Coccidioides immitis is endemic in Monterey County. The Monterey County Health Department recently issued a health advisory on an increase in the number of cases being reported. Valley Fever is easily confused with community acquired pneumonia and tuberculosis. The Monterey County Public Health Laboratory has validated a PCR method for detecting this mold in respiratory specimens. Extra pulmonary specimens are tested and reported for investigational use.
Hospital labs are reminded that unknown mold isolates can be transported to our laboratory as Category B specimens. However, isolates from patients diagnosed as Coccidioides immitis must be destroyed within 7 days or transferred as a Category A specimen to a laboratory registered to possess select agents. The form for reporting isolation and destruction of select agents has been recently revised; section D of the form must know be completed and signed by the submitting laboratory. Any cultures identified in our laboratory as C. immitis will be reported together with the appropriate sections of form 4 that must be completed by the submitting laboratory.
In 2010, the Monterey County Public Health Laboratory improved our ability to type and subtype of influenza viruses. Using new A typing reagents, we can now distinguish swine origin influenza A from human strains. Similarly, new H1 subtyping reagents will differentiate human A/H1 and swine origin 2009 pandemic A/H1 virus. These new assays allow us to detect and confirm the 2009 pandemic A/H1 virus and recognize human cases of novel swine-origin viruses such as the swine origin triple reassortant H3N2 virus (H3N2v). The table below lists the genetic targets we now testing for and how swine origin A/H3 and other circulating strains will have the following result when tested by the full rRT-PCR subtyping panel:
Table1: Possible results:
|Influenza A virus subtype||Influenza rRT-PCR target|
|Inf A||H1||H3||pdm A||pdm H1|
|Sw origin AH3*||+||negative||+||+||negative|
|Probable AH3-2009-AH1 co-infection*||+||negative||+||+||+|
*Samples with this particular rRT-PCR pattern and others not described in table 1 should be notified immediately to the VRDL.
The Monterey County Public Health Laboratory requests that local hospital laboratories submit specimens from the following: 1) fatal respiratory illness; 2) severely ill patients (e.g. in ICU with respiratory illness). Individuals with ILI who are at risk of swine origin influenza (e.g. individuals working with swine or contacts to individuals working with swine) should be submitted for influenza typing and subtyping by rRT-PCR.
Shiga toxin producing E. coli (STEC)
The recent food-borne outbreak in Europe illustrates that serogroups of E. coli other than O157 are capable of producing Shiga toxin and causing severe illness. Since October 2009, the CDC has recommended that stools submitted for diagnosis of community-acquired gastroenteritis should be tested for both O157 and non O157 Shiga toxin producing E. coli (STEC). Testing for STEC is available through the public health laboratory (fee for service) but can also be performed in local hospital labs using commercially available FDA approved test kits. We encourage local labs to consider providing this service and refer isolates of STEC or enrichment broths that are positive for STEC toxin so that the serogroup can be determined. There is no charge for serogrouping of STEC isolates. The following link provides more information on CDC guidelines http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5812a1.htm .
The manufacturer of QuantiFERON TB Gold In-Tube (in vitro test for TB infection) recently announced important changes to their package insert. If you submit specimens to our lab for this test, please note that improper temperature of the collection tube at the time of the blood draw, or over-energetic shaking, may cause gel disruption and could lead to aberrant results. Tubes should be between 17-25oC (63-77oF) at the time of blood filling. This differs slightly from temperature range for shipping tubes; temperature range for shipping is 17-27oC (63-81oF). Tubes should be shaken for 5 seconds (or 10 times) just enough to ensure the entire inner surface is coated with blood (solubilizing antigens on the tube walls) but not so vigorous as to dislodge the gel. The following link provides more information on specimen collection (proper mixing is shown at 5:48 in the video) http://www.youtube.com/watch?v=FwCNlHaLnqw
Laboratory Reportable Diseases
On December 20, 2011, the Monterey County Health Department sent a letter to all local laboratories reminding them of the importance of reporting diseases listed in the California Code of Regulations (CCR) Title 17 (Division 1, Chapter 4, Subchapter 1, Article 1, Section 2505). Compliance with laboratory disease reporting regulations can be accomplished by faxing, mailing, or calling the Health Department’s Communicable Disease Unit within the designated timeframe. Contact information is provided below. Additional guidance is available on the Communicable Disease Unit’s website.
Monterey County Health Department
Communicable Disease Unit
1270 Natividad Road, Salinas, CA 93906
Confidential Fax: 831-754-6682
After-Hours: call 831-755-5100 and ask for the
on-call Health Officer