MDHHS to screen newborns for two Lysosomal Storage Diseases (LSD) beginning August 7, 2017
The MDHHS Newborn Screening Laboratory begins screening for Lysosomal Storage Diseases - Pompe disease and Mucopolysaccharidosis I (MPS I) - August 7, 2017.
Further Information for providers and the public can be found at www.michigan.gov/newbornscreening under ‘Announcements’.
UPDATED LABORATORY GUIDANCE FOR ZIKA VIRUS TESTING – 8/1/2017
Testing at the Michigan Department of Health and Human Services
Miami-Dade County was previously designated as a Zika cautionary (yellow) area, but that designation was removed on June 2, 2017. This means that there are no longer any travel recommendations related to Zika virus for Miami-Dade County, Florida; therefore, travel to this area will no longer meet criteria for testing at BOL. CDC is still recommending that people living in or traveling to Miami-Dade County continue to protect themselves from mosquito-borne illnesses.
The CDC Updated Interim Guidance for Healthcare Providers Caring for Pregnant Women with Possible Zika Virus Exposure – United States, July 2017 can be found at https://www.cdc.gov/zika/laboratories/lab-guidance.html. The interim guidance has been updated based on declining trends in the number of reported cases of Zika virus infection in Region of the Americas, emerging evidence on prolonged detection of Zika immunoglobulin M (IgM) antibodies, and new limitations for interpreting serologic tests during pregnancy. Although IgM is most likely to be detected in the first 12 weeks after infection, emerging data indicate that Zika virus IgM may persist beyond 12 weeks in a subset of infected individuals, limiting the ability of testing to determine whether an infection occurred during or prior to pregnancy. IgM tests are also susceptible to false positives and cross-reactivity with other flaviviruses, especially when an individual has been vaccinated against or previously infected with a related flavivirus. In the United States, as the decline in reported Zika virus cases (including travel-associated cases) continues, the proportion of positive tests that are false positives for Zika virus are expected to increase due to a low positive predictive value. Key changes in the updated guidance for testing pregnant women have been made taking these testing limitations into consideration.
Key updates to the guidance:
Symptomatic pregnant women with possible Zika virus exposure should be tested. When testing symptomatic pregnant women, concurrent NAT and IgM testing is recommended as soon as possible, up to 12 weeks after symptom onset. The recommendation for Zika virus NAT testing has been expanded from ≤ 2 weeks to ≤ 12 weeks because of evidence that Zika virus RNA may persist in the serum of pregnant women with Zika virus infection. NAT testing is now recommended on paired serum AND urine specimens collected at the same visit.
- Asymptomatic pregnant women with ongoing possible exposure to Zika virus should be tested. NAT testing is recommended three times during pregnancy. IgM serology testing is not routinely recommended. Recommendations for the timing of NAT testing are at the initial prenatal care visit, followed by two additional NAT tests performed during pregnancy, coinciding with non-consecutive prenatal visits. Timing of additional NAT testing may be informed by jurisdictional trends in Zika virus transmission, the expected length of Zika virus nucleic acid detection in serum, and the duration of exposure during pregnancy. Although not routinely recommended, after pre-test counseling and individualized risk assessment, physicians and patients, through a shared decision-making model, may collaboratively elect to have IgM testing performed concurrent with NAT testing. For women who have a positive NAT test during pregnancy, additional NAT testing is not recommended. If a patient has previously been confirmed positive for Zika virus infection, no additional IgM serology testing is recommended.
- Asymptomatic pregnant women with recent possible Zika virus exposure but no ongoing exposure (i.e., travelers) may be considered for testing. Although not routinely recommended, testing may be considered on a case-by-case basis using a shared physician-patient decision-making model and in line with jurisdictional recommendations. If testing of asymptomatic pregnant women is performed, the same algorithm as for symptomatic pregnant women should be followed using the timeframe from the last possible exposure to Zika virus.
- Pregnant women with possible exposure to Zika virus and who have a fetus with prenatal ultrasound findings consistent with congenital Zika virus infection should be tested. NAT and IgM testing should be performed on maternal serum and urine following the algorithm for symptomatic pregnant women. If amniocentesis is being performed as part of clinical care, NAT testing of amniocentesis specimens should also be performed. Testing of placental and fetal tissues may also be considered.
- Testing guidance for symptomatic non-pregnant individuals remains unchanged with this updated interim guidance.
For SYMPTOMATIC NON-PREGNANT patients with exposure to Zika virus, RNA nucleic acid testing (NAT or PCR) of serum and urine is recommended up to 2 weeks after symptom onset. IgM serology is performed up to 12 weeks after symptom onset.
Please see figures 1-3 for testing algorithm performed at BOL.
Pre-conception screening and baseline serum screening are not recommended. Couples planning to conceive should consider avoiding travel to areas with local Zika virus transmission. Women who are exposed to the virus through travel or unprotected sex with a partner who has traveled to an area of risk should consult with their healthcare providers. Current recommendations from the CDC are that they should wait at least 8 weeks from symptom onset or last possible exposure. Men should avoid attempting conception for at least 6 months from symptom onset or last possible exposure. The BOL cannot test women or men for purposes of family planning or to see if an individual is infectious.
*Some commercial laboratories offer testing for Zika.
There are currently no EUA-approved tests for screening of semen for male partners requesting screening.
Information regarding testing infants at the time of birth can be found on CDC’s Zika website at https://www.cdc.gov/zika/hc-providers/infants-children.html and also in the Interim Guidance for the Evaluation and Management of Infants with Possible Congenital Zika Virus Infection at https://www.cdc.gov/zika/pdfs/zika-evaluation-management-infants.pdf
The entire MMWR report with CDC’s Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure-United States (Including U.S. Territories), July 2017, can be found at https://www.cdc.gov/mmwr/volumes/66/wr/mm6629e1.htm?s_cid=mm6629e1_e
MANDATORY PAPERWORK FOR SPECIMEN SUBMISSION
Zika Supplemental Questionnaire Form - *FORM MUST BE COMPLETED IN FULL
SPECIMENS, SHIPPING, AND VOLUMES REQUESTED FOR ZIKA TESTING
2 Tubes (2 mL each) Serum + 1 Tube (2 mL) Urine
-Serum MUST be submitted regardless of other sample types submitted (CSF and amniotic fluid may be submitted for testing only if sent with paired sera)
-Ship specimens on a frozen ice pack using screw-capped tubes with O-rings
-Please be especially careful when labeling specimen vials for submission as “urine” or “serum”
Shippers are available from the BOL by contacting Josh Hall at 517-335-9040 or by email at firstname.lastname@example.org
For questions about Zika testing, please contact one of the following:
Bruce Robeson, Virology Unit Manager
Email: email@example.com Phone: 517-335-8098
Kristine Smith, Immunology Unit Manager
Email: firstname.lastname@example.org Phone: 517-335-8100
Areas with active Zika transmission can be found at the CDC website: http://www.cdc.gov/zika/geo/index.html.
It is important to note that Zika virus infection can cause signs and symptoms similar to those seen in patients with other arthropod-borne virus (arbovirus) infections, including dengue virus, a related flavivirus, and chikungunya (CHIK) virus, an unrelated alphavirus. It is also important to note that a positive result for one of these viruses does not preclude infection with the others. Co-infection with Zika virus and dengue or CHIK virus is rare, but it has been seen in Michigan. Infections with dengue and chikungunya virus have been detected in the BOL Zika laboratory. For this reason, the BOL tests for all three arbovirus infections: Zika, dengue and chikungunya, by both PCR and IgM capture ELISA.
Please note that Zika, dengue and chikungunya virus infections are all on the 2017 list of nationally notifiable conditions https://wwwn.cdc.gov/nndss/conditions/notifiable/2017/. Therefore, results of testing should be reported back to state or local health department staff to facilitate investigation and classification of the case and reporting to CDC.
For more information on Zika virus, visit CDC’s webpage at https://www.cdc.gov/zika/index.html.
Change in Syphilis Methodology
The Michigan Department of Health & Human Services Bureau of Laboratories will be changing methodology for syphilis treponemal antibody testing beginning on July 5, 2016. We will continue to follow the forward syphilis algorithm as recommended by the CDC (see chart), but instead of the Treponema pallidum Particle Agglutination (TP-PA) assay for the detection of treponemal antibodies, confirmatory testing will be performed using the Multiflow ImmunoAssay (MIA) on the Bio-Rad BioPlex® 2200 instrument. The validation studies at BOL showed a 95.3% accuracy rate when comparing the BioPlex® 2200 with the current TP-PA method, and other studies have also shown comparable sensitivity/specificity rates between both assays.
TP-PA methodology is based on the agglutination of patient (IgM/IgG) antibody with gelatin particles sensitized with Treponema pallidum (Nichols strain) antigen. The new technology relies on the simultaneous detection of IgG antibodies bound to beads coated with three recombinant antigens associated with T. pallidum (15kDa, 17kDa and 47 kDa). Studies have shown that for specific T. pallidum antibodies, the time difference for detection of IgG antibodies compared to IgM is negligible (generally within just a few days). If clinically indicated, a second specimen collected 2-4 weeks later may be submitted for re-testing. The required specimen source will remain as serum.
As of July 5, if the TP-PA box is checked on our current test requisition, the MIA will be performed in its place. However, the TP-PA will continue to be offered when MIA results are either equivocal or uninterpretable or by prior authorization only. We will discontinue the use of the Fluorescent Treponemal Antibody (FTA) assay, as this test is no longer recommended by the CDC as a confirmatory method due to its low specificity.
Syphilis IgG Multiplex ImmunoAssay (MIA) results will be reported as follows:
Interpretations for Syphilis IgG MIA
Treponemal antibodies are present.
Equivocal results are obtained when the sample index is just below the positive assay cutoff value. See TP-PA results.
Treponemal antibodies are absent.
An uninterpretable result means that a non-specific reaction occurred when testing the patient sample. See TP-PA results.
If you have any questions please feel free to call or send an email using the contact information below.
Kristine W. Smith, MT (ASCP)
Unit Manager/Bacterial & Viral Serology
Infectious Disease Division
Bureau of Laboratories
Michigan Department of Health & Human Services
3350 N. Martin Luther King Blvd.
Lansing, MI 48909
Janice Matthews-Greer, PhD, DABMM
Section Manager, Virology & Immunology
Division of Infectious Disease
Bureau of Laboratories
Michigan Department of Health and Human Services
3350 North Martin Luther King Jr Blvd
Lansing, Michigan 48909
Call Material for the STI and Lead Submitter Billing Conference Call on March 18th, 2016 at 9:30am
For more information on the Washington Publishing Company listing of the Claims Adjustment Reason Codes and the Remittance Advice Remark Codes, refer to:
Conference Call Recordings:
BOL Billing ICD10 Compliance
In order to achieve Centers for Medicare & Medicaid Services (CMS) compliance, the Michigan Department of Health and Human Services Bureau of Laboratories (MDHHS BOL) requires health care providers use ICD-10 diagnosis codes for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC), and blood lead laboratory test orders collected on or after October 1, 2015.
For the complete letter, click here.
Laboratory Response Network Regional Laboratory Reorganization Update
LRN Reorganization Update 1-26-2015
Patient Access to Laboratory Results
Instructions - added 10/01/2014
Form to request a copy of your laboratory results, DCH-1226 - added 10/01/2014
Notice of Privacy Practices, DCH-3924 - added 10/01/2014
Ebola Laboratory Update #7 - added 2/6/2015
Ebola Laboratory Update #6 - added 1/5/2015
Updated Ebola Resources 12/03/14 - added 12/05/2014
Updated Ebola Resources 11/19/14 - added 11/21/2014
Updated Ebola Resources 11/12/14 - added 11/14/2014
Ebola Laboratory Update #5 - added 11/03/2014
CDC Fact Sheet: Tightened Guidance on PPE for US Healthcare Workers v 10/20/14 - added 10/24/2014
Ebola Virus Laboratory Update #4 - added 10/22/2014
Ebola Virus Laboratory Update #3 - added 10/17/2014
Updated Ebola Resources - added 10/10/2014
Updated Ebola Resources - added 10/03/2014
Updated Ebola Resources - added 9/26/2014
Ebola Virus Laboratory Update #2 - added 8/22/2014
Ebola Virus Guidance for Local Health Departments and Healthcare Providers VER2 - added 8/15/2014
Ebola Virus Laboratory Update #1 - added 8/08/2014
Ebola Virus Guidance for Local Health Departments and Healthcare Providers - added 8/07/2014
Web Portal for Electronic Test Ordering and Results Delivery (ETOR)
The Michigan Department of Community Health Bureau of Laboratories (MDCH BOL) has instituted a web portal for Electronic Test Ordering and Results Delivery (ETOR). ETOR is an alternate, voluntary method for clients to order laboratory tests and receive test results. Participating clients will be able to log into the web portal and electronically fill out their test request forms; print a packing list to be submitted with the sample to the MDCH BOL for testing; track their samples through the MDCH laboratory; and look up, download or print pdf copies of final reports. Clients using the web portal will no longer have to hand write or submit test request forms. This information will be collected in the web portal and imported into the BOL Laboratory Information Management System (LIMS) upon arrival of the specimen. Clients will have to option of continuing to receive final reports via fax or hard copy, as they do now. The web portal result delivery will also be available to the client. Upon request, any client may discontinue their fax or hard copy reporting system in favor of receiving only web portal results. Access to the ETOR web portal is through a State of Michigan Single Sign On (SSO) Account. Clients who currently have a SSO account will only need to request the ETOR application link. Clients without SSO accounts will need to register for one. Complete instructions can be found in the ETOR manual, linked below. Most of the current testing performed at MDCH is available in ETOR. Check the manual, linked below, for a complete listing of available tests. More tests are being added as they are available.
Pre-paid CT/GC tests can be ordered through ETOR by including the pre-paid form in the shipping box with the samples. The only information needed to be hand written on these pre-paid forms is the patient name. T. vaginalis testing is on a fee-for-service basis only. Medicaid (other than Plan First) or private insurance information is entered in the ETOR portal. If no billing information is provided or the patient is not eligible, the submitter will be billed.
Please note, at this time, ETOR is available only for specimens submitted to the Lansing laboratory with the exception of C. trachomatis and N. gonnorrhoeae Non-Culture. This test may be ordered through ETOR for samples being submitted to the Lansing or Saginaw laboratories.
New Molecular Test for Trichomonas Available
On November 18, 2013, the Michigan Department of Community Health Bureau of Laboratories (MDCH BOL) will begin offering a nucleic acid amplified test (NAAT) for Trichomonas vaginalis (T. vaginalis) on a fee-for-service basis. The test will be available for $11.50 when ordered in conjunction with non-culture testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) or CT only. Testing will be available on endocervical, vaginal swabs and urine specimens from symptomatic and asymptomatic women. The test is performed on the same specimen collected for CT/GC testing.
See the full announcement.
Medicaid Claims to Require Physician's NPI
Effective October 1, 2013, the ordering physician’s NPI is required by CHAMPS for all Medicaid claims submitted to the MDCH Bureau of Laboratories. In addition, the ordering physician must be enrolled in CHAMPS. Failure to supply the ordering physician’s NPI on the test requisition form AND enroll as a provider in CHAMPS will result in a rejected claim. Your office will be billed if Medicaid rejects the claim.
If you are not enrolled as a provider then call 800-292-2550 and select option 3 to enroll in CHAMPS. Enrollment is free of charge.
Hepatitis C - Important Changes
The testing algorithm for Hepatitis C virus (HCV) will be changing as of November 1, 2013.
HCV testing will now consist of two tests, a serologic screening test and a molecular test.
The serologic screening test detects the presence of antibody to HCV, but does not differentiate between past infection, current infection, or possible false-positive results. Specimens with demonstrable antibody to HCV will automatically be tested by the molecular test for Hepatitis C viral RNA. The presence of Hepatitis C viral RNA confirms current HCV infection.
It is critical for the molecular test that specimens are kept cold (or frozen) until testing is performed. Specimens must be transported at 2 to 8 ºC or colder. Any specimen that is not cold when received at the MDCH laboratory will be screened for antibody to HCV, but antibody-positive specimens will be reported as unsatisfactory for molecular testing.
See the full announcement.
BOL Receives Contract to Investigate Tuberculosis Nationwide
The MDCH Bureau of Laboratories (BOL) has been awarded a $3.6 million contract to provide Mycobacterium tuberculosis (TB) genotyping for the entire United States from the Centers for Disease Control and Prevention (CDC). The laboratory will receive specimens from all 50 states to perform this molecular genetic testing making Michigan a global leader. TB genotyping results used in combination with epidemiologic investigations help to establish important links between one patient and another. This information can lead to the discovery of unsuspected TB cases and help prevent further spread of illness. MDCH BOL has been involved with genotping of Mycobacterium tuberculosis since the technique was first developed in the 1990s. This is the third genotyping award made to the BOL.
Laboratory System Podcasts
As a part of the May, 2013, Laboratory System Advisory Group meeting, a series of podcasts were developed on the value of the Michigan Laboratory System. These podcasts can be viewed in either QuickTime or RealPlayer.
Your Public Health Laboratory System - Michigan
The Value of the State Public Health Laboratory
The Hospital Laboratory Role in the Public Health Laboratory System
The County Health Department's Role in the Public Health Laboratory System
State Public Health Role in Emergency Response
New Chemical Threat Response Training Coordinator
On April 15, 2013, Teresa Miller assumed the role of the Bureau of Laboratories (BOL) Chemical Threat Response Training Coordinator. Teresa has been with the BOL for a number of years in various positions, lastly in the Quality Assurance Section. As Teresa steps into this new position, she will be contacting laboratories, local health departments, and other partners to schedule chemical exposure (threat) packaging and shipping training. Teresa can be reached at 517-241-0925 or MillerT28@michigan.gov
On-Demand training is also available through MiTRAIN at https://mi.train.org
Course title: Laboratory Response and Hospital Preparedness in a Chemical Exposure (Terrorism) Event
Course ID: 1010548
New CDC Submission Forms
CDC has initiated a new electronic process to submit specimens to CDC laboratories for testing.
Reminder: Specimens sent to CDC for testing must be submitted through the state public health laboratories, with very rare exceptions.
CDC will require new electronic submission forms (Forms 50.34, rev. 2013) after Feb. 4, 2013. We have completed the State Public Health Laboratory portion of the forms for you on the version located on the MDCH Bureau of Laboratory web page: http://www.michigan.gov/mdch/0,4612,7-132-2945_5103-14806--,00.html
The CDC Specimen Submission web page has a webinar presentation (with slides explaining how to use the features of the new form) and training documents for completing the new forms. http://www.cdc.gov/laboratory/specimen-submission/form.html
As information is entered on the forms, a barcode for use by CDC is created within the form. The completed electronic form must then be printed out and submitted along with the specimen(s) to the state public health laboratory. Older versions of this form with revision dates before 2013 (most were originally designed to print with green font) will not be accepted by CDC after Monday Feb. 4, 2013.
Please discard any paper CDC submission forms that you may have filed away in your laboratory, and please delete any Internet browser "bookmarks" to older versions of the CDC submission form (e.g., those provided during the recent fungal meningitis outbreak).
Please share this information with your laboratory send-outs staff and request they discard and delete all older versions of CDC form 50.34.
Results Reporting from CDC:
CDC will soon be sending all results by email.
All submitters wishing to receive emailed CDC results must provide a valid email address to which these encrypted CDC report files will be forwarded.
If you haven't been contacted about receiving emailed CDC results, please email CDCReports@michigan.gov
Questions regarding completion of the new CDC form or receiving of CDC results should be directed to CDCReports@michigan.gov
New Test Directory
One exciting new feature of CDC's electronic submission process will be a drop-down test directory menu. We anticipate this test directory will be very helpful in preparing the submission forms. This new directory can be found at http://www.cdc.gov/laboratory/specimen-submission/form.html
New Laboratory Director
Dr. Sandip Shah has been selected as the new Director of the State Laboratory. Since August, Dr. Shah has filled the role as Acting Director. Dr. Shah worked as a microbiologist with the Michigan Department of Public Health in 1987 and progressed to Laboratory Scientist Manager; Director, Division of Infectious Diseases; and now Laboratory Director. He holds an Associate's Degree in Biology from the University of London; a Bachelor's Degree in Microbiology/Chemistry from Gujarat University in Ahmedabad; a Master's Degree in Microbiology/Biochemistry from Maharaja Sayajirao University in Baroda; and a Doctoral Degree from Michigan State University College of Veterinary Medicine in large animal clinical sciences/microbiology. Additional Certificates and Licenses include ASCP (Medical Technology from the American Society for Clinical Pathology) issued in 1982; CST 370 (PC coordinator and system specialist) issued in 2000 by PTD - Lansing Computer Institute; and HCLD (High Complexity Clinical Lab Director) issued in 2010.
MDCH Confirmatory Testing for Carbapenem-Resistant Enterobacteriaceae (CRE)
The MDCH Bureau of Laboratories has received a grant to develop non-automated AST capacity in state public health laboratories for CRE and VRSA to provide confirmatory testing for clinical laboratories within their jurisdiction. A webinar was held on December 11, 2012 to discuss the project design and the clinical laboratory role.
CRE Confirmatory Testing Criteria - added 2/1/2013
CRE Lab Flow Chart - added 2/1/2013
Multistate Outbreak of Fungal Meningitis Cases Resulting From Potentially Contaminated Steroid Injections
Fungal Meningitis Cases Resulting From Potentially Contaminated Steroid Injections- Oct 5th
MDCH Meningitis Update #3 - October 11, 2012
MDCH Meningitis Update #4 - October 11, 2012
MDCH Meningitis Update #5 - October 17, 2012
CDC Stat Specimen Submission Form
For updated information regarding this outbreak, go to http://www.cdc.gov/hai/outbreaks/meningitis.html
First Case of Influenza A (H3N2v) Detected in Michigan
The first case of variant H3N2 influenza infection in Michigan has been reported in a Washtenaw County child. State laboratory results indicate the child has tested positive for influenza A (H3N2) variant, or H3N2v. The child, who had recent exposure to swine at the Ingham County Fair, experienced mild illness and was not hospitalized. The state laboratory results were sent to the Centers for Disease Control and Prevention (CDC) for confirmatory testing.
The following guidance outlines the MDCH recommendations for influenza surveillance, reporting and testing for laboratories and will assist in characterizing the current H3N2v outbreak and virus transmissibility.
Blood Lead Testing Collection Videos
Filter Paper Collection Video- This video provides a step-by-step demonstration of proper specimen collection using filter paper. It can be viewed at http://youtu.be/WAKcq3N3mow.
Capillary Draw Collection Video- This video provides a step-by-step demonstration of proper specimen collection using a capillary vacutainer. It can be viewed at http://youtu.be/TkYGbJI2VY4.
Changes in Testing Services
Saginaw County Health Department laboratory receives contract from MDCH to provide Chlamydia/gonorrhea testing. Effective October 1, 2011, the Saginaw County Health Department began providing testing services for select agencies in Michigan. Other agencies have been instructed to direct their specimens to the MDCH lab in Lansing for testing. You may contact either Amy Peterson (313-345-4425) or Dr. James Rudrik (517-335-8063) for more information.
Kalamazoo County Health Department to provide surge capacity testing for Norovirus testing. Effective March 1, 2012, MDCH will consolidate most norovirus testing performed in support of outbreak investigations at our Lansing testing. The Kalamazoo County Health Department Laboratory will continue to provide testing for outbreaks that occur in Kalamazoo County and will also provide surge capacity support to the MDCH laboratory. Oakland and Saginaw Counties will also continue to provide norovirus testing services for outbreaks which occur in their respective counties. Other agencies are encouraged to continue to coordinate the collection and submission of testing services through the MDCH Bureau of Epidemiology (517-335-8889)
All bacterial foodborne testing services will be consolidated at the MDCH laboratory. Effective January 2, 2012 all laboratory testing for bacterial foodborne agents will be consolidated at the MDCH laboratory. This testing service is no longer available at Kalamazoo, Kent, and Saginaw Counties and the City of Detroit. Please contact the MDCH laboratory at 517-335-8063 if the event this testing services are required in support of a bacterial foodborne outbreak investigation.
Newborn Screening Program Adds SCID Testing
The Michigan Newborn Screening Laboratory began testing for Severe Combined Immunodeficiency (SCID) on October 1, 2011. Information can be found on the Michigan Newborn Screening Program page.
Virtual Tour Available
Have you ever wanted to tour the State Public Health Laboratory? Take a virtual tour now by viewing our new video.
MDCH Laboratory Research Collaboration: ERIN
The MDCH microbiology lab is collaborating with Michigan State University Enterics Research Investigational Network, Cooperative Research Center (MSU ERIN CRC) to study the impact that four common diarrheal pathogens have on the composition and function of host intestinal microbiome. MDCH will screen stools from cases and controls for EHEC, Salmonella , Campylobacter, Clostridium difficile, and Shigella and provide genetic and phenotypic characteristics . Beneficial microbial communities, microbes and microbial products important for preventing enteric disease will be identified, which in turn, could guide future prevention and treatment strategies.
Bureau of Laboratories Annual Reports