An Integrated Approach to Laboratory Testing for Patients with Ebola Virus Disease

Extract

Beginning in 2003, the Nebraska Medical Center in Omaha developed a laboratory capability plan in conjunction with the creation of a biocontainment unit (BCU) for treatment of patients harboring emerging infectious organisms. The laboratory response planning involved experts at the Nebraska Public Health Laboratory (NPHL), University of Nebraska Medical Center (UNMC), the Nebraska Department of Health and Human Services (DHHS), and the Centers for Disease Control and Prevention (CDC). Special emphasis was placed on diagnostic testing for highly contagious and pathogenic organisms, including Francisella tularensis and high consequence viruses causing avian influenza and hemorrhagic fevers such as Ebola.

Due to the recognition that certain organisms and conditions would need to be ruled out, preparations also included the capability to test specimens for other diseases, including malaria and tuberculosis. Originally, a limited number of point of care (POC) hematology and chemistry tests were planned, to monitor patients who harbored a high consequence pathogen. This testing was to be performed in the biosafety level 3 (BSL-3) laboratory within the NPHL at UNMC, which is within 1 city block from the Nebraska Medical Center, the main campus facility for the parent organization; the BCU is located at the Nebraska Medical Center. At various times, the laboratory staff conducted drills or participated in simulated training exercises with the medical staff of the BCU and state and national organizations to refine operational plans. Preparedness efforts included drafting of memoranda of understanding that detailed specific responsibilities and capabilities. However, when the first patient with Ebola virus disease (EVD) arrived, a number of factors resulted in reconsideration of the original testing plan.