Laboratory surge response to pandemic (H1N1) 2009 outbreak, New York City metropolitan area, USA

Abstract

The North Shore-Long Island Jewish Health System Laboratories serve 15 hospitals and affiliated regional physician practices in the New York City metropolitan area, with virus testing performed at a central reference laboratory. The influenza A pandemic (H1N1) 2009 outbreak began in this area on April 24, 2009, and within weeks respiratory virus testing increased 7.5 times. In response, laboratory and client service workforces were increased, physical plant build-out was completed, testing paradigms were converted from routine screening tests and viral culture to a high-capacity molecular assay for respiratory viruses, laboratory information system interfaces were built, and same-day epidemiologic reports were produced. Daily review by leadership of data from emergency rooms, hospital facilities, and the Health System Laboratories enabled real-time management of unfolding events. The ability of System laboratories to rapidly increase to high-volume comprehensive diagnostics, including influenza A subtyping, provided key epidemiologic information for local and state public health departments.

Figure 1

Daily clinical virology test volumes in the North Shore–Long Island Jewish Health System, New York City metropolitan area, USA, April 24–May 15, 2009. General clinical laboratories performed influenza A/B rapid antigen testing only. The central Clinical Virology Laboratory performed direct immunofluorescence antibody testing and R-Mix viral culture, and beginning May 2, the central Molecular Diagnostics Laboratory performed molecular testing for respiratory viruses (xTAG Respiratory Virus Panel, Luminex Molecular Diagnostics, Toronto, Ontario, Canada).

Figure 2

Cumulative virology test volumes and influenza A–positive results, North Shore–Long Island Jewish Health System, New York City metropolitan area, USA, April 24–May 15, 2009. INFA RAP, rapid antigen test for influenza A; DFA, direct immunofluorescent antibody test; VCR, rapid respiratory virus culture by R-Mix (Diagnostic Hybrids Inc., Athens, OH, USA); RVP, Luminex xTAG Respiratory Virus Panel (Luminex Molecular Diagnostics, Toronto, Canada). White bars, number of tests with negative results for influenza A.; black bars, number of test results positive for influenza A. Actual numbers are included above the bars. For influenza A, the percentages of samples positive for influenza A are shown in parentheses.