Category: Pandora Report

Pandora Report 12.25.2015

by spopescu, posted in Pandora Report

Happy Holidays fellow biodefense gurus! We at the Pandora Report would like to wish you and yours a lovely holiday season, filled with happiness, health, and a side of relaxation. Your favorite weekly dose of biodefense news be taking a few weeks off from reporting while I venture to the land of Oz. Rest assure, should there be a zombie outbreak, I’ll report it first hand! Since we’ll be radio silent for a couple of weeks, we’ve compiled a pretty swanky “I love biodefense and need more of it” reading list to keep you busy. Before you venture down the biodefense rabbit hole, here is fun history fact Friday: on December 24th, 1814, the war of 1812 ended and on December 24, 1936, the first radioactive isotope medicine was administered by Dr. John Lawrence. 

The Revolving Door of Biosafety7898_lores
GMU Biodefense Master’s student and lab guru, Scott McAlister discusses the importance of biosafety in the changing world of global health. Through his review of the 2009 report by the Trans-Federal Task Force on Optimizing Biosafety and Biocontainment Oversight and a 2015 memorandum released by the White House to enhance biosafety, he discusses the ever changing components of US biosafety. Scott breaks down and compares each report’s recommendations, language, and what these translate to within US laboratories. Moreover, given the recent failures, have US biosecurity practices and recommendations evolved over the past 6 years? Take a look into this review to see where we hope to be and if we’ve progressed since 2009.

National Action Plan for Combating Multidrug-Resistant TB
This week the White House released its national plan for combating the growing threat of multidrug resistant tuberculosis. While US rates of TB cases have dropped, the growing threat of multidrug resistant TB (MDR-TB) and extensively resistant TB (XDR-TB) requires action. This new plan is set to span over 3-5 years and has three goals that will focus on strengthening domestic capacity, improving international capacity and collaboration, and accelerating basic and applied research and development. Extensive collaboration within US agencies and international partners will be necessary to combat the evolving threat of drug resistant tuberculosis.

We’re Not Prepared for a Biological Attack
GMU Biodefense PhD alum, Dr. Daniel M. Gerstein, discusses biopreparedness and where the US stands in his work for US News  & World Report. Throughout his in-depth analysis, Dr. Gerstein emphasizes the importance of US leadership within the Biological Weapons Convention (BWC). Pointing to the disappointing Seventh and Eighth Review Conferences, Dr. Gerstein notes, “biological warfare can no longer be considered the purview of only state actors. And this democratization of biotechnology means that the world is literally one rogue microbiologist away from a potentially devastating biological attack.” Dr. Gerstein emphasizes that authorities often fail to realize that biological weapons may not act like naturally occurring diseases or outbreaks.

Holiday Biodefense Book Club
During the cold winter months it’s always nice to curl up by the fire with a good book and relax. GMU Biodefense Master’s student, Rebecca Earnhardt, and I have picked a handful of books to spark your interest. If we could have a book club with our awesome readers, we would love it, but in the mean time, here are our recommendations for a few literary works that you might enjoy!

  • Phantom Menace or Looming Danger?: A New Framework for Assessing Bioweapons Threats By Kathleen M. Vogel — Johns Hopkins Press, 2012. The military has gathered reconnaissance of a possible biological research facility, evidence of a paper trail indicating procurement of weapons delivery systems, and collection of specialized personnel to manufacture biological agents.  Do all of these pieces point to an imminent biological weapons danger?  Kathleen M. Vogel, in Phantom Menace, argues that there is more to the picture of biological weapons development than the technical and physical aspects of manufacturing.  Through examination of three case studies, Vogel highlights the shortcomings of the dominant biotech revolution frame within biological weapons assessments.  The biotech revolution frame, as described by Vogel, misses the important social and contextual factors that affect biological weapons innovation.  The alternative offered by Vogel is termed the biosocial frame.  Vogel highlights in her biosocial frame how tacit knowledge and hands-on experience is vital to biological weapons assessments.  While Vogel does not particularly focus on political influences, I enjoyed the book because of her explanation of the importance in incorporating sociological aspects into biological weapons assessments.  I think this makes Vogel’s work a key book in the field of biodefense.
  • Innovation, Dual Use, and Security: Managing the Risks of Emerging Biological and Chemical Technologies. Editor: Jonathan B. Tucker — MIT Press, 2012. The hotly debated concept of ‘dual-use’ is explored extensively through this multipart work edited by the late chemical and biological weapons expert, Jonathan B. Tucker.  This book takes on the conceptual nuances of dual-use with four parts focused on emerging technologies within the areas of directed design, acquisition of novel molecular parts, modification of biological systems, and enhanced production and packaging capabilities.  Each section, authored by leading experts in the field of biodefense research, including Filippa Lentzos and Gerald Epstein, applied Tucker’s framework of risk assessment for dual-use potential and governability.  This framework incorporates key aspects of assessing dual-use potential, including technological monitoring, technology assessments, and governability of the technology.  The strength of this framework lies in its applicability to emerging technologies, which may enable policy makers to continuously review a particular technology or an emerging area of research.  In the concluding chapter, Kirk Bansak and Jonathan Tucker redirect attention to the intervening social processes that construct relationships between the technology and its users, and how these social processes may create an environment ripe for misuse.  To me, this book is a highly valuable and informative work on the range of dual-use issues and conceptual applications.  I think this book is an important read not only because it covers a variety of dual-use issues, but also in its wide-ranging review of relatively recent biotechnology and life science innovations.  The variety of case studies makes this book an enjoyable read!
  • Spillover: Animal Infections and the next Human Pandemic by David Quammen. New York: W.W. Norton, 2012. Not only is David Quammen one of my favorites, but his overview of zoonotic diseases and the concept of spillover will both captivate and inform you. Ranging from West Nile Virus to Ebola, Quammen presents several of the zoonotic diseases you may have heard of and others that may cause you to reconsider kissing a horse anytime soon. Each chapter presents a new disease, it’s history, and a new outbreak that should raise our attention to global health security. While he doesn’t touch much on avian influenza or multi-drug resistant organisms, his points on humans infringing upon animal ecosystems and the resulting disease spillovers are harrowing. Quammen’s adventures remind me of a microbial Indiana Jones (hint hint Hollywood, that would make an excellent movie!), even with the cheeky wit. I would recommend Spillover as a gateway to understanding the role of zoonotic diseases and the emphasis we’re seeing on One Health. While his parts on Ebola aren’t as dramatic as Richard Preston, you’ll be sure to enjoy his approach to epidemiology and the impact of spillover on global health. Quammen did extend his sections on Ebola into another book that includes information related to the 2014/2015 outbreak. If you enjoy on-the-ground reporting, you’ll find this within Quammen’s book.
  • Greek Fire, Poison Arrows, and Scorpion Bombs: Biological and Chemical Warfare in the Ancient World by Adrienne Mayor. Woodstock: Overlook Duckworth, 2003. As a lover of all things biodefense and classical, I was excited when I cam across Adrienne Mayor’s book. Combining ancient history and bioweapons? Sold! Mayor’s breakdown throughout the book reveals the mythical and historical accounts of chemical and biological weapons in the ancient world. While a bit dramatic and sometimes repetitive, I found her book to be enjoyable in that few people have combined ancient history and chem/bioweapons to such an extent. Mayor makes sure to include references to mythology that heavily impact these ancient societies. While the lines of chemical and biological weapons were sometimes muddied and some generalizations related to classical history did occur, I would recommend her book to anyone who enjoys history (especially ancient history), mythology, and CBW. Realistically, with such a catchy title, how could you resist?

Stories You May Have Missed:

Pandora Report: 12.18.2015

by spopescu, posted in Pandora Report

Hungry, hungry anthrax hippos? If there’s one thing we love about the science community, it’s when a gem pops up in your inbox like this (thanks ProMed!). In Ebola news, public health officials are exploring the possibility that survivors may be a potential source of case surges. Fun history fact Friday: On December 18, 1620, the Mayflower docked at Plymouth Harbor and passengers began settlement and on December 14, 1980, the CIA issued a warning about Soviet arms sales to Third World nations. Take a break from holiday preparations with this week’s Pandora Report – we’re discussing everything from zombies to Bob Dylan lyrics!

Epidemiology of a Zombie Outbreak
Tara C Smith and the writers of The BMJ certainly know how to hook a biodefense nerd – epidemiology of zombie infections? Don’t mind if we do! Using historical tales and movie outbreaks, Smith takes us through several hypothetical zombie outbreaks we’ve experienced as viewers or readers for the past few decades. Tracing the origins of certain outbreaks and the transmission patterns via bite, this scientific approach to one of our favorite topics is fascinating.  Potential etiological considerations included weaponized Yersinia pestis, a mutation of bovine spongiform encephalopathy, or a genetically modified form of the Ebola virus that was tested on chimpanzees (that later escaped!). Last but not least, we can’t forget to consider the ethical implications of such an outbreak. How do we handle resource depletion or quarantine? All things to consider before the zombie apocalypse!

Risk & Benefit Analysis of Gain of Function Research 
With the National Science Advisory Board for Biosecurity (NSABB) meeting fast approaching (January 7-8, 2016!), we’re recapping the role of gain-of-function (GoF) research in biodefense. Earlier this year, Gryphon Scientific was awarded a NIH contract related to assessment of GoF research and the risk-versus-benefits that may impact future federal funding. With the intent to make future recommendations, the assessment had three major tasks: a risk analysis (RA) of accidents and natural disasters, a biosecurity RA, and a benefit assessment. Extensive review and analysis of data from the intelligence and law enforcement community reviewed potential gaps within security practices. “The biosecurity RA is delivered in two parts because risks posed by malicious acts targeting laboratories that conduct GoF required a different analytical approach than the assessment of the risk generated by the misuse of published GoF research.” GMU Biodefense alum and previous Pandora Report editor, Julia Homstad, is also the lead author on Chapter 11 (Risk of Loss of Trust in Science). Perhaps one of my favorite points from the report was that “this assessment requires the identification of scientific and non-scientific barriers to the realization of these benefits.” You can also find Michael Selgelid’s White Paper regarding the ethical implications of GoF research. While the 1,001 pages may seem a daunting task, this is not only a highly relevant report, but approaches GoF concerns and risks in an engaging and holistic manner.

Bob Dylan Lyrics in Medical Literature?
Have you ever read a scientific article and felt a complete unknown, like a rolling stone? Scientists at the Karolinska Institute in Sweden have been sneaking Bob Dylan song lyrics into their papers as part of a long-standing bet since 1997. “It all started in 1997 with a review in Nature Medicine entitled ‘Nitric oxide and inflammation: the answer is blowing in the wind.'” Carl Gornitzki and colleagues from The BMJ decided to do some additional digging in Medline and found that 213 of 727 found references were unequivocally citing Bob Dylan. Starting a few years after his musical debut, research papers included a variety of biomedical topics, like those of Hermanson et al., who managed to work “like a rolling stone” into their paper on epigenetics. The variety of lyrics found throughout the literature is certainly more than a simple twist of fate.

Outbreak Preparedness 2015 Report
Ever wonder how your state ranks in terms of emerging infectious disease preparedness? Trust for America’s Health and the Robert Wood Johnson Foundation recently published their 2015 report regarding state capabilities to protect against new infectious disease threats (MERS-CoV, multi-drug resistant organisms, etc.) and “resurging illnesses like whooping cough, tuberculosis, and gonorrhea.” The report found that over half of US states ranked at five or lower on a scale of ten. The five all-star states (scoring eight) were Delaware, Kentucky, Main, New York, and Virginia (go Virigina!). The report findings noted that “the nation must redouble efforts to protect Americans” and included points on healthcare-associated infections, flu vaccination rates, food safety, and superbugs. Check out the report to find where your state ranked!

Fighting Antibiotic Resistance in the United States18170_lores
On Thursday, the House Appropriations Committee presented the 2016 Omnibus Appropriations bill, which revealed discretionary funding plans for the federal government. Buried in new legislation, the FDA and NIH will receive part of this discretionary funding to help fight antibiotic resistant bacteria and “advance prevision medicine initiatives”. The FDA is set to receive $2.7 billion, which was over a $10 million increase from FY2015. Within the bill, there is “funding for the Combating Antibiotic Resistance Bacteria (CARB) initiative ($8,732,000), the precision medicine initiative ($2,392,000), and the Orphan Product Development Grants Program ($2,500,000). The NIH will receive an extra $2 billion for FY2016, which supported projects specially for Alzheimer’s diseases research, brain research, antibiotic resistance, the Precision Medicine Initiative, etc. Given last week’s report on the phantom menace CRE and growing cases of multi-drug resistant organisms, it’s extremely important antibiotic resistance be given more attention.

Stories You May Have Missed:

  • CDC Establishing Flu Vaccine Efficacy Lab Network – The CDC has provided funding for a network of US institutions to collect and analyze information related to annual flu vaccine effectiveness. “Participating institutions will coordinate enrollment of patients with acute respiratory illness, confirm influenza infection using a standardized reverse-transcription PCR (RT-PCR) assay, and estimate vaccine effectiveness.” The 30 million dollar funded project will run from July 2016-2021.
  • Avian Influenza in France – France has reported 30 outbreaks of avian influenza, specifically one of the highly pathogenic influenza. Unfortunately the strain in the most recent cases hasn’t been identified, but these outbreaks been attributed to one of the H5 strains.
  • Hawaiian Dengue Outbreak Update – Cases of dengue virus on Hawaii Island have now reached 157. There are 7 individuals considered still infectious and the Hawaii Department of Health (HDOH) continues their efforts to identify cases and reduce transmission. 140 of the cases are Hawaii Island residents, and 34 of the overall cases have been children under the age of 18.

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Pandora Report 12.11.2015

by spopescu, posted in Pandora Report

If you’re in Boston and enjoying a Chipotle burrito bowl, you may want to put the fork down. As many as 80 cases of norovirus were reported in association with a Boston Chipotle. The norovirus surge occurs just months after the multi-state Chipotle-linked E. coli 026 outbreak. This week we’re discussing superbugs Star Wars style, the decline of infectious disease specialists, Ebola lab stories from the field, and much more. Fun history fact Friday: on December 7, 1941, Pearl Harbor was bombed and on December 10, 1901, the first Nobel Prizes were awarded in Stockholm, Sweden 

“Phantom Menace” Superbug?
In a lab far, far away… How could we resist a Star Wars reference to antibiotic resistance? A recent CDC MMWR reported a growing incidence of a particularly concerning antibiotic-resistant organism. Carbapenem-resistant Enterobacteriaceae (CRE) are continuing to raise concerns due to cases related to endoscopic retrograde cholangiopancreatography (ERCP) scopes. Since it’s discovery, global health experts (including the CDC) have been keeping a close eye on CRE transmission and cases. A variant of CRE, called OXA-48-type carbapenemase, was seen in Enterobacteriaceae in Turkey in 2001. 52 isolates of CRE producing OXA-48-like carbapenemases were found in 43 patients in the US from June 2010-August 2015. A study in 2012 first referenced OXA-48-like carbapenemases as the phantom menace. The concerning issue with this particular CRE strain, aside from its known-resistance, is the growing emergence in the US. The difficulty in treatment and extreme care for isolation precautions makes patient care challenging. Interestingly, for those patients who provided a travel history, the majority (66%) had traveled internationally within the year before specimen collection and 55% were actually hospitalized outside the US for at least one night. The US cases involved several clusters and were spread across 19 states. Even more worrying, the laboratory diagnosis is tricky as “most U.S. clinical laboratories that test for CRE organisms wouldn’t identify this particular type of bacteria because it’s not part of standard testing.” The increase in cases and ease of hospital transmission are just a few more reasons why antimicrobial stewardship is so vital. May the force be with you!

Ebola Surveillance & Lab Response SeminarIMG_4700
In case you missed GMU’s seminar on global health security on Monday, 12/7, here’s a recap! Speakers included Dr. Matthew Lim (Senior Policy Advisor for Global Health Security, HHS, fmr Civil-Military Liaison Officer to WHO), Jeanette Coffin (Section Manager, Biosurveillance Division, MRIGlobal), and Phil Davis (Associate Scientist with MRIGlobal). Ms. Coffin and Mr. Davis discussed the operations, supported by the Defense Threat Reduction Agency’s (DTRA) Cooperative Biological Engagement Program (CBEP). The mobile lab was launched in December 2014. With only six weeks to train, prepare staff, acquire equipment, deliver, assemble, and much more, it’s a pretty impressive feat that this team pulled off. Ms. Coffin and Mr. Davis discussed how they were able to reduce much of the travel delay and time lag for Ebola testing results. Using equipment to perform RNA extraction and PCR’s, lab technicians were working in tight quarters in Moyamba and Lakka, Sierra Leone. To date, the DTRA-CBEP mobile lab operations tested 7,242 samples for Ebola. While they discussed many of the strengths like flexibility, relationship with vendors, and self-containment, there were also several challenges. Difficulties ranged from inadequate power and internet, to road reliability, food/water safety, haggling, and security issues related to petty theft and missing supply containers. Sustainability was heavily discussed as their expected withdrawal is June 2016 and the team hopes to provide education for ongoing surveillance. Next, Dr. Matthew Lim spoke of the history and impact this outbreak had on global health security. He emphasized “how much this has overturned the paradigm we have about health and security”. Dr. Lim’s discussion was fascinating in that he speaks from experience at both the WHO and HHS, pointing to the role of member states and how WHO funding cutbacks impacted outbreak response. He noted that the Global Health Security Agenda heavily emphasizes partnership of it’s 50 state members, NGO’s, and within the 11 action packages. He explained that global health affairs, in many ways, join foreign policy and health policy, highlighting the need for less siloing and more partnership to help encourage capacity measures. Overall, the standing-room-only seminar touched on both the operational struggles and the overarching role of global health security in both the Ebola outbreak, but also future preparedness efforts.

Daesh and Chem/Bioweapons?
The UK and France have moved to call ISIS, “Daesh”, to remove the association with Islam. Given Daesh’s use of mustard gas, is bioterrorism a stretch? Sandra Maksimovic-Sara of Outbreak News Today discusses their attempts to obtain biological and chemical weapons as a means of using non-conventional weapons to change their modus operandi. While she doesn’t mention tacit knowledge, Maksimovic-Sara notes that “for a biological and chemical terrorist attack, there must be some know-how and background and a professional approach, which is so far away from impatient aggressive Islamic terrorists gathered in Daesh. They want fast track acts and fast track results.” While preparedness efforts must account for a variety of attacks, it’s vital to remember technical limitations. As Dr. Sonia Ben Ouagrham-Gormley noted, tacit knowledge is a significant hurdle for non-state actors to overcome in their quest for bioweapons.

To Quarantine or Not To Quarantine? 
The fallout of the 2014 West Africa Ebola outbreak is still ongoing and while many US hospitals feel they are better prepared to handle cases, there are many that experienced negative treatment related to preparedness efforts. There have been several returned travelers from the affected countries that were put into quarantine upon arrival in their home country. While many were involved in patient care, there are several that had no interaction with patients and experienced what many would call, “fearbola“. While quarantine efforts are important for those that may have had patient interaction, risk assessments are vital. Sheri Fink of The New York Times notes that several states “have the legal authority to impose quarantines, often exceeded those guidelines, restricting the movements of returning health workers and others.” Many who were quarantined experienced public harassment, media scrutiny, and some have filed lawsuits for civil rights violations.

France’s Bioterrorism Preparedness
Given the November terrorist attacks in Paris, it’s not surprising that France is looking to ramp up their biodefense efforts. Following the arrival of a third generation vaccine, France has decided to revise its smallpox preparedness and response plans. Last revisited in 2006, the plan is to vaccinate first responders and healthcare professionals that are most likely to identify and care for smallpox cases. Smallpox has long been an organism of concern for bioweapon applications. In coordination with the Secrétariat Général de la Défense et la Security Nationale, (SGDSN- General Secretariat for Defense and National Security) these plans will include the new vaccine, Imvanex, that was developed by the Danish biotech company, Bavarian Nordic, “on behalf of the US under Bioshield”. While the new plan involves “circles” of people, the new transgenic vaccine has vastly decreased the side effects that were commonly associated with first and second generational variola vaccines. In the past, smallpox vaccines were associated with high volumes of side effects, which was a roadblock to previous mass-vaccination efforts as a biodefense strategy. France has several biopreparedness strategies that include a syndromic surveillance program, SurSaUD, a White Plan, and many other efforts to prevent, identify, and respond to health security threats. The updated French plans hope to “frustrate and deter terrorists” as well as respond to concerns of re-emerging infectious diseases. Elisande Nexon presents an overview of France’s biopreparedness efforts and the public health threats they may encounter. While the November attacks in Paris will most likely initiate additional changes to France’s biopreparedness, their existing methods are extensive and reveal national support for biodefense.

Stories You May Have Missed:

  • Infectious Disease Specialists on the Decline – The National Resident Matching Program (responsible for matching medical students with specialty training programs) announced that of the 335 infectious disease fellowship positions available, only 218 were filled. This is especially concerning as it follows several years of low matching for infectious disease positions. The Infectious Disease Society of America has even begun brainstorming recruiting tactics for what many consider a “thinking specialty” that may not have the glamor or pay that draws students into the field. Speaking from experience as an infection preventionist, the infectious disease physicians I have worked with were by far the most dedicated, intelligent, and passionate people. I think we can all safely agree that the world needs more infectious disease specialists, especially following outbreaks like those of Ebola and Zika virus.
  • USAMRIID Supported Study Traces Ebola Outbreak – a recent study lead by USAMRIID found that a majority of the Liberian Ebola cases “can be traced back to a form of the virus transmitted from Sierra Leone”. The sequencing of hundreds of isolates also supports the role of high-density neighborhoods as an accelerant for the outbreak. Interestingly, researchers found that the Ebola strain diversified in Liberia prior to being transmitted to cases in Guinea and Mali.
  • Yamuna River Harbors High Volume of Antibiotic-Resistant Organisms – Researchers found that the Yamuna river in Dehli, India, had an alarmingly high amount of resistant organisms. There were large quantities of several organisms found that showed resistance to many common antibiotics like ampicillin, streptomycin, etc.
  • MERS Was the Most 2015 Googled Word in Korea – also considered Korea’s “hottest” Twitter issue, MERS became the most searched topic after the first patient was confirmed on May 20th.

Pandora Report 12.4.2015

by spopescu, posted in Media Notes, Pandora Report

This week, Washington, DC hosted the Summit on Human Gene Editing, where the ethical and legal implications of gene editing technologies, like CRISPR-Cas9, were heavily discussed. In this week’s report, Greg Mercer works his magic, revealing the internet and social media trends following the shootdown of a Russian SU-24 on November 24th. We’re also reporting updates in the Zika virus and dengue fever outbreaks as well as the Harvard-LSHTM Panel Report on Global Response to Ebola. France is currently experiencing an increase of highly pathogenic avian influenza cases while a Black Angus beef cow in Alberta was discovered to have bovine spongiform encephalopathy (BSE). Fun history fact Friday – on December 3, 1967, the first human heart transplant was performed in Cape Town, South Africa and on December 4, 1945, the Senate approved US participation in the UN. Before we start our weekly roundup, make sure to mark your calendars to attend GMU’s seminar on Ebola surveillance and laboratory response this Monday, December 7th from 4:30-6pm at our Fairfax campus (details below!).

Zika Virus Outbreak – Updates
The growing outbreak of Zika virus has now seen locally acquired cases reach ten countries, causing the Pan American Health Organization (PAHO) to issue an alert, “urging countries in the region to be on the lookout for the disease and to watch for unusual patterns in newborn.” Brazil has been hit hard with a rise from 739 on November 27th, to 1,248 cases reported on November 30th. Six of the ten countries saw cases occur in November, hinting that the outbreak could just be starting. The growing concerns regarding the outbreak are also related to the newest evidence linking microcephaly and maternal cases. Zika virus genome was found in the amniotic fluid of two pregnant women and fetal diagnosis of microcephaly was performed via ultrasound. Even more so, French Polynesian health officials reported an unusual spike in nervous system malformations in babies that were born during a Zika virus outbreak in the region from 2014 to 2015. The concern regarding neurological conditions raises red flags as Brazilian health officials are reporting neurological complications, like that of Guillain-Barre syndrome, in Zika virus patients. The WHO reported 739 Brazilian microcephaly cases in newborns and while there is only ecological evidence linking the virus and microcephaly, investigations are ongoing. The outbreak first started in February 2014, on Easter Island (Chile) and has seen been identified in Colombia, Guatemala, Brazil, El Salvador, Mexico, Paraguay, Panama (confirmed cases as of December 4, 2015), Suriname, and Venezuela. Spread by Aedes mosquitoes, this vector-borne organism has similar symptoms to dengue fever and illness tends to last between four and seven days.

Event: Ebola Surveillance & Laboratory Response – Lessons for Global Health SecurityScreen Shot 2015-12-03 at 9.34.57 AM
Time/Location: Monday, December 7, 2015 from 4:30pm-6pm in Robinson A-203 at George Mason University.
As the recently released Harvard-London School of Hygiene and Tropical Medicine Independent panel on the Global Response to Ebola indicates, the West African Ebola epidemic highlighted
many gaps in national and international health and response systems that are critical for protecting global health security.  Join leaders and experts who helped to lead the U.S. response for Ebola to discuss the international response to the epidemic, the importance of robust biosurveillance systems, and how the experience with Ebola influences our approach to Global Health Security. Speakers:

  • Dr. Matthew Lim, Senior Policy Advisor for Global Health Security, HHS, fmr Civil-Military Liaison Officer to WHO
  • May Chu, Ph.D. fmr Assistant Director for Public Health, Office of Science Technology and Policy, White House; Senior Science Advisor, CDC
  • Jeanette Coffin, Manager U.S. mobile laboratory deployment, MRIGlobal

It’s Definitely Maybe World War 3
GMU’s Greg Mercer breaks down the November 24th Turkish shootdown of a Russian SU-24. Greg reviews the media attention following the event and the “immediate buzz about declarations of war, what exactly NATO owes Turkey vis-à-vis Russia, and the possibility of military confrontation between Russia and the West.” Through his use of google trends and Twitter, Greg shows just how much hype and concern the notion of WWIII got during this time. Take a look at his recap and debunking of the WWIII buzz and how quickly it caught like wild fire.

Reporting from the Panel on the Final Report of the Harvard-LSHTM Independent Review of the Global Response to Ebola
If you missed the Center for Strategic & International Studies (CSIS) Global Health Policy Center’s Launch of the final report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola, don’t worry! I was fortunate to attend and a great deal of the report (we reported on last week) heavily emphasized “on the ground” capacity. Dr. Peter Piot, Director and Handa Professor of Global Health, London School of Hygiene and Tropical Medicine (LSHTM), joined via video link and started by saying that this would not be a WHO-bashing event. As one of the original researchers on Ebola during its 1976 discovery, he mentioned that the Democratic Republic of Congo (DRC) is a great example of local capacity in their success of ridding themselves of the disease within a few months of the outbreak starting. Dr. Piot heavily emphasized the work of several countries and how the WHO brought together multiple ethicists to review research during such a terrible outbreak. Lastly, Dr. Piot noted that “we risk focussing too much on global and not enough on local” in our future efforts. Dr. Suerie Moon, Research Director and Co-Chair of the Forum on Global Governance for Health at Harvard Global Health Institute, then spoke on the “weak coordination of global response” and how it severely aided the spread of Ebola. Dr. Moon highlighted the need for a global strategy to ensure adequate funding (external financing for the poorer countries and transparent tracking of financing) and the necessity for external assessment of country capacity. She pointed to the need for political and economic incentives and disincentives to not only report cases but also discourage the hiding of outbreaks. Reviewing each recommendation, the panel noted that “human health is a vital part of human security”. In one of her closing comments, Dr. Moon stated that “there are many unanswered questions regarding ebola response and we need to address a number of aspects that went wrong” and “a major theme is accountability at all levels, across all types of players.” Dr. Moon pointed out that the necessity of so many reforms shows just how much work is needed and that now is the time to see political support occur. Muhammad Pate, former Nigerian Minister of State for Health, expressed that “one of the lessons, at the national level, in terms of surveillance and accountability to respond, was missing and something that national leaders need to own up to is building their own public health systems.” Dr. Sophie Delaunay, Doctors Without Borders/MSF, then discussed the role of medical innovations and how the outbreak provided us with a unique opportunity to collect data. Dr. Delaunay said it will “be a complete nightmare to connect all the dots” in this outbreak and there is a desperate need for better R&D regarding disease outbreaks and response. “We ask for governments and policy makers to support collaboration on R&D to demonstrate their willingness to be more effective in the next outbreak” noted Dr. Delaunay. She heavily pushed for global financing efforts to facilitate investment in R&D and response. After the initial panel, there was a secondary group that shared their thoughts on the report, including Dr. Tom Frieden (CDC Director), Julie Gerberding (Exec. VP for Strategic Communications, Global Public Policy and Population Health, Merck) and Ron Klain (Former US Ebola Response Coordinator, White House and General Counsel, Revolution LLC). Ron Klain pointed to the failure of the WHO and “if institutions failed us, individuals shined. We did see extraordinary compassion from the rest of the world and tremendous outpouring of support. ” Mr. Klain mentioned that “the scariest thing about Ebola is the warning signs of how badly we failed this when the threat could’ve been worse and the epidemic we face could be much much more dangerous in the future.” Dr. Frieden emphasized the need of human resources management improvement at the WHO and how global outbreak response could work to support each other better. Lastly, Dr. Frieden emphasized a topic near and dear to my heart; infection control and it’s necessity in global disease prevention. Overall, the panel touched on several key points to the outbreak, emphasizing the need for the biggest players (including MSF) to lead by example via data sharing, etc. The push for political support on incentives and local capacity/accountability was perhaps one of the biggest recommendations and points emphasized from this event.

Gene Editing and CRISPR!
This was a busy week in the biotech world. The International Gene Editing Summit kicked off in Washington, DC. Bringing together experts from around the world, the summit touched on the newest technical innovations, ethical and legal concerns, and even social implications of genome editing advances. Genome Web has provided a great overview of the summit. Nature also published their Four Big Questions related to genome editing, touching on points related to editing the human germline and the ethical implications for technology that “researchers are still grappling with the known unknowns”. Recently, biologist, Emmanuelle Charpentier, discussed CRISPR-Cas9 and that it’s simply too early to begin gene editing as “the tools are not ready” and “as of today, I’m in favor of not having the manipulation of the human germlines. As long as they’re not perfect and ready, I think it’s good to have this ban against editing the germline.” Buzzfeed noted that over the course of the conference, there was a substantial push for a delay in the use of genetic engineering in fertility clinics due to the risk of making “designer babies”. Given the heavily debated nature of this topic it’s not surprising that the US National Academy of Sciences, Engineering and Medicine, the UK’s Royal Society, and the Chinese Academy of Science, all agreed that it “would be irresponsible to proceed with any clinical use of germline editing.” While the future is left open to gene editing on humans, there was heavy accentuation throughout the conference on the ethics and societal views of these scientific breakthroughs and the necessity to revisit their applications on a regular basis.

Dengue Fever Outbreak in Hawaii 
The Dengue fever outbreak on Hawaii Island is still growing. Now at 122 confirmed cases, this is one of the biggest outbreaks they’ve seen with local transmission. As of 12/2, the confirmed cases involved 106 Hawaii Island residents and 16 visitors. The Hawaii Department of Health (HDOH) has published information, hoping to aid prevention efforts, regarding the Aedes aegypti and Aedes albopictus mosquitos that are responsible for spreading the disease. There have been 313 reported potential cases and you can even find a map of the case distribution here!

Stories You May Have Missed:

  • 2015/2016 Flu Season- Where Are We?– The CDC 2015/2016 influenza activity showed a bit of a spike during the November 15-21 week. Influenza A (H3) is still the predominant species in laboratory confirmed cases. If you’re looking to keep an eye on seasonal flu, Google Flu Trends may no longer be operational, but you can still keep an eye on Flu Near You or the CDC’s page.
  • MERS-CoV Severity and Incubation Period– The CDC & Emerging Infectious Diseases published a report regarding the association of severe MERS-CoV illness and a shorter incubation period. Analyses of 170 patents in South Korea revealed a longer incubation period associated with a decreased risk for death while “patients who died had a shorter incubation period.” This mirrors the results of a previous study that had similar results with SARS coronavirus.
  • Salmonella Outbreak Associated With Recalled Nut Butters – The CDC is currently investigating 11 illnesses across nine states that may be linked to recalled nut butters. The Salmonella serotype is Paratyphoid B variant L (+) tatrate (+) (previously called Salmonella Java) and has caused illness in California, Colorado, Georgia, Hawaii, Idaho, Illinois, North Carolina, and New Jersey.
  • Taiwan CDC Holds Bioterrorism Drill – Involving 70 participants, the course utilized a subway union station to allow people to simulate first responders and real-life operations. “CDC bioterrorism teams are tasked with the investigation and identification of biological threats and attacks. Members take on containment and mitigation of damage for any individuals that are harmed during and as a result of an attack.” Go Taiwan!

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Pandora Report: 11.27.2015

by spopescu, posted in News, Pandora Report

We hope you’re having a lovely holiday week and recovering from a day of full of tryptophan overload! This week we’re starting off with a look at the Government Accountability Office’s review of the BioWatch program. We’re discussing another panel review of the WHO Ebola response efforts, the role of tacit knowledge in bioweapons development, and how the Beagle Brigade is fighting bioterrorism one belly-rub at a time. Fun history fact Friday: on November 26, 1940, President Franklin Roosevelt declared the government would bar strikes “at plants under government contract to provide war materials for the US military and its allies” and on November 25, 1915, Albert Einstein published his equations on the Theory of General Relativity!

Government Accountability Office Finds BioWatch Unreliable
The BioWatch program was introduced in 2003 to perform active environmental surveillance for potential bioweapon use. The struggle has been to accurately discern between organisms that are naturally occurring and those that are being intentionally released. With several false alarms, the program has been under heavy scrutiny. Timothy M. Persons, chief scientist of the Government Accountability Office (GAO), states that authorities “need to have assurance that when the system indicates a possible attack, it’s not crying wolf. You can’t claim it works”. DHS official Jim H. Crumpacker, points out that the system is used as an early warning and there is an inherent level of uncertainty and limitation. The report (published in October but not publicly released until November 23, 2015), which you can read here, states that from 2003-2014, BioWatch made 149 mistaken detections that were “false positives”. The report says that “GAO recommends DHS not pursue upgrades or enhancements for Gen-2 until it reliably establishes the system’s current capabilities.”

Expert Review of Ebola Outbreak Response
A 19 member review panel, convened by the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine, reviewed the Ebola outbreak response as a gateway to “public debates alongside reports on outbreak response and preparedness”. Led by Dr. Peter Piot, one of the scientists to discover Ebola in 1976, the group pointed to several issues needing attention on a global scale. Findings pushed for the WHO to reorganize their disease outbreak functions and streamline processes to “avoid political pressure, build country core capacities, and ensure adequate funding”. The ten suggested reforms heavily emphasize the importance of core capacities within countries to be able to detect and respond to outbreaks. Strengthening a country’s capacity to do surveillance, response, and prevention is crucial in reducing the risk of multi-national outbreaks that spread like wildfire. The report also suggests incentives for early outbreak reporting and more science-based justifications for economic impacts like travel restrictions, etc.

Tacit Knowledge and the Bioweapons Convention
GMU Biodefense Professor, Dr. Sonia Ben Ouagrham-Gormley, takes on the August 2015 Biological Weapons Convention and the exciting inclusion of tacit knowledge in bioweapons development. Dr. Ben Ouagrham-Gormley has contributed heavily to the field of biodefense, specifically on the role that tacit knowledge plays as a key determinant of bioweapons development. In past nonproliferation efforts, tacit knowledge has been widely neglected. Tacit knowledge “consists of unarticulated skills, know-how, or practices that cannot be easily translated into words, but are essential in the success of scientific endeavors.” Simply put, it takes more than a manual or YouTube video to truly perform a scientific experiment, etc. Tacit knowledge is seen in scientists that have spent years not only learning, but experiencing the quirks and challenges of performing experiments. The lessons of failed endeavors, teachings of fellow scientists, and instincts built by years of experience, are all components in tacit knowledge. Dr. Ben Ouagrham-Gormley points to the role tacit knowledge has played in the history of failed bioweapons programs (state and non-state). While some analysts believe the advancing biotechnologies will “de-skill” the field and lower the bar for bioweapons development, Dr. Ben Ouagrham-Gormley highlights that tacit knowledge is a massive roadblock. Pointing towards the new focus on tacit knowledge, she notes that this will only help “advance key mandates of the bioweapons convention, naming the assessment of new technologies, the improvement of national implementation, and the strengthening of cooperation among member states.”

The New Line of Biodefense: Adorable Dogs

Courtesy of BarkPost
Courtesy of BarkPost

There are few times when I get to combine a love of rescue dogs and biodefense nerdom and fortunately, today is that day! The Beagle Brigade is a group of rescue beagles that have been specially trained “to sense for items used for bioterror which include contraband money, pests, and unlawful wildlife”. Even more, the Beagle Brigade is part of the USDA’s Animal and Plant Health Inspection Service (APHIS). They work in baggage-claim areas at international airports, wearing green jackets, to help identify any meat, animal byproducts, fruit, or vegetables that could be carrying any diseases or pests that have the potential to cause a devastating outbreak in the US. They’ve been specially trained to pick up “restricted” (fruit, vegetable, etc.) versus non-restricted items and have a 90% success rate! I think we can safely say the Beagle Brigade wins the award for “most adorable biodefense strategy”.

Genetically Engineered Mosquitoes Battle Malaria 
Recently published work shows how researchers used “a controversial method called ‘gene drive’ to ensure that an engineered mosquito would pass on its new resistance genes to nearly all of its offspring – not just half, as would normally be the case.” These “mutant mosquitoes” are engineered to resist the parasite that causes malaria infections. This particular work solves the issue that many were facing when it came to passing down resistant genes through a species. While this may mark the end of a long battle against malaria, many are pointing to the ethical and dual-use concerns of such work. The growing concern surrounds the high speed of such technological innovation and the lagging of regulatory and policy guidelines, especially regarding work in wild populations. The potential to alter an entire ecosystem has many concerned over the ramifications of such work. The research team is currently working to prepare mosquitoes for field tests, however they are non-native mosquitoes.

Stories You May Have Missed:

  • Stories From A Biodefense PhD Student- GMU Biodefense PhD student, Craig Wiener, discusses his journey from master’s student to PhD candidate. Craig explains what sparked his interest in not only biodefense, but GMU’s program, and how that’s translated into real-world experiences. “Mason has provided me the depth and breadth of knowledge that I needed to converse with senior policymakers, technologists, and scientists,” he says. “It bridged the gap between science and policy so I could be respected in both worlds because I knew what I was talking about.”
  • East Bronx Legionnaires’ Outbreak Traced to Psychiatric Center–  The New York City Health Department announced that the cooling tower at  the Bronx Psychiatric Centre was the likely source of the break that hit East Bronx earlier this fall. Samples from four cases matched those taken from the water tower. Remediation and disinfection is being performed on the water tower.
  • Liberia Reports Death of Boy – A boy who was part of the family cluster of Ebola cases in Liberia, has died of the disease. The 15-year-old boy was one of the three confirmed cases reported on November 20th, which marked the end of the Ebola-free period for Liberia since September 3rd. There are currently 153 contacts and 25 healthcare workers being monitored.

Pandora Report: 11.20.2015

by spopescu, posted in News, Pandora Report

Much has happened since we reported last week, and with so many tragedies that have occurred, we look towards future preparedness efforts to prevent such misfortunes. The French Prime Minister warned on Thursday, “we must not rule anything out, there is also the risk from chemical or biological weapons.” French emergency medical services are also being supplied with sarin gas antidotes. Check out the CBRN Policy Brief by Dr. Garza, GMU Biodefense Affiliate Research Scientist and former Assistant Secretary for Health Affairs and Chief Medical Officer at the Department of Homeland Security. Dr. Garza provides an extensive look into US federal preparedness, which will be increasingly relevant given the Paris attacks and ISIS interest in chemical weapons. In looking towards the future, we’re celebrating World Antibiotic Awareness/Get Smart About Antibiotics Week to better appreciate the importance of microbial stewardship. Do you ever find yourself reading the Pandora Report and wondering, “all this biodefense stuff is so fascinating, I wonder how I could go more of it?” Good news, GMU has an entire Master’s program (and PhD if you really want to venture down the rabbit hole) in Biodefense! Fun History Fact Friday: On November 19, 1863, President Abraham Lincoln gave the Gettysburg Address at the dedication of the military cemetery in Gettysburg, Pennsylvania.

World Antibiotic Awareness Week 2015
Whether you want to call it the World Antibiotic Awareness Week (via WHO) or Get Smart About Antibiotics Week (via CDC), the importance of antimicrobial stewardship can’t go unnoticed. The threat of antibiotic resistance is growing and we can all play a vital role in stopping it. Did you know in the US alone, 2 million people a year become infected with an antibiotic resistant organism? At least 23,000 people a year will die as a result of resistant organisms. There is a growing list of infections that are becoming harder to treat, like tuberculosis, pneumonia, gonorrhea, etc. The CRE outbreak earlier this year is just one example of a highly resistant and deadly multi-drug resistant organism (MDRO). While many think global health security issues are acts of bioterrorism and lab safety failures (which they are!), the threat of MDRO’s is also a looming danger. Imagine a world where we have no effective antibiotics. Pretty scary, isn’t it? The WHO provided recommendations for healthcare workers and policymakers, but here are a few things you can do:

  • always take the full prescription (don’t just stop when you feel better!)
  • Have left-over antibiotics? Don’t take them.
  • Don’t share antibiotics.
  • Prevent infections before they happen – wash your hands, use safe food practices, avoid close contact with sick individuals, and keep your vaccinations up to date!

GMU Master’s in Biodefense
Have a passion for biodefense and global health security? Hoping to take your education and experience to the next level? GMU’s MS in Biodefense can help bridge those gaps. Did I mention we also have an online biodefense MS? Our program connects the worlds of science and policy, furthering students’ understanding of the complexities within global health security through classes on homeland security, biodefense strategy, specific threat agents, etc. One of our graduates, Kathleen Danskin, is actually working with GAP Solutions Inc., supporting the US Department of Health and Human Services (HHS) Office of the Assistant Secretary of Preparedness and Response (ASPR). Kathleen’s experience is a perfect example of GMU’s multifaceted approach to biodefense and support for work experience. The MS in Biodefense requires the completion of 36 credits (18 credits of core classes like those listed above, 9-15 credits in a field of specialization, electives, and 3 credits in a Capstone Course). Perhaps one of the program’s greatest strengths is its faculty. They’re not only subject matter experts with an amazing range of experiences and knowledge, but also extremely supportive and encouraging of their students. If you happened to miss our Open House on Wednesday, check out our recorded webcast that specifically discusses the Biodefense MS program. If you plan to apply, make sure to get your Spring 2016 application in by December 1st!

Putting the Global in Global Health Security
Dr. Stephen Redd, Director of the CDC’s Office of Public Health Preparedness and Response, writes about a holistic approach to global health security. Dr. Redd discusses the challenges of improving both domestic and global health security “by preventing avoidable epidemics, detecting threats early, and responding rapidly and effectively to any public health event.” The 2014 Ebola outbreak brought the realities of emerging infectious diseases and global outbreaks to the frontline of US concerns. This particular outbreak emphasized the importance of surveillance and response on a global scale. A disease outbreak in one country can quickly stretch beyond the borders of another. Dr. Redd points out that epidemics know no boundaries and we must stop thinking of outbreaks in terms of individual country responsibilities. Mirroring these sentiments, I believe the concept of One Health plays a growing role in global health security and our future practices. Dr. Redd notes that the US must continuously adapt to prepare for these threats. As emerging infectious disease outbreak occur, the role of spillover between the human, animal, and environmental sources makes prevention, surveillance, and response that much more vital.

Officials: IS Is Determined to Develop Chemical Weapons
Iraqi and US intelligence officials are reporting that the Islamic State group is on the quest to develop chemical weapons. Sources state that they are setting up branches specifically for chemical weapon efforts and experimentation. This wouldn’t be a far reach considering IS was reported to use mustard gas in Syria against Kurdish fighters. Intelligence officials are also pointing to IS efforts of finding and employing chemical weapons experts from a range of international venues. “Still, U.S. intelligence officials say they don’t believe IS has the technological capability to produce nerve gas or biological agents, and that the militants were more likely to harm themselves trying to make them. A European official privy to intelligence on the extremist group’s programs agreed, saying so far even IS production of mustard gas was in small quantities and of low quality.”

Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) 2016 Stakeholders Workshop
PHEMCE helps coordinate Federal efforts to better prepare the US with medical countermeasures to combat CBRN and EID threats. Attend their January 6-7, 2016 workshop at the NIH Natcher Conference Center to address where we’re at and how we can work to be better prepared in the future.

Stories You May Have Missed:

  • Paris Attacks Point to Preparedness Needs– GMU Biodefense alum, Dr. Daniel M. Gerstein, discusses the preparedness fallout of the 11/13 Paris attacks. While many news outlets are reporting on the attacks, Dr. Gerstein addresses the collective roles for homeland security and how strategies like “DHS’s ‘see something, say something’ campaign provides recognition of the importance of individual vigilance and reporting of suspicious behavior.”17779_lores
  • CDC Lowers Initial Chipotle E coli Case Count– Public health officials working on the outbreak associated with Chipotle restaurants in Washington and Oregon have dropped the case count from 50 to 37. Officials stated that “the CDC is now only reporting ill people that have been confirmed by PulseNet as being infected with the outbreak strain of E coli 026.” Of the 37 cases, 13 have been hospitalized.
  • Ebola Drug Protects Mice- FDA-approved Gamma interferon is showing promise in studies by University of Iowa researchers. When given 24 hours before or after exposure to the virus, it was able to fully protect mice from death from Ebola. While the team is still working to see how late the gamma interferon can be given after exposure, the success so far as a prophylaxis and post-exposure treatment is a huge breakthrough. With reports of a new case in Liberia, an effective ebola drug will be necessary to help stop the outbreak.
  • Cameroon is Experiencing a Measles and Cholera Outbreak– There have been 858 documented measles cases, with a surge in the past six weeks. The Mokolo health district has experienced the greatest number of cases (587). 36 cases of cholera have also been reported over the last four weeks. Public health officials are working to contain both outbreaks.
  • Hawaii Dengue Fever Update- The National Guard has been called in to assist with the Dengue fever outbreak as case numbers hit 79 infections.

 

Pandora Report: 11.13.2015

by spopescu, posted in Pandora Report

Given the auspicious nature of Friday, the 13th, how about we start the Easy-Bake Oven version of bioreactors? (insert evil genius laugh). Our report this week is rich in biosafety, GMU Open Houses, and updates on global outbreaks. Fun History Fact Friday – this week in 1989, the Berlin Wall came down! Before we venture down the rabbit hole, don’t forget to get your flu shot before the 2015/2016 influenza season hits too hard!

DIY Bioengineering 
If you’re in search of the perfect holiday gift for your favorite biodefense/bioengineer, you can thank the creators of Amino (personally, I think calling it the Easy-Bake Oven Bioreactor is just so much more fun). The kit starts at $700 and comes with all the essentials for your “recipe” (main bacterial culture, DNA, pipettes, incubators, agar plates and various sensors for monitoring microbial growth). Did I mention it comes in a nice color-coded, pleasing-to-the-eye plywood dashboard? MIT graduate, Julie Legault, is the master genius behind Amino, and uses the “apps” (step-by-step guides) to help make even the most science adverse individual capable of making DNA products. Liz Stinson points out that “they walk users through how to insert the DNA into untransformed bacteria cells, and how to incubate, grow, and maintain the altered microorganisms”. Just make sure your new gift comes with some information on dual-use research of concern and avoids any select agents…

Master’s Open House 
Make sure to swing by our GMU Master’s Open House on Wednesday, November 18th at 6:30pm to learn about all our different programs! Good news – you can virtually attend via this link and even ask questions live! We’ll be talking biodefense and all the ways you can use our MS degree (online or in person!). Whether its fighting food safety issues, pandemic influenza, or zombies, we’re passionately trying to make the world of global health security stronger and more diverse!

Biological Research: Rethink Biosafety 
“Biology must move forward on safety and security. Let’s not reinvent the wheel, but learn from those doing safety better.” Tim Trevan’s comments echo the sentiments of many within the biosecurity field. The anthrax mishaps at Dugway and the CDC BSL-3 lab in Atlanta compound a growing concern over the handling of select agents and the lab safety practices and processes that seem to be failing. Trevan poses the question, “what are the prospects for managing the more intractable risks globally if measures to ensure the safe handling of dangerous pathogens are failing at the best-equipped facilities in the country with the most advanced biotechnology in the world?” In his words, Trevan has hit the nail on the head and summarized the realities of lab safety culture. So what’s to be done? Trevan makes the unexpected recommendation of  using nuclear security experts to advise on biosafety and biosecurity. This strategy utilizes a practice that is also common in healthcare – a culture of safety. By focussing on the prevention of failure, instead of maximizing output, safety becomes an engrained practice in all levels of an organization, transforming it into a “high-reliability organization” (HRO). By using examples within industries like offshore oil drilling, airlines, etc., Trevan points to the growing biotech capabilities that make biosecurity that much more imperative. In healthcare, I’ve seen organizations truly transform their practices by moving to a culture of safety (and utilizing “just culture” when it comes to patient safety) and while it’s not a wholly easy process, the foundations are already present in the existing teachings of patient care. Labs have the training and knowledge for safety, but as Trevan points out, it’s time to bring in those with the expertise to help move towards a culture of safety.

Screen Shot 2015-11-12 at 9.56.04 AM
Courtesy of HDOH

Dengue Fever Outbreak in Hawaii 
If you’re considering a winter retreat to Hawaii, make sure to grab some bug spray. Hawaii Island is currently experiencing a Dengue outbreak that has just reached 33 cases. Dengue is not endemic to Hawaii and while travelers have imported cases from time to time, this is marks the first big cluster of locally-acquired cases since 2011. The Hawaii Department of Health (HDOH) continues investigations and reports (as of 11/11)  25 Hawaii Island residents and 8 visitors have been laboratory confirmed with dengue fever. The HDOH has provided maps related to exposure areas to help people avoid high-risk locations or at least use preventative measures. If you’re traveling to Hawaii Island or an area where dengue is endemic, make sure to take steps to reduce the risk of mosquito bites and the potential for transmission!

Ebola Update
Guinea has reported no new cases in the last week. While they’re still on high alert after the cases surrounding a family, they are hopeful. Liberia and Sierra Leone have hit their 90-day enhanced surveillance period, meaning they have no new cases and are now working towards the WHO’s second objective (managing and responding to residual risks). Pauline Cafferkey has made a full recovery after her hospitalizations due to post-Ebola recovery complications. Researchers at Columbia University’s Mailman School of Public Health used a new statistical model to map the outbreak. Results will be published in the Journal of Royal Society Interface, which shows the development of the outbreak and role early detection and response plays.

Stories You May Have Missed: 

  • Joint Services Mask Leakage Tester (JSMLT) Contract – the DoD has announced that Air Techniques International, Inc. has been awarded a contract regarding the maintenance of the JSMLT. The JSMLT does quality control and ensures proper fitting (portably) on CBRN protective masks.
  • H7N9 Cases in China Rise– China has confirmed two more cases that occurred in October, bringing the total case count to four. Many in public health are noting that these cases bring about a fourth wave of infections (starting in October). The two new cases were a a 62-year-old woman from Shengzhou and a 51-year-old farmer from Hangzhou.
  • Boosting Biosecurity in Nigeria & Kenya– The Institute of Human Virology at the University of Maryland have announced two grants to help build biosecurity in Nigeria and Kenya. The first grant of $13 million will go to strengthen laboratory infrastructure in Kenya, and the second of $10 million will help those in Nigeria quickly detect and respond to emerging infectious diseases.

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The Candidates on Nonproliferation Part III

by spopescu, posted in Commentary, News, Pandora Report, Reviews

The Candidates on Nonproliferation – Part 3
By Greg Mercer

I initially set out to write this as a candidate-by-candidate look at what the 2016 crop had to say about an issue near and dear to Biodefense students’ hearts: nonproliferation. As it turns out, though, not many candidates have well-developed stances on highly specific policy issues (or any issues, depending on how serious a candidate we’re talking about) more than a year from the general election. Lucky for us though, there’s been a major nonproliferation news event to drive the foreign policy debate: the Iran nuclear deal. So this is a rundown of what’s been said and is being said about nonproliferation and WMD policy in the 2016 election.

See part 1 here
And part 2 here

I’m spending even more time on campaign sites to see what the 2016 election looks like for nonproliferation.

This time, I’ll take a look at top Democrat contenders. In contrast to the Republicans, most Democrats support the Iran deal, and generally tend to favor international arms control regimes.

Hillary Clinton:
In the Democratic debate, Hillary Clinton named loose nukes among the paramount threats to the US.  This issue is commonly understood to hinge on loose radiological material from the former Soviet Union (which is notoriously poorly controlled) and other states maintaining poor control of their nuclear weapons.  The Associated Press recently released an investigation into the Moldovan nuclear black market and Islamic extremists.  She has also strongly endorsed the Iran deal, and has a unique role in the debate, having helped to implement sanctions and launch negotiations with Iran as former Secretary of State.  The Politico story linked notes that she was more hawkish than Obama on Iran in the past.  (Her support of the Iraq War in Congress has been a recurring talking point for opponents).  Now, though, their views seem to be pretty closely aligned.  Hillary’s national security issues page also leans heavily on her experience at the State Department (in addition to being pretty relentlessly on-brand).  Among the usual issues- ISIS, Russia, Israel, the Iran deal- is a very interesting one: “Highly contagious diseases are a constant threat. Warmer and drier conditions caused by global climate change, along with our increasingly interconnected world, enable germs to spread more quickly across the globe. America must remain vigilant and do more to prevent and contain outbreaks.”   This is an uncommonly specific stance, and is placed alongside cyberattacks and climate change to make up an emerging threats triumvirate.  So far, though, there hasn’t been much elaboration on actual policy options to combat this threat, or what makes it a defense issue versus, say, an international development one.

Bernie Sanders:
In 2009, Bernie Sanders echoed President Obama’s call for “a world without nuclear weapons.”  While this obviously hasn’t happened, Sanders released a statement calling for an end to the production of weapons-grade uranium and stopping the spread of nuclear weapons.  In March of 2015, Sanders cosponsored a bill to reduce American spending on nuclear weapons by $100 billion over 10 years (in grand Congressional naming convention, the Smarter Approach to Nuclear Expenditures Act, aka SANE).  A House and Senate version have been introduced, but are part of a much larger budget fight.  Sanders’ issues page supports the Iran deal, though it interestingly says the “agreement is not perfect,” but ultimately concludes that it is a far superior option to military action. As usual, Sanders officially gives his support to Obama and Secretary of State Kerry’s negotiations.  This page also does the thing where a first-person snippet introduces a long set of third-person position statements, but the personal statement highlights Sanders’ votes against the first and second Gulf Wars.  This casts him pretty clearly as anti-military intervention to prevent proliferation, but with the caveat that it remains an option.  There is also a separate, editorial-style section on just the Iran Deal, which offers more detail about uranium and centrifuge reductions.  Once again, it calls war “the last option.”  Much of Sanders’ campaign so far has hinged on economic and social issues, however, and he even said in the most recent debate that climate change is the most pressing national security threat.  When looking for threats to security, Sanders mostly looks beyond weapons of mass destruction.

Continue reading “The Candidates on Nonproliferation Part III” →

Pandora Report 10.30.2015

by spopescu, posted in Pandora Report, Program News, Uncategorized

The witching hour is upon us! Halloween is tomorrow and with that we must ask, how good are your zombie fighting skills? Good news if you’re in Arlington, VA, as it’s considered one of the top ten cities to survive the zombie apocalypse – good thing GMU has a campus there (we biodefense folks are the ultimate planners!). This week was busy with the release of the Blue Ribbon Study Panel on Biodefense’s National Report. I was able to attend the panel event, so read on for my comments and your weekly dose of biodefense news!

DSC_3586GMU Biodefense Program News & Alumni 
We’ve added a new page to salute our biodefense alumni and all that they do with their GMU education. GMU Biodefense students have a diverse background in their education, experiences, and interests, and we absolutely love getting to brag about all the amazing things they accomplish after their studies. Whether it’s a new publication or an award, we hope to pass along their accolades, so please check out our new page to see how GMU Biodefense alumni are contributing to the world of global health security!

12111966_10104338304988922_3051154411712634566_n-1Blue Ribbon Study Panel on Biodefense Releases Report– I had the pleasure of attending the Blue Ribbon panel on Wednesday, in which they reviewed their report, “A National Blueprint for Biodefense: Leadership and Major Reform Needed to Optimize Efforts”. The panel event saw Senator Joe Lieberman, former Governor Tom Ridge, and former Homeland Security Advisor, Kenneth L. Wainstein, discuss the challenges of biodefense, the report, and answer several questions regarding their findings. The report is comprised of 33 recommendations that range from unification of biodefense budgeting to optimizing the National Biosurveillance Integration System and to improving surveillance and planning for animal and zoonotic outbreaks. Along with these 33 recommendations, there are 100 action items. Perhaps one of the biggest take-aways from the report is the recommendation that the Office of the Vice President of the US assume authority over biodefense efforts. There is heavy emphasis on a unified budget and centralization to combat the redundancy and current siloing we see in existing programs.  Senator Lieberman discussed the role of the research and private sector’s involvement, with former Gov. Ridge noting that “we need to start thinking differently about how we incentivize the private sector.” The panel discussed that despite our past efforts, the Ebola outbreak in 2014 showed that the “threat is real, lets not wait for it to occur” and as former Gov. Ridge noted, “we don’t give bioweapon threats the attention they need. The threat is ahead of us.” Senator Lieberman commented on the Ebola situation,  noting that our response was dismal and despite 10 months of warning, basic human errors led to a failure in providing hospitals with general guidelines. Whether it is an intentional bioweapons attack, outbreak of an emerging infectious disease, or unintentional, accidental release due to lab safety errors, the panel’s goal of having centralized leadership reveals the complex nature of these challenges. Also, did I mention that they included infection control in their guidelines (#18)?! Overall, I found the event highly engaging and was pleased to hear the panel members approach these topics with not only a sense of urgency, but a holistic manner to meet the challenges of biodefense.

Jump Start – Accelerating Government Response to A National Biological Crisis
UPMC Center for Health Security has released their July 2015 report that “examines a scenario in which the US is suddenly faced with a newly emerged intentional biological threat that could produce catastrophic public health consequences and threaten our economy, government, and social structure.” The report reviews governance, public health response, medical countermeasures, healthcare system response, decontamination and remediation, and environmental detection, while making recommendations. Utilizing published literature and subject matter expert interviews, the Jump Start report scenario occurs in central Moscow subway stations and Red Square. It discusses responses in a post-Amerithrax world and highlights the need to stop the spread of infectious diseases while emphasizing that in a similar scenario, the US government should push out table-top exercises at a national level to test readiness to biothreats. The role of healthcare infrastructure and capacity comes into play, highlighting the limitations that diagnostic testing plays – even if the solutions aren’t available. I’d be curious to see a more detailed analysis of how we approach novel agents and the time-lag this can often cause in diagnosis. Also – what would be the ethical dilemmas regarding invasive medical treatments for a novel agent? Medical ethics became a very real issue during Ebola preparedness (perhaps not as well discussed in media circuits) as the invasive care capabilities of healthcare professionals in the US correlates with increasing risk for disease transmission.

White House Calls for Better Biosafety –  As fallout from several lab safety breaches, the White House issued recommendations that focus on labs that are registered to work with pathogens from the Select Agents list. Ranging from increased training to assessing the number of high containment labs we have in the US, this memo, with a deadline for the recommendations, sets the tone for change when it comes to biosafety.

Saudi Arabi MERS Cluster – reports from Saudi Arabi’s Ministry of Health have confirmed a healthcare-associated cluster of MERS-CoV cases that involved seven individuals. The initial patient was seen in the emergency department of Almana General Hospital, with five other patients exposed in the hospital, and an additional case that is believed to not have had a healthcare exposure. All patients are under observation in the King Fahad Hospital. One of the patients is reported to be a nurse. In previous weeks, there was a cluster of cases related to janitors living together in Riyadh.

Stories You May Have Missed:

  • The African Development Bank Group (AfDB) has approved a $33.3 million grant towards a Post Ebola Recovery Social Investment Fund (PERSIF) for efforts in Guinea, Liberia, and Sierra Leone. The US State Department is contributing a $5 million grant towards this to help support livelihood development for women, girls, and orphans from the affected countries. The goal is to build resilience in the affected countries and strengthen the economic systems while improving governance and communication.
  • Nigeria was just removed from the WHO’s list of polio-endemic countries! After halting the spread of wild poliovirus transmission during a 15 month period, Nigeria was declared free of the disease! The WHO is continuing to work on the remaining two polio-endemic countries; Afghanistan and Pakistan.
  • Three more cases of Ebola in Guinea were reported this week. The three patients are all family members, with one being a pregnant woman. Guinea experienced several cases last week while Liberia has been EVD-free since September 3rd and Sierra Leone just passed their six week mark without a new case.
  • The WHO announces that TB surpassed HIV as the leading cause of death from infectious disease in 2014. Better surveillance enabled global public health teams to identify new cases. In Indonesia alone, there were one million new cases reported this year. The WHO notes that while surveillance efforts are revealing new cases, progress is still insufficient, especially in regards to drug resistance.

 

Pandora Report 10.23.2015

by spopescu, posted in Pandora Report

Happy Infection Prevention Week! Make sure to give any infection preventionists you know a big hug or at least a hearty handshake (only clean hands though!). Not only do we get to celebrate National Infection Prevention week, but it’s also National Biosafety Stewardship Month, so get your party hand sanitizer ready to go and let the frivolity begin! Foodborne illness is the name of the game this week and we’ll be discussing outbreaks. Friendly reminder – the influenza vaccine is available in most offices/clinics now, so get your flu shot as there have already been cases springing up across the US. Fun fact – did you know that a report published this week identified Yersinia pestis in the tooth of a Bronze Age individual, which means there were plague infected humans 3,300 years earlier than we thought!

National Biosafety Stewardship Month – October is National Biosafety Stewardship Month (thanks NIH!) to celebrate and encourage people to focus on biosafety policies, practices, and procedures. Given the lab biosafety issues we’ve seen recently, I think we can all safely (or should I say, “biosafely”?) agree that a little extra attention to these issues and the promotion of better practices is a great thing. Institutions are encouraged to use more of a just culture approach to incident reporting and to promote public transparency. Happy National Biosafety Stewardship Month!

Water Quality for the Olympic Games in Rio De Janeiro, 2016
The 2016 Summer Olympics are fast approaching and with any large event, health issues become a main concern. The WHO is providing technical advice to the Brazilian national authorities regarding public health concerns, as well as to the International Olympic Committee and the Local Organizing Committee. Clean drinking water, sewage pollution, and a host of other health issues can become a nightmare during such a large-scale event. While there aren’t recommendations for specific viral testing of the water, the WHO does encourage additional testing in the event of an outbreak. Sanitary inspections and other preventative procedures are being recommended to avoid outbreaks and public health issues. As we get closer to the 2016 Olympics, it is very likely concerns over vector-borne diseases will be addressed through vector control and public health education.

CDC Launches Redesigned FOOD Tool for Foodborne Outbreaks 

Courtesy of CDC FOOD Tool
Courtesy of CDC FOOD Tool

The CDC has updated their online foodborne illness outbreak investigation tool! The Foodborne Outbreak Online Database Tool (FOOD Tool) allows the user to search the outbreak database by state, food, ingredient, year, location of food preparation, and organism. The FOOD Tool also provides the case information related to the outbreak, so users can see the number of affected persons, hospitalizations, deaths and laboratory-confirmed organisms. This database pulls from CDC’s Foodborne Disease Outbreak Surveillance System (FDOSS) and allows users to not only look at data and trends over time, but also compare their cases to other outbreaks.

Syrian Refugee Resettlement and Why We Should Be Letting Them All In 
Dr. Trevor Thrall, one of our amazing GMU Biodefense professors, has written a piece for The Atlantic on the importance and benefits of taking in all Syrian refugees. Dr. Thrall discusses the limitations of addressing the root cause of the Syrian conflict and how the US and its European allies should take in refugees. Discussing the military alternatives to the Syrian crisis, he states, “going in militarily is not the answer, then. Instead, those civilians under threat should get out. Refugees typically receive support in the countries to which they flee, but the vast numbers involved in this case threaten to overwhelm Turkey, Jordan, and Lebanon, which have so far accommodated the vast majority of the outflow.” Dr. Thrall points out that while resettlement would cost a substantial amount of money, it would cost far less than military intervention and you simply can not ignore the moral superiority in aiding refugees.

Chipotle’s Bad Tomatoes Came From Nation’s Largest Field Producer
To our readers in Minnesota, did you happen to eat at a Chipotle in August? If so, we hope you weren’t one of the affected individuals that contracted Salmonella Newport as a result of contaminated tomatoes. The Minnesota Department of Health investigated the 64 cases resulting from this outbreak, however it was just released that the contaminated tomatoes were actually supplied by Six L’s Packing Co (doing business as Lipman Produce), which is actually one of the largest tomato suppliers in the US. Packing 15 million boxes of tomatoes this past year, Lipman was later dropped as a supplier by Chipotle after learning of the source of contaminated produce. The tomatoes were removed but it’s estimated that during the window of exposure, roughly 560,000 people consumed Chipotle. The good news is that we’re out of the incubation period, so if you happened to eat at a Minnesota Chipotle, you’re in the clear.

Stories You May Have Missed:

  • 80 Illnesses Linked to Shigella Outbreak; CA Seafood Restaurant Closed –  Mariscos San Juan in San Jose, CA is currently closed after the Santa Clara County Health Department connected a recent outbreak of Shigella to their food. While the exact source hasn’t been identified, over 93 people were sickened in relation to contaminated food at the restaurant.
  • Subway to Phase Out Poultry Products Raised With Antibiotics–  On Tuesday, Subway Restaurants announced that they will be transitioning to only serve poultry products that have been raised without antibiotics by early next year. Other chain restaurants, like Chick-fil-A and Chipotle, are jumping on the train to phase out chicken and turkey products that were raised with antibiotics.
  • Scottish Nurse and Ebola Complications – Pauline Cafferkey continues to battle post-Ebola complications. Reports last week noted neurological issues and it was recently reported that she has meningitis after the virus persisted in her brain and CSF after her initial recovery. Ongoing research is looking into the long-term effects of the disease as the West African outbreak was the largest in history and researchers have never had the opportunity to look at chronic issues associated with disease recovery.