Trends in Global Health Security (June 17, 2015)

Recent events in Africa, Asia, and the United States have reaffirmed the significant enduring challenges to strengthening global health security.

While Liberia has not reported any Ebola cases since April 2015, Guinea and Sierra Leone continue to report approximately 20-30 new cases a week. Most of these new cases can be traced to previous cases along well-characterized chains of transmission, but a worrying number of them arose from unknown sources of infection and/or were associated with a large number of high-risk contacts. The emergence of Ebola cases of unknown origin in Guinea and Sierra Leone emphasizes the need for stronger surveillance and contact-tracing efforts in those countries and highlights the risk that the outbreak could spread uncontrollably again if containment measures are relaxed. The development of an Ebola vaccine continues apace, with three vaccine candidates entering Phase III clinical trials in West Africa. Vaccine testing hit a setback in Ghana, however, where the parliament suspended a planned trial of two vaccines after local protests.

South Korea has become the epicenter for the largest outbreak of MERS-CoV outside of the Middle East. South Korea now reports 161 cases and 19 deaths from the virus. The outbreak has been traced to a single infected traveler who returned to South Korea in May after visiting several Persian Gulf countries, highlighting the vulnerability of all countries in this globalized world to unexpected outbreaks of unusual diseases. According to the World Health Organization (WHO), gene sequencing does not reveal any significant differences between the strain responsible for the outbreak in South Korea and strains circulating in the Middle East. Transmission of the virus in South Korea, as in other hard-hit Middle East countries like Saudi Arabia, has been strongly associated with health care settings. So far, there is no evidence of sustained community transmission. A joint South Korean-WHO inquiry identified several reasons for the severity of the outbreak in South Korea including a lack of awareness among health care workers and the general public about MERS; weak infection prevention and control measures in hospitals; close and prolonged contact of infected MERS patients in crowded emergency rooms and multi-bed rooms in hospitals; the practice of “doctor shopping” (seeking care at multiple hospitals); and the custom of many visitors or family members staying with infected patients in the hospital rooms which facilitated the secondary spread of infections among contacts. An interesting parallel between the Ebola outbreak in West Africa and MERS in South Korea is the role of social practices and customs that amplify disease transmission. On June 17, WHO reaffirmed that the MERS-CoV outbreak, which has caused at least 1,320 infections and 466 deaths since 2012, still does not qualify as a public health emergency of international concern under the 2005 International Health Regulations.

The inadvertent shipping of live anthrax spores by the Department of Defense’s Dugway Proving Ground has expanded to 69 labs in 19 states and the District of Columbia and five foreign countries (Australia, Canada, Japan, South Korea, and the United Kingdom). The list of foreign countries that may have accidentally received samples of live anthrax may grow since the such samples might have been sent to U.S. bases in the Persian Gulf for proficiency testing of biodetection systems deployed in that region. The Pentagon’s inquiry into what human, technical, and/or procedural errors led to this long-standing unsafe handling and shipping of anthrax is due to be completed by early July. The Centers for Disease Control and Prevention (CDC) is conducting its own investigation, but there is no word on when it will be completed. In the meantime, USA Today has reported that Dugway was cited in 2007 for shipping live anthrax spores after using an unproven chemical inactivation method and ignoring results from sterility testing that showed that some of the samples still contained live bacteria. While the current inactivation technique used at Dugway is irradiation, this previous incident might reflect the lack of a strong safety culture at the facility which may have contributed to the current biosafety failure. Dugway’s biosafety problems are also similar to problems encountered by the CDC in 2004 and 2014 when it also failed to improperly inactivate anthrax and inadvertently shipped live samples of the bacteria to other labs. This recurring pattern of anthrax being inactivated improperly and not detected by post-inactivation testing raises serious questions about the scientific and technical foundations for this process.

A common theme throughout these outbreaks and incidents is the need for the scientific, public health, academic, private sector, and policy communities to work together to devise solutions to the most pressing problems in global health security.  Pandemics, Bioterrorism, and International Security is a three-day non-credit course offered by George Mason University that introduces participants to the challenges facing the world at the intersection of national security, the life sciences and public health. This course provides participants with an opportunity to learn about cutting-edge issues in global health security from a Special Agent in the FBI’s Weapons of Mass Destruction Directorate, the former commander of USAMRIID, the lead virologist and Ebola expert at NIH’s BSL-4 laboratory, and internationally recognized biosecurity experts from MIT, Dartmouth, and George Mason University. For more information and to register, please visit http://www.ocpe.gmu.edu/programs/health_public_safety/bioterrorism.php

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