Improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.

Volume 102, Issue 6 (2003)

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Thomas C. Meyer, MD, Medical Editor, WMJ
A well-deserved salute to the Wisconsin State Laboratory of Hygiene
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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.

Original Research

Jamie J. Schauer, PhD; Glynis C. Lough, BS; William C. Sonzogni, PhD
Outdoor Air Pollution Activities at the Wisconsin State Laboratory of Hygiene
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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.

Peter A. Shult, PhD; Carol Kirk
Laboratory-Based Surveillance for Influenza: Role of the Wisconsin State Laboratory of Hygiene
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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.

Philip Wand, BS
Laboratory Role in Tuberculosis Control
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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.

John R. Pfister, MS; Rjurik Golubjatnikov, PhD; Christine M. Arcari, PhD; Jeffrey P. Davis, MD
Targeted Laboratory Screening for Sexually Transmitted and Bloodborne Infections in Wisconsin
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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.

David Warshauer, PhD; Tim Monson, BS; Terry Kurzynski, MS
The Wisconsin State Laboratory of Hygiene and Emerging Enteric Pathogens
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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.

Gary L. Hoffman, BS; Ronald H. Laessig, PhD
Screening Newborns for Congenital Disorders
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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.

David J. Hassemer, MS
Wisconsin State Laboratory of Hygiene’s Role in Clinical Laboratory Improvement
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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.

Peggy L. Hintzman, MBA
The State Laboratory of Hygiene’s Role in Terrorism Preparedness and Response
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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.

Rjurik Golubjatnikov, PhD; Donna Anderson BS, MBA; Lorraine F. Meisner, PhD; Stanley L. Inhorn, MD
Prenatal Screening at the Wisconsin State Laboratory of Hygiene
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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.

Terrance L. Burk, CIH; Jason T. Loughrin, BS; Christine J. Powell, BS; John J. Knight, BS
Occupational and Industrial Health at the Wisconsin State Laboratory of Hygiene
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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.

Jon Standridge, BS
Protecting the Waters of Wisconsin from Microbiological Threats
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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.

Patrick Harding, BS; Laura J. Liddicoat, BS, MT (ASCP)
Forensic Toxicology Program: Alcohol and Drug Testing in Wisconsin Drivers
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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.

Case Reports

Stanley L. Inhorn, MD
The Wisconsin State Laboratory of Hygiene: A Century of Service and Progress
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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.

Ronald H. Laessig, PhD
The Current and Future Roles of the Wisconsin State Laboratory of Hygiene
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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.

Your Practice

Jay A. Gold, MD, JD, MPH, and Shanin Pepple
CMS offers CME program for quality improvement
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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.

Maureen E. Hansen, CLU, Financial Consultant, SVA Planners, Inc., Registered Investment Advisor
Estate planning for the second time around
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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?

Your Profession

Philip M. Farrell, MD, PhD
A fruitful and gratifying collaboration
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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.