Pandora Report 6.10.2016

Summer temperatures are soaring (Arizona hit 115F last week, so I guess it’s time to start baking cookies on the dashboard again- just make sure not to use General Mills flour!) and we’ve got your weekly biodefense cool down. Check out this global outbreak monitor, where you can keep an eye on all your favorite cases. The DoD is currently conducting market research to identify vaccine developers for medical countermeasure manufacturing. They’re looking for “advanced manufacturing platforms which are adaptable to incorporating known antigens for use as a prophylaxis countermeasure against weaponizable biological agents.” Before we venture down the biodefense rabbit hole, the Pandora Report will be on hiatus next week (June 17th), but don’t fear- we’ll return the week of June 24th!

Infectious Disease Threat Management
Are emerging infectious disease outbreaks an anomaly or are these events the new norm? Dr. Daniel M. Gerstein points to a 2014 study on the global rise of these outbreaks, which point to the growing threat of zoonotic disease spillover. Gerstein discusses the common trend of failure to predict such events but also the poor response in medical countermeasures and diagnostics. Between West Nile Virus, Ebola, H1N1, and now Zika, we’ve had ample time to get both preparedness and response right. “A recent commentary by Ronald A. Klain — a former White House Ebola response coordinator — should be required reading on the United States’ lack of preparedness for responding to the Zika virus. In it, Klain provided both a dire assessment of Congress’ uncertain funding support for the current response, and made longer-term recommendations for improving our rapid response to infectious disease outbreaks. Yet while these recommendations are spot on, including calls for a dedicated organization with specialized capability to respond to disease outbreaks, more must be done to ensure adequate preparedness against emerging infectious disease in the future.” U.S. preparedness measures utilize epidemiology and biosurveillance, however these are both passive methods that rely on reactive measures, rather than proactive. “This reactive approach to emerging infectious disease should be augmented with an anticipatory model that accounts for the dramatic changes occurring through globalization, greater interactions between human and zoonotic populations, and changes to the environment and climate patterns.” He points to the need for predictive analytical tools and modeling to better focus research and development efforts in order to control and prevent such events. Gerstein acknowledges the long-term and challenging realities of such efforts though, pointing to the need for private sector contributions and strategies to focus on anticipating infectious disease threats.

CDC Biosafety Failures – “Like a Disaster Movie” 
The stories of biosafety failures in U.S. labs working with select agents is enough to send chills through even the toughest of pathologists. Reporters recently gained access to records from the CDC regarding the 2009 events in which safety mechanisms in a CDC biosafety level 4 lab failed. “The gasket seal around the exit door to the changing room deflated to the point that the scientists could see light coming in. And as they held that door shut and started an emergency chemical deluge, things got even worse.” Records include emails that hoped to avoid federal lab regulatory reporting. While these reports are shocking to biosafety experts like Richard Ebright from Rutgers University, CDC officials claim there was no risk from the equipment failures. The release of these records draws further attention to the failures but also the CDC response and challenges in even getting the records released under the Freedom of Information Act. You can read more of the records released to USAToday here and here.

Back to the Future in Global Health Security? 
People frequently think back to the days of the Black Death as a reminder of the progress we’ve made in disease defense. Are we really in a better position though? Globalization, growing populations, rising global temperatures, urbanization, and easy international travel all make it possible for diseases to jump around in a matter of hours. WHO Director-General Margaret Chan noted that “For infectious diseases, you cannot trust the past when planning for the future. What we are seeing is a dramatic resurgence of the threat from emerging and reemerging infectious diseases. The world is not prepared to cope.” The lessons from Ebola, H1N1, and even Zika haven’t truly sunken in yet and there are more outbreaks on the horizon. “International mechanisms must be established to coordinate the upstream research and development (R&D) of new medical tools to respond to priority pathogens and the downstream testing, manufacturing, and delivery of those tools as part of the larger humanitarian response to an ongoing outbreak.” Researchers have suggested four lessons from our past to encourage technological innovation to better prevent and respond to health crises – ensure adequate and sustainable long-term investment, coordinate R&D around a roadmap of priority goals, engage and energize a network of geographically distributed multi-sector partners, and remember that sustainability depends on adequate systems and equitable access. Establishing an environment of coordination and sustainability will be vital to move from a reactive to a proactive practice of global health security.

DoD Biosafety Report
GMU Biodefense MS student, Stevie Kiesel discusses the report the DoD Inspector General published regarding the biosafety and biosecurity failures within DoD labs that work with biological select agents and toxins (BSAT). Stevie’s deep dive into this report addresses the systematic failures that led to such events. Inconsistent internal or external technical or scientific peer reviews and even inspection standards led to not only missing inspections, but also duplicative ones. “Some inspectors failed to review specific vulnerability assessments for their assigned labs to ensure that shortcomings identified during previous inspections had been mitigated.  In some cases, these vulnerability assessments were not reviewed because they had never been conducted, or had not been conducted annually as required.”

Immune System Education and the Realities of the Antibiotic Resistance
Autoimmune diseases and antibiotic resistance have risen in the past half-century…but what does this really mean? The human microbiome (your body’s own community of microbes that help run your immune system) is now being considered as a potential puzzle piece for the increase in autoimmune issues. Have these microbiome communities changed so largely that our entire society is being impacted? “To test this possibility, some years ago, a team of scientists began following 33 newborns who were genetically at risk of developing Type 1 diabetes, a condition in which the immune system destroys the insulin-producing cells of the pancreas. After three years, four of the children developed the condition. The scientists had periodically sampled the children’s microbes, and when they looked back at this record, they discovered that the microbiome of children who developed the disease changed in predictable ways nearly a year before the disease appeared. Diversity declined and inflammatory microbes bloomed. It was as if a gradually maturing ecosystem had been struck by a blight and overgrown by weeds.” Coupled with several other studies, there is a growing thought that toughening the immune system early in life can alter our response later in life or that the kind of microbiome you have will determine your response to viral infections. So what happens if our immune systems begin to fail us and antibiotics are a thing of the past? That’s a pretty devastating notion and it’s right before the weekend, so let’s scale it back to just consider a world without antibiotics – would you still shake hands or take an international flight? Physiologist Kevin Fong notes “If we are to avoid a return to the pre-antibiotic landscape with all its excess mortality we must be bold. To squander the advantage we have so recently gained against microorganisms in the fight for life would be unthinkable.”

The Race Against Zika 
The debate regarding the 2016 Rio Olympics took a turn this week as the WHO stated it will look again at the Zika risk during the games.  150 international experts penned an open letter to the WHO regarding their “irresponsible” actions and that the organization was rejecting calls to move or postpone the games due to it’s official partnership with the International Olympic Committee. What are the actual risks? Will the Rio Olympics put the rest of the world at risk for Zika? Here is an interesting infographic and article on that exact question. Bringing thousands of people from different countries together is definitely a gold medal strategy for spreading infectious disease. The ECDC has posted their epidemiological data here, as well as their risk assessment. A new study looks at sexual transmission and the persistence of Zika virus in semen, finding that RNA can persist in semen for 62 days. Researchers found a case of a woman with Zika virus presenting 44 days after the onset of symptoms in her partner, which “corresponds to a sexual transmission occurring between 34 and 41 days after the index case.” This announcement comes after there were no previously reported secondary cases more than 19 days after the onset of signs in a man. Concerns regarding congenital eye issues in babies without microcephaly were also raised after a case was identified. As of June 8th, the CDC has reported 691 travel-associated cases within the U.S.

Stories You May Have Missed:

• CRISPR’s Gene-Editing Skills on RNA – researchers have now established a method for targeting and cutting RNA. “The new cutting tool should help researchers better understand RNA’s role in cells and diseases, and some believe it could one day be useful in treatments for illnesses from Huntington’s to heart disease.” The process involves using CRISPR to create “blades”. Given the concerns around CRISPR and dual-use technologies of concern, researchers are pointing out that there are far less ethical concerns regarding manipulation of RNA.
• Legionnaires’ On the Rise – sadly this isn’t the name of a new historical action flick, but rather a public health concern that has the CDC looking into water system integrity. Cases of Legionnaires’ disease have quadrupled since 2000. The CDC has stated that the reason for such a stark increase is most likely due to aging building water systems, an aging population, and better surveillance/reporting systems.
• Ebola Stability Under Hospital and Environmental Conditions – a new study looks at the role of fomites in EVD transmission, especially in healthcare settings. “To assess the potential contribution of fomites to human infections with EBOV, we tested EBOV stability in human blood spotted onto Sierra Leonean banknotes and in syringe needles under hospital and environmental conditions.” Researchers found that the virus survived more than 30 days in blood in syringes, despite hot/humid conditions, and six days on paper money under experimental conditions.