Laboratory response network

Many diseases, including anthrax, are most effectively treated before actual manifestation of the symptoms is observed. Presently a presumptive identification of Bacillus anthracis can be made in about 3 hours however, if a full laboratory response network (LRN) confirmation procedure is utilized, the theoretical time increases substantially to approximately 48 hours. During the recent anthrax cases 72 to 96 hours were common to complete the entire LRN protocol. In the meantime antibiotics were administered as a precaution based on the presumptive results to individuals thought to be exposed to B. anthracis spores or with anthrax symptoms. The mass administering of antibiotics from a cost standpoint, as well as from medical prudence to prevent the rise of antibiotic-resistant strains, is not the optimal answer to the anthrax infection problem. Therefore it is important that early tests be rapid and reliable with a minimum number of false positive and false negative results. 

Coordinate all aspects of testing, packaging, and transporting with public health laboratory/Laboratory Response Network (LRN). 

Laboratory Response Network (LRN)—A network of labs developed by the CDC, APHL, and FBI for the express purpose of dealing with bioterrorism threats, including pathogens and some biotoxins. 

CDC (Centers for Disease Control and Prevention). 2006a. Laboratory Response Network. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention [online]. Available http //www.bt.cdc.gov/lrn/pdf/lrn-overview-presentation.pdf [accessed Jan. 18, 2006]. 

Describe the structure and functions of the Laboratory Response Network. 

In 1999, the Centers for Disease Control and Prevention (CDC) established the Laboratory Response Network (LRN). The CRN s purpose is to run a network of labs that can respond to biological and chemical terrorism. The LRN has grown to greater than 100 LRN laboratories since it was established. It now includes state and local public health, veterinary, military, and international labs. 

In the absence of an unambiguous history of ricin exposure, the preferred diagnostic method is specific immunoassay of ricin in serum, respiratory secretions, or other clinical samples associated with poisoning. Most of the methods described for ricin detection are experimental or are under development. The CDC and the Federal Laboratory Response Network have the capability to detect ricin in environmental specimens using validated polymerase chain reaction (PCR) tests and time-resolved immunofluorescence assays, with cell-based bioassays to confirm ricin activity. The U.S. Department of Defense has produced experimental field immunoassays, but commercial distribution of field test kits currently is limited. 

The Communicable Disease Center created the Laboratory Response Network for Terrorism (LRNT) and a Rapid-Response Advanced Technology (RRAT) laboratory, both linked to the Enviromnental Protection Agency. 

For a contact list, see the links provided by the Association of Pubhc Health Laboratories.) These laboratories are part of the national Laboratory Response Network (LRN), a multilevel system designed to link state and local laboratories with advanced-capacity biosafety facilities and to provide surge capacity in the event of a bioterrorism incident. 

In practical terms, early detection systems of various pathogens gained high priority. BioWatch—a Department of Homeland Security s effort to collect air samples form dozens of cities around the country to detect biological agents—biosensors have been deployed in more than 30 urban areas (at a cost of 79 million for 2006). Air is thus monitored air 24 hours a day and samples are collected daily and taken to labs that are part of the Centers for Disease Control and Prevention Laboratory Response Network. The results are provided within 12 to 36 hours [336]. 

Many hospital and private reference laboratories use what are called the rule-out-and-refer (ROAR) guidelines as defined and made available by the CDC. The laboratories that use these procedures are referred to as sentinel laboratories in the CDC s Laboratory Response Network (LRN) (Centers for Disease Control and Prevention 2014). The guidelines are utilized to rule out the presence of biological agents with the use of just a few rapid method biochemical reactions. If the organism cannot be ruled out, the sentinel laboratory s role is not to identify the organism but rather is required to refer to the state s public health laboratory, where confirmation can be achieved by advanced biochemical tests, gene amplification, and other molecular methods. 

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