Editorials

A well-deserved salute to the Wisconsin State Laboratory of Hygiene

Thomas C. Meyer, MD, Medical Editor, WMJ

We were delighted to be asked to publish a centenary celebration issue devoted to the Wisconsin State Laboratory of Hygiene (WSLH)—surely the unsung basis for much of today’s medical practice.


Author Affiliations: Medical Editor

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, WI 53715

Original Research

Outdoor Air Pollution Activities at the Wisconsin State Laboratory of Hygiene

Jamie J. Schauer, PhD; Glynis C. Lough, BS; William C. Sonzogni, PhD

Outdoor air quality testing at the Wisconsin State Laboratory of Hygiene (WSLH) began in the 1970s with the advent of the federal Clean Air Act. Since then, air quality has emerged as a major environmental issue equal to or more important, from a public health standpoint, than water pollution. Epidemiological studies have shown that health issues are not limited to highly urbanized areas. In Wisconsin, local climatic conditions caused by the Great Lakes can result in unhealthy conditions even in relatively pristine areas. Air pollution affects thousands of Wisconsin residents each year, and it can be severe enough to require a physician’s care. Although certain air testing (e.g., ozone) is done regionally by in situ monitors, the WSLH analyzes a variety of air pollutants including ozone precursor hydrocarbons, air particulates, and toxic metals. Exposure to aerosols containing metals may not follow typical patterns of air pollution based on routinely monitored particle mass.

Author Affiliations: Authors are with the Wisconsin State Laboratory of Hygiene (WSLH) and the Environmental Chemistry and Technology Program, Civil and Environmental Engi-neering (CEE), University of Wisconsin-Madison. Drs Schauer and Sonzogni are professors that hold joint

Corresponding Author: Please direct correspondence to William Sonzogni, PhD, Wisconsin State Laboratory of Hygiene, PO Box 7996, Madison, WI 53707-7996.

Laboratory-Based Surveillance for Influenza: Role of the Wisconsin State Laboratory of Hygiene

Peter A. Shult, PhD; Carol Kirk

Influenza poses a significant threat to public health worldwide. In the United States alone, mortality attributed to annual epidemics of influenza is estimated at 36,000 deaths per year. Influenza viruses also cause pandemics, during which the rates of illness and death can be expected to be much higher. In order to optimize prevention and control strategies for influenza, a variety of surveillance activities are carried out year-round internationally, nationally, and at the state level. This article summarizes relevant features of influenza and the surveillance activities carried out at each of these levels to monitor influenza activity. Particular emphasis is given to the state’s laboratory-based surveillance network, developed and coordinated by the Wisconsin State Laboratory of Hygiene, that features strong and productive partnerships with private sector clinicians and laboratories and that provides a solid foundation for surveillance directed at other public health threats such as Severe Acute Respiratory Syndrome and bioterrorism.



Author Affiliations: Dr Shult is Director of the Communicable Disease Division and Emergency Laboratory Response at the Wisconsin State Laboratory of Hygiene. Ms Kirk is the WSLH Laboratory Network Coordinator and an Advanced Microbiologist in the Communicable Disease Divisio

Corresponding Author: Please direct correspondence to Peter Shult, PhD, Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53706; 608.262.5419; fax 608.262.3257; e-mail shult@mail.slh.wisc.edu

Laboratory Role in Tuberculosis Control

Philip Wand, BS

The term “tuberculosis” (TB) refers to infection with the bacterium Mycobacterium tuberculosis that has progressed to active disease. This disease is a public health threat because it is caused by a microorganism that is potentially fatal for humans, and transmission is commonly through the inhalation of airborne droplets expelled by infectious persons with active disease. The World Health Organization (WHO) estimates that there are more than 8 million new cases of TB each year, 2 million deaths from the disease each year, and that one-third of the world population is infected with M. tuberculosis and at risk for active disease.1 In 2003, the 100-year anniversary of the founding of the Wisconsin State Laboratory of Hygiene (WSLH), TB is recognized as a disease that is preventable and now almost always treatable. An early and accurate diagnosis of TB is perhaps the most significant intervention step in TB control. Early diagnosis permits expedited treatment and limitation of spread. An effective TB laboratory program plays an essential role in the early and accurate diagnosis and appropriate treatment of TB. This article examines that role.



Author Affiliations: Mr Wand is an Advanced Microbiologist with the Wisconsin State Laboratory of Hygiene and is the Tuberculosis Laboratory Program Coordinator.

Corresponding Author: Please direct correspondence to Phil Wand, Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53706; 608.263.5364; e-mail wand@mail.slh.wisc.edu.

Targeted Laboratory Screening for Sexually Transmitted and Bloodborne Infections in Wisconsin

John R. Pfister, MS; Rjurik Golubjatnikov, PhD; Christine M. Arcari, PhD; Jeffrey P. Davis, MD

Public health laboratories play an important role in screening programs for asymptomatic diseases of public health importance in high-risk and underserved populations. The implementation of targeted screening strategies for communicable diseases requires thorough planning and evaluation. The Wisconsin State Labora-tory of Hygiene (WSLH) systematically selects and evaluates laboratory tests used in communicable disease control programs coordinated by the Wisconsin Division of Public Health. To do this, the epidemiologic features of the disease in potential target populations are carefully assessed, with the choice of laboratory tests based on performance as well as practical and cost considerations. Laboratory testing at WSLH plays a crucial role in screening programs for sexually transmitted and bloodborne infections. Hallmarks of these programs are cross-sector collaboration, empirical selection of laboratory testing methods, and the use of epidemiologic data to develop and evaluate targeted screening strategies.



Author Affiliations: Mr Pfister is Assistant Scientist/Epidemiologist, Wisconsin State Laboratory of Hygiene; Dr Golubjatnikov is Emeritus Chief Immunologist, Wisconsin State Laboratory of Hygiene and Emeritus Assistant Clinical Professor of Population Health Sciences, Univer

Corresponding Author: Please direct correspondence to John R. Pfister, MS, Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53706; 608.262.7404; jp@mail.slh.wisc.edu.

The Wisconsin State Laboratory of Hygiene and Emerging Enteric Pathogens

David Warshauer, PhD; Tim Monson, BS; Terry Kurzynski, MS

At the turn of the 20th century, typhoid fever was common in Wisconsin, and was a major impetus for the establishment of the Wisconsin State Laboratory of Hygiene (WSLH) in 1903. By the 1940s, typhoid was virtually eliminated in the United States due to public health measures such as disinfection of drinking water, sewage treatment, pasteurization, and shellfish bed sanitation. However, new food and waterborne pathogens have emerged to take the place of Salmonella Typhi. Infections with non-typhoidal Salmonella strains in the United States have increased almost 10-fold since the 1950s.1 In the last 20 years, the emergence of food-borne pathogens, such as Escherichia coli O157:H7, Cyclospora cayetanensis, Noroviruses (Norwalk-like viruses), Cryptosporidium parvum, Campylobacter jejuni, Yersinia enterocolitica, and multi-drug-resistant Salmonella, has identified a need for accurate laboratory diagnosis of enteric disease and outbreaks.

Author Affiliations: Dr Warshauer is Chief Bacteriologist; Mr Monson and Mr Kurzynski are Advanced Microbiologists at the Wisconsin State Laboratory of Hygiene.

Corresponding Author: Please direct corresondence to David Warshauer, PhD, Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53706; 608.265.9115; warshadm@mail.slh.wisc.edu.

Screening Newborns for Congenital Disorders

Gary L. Hoffman, BS; Ronald H. Laessig, PhD

The Newborn Screening Laboratory at the Wisconsin State Laboratory of Hygiene (WSLH) tests all newborn babies in the state of Wisconsin for 26 congenital disorders. The screening is mandated by state statute (253.13) and attempts to identify those babies at highest risk for any of the screened-for congenital disorders. The Newborn Screening Laboratory at the WSLH is part of the state’s newborn screening program, a cooperative effort between the Wisconsin Department of Health and Family Services, state birthing hospital staff, several public and private specialty clinics, primary care providers, and parents. Screening occurs within the first hours (median 38 hours) of life when a few drops of blood from the baby’s heel is collected, applied to a special paper, dried, and sent to the WSLH for analysis. Those babies determined to have at-risk test results get repeat testing to confirm the initial test results and, if warranted, the baby is referred to a specialty clinic for a diagnostic work-up and treatment if necessary. Since its inception in the early 1960s, newborn screening in Wisconsin has saved approximately 1300 children from serious mental or other medical problems.



Author Affiliations: Mr Hoffman is the Manager of the Newborn Screening Laboratory. Dr Laessig is the Director of the Wisconsin State Laboratory of Hygiene.

Corresponding Author: Please direct correspondence to Gary Hoffman, Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53706; 608.262.4692; hoffman@mail.slh.wisc.edu.

Wisconsin State Laboratory of Hygiene’s Role in Clinical Laboratory Improvement

David J. Hassemer, MS

The clinical laboratory at the beginning of the 21st century is a highly automated, multi-faceted entity, capable of turning out complex test results on a variety of samples in a relatively short period of time. These test results are used by physicians to diagnose illness, establish treatment strategies, and monitor therapies for patients. They must be of the highest quality and reliability to insure that the course of action taken by the health care provider will lead to the best possible outcome for the patient.



Author Affiliations: Mr Hassemer is Director of the Laboratory Improvement Division at the Wisconsin State Laboratory of Hygiene.

Corresponding Author: Please direct correspondence to David Hassemer, WSLH Proficiency Testing Program, 465 Henry Mall, Madison, WI 53706; 608.265.1100, ext. 102; fax 608.265.1114; e-mail hassemer@mail.slh.wisc.edu.

The State Laboratory of Hygiene’s Role in Terrorism Preparedness and Response

Peggy L. Hintzman, MBA

In the fall of 2001, the national public health system found itself responding to acts of terrorism. The intentional release of Bacillus anthracis spores on the East Coast tested the capacity of all state public health laboratories to respond. The impact on the public health system extended to the Wisconsin State Laboratory of Hygiene (WSLH). Fortunately, participation in the National Laboratory Response Network helped the WSLH meet the challenge of 24 hour/7 days a week coverage, and subsequent federal funding increases have enabled the WSLH to expand its technical capabilities and provide training and outreach to other Wisconsin laboratories to prepare them for their roles in man-made or naturally-occurring public health emergencies.



Author Affiliations: Ms Hintzman is the Associate Director of the Wisconsin State Laboratory of Hygiene.

Corresponding Author: Please direct correspondence to Peggy Hintzman, Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53706; 608.262.8856; fax 608.262.3257; e-mail plh@mail.slh.wisc.edu

Prenatal Screening at the Wisconsin State Laboratory of Hygiene

Rjurik Golubjatnikov, PhD; Donna Anderson BS, MBA; Lorraine F. Meisner, PhD; Stanley L. Inhorn, MD

Entry of public health laboratories into the medical arena of prenatal health evolved from their traditional role in communicable disease control, including sexually transmitted diseases. At the turn of the 20th century, syphilis was a major health problem, resulting in high morbidity and mortality rates in Wisconsin. Furthermore, four centuries before 1900, syphilis had been linked to abnormalities of the newborn.1 Prevention of congenital syphilis as a public health activity motivated Wisconsin and other states to enact premarital laws and to conduct other control efforts. In 1912, the Mendota State Hospital opened a laboratory using the recently developed Wassermann test to investigate institutionalized patients. This laboratory was transferred to the University of Wisconsin Psychiatric Institute in 1925, where new testing procedures were developed. In 1951, this activity was assumed by the Wisconsin State Laboratory of Hygiene (WSLH). Around this time, other congenital infections were recognized, which stimulated the WSLH to develop a testing program for congenital infections.



Author Affiliations: Dr Golubjatnikov is Emeritus Chief Immunologist, Wisconsin State Laboratory of Hygiene (WSLH) and Emeritus Assistant Clinical Professor, Population Health Sciences, University of Wisconsin-Madison. Ms Anderson is Microbiologist Supervisor, Wisconsin State

Corresponding Author: Please direct correspondence to Dr Lorraine Meisner, Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53706; 608.262.9240; fax 608.262.3257; e-mail lorraine@mail.slh.wisc.edu

Occupational and Industrial Health at the Wisconsin State Laboratory of Hygiene

Terrance L. Burk, CIH; Jason T. Loughrin, BS; Christine J. Powell, BS; John J. Knight, BS

Occupational hazards have been known for centuries, but the creation of facilities capable of carrying out the testing necessary to assess these risks is a comparatively recent development. The Wisconsin State Laboratory of Hygiene (WSLH) created the Wisconsin Occupational Health Laboratory (WOHL) in 1937 to address this need. Since then, WOHL’s range of analytical capacity has grown to include an impressive array of assays, including volatile organic compounds, asbestos, silica, environmental lead, bioaerosols, and elemental carbon. WOHL has been a leader in emerging occupational health threats, and has been the primary testing facility for the United State’s Occupational Safety and Health Administration’s (OSHA) consultation program since 1977. Through it all, WOHL has remained a fee-for-service branch of the WSLH and has not used Wisconsin taxpayer funds to support its day-to-day operations.



Author Affiliations: Authors are with the Wisconsin Occupational Health Laboratory. Mr Burk is a Certified Industrial Hygienist and Director. Mr Loughrin is a Senior Chemist in the Metals Section. Ms Powell is an Advanced Microbiologist. Mr Knight is a Senior Chemist in the A

Corresponding Author: Please direct correspondence to Terrance Burk, Wisconsin Occupational Health Laboratory, 2601 Agriculture Dr, Madison, WI 53718-6780; 800.446.0403; fax 608.224.6213; e-mail tb@mail.slh. wisc.edu.

Protecting the Waters of Wisconsin from Microbiological Threats

Jon Standridge, BS

Wisconsin is blessed with an abundance of high quality water that has played a significant role in the economic and social development of the state. The quality of life for Wisconsinites is often at least partially defined by pristine inland lakes, a portion of the Great Lakes shoreline, or great-tasting well water. While no one likes to associate water with disease, especially waters like those we enjoy in Wisconsin, the historical reality is that there is a strong connection. Until the 1920s, intestinal diseases such as typhoid fever and cholera often spread through water and were a leading cause of death in the United States. While easy access to modern medical care combined with improved water treatment technologies have greatly decreased waterborne disease, the microbiology of Wisconsin’s waters still deserves continued vigilance and attention. The World Health Organization currently estimates that, on a global basis, 4 billion annual cases of waterborne diarrhea result in more than 2 million deaths per year1—the equivalent of 20 jumbo jet crashes per day. Most of these deaths are in children under 5 years of age. The daily global death toll from waterborne disease is at least 1000 times greater than from the Severe Acute Respiratory Syndrome epidemic that recently made headline news. Waterborne disease is not just a problem in underdeveloped countries. Scientists who study disease transmission believe that 10%-30% of the vomiting and diarrhea illness in North America, including Wisconsin, may be acquired from water.



Author Affiliations: Mr Standridge manages the Water Microbiology Team at the Wisconsin State Laboratory of Hygiene.

Corresponding Author: Please direct correspondence to Jon Standridge, Wisconsin State Laboratory of Hygiene, PO Box 7996, 2601 Agriculture Dr, Madison, WI 53707-7996; 608.224.6209; fax 608.224.6213; e-mail jhs@mail.slh.wisc.edu

Forensic Toxicology Program: Alcohol and Drug Testing in Wisconsin Drivers

Patrick Harding, BS; Laura J. Liddicoat, BS, MT (ASCP)

The Forensic Toxicology Program of the Wisconsin State Laboratory of Hygiene (WSLH) provides analytical and support services to assist in the identification of alcohol- and/or drug-impaired drivers and to assist in determining cause of death. These services are provided to law enforcement agencies, the Wisconsin Department of Natural Resources, the Wisconsin Department of Transportation, and county medical examiners and coroners. Program staff is active in alcohol and drug training, policy-making, and research on a national and international level.



Author Affiliations: Authors are with the Wisconsin State Laboratory of Hygiene, Mr. Harding is the Chemist Management Supervisor and Ms. Liddicoat is a Chemist-Supervisor in the Forensic Toxicology Program.

Corresponding Author: Direct correspondence to Patrick Harding, Wisconsin State Laboratory of Hygiene, 2601 Agriculture Dr, Madison, WI 53718; 608.224.6247; e-mail bayouboy@mail.slh.wisc.edu

Case Reports

The Wisconsin State Laboratory of Hygiene: A Century of Service and Progress

Stanley L. Inhorn, MD

At the start of the 20th century, childhood infectious diseases, waterborne epidemics, tuberculosis, and pneumonia ravaged Wisconsin’s population. Prior to 1900, investigators in Europe, notably Pasteur and Koch, proved that bacteria were the causative agents of specific diseases, thereby providing the first opportunity to control these scourges. Doctor Edward A. Birge, a University of Wisconsin (UW) biology professor, traveled to Europe to study in the laboratories of these men, and after his return in 1885, he developed a bacteriology course. Two of his students were Cornelius Harper, who became a physician and later State Health Officer, and Harry Russell, who later traveled to study with Koch. In 1893, Russell became the first bacteriology appointee in the UW Department of Agriculture.

Author Affiliations: Doctor Inhorn is Medical Director Emeritus, and Professor Emeritus, University of Wisconsin Departments of Pathology and Laboratory Medicine and Population Health Sciences.

Corresponding Author: Please direct correspondence to Stanley Inhorn, MD, Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53706.

The Current and Future Roles of the Wisconsin State Laboratory of Hygiene

Ronald H. Laessig, PhD

Ronald H. Laessig, PhD, the Assistant Director and Chief of Clinical Chemistry who had joined the Wisconsin State Laboratory of Hygiene (WSLH) in 1966, was appointed director to succeed Stanley Inhorn, MD. Laessig, whose background is in analytical chemistry, was immediately challenged by increased demand for environmental testing, toxicology services for coroners and law enforcement agencies as well as the rapidly changing health care systems—primarily the emergence of HMOs and reference laboratories. Tremen-dous changes in laboratory technology, including automation and increased interest in regulations for all types of laboratories, clinical and environmental, led to a major evolution in quality assurance concepts and standards of performance. New contagious diseases continued to remind the world that antibiotics and mass immunizations had not eliminated the need for traditional public health programs. An epidemic of opportunistic infectious diseases in young men was first recognized in 1981. Initially the diagnosis of “AIDS” was clinical, supported by a panel of tests for various opportunistic infections. This rapidly gave way to sensitive antibody tests and ultimately tests for the viral agent itself. The Wisconsin Division of Public Health (WDPH), charged with controlling this epidemic, found that a new public health partnership had begun to emerge—the CDC, the State Health Department, the WSLH, local clinical laboratories and primary health care providers. Public Health no longer was solely a “state” or “government” issue in Wisconsin—it was becoming a broad-based partnership.



Author Affiliations: Dr Laessig is the current Director of the Wisconsin State Laboratory of Hygiene and Professor in the University of Wisconsin Departments of Population Health Sciences and Pathology and Laboratory Medicine.

Corresponding Author: Please direct correspondence to Dr Ronald H. Laessig, Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53706; 608.262.0322; fax 608.262.3257; e-mail rhl@mail.slh.wisc.edu

Your Practice

CMS offers CME program for quality improvement

Jay A. Gold, MD, JD, MPH, and Shanin Pepple

Through a new program, Wisconsin physicians, phy-sician assistants and nurse practitioners can earn continuing medical education (CME) credit for participating in quality improvement projects in their own clinics.



Author Affiliations: Authors are with MetaStar, Inc. Doctor Gold is Senior Vice President and Principal Clinical Coordinator; Pepple is a Communications Specialist. This material was prepared by MetaStar, Inc., the Quality Improvement Organization for Wisconsin, under a contr

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, WI 53715

Estate planning for the second time around

Maureen E. Hansen, CLU, Financial Consultant, SVA Planners, Inc., Registered Investment Advisor

Thinking about tying the knot for the second time? If so, you may need to answer some tough questions first. Whose house will you live in? Who will pay for routine living expenses? Who will pay for medical insurance? Will you file joint income tax returns? Who will pay for vacations and travel? What will happen to your property when you die?



Author Affiliations: Based in Brookfield, Wis, Ms Hansen is a fee-only financial consultant with SVA Planners Inc., Registered Investment Advisor. Hansen works with individual investors and business clients, helping them manage their retirement plans, monitor their investment

Corresponding Author: For more information, call Wisconsin Medical Society Insurance and Financial Services, Inc. toll free at 866.442.3810.

Your Profession

A fruitful and gratifying collaboration

Philip M. Farrell, MD, PhD

proudly join the Wisconsin State Laboratory of Hygiene (WSLH) in celebrating its 100th anniversary this year. University of Wisconsin Medical School—indeed, the entire state—is deeply indebted to the WSLH for the critical role it has played in helping protect the health of Wisconsinites and their environment.

Author Affiliations: Doctor Farrell is Dean, University of Wisconsin Medical School, and Vice Chancellor for Medical Affairs at UW-Madison.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715