This story appeared in the department’s 2025 annual report
Sometimes it can be difficult to grasp all the work being performed by the Nebraska Public Health Laboratory (NPHL). The lab is a cooperative partnership among the University of Nebraska Medical Center, Nebraska Department of Health and Human Services and Nebraska Medicine. This partnership was formed in 1997 when the state legislature and governor established the lab in Omaha.
The original focus of testing was to provide support for state-sponsored prevention programs for the detection of sexually transmitted diseases, enteric diseases such as salmonellosis, and respiratory diseases such as influenza. In 1999, testing at NPHL was expanded to include testing for bio-threat agents in environmental samples and the detection of chemical agents in human specimens through grant funding from the Centers for Disease Control and Prevention (CDC). The lab also has an extensive outreach and education program throughout Nebraska.
NPHL is hosted by the UNMC Department of Pathology, Microbiology, and Immunology. Peter Iwen, MS, PhD, D(ABMM), F(AAM), a professor in the department, serves as NPHL director. Emily McCutchen, MS, was recently promoted from laboratory manager to deputy director.
“Two things to recognize that make us unique from other public health lab,” Dr. Iwen said. “First, we are on an academic health center campus and under administrative support of the university. Other public health labs (PHLs) are co-located on campuses, but they are separate from the administrative side.
“The second is that 90% of our support is federal dollars through contracts that filter through the state department of health and human services. These federal dollars are available to support public health laboratory testing, but not research. So, we are not federally funded to perform basic or translational research activities.” That does not mean research opportunities don’t present themselves from time to time. “For instance, all the Salmonella isolates that are detected in clinical laboratories in the state are submitted to us for further characterization to support federal programs. Identification of unique isolates allows for us to present our findings in through research publications,” McCutchen said. “An instance we recently had a patient with salmonellosis that occurred after exposure to a colonized pet bearded dragon that had a unique resistance profile that ended up being a rare finding. The recognition of a unique species came from the testing that was federally supported, which resulted in a published report.”
NPHL welcomes the opportunity to share its experiences with other researchers and colleagues who work in other PHLs, Dr. Iwen said. “Working in the PHL we are able to experience a lot of unique cases. Arguably we are the only PHL in the nation who provided laboratory testing to support multiple patients who had Ebola virus and to confirm a case of Lassa fever in a traveler. We also were one of the first labs in the nation to test for SARS-CoV-2 in travelers admitted to the National Quarantine Unit. As a PHL that supports facilities that care for patients with the potential to have a high-consequence pathogen, we are in a unique position to get these unusual cases.”
“Researchers may only rarely observe these organisms, especially these rare ones that might be observed in our laboratory. We thus look for opportunities to share with others who may have an interest in advancing on our findings,” McCutchen said.
Dr. Iwen said one example of how NPHL has help support researchers is in the study of tularemia with Dr. Marilynn Larson, an associate professor within the department. Tularemia is caused by a high-consequence pathogen, Francisella tularensis, that is endemic in Nebraska and can cause severe illness when contracted. This pathogen is only found in a few select environments in the U.S. and has also been classified as a biothreat agent requiring not only high-level containment to handle but also special permission from the federal government to perform research in the laboratory (Tier 1 Select Agent Registered Laboratory),” he said. “Dr. Larson obtains isolates that we detect and performs molecular genomic studies on those.”
They also collaborate with a UNL researcher to study antibiotic resistance by providing whole-genome sequencing data. Having the instruments available to provide automated WGS for a reasonable cost in a timely manner has allowed NPHL to provide a fee for service to support researchers within the university system.
As a public health laboratory, NPHL has multiple opportunities to provide information to complete the story that might arise in an outbreak. One example was a 2022 salmonellosis outbreak linked to alfalfa sprouts. NPHL interacted with a host of state and federal agencies to determine the source of infection and link that source to a multi-state outbreak from Nebraska. “We provided the sequencing for both clinical and environmental samples and were able to link a food-borne pathogen to its food source,” McCutchen said.
She said state law requires specific foodborne and other unique isolates be forwarded to NPHL. This provides a bank of archived isolates that are available for additional studies if needed. Finding something unique in that bank provides for us an opportunity to share with other laboratory partners,” she said. “We use this as an opportunity to provide an additional resource to support public health within the state.”
Fortunately, federal funding has remained consistent for NPHL, Dr. Iwen said, particularly for bioterrorism preparedness—an area where UNMC has become a leader. With the patient care biocontainment unit at Nebraska Medicine and the availability of the Nation Quarantine Unit on campus, NPHL supports these programs by providing testing for the diagnosis of high-consequence pathogens (HCP). NPHL also has trained other public health labs on how to safely handle and test specimens that might contain an HCP.
The takeaway is the breadth of expertise, in areas such as antimicrobial resistance, bio preparedness, biosafety and biosecurity, laboratory leadership, high-consequence pathogens, and food-borne outbreaks, McCutchen said. “With the opportunities that we have working in the PHL, we cover a broad range of expertise, which allows us to share our knowledge.”
Dr. Iwen said NPHL provided some of the first articles pertaining to Ebola and SARS-CoV-2 safety in the laboratory. In addition, NPHL also is vitally important to clinical laboratory partners across the state. “Laboratorians that support rural clinical laboratories in Nebraska look to NPHL for training to provide guidance when dealing with pathogens of public health concern,” he said.
NPHL also assists the state by providing laboratory information for health alert network releases. Probably 90% of these alerts deal with infectious diseases, McCutchen said.
“As we start our workday, we joke among ourselves on what is our day going to be like today,” Dr. Iwen said. “We usually start with a planned agenda but frequently need to recalculate as our day’s priorities might change after the phone starts to ring. It might be a request for testing for a unique disease such as measles or mpox. As a laboratory that supports the national Laboratory Response Network (LRN), we work with our federal partners and frequently become the only source within the region to provide laboratory testing for these unique pathogens.”
McCutchen said they used to send measles testing to a regional CDC lab in Minnesota. “However, now that measles volumes are up around the country, the request for testing has increased and the potential for outbreaks occurring does require a more rapid approach for testing which is where the PHLs come in to provide state support.”
When it came to mpox (formally called monkeypox), NPHL was one of the few public health labs in the U.S. that had available an orthopoxvirus assay as a regional test site for the smallpox virus, Dr. Iwen said. This assay allowed NPHL to provide regional support during the early stages of the mpox outbreak. Currently, NPHL has verified a recently FDA-cleared assay to provide for mpox diagnostic testing to support testing for Nebraska. NPHL also tests for biothreat agents that might be present in environmental samples, such as the bacterium that causes anthrax. “If any individual were to open a suspect letter that might contain a white powder, NPHL provides a team to respond in the middle of the night to provide testing to identify a potential biothreat agent,” McCutchen said.
Dr. Iwen said NPHL as a member of the LRN also provides testing for several other states, including Kansas, Iowa, South Dakota, Wyoming, Colorado, and Oklahoma.
In 2025, NPHL:
- Expanded the respiratory testing program by adding instrumentation that paved the way for a significant increase in influenza-positive sample submissions. “We went from annually doing 70 submissions to over 2,000 last year,” McCutchen said. “Laboratorians across the state now submit influenza-positive samples to NPHL so we can test the samples to characterize exactly which influenza viruses are circulating across Nebraska.”
- Supported the avian influenza (H5) order from the federal government to request that all influenza positive specimens from hospitalized patients be subtyped within 24 hours to provide expanded surveillance for public health. Laboratory staff brought up and implemented testing within 48 hours.
- NPHL provided WGS for C auris (Candida auris), a highly resistant yeast that has become more common in the U.S., “with multiple positive cases now detected in Nebraska hospital-acquired infection outbreaks.”
- NPHL had one of its busiest years ever for tularemia and for brucellosis, another HCP that has been identified in the state.
- Updated the biosafety level 3 (BSL-3) laboratory that supports the NPHL, including installation of a new electronic monitoring system for the air handler.
- NPHL hosted disaster response training that involved the Nebraska National Guard, the FBI, and civil support teams from around the nation in July.
- Validated new assays for norovirus and EV-D68 testing of wastewater.