Your weekly dose of all things biodefense is here to fill you in on Ebola in the DRC, antibiotic resistance, the role of the U.S. in global health response, and more!
Ebola Rears Its Ugly Head in the DRC
Sadly, Ebola has returned as cases are sprouting up in the Democratic Republic of the Congo (DRC). On Friday, May 12th, the WHO confirmed an outbreak of the Zaire strain involving nineteen cases and three deaths. “WHO and partners are completing the epidemiological investigation to better understand the extent of the current outbreak and who are potentially at risk of Ebola,” WHO spokesperson Tarik Jasarevic told CIDRAP News. “If pertinent, ring vaccination, as used in the phase 3 study in Guinea, would be the recommended delivery strategy.” These new cases will truly be a test to see if response efforts have changed since the 2014/2015 outbreak in West Africa. Between the WHO response and the potential for real-world testing of the new Ebola vaccine, many are hoping this will be the game-changer. The Global Outbreak Alert and Response Network (GOARN) has been activated and per the WHO website, “the need and feasibility of potential Ebola ring vaccination is being discussed.” Reuters reported that “the GAVI global vaccine alliance said on Friday some 300,000 emergency doses of an Ebola vaccine developed by Merck could be available in case of a large-scale outbreak and that it stood ready to support the Congo government’s efforts to bring the epidemic under control.Under an agreement between GAVI and Merck, the developer of an Ebola vaccine known as rVSV-ZEBOV, it said up to 300,000 doses of the shot would be available in case of an outbreak.” MSF (Medicins sans Frontieres) announced, shortly after the WHO confirmation of cases, that they would be sending a team of 14 people to Likati to launch “an emergency intervention” and that a team of 10 people from the Ministry of Health would also be joining. MSF noted that “the team will be made up of doctors, nurses, logisticians, water and sanitation experts, health promoters and an epidemiologist. Along with organisations already present in the area, the MSF emergency team will conduct an assessment of the situation and may construct an Ebola treatment centre and help care for those suspected or confirmed to be affected by the virus. Fifteen tonnes of medical and logistical supplies will be sent by cargo plane from Kinshasa to allow the team to immediately begin their intervention in Likati.” You can read more about the outbreak timeline here and check out this latest article on how the WHO is preparing to use the experimental vaccine.
Summer Workshop Instructor Spotlight: Andrew Kilianski
As we get closer to the July 17th start date for the Summer Workshop on Pandemics, Bioterrorism, and Global Health security, we’d like to show off some of the wonderful instructors. Dr. Kilianski is currently a GMU professor and biological scientists at the Depart of Defense. His work focuses on combating current and future threats from weapons of mass destruction in addition to teaching classes on biosurveillance and virology in the GMU Biodefense graduate program. Dr. Kilianski was previously a National Research Council fellow with the US Army at Edgewood Chemical Biological Center. During his tenure at ECBC, his research focused on biosurveillance and the identification and characterization of novel agents that threaten today’s warfighter. Dr. Kilianski’s research interests also included emerging viral pathogens and public health and biodefense policy, and he was selected as an Emerging Leaders in Biosecurity Initiative Fellow for 2015. His research has been published in peer-reviewed journals such as PLoS Pathogens, Journal of Virology, and Emerging Infectious Diseases while also publishing multiple commentary and op-ed articles. He received his Ph.D. in Microbiology and Immunology from Loyola University Chicago where his dissertation research involved uncoupling virus-host interactions important for coronavirus pathogenesis and developing antiviral compounds against emerging coronaviruses (SARS-CoV and MERS-CoV). During the workshop, Dr. Kilianski will be lecturing on biosurveillance and its role as an integral component of any biodefense strategy and how U.S. policy has mandated that such efforts be accelerated. He notes that “this construct, and how the US and international entities engage in biosurveillance will be covered, as well as how recent Ebola and Zika virus outbreaks have tested the system. Emerging technologies and their role in biosurveillance will also be reviewed. Finally, paths toward integrated biosurveillance for the US and international communities will presented for group discussion discussion.” Dr. Kilianski is a wonderful instructor and his lectures are both engaging and thought-provoking. Don’t miss out on the early-bird registration discount (10%) being offered until June 1st!
GMU Biodefense PhD Student’s Research Could Change Disease Response, Especially When Air Travel Is Involved
Have you ever wondered about the role of air travel during outbreaks? Nereyda Sevilla will be graduating this month with her PhD in biodefense after looking into this very issue. “She believes she has a way to change how authorities and the public respond to disease outbreaks perceived to be transmitted by air travel. If she’s right, it could potentially save billions of dollars in misdirected federal and state money and give millions of air passengers more precise information about infections.” A civilian aerospace physiologist for the Medical Research and Acquisitions Division in the Office of the Air Force Surgeon General, and all around biodefense fan, Nereyda focused her research on the role of air travel and the spread of disease. Utilizing outbreaks like SARS, H1N1, and Ebola, she looked at air travel as a potential incubator for disease transmission. “Sevilla pointed out that despite the numerous aircraft involved, no one became infected with Ebola on an airplane. And yet authorities spent billions on entry and exit screenings, which heightened fear among the general population. Sevilla used an open-source model to study what would happen during a possible future outbreak of pneumonic plague, an infectious lung disease that continues to rear its deadly head around the world. The model could be a game-changing tool, said her professor.” Nereyda says that she’s “found the airplane is not what’s going to get you infected with disease. You’re more likely to get sick from waiting in the boarding area next to some one with a cold.” You can also read this article she wrote regarding the open-source model. Nereyda is a great example of the diverse and passionate students within the GMU biodefense program and we’re excited to show off her amazing research and congratulate her on graduating!
Global Health and the Future Role of the United States
The National Academies of Science just released their report on global health and the role of the U.S. as a leader through efforts like PEPFAR (U.S. President’s Emergency Plan for AIDS Relief), etc. The U.S. has taken a major role in strengthening global health security, whether it be through efforts like the Global Fund to Fight AIDS, TB, and Malaria, or through collaborative international efforts to help strengthen national health systems like the Global Health Security Agenda. “However, resources are not unlimited, and the case for continued commitment must be made. Against the backdrop of the influential legacy of the United States on the global health stage, the new administration is now faced with the choice of whether or not to ensure that gains in global health—won with billions of U.S. dollars, years of dedication, and strong programs—are sustained and poised for further growth.” The report also notes that “approximately 284,000 deaths were attributed to the 2009 H1N1 influenza outbreak, for example, and 2 million excess deaths are projected for a future moderate influenza pandemic. In only a few short months in 2003, the outbreak of severe acute respiratory syndrome (SARS) cost the world $40–$54 billion, while in 2014, the United States alone committed $5.4 billion in response to the Ebola outbreak, $119 million of which was spent on domestic screening and follow-up of airline passengers.” Following a rigorous review, the committee established 14 recommendations that would aid in the delivery of a strong global health strategy and help the U.S. maintain its role as a leader in global health security. The 14 recommendations/actions are: improve international emergency response coordination, combat antimicrobial resistance, build public health capacity in low- and middle-income countries, envision the next generation of the President’s Emergency Plan for AIDS Relief, confront the threat of tuberculosis, sustain progress towards malaria elimination, improve survival in women and children, ensure healthy and productive lives for women and children, promote cardiovascular health and prevent cancer, accelerate the development of medical products, improve digital health infrastructure, transition investments toward global public goods, optimize resources through smart financing, and commit to continued global health leadership.
Would You Survive the Oregon Trail?
If you ever played the video game, you know the chances of making it through this covered-wagon adventure without snakebites, dysentery, or some other misery, were quite low. “The game, one of the earliest educational computer games to reach wide distribution, simulated a 1848 covered-wagon trip from Missouri through the wild frontier of the western US.” Diseases were common to those of us who ventured across the Oregon Trail, but now you can take a quiz to see just how much you really know about those historic bugs.
GAO Report: U.S. Needs To Do More To Prevent Possible Bird Flu Pandemic
A recent Government Accountability Office report is pointing out just how vulnerable the U.S. would be if faced with an avian influenza pandemic. The GAO report focused on three areas – how outbreaks of avian influenza have affected human and animal health, and the U.S. economy, the extent to which the USDA has taken actions to address lessons learned from outbreaks in 2014 and 2016, and the ongoing challenges federal agencies face in their efforts to reduce the potential harm of such an outbreak. The report comes at a crucial time as China is currently battling an outbreak of the deadly H7N9 strain. Within the report there are several findings: “Unless the agency is responding to an emergency, the Agriculture Department doesn’t have the authority to require poultry producers to take preventive biosecurity measures to keep avian influenza from spreading from farm to farm.” The report notes that the USDA has found lessons learned from its responses to previous events however, they have not established plans for evaluating if these corrective actions actually resolved the issues. The topics within the lessons learned include biosecurity, communication, continuity of business, diagnostics, etc. Simply put, while they identified problems and took corrective actions, there has been virtually no evaluation as to their efficacy. Another issue raised within the GAO report focuses on vaccination and the challenges of egg-based vaccine manufacturing. DHHS stockpiles vaccines supplied by four companies, however only one has a U.S.-based manufacturing facility for egg-based vaccines. “We identified two other issues that federal agencies face associated with mitigating the potential harmful effects of avian influenza. First, outbreaks of the disease threaten the poultry that produce the eggs used in the production of human pandemic influenza vaccine. Second, funding for a voluntary surveillance program that gathers data on influenza A viruses in swine that could pose a threat to human health will be exhausted in fiscal year 2017”. Overall, the USDA must focus more on evaluation and working towards preparedness to combat the growing threat.
Getting Our Hands on Older Antibiotics & The Broken Chain of Hospital Reporting
A recent article in Clinical Microbiology and Infection looked at the recommendations and availability regarding older antibiotics. Researchers found that these antibiotics are not universally available or marketed, which means that physicians have to use other, less optimal, antibiotics that are broad-spectrum. “For example, in the treatment of sore throat, amoxicillin is used instead of penicillin. Fluoroquinolones are used instead of nitrofurantoin, fosfomycin or pivmecillinam for the treatment of cystitis, and co-amoxiclav or cephalosporins for the treatment of skin and soft tissue infections instead of appropriate oral formulations of antistaphylococcal penicillins. Additionally, some old antibiotics such as temocillin or i.v. fosfomycin are valuable alternatives for the treatment of some resistant bacteria. The limited access to these old antibiotics is a threat to antibiotic stewardship.” “In 2011, the ESCMID Study Group for Antimicrobial stewardshiP (ESGAP) showed that 22 out of 33 old but potentially useful antibiotics were marketed in fewer than 20 of the 38 included countries in Europe, USA, Canada, and Australia; economic motives were the major reason for not marketing these antibiotics. ESGAP and the international network ReAct (Action on Antibiotic Resistance) updated this survey in 2015. The situation was worse than in 2011, with even fewer antibiotics available in the included countries.” As if the battle of the resistant bug wasn’t bad enough, it seems that hospitals and their federal oversight systems are failing. Hospital reporting and CMS (Centers for Medicare and Medicaid) validation of such data was recently found to be not only poor, but often inaccurate. GMU biodefense PhD student, Saskia Popescu, looks at the process for which hospitals report healthcare-associated infections and drug resistant organisms for reimbursement through CMS and just how broken the CMS data validation process actually is. “During their annual data evaluation, CMS is supposed to randomly select 400 participating hospitals and request samples of medical records to evaluate the clinical-process-of-care measures and HAI measures. Additionally, they are encouraged to look at a targeted sample of 200 additional hospitals based off a certain threshold, which would be if they failed validation the year before or submitted data after the CMS deadline. CMS has several selection criteria for this ‘targeted’ sample, which includes ‘threshold-based criteria’—hospitals that fail to report half of their HAI’s, late reporting, a new hospital, etc.—or, ‘analysis-based criteria’—abnormal or conflicting data patterns and a rapid change in data patterns. Unfortunately, the report shows that CMS failed to use these measures when they did this targeted sample review in 2016 (which looked at data from 2013/2014). During this review, CMS only selected 49 hospitals and none of these hospitals were chosen from this analysis-based criteria (ie, they were not looking for those with aberrant data patterns or suspicious changes in reporting).”
Stories You May Have Missed:
- Operation Whitecoat Documentary– Don’t miss out on the June 1st release of the post-WWII documentary on Operation Whitecoat (1954-1973). “During the Cold War, more than 2,300 non-combatant conscientious objectors from the Seventh-day Adventist church volunteered to serve their country by participating in U. S. Army medical experiments focused on developing defensive medical countermeasures against the Soviet Union’s bio-warfare capabilities. These volunteers were exposed to experimental vaccines and infectious pathogens.Operation Whitecoat tells the story of these patriots–their commitment to both their religious principles and desire to serve in America’s defense, their courage to participate in these tests, and their contributions that went far beyond Army biodefense.”
- How Plagues Help Scientists Puzzle Out the Past –I imagine bioarchaeologists as a mix between Indiana Jones and one of the researchers from Contagion – learning about the past to prevent future pandemics. Plagues and pandemics carry with them a lot of information – how society at the time handled it, health and wellness, medical care, etc. “The tragedy of mass causalities exposes lives that would, statistically, rarely be unearthed, including the adolescents and adults who form the bulk of a living population, so rarely represented in a cemetery. Calamities such as plague that knock everyone into the grave with one indiscriminate sweep are one of the few chances bioarchaeologists have to overcome something known as the Osteological Paradox, a term coined by researcher James Wood and colleagues to cover the very awkward point that, in studying past lives, the evidence bioarchaeologists actually have to go on are past deaths. “
The Pandora Report 
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