“A Wing and a Prayer”

Summary and analysis of the NAHLN

HPAI exercise program

Joel Silverman, Ph.D.• Rosemary Speers, Ph.D.

IPR 12904 / April 2009
This document has been cleared for public release by USDA.

This document was supported by contract number 53-6395-4-C005 from the U.S. Department of Agriculture, Animal and 

Plant Health Inspection Service. This document represents the best opinion of CNA at the time of issue. It does not necessarily represent the opinion of the Department of Agriculture. Copyright © 2009 CNA

Approved for distribution: April 2009

Dr. Barry Howell

Director, Warfare Capabilities and Employment Team

Operations and Tactics Analysis

.
i

Contents

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Highlights of the exercise program. . . . . . . . . . . . . . . . 3

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . 3

Tasking and approach . . . . . . . . . . . . . . . . . . . . 4

Participants and locations . . . . . . . . . . . . . . . . . . 4

Scenarios . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Timelines of key events . . . . . . . . . . . . . . . . . . . 7

Commercial scenario . . . . . . . . . . . . . . . . . . 7

Backyard scenario. . . . . . . . . . . . . . . . . . . . 9

Outcomes and analysis . . . . . . . . . . . . . . . . . . . . 10

Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . 13

Recommendations for USDA-APHIS and NAHLN. . . . . 13

Recommendations for State animal health agencies . . . . 19

Recommendations for NAHLN laboratories . . . . . . . . 22

Appendix A: Overview of the exercise design . . . . . . . . . . 25

Components of the board game. . . . . . . . . . . . . . . 25

Map . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Disease spread model. . . . . . . . . . . . . . . . . . 27

Laboratory representation . . . . . . . . . . . . . . . 28

Response teams . . . . . . . . . . . . . . . . . . . . . 29

Status markers. . . . . . . . . . . . . . . . . . . . . . 30

Sequence of play . . . . . . . . . . . . . . . . . . . . . . . 30

Appendix B: Lessons learned about laboratory operations . . . 33

Laboratory capacity . . . . . . . . . . . . . . . . . . . . . 33

Presumptive phase . . . . . . . . . . . . . . . . . . . 34

Surge phase . . . . . . . . . . . . . . . . . . . . . . . 35

Recovery phase . . . . . . . . . . . . . . . . . . . . . 42

Laboratory supplies and reagents . . . . . . . . . . . . . . 43

Bio-security . . . . . . . . . . . . . . . . . . . . . . . . . . 45
ii

Appendix C: Lessons learned about laboratory– field 

coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Prioritization of samples for laboratory testing . . . . . . . 47

Transport of samples. . . . . . . . . . . . . . . . . . . . . 49

Shipping samples to NVSL . . . . . . . . . . . . . . . 49

Delivery of outbreak surveillance samples to 

the laboratory . . . . . . . . . . . . . . . . . . . . . 50

Integrating laboratory response into the incident 

command structure . . . . . . . . . . . . . . . . . . . . . 51

Appendix D: Lessons learned about notification and 

communication . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Activation of NAHLN . . . . . . . . . . . . . . . . . . . . 59

Information management . . . . . . . . . . . . . . . . . . 62

Interagency support . . . . . . . . . . . . . . . . . . . . . 64

Department of health. . . . . . . . . . . . . . . . . . 65

Emergency management agency. . . . . . . . . . . . 66

Department of natural resources / wildlife . . . . . . 68

State poultry federation . . . . . . . . . . . . . . . . 68

Interagency notification . . . . . . . . . . . . . . . . 69

Appendix E: Summary tables . . . . . . . . . . . . . . . . . . . 71
1

Summary

To address action items assigned to it in the implementation plan for

the National Strategy for Pandemic Influenza, the U.S. Department of Agriculture, Animal and Plant Health Inspection Service (USDA-APHIS)

initiated an exercise program to examine the integral connections

between field actions and laboratory response during an avian influenza outbreak. To carry this out, USDA-APHIS asked CNA to design a

tabletop exercise and deliver it to member laboratories of the National

Animal Health Laboratory Network (NAHLN). In total, we conducted

38 exercises from February to October 2008. The exercises involved

more than 700 participants, representing 45 States and numerous Federal, State, and local agencies as well as the poultry industry.

USDA-APHIS further asked CNA to examine the lessons learned from

this exercise series to conduct a system-wide analysis of the NAHLN. To

do so, we examined three main themes that were discussed in detail

at all of the NAHLN exercises: laboratory operations, laboratory-field

coordination, and notification and communication. Our analysis

resulted in recommendations for the coordination of animal health

laboratory response capabilities across the United States that address

resource management, process alignment, notification and warning,

and knowledge management strategies for the NAHLN, its component laboratories, and their interface with field operations.

Overall, we found that all but four of the NAHLN laboratories would

have sufficient capacity to handle the first few days of testing for scenarios that were presented in this exercise program. As might be predicted, laboratories in States with a high density of commercial poultry

operations were the most likely to quickly receive more samples per day

than they could process. However, the reasons for this were somewhat

counter-intuitive. The overwhelming number of laboratory samples

resulted from outbreak surveillance among commercial farms and

marketability testing that far exceeded the testing workload for locations with sick birds. Conversely, once full surveillance of backyard

farms was underway, all of the individual laboratories could be overwhelmed with testing of individual birds and small flocks.
2

We also found a surprising amount of variation in how the NAHLN

laboratories would handle the increased workload. These differences

were as dependent on the administrative structure and organization

of the labs as they were on specific capabilities and capacities for testing. This presents a notable challenge to NAHLN leadership, which

must coordinate response operations across a network of laboratories

that are not managed by USDA or any single agency.

To help meet these challenges, we recommend that USDA-APHIS

and NAHLN do the following:

• Assist States with developing tailored laboratory response plans

that account for handling overflow samples—whether from

infected locations, outbreak surveillance, or routine testing—

during an avian influenza outbreak.

• Identify and document how laboratories will be compensated

for conducting overflow testing.

• Continue working with the National Veterinary Stockpile program to include laboratory resources.

• Continue efforts to electronically link the NAHLN data repository with the Emergency Management Response System that is

used for field operations.

• Revise the definition of NAHLN “activation” and clarify the

process of activating individual laboratories as well as the entire

network. 

We also recommend that State-level animal health agencies should:

• Further integrate laboratory requirements into the incident

command system—for example, by having a laboratory liaison

and incorporating laboratory resource requirements into the

staffing and budgeting processes.

• Re-examine surveillance and sample prioritization plans in

order to better coordinate them with laboratory operations.

Finally, we recommend that individual NAHLN laboratories work

with State animal health officials and NAHLN for recovery planning.
3

Highlights of the exercise program

Introduction

On November 1, 2005, the President of the United States issued the

National Strategy for Pandemic Influenza (NSPI) to outline the coordinated U.S. Government effort to prepare for pandemic influenza. In

2006, an implementation plan for the NSPI was issued to clarify the

roles and responsibilities of government and nongovernment entities

in carrying out the national strategy. To address action items assigned

to it in the implementation plan (specifically, items 7.1.1.1 and 7.1.3.2),

the U.S. Department of Agriculture, Animal and Plant Health Inspection Service (USDA-APHIS) initiated an exercise program to evaluate,

train, and enhance resources and readiness of the animal health community. To carry this out, USDA-APHIS asked CNA to design an exercise that would examine the integral connections between field

actions and laboratory response during an outbreak of highly pathogenic avian influenza (HPAI) and to conduct a series of exercises with

the National Animal Health Laboratory Network (NAHLN).

USDA-APHIS further asked CNA to synthesize the lessons learned

from each of these exercises in a broad meta-analysis. Analysis of the

overarching lessons learned will allow USDA-APHIS and the NAHLN

to understand response capabilities across the United States, to better

coordinate with all levels of government, and to improve and refine

emergency policies and response plans. 

This document is organized as a summary report that presents our recommendations and appendices that synthesize lessons learned across

the exercise program. In the following sections, we describe highlights

from the exercise program and provide recommendations for the next

steps that USDA-APHIS and NAHLN, State animal health agencies,

and individual NAHLN laboratories can take to enhance overall

NAHLN preparedness. 
4

Tasking and approach

USDA-APHIS asked CNA to design and deliver a tabletop exercise to

examine the integral connections between laboratory operations and

field actions during an HPAI outbreak. We worked with the NAHLN

Coordinator and NAHLN Steering Committee to create a board game

that examined HPAI response, and then developed an exercise program that incorporated this game.1 By using this board game as the

foundation for tabletop exercises throughout the country, we could

examine and highlight the variations among States and regions, and

the subsets or patterns that exist in laboratory plans and capabilities. 

The features of this exercise program—most notably, the use of a

common format in many different locations—enable USDA-APHIS

and NAHLN to analyze the animal health laboratory response system

in a way that no single exercise would allow. CNA analysts facilitated

each exercise and then documented the key events and decisions in

after-action reports for each State or region. We then reviewed our findings, as well as participants’ feedback, and analyzed the entire exercise

program to identify recommendations for USDA-APHIS and NAHLN,

for State animal health agencies, and for NAHLN laboratories.

Participants and locations

In total, we conducted 38 exercises from February to October 2008.

They involved all but one of the NAHLN laboratories (see figure 1).2

Thirty-two exercises involved a single laboratory, or multiple laboratories within a single State. Five exercises included two or more laboratories from neighboring States, and one exercise included

representatives from a neighboring State that has no NAHLN laboratory to perform AI testing. Overall, more than 700 participants, representing 45 States and numerous Federal agencies, participated in

the exercise program. 

The laboratory director served as the host for each exercise. Participants typically included senior staff from various laboratory divisions/sections and several representatives from State and Federal

1. Appendix A describes our game components in detail.

2. The remaining laboratory did not respond to invitations to host an exercise.
5

animal health agencies, such as the State animal health official (or

representative), and the USDA-APHIS Area Veterinarian in Charge

(AVIC) and/or Area Emergency Coordinator (AEC). Most exercises

also included representatives from one or more other local, State, or

Federal agencies, such as the:

• State and/or local department of health 

• State and/or Federal agency for wildlife

• State emergency management agency.

In addition, many exercises included representatives from the commercial poultry industry, such as leaders from a State poultry federation or veterinarians from individual poultry companies. 

Figure 1. Locations of NAHLN laboratories (map courtesy of USDA-APHIS)a

a. All NAHLN laboratories were invited to participate in the exercise program.
6

Several exercises were attended by personnel from other Federal

Government agencies. These included the Department of Homeland

Security (DHS); the Federal Bureau of Investigation (FBI); and the

National Wildlife Health Center, which is run by the Department of

the Interior (DOI). A number of students and visitors also observed

the exercise at some locations. The list of participants was determined

by each exercise host, in coordination with animal health officials for

that State. A summary of exercise locations and participants is provided in appendix E. 

Scenarios

All but two of the exercises began with the same scenario, in which

increased mortality and respiratory signs are observed in susceptible

poultry (not wild fowl).3 We deliberately started the scenario at the

very first report of clinical signs—which could be several days prior to

official confirmation of HPAI by the National Veterinary Services Laboratories (NVSL)4—because the NAHLN laboratory would likely be

involved at this early stage of an outbreak. The scenario for 25 of the

38 exercises began with clinical signs observed among birds at a commercial poultry facility. Alternatively, we began the scenario at a backyard farm for States that are primarily concerned about backyard

flocks. Specifically, these scenarios were as follows:

• Scenario 1: The company veterinarian at a commercial facility

observes increased mortality (perhaps only a few percent above

the normal daily mortality rate) and birds with respiratory distress. The company veterinarian either:

— contacts the State animal health official, who dispatches a

foreign animal disease diagnostician (FADD) to collect samples for laboratory testing, or

— submits additional samples directly to the laboratory after

noticing the ill birds.

3. In two exercises, the scenario began with positive laboratory results

from routine surveillance testing. 

4. Confirmation of HPAI generally entails virus isolation and sequencing,

the results of which are available between 5 and 14 days after NVSL

receives the samples. 
7

• Scenario 2: A farmer arrives at the laboratory with several dead

chickens, and reports that about half of his remaining flock

have respiratory signs.

Laboratory staff were familiar with both of these scenarios. Reportedly, it is not unusual for a farmer to bring several dead birds directly

to the laboratory, or for a company veterinarian to submit additional

samples for testing. Exercise play proceeded from one of these starting points, with participants discussing the next steps they would take

for diagnostic testing and notification of results. Participants decided

the day of the week on which the scenario would start, and exercise

play continued for several additional scenario days. Each exercise

lasted for about 4 hours, including an introduction brief, exercise

play, and a hot-wash review.

Timelines of key events

We reconstructed the exercise scenario, events, and participants’

decisions in after-action reports for all of the individual exercises. We

further developed a conglomerate reconstruction that describes the

key events for each scenario (figure 2). Below, we summarize the

common events and decisions that took place in the commercial scenario and in the backyard scenario. 

Commercial scenario

As described above, samples were submitted to the laboratory either

by a commercial poultry veterinarian or by an individual (typically,

but not always an FADD) who was dispatched by the State animal

health official. Once the NAHLN laboratory received the samples on

Day 1, they were generally able to provide a presumptive diagnosis of

avian influenza to State and Federal regulatory officials within four to

six hours after receiving the samples.5 Samples were then sent to

NVSL for further screening and testing, either late on Day 1 or early

on Day 2. 

5. Screening tests run by NAHLN labs are polymerase chain reaction

(PCR) tests. These tests include the matrix test, which screens for all AI

viruses, and the H5/H7 test, which screens for the H5 and H7 subtypes.
8

On Day 2, State and Federal officials, in coordination with commercial facilities, began making preparations to begin outbreak surveillance operations. This generally included one of two strategies:

• Collect samples from poultry at all locations within a specific

radius of the index farm.

• Collect samples from all commercial poultry facilities that are

on the same network as the index farm (e.g., all egg-layer

operations). 

Depending on the capabilities of the State animal health agency and

the commercial facilities, the laboratory could expect the first wave of

samples to arrive either late on Day 2 or on Day 3. In the meantime,

laboratory staff said they would conduct an inventory of supplies and

reagents. The lab would also run any samples collected from other

facilities that had birds with clinical signs. In this scenario, NVSL

would likely have completed preliminary PCR testing and initiated

virus isolation and sequencing6 by the end of Day 2.7

Figure 2. Timeline of the commercial and backyard scenarios

Day 1 Day 2 Days 3, 4, 5, etc

Backyard Commercial

Farmer 

drops off 

dead birds 

at Lab

Pathology followed 

by PCR testing

State Veterinarian 

and USDA AVIC 

contacted

Presumptive PCR 

positive

Company 

sends samples 

to Lab

OR

FADD collects 

samples and 

delivers to Lab 

and NVSL

Samples sent 

to NVSL

Preliminary 

planning for 

surveillance

Lab inventory 

supplies/ reagents

Lab runs PCR from 

new sites with 

clinical signs 

NVSL confirms 

PCR

Surveillance sample 

collection and testing

State Veterinarian 

and USDA AVIC 

contacted

Presumptive PCR 

positive

Samples sent 

to NVSL

Trace-out 

investigation

Lab inventories 

supplies/ reagents

Lab runs PCR from 

dangerous 

contacts

NVSL confirms 

PCR

Continue sample collection 

and testing from 

dangerous contacts

Day 1 Day 2 Days 3, 4, 5, etc

Backyard Commercial

Farmer 

drops off 

dead birds 

at Lab

Pathology followed 

by PCR testing

State Veterinarian 

and USDA AVIC 

contacted

Presumptive PCR 

positive

Company 

sends samples 

to Lab

OR

FADD collects 

samples and 

delivers to Lab 

and NVSL

Samples sent 

to NVSL

Preliminary 

planning for 

surveillance

Lab inventory 

supplies/ reagents

Lab runs PCR from 

new sites with 

clinical signs 

NVSL confirms 

PCR

Surveillance sample 

collection and testing

State Veterinarian 

and USDA AVIC 

contacted

Presumptive PCR 

positive

Samples sent 

to NVSL

Trace-out 

investigation

Lab inventories 

supplies/ reagents

Lab runs PCR from 

dangerous 

contacts

NVSL confirms 

PCR

Continue sample collection 

and testing from 

dangerous contacts
9

From Day 3 until the end of the timeframe for this exercise scenario,

the laboratory would mostly focus on testing outbreak surveillance

samples from commercial facilities. State animal health agencies

might also begin area surveillance of backyard flocks within a specified radius of the index farm, depending on the number of personnel

available to do so. Due mostly to the outbreak surveillance testing of

commercial operations, the number of samples coming into the laboratory could easily exceed the lab’s capacity by this time. 

Backyard scenario

As described earlier, the backyard scenario began when a concerned

farmer or local veterinarian brought dead birds directly to the laboratory.8 Once the NAHLN laboratory received samples, they were

generally able to provide a presumptive diagnosis of avian influenza

to State and Federal regulatory officials within four to six hours after

receiving the samples. Upon notification, State and Federal officials

would typically contact the farmer and deploy a team to investigate,

collect additional samples, and begin an epidemiological investigation. Then, either late on Day 1 or early on Day 2, the field team or

the NAHLN laboratory (or sometimes both) would send samples to

NVSL for further screening and testing.

On Day 2, State and Federal officials would request preliminary

results from the epidemiological investigation. Depending on the

number of personnel available, they would send teams to investigate

any other flocks with direct contact to the infected birds and collect

samples. However, new premises that had birds with clinical signs typically would take precedence over direct contact premises. In most of

the exercises, the laboratory staff anticipated that they could manage

6. In addition to the aforementioned PCR screening tests, NVSL can run

an N1 test, which screens for the N1 subtype. After the screening tests,

NVSL conducts confirmatory testing, which may include virus isolation

and genetic sequencing.

7. Variations in the timeline for NVSL confirmation depended on when,

and how, the NAHLN laboratory could transport samples to Ames, IA.

8. In some States, the samples may have initially arrived at a branch laboratory and then been transported to the NAHLN lab.
10

these samples. The number of arriving samples that the lab could process was limited not by laboratory capacity but by the number of field

personnel available to collect them. In the meantime, the laboratory

would conduct an inventory of supplies and reagents. As in the commercial scenario, NVSL would likely have completed preliminary

PCR testing and initiated virus isolation and sequencing by the end of

Day 2.

Beginning on Day 3 and continuing through the end of the timeframe for this exercise scenario, the laboratory would focus on testing

samples from new premises with clinical signs and from dangerous

contacts identified through the epidemiological investigation. Participants agreed that once additional field personnel deployed to the

area (from either USDA or neighboring States), the number of outbreak surveillance samples collected would quickly rise and the laboratory could become overwhelmed. However, this would likely not

occur before Day 5 or 6; thus, the labs and NAHLN would have time

to make necessary preparations for managing overflow samples. 

Outcomes and analysis

After completing after-action reports for all of the individual exercises, we reviewed and compared the lessons learned in order to

assess their commonalities and differences. We looked for subsets and

patterns in the issues that were discussed during each exercise. We

also created a database to track information about the exercise program, including the list of participants, key events and decisions

during each exercise, lessons learned, recommendations, and feedback comments. 

To derive the lessons that arose across the entire exercise program, we

defined a set of categories that would provide a common basis for analysis. We grouped the categories into three main themes that were discussed in detail at all of the NAHLN exercises: laboratory operations,

laboratory-field coordination, and notification and communication.9

9. In contrast, issues that were specific to field operations (e.g., appraisal

or mass depopulation) were not discussed in detail at all exercises

because of variations in the types of field personnel who participated.
11

The appendices of this report present our synthesis of the lessons

learned on the following topics:

• Laboratory operations (See Appendix B)

— surge capacity

— supplies and reagents

— bio-security

• Laboratory-field coordination (See Appendix C)

— prioritization of samples for laboratory testing

— transport of samples

— integrating laboratory response into the incident command

structure

• Notification and communication (See Appendix D)

— activation of NAHLN

— information management

— interagency support.

Overall, we found that only four NAHLN laboratories would be overwhelmed by the scenarios that were presented in this exercise. Laboratories in States with a high density of commercial poultry

operations were the most likely to quickly receive more samples per

day than they could process. This was a consequence of outbreak surveillance of commercial facilities and marketability testing that far

exceeded the testing workload for locations with ill birds. However,

once full outbreak surveillance of backyard farms was underway, any

of the laboratories could be overwhelmed with testing of individual

birds and small flocks.

We also found a surprising amount of variation in how the NAHLN

laboratories would handle the increased workload. These differences

were as dependent on the administrative structure and organization

of the labs as they were on specific capabilities and capacities for testing, and resulted mostly from such issues as funding sources, overtime regulations, and safety concerns. This high degree of variation
12

presents a notable challenge to NAHLN leadership, which must coordinate response operations across a network of laboratories that are

not managed by USDA or any individual agency.

States that have branch laboratories were better able to handle the

surge in samples that results from continuing routine testing in addition to conducting outbreak testing. Similarly, individual NAHLN

laboratories that have working agreements with other individual

NAHLN laboratories were better able to distribute the workload.

These results highlight the benefit of having a laboratory network

such as NAHLN, where member laboratories that meet the same

quality standards can work together to meet the nation’s needs for

rapid response and recovery testing.
13

Recommendations

Each exercise was part of an overall exercise program focusing on the

integration of laboratory response and field operations during an

avian influenza outbreak. A key component of this program is the

identification of overarching lessons that will allow USDA-APHIS and

NAHLN to better understand and coordinate laboratory response

capabilities across the United States. The appendices to this report

present our synthesis of the lessons learned and best practices that

arose during the program. Below, we list, and discuss our rationales

for, our recommendations for further enhancing the emergency preparedness of NAHLN, its member laboratories, and State animal

health agencies. 10

Recommendations for USDA-APHIS and NAHLN

Assist States and regions with developing tailored plans for overflow 

sample testing during an emergency. 

As described above, the NAHLN exercise program revealed that all

but four laboratories have the capacity to manage the additional samples that would be expected during the first three days of an HPAI

outbreak. However, within a few days later—depending on the

number of outbreak surveillance samples and the availability of field

personnel to collect them—all laboratories will likely have more samples than they can manage on their own 

NAHLN leadership should work with each of the member laboratories

to identify alternative laboratories that can handle overflow routine,

commercial marketability, and/or wildlife samples. The plans will

need to be tailored, since each laboratory has a different set of compet10. Recommendations for individual laboratories and agencies are

included in the after-action reports from each exercise. 
14

ing priorities for overflow testing. For example, prioritizing poultry

samples over wild bird samples could affect existing agreements and

relationships between USDA-APHIS Wildlife Services and NAHLN laboratories. Decision-making guidance and identification of trigger

points will help each laboratory identify when, and how, to send out

overflow samples. The plans should also address the NAHLN Coordinator’s role for identifying appropriate laboratories to receive overflow

samples, or whether individual MOUs should be in place. 

For some areas of the country (such as New England or the Delaware/Maryland/Virginia peninsula), a regional plan may be more

appropriate than a State plan, and should be considered. In those

cases, the NAHLN Coordinator, in consultation with State animal

health officials, could pre-identify the laboratories that are most likely

to be placed on alert for activation in the event of an AI outbreak in

that region. MOUs could then be established between those labs and

other member labs to facilitate coordination for diagnostic testing.

Identify how laboratories will be compensated for conducting 

overflow testing, whether of outbreak samples or routine samples, 

during an HPAI outbreak.

Response plans should also identify how laboratories will be compensated for testing samples over the course of the outbreak. During the

NAHLN exercises, participants had a number of questions about

reimbursement for expenses related to continuing routine testing

along with conducting outbreak testing. For example, USDA-APHIS

and NAHLN leadership should address whether, and when, the Federal Government will/could pay for the following measures that may

occur in conjunction with NAHLN activation:

• Administrative and shipping costs for sending outbreak samples,

including diagnostic samples from ill birds and outbreak surveillance samples from healthy birds, to another NAHLN laboratory

• Receiving and processing costs for the receiving NAHLN laboratory to test outbreak samples

• Travel and salary costs for NAHLN-trained personnel to go to a

member laboratory in order to expand its capacity for outbreak

testing
15

• Administrative and shipping costs for sending routine samples

(not potential AI samples) to another NAHLN laboratory so

that the primary laboratory can dedicate its own capacity to outbreak testing

• Receiving and processing costs for the receiving NAHLN laboratory to test those routine samples.

In turn, USDA-APHIS and NAHLN should distribute this information to member laboratories so that they can decide how to incorporate it into their own response plans.

Continue working with the National Veterinary Stockpile program to 

include laboratory resources in the NVS.

In a number of exercises, participants listed items that they would like

to have available through the NVS. Examples of these resources are:

• Swabs

• Plasticware, including PCR testing plates and test tubes

• Virucidal chemicals

• PCR kits

• Sample collection kits for field responders

• Strip tests (e.g., Flu DETECTTM).11

For PCR kits and other items with a limited shelf life, participants in

several exercises suggested a system whereby laboratories would contract through the NVS to obtain these supplies on a regular basis,

rather than procure them directly from the supplier. This could be

similar to the contracting assistance that NVS provides for 3D (depopulation, disposal, and decontamination) resources. It would also

enable NVS to have a supply of relatively fresh reagents on hand.

11. Mention of trademark or proprietary product does not constitute a

guarantee or warranty of the product by the USDA and does not imply

its approval to the exclusion of other products that may be suitable.
16

A number of exercise participants also suggested that USDA-APHIS

use plastic test tubes for field collection, rather than the glass ones

that are currently available. According to exercise participants, standardized plastic test tubes are more easily and safely handled by field

and laboratory personnel. 

Develop and distribute a short description of the sample-transport 

services (such as the FedEx White Gloves service) that USDA-APHIS 

makes available to State animal health officials and laboratories.

In many exercises, particularly those where the participants decided

to begin the scenario on a Friday, laboratory and field personnel

struggled to determine the best method for getting samples to NVSL

for confirmatory testing. Further, only in a very few cases were participants familiar with the transport services currently available through

the NVS.12 State officials should have this information on hand so

that they can consider the full range of options for sending high-priority samples to NVSL.

Continue efforts to electronically link the NAHLN repository with 

the USDA Emergency Management Response System (EMRS). 

Currently all NAHLN laboratories have the potential to link their laboratory information management system (LIMS) database with the

NAHLN repository, either via web-based entry or electronic messaging. However, the NAHLN repository cannot interface electronically

with the USDA Emergency Management Response System (EMRS),

which is the database that USDA-APHIS uses to track outbreak

response operations. Therefore, we found that NAHLN laboratories

would need to relay laboratory results to the unified command team

via an alternative protocol set up just for the AI incident, such as by

phone calls or faxes. Laboratory results would then have to be reentered by hand into EMRS. 

12. If the State animal health official and AVIC agree, they can request the

FedEx White Gloves service through a contract provided by the NVS.

Upon activating this service, FedEx will pick up and deliver samples anywhere in the country within a few hours. Participants noted that this service is expensive and should only be used for high-priority samples.
17

Also, some laboratories have developed spreadsheets that assist this

process and include common identifiers to link lab results with premises information. Exercise participants noted that often the only

common identifier is the address of the premises. USDA-APHIS

should examine which other common identifiers are already in use,

and consider including them in an electronic link between LIMS,

NAHLN, and EMRS databases. 

Consider revising the definition of NAHLN “activation” and clarify the 

process of activating individual laboratories as well as the entire network. 

For a case of AI, a NAHLN lab can make a presumptive diagnosis of

whether the virus is present, and whether it is type H5 or H7. Consequently, the individual laboratory may increase its own state of readiness before NVSL confirms the result, or is even aware of the need for

confirmatory testing. This scenario doesn’t appear to fit with the current definition of NAHLN “activation” for outbreak testing. 

During the NAHLN exercise program, we identified several scenarios

that should be addressed in the definition of NAHLN activation. In

these cases, NVSL and/or the NAHLN Coordinator could:

• Delegate a member laboratory to handle subsequent outbreak

surveillance testing (after the first case is confirmed by NVSL

for each new outbreak area). Samples would then be considered positive if the results of the screening test are positive.

• Designate other selected NAHLN labs (but not necessarily the

entire network) to assist the laboratory that is primarily responsible for handling samples from the outbreak area.

• Request personnel from other member laboratories to assist a

NAHLN lab that has reached its capacity.

These processes should be addressed in the formal NAHLN activation plan and communicated to all member labs.
18

Examine the feasibility of several policies that were proposed during 

the NAHLN exercise program to increase laboratory response 

capacity using in-State resources. 

During most exercises, participants raised questions about NAHLN

and NVSL policies. Some participants were looking for clarification

of existing policies and procedures. Others brought up new ideas for

helping laboratories handle the outbreak testing workload. Examples

of these questions are provided below.

• Finding additional personnel and laboratory space. In most

exercises, participants identified several in-State sources of PCR

technicians and equipment—such as public health laboratories,

universities, and National Guard Civil Support Teams—that

could assist with testing, but are not trained and proficiencytested (personnel) or validated (equipment) for using NAHLN

protocols. Questions arose whether the personnel and equipment could be tested by NAHLN on short notice and approved

for use with AI outbreak testing.

• Changing the sequence of laboratory testing. In many exercises, participants questioned whether the testing process could

be modified once NVSL had confirmed the first presumptive

positive PCR test result. For example, participants suggested

using strip tests, either in the field or at the laboratory, to indicate priority for further testing (samples with a positive result

from a strip test would be higher priority for PCR tests). Participants also suggested bypassing the avian influenza matrix test

and conducting only the H5/H7 screening test on outbreak

surveillance samples.

Provide guidance on the required use of BSL-3 spaces for HPAI testing.

A number of participants were unsure what triggers would require

them to move testing from BSL-2 (bio-safety level 2) spaces to BSL-3

spaces. This has significant operational impact since most laboratories, including those from States with large commercial poultry industries, have much less BSL-3 capacity, and some have none at all.

Decision tools and triggers should be included in laboratory emergency plans, including options for sending out samples to laboratories that do have BSL-3 capacity.
19

Provide guidance on USDA’s expectations of when and how State and 

Federal interagency partners will be notified of a potential HPAI 

outbreak.

We found notable variations as to when and under what conditions

the laboratory directors and State animal health officials would notify

other agencies, including industry personnel, of a potential HPAI

outbreak. In some States, industry and selected interagency partners

would be notified of the first presumptive positive result. In others,

the information would remain confidential until NVSL has

confirmed the result and USDA-APHIS is about to make an

announcement. These differences have implications for the speed

and coordination of response operations in each State. However, the

need to closely hold proprietary information must also be recognized. We suggest that USDA-APHIS provide guidance on when other

agencies, and industries, should be notified, and what notifications

will be the responsibility of USDA-APHIS.

Recommendations for State animal health agencies

Identify appropriate timelines for notifying State and Federal 

interagency partners. 

As noted above, we observed considerable differences among exercise

participants in their plans for early notification of other agencies that

may have an active role in HPAI response, such as public health, wildlife, emergency management, and poultry industry organizations.

These differences appeared to exist even among States that routinely

work together on commercial poultry issues. State plans should identify which agencies and organizations will be notified of a presumptive

positive result, and by whom, and which response partners will be notified shortly before USDA announces a confirmed case of HPAI. 

Include a laboratory liaison position in the unified command for an 

HPAI outbreak.

Having a liaison between the laboratory and the unified command has

proven successful in previous animal disease outbreaks, such as the

2002-03 outbreak of exotic Newcastle disease. Personnel in this position do not necessarily need to be laboratory staff, but they should be
20

familiar with laboratory operations and with the incident command

system (ICS). Responsibilities for this position could include:

• Training field personnel on the proper ways to collect samples

• Assisting with surveillance planning, to include route management, bio-security, handling, documentation, and transportation of samples

• Communicating the laboratory’s resource needs to the command staff

• Coordinating the field’s resource needs for sample collection

and transport.

Re-examine outbreak surveillance plans so that they are better 

coordinated with laboratory operations.

In several of the States that participated in this exercise program, outbreak surveillance samples consisted of bird carcasses or blood samples. These types of samples can present a challenge for the

laboratory, which will need to store, and later dispose of, a number of

carcasses. It is generally more efficient for the laboratory to receive

swab samples. In addition, protocols should be developed that facilitate coordination between field and laboratory personnel. Such protocols could include a system to provide swabs and train field

personnel, a phone call to the receiving laboratory with information

about the number and priority of samples, and a scheduling system

that would allow for the preferred number of samples to arrive at the

laboratory at one time.

Also, the frequency of outbreak surveillance sampling can quickly

overwhelm laboratory capacity. Layer operations may require daily

surveillance testing so that eggs can be moved from the farm. For allin/all-out poultry operations, State officials should consider whether

outbreak surveillance samples during an HPAI outbreak need to be

collected daily or less often. 
21

Provide swab collection kits to field responders and training on how 

to use them.

Reportedly, many States have swab collection kits on hand, or ready

to be prepared, in the event of an HPAI outbreak. A few States have

pre-distributed these kits to commercial poultry operators in order to

facilitate rapid sample collection. However, we found that in some

States the field staff, and especially industry personnel, were not

trained or equipped for collecting swab samples. Having such kits

available can reduce sample-collection time and ensure that the laboratory receives the preferred type of samples for rapid PCR testing.

Re-examine sample prioritization plans so they are better aligned 

with laboratory operations. 

During an HPAI outbreak, laboratories can receive samples from a

variety of sources—from sick birds, outbreak surveillance of commercial or backyard bards, routine surveillance of commercial

operations, and wildlife—and the default plan may be to test them in

the order they were received. A sample prioritization strategy will

help the laboratory manage its workload while providing the most

important information for those State officials who must make decisions regarding disease eradication. The strategy should include decision points for identifying which samples could be sent to another

laboratory, if the NAHLN laboratory has an excessive workload.

Develop a protocol for integrating laboratory resourcing 

requirements into ICS processes.

At the start of most exercises, participants assumed that each laboratory would be responsible for procuring and tracking its own

resources. However, during the exercise players recognized that such

administrative and logistics functions could also be handled by the

incident command post (ICP). This would allow laboratory staff to

focus on supporting the testing process, and would centralize the

expense and reimbursement tracking during an outbreak. 

In this system, the NAHLN laboratory would relay its resource

requirements to the ICP, and command staff (in the logistics or

administrative sections) would fill those needs. USDA-APHIS,
22

NAHLN, and State animal health agencies need to address several

issues to facilitate this integration:

• The National Information Management System (NIMS)

requires a typing system, to ensure that the requested resources

match the required resources. At this time, there is no system

of national standards in place for animal health laboratory personnel, supplies, or equipment. 

• The interface between NIMS and the major resource providers

for laboratory supplies, such as NAHLN and NVS, is still in

development. ICP staff will need to know that they should contact NAHLN for fulfilling laboratory personnel requests. 

• Laboratory resources will need to be considered and included in

an emergency budget submitted by a State animal health official.

Recommendations for NAHLN laboratories

Re-examine the laboratory’s emergency response plan, taking into 

account lessons learned from the NAHLN exercise program.

While most laboratories already have an emergency response plan in

place, the NAHLN exercise program highlighted additional items

that could be addressed in order to improve that plan. These

included the following:

• Notification procedures and contact information for staff, and

for State and Federal regulatory officials who will receive information directly from the laboratory.

• In-State resources that could be used in an emergency to augment laboratory testing capacity or administrative functions. A

few resources identified during the exercise program were:

– State public health laboratory resources (staff, supplies,

and equipment)

– University students, faculty, and laboratories

– National Guard Civil Support Teams.
23

• Procedures for requesting additional supplies and reagents

from the NVS (when available) or other sources, and/or for

forwarding supply requests to the ICP.

• Funding sources, and how to receive reimbursements, for laboratory expenses such as:

— Processing outbreak samples

— Sending overflow samples to another laboratory

— Receiving personnel to assist in the laboratory.

• Protocols for coordinating with field personnel and unified

command (which should align with the State FAD emergency

response plan), including a laboratory liaison to work with the

unified command. 

• Protocols for coordinating with NAHLN when the laboratory is

activated to support outbreak testing in its home State or in

another State.

• Memoranda of agreement with other laboratories to handle

overflow samples.

• Steps for handling routine samples in addition to outbreak

samples, such as:

— Re-directing samples to branch laboratories within the State.

— Working with veterinary providers to reduce the number of

routine samples while outbreak testing is being conducted.

— Seeking assistance from another NAHLN laboratory.

• Preparation and distribution of sample-collection kits to field

responders.

• Identification of sources for, and steps to obtain, prophylaxis

medications (such as anti-virals) for laboratory staff. 

• Procedures for enhancing bio-security outside of the laboratory,

such as erecting signs, changing traffic flow, and determining

locations for curbside drop points and pressure-wash sites.
24

One suggestion from the exercise program was to develop an emergency response plan consisting of time-based modules, which could

be activated depending on the level of the outbreak. The first stage of

the plan would cover the first week or 10 days, when the response is

primarily local. The second stage of the plan would provide direction

for the first month or so, including strategies for managing additional

personnel and an overload of samples. The final stage of the plan

would detail how to maintain the level of testing required to prove

that the State is free of disease, and how to maintain mental and physical health among employees.

Work with State animal health officials and NAHLN for recovery 

planning.

Many of the laboratories that participated in this exercise program

expressed concern about maintaining business continuity during an

HPAI outbreak. In particular, some labs are funded by fee-for-service

agreements, and their staff members were concerned that they

wouldn’t regain those fees after outbreak testing was completed.

State-wide recovery plans should include the laboratories, and, in

turn, laboratories should include recovery measures in their own

response plans. NAHLN can facilitate this planning by working with

member laboratories to identify specific recovery issues.
25

Appendix A: Overview of the exercise design

This appendix describes our game design, and explains how the

board game components were used for the series of tabletop exercises with NAHLN laboratories. We drew on USDA-APHIS’s current

plans and experiences to represent how animal health emergency

field actions and laboratory functions work together. We incorporated models, rules, and procedures that best reflect the tasks and

roles the participants would engage in during an outbreak of HPAI.

Our goal was to present challenging material to the participants, in

order to capture the communications, conflicts, and decisions they

would face in an actual event.

The objectives for this exercise program came from the National Strategy for Pandemic Influenza and its accompanying implementation plan,

and from meetings with USDA-APHIS and NAHLN leadership.

Broadly stated, the goal was to test, evaluate, train, and enhance the

resources and readiness of the animal health community, and to help

that community prepare to respond to an outbreak of HPAI. More

specifically, the exercise focused on the interactions between field

operations and laboratory response.

Components of the board game

We produced a tabletop board game to serve as the foundation for the

series of exercises with NAHLN laboratories. Note that we intentionally make a distinction between the game and the exercises that employ

it. The game has a number of components that represent various

facets of animal disease outbreak response. The use of those components together in a specified sequence of play can be viewed as a basic,

yet interactive, model of HPAI response. We deliberately abstracted

and simplified many tactical details, for both the field and the laboratory, in order to focus on the roles of the players as decision-makers.

In turn, the exercise involves a number of participants who are using

the game as a tool for discussing HPAI response actions and decisions. 
26

Map

The primary component is a game board that has a simplified map of

a 13-jurisdiction area of an unspecified region (see figure 3). Commercial poultry operations are represented by purple squares depicting poultry houses and are distributed across the map. Backyard

flocks are represented by green squares and are also distributed

across the map. Wild birds are represented by blue squares and are

clustered near water features. The green squares next to city skylines

represent live-bird markets, swap meets, or other events where a large

number of birds come together for a short period of time, intermingle, and then disperse.

Commercial poultry premises are further broken down into three

networks, which are delineated by the shape (triangle, circle, or

square) at the upper left of the square. Participants decide what type

of poultry each of these networks represents (e.g., broilers, turkeys,

or ducks), based on what makes the most sense for their State.13 Participants also determine how large a typical commercial facility would

be within each network, in terms of number of houses and number of

birds per house. 

Figure 3. Map used for the HPAI table-top exercises

Commercial Premises

Wild Bird Populations

Backyard Birds 

Live Bird Market 
27

For example, in one of the exercises:

• The Triangle network represented broiler operations, each

with four houses of 25,000 birds per house.

• The Square network represented broiler breeder operations,

each with two houses of 10,000 birds per house.

• The Circle network represented layer operations, each with

eight houses of 50,000 birds per house.

Participants also determine the density of other commercial and

backyard premises around those sites shown on the game board.

Finally, they assign the number of birds on a typical backyard farm. In

these ways, the “standard” map used for all of the NAHLN exercises

is adapted to the specific types of bird populations within each State.

Disease spread model

The transmission of disease between premises is determined by a disease spread model. The disease model used is the DADS model (Davis

Animal Disease Simulation) that was developed to study transmission

of foot-and-mouth disease in California and was adapted within CNA

to model spread of disease in poultry. The general locations of the

premises on the board are fed into the model, along with HPAI-specific parameters. The model then generates thousands of “adequate

contacts,” where disease will occur if the sender is infected; these contacts are sub-sampled for the disease spread cards. 

The disease transmissions in the model are stochastic—that is, they

have a random component but certain transmissions have a greater

chance of occurring than others. All things being equal, the disease

has a greater chance of spreading to closer premises than to those farther away. It also is more likely to spread to other premises of the same

type (backyard, commercial, or wild bird). If the disease is on commercial premises, it is more likely to spread to other premises within

the same network. 

13. Some States do not have sufficient commercial poultry for multiple networks. In those cases, the game proceeded with fewer networks.
28

Laboratory representation

Laboratory components depict the process to receive, test, and transmit diagnostic samples (figure 4). Samples collected from premises

are represented by colored disks (e.g. purple for routine samples;

yellow for swab samples, red for blood samples, and black for carcasses). Once samples have been collected, laboratory personnel

assign and prioritize them. Players can request resources to augment

capacity, and/or they can decide to send some samples to another

laboratory for testing.

For example, exercise participants must first define what type and

number of samples are being sent to the laboratory. Once a group of

samples has been collected from the field, they are placed on the

board that says “Receiving,” and then assigned to a laboratory unit. If

those samples are later sent to NVSL for confirmatory testing, they

will be placed on the “In Transit” board for a short time, and then

transferred to the NVSL board. 

Figure 4. Representation of laboratory samples and assignments in the HPAI exercise.

Receiving NAHLN Lab In Transit NVSL

swabs blood

carcasses routine

Receiving NAHLN Lab In Transit NVSL

swabs blood

carcasses routine
29

Response teams

This game includes a simplified sequence of actions to eradicate

HPAI virus from infected premises. These steps are as follows:

• Quarantine a location that has birds with clinical signs.

• Use laboratory testing to diagnose the disease.

• Establish an ICP, as described by that State’s HPAI response plan.

• Depopulate and dispose of the birds, and then disinfect the

premises (3D).14

Because each of these steps requires different expertise—and, potentially, different personnel and equipment—the steps are represented

by separate teams and actions.

Accordingly, exercise players can use the following response teams to

eradicate the disease:

• Quarantine & Tracing teams. These teams represent the personnel, such as the foreign animal disease diagnostician

(FADD), and the resources required to quarantine, begin

trace-outs, and collect samples at an infected location.

• Diagnostic teams. These teams represent the personnel and

resources required to conduct diagnostic testing on samples

collected from an infected or susceptible location. Responsibilities could include collecting samples from the birds, packaging and shipping those samples, receiving and logging the

samples, conducting laboratory testing, and then reporting the

results.

• Depopulation, Disposal, and Disinfection (3D) teams. These

teams represent the personnel and resources required to

depopulate affected birds, dispose of the carcasses, and clean

and disinfect the infected or susceptible location.

14. Other response steps, such as enforcing movement control and conducting appraisal, are not included as separate response steps in the

NAHLN version of the exercise. 
30

• Surveillance teams. These teams represent the personnel and

resources required to conduct area surveillance by collecting

samples from locations that are presumed to be uninfected.

These teams are represented by team markers that could move

around the game board. Players decide which teams they will assign

to the field, or to the laboratory, during each turn of the game.

Status markers

Status markers are placed on the game board to indicate whether

those premises have:

• Birds with clinical signs for avian influenza

• Been quarantined

• Birds that have been diagnosed with avian influenza

• Been depopulated and decontaminated.

In this way, the game board with status markers is intended to represent a local area map that might be found in an incident command

post (ICP) and the markings that responders would make to indicate

infected locations. Status markers are updated following a report of

new disease spread, of new laboratory results, and/or of actions of

field teams.

Sequence of play

The sequence of play during the exercise is intended to represent the

daily “battle rhythm,” or operational cycle, of an ICP of an emergency

operations center (figure 5). It is roughly broken out into three

phases: a situation update, operations (field and laboratory), and

incident action planning. Each turn of the game represents one day

of the exercise scenario. 

Accordingly, each new day begins with a situation update. Participants are given reports of new clinical signs, new laboratory results,

and other findings or events that may influence the HPAI response

operations. Following that is an operations phase, where participants

update the map based on the information provided in the situation
31

update. For example, participants may place new status markers on

the map to indicate which premises have now reported birds with

clinical signs for avian influenza. They may also decide where, and

how, to conduct response operations (such as quarantine or 3D) by

deploying new teams and carrying out their corresponding response

operations. 

Surveillance teams may collect laboratory samples, which the laboratory then receives for testing. At this point, laboratory representatives

may assign those samples to the appropriate laboratory units. If there

are any overflow samples, participants then have the option of deferring testing or shipping those samples to other laboratories. 

Figure 5. Sequence of play for the HPAI exercise

1.

Advance the

turn marker

3. Draw 

event cards

2. Report lab 

Results –and–

Report new

clinical signs

4. Deploy new

field teams

Retrain or stage

unused teams

5. Response 

operations

update 

the map

8. 

Select 

new teams

6. Collect 

samples

7. Assign 

samples

Update the 

map

1.

Advance the

turn marker

3. Draw 

event cards

2. Report lab 

Results –and–

Report new

clinical signs

4. Deploy new

field teams

Retrain or stage

unused teams

5. Response 

operations

update 

the map

8. 

Select 

new teams

6. Collect 

samples

7. Assign 

samples

Update the 

map
32

During the final phase of each day, exercise participants plan for

additional resources that will be required for subsequent days, based

on what they observe on the exercise map.

Exercise play continues until the time allotted for each NAHLN exercise (usually about 4 hours) has expired. (Most of the exercises

reached at least Day 3 of the scenario, and some progressed several

days further.) Facilitators then conduct a hot-wash review and distribute feedback forms to solicit the participants’ ideas and questions that

were generated by the exercise.
33

Appendix B: Lessons learned about laboratory 

operations

A focal point for each exercise, and for the entire program, was the

examination of laboratory operations, including what steps the laboratory would take to complete outbreak testing and when those testing requests might exceed the lab’s capacity. The high level of

participation among NAHLN laboratories generated useful insights

and lessons about laboratory emergency response. Many of the laboratory staff members had worked through animal disease outbreaks,

and they added their experience to the exercise discussions. 

In our review and analysis of outcomes from each exercise, we identified several overarching themes in the discussions about laboratory

operations. These themes include:

• Laboratory capacity

• Supplies and reagents

• Bio-security.

In the sections below, we synthesize the discussion points and lessons

learned that arose during the NAHLN exercise program across each

of these topics. 

Laboratory capacity

Probably the single most frequent question that laboratory personnel

raised throughout this exercise series was whether their lab has sufficient capacity to manage the volume of samples that could be generated during an HPAI outbreak. That question is generally not

answered by a simple “yes” or “no.” It is best answered by examining

the decisions that laboratory personnel will need to make throughout
34

an outbreak. To do so, we separated the disease outbreak into several

decision-making phases:

• The disease is first detected (presumptive phase).

• Preliminary PCR testing is completed, and the extent of the

outbreak is determined (surge phase).

• The disease is contained (recovery phase). 

Below, we use this construct of outbreak phases to synthesize the various

insights, issues, and lessons that arose regarding laboratory capacity.

Presumptive phase

Capacity for HPAI testing varies greatly among the NAHLN laboratories. Given this exercise scenario, we observed that all but four laboratories have capacity to manage the number of samples expected

during the initial couple of days following presumptive diagnosis of

AI. For the most part, therefore, laboratories will be able to manage

the expected number of samples from the initial round of outbreak

surveillance of commercial facilities or dangerous contacts linked to

the index site. 

In the initial phase of the exercise, participants began considering

various ways to ramp up their own capacity. If necessary, most laboratories can ask personnel to work extended shifts to manage these samples along with routine samples that come into the laboratory on a

daily basis. The exceptions could be the laboratories in those States

that have a high volume of commercial poultry and can begin outbreak surveillance sampling very quickly. Those few labs would

quickly need to investigate ways to send overflow samples to other laboratories. 

The limiting factor for capacity at this point of an outbreak is not

likely to be PCR testing capability, since few labs would expect to

receive more samples than would fill a couple of 96-well plates. Nonetheless, exercise participants anticipated that they would become

overwhelmed as outbreak surveillance got underway, due to a variety

of other chokepoints. These include:
35

• Sample accession and data entry

• Equipment or personnel for sample extraction

• Equipment or personnel for sample PCR testing.

• Laboratory space

— Hood space for extracting samples

— BSL-3 space that may be necessary once HPAI is confirmed.

Individual laboratories varied greatly in terms of which factors would

be a chokepoint. For example, some laboratories have plans in place to

facilitate receiving a large number of samples while others have ample

physical space. 

Surge phase

Once an epidemiology investigation begins and outbreak surveillance operations ramp up, the number of samples collected will likely

exceed the capacity of all individual laboratories. However, as we

observed during the exercises, the impact of this can be reduced for

States or regions that have agreements in place to distribute the overflow samples to other laboratories. At this point, laboratory directors

and animal health officials will need to decide on the priorities for

the overflow samples, including outbreak samples, routine samples,

and wildlife samples. 

These decisions varied greatly in the NAHLN exercises. Some labs

opted to delay the testing of routine samples and focus on outbreak

samples. Others chose to continue testing nearly all routine samples

and considered sending overflow outbreak samples to another laboratory. A number of factors contributed to these decisions, including the

lab’s ability to increase its own capacity, its funding sources, and the

possibility that it will need to handle other types of samples, such as

those from wild birds or those for marketability of poultry products.

Increasing capacity

Capacity can be increased by having more personnel and/or more supplies and equipment available to conduct testing. For personnel needs,

exercise players suggested a variety of in-State sources of personnel who
36

might be readily available at this stage of the response. These sources

included:

• University students and faculty

• State public health laboratories

• National Guard Civil Support Teams.

Exercise players were quick to point out that in-State personnel would

only be able to perform tasks that do not require formal proficiency

training. However, in several exercises, participants questioned

whether NVSL could either relax proficiency-training requirements

during an emergency or develop a just-in-time proficiency training

package. Players expected that eventually NAHLN would be activated

and a decision would be made whether proficiency-trained personnel

and certified equipment from other NAHLN labs would be deployed. 

Exercise players also suggested several ways to increase testing

throughput once the disease has been confirmed by NVSL, such as:

• Running only the H5/H7 screening test.

• Running strip tests (e.g., Flu DETECTTM).15

Participants were not aware of any formal policy regarding these alternatives, and suggested that they be considered. 

Handling outbreak samples

All labs reported that their highest priority would be samples from premises with clinical signs. Decisions about outbreak surveillance samples

were more varied, often depending on the lab’s decision for routine

samples. In some instances, participants questioned whether the State

animal health official from another State would agree to accept outbreak surveillance samples from a State with an HPAI outbreak. Other

issues raised were how test results would be reported from an out-of-State

laboratory and how those laboratories would be funded. Each of these

topics is discussed in more detail in separate appendices of this report.

15. Mention of trademark or proprietary product does not constitute a

guarantee or warranty of the product by the USDA and does not imply

its approval to the exclusion of other products that may be suitable.
37

Handling routine samples

The question of how laboratories would handle routine samples had

a greater variety of answers than we expected. The primary driver of

this difference appeared to be the need to preserve the laboratory’s

“market share” of diagnostic testing, both during and after the

outbreak. Routine testing is the main source of funding for many laboratories, particularly those that are part of a university system rather

than part of the State animal health agency. These laboratories were

especially concerned about their own continuity of business needs—

i.e., if they sacrificed their main line of business during an HPAI outbreak, they might not be able to be fully reconstitute it afterwards. 

For our purpose, “routine samples” are defined as samples that arise

from day-to-day animal health diagnostic needs within the State and

not from the HPAI outbreak. These could be samples from private veterinarians for diagnosis of individual animals, from routine surveillance of livestock or food (such as dairy products), or from research

studies. A laboratory has two basic choices: it can continue testing all

of its routine samples while also testing outbreak samples, or it can

send some or all of those samples to one or more other laboratories.

During the exercise program, we observed labs making each of these

choices, as well as including a number of other conditions to help

manage their combined workload while also trying to preserve their

continuity of business:

• Sixty percent of the laboratories chose to keep all of their routine samples and continue testing them in-house.

— Some kept them all for testing at the primary/headquarters

laboratory.

— Others kept them within the State’s laboratory system but

sent them to branch laboratories.

— Others slowed down the number of routine samples

coming in to the laboratory, so as to preserve some capacity

for testing outbreak samples.

• Forty percent of laboratories chose to send out their routine

samples.
38

We’ll discuss each of these choices in further detail below, and provide some examples from the NAHLN exercise program.

Some laboratories chose to keep all of their routine samples. 

As mentioned above, a number of NAHLN laboratory personnel

expressed concern about the need to maintain their funding stream

before, during, and after an HPAI outbreak. Laboratory personnel

felt that the best way to do this was to continue testing as many routine

samples as possible, while also meeting the diagnostic testing needs

of the outbreak response. Laboratories that are part of a university

system usually elected to keep all of their routine samples for in-house

testing. This decision reflects their need to receive payments for individual tests in order to maintain their operating budget.

Examples of the arguments supporting this strategy are:

• “We need to maintain the funding stream for our laboratory. If

we don’t, we’ll lose our market share to commercial labs that

can pick up some of the State’s testing needs.”

• “We’re not sure if the emergency/outbreak funding will pay for

sending routine samples (i.e., not potential HPAI samples) to

other laboratories. We can’t pay for other labs to do this testing

for us.”

• “We’re in a ‘bovine State’ and we can’t drop our routine testing

for cattle and dairy products. Yes, HPAI is very important, but

we also need to preserve our primary industry, which is beef (or

dairy, etc.)” 

Laboratories were also concerned about maintaining the timeliness

of testing routine samples. If routine samples need to be sent to other

labs, even to those within the same State, some private practitioners

and commercial operators will need to accept a delay in receiving test

results.

NAHLN laboratories that are part of an in-State laboratory network

nearly always elected to send routine samples to branch laboratories.

In this way, the laboratory that is NAHLN-certified for HPAI testing

(usually the primary, or main, laboratory) would receive all of the
39

outbreak samples, while routine samples for other diagnostic testing,

such as for serology, would be diverted to a designated branch lab.

Exercise participants gave a number of arguments to support this

strategy, such as:

• “We can shuffle the workload within our State laboratory system

and meet all of the testing needs.”

• “We’ll still be able to follow our State’s protocols, keep the funding for all types of tests, and serve the needs of our animal

health officials and industry with direct communication and

timely test results.”

Further, personnel, and even equipment, from within the laboratory

system may also be shuffled to different locations in order to accommodate these plans.

Some States have a single animal diagnostic laboratory, and therefore

do not have the option of sending routine samples to branch labs. An

alternative decision was to reduce the number of incoming routine

samples while the lab was also confronted with outbreak testing.

During the exercises, lab personnel identified several methods for

reducing the number of routine samples that must be tested concurrently with outbreak samples. For example, some said:

• “We’ll test the high-priority routine samples now and we’ll

freeze the rest. We’ll test those later (after the outbreak workload has diminished).”

• “The number of routine samples will be decreased anyway,

because we won’t be conducting as much routine surveillance

if birds aren’t moving (around the State).”

• “We’ll communicate with the State veterinary medical association, and other practitioner groups, about holding off on sending us samples until the outbreak is finished.”

Exercise participants noted that with this strategy the laboratory could

still get paid for doing the routine testing, even if it occurred after the

peak of the outbreak. They could also better manage and maintain the

lab’s workload. As the outbreak testing needs decrease, the laboratory

could begin taking some of the routine samples from the freezer. This
40

option would allow the laboratory to maintain an increased operational tempo for staffing and use of equipment, rather than being subjected to daily dips and rises in the number of samples.

Some laboratories chose to send routine samples to other NAHLN labs. 

In contrast, some laboratories would choose to send out their routine

samples—not to branch labs, but to laboratories in neighboring

States. A number of arguments supported this strategy, such as:

• “All of the outbreak samples should be handled by one lab—

our State lab—if at all possible. This is best for scientific and

political reasons.”

• “We just don’t have the capacity to do everything (outbreak and

routine samples). The delay that results from sending samples

to others makes more sense for routine samples than for outbreak samples.”

• “It makes more sense to send routine samples across State lines

than to send potential HPAI samples.”

Most often, the laboratories that chose this strategy already have

MOUs in place with other labs. They would not necessarily rely on

NAHLN to identify labs to receive the routine samples, but would

instead reach out first to neighboring labs with which they already

have agreements. Also, some laboratory personnel knew that certain

neighboring labs use the same LIMS database. They would want to

send samples to those labs because the results could be electronically

linked and thus more easily reported to animal health officials. However, it is possible that the lab in the neighboring State will also see an

increase in testing samples from facilities that are trying to show they

are disease-free. This will need to be considered when developing the

strategy for managing overflow samples.

While the variety of strategies for handling routine samples during an

HPAI outbreak was somewhat unexpected, the arguments were reasonable for each lab’s individual situation. This reflects the diversity

among the laboratories that are part of the NAHLN. It also presents

a number of issues for officials within APHIS-VS about how best to

handle the simultaneous needs for routine and outbreak testing. 
41

Handling wildlife samples

Wild bird samples were a wildcard during the exercises. Most of the

labs conduct diagnostic testing for routine wild-bird surveillance,

which is often seasonal because of migratory patterns of the wild

birds. In some instances, wild birds can account for several hundred

PCR tests a day, though only for a limited time each year. If the HPAI

outbreak occurred at the same time as an increase in wild-bird testing,

the lab could get overwhelmed much more quickly.

The solution most often mentioned for handling wildlife samples in

addition to outbreak samples was to identify an alternative test site.

This would help preserve the State animal health laboratory’s capacity for testing of higher-priority samples. Reportedly, USDA-APHIS

Wildlife Services has agreements with all NAHLN labs and could send

those samples elsewhere if requested. In several exercises, players suggested that these wild-bird samples could be re-directed to another

lab at the request of State animal health officials.16

Exercise participants also suggested that wild-bird samples could be

sent to the National Wildlife Health Center (NWHC) in Madison, Wisconsin. However, NWHC representatives who participated in the

NAHLN exercise program noted that this would require coordination

between two Federal agencies (DOI and USDA) and possibly the sharing of emergency funds for outbreak testing. The issue of how, and

whether, the NWHC could assist with laboratory testing in an HPAI

outbreak among commercial poultry was not fully resolved during the

exercises.

Laboratory funding

Maintaining a funding stream is a predominant concern for most of

the NAHLN laboratories that are associated with a university. Compared to laboratories operated by State departments of agriculture,

16. Wild bird submissions to the NAHLN would have to continue, as

required by existing agreements in place with all 50 states. Simply prioritizing poultry samples over wild bird samples could affect these existing agreements and relationships. Therefore, the wild bird component

would likely cause a greater impact on laboratory capabilities than was

discussed during individual exercises.
42

university labs have more difficulty accommodating the expected

volume of samples without clear funding arrangements. Exercise participants from these laboratories said they would first look to the State

animal health agency to provide supplemental funding until the Federal response was in place, but they were uncertain how this would

work and whether it was feasible. They generally agreed that a declaration by the Governor would be extremely helpful in arranging for

supplemental funding. 

Participants also questioned whether outbreak (i.e., “emergency”)

funding could be used to pay for having other labs conduct routine

tests for the State that is affected by an HPAI outbreak, or the

increased costs that might result from shuffling workload, personnel,

and equipment between branch laboratories within the same State.

Recovery phase

The number of diagnostic tests required to prove that an area is “free”

of disease far exceeds the number required (only one test) to prove

that the virus is present. As we observed after the exotic Newcastle disease outbreak in 2002–03, laboratories will have an increased workload for diagnostic testing long after the disease is contained. As

surveillance continues past the point of finding new disease cases, the

laboratory will be involved with “negativity” testing so that poultry

farms can repopulate and recover. 

Federal and State animal health agencies should consider the

extended laboratory response time when planning for resource allocation and emergency funding. Even if the laboratory is well integrated with the incident command system, its high work load may

continue after the ICP has shut down. It may face a challenge in

ensuring that funding is in place for personnel and supplies to support the extended testing.

The NAHLN tabletop exercises focused on the first few days of an

HPAI outbreak, and spent less time on recovery issues. Still, in most

of the exercises, participants raised issues about laboratory testing for

marketability and proof of negativity, and concerns about the laboratory maintaining its own “market share.” 
43

For example, in one exercise, a poultry federation representative

inquired about conducting marketability testing for egg-layer operations in areas of the State that were not (yet) affected by the outbreak.

Could the NAHLN laboratory receive samples from these farms,

which were presumed to be negative for AI, so that they could

continue marketing table eggs? If so, how often could/should those

farms submit samples? Quick calculations during this exercise suggested that the marketability testing could eventually overwhelm the

capacity of the entire NAHLN network. This raised concerns over the

delicate balance of needing to eradicate the disease while also preserving business continuity.

A number of laboratory directors expressed concern over maintaining their own lab’s business continuity. If they had to re-direct routine

samples during an outbreak, would they regain those opportunities

afterwards? Overall, it became clear that laboratories need to be

included in continuity of business planning, both for the labs’ support to industry and for the labs’ own recovery efforts.

Laboratory supplies and reagents

During the exercises, laboratory representatives frequently stated

that a primary concern would be maintaining sufficient amounts of

supplies and reagents for PCR testing. In almost all circumstances,

laboratory staff would inventory their supplies on Day 2 at the latest

(and more often on Day 1 after obtaining the presumptive positive

PCR result). They would order any necessary supplies and reagents,

based on estimates of the expected number of samples provided from

response personnel. The labs would continue to monitor their supplies and reagents throughout the outbreak response.

Most labs are constrained in some fashion by university or State regulations that limit the amount of supplies and reagents they can purchase at any given time. Such constraints would be particularly

significant in the early days of the response, when the lab’s workload

is rapidly increasing but the response operations have not progressed

to the point where a State or USDA emergency has been declared

(which would ease spending constraints). Some labs have developed

work-around solutions, such as having many people in the lab ordering the maximum amount that an individual can request. 
44

Participants made a number of additional suggestions for obtaining

supplies and reagents during the initial days of an HPAI outbreak.

They identified alternative sources of supplies, such as the following:

• The State public health laboratory. Participants cautioned,

however, that the public health lab could be reluctant to provide supplies and reagents if they expect an increase in human

influenza testing of the worried-well once the outbreak is

known to the general public. Also, the reagents used in CDC

(Centers for Disease Control and Prevention) protocols for AI

testing are different from those used in NAHLN protocols, so

they might not be usable for animal health diagnostic testing.

• University laboratories. This suggestion was most common

during exercises involving a university-sponsored laboratory.

Research laboratories may have supplies that could be used for

AI diagnostic testing, though the research programs would

need to be reimbursed.

• NVSL. In several exercises, participants suggested that the courier who delivers the presumptive positive samples to NVSL,

could bring supplies and reagents back to the laboratories.

• Other NAHLN laboratories. This was the default response given

by most laboratories when asked how they could obtain supplies

and reagents in an emergency. During a few exercises, the staff

of one laboratory contacted another laboratory and made

notional arrangements for supplies and reagents to be delivered.

In many exercises, participants also questioned whether laboratory

supplies and reagents were available from the National Veterinary

Stockpile (NVS). Currently, laboratory supplies and reagents are not

available through the NVS program; however, NVS personnel are in

the process of identifying which supplies should be included and how

to maintain them. Exercise participants suggested that the following

items be included in the NVS:

• Swabs

• Plasticware—including PCR testing plates and test tubes

• Virucidal chemicals
45

• PCR kits

• Sample collection kits for field responders

• Strip tests (e.g., Flu DETECTTM). 17

Exercise participants also discussed how PCR kits could be maintained

in the NVS. PCR kits have a limited shelf-life, and a system would have

to be developed whereby the stocks are refreshed on a regular basis.

One common suggestion was for the laboratories to purchase supplies

from NVS on a rotating basis so they can be used for routine testing

rather than discarded. Participants also questioned whether suppliers

could keep up with the expected demand, and suggested that USDA

coordinate with suppliers to conduct a feasibility study. 

Bio-security

Bio-security concerns regarding sample collection and transport were

a significant discussion point in most exercises. Participants noted

that they would develop a transportation route that would, as much

as possible, maintain clean sample-collection methods between

farms. The ICP would have responsibility for developing the samplecollection plan. In some, but not all, instances, the laboratory would

participate in this planning. 

While a number of methods were suggested, most exercises focused

on setting up centralized collection points, where field personnel

would deliver samples from infected and suspected premises. Other

personnel would then collect samples from the central location and

bring them into the laboratory. This set-up would also minimize the

amount of traffic coming to the laboratory and would facilitate additional coordination with the lab about the numbers and types of samples that would be arriving.

In most instances, participants noted they would further limit traffic

flow around the laboratory and restrict access. They would also designate an area for cleaning and disinfection of transport vehicles. This

would be more challenging for some labs, such as those on university

17. Mention of trademark or proprietary product does not constitute a

guarantee or warranty of the product by the USDA and does not imply

its approval to the exclusion of other products that may be suitable.
46

campuses or in densely populated areas. Those participants recognized

that they would need to coordinate with their respective veterinary

schools and campus safety personnel to collaborate on signs, traffic flow,

and the locations of curbside drop points and pressure washing sites. 

In some instances, participants suggested moving the testing to a

more remote area and secure location. They felt that this would alleviate some environmental health and safety concerns the university

might have about potential contamination. It would also eliminate

any need to impose bio-security measures or to limit transportation in

the middle of the campus.

Several of the larger laboratories have the space to set up a separate

receiving area for outbreak samples, but most would use the same

receiving area that they use on a routine basis. Necropsies would be

performed in the same area as routine samples. Participants stated

that it would not be possible to perform necropsies in a hood, as the

dander would foul the ventilation system. 

The initial PCR tests would be done in BSL-2 spaces. However, participants were generally unsure of regulatory requirements for the use

of BSL-2 or BSL-3 spaces once HPAI has been confirmed, especially if

NVSL and CDC determine that testing is too dangerous for a nonBSL-3 facility. Most labs have limited BSL-3 testing and storage capabilities, and some have none. Consequently, participants discussed

several options for handling samples according to BSL-3 protocols.

Some of these options are: 

• Coordinate with NAHLN to send samples to laboratories that

do have BSL-3 capability. 

• Explore strategies to inactivate samples in a biosafety cabinet so

the rest of the testing can be done within BSL-2 spaces.

• Deploy portable BSL-3 laboratories from the National Veterinary Stockpile (provided that this capability is added to the

NVS) or other laboratories to augment capacity. 

The third option was especially appealing to participants from laboratories located on a university campus or in a populated area. They

discussed the use of portable laboratory space as a general solution

for alleviating a number of bio-security concerns.
47

Appendix C: Lessons learned about laboratory– 

field coordination

Often, animal disease exercises don’t fully acknowledge the laboratory component of response operations. This exercise program, with

its objective of examining the integral connections between field

actions and laboratory response, provided an opportunity for field

and regulatory personnel to discuss the field response and identify

where better coordination with the laboratory is required. Also, this

was the first opportunity for many laboratory staff to participate in an

exercise. Thus, the NAHLN exercise program also provided an

opportunity for laboratory personnel to better understand how the

lab connects with the overall response structure. 

In our review and analysis of the outcomes from each exercise, we

identified several overarching themes that arose in discussions about

laboratory–field coordination. These themes include:

• Prioritization of samples for laboratory testing 

• Transport of samples

• Integration of laboratory response into the incident command

structure (ICS). 

In this appendix, we synthesize the discussion points and lessons

learned that arose during the NAHLN exercise program across each

of these topics. 

Prioritization of samples for laboratory testing

Diagnostic samples from sites with new clinical signs were the top priority for laboratory testing in all of the NAHLN exercises. The exercises revealed, however, that the priority of other samples, such as

outbreak surveillance samples from commercial facilities, backyard
48

farms, and wild birds, differed across the States. Participants

appeared to take a number of factors into account when assessing

which samples would be highest priority, and thus be processed first.

These factors included:

• The types of commercial poultry operations that were affected

• The density of commercial facilities in the outbreak area

• Whether the outbreak began in a backyard farm or on a commercial facility 

• The presence and volume of migratory birds (seasonal

variations). 

For example, since egg-layer operations need to move products daily,

those outbreak surveillance samples may be given higher priority

than samples from broiler operations. Also, we noted that States with

a large number of commercial poultry facilities may not begin surveillance of backyard farms until the first round of commercial surveillance has been completed. Closely connected commercial facilities,

such as those that are part of the same network or in close geographic

proximity, may have higher priority than commercial farms that are

farther away.

If the expected number of samples exceeds the laboratory’s capacity,

a prioritization strategy should be established. This strategy will

require coordination between laboratory and field personnel. During

the NAHLN exercises, we observed that laboratory staff were generally reluctant to assume or establish a prioritization strategy on their

own. They would rely on field personnel or animal health officials to

indicate which samples should be tested first, or whether all outbreak

samples should have the same (high) priority. Alternatively, samples

would likely be processed in the order in which they were received at

the laboratory.

In addition, participants recognized that the sample prioritization

strategy needs to align with the laboratory’s requirements for overflow

samples. The strategy that is developed within each State may influence requests that are made for NAHLN assistance. For example, the

unified command may feel that surveillance samples from commercial
49

facilities should be a high priority. However, the lab may feel compelled to complete some of its routine testing before processing outbreak surveillance samples from farms that are presumed to be

negative. If the lab does not have sufficient capacity to do both within

the same day, some samples will need to be delayed or sent to another

laboratory.

Thus, laboratory–field coordination is needed to establish a sampleprioritization strategy for each State. We observed that exercise participants frequently made assumptions about what samples should be

highest priority, but that those assumptions differed among agencies

and among States. In the event that the sample-testing workload does

not exceed a laboratory’s capacity, all of the samples can be handled

in the most timely manner. Nonetheless, it is important that the lab be

a part of the planning and decision process when the sample-prioritization plan is developed. As we further discuss below, integrating laboratory operations into the ICP functions could help accomplish this.

Transport of samples

Since we conducted exercises in locations across the country, we

noticed a wide variety in decisions about how to transport samples.

Local geography was a factor in these plans, as was the distance to a

NAHLN laboratory or to NVSL. In this section, we discuss both of these

transport concerns—shipping samples to NVSL for confirmatory testing and collecting and distributing surveillance samples.

Shipping samples to NVSL

In many exercises, the process of shipping samples to NVSL led to a

lengthy discussion, particularly if participants had decided to start the

exercise scenario on a Friday. Standard protocol is for the laboratory

to send any samples that are presumptive positive to NVSL for confirmatory testing via FedEx. However, many laboratories are located in

rural areas or on university campuses with limited options for late

evening or weekend FedEx service; therefore, the samples might not

be sent until the following workday. In those instances, participants

identified several ways to get samples to NVSL more quickly. These

included:
50

• Driving samples directly to NVSL, which was an option if the

State is in the Midwest and if driving would take about the same

amount of time as shipping by FedEx.

• Flying samples to Ames, IA, on a commercial, charter, or government aircraft.

There is another option for getting high-priority samples to NVSL,

which was discussed at only one of the NAHLN exercises. USDAAPHIS has a contract in place with FedEx, called the White Gloves

service. This contract essentially makes FedEx available anytime/anywhere to pick up a package and deliver it overnight. It is costly, and

USDA-APHIS recommends that it be used only for high-priority samples and/or when there are no other options. The contract is managed through the National Veterinary Stockpile. To use this service,

the State Veterinarian and USDA AVIC need to request it.

Delivery of outbreak surveillance samples to the laboratory

A frequent topic of discussion during the exercises was collection and

delivery of samples to the NAHLN laboratory. Laboratory staff commented that communication from the field staff about the number

and priority of samples to expect, such as a phone call from the ICP,

would assist the laboratory in preparing the extraction processes, and

cut down on the time necessary to run the tests once samples are

received. Further, laboratory participants stressed the importance of

scheduling sample collection and delivery so as to maximize the

number of samples run at a time (so that the samples could be

“batched” for PCR testing). Again, laboratory–field coordination

would be critical for handling samples in the most efficient way.

During several exercises, participants proposed setting up sample collection stations as a means to minimize bio-security concerns. Other

advantages of these stations are that the samples are collected in

batches, and that a courier can call the lab when he/she reaches the

collection station. In addition, some States (such as Alaska, California, and New Mexico) have courier services already established.

These services are especially helpful in large States, and can be shared

with the State department of health, so that samples from remote

areas can be brought to the State laboratories.
51

Another transport concern arises when outbreak samples are sent to

another State for testing. Participants at several laboratories were

unsure of the processes required to send potential HPAI samples

across State lines, including any bio-security requirements that would

need to be made by both the shipping and receiving laboratories.

Though this may be handled in the same way that samples are packaged and shipped to NVSL for confirmatory testing, the timeframe is

important. After the first samples have been confirmed, subsequent

samples may fall under “select agent” rules from the Department of

Homeland Security, which impose further transport and handling

regulations. 

Integrating laboratory response into the incident command 

structure

During the NAHLN exercises, a number of arrangements were mentioned for coordination between the laboratory and the unified command. We grouped these into three categories, listed here with

increasing levels of coordination between the laboratory and the incident command post (ICP).

• The laboratory operates separately from the ICP, and the laboratory director communicates directly with the State animal

health officials and the AVIC, who, in turn, communicate with

the ICP.

• The laboratory designates a staff member to serve as the “laboratory liaison” at the ICP. In this case, either:

— the laboratory director still communicates directly with the

State animal health officials and AVIC, or

— the laboratory liaison communicates directly with the incident commander(s) (who may be the State animal health

official and/or the AVIC). 

• Laboratory operations are fully integrated into the incident

command system by including laboratory response needs in the

Operations, Logistics, Planning, and Administration/Finance

sections of the ICP.
52

Below we discuss each of these coordination levels in further detail

and provide some examples from the NAHLN exercise program.

Many labs operate separately from the ICS

In many of the States that we visited, the HPAI response plan and/or

ICS chart does not directly mention the laboratory. In these cases,

communication between the laboratory and the ICP usually flows

through the State animal health official and/or the AVIC, as shown

in figure 6. For example, the laboratory director communicates

directly with the State animal health official and the AVIC (usually

through conference calls) and then those lead officials communicate

with the ICP. This appears to be a “status quo” arrangement that mirrors communication lines that are in place for day-to-day operations.

However, it may present challenges as the laboratory becomes

involved with outbreak response. 

With this arrangement, the laboratory functions largely as a standalone entity that supports the field response operations. For example,

some exercise participants mentioned that laboratory results would

be faxed to the AVIC’s office, where they would be entered into the

Figure 6. Laboratory functions separated from incident command

Incident 

Command

Plans

Logistics

Operations

Admin / 

Finance

Diagnostic 

Laboratory
53

EMRS database that is used to manage field operations. In another

example, the laboratory director and the State animal health official

would work together to identify which types of samples were highest

priority and should be tested first. The State animal health official

would then discuss this prioritization request with the ICP and relay

it to field responders.

If the lab is mostly separate from the ICS, requests for additional

resources would be made through one of three pathways:

• The laboratory director would make requests for personnel or

other resources through NAHLN.

• The State animal health official would make requests for

resources from other State agencies.

• The State animal health official and AVIC would make requests

for resources from USDA-APHIS (for example, from the NVS).

As a result, this coordination arrangement may require a greater level

of communication between personnel within USDA-APHIS to ensure

that the laboratory’s resource needs are met, because those links are

not as likely to be made within the ICP. For example, the laboratory

director may have a need for additional NAHLN-trained personnel

and personal protective equipment (PPE) for them to wear. These

requests would be made separately if the laboratory director communicates with the NAHLN Coordinator (to request personnel) and the

AVIC communicates wtih the NVS Director (to request PPE). 

Also, if the laboratory is part of a university system, it may not have a

direct link to communicate with other State agencies about its

resource needs and may have to go through the State animal health

official in order to do so. This concern arose in a number of exercises,

with some participants questioning even whether all laboratory personnel would know about the outbreak. Alerts and notification messages that are sent to State agencies, or through the State EOC, may

not automatically reach a university laboratory. Also, branch labs may

not hear about HPAI samples tested at the main laboratory, or personnel in research divisions may not be aware of high-priority diagnostic testing that is taking place. 
54

Some labs identify a connection point between the laboratory and the 

ICP, such as a lab liaison

One lesson that is frequently mentioned from the 2002–03 outbreak

of exotic Newcastle disease (END) in the southwestern United States

is the need for a laboratory liaison to serve in the ICP. During the

END outbreak, the California Animal Health and Food Safety

(CAHFS) laboratory had a staff member work directly with the ICP to

conduct training on sample collection and packaging, to relay laboratory concerns to the incident commanders, and to respond to questions that field responders had about laboratory operations. This

proved to be a useful practice and has been replicated in subsequent

response operations. Several other States have similarly identified this

position in their ICS organization chart for animal disease outbreaks.

In general, States that have conducted a number of animal health

response exercises and/or have had outbreaks of foreign animal diseases are most likely to have designated a “laboratory liaison” who

serves in the ICP and provides a connection point between the field

operations and the laboratory (figure 7). 

Figure 7. Laboratory functions partially integrated with incident command

Incident 

Command

Plans

Logistics

Operations

Admin / 

Finance

Diagnostic 

Laboratory

Laboratory

liaison

Incident 

Command

Plans

Logistics

Operations

Admin / 

Finance

Diagnostic 

Laboratory

Laboratory

liaison
55

The lab liaison usually serves in the Planning section of the ICP and

is a connection point and conduit for information flow between the

laboratory and the ICP. The communications with lead officials can

follow either of two pathways:

• The laboratory director still communicates directly with the

State animal health official and AVIC.

• The laboratory liaison communicates directly with the incident

commander(s) (who may be the State animal health official

and/or the AVIC). 

This coordination arrangement better facilitates a shift in communication from day-to-day situations to an outbreak response. In some

States, the personnel identified to be incident commanders are the

State animal health official and/or the AVIC—in this case the two

pathways would essentially be identical. However, an APHIS incident

management team (IMT) might be called upon to help manage field

operations as the outbreak expands. If the incident command team

changes, the lab liaison may need to work with both the new incident

commander(s) and the lead regulatory officials (State animal health

official and AVIC) in that State. The lab liaison would then communicate directly with the laboratory about changes taking place at the ICP.

With this arrangement, the lab liaison can help establish sampling

and testing priorities more directly with the field responders, by working with the Operations or Planning section chiefs. The operational

cycle (or “battle rhythm”) of the laboratory can also be better

matched to the operational cycle of the ICP. Similarly, the lab liaison

can work with the Operations and Planning sections to design a

sample collection and transport strategy that is better aligned with

laboratory operations and requirements. Other roles and responsibilities discussed during the exercise include training field personnel on

the proper ways to collect samples, and developing a surveillance

plan, which would include route management, bio-security, handling,

documentation, and transportation of samples.

It is also important to recognize that the lab liaison does not need to be

someone from the laboratory. In fact, most laboratories will need all

their personnel to manage the influx of samples and the accompanying
56

data management requirements. That said, the lab liaison should be

someone who has a working knowledge of laboratory operations and is

able to effectively communicate laboratory requirements to the ICP. If

the lab liaison is filled by someone from the laboratory staff, he/she

should be familiar with ICS (and probably has received some formal ICS

training) and with the State AI response plan.

For those States that use this response management architecture, participants still expected that the lab would be responsible for maintaining its resource requirements, including ordering laboratory

supplies, PCR kits, and personal protective equipment, as well as

coordinating with NAHLN and other laboratories for additional personnel. However, as the exercise progressed, players recognized that

there would be some benefit to having the laboratory more fully integrated into the ICS.

A few labs are more fully integrated into the ICS

Only a handful of States mentioned that the ICP would be primarily

responsible for handling resource requests for the laboratory. This

was generally seen as a benefit to laboratory personnel: those who are

responsible for testing could continue with that work in the face of an

outbreak and wouldn’t need to spend time ordering reagents or supplies. However, this arrangement requires a greater level of coordination between the laboratory and the ICP.

With this coordination arrangement, the laboratory operations are

potentially connected with all sections of the ICP, and not just with a

single seat in the Planning section (figure 8). For example, the laboratory can work with the ICP’s:

• Planning section, for epidemiology and surveillance strategies

• Operations section, for collecting samples and setting priorities

for which samples to send to other laboratories

• Logistics section, for working out sample transport and packaging requirements

• Administration and Finance section, for tracking laboratory

expenses and resource requests.
57

This coordination arrangement may require ICP personnel, such as

those as in the Logistics section, to communicate directly with

NAHLN for resource ordering. They may not be aware of the

resources that are available from NAHLN or NVSL, or of the constraints associated with scientific testing. They may also be more likely

to consider other sources, such as EMAC (Emergency Management

Assistance Compact) agreements or in-State options, such as National

Guard Civil Support Teams, to fulfill the requests. For example, participants in a couple of exercises mentioned the possibility of requesting additional laboratory resources from neighboring States through

an EMAC agreement. It was unclear how, or whether, those requests

would be coordinated with NAHLN. 

Similarly, ICP personnel may be involved with tracking laboratory

expenses, to include reimbursement requests to be submitted after

the situation has been declared to be an emergency. This may help the

laboratory regain some of its expenses for handling outbreak samples,

but will require that ICP personnel understand how to document

Figure 8. Laboratory functions fully integrated with incident command

Incident 

Command

Plans

Logistics

Operations

Admin / 

Finance

Diagnostic 

Laboratory

Laboratory

liaison

Surveillance 

planning

Laboratory 

resources

Laboratory 

funding

Laboratory 

results

Incident 

Command

Plans

Logistics

Operations

Admin / 

Finance

Diagnostic 

Laboratory

Laboratory

liaison

Surveillance 

planning

Laboratory 

resources

Laboratory 

funding

Laboratory 

results
58

laboratory expenditures. To continue with an example mentioned

previously, a request for NAHLN-trained personnel and for their PPE

could be coordinated in the ICP rather than at USDA-APHIS. This

would also require the State animal health official to include expected

laboratory expenses in the budget that is put together for managing

the outbreak response. Therefore the lab directors should coordinate

with their respective State animal health officials to develop an emergency budget for laboratory expenses prior to an outbreak situation.

One suggestion was for the lab to develop a tiered-type budget with different activation levels depending on the severity of the outbreak. 

Players in several exercises identified two additional obstacles to more

fully integrating the lab into the ICS architecture:

• The National Incident Management System (NIMS) requires a

resource-typing system, to ensure that the requested resources

match the required resources. At this time, there is no system

of national standards in place for animal health laboratory

resources. 

• The interface between NIMS and resource providers, such as

NAHLN and NVS, is still in development. A significant amount

of education would need to take place in order to ensure that

the two structures understand each other.

Although none of the laboratories that we visited has full integration

with the ICP, many are on a path to doing so. A few States have also

developed a separate ICS organizational chart for the laboratory, with

identified connection points for how that chart fits within the overall

ICS. Reportedly, this has worked well, and might be a better arrangement for university laboratories that are not as easily integrated into

the State’s emergency response system. 
59

Appendix D: Lessons learned about notification 

and communication

Throughout the NAHLN exercise program, participants recognized

opportunities to increase their effectiveness by calling on the support

of response partners when necessary and appropriate. They also created new relationships among organizations and levels of government. To reach these objectives, the game design emphasized the

need for communication, timely notification, and information sharing between the laboratory and the field, and among all response

partners. 

In our review and analysis of the outcomes from each exercise, we

identified several overarching themes that arose in discussions about

notification and communication. These themes include:

• Activation of NAHLN

• Information management

• Interagency support.

In this appendix, we synthesize the discussion points and lessons

learned that arose during the NAHLN exercise program across each

of these topics. 

Activation of NAHLN

One of the analysis threads that we looked at during the exercise program was the “activation” of NAHLN. This is currently defined as: 

The implementation of the state of readiness and the commitment to perform diagnostic tests up to the capacity of

the laboratory as required by Federal and State officials to

meet the needs for diagnostic services to contain, control,

eradicate and recover from a disease event.
60

The NAHLN activation plan is written with foot and mouth disease

(FMD) in mind, and assumes that NVSL will diagnose the first case

since NAHLN laboratories do not have the reagents and/or authority

to fully test for FMD. With avian influenza, a NAHLN lab will be able

to make a presumptive diagnosis of whether the AI virus is present,

and whether it is type H5 or H7. State officials may take response

actions at this point (before NVSL has confirmed the diagnosis),

which could include implementing the laboratory’s “state of readiness” for further diagnostic testing. 

Indeed, in almost all of the exercises in this program, we heard participants say they would take a number of steps following presumptive

diagnosis, such as to conduct inventories of supplies and reagents,

develop staffing plans, and enhance their bio-security measures. In

some instances, commercial facilities would even begin 3D operations, and some States can provide indemnity funding based on a presumptive positive diagnosis. 

All of these steps may take place before NVSL receives samples from

the index case and before any other NAHLN laboratories are aware

of the potential outbreak. Thus, it seems inaccurate to say that the

entire laboratory network would be activated at this point, even

though one of the NAHLN laboratories has implemented its state of

readiness to perform diagnostic tests up to its own capacity.

Instead, during the exercise program we identified three other possible definitions of NAHLN activation that could apply shortly after an

individual laboratory reaches a presumptive diagnosis of AI. These

definitions are as follows: 

• NVSL delegates authority to one of the NAHLN labs to conduct

outbreak surveillance testing for samples within the identified

outbreak area (after the first case is confirmed by NVSL for

each new outbreak area). This means that new samples originating from the outbreak zone would be considered positive if

the results of the screening tests conducted at the NAHLN laboratory are positive. This authority will most likely be delegated

to the laboratory that handled the initial/index samples from

the outbreak. In this way, NAHLN is activated because NVSL
61

has delegated authority to a member laboratory, and may put

other laboratories on alert for future activation.

• The NAHLN Coordinator designates other NAHLN labs to

assist the laboratory that is primarily responsible for handling

samples from the identified outbreak area. This means that

other NAHLN laboratories implement their own state of readiness to perform diagnostic testing on outbreak samples. In this

way, the network is activated because additional member laboratories will help meet Federal and State needs for diagnostic

services.

• The NAHLN Coordinator requests personnel from other

member laboratories to help a lab that requires assistance. This

means that personnel who are trained and proficiency-tested in

NAHLN-approved methods for HPAI testing will travel to

another laboratory to increase its throughput capacity. In this

way, the network is activated because NAHLN is relying on the

breadth of trained personnel among all member laboratories.

The first stage described above further extends, and perhaps provides

a more concrete definition for, what it means when an individual lab

is activated. But does it also mean that the network is activated? The

other definitions listed above involve more than just a single NAHLN

laboratory. However, the second and third possible definitions did

not always manifest during exercise play. In some cases, the primary

laboratory wasn’t overwhelmed, and didn’t need to request assistance

for diagnostic testing. In most cases, lab directors chose to take one

action or the other, but generally not both. 

For example, not all labs can provide work space for additional personnel because of facility limitations. Instead, the lab director could

choose to send samples to another laboratory. By doing so, the primary laboratory could preserve its capacity for handling routine samples along with outbreak samples. Alternatively, some labs have

sufficient space for additional personnel and would request those

staff from NAHLN. By doing so, they could keep all of the outbreak

samples within the State and at the same laboratory. 
62

A fourth option also arose during the HPAI exercises. Some laboratories would elect to keep the outbreak samples but send out some of

their routine testing (this is discussed in more detail in Appendix B).

This option doesn’t appear to fit the definition of NAHLN activation,

which is intended to “meet the needs for diagnostic services to contain, control, eradicate and recover from a disease event.” Instead,

the NAHLN activation plan obligates member laboratories to individually address “managing the routine diagnostic case load or re-directing it to another laboratory.” Thus, it doesn’t appear that NAHLN

activation is intended to apply to the case of a member laboratory

requesting NAHLN assistance with routine testing while the requesting laboratory conducts the outbreak testing. However, 40 percent of

the laboratories that participated in this exercise program would have

chosen this option. This raises a question of whether NAHLN should

assist member laboratories with finding alternate means for completing routine testing during an outbreak.

Another point of confusion during the exercise program was whether

NAHLN would provide funding to a member laboratory once it is formally activated. Exercise participants assumed that NAHLN would

pay travel and salary expenses for additional personnel, and that the

primary laboratory would continue to receive funding for processing

the samples, in order to help pay for supplies and facility costs. Alternatively, participants assumed that NAHLN would pay for sending the

outbreak samples to other member laboratories. Further, participants

were unclear as to who would provide funding to laboratories to run

routine samples that have to be sent out to other labs.

Information management

When samples arrive at a laboratory, they are assigned a unique accession number and entered into the laboratory information management system (LIMS). However, the accession number does not

correspond with the USDA premises identification (PremID)

number coded into the USDA Emergency Management Response

System (EMRS), which is used to track information about field operations. Therefore, the only way to correlate samples between the laboratory and the field is typically through other information on the

label, such as the name or address, which can be difficult to read and
63

transcribe. Further, the PremID corresponds only to the address and

therefore may not be specific enough if samples are collected from

multiple houses at the same location. 

Exercise participants suggested several common solutions to better

correlate premises identification with their laboratory results. These

included:

• Developing a barcoding system to record the laboratory accession number, the address, the USDA PremID and the laboratory’s identification number. This would require the laboratory

or State animal health agency to maintain a stock of sample collection kits with labels that are pre-printed with accession numbers that are already assigned. Those kits would then be

distributed to field personnel. Finally, while most laboratories

already use a barcoding system for wild-bird samples, many

field personnel do not have barcoding equipment and would

require training on the systems prior to use.

• Revising LIMS databases. Participants also agreed that their

LIMS databases need to be revised, to include a section to be

filled out during an emergency. It would include the address,

PremID, and GPS coordinates for the specific location at which

samples were collected. 

Currently all NAHLN laboratories have the potential to link their

LIMS database with the NAHLN repository, either via web-based

entry or electronic messaging. However, the NAHLN repository

cannot interface electronically with EMRS. Therefore, during an outbreak the NAHLN laboratories would need to relay laboratory results

to the unified command team via an alternative protocol set up just

for the emergency, such as by phone call or fax. Laboratory results

would then be entered by hand into EMRS. It is our understanding

that NAHLN and USDA-APHIS personnel are already developing

solutions for this issue.

Finally, participants were unclear as to the information management

chain if outbreak samples need to be sent to an out-of-State NAHLN

laboratory. There was no consensus on whether samples in this situation would be accessioned first at the laboratory in the State with the
64

outbreak and then sent to another lab, or whether they would be sent

directly from the field to the out-of-State lab. There was general

agreement that it would be more efficient to send samples directly

from the field, but in some exercises there was concern as to whether

those samples would be packaged and shipped properly. All agreed

that this decision would be made by State and Federal regulatory officials at the time of the emergency. 

Further, once the samples have been sent to an out-of-State laboratory,

participants were unclear as to what process would be implemented to

send test results back. Most participants agreed that once an ICP was

established, results for outbreak samples would be sent there. However, it was unclear whether those results would also be sent to regulatory officials in the State that did the testing. This is further

complicated when routine samples are sent out-of-State for testing. 

Some participants indicated their preference for sending samples to

other laboratories that use the same LIMS database. However, they

were unsure whether they would have authority to choose which State

to send samples to, or whether NAHLN would be responsible for that

decision. For example, officials in Indiana said they prefer to send

overflow outbreak samples to Kentucky, since both States use the

same LIMS database. However, the question was raised whether

NAHLN would choose to send the samples to a different State

because the Kentucky laboratory might start receiving an increased

number of surveillance samples as well. 

Interagency support

Officials from a variety of government and private agencies, at the

Federal, State, and local levels, participated in the NAHLN exercise

program. Interagency representation depended largely on whom the

exercise hosts had invited to participate. In some cases, the exercise

included only participants from the State animal health agency,

USDA, and the NAHLN laboratory. In most cases, the exercise

included participants from other State-level agencies, such as the:

• State department of health

• State emergency management agency
65

• State department of natural resources/conservation/wildlife.

• State poultry federation (or industry representatives).18

Any additional Federal personnel present usually represented the

USDA-APHIS Division of Wildlife Services. One of the exercises (in

Wisconsin) included participants from several additional Federal

agencies, including the Department of the Interior (DOI), Federal

Bureau of Investigation (FBI), U.S. Agency for International Development (USAID), and Food and Drug Administration (FDA). 

In this section we describe the types of questions and discussion

points that arose when different agencies participated in the exercise,

and the primary contributions that those agencies offered for HPAI

eradication and recovery. 

Department of health

Representatives from the State and/or local department of health

(DOH) participated in 25 out of the 38 NAHLN exercises. DOH officials tended to raise such exercise questions as:

• When will our agency be notified?

• What steps are taken at a commercial poultry farm to identify,

investigate, and eradicate the disease?

• How can we take part in field investigations to:

— collect epidemiological data?

— query bird owners about the health of people in their

household?

— protect the health and safety of animal health responders?

The exercise served to educate many DOH representatives on commercial poultry operations and the bio-security measures that are

already in place to protect birds, and farm personnel, from illness. We

18. While a poultry federation is not an State agency per se, these organizations are included here because they represent poultry operators across

the entire State.
66

observed DOH officials asking industry personnel a number of questions. The opportunity for this interaction was frequently noted on

participants’ feedback forms as a benefit of attending the exercise.

DOH officials offered several types of assistance for HPAI eradication

and recovery, such as:

• Monitoring the health of field responders and laboratory

personnel

• Providing anti-viral medications for prophylaxis of field

responders and laboratory personnel

• Establishing call-in lines to answer questions from the general

public

• Providing epidemiologists

• Providing personnel and supplies to assist the animal health

laboratory.

Animal health officials usually accepted the offers of assistance with

outbreak epidemiology, public communication, and anti-viral medications. Public health personnel often volunteered assistance in

terms of reagents or trained personnel, but those resources would not

meet NAHLN requirements. For example, CDC protocols for AI testing focus only on the strains that are considered most likely to spread

to humans. USDA protocols focus on strains that must be reported to

trading partners. Also, a number of animal health officials noted that

the public health laboratories in their States refuse to accept any

animal samples. 

In some cases, the State animal health laboratory and public health

laboratory share the same building, or are nearby. In these situations,

participants often noted that several personnel in both laboratories

had been cross-trained and thus could assist in the HPAI diagnostic

testing.

Emergency management agency

Seven out of the 38 exercises included representatives from the State

emergency management agency (EMA). In some cases, the exercise
67

served to increase the awareness of emergency management officials

about an animal health outbreak. At other exercises, it was evident

that the EMA regularly partners with the animal health agency. When

emergency management officials were present, they tended to raise

such questions as:

• When will our agency be notified?

• How can we (the EMA) help coordinate the HPAI response? 

• What resources will the animal health agencies want to request

from other State agencies?

EMA officials offered to help coordinate the response, either through

the State EOC or by being part of the ICP that was established by the

animal health agency. They felt the EMA should be a conduit for

requests for assistance (RFAs) from other State agencies. For example, if the animal health responders needed trucks to haul 3D supplies, the EMA could coordinate a mission assignment to the State

department of transportation. The EMA officials would know what

other types of resources were available and how to access them.

In a few exercises, State EMA officials suggested using Emergency

Management Assistance Compact (EMAC) agreements with other

States as a means of obtaining additional resources. For example,

they inquired about getting the following assets through an EMAC:

• Laboratory supplies, such as plasticware or reagents

• Personnel to assist in the laboratory

• Foaming machines for depopulation.

In turn, this raised questions about how NAHLN requirements would

be met for the requested laboratory resources. Most of the EMA officials were not familiar with NAHLN. As a result, they might not

understand the need to find additional laboratory staff that are

trained and proficiency-tested in NAHLN protocols for AI testing. In

Appendix C, we discussed how these resource requests might be handled if the EOC or ICP were to communicate directly with NAHLN

leadership.
68

Department of natural resources / wildlife

Representatives from the State and/or Federal agency responsible for

wild birds participated in 19 out of the 38 exercises. These participants were much more familiar with HPAI response than either the

DOH or EMA participants, because of the ongoing nationwide surveillance of wild birds for AI. They were also trained in handling birds

and offered assistance in a variety of ways, such as:

• Collecting samples from live birds

• Assisting with depopulation of an affected flock

• Hazing wild birds away from commercial poultry farms

• Monitoring the health of wild birds in the outbreak area.

Animal health officials most often accepted the offers of assistance

from wildlife agency participants. Some noted that wildlife specialists

might not be able to assist with mass depopulation of commercial

poultry because they are trained to handle individual birds, but that

they could be very helpful with handling backyard flocks or game

birds. Similarly, their training and experience with collecting samples

from wild birds could be used to expand the surveillance efforts. 

In some cases, wildlife officials noted that they would increase surveillance sampling among wild birds in the outbreak area as a result of

the HPAI diagnosis among commercial poultry. This raised questions

about how those extra samples would be tested—a topic that is discussed in more detail in Appendix B. 

State poultry federation

Fourteen out of the 38 exercises included representatives from a

State poultry federation, or other representatives from the poultry

industry. Typically the poultry industry took an active role in the field

response as well as incident management. In response to an outbreak,

commercial operators would enact enhanced bio-security measures.

In some States, industry personnel are also responsible for collecting

surveillance samples from their facilities and delivering them to the

laboratory. When industry officials were present, they tended to raise

such questions as:
69

• How should we coordinate to get samples to the laboratory?

• What types of samples are most appropriate for laboratory

testing?

• How can we get additional supplies?

Industry representatives also provided information to other exercise

participants about general practices within their industry, such as biosecurity measures, the roles of company veterinarians, and how they

would manage disease eradication within their own facilities. They

stressed the importance of timely test results for decisions they would

make within the industry network. Many had surveillance plans

already in place, or suggested them during the exercise, to help the

industry maintain its continuity of business as much as possible.

Interagency notification

Overall, interagency participants were most concerned about when

they would be notified of the situation. We found wide differences in

plans to notify other State agencies about the potential HPAI outbreak, and in the times at which that communication would take

place. Notification is most likely to occur at one of three points in the

outbreak response:

• Following the presumptive diagnosis of AI at the NAHLN laboratory, because the other agencies are included in a standard

notification chain that is already in place 

• When animal health responders want to tap into State

resources, such as a Governor’s jet for taking samples to NVSL

or anti-viral medications for prophylaxis of laboratory staff

• After confirmation of HPAI from NVSL and shortly before any

public announcement is made by USDA.

Most officials wanted to be notified as soon as possible, so they would

be prepared to manage the impact of the outbreak on their own

agency responsibilities. For example, 

• DOH officials wanted to be notified as soon as possible, because

they felt that this was necessary to protect public health. They
70

also wanted to be able to be prepared to handle phone calls and

other inquiries from the general public about the possibility of

human influenza resulting from the AI outbreak. 

• EMA officials wanted to be notified so that they could respond

to RFAs from other State agencies as quickly as possible.

• Wildlife officials wanted to be notified as soon as possible so

that they could increase surveillance of wild birds in the vicinity

of the index site.

• Industry officials wanted to be notified as quickly as possible so

that they could increase bio-security measures at all facilities

sharing the same network and begin increased surveillance.

When animal health officials said notification of other State agencies

would be delayed, we observed a number of reasons for doing so.

These reasons included concerns that: 

• The agency is not allowed to release information about positive

test results until it is confirmed by NVSL.

• Information would be released to the general public and generate fear of a pandemic influenza outbreak.

• Other agency priorities would interfere with, or put restrictions

on, the animal health response.

Overall, the exercise program helped laboratory staff and State

animal health officials become more aware of support that could be

available from interagency partners. These contributions, and information on how to officially request them, can be included in emergency response plans. USDA-APHIS should be aware that notification

of State-level interagency partners will occur at different times, based

on plans that are in place in each State. 
71

Appendix E: Summary tables

In total, we conducted 38 exercises from February to October 2008.

Overall, more than 700 participants, representing 45 States and

numerous Federal agencies, participated in the exercise program.

The date of the exercise, participating laboratories, and total number

of participants are shown below in Table 1. A breakdown of participating agencies is shown in Table 2.

Table 1. Dates and participating laboratories for the NAHLN exercise program

Exercise 

date

(2008) Participating NAHLN laboratories

Number of 

participants

February 11 Iowa State University Veterinary Diagnostic Laboratory 19

February 14 Ohio Department of Agriculture Animal Disease Diagnostic Laboratory 22

April 28 University of Missouri Veterinary Medical Diagnostic Laboratory 10

April 29 Illinois Department of Agriculture Centralia Animal Disease Laboratory and 

Galesburg Animal Disease Laboratory

16

May 5 Arizona Veterinary Diagnostic Laboratory 16

May 9 University of Georgia Veterinary Diagnostic Laboratory, 

Athens Veterinary Diagnostic Laboratory, 

Tifton Veterinary Diagnostic Laboratory, and 

Georgia Poultry Laboratory

19

May 13 Thompson Bishop Sparks State Diagnostic Laboratory (Alabama) 22

May 14 Mississippi Veterinary Research and Diagnostic Laboratory 10

May 15 Louisiana Veterinary Medical Diagnostic Laboratory 19

May 16 Purdue University Animal Disease Diagnostic Laboratory (Indiana) 18

May 19 Harrisonburg Regional Animal Health Laboratory (Virginia) 18

May 28 Nebraska Veterinary Diagnostic Center 11

May 29 Kansas State Veterinary Diagnostic Laboratory 35

May 29 Washington Animal Disease Diagnostic Laboratory, 

Avian Health and Food Safety Laboratory (Washington), and 

Idaho Department of Agriculture Animal Health Laboratory

23

June 3 Hawaii Department of Health State Laboratory Division 12

June 10 Oregon State Veterinary Diagnostic Laboratory 14
72

June 13 South Dakota Animal Disease Research and Diagnostic Laboratory and 

North Dakota Veterinary Diagnostic Laboratory

11

June 16 Moorefield Animal Health Diagnostic Laboratory (West Virginia) 19

June 26 Animal Health Diagnostic Center at the Cornell University (New York), 

New Jersey Department of Agriculture Animal Diagnostic Laboratory, 

Pennsylvania Veterinary Laboratory, and 

Pennsylvania State University Animal Diagnostic Laboratory

20

June 30 Michigan State University Diagnostic Center for Population and Animal 

Health

26

July 22 Rollins Diagnostic Laboratory (North Carolina) 24

July 25 Wyoming State Veterinary Laboratory, 

Colorado State University Veterinary Diagnostic Laboratory, and 

Montana Veterinary Diagnostic Laboratory

23

July 29 California Animal Health and Food Safety Laboratory and 

Nevada Animal Disease and Food Safety Laboratory

16

August 1 Wisconsin Veterinary Diagnostic Laboratory and 

USGS National Wildlife Health Center

34

August 7 Kissimmee Diagnostic Laboratory (Florida) 12

August 12 Murray State University Breathitt Veterinary Center (Kentucky) 23

August 13 New Mexico Veterinary Diagnostic Services 18

August 14 CE Kord Diagnostic Laboratory (Tennessee) 25

August 18 Arkansas Livestock and Poultry Commission Laboratory 21

August 25 Environmental Health Laboratory (Alaska) 9

Sept 11 Connecticut Veterinary Medicine Diagnostic Laboratory 14

Sept 17 University of Illinois College of Veterinary Medicine Veterinary Diagnostic 

Laboratory

11

Sept 18 Utah Veterinary Diagnostic Laboratory 15

October 1 University of Minnesota Veterinary Diagnostic Laboratory 15

October 2 Clemson Veterinary Diagnostic Center (South Carolina) 12

October 7 Oklahoma Animal Disease Diagnostic Laboratory 9

October 14 University of Delaware Poultry Laboratory, 

Charles C. Allen Biotechnology Laboratory, and 

Maryland Department of Agriculture and Animal Health Laboratory

43

October 17 Texas Veterinary Medical Diagnostic Laboratory (College Station) 23

TOTALS

38 

exercises

54 laboratories 707 

participants

Table 1. Dates and participating laboratories for the NAHLN exercise program

Exercise 

date

(2008) Participating NAHLN laboratories

Number of 

participants
73

Table 2. Interagency participation in the NAHLN exercise program

Participating agencies

Exercise 

location

USDA

APHIS

State 

animal 

health

agency

State

(or local)

public 

health

agency

State 

(or Federal)

wildlife

agency

State

emergency

management

agency

Industry

organization

Alabama X X X

Alaska X X X X

Arizona X X X X

Arkansas X X X X X X

California and 

Nevada

XXX

Colorado and 

Wyoming

XXX X

Connecticut X X X

Delaware and 

Maryland

XX X X

Florida X X

Georgia X X X X

Hawaii X X X X

Illinois X X X X

Illinois - UIUC X X

Indiana X X X X X

Iowa X X

Kansas X X X X X

Kentucky X X X X

Louisiana X X X

Michigan X X X X X

Minnesota X X X

Mississippi X X

Missouri X X X

Nebraska X X X X

New Mexico X X X X

New York, 

New Jersey, 

Pennsylvania

XXX

North Carolina X X X X X

Ohio X X X X

Oklahoma X X X

Oregon X X

South Carolina X X X X
74

South Dakota X X X

Tennessee X X X X X X

Texas X X

Utah X X X X

Virginia X X X X

Washington X X X

West Virginia X X X X X

Wisconsin X X X X X X

Table 2. Interagency participation in the NAHLN exercise program

Participating agencies

Exercise 

location

USDA

APHIS

State 

animal 

health

agency

State

(or local)

public 

health

agency

State 

(or Federal)

wildlife

agency

State

emergency

management

agency

Industry

organization

4825 Mark Center Drive, Alexandria, VA 22311-1850 703-824-2000 www.cna.org

IPR 12904 / February 2009