Inside the Missouri State Public Health Laboratory (MSPHL)

Welcome to the Missouri State Public
Health Laboratory, where on any given day human specimens, food, water, animals or an
unknown powder could arrive for analysis. Testing must be completed accurately and
quickly because the results will assist health officials and providers who make
life-saving and life-altering decisions. Is this patient part of a foodborne
outbreak? Is it safe to drink that water? Will the teenager who picked up a bat
require a rabies vaccinations? Did the critically ill patient contract a new
and deadly virus? Is that packaged meat contaminated with e-coli?
What kind of genetic or metabolic disorders could that newborn baby have?
The Missouri State Public Health Laboratory will deliver these answers
and much more. The Missouri State Public Health Laboratory provides thousands of
routine tests every day, but when the state of Missouri is hit by an
earthquake, flood, or disease outbreak the laboratory will shift into emergency
response mode working long hours to handle a surge in testing, while also
maintaining regular services. The men and women who work at the Missouri State
Public Health Laboratory perform vital functions to help detect, investigate,
prevent, and control public health threats from all corners of the world.
Now, let’s look at how the laboratory has evolved over the years. The Missouri
State Public Health Laboratory has been in existence since beginning of the
1900’s and is currently in its sixth location. The Bureau of Laboratories of
the Missouri Division of Health was organized in 1906 and at that time had
only one bacteriologists located in St. Louis. In 1910, the laboratory moved to
Jefferson City. It was housed in the Missouri State Capitol. Unfortunately, the
next year the Capitol building, mostly made of wood, was destroyed by fire after
a bolt of lightning struck the dome. The laboratory has moved several times since
1911 but it’s longest stint was in it’s location on McCarty Street in Jefferson
City. The laboratory was located here starting in 1978 and this site survived
the historic Missouri floods of 1993 amd 1995. In 2007, the laboratory moved to it’s
current location near the historic Missouri State Penitentiary. This new
state-of-the-art building cost around $32 million, it was designed by the
Clark Emerson company. The laboratory is a
safety-level 3 laboratory, with limited access. It is equipped with a robust
emergency power supply consisting of 2 large capacity generators. The facility
also has extensive security and surveillance systems, with internal and
external cameras recording around-the-clock. The laboratory is
supported by a staff of nearly 100 scientists and support staff who are all
dedicated to delivering quality public health laboratory services. The
laboratory is also the only representative in the state for the
Centers of Disease Control and Prevention National Laboratory Response
Network and the Food and Drug Administration’s National Food Emergency Response
Network. This means the laboratory provides testing for new and emerging
diseases such as Ebola, MERS and Zika. It also performs testing for the FBI if an
unknown substance is found and deemed to be a credible threat. The laboratory is
certified to provide testing for food served in high-profile events such as
the Democratic and Republican National Conventions, the Presidential
Inauguration and the Super Bowl. Now, let’s go inside the Missouri State
Public Health Laboratory and learn about the diverse and wide-ranging areas of
scientific testing and data collection taking place. The laboratory is divided
into multiple testing units. This includes chemistry, environmental
bacteriology, microbiology, virology, immunology, newborn screening, molecular, and breath alcohol. The laboratory also has several support units. The Missouri
State Public Health Laboratory receives approximatley 300,000 samples every year
and as a result has an output of over 7 million results per year. None of this
can happen without the Central Services Unit. Workers in the Central Services
Unit maintain a statewide courier system for specimen and mail delivery to and
from the Missouri State Public Health Laboratory. The unit also makes sure that
incoming mail and specimens are triaged, and sent to the proper areas within the
laboratory. Central Services works with Missouri’s Office of Administration to
maintain the daily functions of the building. This includes air handling
systems, boilers, chillers and water systems, which help keep up with the
demands of a controlled scientific atmosphere. They also collect,
decontaminate, wash and return glassware and laboratory coats to scientific staff.
The Central Services Unit also maintains a warehouse and inventory
of general supplies used throughout the laboratory. Workers send out hundreds of
thousands of collection kits to requesting specimen submitters. In any
given year, this number can reach over 300,000 kits.
The unit is responsible for overseeing hazardous waste storage and removal. They collect biological waste from the laboratory space four times a day. The
laboratory generates and decontaminates over 23 tons of biological waste per
year. Now, let’s learn about the other units located within the Missouri State
Public Health Laboratory. Environmental specimens such as food, water, and human
specimens received for chemical testing are forwarded to the Chemistry Unit. This
unit is split into two different testing areas, the Radiological Laboratory and
the Chemistry Laboratory. The Radiological Laboratory provides testing
of air, food, and water samples during any sort of contamination event, whether it’s
intentional or accidental. Scientists here also provide radiological testing
for monitoring purposes in areas where the general public could be exposed. The
Chemistry Laboratory provides blood lead testing for children.
Scientists here also provide environmental lead testing in homes of
individuals with elevated blood lead levels. They analyze specimens such as
paint chips, dust wipes and soil samples for traces of lead. They also test water
samples for the presence of heavy metals and volatile organic compounds, which can
be dangerous or even deadly if consumed by humans and animals.
The Chemistry Unit also provides analysis of human and food specimens for
agents of chemical terrorism, such as cyanide, nerve agents, blister agents and
more deadly chemicals. The Chemistry Unit also works with state epidemiologists for
the surveillance of opioids, using newly developed and enhanced methodologies.
Other environmental samples received for bacterial testing are sent to the
Environmental Bacteriology Unit. This unit provides testing for all water and
food samples. The water laboratory provides testing for all private and
public water supplies for the presence of bacteria. It also provides bacterial
count testing for Missouri’s public beaches and lakes maintained by the
Missouri Corps of Engineers and the Missouri Department of Natural Resources.
The unit inspects and approves samples from Missouri’s
public water facilities and inspects and gives certifications to milk produced in
dairy laboratories around the state. The food laboratory provides testing for
foodborne disease investigations. Scientists here provide testing in
support of surveillance or enforcement actions resulting from sanitary
investigations. The Food Laboratory also provides testing on packaged meat
specimens and seafood testing for the National Antibiotic Resistance
Monitoring System and the unit provides testing for the Manufactured Foods
Regulatory Program Standards. This unit also provides testing support for state
and federal investigation in suspected bioterrorism events. Finally, the
Environmental Bacteriology Unit partners with the Microbiology Unit and the
Molecular Unit for foodborne outbreak testing. Many nationwide and regional
food recalls are result of similar testing. If a suspected disease-causing
agent is isolated from a food source a pure culture of the agent is
transferred to the Microbiology Unit for further testing. The Microbiology Unit
assists in outbreak detection and statewide surveillance of various types
of toxins and bacterial pathogens in humans including Salmonella, e.coli, and
whooping cough to name a few. Tthe laboratory also tests patient’s
stool samples for the presence of intestinal ova and parasites. This
includes Giardia, Entamoeba and hook worms. The unit also does skin scrape
testing for the presence of scabies and blood smear testing for the presence of
blood-borne pathogens such as malaria and Babesia. The Microbiology Unit tests
for tuberculosis by culture and smear methods on respiratory specimens. Another important duty of the Microbiology Unit is manufacturing over 95 percent of the
culture and biochemical media used for plating, growing, and bio-chemically
identifying bacteria. The unit provides quality control testing in all bacteria
testing media made in-house, including sterility, growth, and sugar reactions. The
unit also creates and maintains media that is sent out to other locations for
sample collections to be returned to the laboratory for testing. Viral specimens
sent to the Missouri State Public Health Laboratory are forwarded to the Virology
Unit. This unit performs serological testing for measles, rubella, hepatitis A
and B, West Nile virus, St. Louis Encephylitis virus, Zika virus and other arboviruses. The virology unit also performs culture
testing for various respiratory viruses in support of the influenza program. They
are also involved in gastrointestinal outbreak identification by testing for
viruses such as adenovirus virus and rotavirus. This unit is also the only laboratory in
the state of Missouri that does testing on animals for the presence of the
rabies virus. This includes wild creatures such as bats and skunks, as
well as domesticated animals that pose potential human exposure risks. Specimens received for sexually transmitted infection testing are taken to the
Immunology Unit. This unit provides testing for HIV and provides testing for
syphilis, gonorrhea, and chlamydia utilizing the latest technologies. These
include automated testing syphilis screening and antigen antibody screening
for HIV, in order to identify acute HIV infection. The Missouri State Public
Health Laboratory also tests every baby born in the state of Missouri within the
first few days after birth. In the Newborn Screening Unit, scientists test
for over 70 genetic metabolic and hemoglobin disorders. These tests include
PKU, sickle cell anemia, amino acid disorders and cystic fibrosis, to name
just a few. The Newborn Screening Program in
Missouri is a national and world leader when it comes to screening newborn
babies. The laboratory is the first in the nation to test for liposomal
storage disorders, and the first in the world to implement micro-fluidics
testing technology for LSDs. The unit is always busy, scientists provide testing
Monday through Saturday and on state and national holidays to avoid any lag in
detection, so that affected babies can be identified and treated quickly. Some
newborn screening is also provided by the Molecular Unit. This unit performs
newborn screening for Krabbe and severe combined immunodeficiency. The
Molecular Unit also provides many other tests. This unit performs polymerase
chain reaction testing for viral diseases like influenza and norovirus, as
well as testing for chickenpox, and Ruellan Smallpox. The influenza testing
done here provides information that is used to help determine flu vaccines for
years to come. Scientists in this laboratory also use PCR to test for Bordetella pertussis, the bacteria that causes whooping cough and for a
toxin found in pathogenic e coli. The Molecular Unit uses whole genome
sequencing for various bacterial specimens, and this laboratory provides
rapid screen testing on environmental samples for agents of bioterrorism. The
Missouri State Public Health Laboratory also has a small branch laboratory
located in Poplar Bluff, Missouri that houses most of the breath alcohol unit,
which is used by law enforcement throughout the state of Missouri. The
breath alcohol unit maintains equipment and provides technical support for the
Missouri State Highway Patrol and provides expert testimony for related
judicial cases. The Missouri State Public Health Laboratory relies heavily on
support units to maintain functionality. The previously mentioned Central
Services Unit is one of the few that are essential to the daily operations of the
laboratory. The laboratory also houses the Post Analytical Reporting Team and
the Laboratory Preparedness Education and Safety Unit. The Post Analytical
Reporting Team enters data results for every test received and completed at the
laboratory. They also return reports to submitters, private citizens, partners and
stakeholders. They are the face of customer service for the Missouri State
Public Health Laboratory. The laboratory Preparedness Education and Safety Unit
oversees the Missouri State Public Health Laboratory’s preparedness and
emergency grant and programs. The unit also provides outreach, training and
educational materials to internal laboratory staff and Clinical Laboratory
partners in areas of biosafety, biosecurity, select agents and packaging
and shipping of infection substances. The Laboratory Information Management
Systems assists all units in providing state of the art technology for
electronic processing and reporting of results. The Fiscal staff at the
laboratory assures that grant contracts and budgets are maintained in order for
the laboratory to provide quality public health services. The Laboratory Executive
Management Team provides leadership and guidance in support of all laboratory
activities. The Missouri State Public Health Laboratory and the folks who work
here are proud of the work and positive effect they have on public health. Most
of the work done here is behind the scenes and many who choose to work in
public health do it because they want to make a difference in people’s lives. If
you’d like to learn more about the laboratory and what happens here you can
visit health.mo.gov/lab. Thanks for
watching! you

Stephen Childs

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