The Society of American Federal Medical Laboratory Scientists
SAFMLS
2020-12-07
NEW SAFMLS MEMBERSHIP PROCESS
SAFMLS members, with the transition to ASCLS there is a new membership process. The SAFMLS board of directors will have full administrative control over the membership process. The good news is that your membership dollars will directly benefit the SAFMLS organization. That means more resources for things that are important to our members and organization. The memberships that CLMA honored expire on 31 Dec 2020. Be advised that there will be a hard cutoff date for SAFMLS memberships in 2021 so we can inform ASCLS of our membership list to accommodate conference planning in FY21. This will lock in your membership rates for the Joint Annual Meeting (JAM) with ASCLS 27 June to 1 July 2021 in Louisville, KY. Since we are all waiting on the edge of our seats for what travel looks like in 2021 there is comfort in knowing that if there are travel issues ASCLS is prepared to transition to a virtual conference with discounted rates as a contingency plan.
SAFMLS membership renewal process using the following steps:
Go to the SAFMLS membership site: https://safmls.wildapricot.org/ (Using Chrome is best)
Select “Log in” on the top right
Use your email (most likely your military email address) to log in to the site. Use the forgot password option to set up a password. Look for an email from the “Wild apricots” site to update/setup your password. Note: If no email is sent make sure to check your “Junk email” and allow emails from the website.
Upon successful login there should be a Renewal notice on the bottom right screen that pops up; click on the link to renew your membership. If the renewal notice doesn’t pop-up; go to the “Join Us” tab above. Then select “Edit your member profile”.
Update your profile and the “Invoices and Payments” link should take you to the section where you can renew your membership.
Thank you all for your continued support and I look forward to seeing all of you (hopefully in person) at the JAM 2021 conference with ASCLS.
AMY L. BOGUE, MS, CLS, MLS(ASCP)\(^{cm}\), SM(ASCP)
SAFMLS Secretary
1 Upcoming Event
SAFMLS/ASCLS 2021 Joint Annual Meeting
ANNUAL MEETING ABSTRACT SUBMISSIONS Poster abstracts for the 2021 Joint Annual Meeting will be solicited beginning in January 2021.
Say What? SAFMLS/ASCLS 2021 Joint Annual Meeting
Say Where? Omni Louisville Hotel, Louisville, KY 400 S 2nd St, Louisville, KY 40202
Say When? 1300, Sunday, June 27 to 1800, Thursday, July 1 2021
Say How? Get funded through your local channels, let your supervisor know about this not to be missed event with lots of exciting changes going on.
Information
Conference approval and funding information:
Each Service and DoD Organization has its own policies on this so speak to your supervisor. What we know currently—there is no central funding available each organization funds staff based on their organization
Conference Approval:
ARMY: “Non-DoD conferences per AR 1-50, paragraph 2-7, GOs, SES members, and 0-6/GS-15 Commanders of Army medical centers and community hospitals may approve funded attendance for non-DoD conferences with total costs under $1OOK, and fewer than 50 Army attendees within their purview. A list of 0-6/GS-15 Commanders of MEDCOM Military Treatment Facilities (MTF} with conference approval authority is on the Office of the Administrative Assistant (OAA} Conferences home page. No other MTF Commanders are authorized conference approval authority.”
NAVY: Requires a conference packet which was submitted and approved-letter was provided to attendees
AF: none required as it is under the amount
DHA: none required as it is under the amount
REGISTRATION:
Will be updated at a later date.
FLIGHT: Nearest airport: Louisville International Airport (Airport code is SDF)
Hotel Reservation:
Per diem rate in Louisville, KY is $120/night The conference is at the Omni Louisville Hotel at 400 S 2nd St, Louisville, KY 40202.
Kentucky and Hotel Tax Exempt sheet: can be found by CLICKING HERE
- Please present this form when you check in to the conference center.
Uniform:
- Civilians: Business casual for all participants and Business attire if presenting;
- Military: Class Bs for all attendees and ASUs for presenters;
- Navy Service Working Uniform (Khakis) for participants and for the CLMS/Navy Breakout;
- Presenters for CLMA KnowledgeLab, Service Dress Blues with ribbons and name tag
- Don’t forget covers/headgear!
Conduct:
This is a professional conference with professionals. This is a great time to have fun, network with others, and discover best practices in our field. Since this is a professional event, please remember to always act appropriately both in and out of uniform. You are a representation of yourself, your unit, and your Service, act appropriately at all times. The conference is your place of duty if you are TDY not the derby races or fill in the blank place. Don’t forget drinking in uniform is not allowed at this event and it is best to wear civilian casual business attire to the social events; not a uniform. So please change out of your uniform before going out to the CLMA social activities. Don’t forget a three star General will be attending the event so please be present for his Key Note speech and be prepared to sing the Service songs.
MAJ Melissa Baltazar, USA
2 President’s Message
Colonel Mikal L. Stoner, USA
Dear SAFMLS Team,
Time flies when you’re having fun! We are excited to bring you another Society Scope edition. I cannot express how impressed I am with all of the DoD labs during this pandemic. We have tested over 1M specimens; set up several new testing locations; created a surveillance pooling strategy with the public health and research labs that has proven to be successful; are prepared for flu season; and have adapted to our new environment. Although somewhat rocky at times we all pulled in together and did the best we could.
As you all know, these are unprecedented times that we haven’t seen in the U.S. in more than 100 years. Even when HIV first kicked off, although difficult in the beginning of that epidemic for labs, it never reached this level of demand or visibility. It is an honor to serve as your President and I want to thank you for your continued support in our organization and towards our Society Scope.
There are several new processes now that we are no longer with CLMA. ASCLS is set up differently and because of this SAFMLS will start tracking our own memberships again. The process is simple and allows you to pay via credit card online. The good news is ASCLS will accept our members in good standing to attend the annual meeting at the ASCLS membership price.
Looking towards the future we have already started planning our annual meeting. This will be the first with ASCLS and AGT. Both organizations are very excited for us to join them. They are looking forward to celebrating our customs and courtesies and welcome this new change and have agreed to allow us to continue them. With that, we have teed up LTG Ronald Place, the DHA Director, as our keynote speaker.
Speaking of next year’s annual meeting, the poster submission guidance will be coming out to you soon. If you didn’t get the opportunity to submit an abstract for an oral presentation you can now submit one for a poster. Those of you that submitted for an oral presentation will receive notice around 5 December of your presentation and the next steps you need to do. If you didn’t make it, don’t fret, as you can still submit your topic for a poster presentation.
I can’t wait until I get a chance to not only see you all in Louisville at ASCLS 2021 JAM (Joint Annual Meeting), but also get a chance to see and hear about all of the great things each of you is doing. As COL Tyner says,
“DEFEAT INFECTION!”
Best regards,
Mikal Stoner
3 Editor’s Corner
LTC Tony Pierson, USA
There are many similarities between military labs and our civilian counterparts, but there are also issues unique to the military. While national periodicals provide good technical information, they cannot anticipate or address challenges unique to our population. As such, membership in the Society of American Federal Medical Laboratory Scientists (SAFMLS) provides a consortium of laboratorians who share unique military experiences. And the Society Scope is our platform to present information to the most appropriate audience (each other). However it is difficult to publish the scope without community support.
I’ve gone back into the archives and it is a recurrent theme over the last few years that the Scope is chronically pleading for its members to contribute articles. I hypothesize that the lack of involvement is partially due to the decreased emphasis placed on attending the SAFMLS conference (not to mention the lack of funding). I recall the last SAFMLS that I attended when it was a stand-alone conference; it was a vibrant and inclusive meeting. As corny as it sounds, I even enjoyed each military branch singing their song, and loved it when we all sang the Marines’ Hymn. That era of collaboration and comradery took a hit when it was determined that SAFMLS could not continue having individual conferences, leading to several years without annual meetings. The ensuing association with the Clinical Lab Managers Association (CLMA) was an effort to keep SAFMLS in existence, and it provided a successful lifeline. And going forward, our new alliance with the American Society for Clinical Laboratory Science (ASCLS) and the Association of Genetic Technologists (AGT) promises even better meetings.
Getting back to my original point; we had a society with robust community involvement and copious funds to attend annual meetings. The recent pandemic has illustrated the importance of what we do, and I believe our funding drought is cyclical, and we are due for an upswing. But the first step in getting back to where we were is to get involved. Please consider submitting an article to the Scope. If you are in my general career trajectory, you remember what SAFMLS was; it is our turn to pick up the ball and advance it forward, so that SAFMLS returns to its former glory. If you are a mentor, encourage your mentees to submit articles. While you are at it, get them to become members. And let’s be optimistic and plan for Louisville 2021!
4 Submitted Articles
4.1 USNS COMFORT (T-AH 20) Clinical Laboratory Microbiology Services to Address the COVID-19 Pandemic in New York City
Corresponding Author:
Contributors:
* Krystal Glaze MLS, LCDR, MSC
* Joshua Cox MLT, HM2, USN
* Timothy Maxey, MLT, HM2, USN
* Jeremy Parr MLT, HM3, USN
* Makayla Kempton MLT, HN, USN
* Taylor Norris MLT, HN, USN
Department of Laboratory Medicine, Navy Medicine Readiness and Training Command, Portsmouth, VA
Funding: none
Disclosure: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
Copyright Statement: I am a military service member. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. 101 defines a United States Government work as a work prepared by a military service member or employee of the United States Government as part of that person’s official duties.
Background: The hospital ship USNS COMFORT (T-AH 20) is one of two Mercy-class Naval Hospital ships commissioned in the late 1980s. The USNS COMFORT primary mission is military combat casualty receiving; however, in more recent years the ship has provided humanitarian assistance and disaster relief efforts to the Caribbean and Latin America.\(^{1-4}\) In response to the Coronavirus 2019 pandemic (COVID-19), Navy Medicine deployed the USNS Comfort as a pandemic infection response and was ordered to have the manning and supply to fully use the 1,000 hospital beds on board. The hospital ship has ample clinical and anatomic pathological capabilities to include primarily non-gynecological tissue examination, hematology, basic coagulation, chemistry/immunochemistry, serology, urinalysis, transfusion services and microbiology. This paper specifically seeks to outline the steps taken to establish a fully functional microbiology laboratory in addition to a mobile infectious disease testing site and the lessons learned associated with these efforts.
Timeline: The USNS COMFORT (T-AH 20) completed a five-month humanitarian mission in the Caribbean and Latin America on November 15, 2019 and entered a maintenance period in January 2020. On 18 March 2020, the USNS COMFORT (T-AH 20) was activated from that maintenance period in Norfolk, VA. The initial goal of Operation Gotham Response, was to deploy to New York City to offload COVID-19 negative patients from inundated local hospitals as a result of the COVID-19 pandemic. The ship moored at Pier 90 in New York City Harbor, NY on 30 March 2020. With less than seven days to activate, nine laboratory personnel established a fully functional microbiology department. Testing capabilities included two COVID-19 test methodologies, blood, wound, urine, respiratory, throat, anaerobic, and stool cultures. The microbiology team commenced its first COVID-19 test 29 March 2020 for a member of the ship’s crew. On April 1, 2020 the first NYC patients arrived at Pier 90. Each patient was swabbed for COVID-19 prior to admission. The first NYC patient admitted to the ship tested positive for novel coronavirus on 4 April 2020. The USNS COMFORT (T-AH 20) leadership quickly realized the ship could be transitioned to a COVID positive treatment facility which would be more impactful to relieve the burden on the local hospitals. On April 6, 2020 the ship began accepting its first known COVID-19 positive patients. The last patient was discharged from the ship on 30 April 2020 and the ship returned to its homeport of Norfolk, VA on May 2, 2020.
Manning and Supply: The microbiology divisional manning for the mission consisted of 1 medical laboratory scientist as the lead, 1 microbiologist, 1 biochemist, and 6 medical laboratory technicians. The division operated two COVID-19 testing sites 24 hours each day. The majority of technicians staffed the day shift to handle the COVID-19 testing workload in conjunction with standard microbiology plate reading and susceptibility testing. The remaining staff were two-person teams, as one supported the new sample plating that was received in the main microbiology division, while the other was responsible for the mobile COVID-19 testing site. Once the ship began taking known positive COVID-19 patients, it was critical to identify the status of unknown patients for admission purposes. Consequently, the microbiology team was asked to establish a mobile COVID-19 testing site. Prior to leaving the Norfolk, VA pier, the team setup two Next Generation Detection System (NGDS) FilmArray analyzers manufactured by BioFire Defense, LLC and one Applied Biosystems\(^{TM}\) 7500 Fast Dx Real-Time PCR analyzer supplied with manning augmentation from Navy Environmental and Preventive Medicine Unit TWO (NEPMU-2). Upon receiving the mobile site request, three additional FilmArrays were acquired from the Naval Surface Warfare Center – NavSea Warfare Center. Additionally, a field mobile biological safety hood was acquired from Biological Defense Research Directorate.
Due to the ship being in a maintenance period immediately prior to Operation Gotham Response, the main microbiology department was not functional. Over the course of seven days the team was required to perform quality control checks, calibrations, and rapid validation checks on all equipment to include one biological safety cabinet, multiple incubator and refrigerator units, all five NGDS FilmArray analyzers, a Beckman Coulter MicroScan autoSCAN-4 system, and Becton Dickinson BACTEC blood culture system. The ship does not maintain temperature sensitive storage or short dated items when in the maintenance period; therefore, the microbiology team had to order all microbiology consumables (i.e. antibiotic discs, culture media, and viral transport media). Most ubiquitous items were procured through the Defense Medical Logistics Standard Support (DMLSS) system using the ships authorized medical allowance list (AMAL). Other more uncommon or scarce (i.e. viral transport media) consumables were procured through alternative sources using a line of credit. While the credit procurement proved effective in getting most consumables in a relatively fast manner (5-7 business days), the DMLSS ordering and receipt process was slow at best. Critical items were received four or more weeks after initial order execution, with some items never arriving to NYC during the six-week mission. Of the cold storage items received, additional quality and sterility checks were performed because the cold chain was broken in shipment.
The initial mission detailed the USNS COMFORT (T-AH 20) providing care for as many as 750 beds with a 50 plus bed intensive care unit (ICU). However, once the admission shifted to accept known COVID-19 positive patients, the ICU staffing and pharmaceutical capabilities became the rate-limiting step. Initially, the laboratory could not support the initial quota due to limited supplies. Specifically, the microbiology division left Norfolk with 168 COVID-19 tests for the NGDS FilmArray and approximately 300 tests for the ABI 7500 Fast Dx platform. Other limitations included selective media for stool and deep wound (anaerobic) cultures. Collectively these limitations were monitored and reported on a daily basis by way of the microbiology team performing daily test counts and weekly consumable inventories. Because Operation Gotham Response did not have a clear end date, the team continued this accounting and reporting process.
Testing Capability and Workload: The following microbiology tests were available throughout the mission: -Cultures (blood, superficial wound, anaerobic, urine, respiratory, throat, stool) -Culture antimicrobial susceptibility -Rapid Strep A -Vaginal Fluid Examination -Fecal occult -Fecal Leukocytes -Rapid Clostridium Difficile A&B toxin -SARS-CoV-2 (COVID-19) (FilmArray andABI 7500 Fast Dx ) -Respiratory Panel (FilmArray) -Meningitis Panel (FilmArray) -Gastrointestinal Panel (FilmArray)
A total of 359 cultures and PCR tests were performed, of note, 125 COVID-19 tests and 104 blood cultures. Gram stains and supplemental identification testing were performed as indicated by the isolated organism. In some instances when the COVID-19 and respiratory PCR panel were negative, a rapid strep A test was performed. Additionally, C. difficile toxin antigen testing was performed on a few occasions later in the mission. 1 meningitis panel was performed (not graphed below). While the majority of the workload was generated by the NYC patients, the sum does include staff members that were seen in sick-call throughout the mission.
100 organisms were isolated from the cultures performed, to include 14 extended-spectrum β-lactamases (ESBL) Klebsiella pneumoniae, seven Methicillin-resistant Staphylococcus aureus (MRSA), and three ESBL Escherichia coli. Of these 24 multi-drug resistant organisms (MDROs), 16 were isolated from blood cultures, three from urine, and two each from respiratory and wound cultures. Enterococcus faecalis was also a common isolate as it was identified in 12 blood cultures, three wound cultures and one urine culture.
Establishing a Novel Test: For the first time in the USNS COMFORT’s (T-AH 20) documented laboratory history, a novel test was required and the primary focus of the ship’s mission. The SARS-CoV-2 test primarily used for Operation Gotham Response was the Emergency Use Authorization (EUA) COVID-19 NGDS FilmArray panel developed by BioFire Defense, LLC. The test panels contain three different assays for the detection of SARS-CoV-2 RNA with a sensitivity of 80% or greater. The ship’s laboratory is Clinical Laboratory Improvement Program (CLIP) certified and therefore is require to maintain compliance in accordance with Department of Defense (DOD) 6440.02M procedures. With this in mind, the microbiology team utilized modified versions of existing procedures and validation plans provided by the NEPMU-2 team. The validation modifications were necessary because of supply limitations at the time of the mission. All procedures and validations were reviewed and approved by the laboratory medical director.
Mobile COVID Testing Site: The mobile COVID-19 testing site was established on the main deck of the ship in the forward bay of Casualty Receiving (CASREC). This area was somewhat separated from the patient receiving area but close enough for microbiology staff to speak with the clinical staff. Additionally, the area was close to the isolation rooms located in CASREC. Two NGDS FilmArray analyzers were setup with one field biological safety hood. The hood was placed on an unused patient bed to elevate the working level. A sharps container and most of the preparatory regents were placed inside the hood for ease of sample preparation. The photograph below is an authentic depiction of the mobile site.
The mobile site was used for a significant percentage of NYC patients without a history of previous COVID-19 testing. Prior to the site’s establishment, the patient samples were collected at the pier and carried to the main laboratory of the ship on the 01 deck in batches. This took time and slowed the admission process, but testing with the ABI 7500 Fast Dx platform’s higher throughput compensated for the delayed turn-around-time prior to establishing the mobile testing site. Once the site was established the in the patient admission process was significantly expedited. Since the majority of patients came in groups and in the late evening or night, the mid-day and night shift microbiology technician worked with the ship’s department of medical operations (DMOP) team to determine exactly when the mobile site required manning. The microbiology team utilized the DMOP assigned Medical Officers to report all COVID-19 results to expedite the movement and assignment of patients on the pier who were waiting on admission to the ship. This was a critical process because the ship intensive care unit (ICU) had separate bays for COVID-19 positive versus COVID-19 negative patients.
Lessons Learned: Upon initial notification about the USNS COMFORT (T-AH 20) activation for COVID-19, the microbiology team identified necessary testing capability. Vendor contacts were identified and communicated to the ship’s supply team early on and often. The microbiology team met with clinical specialist to ensure the testing formulary was appropriate for the anticipated patient needs. These efforts directly contributed to the quick procurement of many scarce consumables (i.e. viral transport media, nasopharyngeal swabs, COVID-19 tests) as well as the quick acquisition of three additional NGDS FilmArray analyzers.
The microbiology team also worked closely with the infectious disease provider to establish a COVID-19 algorithm based on current testing capabilities. This collaboration helped communicate to providers the need to manage expectations with regards to COVID-19 testing capabilities.
The mobile COVID-19 testing site was a success because it significantly accelerated the patient assignment and admission process for patients without prior COVID-19 testing. It was advantageous for the site to remain on board, but with the appropriate temperature controlled workspace, the site could have been moved onto the pier for an even greater impact. The ship might consider looking into the permanent procurement of a field biological hood for other combat or disaster relief missions.
One major challenge with maintaining regulatory compliance throughout the mission was short dated consumables. In a land based hospital there are options for rapid logistical operation. For various logistical reasons, the hospital ship could not directly receive items procured through the DMLSS process. This resulted in delayed consumable deliveries. Consequently, short dated items required medical director approval for extension of use. The microbiology team was also required to perform additional quality control checks to ensure consumables maintained appropriate performance before patient testing. In those instances where critical testing items were limited (i.e. COVID-19 tests), the medical director and microbiology leadership determined the best way to meet the validation requirement without depleting tests needed for patients . Some of the challenges related to supply will remain unavoidable until the supply process for disaster relief is improved.
The depleted supply chains across the country also contributed to microbiology challenges. This was mostly seen with the reagents (i.e. master mix, extraction kits) required for the ABI 7500 Fast Dx testing platform. Due to the limited production and rigid distribution process, these items were scarce throughout the mission and significantly limited the testing capabilities. This was particularly true for the ABI 7500 Fast Dx platform as the analyzer has the ability to perform higher throughput testing (to include surveillance) than the NGDS FilmArray. If the reagents for this platform were readily available, large groups of patients, high risk healthcare providers, and the ship’s crew could have been tested at various critical points during the mission.
Due to the longstanding nature of the USNS COMFORT (T-AH 20), much of the microbiology equipment on board is dated. The equipment is actually integrated into the ship hull, thereby making it extremely difficult to replace and/or update. One example of this was the high efficiency particulate air (HEPA) filters in the main microbiology biological safety cabinet and the genetic testing extraction space. This item could be addressed as part of the existing laboratory fleet inspection for the ship.
Conclusion: The microbiology team assigned to the USNS COMFORT (T-AH 20) for Operation Gotham Response established a fully functional microbiology laboratory while maintain regulatory standards over a six week period. Despite several systemic supply challenges, the team was able to provide accurate clinical results such as MDRO identification and infectious testing for the novel SARS-CoV-2 during the coronavirus pandemic. Mobile microbiology testing for clinical diagnosis rather than research purposes is a newly realized functionality that may aid in future disaster relief missions. Alternative options related to quality management and compliance should be considered to simultaneously meet mission and regulatory requirements. Collaboration with the clinicians early on helps in managing expectations of ancillary services. Laboratory AMALs for unique and sometimes limited laboratory consumables should be developed, regularly reviewed, and appropriately updated by the laboratory subject matter expert assigned to the USNS COMFORT (T-AH 20) platform to enhance the supply chain process.
References:
- https://usnhistory.navylive.dodlive.mil/2018/11/02/legacy-of-usns-comfort/
- http://www.mercy.navy.mil/History.html 3.https://web.archive.org/web/20150426120150/http://www.med.navy.mil/sites/usnscomfort/Pages/default.aspx
- https://usnhistory.navylive.dodlive.mil/2018/11/02/legacy-of-usns-comfort/
- https://www.biofiredx.com/covid-19/
- DODD Manual. Clinical Laboratory Improvement Program (CLIP) Procedures. 6440.02-M.
Acknowledgments: LT Daniel Siliberg Microbiologist, LCDR Luis Estrella Biochemist, HM1 Nsikanete Davis
4.2 Weed Army Community Hospital’s Laboratory COVID-19 Response
Written by CPT Daniel Dees
Fort Irwin, CA is home to the National Training Center (NTC) located north of Barstow, CA 34 miles out into the Mojave Desert. The austere location serves to support the unique mission of NTC of training an average of 10 brigade combat teams, amounting to approximately 60,000 soldiers, per year. At close to 1,000 square miles of desert and restricted air space to facilitate training, NTC allows brigades the one of a kind opportunity to train all capabilities that will be used in theater. The ability to so closely simulate a deployed environment is one of the reasons that the recent COVID-19 pandemic presented additional challenges for those serving and rotating at NTC, and the laboratory professionals from Weed Army Community Hospital (WACH) rose to meet those challenges head on.
Following the announcement of the Department of Defense wide travel ban, planning for an influx of testing began lead by the then laboratory manager, CPT Laurenti Patton. As WACH laboratory lacked any molecular capabilities at that time, CPT Patton immediately began coordinating with regional command to receive the first round of analyzers capable of performing testing, the BioFire® Film Array® while providing daily data on testing and logistical requirements. By mid-April deputy laboratory manager, CPT Daniel Dees had written and performed initial validations making WACH laboratory one of the first in Central Region to have validated analyzers up and running with limited test kits to go with it. As WACH began processing in-house SARS-CoV-2 tests, the next challenge was to meet DHA’s expectation of obtaining capabilities to run approximately 800-900 tests per 24 hours to meet the demand for upcoming rotations. This planning came with a visit from the Chief of Staff of the Army, General James McConville, to discuss strategies and resources needed to test all Soldiers, DA civilians and contractors associated with rotations, and to mitigate any downtime from training. The increased capabilities were accomplished with the addition of 2 Cepheid® GenXpert®-4 and 1 Cepheid® GeneXpert®-16 molecular analyzers and a lot of hard work by the WACH laboratory staff.
To date, WACH laboratory technicians have manually prepared and processed approximately 9,000 SARS-Cov-2 tests with the vast majority being mass testing in support of NTC rotations using the recently obtained molecular testing platforms. This effort lead by the current WACH laboratory manager, 2LT James Phillips, has led to zero downtime in rotational training time due to lack of testing capabilities. 2LT Phillips joined the WACH laboratory out of his basic officer leadership course to replace CPT Patton following a PCS, and hit the ground running to ensure smooth continuation of services and execution of the mass testing. He and the WACH laboratory staff continue to expand capabilities by being the first community hospital in the DOD to obtain and validate the SARS antigen fluorescent immunoassay for Sofia® analyzers. Throughout the length of the pandemic, WACH laboratory staff have received multiple commendations from higher for their significant contributions to the continued success of the NTC mission. These include coin presentations by the RHC-C Commanding General, BG Wendy Harter, FORSCOM Deputy Commanding General, LTG Leopoldo Quintas, and Chief of Staff of the Army, GEN McConville.
4.3 Respiratory Syncytial Virus: The lesser regarded RNA viral threat.
Written by LTC Gerald Kellar
Since the 1960s respiratory syncytial virus (RSV) has been regarded as a major healthcare burden, especially in regards to young children.\(^{1-2}\) RSV infects 37-million children annually, has been linked to the onset of asthma, and is the leading cause of bronchiolitis and hospitalization in children under the age of five.\(^{2-3}\) Yet, despite its widespread prevalence and noted pathology, no vaccine for RSV currently exists, with only one catastrophic trail having been attempted in 1969.\(^{1-3}\)
I decided to tackle RSV based pathology for my PhD thesis project in an attempt to assemble a few pieces of the puzzle that have eluded researchers these past decades. To do this, I decided to use age appropriate mice (3-week old C57BL/6 (B6) mice), which are more difficult to deal with because of their small size; however, give a truer picture of a juvenile’s lung architecture and immune response.\(^{4}\) The initial immune response to RSV infection (inoculated with: 1x10\(^{5}\) PFUs of RSV Line 19) at 72-hours post infection of these 3-week old B6 mice (hereafter referred to as juvenile mice) was compared to 8-week old B6 mice (hereafter referred to as adult mice), revealing some interesting immunological differences. My first observation was the disparity in the myeloid cell populations recruited into the lung tissue: monocytes, neutrophils, and eosinophils were all elevated in the juvenile mice, which is depicted in figures 1A, 1B, and 1C, respectively, below. The increased presence of myeloid cells has been linked to RSV induced lung damage and negative clinical outcomes, while being considered as the primary mechanism for failure in the one attempted RSV vaccine trial.\(^{1,3,5}\)
A second interesting observation involved the often-overlooked extracellular matrix (ECM). Viral infection leads to the breakdown of the ECM as monocytes and neutrophils attempt to remove infected cells, with these ECM components and resulting cellular debris further driving inflammation and possible lung damage.\(^{6-7}\) The natural scavenging mechanism for this generated debris is CD64, a type of FC receptor present on monocytes and alveolar macrophages.6 However, the monocytes of the juvenile mice seem to have a lag in CD64 upregulation as shown below in figure 2A, which could contribute to the increased hyaluronan (HA) presence observed in the juvenile histology, as shown in figure 2B and 2C.\(^{6}\)
In conclusion, juvenile mice appear to have a sustained immunological response to RSV infection, characterized by an enduring myeloid presence, a lack of debris clearance capability, leading to the possible build-up of cellular debris and HA, which could contribute to the enduring cellular presence.\(^{7}\) The continued presence of which would further contribute to airway remodeling and overall lung pathology which would prime the “lungscape” for the progression to and onset of asthma.\(^{5-7}\)
If you’re interested in seeing the complete story (including some human cell culture data I gathered in a collaboration with Seattle Children’s Hospital) check out the recently published article in the Journal of Immunology: doi:10.4049/jimmunol.2000683. If you have any other comments or questions about the research or the experimental methods used please feel free to contact me at: gerald.g.kellar.mil@mail.mil.
References:
- Kim, H.W., J.G. Canchola, C.D. Brandt, G. Pyles, R.M. Chanock, K. Jensen, and R.H. Parrott. 1969. Respiratory Syncytial Virus Disease in Infants Despite Prior Administration of Antigenic Inactivated Vaccine. Am J Epidemiol. 89: 422-434.
- Sigurs, N., F. Ajassim, B. Kjellman, P.D. Robinson, F. Sigurbergsson, R. Bjarnason, and P.M. Gustafsson. 2010. Asthma and allergy patterns over 18 years after severe RSV bronchiolitis in the first year of life. Thorax. 65: 1045-1052.
- Becker, Y. 2006. Respiratory syncytial virus (RSV) evades the human adaptive immune system by skewing the Th1/Th2 cytokine balance toward increased levels of Th2 cytokines and IgE, markers of allergy-a review. Virus Genes 33: 235-252.
- Schittny, J. 2017. Development of the Lung. Cell Tissue Res. 367: 427-444
- Soukup, J.M., and S. Becker. 2003. Role of monocytes and eosinophils in human respiratory syncytial virus infection in vitro. Clin. Immunol. 107: 178-185.
- Mold, C., H.D. Gresham, and T.W. Du Clos. 2001. Serum Amyloid P Component and C-Reactive Protein Mediate Phagocytosis Through Murine Fc𝜰Rs. J. Immunol. 166: 1200-1205.
- Termeer, C.C., J. Hennies, U. Voith, T. Ahrens, J.M. Weiss, P. Prehm, and J.C. Simon. 2000. Oligosaccharides of Hyaluronan Are Potent Activators of Dendritic Cells. J Immunol. 165: 1863-1870.
5 Making an Impact Across the Globe
Getting the right answer: A Madigan microbiologist tests viruses from JBLM to Liberia
Unique Army lab answers nation’s call in supporting COVID-19 response
Pathfinder medical technician discovers safer COVID-19 swab technique
6 Superstar Corner
6.1 Kirti K. Tiwari
Rank: CPT
AOC: 71A
Unit: Alpha Company, DDEAMC
Position: Commander
CPT Tiwari takes extreme pride in his MEDCOM Patch. He immigrated from India in 2011 and enlisted in the Army as a 68W. CPT Tiwari earned his Master’s degree in Cell and Molecular Biology. He received a Direct Commission as a 71A, Army Microbiologist in 2017. CPT Tiwari currently serves as the Commander for Alpha Company, Dwight D. Eisenhower Army Medical Center (DDEAMC). He is a consummate clinician whose proficiency and expertise as an Army Microbiologist has been pivotal to the successful clinical response, training, test expansion and clinical research. His efforts resulted in the establishment of a Regional COVID-19 Reference Laboratory. He aspires to be a physician through USUHS and an Army Astronaut to fly and represent the AMEDD in Space one day.
7 SAFMLS Officials
7.1 Board of Directors
President: Colonel Mikal L. Stoner, USA
Vice-President: Maj Mark Lisanby, USAF
Treasurer: CPT James Lehman, USA
Secretary: Capt Amy Bogue, USAF
7.2 Members-at-Large
COL Jeff Smith, USA
CPT Sascha F. Jung, USA
SFC Christopher Soto, USA
LDCR Syed Husain, USN
Lt Tammy Nguyen, USN
Capt Alex Hastings, USAF
Capt Jamie Olguin, USAF
7.3 Ex-Officio Members
COL Eva Calero, USA
COL Karen Burmeister, USA
CDR Todd Tetreault, USN
COL, Dan Bessemer, USAF
LtCol, Angel Hudson, USAF
CDR Arash Mohtashamian, USN
Col Donald Trummel, USAF
7.4 Additional Key Board Members
Web Master: CPT Jason Reeves, USA
Scope Editor: LTC Tony Pierson, USA
Scope Publisher: CPT Jason Reeves, USA
8 Advertiser Information
Advertising rates:
- Full page ad = $400
- 1/2 page ad= $200
- 1/4 page ad= $100
Ads should be sent to: LTC Tony Pierson, USA, scope@safmls.org
Publishing by Jason Reeves
webmaster@safmls.org