Evaluation of the Laboratory Response Network and Testing Access During the First 10 Weeks of the Mpox Response, United States, May 17-July 31, 2022

Abstract

Objectives: The Laboratory Response Network (LRN) consists of US and international laboratories that respond to public health emergencies, such as biothreats. We used a qualitative approach to assess the successes and challenges of the LRN during the initial 10 weeks of the 2022 mpox outbreak (May 17-July 31, 2022).

Methods: We conducted 9 unstructured interviews, which included 3 interviews with subject matter experts from the Centers for Disease Control and Prevention (CDC) and 6 interviews with state and local public health laboratories and epidemiologists and Association of Public Health Laboratories (APHL) staff. We asked guiding questions on investments in preparedness, successes, and challenges during the initial mpox response and asked for suggestions to improve future LRN responses to infectious disease outbreaks. We also reviewed data from 2 contemporaneous APHL surveys conducted in June and July 2022 in 84 LRN public health laboratories.

Results: Notable successes included availability of an assay that had received clearance from the US Food and Drug Administration (FDA) for testing orthopoxviruses (non-variola Orthopoxvirus [NVO] assay) and a trained workforce; strong relationships among FDA, CDC, and the LRN; and strong communications between LRN laboratories and CDC. Challenges included variability among LRN laboratories in self-reported testing capacity, barriers to accessing the NVO assay for health care providers, and gaps in LRN function during surges of testing needs.

Conclusions: The LRN system plays an essential role in the response to emerging infectious disease outbreaks in the United States. Lessons learned from the LRN's initial response to the mpox outbreak can help guide improvements to better position the LRN for future responses, including continued engagement with health care providers, commercial laboratories, and laboratories in health care settings.

Keywords: emergency preparedness; laboratory; mpox; response; variola virus.

Figure 1.

Timeline of mpox response activities by the Laboratory Response Network (LRN), United States, May 17–July 31, 2022. Abbreviations: CDC, Centers for Disease Control and Prevention; FDA, US Food and Drug Administration; HAN, Health Alert Network; IRR, International Reagent Resource; MA, Massachusetts; MMWR, Morbidity and Mortality Weekly Report; PCR, polymerase chain reaction; WHO, World Health Organization.

Figure 2.

National testing volume and testing capacity for mpox using the non-variola Orthopoxvirus (NVO) test in public health laboratories in the Laboratory Response Network (LRN), United States, May 17–July 30, 2022. Source: Surveys conducted at the Association of Public Health Laboratories (APHL) (by T.W.) on June 28, 2022, with 84 LRN laboratories, and on July 25, 2022, with 83 LRN laboratories. Surveys were distributed via email to LRN laboratories, and survey responses were collated by APHL.