Pandora Report 1.19.2018

Happy Friday and welcome to your favorite source for all things biodefense! We hope you’re able to avoid the onslaught of respiratory viruses that are circulating right now, but on the off chance that you’re battling a bug, here’s some infectious disease new that won’t get you sick.

Fighting Influenza
Whether you’re fighting the flu or watching the mayhem unfold in the news, you can’t escape influenza right now. We’re getting hit hard with flu season in the United States and the CDC has reported that activity is still rising and we’re not out of the woods yet. You can find the latest flu data here, but what is worrying so many is the hit that hospitals are taking across the country. It’s not just that we’re facing an IV bag shortage due to the devastation Hurricane Maria wreaked upon Puerto Rico, but that hospitals are being overrun with an onslaught of ILI (influenza like illness) patients. Wait times are through the roof, staff are stretched thin, patients are being admitted into overflow areas, hospitals are having to divert patients because they’re so full, triage areas have been set up in parking lots and emergency areas, and hospitals are even struggling to ensure they have enough PPE and influenza tests. This year marks the centennial of the 1918/1919 influenza pandemic, and it seems like what’s going on is out of a history book instead of down the street. As an infection preventionist and infectious disease epidemiologist, it is not surprising or unexpected that we’re running into these issues. It’s easy for people to point to the current situation and use it as an example of why we’re not ready for a flu pandemic – and they’re right, but it shouldn’t take what’s going on to see that. These are not new issues. Infection control and hospital preparedness has been struggling for a long time and it doesn’t take a pandemic to prove it. Even after the surge of funding and focus on hospital preparedness post-Ebola, we still struggle with these issues, but throw in budget cuts and an administration that is set to pull funding away from public health…well, the outlook is dismal.

With so much attention on influenza, pandemic preparedness, and how we’re just not ready for the next great flu pandemic, what kind of household interventions can we apply in our own little ecosystems? Researchers looked at a HPAI H5N1 outbreak and estimated the reduction in primary attack rates for household-based interventions. “We show that, for lower transmissibility strains, the combination of household-based quarantine, isolation of cases outside the household, and targeted prophylactic use of anti-virals will be highly effective and likely feasible across a range of plausible transmission scenarios. For example, for a basic reproductive number (the average number of people infected by a typically infectious individual in an otherwise susceptible population) of 1.8, assuming only 50% compliance, this combination could reduce the infection (symptomatic) attack rate from 74% (49%) to 40% (27%), requiring peak quarantine and isolation levels of 6.2% and 0.8% of the population, respectively, and an overall anti-viral stockpile of 3.9 doses per member of the population.” While we all may not access to anti-virals, the use of quarantine and isolation are all effective strategies. From an infection control standpoint, it can be tough to maintain such efforts in a household where one or two people are sick. When in doubt, wash your hands, cover your cough, and clean those high-touch surfaces/objects!

GMU Biodefense MS Open House
Mark your calendars for the February 21st Master’s Open House at GMU’s Arlington campus! If you’ve been thinking about getting a MS in biodefense (who wouldn’t want to take classes on biosurveillance, historical bioweapons programs, and more?!), this is a great chance to talk to faculty and learn about the admissions process. GMU has biodefense MS programs in person and online, so even if you’re not in the DC-area, you can get your biodefense on.

Smallpox, Horsepox, And The Trouble With Poxviruses
It seems only a few months ago that news broke of a Canadian research team’s de novo synthesis of horsepox. Since then, there has been considerable discussion surrounding not only the biosafety and biosecurity behind research involving an orthopoxvirus, but also the implications of normalizing orthopoxvirus synthesis, and again, if the remaining smallpox stockpiles should be destroyed. The latest report from researchers at the University of Alberta points to the potential smallpox vaccine developments that synthetic viruses could bring. “Virologist David Evans and his research associate Ryan Noyce produced an infectious horsepox virus, which they synthetically reconstructed using a published genome sequence and DNA fragments manufactured entirely by chemical methods. The team went on to show that the synthetic horsepox virus could provide vaccine protection in a mouse model of poxvirus infection.” Unfortunately, the implications of synthesizing an orthopoxvirus aren’t so simple. GMU biodefense professor and program director Dr. Gregory Koblentz evaluated the implications of such synthesis for biosecurity and what would be needed to prevent a reemergence of smallpox. “The synthesis of horsepox virus takes the world one step closer to the reemergence of smallpox as a threat to global health security. That threat has been held at bay for the past 40 years by the extreme difficulty of obtaining variola virus and the availability of effective medical countermeasures. The techniques demonstrated by the synthesis of horsepox have the potential to erase both of these barriers. The primary risk posed by this research is that it will open the door to the routine and widespread synthesis of other orthopoxviruses, such as vaccinia, for use in research, public health, and medicine.” Koblentz notes that while there are potentially legitimate uses for synthesizing orthopoxviruses (safer smallpox vaccine development), it also means that such labs have the potential to produce smallpox from synthetic DNA and emphasized that action is needed now to avoid the misuse of synthetic biology by nefarious actors. “Unfortunately, the current legal and technical safeguards against the synthesis of smallpox virus are weak and fragmented. There is no clear international legal or regulatory framework to prevent the synthesis of smallpox virus. The WHO has a policy banning the synthesis of the smallpox and regulating who can produce and possess large fragments of smallpox DNA, but it hasn’t been widely adopted by states. Furthermore, there is no mechanism—at either the national or international level—for detecting or punishing violations of this policy.” GMU biodefense PhD student Saskia Popescu cited the importance of medical providers understanding the dual-use research of concern debate and that ultimately, biosecurity impacts us all. “From the healthcare perspective, it may not seem like something we should worry about, but the direction of gene editing and dual-use research of concern is something that is intrinsically linked to public health. Nefarious outcomes of such experiments, regardless of the origin or intent, will inevitably make their way into an emergency department, urgent care, or worse, the community. Although we may not be seeing the implications today, as medical providers and healthcare workers, we must keep our ears to the ground, listening for these biotech advancements, and then thinking through what they mean for us tomorrow.”

Blue Ribbon SLTT Ability to Respond to Large Scale Biological Events: Challenges and Solutions
If you missed the Wednesday meeting, here’s a recording to catch up on all things biodefense. “State, Local, Tribal, and Territorial Ability to Respond to Large-Scale Biological Events: Challenges and Solutions government officials, federal and academic representatives, and subject matter experts will discuss their perspectives, experiences, challenges, and recommended solutions with regard to SLTT response to large-scale biological events.”

Gene Therapy Hits a Wall With Microbial Resistance
Can gene editing trigger an immune reaction in humans? A new study is suggesting that it may be a risk. “The CRISPR-Cas9 system, which functions as a genetic scissors and tape for editing DNA, is generally derived from either Staphyloccoccus aureus or Streptococcus pyogenes bacteria.” Most of us though, have been exposed to these organisms throughout our lives. “This prior exposure could potentially render the gene editing ineffective, with the body quickly eliminating all the CRISPR–Cas9 proteins. Or worse, it could trigger the kind of immune storm that killed a young gene therapy patient named Jesse Gelsinger in 1999, derailing the field for more than a decade. ‘We share everyone’s excitement about doing Cas9 genome editing, but we want to make sure we have learned from what happened in the gene therapy world and not ignore the possibility that this could become a problem,’ Porteus says. ‘As we’re all thinking about developing Cas9-based therapeutics, we should think carefully about this potential problem’.”

Pediatric Rabies Death
A 6-year-old boy in Florida has died from rabies he contracted after being scratched by an infected bat. The boy’s father reports that he found the sick bat, put it in a bucket, and told him not to touch it however, he did and was scratched. In response, the father had the boy wash his hands thoroughly based off what he read online and opted not to take him to the hospital because the boy didn’t want to get shots. Unfortunately, within a week, the boy became ill and even after attempts at treatment, passed away. Rabies is almost always fatal once symptoms appear, which highlights the importance of seeking care immediately after exposure.

Stories You May Have Missed:

Thank you for reading the Pandora Report. If you would like to share any biodefense news, events, or stories, please contact our Editor Saskia Popescu (biodefense@gmu.edu) or via Twitter: @PandoraReport

One thought on “Pandora Report 1.19.2018

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s