Pandora Report: 8.3.2018

 Ebola Returns to the DRC and A Lesson in Outbreak Response Failures 
Unfortunately, days after declaring the outbreak over, the DRC has reported four laboratory-confirmed cases of Ebola. The Ministry of Health is also reporting 26 people with hemorrhagic illness signs and symptoms. At this point, there has not been connective evidence between the new outbreak and the last one. The concerning aspect of this outbreak is its location – Beni, within the Magina health district, which is an active conflict zone and poses unique challenges for response efforts. “This new cluster is occurring in an environment which is very different from where we were operating in the northwest,” said Peter Salama, MD, WHO Deputy Director-General, Emergency Preparedness and Response. “This is an active conflict zone. The major barrier will be safely accessing the affected population.” As the DRC continues work to implement control and response measures, a new book from British physician Oliver Johnson and Irish Diplomat Sinead Walsh, is lifting the lid on the botched response to the 2014-2016 outbreak in west Africa. “In Getting to Zero, the duo show how a litany of mistakes made in distant offices in New York, Washington, London and Geneva, combined with poor leadership in Sierra Leone and a weak health service, created a catastrophe that could have been prevented. Among those coming under fire are the British army, the Department for International Development and the US Center for Disease Control. The sharpest criticism is levelled at the WHO, which was slow to declare the Ebola outbreak an international emergency, but also failed to heed early alarm calls made by medics who were working in horrific conditions in the Kenema hospital, where British nurse Will Pooleycontracted the virus.” The news comes just after a new species of Ebola virus was found in bats in the northern part of Sierra Leone.

UK Biological Security Strategy 
The latest policy paper from the British Department for Environment, Food & Rural Affairs, Department of Health and Social Care, and Home Office, has just been released. Outlining everything from the strategy to main assumptions of 2020 and beyond, the policy paper focuses on a response plan that includes understanding the threat, mechanisms for prevention, detection, response, and building a strong science base inclusive of industry and academia. “The strategy also recognises the importance of intervening early to prevent biological threats from emerging, or from spreading once they emerge. To this end, it sets out how we will make best use of our international activity to help reduce the risks to the UK and our interests, at home and overseas. This includes our engagement with international partners (at local, regional and national levels) and forums.” Some of the main assumptions to 2020 and beyond include: the world will continue to become more physically interconnected through travel and migration – affecting both natural health security and deliberate threats, advances in medical technology, genetic engineering and biotechnology will hold significant potential for UK prosperity and growth, etc. Their strategy is also inclusive of relevant national and international programs like the National Counter-Proliferation Strategy to 2020, the Global Health Security and UK Antimicrobial Resistance Strategy, etc.

Three Days Delving into Pandemics, Bioterrorism, and Global Health Security 
If you missed our three-day workshop last month, here’s a quick recap – be warned though, once you read it, you’ll want to join us at the 2019 workshop! “Attendees included people from Health and Human Services, the Department of Defense, and private industry such as Merrick & Company and Emergent Biosolutions. I was surprised to also see people from Sandia National Labs, the Pentagon Force Protection Agency, and even other universities. The diversity of the group led to some thought-provoking conversations surrounding topics like cyberbiosecurity and responding to biosecurity as ‘a wicked problem’. The workshop participants were an engaging group that left me re-thinking how I approach many of these biodefense topics.The workshop began with conversations surrounding how we might analyze biological threats not only from a social and cultural ecological perspective, but also through the resiliency of prevention practices. If we can’t always prevent, how do we respond? MIT’s Sanford Weiner posed such questions to the group, followed by a presentation on the swine flu pandemic of 1976 and discussion on how much the U.S. has learned from mass immunization history, especially compared to the UK.”

CRISPR Woes
CRISPR-Cas9 has been hailed as a revolutionary genome editing tool that will help cure disease. Unfortunately, cell repair following CRISPR enzyme snips isn’t working like we had hoped. “The discovery gives insight into why CRISPR-Cas9 gene editing works remarkably well in nearly every cell attempted, though not with equal success in all cells. ‘If you want to treat sickle cell anemia, your chances of success are inextricably tied to the efficiency with which you can replace the mutated sickle cell gene with the correct one,’ said UC Berkeley postdoctoral fellow Chris Richardson, first author of a paper describing the findings.” While CRISPR can be extremely precise in its ability to target specific DNA sequences, the tricky part is what comes after, when the cell has to repair the damage. “The enthusiasm for using CRISPR-Cas9 for medical or synthetic biology applications is great, but no one really knows what happens after you put it into cells,” Richardson said. “It goes and creates these breaks and you count on the cells to fix them. But people don’t really understand how that process works.”

The High Cost of A Measles Outbreak
Have you ever wondered how large the bill might be for responding to an outbreak of measles? This vaccine-preventable disease is a particularly troublesome foe for public health and infection prevention efforts as its airborne transmission makes control efforts extremely difficult. A new study has just reported the $395,000 price-tag for the New York City health department’s efforts during a 2013 measles outbreak that sickened 58 people. “The first patient was an unvaccinated adolescent who returned to New York City while infectious after visiting London. The outbreak, centered in the orthodox Jewish community, marked the city’s biggest measles outbreak since 1992. With the first case reported in March, health officials spent the next 4 months fielding reports of suspected cases, interviewing patients, reviewing medical and immunization records, tracing contacts, and doing community outreach. The 58 cases came from two neighborhoods of Brooklyn, many of them members of eight extended families, and involved six generations of transmission. Of the total, 45 (78%) were at least 12 months old and weren’t vaccinated due to parental refusal or intentional delay. Twelve patients were younger than 12 months old and were too young to be immunized with measles, mumps, and rubella (MMR) vaccine. One patient was an adult who reported a history of receiving a measles-containing vaccine as a child.” You can read more about the financial impact of a measles outbreak here, where GMU biodefense doctoral student Saskia Popescu was a part of the response efforts.

News You May Have Missed:

  • Trump Taps New White House Science Adviser – Meteorologist Kelvin Droegemeier has been tapped to take over the position and end the void at the White House for the Office of Science and Technology Policy. “Droegemeier would be the first non-physicist to serve as White House science adviser since Congress established the OSTP in 1976. “I think he is a very solid choice,” says John Holdren, who led the OSTP for eight years as Obama’s science adviser. “He is a respected senior scientist and he has experience in speaking science to power.” An expert on extreme-weather events, Droegemeier has been vice-president for research at the University of Oklahoma in Norman since 2009. Last year, Oklahoma Governor Mary Fallin, a Republican, appointed him as the state’s secretary of science and technology.”

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