Pandora Report: 5.3.2019

Happy Friday and welcome to May! To start the month off right, here’s the download of the Max Brooks graphic novel, Germ Warfare: A Very Graphic History. 

Summer Workshop – Discount Extended!
We’re excited to announce that the early registration discount for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security has been extended to June 1st. In this 3.5 day workshop, you’ll hear from experts in the field on virology, public health response, biosecurity, vaccine development, synthetic biology, and so much more. Make sure to register prior to June 1st for an early discount and if you’re registering as a returning student, GMU alum/student/faculty, or part of a large group, you’re eligible for an additional discount. Join us in July for this exciting biodefense event!

U.N. Issues Warning on Growing Antimicrobial Resistance
In a new report from the United Nations, the threat of antimicrobial resistance is front and center. Citing a World Bank simulation that notes deaths due to AMR could rise to 10 million by 2050 if no action is taken, the U.N. highlighted a desperate need to innovate, invest, and accelerate progress in countries. “This is a silent tsunami,” said Dr. Haileyesus Getahun, director of the U.N. Interagency Coordination Group on Antimicrobial Resistance, which spent two years working on the report. ‘We are not seeing the political momentum we’ve seen in other public health emergencies, but if we don’t act now, antimicrobial resistance will have a disastrous impact within a generation’.” “Health officials are struggling to understand the scope of the problem because many countries are ill-equipped to monitor drug-resistant infections. In a survey the United Nations conducted for the report, 39 of 146 nations were unable to provide data on the use of antimicrobials in animals, which experts say is a major driver of resistance in humans as resistant bacteria get transferred to people through contaminated food and water. ‘We are flying pretty blind and working hard to get some clear vision,’ said Sally Davies, the chief medical officer of England and a leader of the United Nations panel. As a first step, the report calls on member states of the United Nations to create national stewardship plans to reduce the unnecessary use of antimicrobials.”

Measles Updates and Why Anti-vaxxers Should Face Isolation and Fines
The U.S. topped 700 measles cases this week as 78 cases were reported in the last week. “Thirteen outbreaks—defined as three more related cases—have now been reported in 2019 so far, and account for 94% of all cases. Nine outbreaks are currently active, up from six reported the previous week. The CDC today spelled out all the details and implications of this year’s surge in cases in an early report in Morbidity and Mortality Weekly Report (MMWR) and in its weekly case update.” Juliette Kayyem is taking a stand on anti-vaxxers, noting that they are dangerous and should face isolation, fines, and arrests. “It is time we stop viewing the anti-vax movement and its adherents’ responsibility for the measles outbreak as a public health problem. With more than 700 reported cases confirmed in 22 states, it is now a public safety crisis, and the tools of public safety — arrests, fines, isolation — are absolutely necessary. The initial steps we have taken are essential: prohibit non-vaccinated children from public spaces, including schools; promote educational efforts; and, in extreme cases, force isolation on pockets of populations that might have been exposed to the outbreak, as is happening now in the University of California system. But these efforts impact the children who might have been put at risk by the decision of individuals not to vaccinate. Viewed through the lens of public safety, it is the parents who should be punished. Why not make them pay for the harms they are causing?Fines for the increased public safety burdens put on these communities by a few ought not to be the responsibility of all. In many states, when hikers ignore warnings that certain trails are too dangerous and then have to be rescued, the fees for the rescue must be paid by the hikers. It’s a fine for making a self-centered decision that placed an unreasonable burden on a larger community. Measles should be no different.”

Are Frontline Hospitals Ready for a Patient With Ebola?
GMU biodefense doctoral student and infection preventionist Saskia Popescu, discusses the gaps in frontline healthcare facilities and what this means for bioprpearedness efforts. “Now fast forward to 2019…how prepared are these frontline facilities today? Unlike the treatment centers, they do not receive funding or undergo assessments of their biopreparedness and frankly, there are a lot of competing interests for hospital administrators to invest in the costly PPE for Ebola. Although some hospital systems have run drills on their preparedness for high-consequence pathogens, they are also typically the systems that maintain a heightened level of readiness, and for most of the other facilities it is less likely Ebola or other special pathogens are getting much attention. Investigators sampled 5 major frontline hospitals in Maricopa County, Arizona, to perform a gap analysis in how their response would be for a patient with Ebola or another high-consequence pathogen. From entering the hospital through the emergency department to cleansing and disinfecting protocols, the investigators evaluated whether health care workers could still answer the questions that were heavily drilled into these hospitals in 2014.”

Trends in Foodborne Pathogen Transmission in the U.S.
Just how much foodborne illness are we seeing in the United States? The CDC just released a new study in their MMWR regarding surveillance from 10 sites across the U.S. from 2015-2018. “During 2018, FoodNet identified 25,606 cases of infection, 5,893 hospitalizations, and 120 deaths. The incidence of infection (per 100,000 population) was highest for Campylobacter (19.5) and Salmonella (18.3), followed by STEC (5.9), Shigella (4.9), Vibrio (1.1), Yersinia (0.9), Cyclospora (0.7), and Listeria (0.3). Compared with 2015–2017, the incidence significantly increased for Cyclospora (399%), Vibrio (109%), Yersinia (58%), STEC (26%), Campylobacter(12%), and Salmonella (9%). The number of bacterial infections diagnosed by CIDT (with or without reflex culture§) increased 65% in 2018 compared with the average annual number diagnosed during 2015–2017; the increase ranged from 29% for STEC to 311% for Vibrio. In 2018, the percentage of infections diagnosed by DNA-based syndrome panels was highest for Yersinia (68%) and Cyclospora (67%), followed by STEC (55%), Vibrio (53%), Shigella(48%), Campylobacter (43%), Salmonella (33%), and was lowest for Listeria (2%).”

The Future of the SNS
While most of us know of the Strategic National Stockpile (SNS), for much of the population, this critical aspect of preparedness and biodefense is likely an unknown. A new article addresses what the SNS is and its future in biodefense. “Consequently, one of the most surprising features about the stockpile is that in all likelihood, it is probably incomplete. The reason for this is that although the stockpile includes what are presumed to be the best medical countermeasures for a broad range of potential biothreats—we don’t know the exact inventory because the identity of the contents are closely held —there is an even broader range of potential biothreat agents that an adversary could use in an attack. And stockpiling countermeasures for every conceivable individual agent is currently not feasible because countermeasures for some biothreat agents do not even exist yet—and even if they did, the continuous maintenance of copious countermeasures may not be logistically or financially feasible. There is also the possibility that an adversary could select or engineer an agent that is simply resistant to all-known medications.”

Ebola in the DRC- What’s the Latest News?
Officials from the WHO recently visited the frontlines of the Ebola outbreak in the DRC. Both WHO Director-General Tedros Adhanom Ghebreyesus and WHO Regional Director for Africa Matshidiso Moeti visited Butembo, following deadly attacks and 14 new cases. “In a statement, the two said they were profoundly worried about the situation and acknowledged that recent surges in infections are the result of setbacks each time the response sustains violent attacks. Most of the response activities—such as community engagement, vaccination, and case investigation—have restarted following a slowdown after the attacks that killed Mouzoko and injured two others, the WHO said. It notes, however, that the torrent of cases in recent weeks is further straining resources.” As the situation worsens in the DRC, financial concerns are growing as only half of the response budget is funded. “In a statement issued 30 April 2019, WHO Director-General Dr. Tedros Adhanom Ghebreyesus expressed his worries about handling increasing cases counts in a volatile ground situation while under-funded. ‘We are entering a phase where we will need major shifts in the response,” said Dr. Tedros. WHO and partners cannot tackle these challenges without the international community stepping in to fill the sizeable funding gap.’ Dr. Tedros made these remarks during a WHO delegation visit to Butembo, the site of the 19 April killing of WHO epidemiologist Dr. Richard Mouzoko by armed men while he and colleagues were working on the Ebola response.”

Rapid Response Teams- 10 Years of Collaborating on Public Health Emergencies
“In 2008, to enable faster, more efficient responses to emergencies, the FDA launched a network of state-based Rapid Response Teams (RRT), comprised of multi-agency, multi-disciplinary teams that operate by the principles of the Incident Command System/National Incident Management System to respond to human and animal food emergencies. In an emergency, the Rapid Response Teams coordinate efforts to align the response activities of agencies that may have overlapping jurisdiction to prevent harm to consumers as quickly as possible. These teams have become valued partners in responding to outbreaks from contaminated human and animal foods, conducting large-scale recalls, and ensuring availability of safe foods during a natural disaster. The FDA can respond more rapidly during an emergency by leveraging the relationships and resources with local, state, and federal partners for the common public health goals we share.”

Meet the Virus Hunters
In the face of this mounting Ebola outbreak in the DRC, Bill Gates has written about the “real-life Sherlock Holmes who helped discover Ebola” and the response team (RST) that helped control the outbreak. “But identifying a virus on a microscope is only the first of many steps to stopping an outbreak. So, with no real idea of what he was up against, Peter headed to Zaire to hunt for patient zero. He and his colleagues drove from village to village in a Land Rover, collecting information about who was sick and where they had been before symptoms appeared. Peter’s experience with Ebola was just the beginning of a long career fighting infectious disease. He was one of the first microbiologists to study AIDS, and in 1995, he became the founding executive director of UNAIDS. During his 13-year tenure, he coordinated the global response to HIV/AIDS through the discovery of the first treatments for the disease and the peak of the pandemic. After a brief stint at the Imperial College London and as a fellow with our foundation, he became the director of the London School of Hygiene and Tropical Medicine where he still teaches today.” “In just a little more than two years since it was created, the RST has already assisted in controlling 11 outbreaks in seven countries. The team has deployed to scenarios ranging from a diphtheria outbreak at a Rohingya refugee camp in Bangladesh to a plague flareup (yes, that plague) in Madagascar. Here’s how the RST works: as soon it becomes clear that an outbreak is underway, the local government (or, in rare cases, the WHO) requests their help. Not every team member is needed for every outbreak—sometimes you need an epidemiologist and a data scientist but not a microbiologist—so the first step is to identify who needs to go. The chosen team then has 48 hours to get their visas squared away, pack up any special equipment, and get to the airport for their flight to the outbreak zone.”

Beyond the Biocontainment Unit: Improving Pathogen Preparedness for Health Workers
“These specialized designations within hospitals have allowed for 10 Regional Ebola and Other Special Pathogen Treatment Centers (RESPTCs) that not only work to enhance preparedness for high-consequence diseases, but have also taught us some critical lessons and provided novel insight into what this level of preparedness means for hospitals.  A recent article published in Health Security focused on the impact that the creation of the BioContainment Unit (BCU) at Johns Hopkins Medical Center brought to infection prevention, preparedness, and evening nursing. The investigators found that beyond ensuring they could care for multiple patients with high-consequence pathogens, the BCU supported institutional efforts including research, educational training, and strengthening infection prevention practices. The BCU also facilitated preparedness networks and collaborative efforts. Within their article, the investigators pointed to several specific examples of how the hospital’s investment in the BCU impacted other facets of health care efforts.”

Stories You May Have Missed:

  • Dr. Frances Kelsey vs. Chemie Grünenthal – “In 1960, Frances Kelsey was a recently appointed medical reviewer at the U.S. Food and Drug Administration. The new drug application (NDA) for Kevadon, or thalidomide as it is better known, was her second file. ‘They gave it to me because they thought it would be an easy one to start on,’ she said. ‘As it turned out, it wasn’t all that easy.’ The applicant was William S. Merrell Inc. of Cincinnati, an American pharmaceutical company with plans to manufacture thalidomide under license from Chemie Grünenthal, a family-owned West German company. As it turned out, Grünenthal had a record of rushing bad and inadequately tested drugs to market.”

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