APHL Public Health Response Coordination

APHL is a founding member of the LRN and supports the network during incidents of biothreat response by coordinating information, providing subject matter expertise on testing and other guidance needed by the laboratories to perform testing safely and effectively. 

Close collaboration among the CDC, FDA, CSTE and APHL member laboratories enabled major progress in identifying chemical agents linked to the multi-state E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) outbreak. The Lung Injury Response Laboratory Working Group identified an association between Vitamin E Acetate (VEA) contamination and EVALI; VEA was detected in 94% of 51 case-associated bronchoalveolar lavage samples. These findings were published in the New England Journal of Medicine on February 20, 2020.

The CDC and FDA recommend that individuals refrain from using THC-containing vaping products, particularly those obtained informally. People using e-cigarettes for smoking cessation should consider FDA-approved cessation therapies, and CDC advises against returning to cigarette smoking. CDC also warns pregnant women and non-users not to begin using e-cigarettes.

FDA agents supported the outbreak response by collecting vape products nationwide and interviewing consumers to assess usage patterns. FDA analyzed products for a wide range of chemicals, including nicotine, THC, cutting agents, pesticides, heavy metals, toxins and other additives. APHL member public health laboratories (PHLs) shipped hundreds of samples to FDA’s Forensic Chemistry Center and conducted additional targeted and non-targeted analyses. The New York State Department of Health Wadsworth Center first identified VEA in October 2019 and publicly reported findings in November 2019.

PHLs worked closely with state and local epidemiologists to support outbreak investigations, including coordinated efforts documented in a September 6, 2019 New England Journal of Medicine report from Illinois and Wisconsin. APHL activated the Incident Command System in summer 2019 to support member needs, including sample triage, technical assistance, information sharing and interagency coordination during national EVALI calls.

APHL stood up an Emergency Operations Center on September 12, 2019, staffed 24/7 at the peak of the response, and deactivated it on December 10, 2019, as activities normalized. APHL also established an EVALI Community of Practice on September 13, 2019, featuring a searchable online platform and regular member calls to share practices and challenges. A survey of state and local laboratory directors was conducted in late September 2019 to assess response activities and needs, with results rapidly shared.

Laboratory testing guidance is available on the CDC STLT webpage. Due to declining cases and identification of VEA as the primary cause, CDC issued its final update on hospitalized EVALI cases and deaths on February 25, 2020. CDC and APHL will continue to provide laboratory assistance as needed; inquiries should be directed to [email protected].

Between March 2024 and July 2025, outbreaks of highly pathogenic influenza (HPAI) A(H5N1) in dairy cows grew to encompass impacts to humans, animals (wild birds, domestic poultry, livestock [particularly dairy cows], other wild mammals and pets) and food products. The most recent human case (the 70^th of the outbreak) was detected in February 2025.

During the response, APHL coordinated with US Department of Agriculture (USDA), US Centers for Disease Control and Prevention (CDC), and the US Food and Drug Administration (FDA), public health partners and public health laboratories to mitigate the impact of HPAI on both animal and public health.  

Public health laboratories in all 50 states were equipped for detecting influenza A (H5N1) viruses, and 26 APHL member laboratories tested milk under the Pasteurized Milk Ordinance. Additional public health laboratories also set up enhanced wastewater surveillance and milk testing to give better situational awareness.

While there have not been any new human cases since February 2025, state and local public health partners also continue to monitor people in the US who have been exposed to infected birds, poultry, dairy cattle or other animals for 10 days after their last exposure.

• H5 Bird Flu: Current Situation
• APHIS: Highly Pathogenic Avian Influenza (HPAI) Detections in Livestock
• Investigation of Avian Influenza A (H5N1) Virus in Dairy Cattle
• FDA Extends Enforcement Discretion for the use of Conjunctival Swabs with the CDC Human Influenza Virus Real-Time RT-PCR Diagnostic Panel, Influenza A/H5 Subtyping Kit through May 1, 2025.
• Highly Pathogenic Avian Influenza A(H5) Virus Testing at MDHHS BOL and CDC
  

The global coronavirus (COVID-19) pandemic began as an outbreak in December 2019, escalating to pandemic status in March 2020. In the US, public health lab​oratories played a vital role in the COVID-19 response by performing testing for SARS-CoV-2. They were the only laboratories authorized to conduct testing outside of CDC at the outset of the pandemic.

APHL operated its ICS from January 2020 through May 2023, when the public health emergency ended. 

When a public health crisis like COVID-​19 strikes, any response effort would be futile without the technical infrastructure in place to send and receive data, or the standardized nomenclature to communicate the ​information. APHL worked with laboratories to ensure they can rapidly receive test orders from healthcare providers and communicate results to CDC, providers and the public. By repurposing a route on the AIMS platform—created in 2008 typically used to send influenza data—APHL was able to quickly onboard laboratories for transmitting COVID-19 testing data directly to CDC via PHLIP. 

APHL collaborated with national public health organizations to create Sara Alert which is hosted on APHL's AIMS Platform. Sara Alert™ was made available in the public domain, free of charge, to public health agencies automates the process of monitoring individuals exposed to or infected with COVID-19 (or any disease, it's configurable)—and will serve as an enduring national resource to contain disease.

APHL participated in the Apple/Google Exposure Notifications System, hosting a national server on the Microsoft Azure cloud and making COVID-19 exposure notifications available to state and territorial public health

APHL, in partnership with CDC and iConnect consulting, offered the use of the LWP for COVID-19 test orders and results to interested public health laboratories during the COVID-19 response. APHL also provided informatics expertise, software and tools required for implementation.

APHL works both domestically and internationally to strengthen national laboratory systems to prepare for and respond to Ebola, as many public health laboratories in the US can conduct testing for Ebola using tests deployed through the LRN and/or using commercially available assays.

• Domestic Efforts: APHL helps strengthen domestic preparedness by monitoring and enhancing laboratory capability and capacity, helping laboratories procure appropriate testing methods, and providing essential biosafety guidance to ensure safe and effective diagnostic practices.

• International Efforts: APHL collaborates with CDC and the African Society for Laboratory Medicine (ASLM) to develop guidance, implement training and provide necessary support for laboratories outside the US to ensure they are also able to perform safe, high quality and efficient testing—reducing the likelihood of an outbreak reaching the US.
  

Between September and December of 2025, an outbreak of Ebola was declared in the Democratic Republic of the Congo, caused by re-emergence of Ebola virus in the Kasai Province. According to reports, the outbreak resulted in dozens of confirmed cases and several deaths, prompting renewed containment and surveillance measures across the region​. No cases of Ebola entered the US during this outbreak. APHL monitored the situation and provided updates to members, so they were informed and prepared should the need to test arise.

After the 2014-2015 Ebola outbreak in Western Africa, APHL remained in Sierra Leone until 2018 to strengthen laboratory capacity and renovate the central laboratory. APHL-ASLM consultants developed laboratory standard operating procedures, supported implementation of a specimen referral system and implemented quality assurance practices at mobile testing centers run by donor nations. In addition​, a unified laboratory implementation plan was developed to enable international aid workers to quickly identify how to support a single, integrated strategy for delivery of laboratory services. 

APHL also assisted ASLM and the African Public Health Laboratory Network (APHLN) to improve surveillance, communications, coordination and information sharing to enable quick response to emerging disease threats as well as implemented data repositories for capacity and capability mapping of member laboratories. This also included ensuring access to specialized testing capacity made available across the network, coordinating action on new global and regional policy priorities and collaboration for research initiatives and sharing relevant data.

APHL also facilitated cross-training and assessments to raise all laboratories to standardized levels of capacity and readiness.

During the height of the 2014–2015 Ebola outbreak in West Africa, APHL provided situational updates and technical assistance to public health laboratories. The association developed a template to assist American laboratories in conducting risk assessments of their facilities and other laboratory guidance documents for clinical and public health laboratories. In addition, APHL worked with state and local public health laboratories to prepare them to conduct Ebola testing and to respond to questions from clinical laboratories in their jurisdictions.

Outside the US, APHL worked with CDC and ASLM to stand up the African Public Health Laboratory Network and explore ways to build laboratory capacity on the continent. APHL facilitated a training on testing for the Ebola virus at the ASLM meeting in Cape Town, South Africa, in 2014 and collaborated with ASLM to develop a webpage and African Public Health Laboratories Network Listserv to share information related to the Ebola outbreak.

Beginning in May 2014 APHL initiated a response to support members as they responded to the first cases of MERS-CoV in the US. While these two instances remain the only confirmed positives cases of MERS in the US, public health laboratories and CDC monitored the situation closely and tested over 1,300 specimens.

CDC real-time reverse transcription polymerase chain reaction (rRT-PCR) test kits were deployed via the Laboratory Response Network (LRN) after the Emergency Use Authorization (EUA) was issued by FDA in June 2013. Most state public health laboratories in the US are approved to test for MERS-CoV using CDC's rRT-PCR assay.

• 2013 Coronavirus Emergency Use Authorization
• Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
• Middle East Respiratory Syndrome (MERS) Information for Laboratories

Mpox is a rare disease caused by the monkeypox virus, part of the orthopoxvirus genus; it consists of Clade I and Clade II, both of which are spread in the same manner and can currently be treated using the same methods.

In 2022 the US saw an outbreak of Clade II mpox with LRN-B laboratories responding to the outbreak. This strain continues to circulate at low levels. Since November 2024 there have been several cases of Clade Ib mpox reported in the US. CDC continues to work with public health partners in the country and around the world to monitor mpox cases and increase surveillance. 

APHL Support for 2022 Mpox Response

During the 2022 outbreak, APHL utilized its ICS to coordinate laboratory responses, ensured members had timely access to diagnostics and information needed to safely perform testing. The organization provided subject matter expertise and technical assistance to both members and federal partners, while facilitating communication among public health laboratories, epidemiologists, health officials, CDC and other key partners. As a trusted resource for the media and the public, APHL promoted the vital role of public health laboratories during crises and leverages its national voice to strengthen laboratory partnerships and coordination. Additionally, APHL offered biosafety guidance and a risk assessment template to support safe and effective testing practices.

Related Resources

• Mpox Testing Regulations FAQ
• APHL-FDA Call on Emergency Use Authorization Process for Diagnostics

On February 1, 2016, the World Health Organization declared a Public Health Emergency of International Concern (PHEIC) by which time locally acquired Zika virus infection had been documented in 22 countries and territories in Latin America and the Caribbean. This recent re-emergence of Zika virus in the Americas and potential links to neurological and auto-immune complications placed health systems across the globe on high alert. On February 26, 2016 there was an authorization by HHS of the emergency use (EUA) of in vitro diagnostics for the detection of Zika virus and/or diagnosis of Zika virus infection. By July 1, 2016, testing was available in all 50 states using IgM ELISA, RT-PCR and PRNT assays. The PHEIC was terminated in November 2016 and while cases decreased substantially, with only 15 local cases in the US in 2017 and none since, Zika virus is considered endemic in the Americas. 

APHL collaborated with CDC, state and local public health laboratories, private clinical and international partners to prepare laboratories in the US and abroad to respond to the outbreak of Zika virus. APHL prepared US state and local public health laboratories to conduct Zika testing including establishing laboratories to perform surge testing for, and responding to questions from clinical laboratories in their jurisdictions. APHL also provided situational updates and technical assistance to member laboratories.

• A Complex Virus, A Coordinated Response: Public Health Laboratories Battle Zika
• Established Surge Laboratories for PRNT
• Developed:
  • Risk Assessment Template for Zika Virus
  • Summary of Commercially available Zika assays with EUA
  • Commercially Available Zika Virus Diagnostic Assays: Considerations for Use

During the 2017 hurricane season—Harvey, Irma and Maria—APHL facilitated coordination between laboratories, CDC, and policymakers; deployed teams to Puerto Rico to assess damage and plan recovery; and later received CDC crisis response funding to accelerate recovery in Houston, Puerto Rico, and the US Virgin Islands. These efforts underscored the essential role of public health laboratories in disaster response and highlighted the importance of preparedness resources for future emergencies.