Using the NC Laboratory Response Forum and Micronet to communicate and plan H1N1 response

In the initial days of the H1N1 pandemic, North Carolina State Laboratory of Public Health used two existing systems, the NC Laboratory Response Forum (LRF) and Micronet, to communicate and plan H1N1 response.

The Micronet listserv was developed in 2001 in the wake of the 2001 anthrax mailings to facilitate communications from the North Carolina State Laboratory of Public Health (NCSLPH). It remains the primary mode of immediate and direct communication from the NCSLPH to sentinel microbiology laboratories in the state and serves as an electronic forum for members to share information on best practices and other relevant issues.

Established in 2006, the North Carolina LRF's overall goal is to strengthen state clinical laboratories' diagnostic capacity; it meets regularly to discuss key improvements to the system. Topics covered during the meetings have ranged from bioterrorism to novel tuberculosis and, notably, influenza preparedness. Members include director-level laboratory representatives from the 11 hospital systems hosting Public Health Epidemiologists, the Public Health Epidemiologist Program Coordinator, the Duke University Electron Microscopy Center, and representatives from the NC Division of Public Health: SLPH, Communicable Disease Branch, and the State Epidemiologist.

During the first wave of H1N1, the Micronet listserv was employed several times each day to communicate CDC Health Alerts, Draft Guidance for Collecting Specimens, contact information, biosafety for laboratory workers, WHO Primer and Sequencing protocols, Influenza Surveillance Reports, Public Health Coordination Center status reports, and other general updates. Micronet listserv users provided entirely positive feedback, often noting that the information distributed was helpful to the clinical laboratorian.

The NC Laboratory Response Forum also held seven conference calls during the first weeks of the H1N1 outbreak. Notes from every call (except the hastily arranged initial call on May 1) were distributed through the Micronet listserv. These calls centered on problem solving and creating transparency with state operations. Discussions during these calls provided clarity on the dynamic state and federal guidance, which had initially made it challenging for many partners to pass on testing guidance to their customers in a timely and helpful manner. The relatively low capacity for H1N1 diagnostic testing in the face of a larger demand by the public and physicians was also discussed.

Through the calls, the NCSLPH was able to confer on unique situations that required adaptation of overall policies, to clarify guidance documents and examine their impact on sentinel clinical laboratories, and to communicate that testing was performed to support enhanced surveillance and characterize the transmission and severity of disease. In the final conference call on May 27, forum members had the opportunity to articulate what efforts were particularly productive and what could have been improved. Sharing information from these conference calls elicited additional questions from the greater Micronet community.

The feedback gained from the participants stands to improve North Carolina's diagnostic strength as well as increase the utility of the LRF and Micronet. Although the regular conference calls have ended, Micronet continues to be a valuable avenue of communication between the NCSLPH and its partners. In summary, the importance of both Micronet and the NC LRF in the response to the first wave of pandemic influenza was clearly demonstrated to all its members.

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