agriculture & Industry—handle non-clinical testing, although ABCL performs bacterial water analyses under contract to ADEM and directly for some municipalities.

The laboratory is a member of the PulseNet foodborne disease surveillance network—yet another program implemented by Massingale—and a member of the Laboratory Response Network (LRN): an LRN reference laboratory for biological threat agents and a Level 2 laboratory for chemical threat agents. However, the ABCL was invited by CDC to provide surge capacity for Level 1 labs due to demonstrated analytical competence.