Lessons from the reestablishment of Public Health Laboratory activities in Puerto Rico after Hurricane Maria

Margaret C Hardy; Rita C Stinnett; Kristine J Kines; Danisha M Rivera-Nazario; David E Lowe; Alexandra M Mercante; Nathalie Gonzalez Jimenez; Rosa I Cuevas Ruiz; Héctor I Rivera Arbolay; Rafael L Gonzalez Peña; Mayra Toro; Alma A Trujillo; Claudia L Pappas; Anna C Llewellyn; Francisco Candal; María Burgos Garay; Gerardo A Gomez; Jeniffer Concepcion Acevedo; Marisela Ansbro; Hercules Moura; Michael W Shaw; Atis Muehlenbachs; Lovisa C Romanoff; Brittany J Sunshine; Dale A Rose; Anita Patel; Craig N Shapiro; S Carolina Luna-Pinto; Satish K Pillai; Eduardo O'Neill

doi:10.1038/s41467-019-10776-y

Lessons from the reestablishment of Public Health Laboratory activities in Puerto Rico after Hurricane Maria

Nat Commun. 2019 Jun 20;10(1):2720. doi: 10.1038/s41467-019-10776-y.

Authors

Margaret C Hardy^{1

2

3}, Rita C Stinnett^{1

4}, Kristine J Kines^{1

5

6}, Danisha M Rivera-Nazario^{7

6}, David E Lowe^{1

8}, Alexandra M Mercante², Nathalie Gonzalez Jimenez⁷, Rosa I Cuevas Ruiz⁹, Héctor I Rivera Arbolay⁹, Rafael L Gonzalez Peña⁹, Mayra Toro⁹, Alma A Trujillo¹⁰, Claudia L Pappas¹¹, Anna C Llewellyn¹², Francisco Candal¹³, María Burgos Garay¹⁴, Gerardo A Gomez², Jeniffer Concepcion Acevedo², Marisela Ansbro¹⁵, Hercules Moura⁷, Michael W Shaw⁶, Atis Muehlenbachs⁶, Lovisa C Romanoff⁷, Brittany J Sunshine¹⁶, Dale A Rose^{17

16}, Anita Patel¹⁸, Craig N Shapiro¹⁷, S Carolina Luna-Pinto¹⁹, Satish K Pillai¹⁶, Eduardo O'Neill²⁰

Affiliations

¹ Laboratory Leadership Service Fellowship, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
² Division of Foodborne and Waterborne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
³ Office of the Chief Regulatory Scientist, Australian Pesticides and Veterinary Medicines Authority, Armidale, New South Wales, 2350, Australia.
⁴ Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
⁵ Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
⁶ Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
⁷ Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
⁸ Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
⁹ Public Health Laboratories, Puerto Rico Department of Health, San Juan, PR, 00936, USA.
¹⁰ Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
¹¹ Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
¹² Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
¹³ Office of Technology and Innovation, Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
¹⁴ Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
¹⁵ Division of Select Agents and Toxins, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
¹⁶ Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
¹⁷ Division of Emergency Operations, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, 30329, USA.
¹⁸ Influenza Coordination Unit, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
¹⁹ Office of the Director, Center for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
²⁰ Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA. eoneill@cdc.gov.

Abstract

Public Health Laboratories (PHLs) in Puerto Rico did not escape the devastation caused by Hurricane Maria. We implemented a quality management system (QMS) approach to systematically reestablish laboratory testing, after evaluating structural and functional damage. PHLs were inoperable immediately after the storm. Our QMS-based approach began in October 2017, ended in May 2018, and resulted in the reestablishment of 92% of baseline laboratory testing capacity. Here, we share lessons learned from the historic recovery of the largest United States' jurisdiction to lose its PHL capacity, and provide broadly applicable tools for other jurisdictions to enhance preparedness for public health emergencies.

Publication types

Review