Pandora Report 9.9.2016

Happy Friday! Spain has reported two cases of Crimean-Congo hemorrhagic fever – the first patient had a tick bite and died in the hospital, and the other is an ICU nurse who cared for the initial patient. A researcher at the Umeå University just got to enjoy the first CRISPR meal- yum!  Check out this video to see bacteria invade antibiotics and transform into resistant superbugs! If you’re interested in attending the Advancing Global Health Security: Driving Innovation through Partnership (where they’ll be talking about everything from Ebola to Zika, lessons learned, and what we still need to improve) on September 19th, make sure to RSVP here.

Aleppo Chemical Weapons Attack  799px-155mmMustardGasShells
On Tuesday, the Syrian city of Aleppo experienced a chemical attack as regime warplanes are said to have dropped barrels with “poisonous gas”. Syrian activists are pointing to the incident involving government warplanes as just another attack in a long stream of chemical attacks.  More than 100 people are being treated for respiratory symptoms, with rescuers rushing children to the makeshift Basel Aslan hospital. “Rebel-held Aleppo has been pounded by the forces of President Bashar al-Assad’s regime, backed by Russian air power. Several cases of chlorine gas bomb attacks also have been reported there.”

FDA Wages War on Antibacterial Soap
The U.S. Food and Drug Administration (FDA) has issued a final rule regarding over-the-counter (OTC) antiseptic wash products containing 19 specific ingredients. This list of ingredients non grata includes the most commonly used ones – triclosan and triclocarban, and will effectively impact 40% of soaps. The FDA is also continuing to study the efficacy and safety of hand sanitizers and wipes. The ruling comes after health officials have been urging for restrictions on the ingredients due to concerns regarding pediatric hormonal functions and aiding the rise of resistant microorganisms. The irony is that research has shown that using the antibacterial soaps is no more effective than using regular soap and water. “It has boggled my mind why we were clinging to these compounds, and now that they are gone I feel liberated,” said Rolf Halden, a scientist at the Biodesign Institute at Arizona State University, who has been tracking the issue for years. “They had absolutely no benefit but we kept them buzzing around us everywhere. They are in breast milk, in urine, in blood, in babies just born, in dust, in water.” From an environmental standpoint, triclocarban takes a while to effectively disappear, with some researchers pointing out that it’s member of the older chemical family of organochlorines (like DDT).

Terror Suspects and Bioterrorism in Kenya
Last week, two terror suspects were arrested in Kenya as part of an extremist cell of medics who are loyal to ISIS. The Kenyan Anti-Terror Police Unit were tipped off that the suspects were planning a large-scale biological attack involving anthrax. Dr. Lawrence Roberge noted that, “I would be very concerned. This is an example of how developing countries with limited detection resources- and certainly less robust biodefense budgets-would become vulnerable to bioweapon attacks.” While information is still limited as to the extent and status of their plan, the growing rate of terrorist attacks in Kenya has many concerned that this may be the first of many indicators pointing to ISIS’ “scramble for Africa”.

Viral Genomes Unlock Secrets Behind Ebola’s Spread
Researchers investigating the 2013-2016 Ebola outbreak in West Africa have used a collaborative sequencing project to look at over 1600 Ebola virus genomes. Encompassing 5% of known cases, this analysis was able to reconstruct the “migration, proliferation and decline of Ebola virus throughout the region”. Their work looked at the association of various factors like geography, climate, demography, and more among 56 administrative regions. “Our results show that during the outbreak viral lineages moved according to a classic ‘gravity’ model, with more intense migration between larger and more proximate population centers. Notably, we find that despite a strong attenuation of international dispersal after border closures, localized cross-border transmission beforehand had already set the seeds for an international epidemic, rendering these measures relatively ineffective in curbing the epidemic.” Through their genomic sequencing they established that the outbreak was a spatially dissociated collection of transmission clusters that varied in size, duration, and connectivity.

Weekly Zika News
Funding issues aren’t the only thing plaguing U.S. Zika efforts, but rather an overall issue of a limited arsenal.  Pesticide issues and resistance have been challenging mosquito control efforts. Only two classes of pesticides against mature mosquitoes are approved, of which one has strict control limits and the other has become relatively ineffective due to mosquito resistance. “The outbreak highlighted gaps in the mosquito control arsenal that remain, according to pesticide makers, abatement officials and entomologists. Few companies make pesticides for use in public health outbreaks, a niche market that is expensive to get into, has a limited upside and varies season to season. Safety testing a new pesticide can cost up to $250 million and take 10 years, said Karen Larson, vice president of regulatory affairs at privately held Clarke Mosquito.” In attempts to spray for mosquitoes, millions of bees have been killed in a South Carolina county. “The apparently inadvertent extermination, the county administrator said, happened after a county employee failed to notify Ms. Stanley’s business, which the administrator said should have been alerted about the spraying strategy. Some hobbyists were also caught by surprise.” Will there be a Generation Zika? Many are wondering if there will be an increased associated with mental illness and long-term health effects due to congenital Zika infections. What does this mean for healthcare and the estimated cost of caring for children with these health issues though? As of September 7th, the CDC has reported 2,964 cases of Zika in the U.S. You can also read PAHO’s epidemiological update here.

Stories You May Have Missed:

  • Small Changes, Big Dividends: A Global Look at Preparedness– Dr. Stephen Redd, Director of the Office of Public Health Preparedness and Response, is talking about the interconnectedness of preparedness and public health in this week’s Public Health Matters Blog. Dr. Redd notes that the U.S. recently invited a team of international experts to evaluate our ability to prevent, detect, and respond to public health threats in 19 different areas. The goal is to not only gain knowledge, but also be able to disseminate it across the globe as other countries work to strengthen their own capabilities.
  • U.S. Failures at Tracking Antibiotic Resistant Bugs– It’s not just enough to know we have MDRO’s (multi-drug resistant organisms), but also the capacity to identify the individuals and perform proper infection control practices. ICU’s are a hot spot ICU’s are a hot spot but many patients are also unaware of this reality and many officials don’t inform them of what they can do to help prevent the spread of infection. On top of these stark realities, the presence of a MDRO not always communicated in the event of a patient’s death.”Drug-resistant infections are left off death certificates for several reasons. Doctors and other clinicians get little training in how to fill out the forms. Some don’t want to wait the several days it can take for laboratory confirmation of an infection. And an infection’s role in a patient’s death may be obscured by other serious medical conditions.”

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