California's public health lab’s findings shape H1N1 prevention, treatment

Marisa Grunder, 27 of Wilton, Iowa, is given a shot during trials of an H1N1 vaccine, developed by CSL of Australia, at the University of Iowa Health Center on August 11, 2009 in Iowa City, Iowa.
Marisa Grunder, 27 of Wilton, Iowa, is given a shot during trials of an H1N1 vaccine, developed by CSL of Australia, at the University of Iowa Health Center on August 11, 2009 in Iowa City, Iowa.
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Since April, H1N1, the “swine flu,” has killed 219 Californians and hospitalized another 3,000. State health officials expect H1N1 to take a greater toll before it goes away.

A public health laboratory in Northern California is guiding how the state’s doctors, clinics, and hospitals attack the swine flu.

Inside a multi-story building in Richmond, in Northern California’s Bay Area, microbiologist Estella Saguare loads liquid containing ribonucleic acid into a tube filled with chemical compounds. Saugure explains, “We’re actually loading the nucleic acid to the rest of the reagents, which then go into the machine that will actually amplify the nucleic acid there if what we’re looking for is present.”

The “what” Estella Saguare is looking for is H1N1, the “swine flu” virus.

The Richmond lab was the first in the state to get the equipment and training to test for H1N1.

Most other states have to send suspect viral samples to the Centers for Disease Control and Prevention in Atlanta – test results can take upwards of three days. Lab supervisor Hugo Guevara says California can confirm swine flu cases a lot more quickly than that.

“We can have the results as early as maybe three and a half hours. And that’s what the doctor needs – a quick response to decide whether to treat or not treat.”

The Richmond public health lab is primed to help the state prevent and treat the H1N1 swine flu virus.

Every year, the lab works with a network of 250 volunteer clinicians. They’re called “sentinel providers” because they track annual influenza outbreaks for the state.

For the last 10 years, those sentinel providers have reported the number of cases of seasonal influenza and the severity of those cases. This year, they’re also tracking H1N1.

The Richmond public health lab’s Dr. Janice Louie oversees that surveillance program. Louie says the information they collect helps health care providers decide how to treat sick patients.

For example, Louie says, “Right now we’re seeing mostly H1N1 swine influenza circulating. If we start to see seasonal influenza circulating, we would let everybody know – our partners throughout the state – because that means physicians would have to change the type of anti-viral treatment they use to cover both seasonal influenza A and the H1N1 virus.”

The Richmond lab hired extra workers to test up to 300 viral specimens a week. That’s a lot more than the lab’s average of 1,000 for a whole flu season. Lab officials expect to test as many as 20,000 specimens by the end of this flu season.

Dr. Louie says they’re not just testing for the H1N1 virus. They also examine samples from patients who died or who suffered severe illness to see if the virus has mutated to a more virulent strain, or if it’s developed a resistance to anti-viral drugs.

The lab also combines data from all its various tests to provide state officials with an overall picture of the H1N1’s behavior. Dr. Louie says that information tells them “which type of patient is doing worse, which cases are having problems with this virus, who is getting hospitalized, who is tending not to do so well.”

Dr. Louie says that information helps state health officials set policies on treatment and who to vaccinate first.

State health officials say up to half of California’s population could catch H1N1 this flu season. They’ve acquired only 750,000 doses of vaccine, but more is on the way.