The Pandora Report

Next week is your chance to attend two amazing biodefense events – one hosted by GMU Biodefense featuring Dr. Kadlec of ASPR and the second on biosecurity in the age of genome editing. You can find all the details below!

Preventing Pandemics and Bioterrorism: Past, Present, and Future
Are you attending our event on the evening of Tuesday, December 4th? Special guest Dr. Robert Kadlec, Assistant Secretary for Preparedness and Response (ASPR) of the Department of Health and Human Services, will be discussing lessons learned for pandemic preparedness since the 1918-1919 influenza pandemic, plans for implementing the new National Biodefense Strategy, and the importance of education for the future of biodefense. Following his speech and Q&A session, you are invited to an informal reception for academic and professional members of the biodefense community to socialize and network. Hors d’oeurves and drinks will be provided. Seats are limited, so make sure you save your spot and RSVP.

Biosecurity in the Age of Genome Editing
Claims of CRISPR use in babies brought forth a flurry of discussion surrounding the ethics and uses of genome editing. This technology promises major beneficial contributions, yet it has the potential to radically alter the security landscape. Next week, on Monday, December 3rd, New America will be hosting an event on the biosecurity implications of genome editing. “In a new report Editing Biosecurity: Needs and Strategies for Governing Genome Editing based on two years of study by researchers from George Mason University, Stanford University, and New America examines the issue and provides concrete and actionable options for policy makers.” This is a great opportunity to learn from and chat with experts in the field on the potential for genome editing technologies to be misused for nefarious purposes and the implications for biosecurity.

Reflections on the 5th Ministerial Meeting of the Global Health Security Agenda
We’re excited to provide you with a full recap of the 5th Ministerial Meeting of the GHSA. Within this summary, you’ll find reflections from NextGen Health Security Network’s Coordinator Jamechia Hoyle, GMU Global Health Security Ambassadors Annette Prieto and Saskia Popescu, and several other attendees. This is a great review of the international meeting in Bali, Indonesia, and the topics that were just as diverse as the biological threats we seek to prevent. From antimicrobial resistance to financing preparedness at the national level, and even strengthening hospital response, we hope you find the review of this exciting meeting as captivating as it was for us to attend!

DRC Ebola Outbreak Updates
Ebola continues to spread within the DRC. On November 26th, 33 more cases were reported, and then on Thursday, it was reported that the total cases have reached 426, 379 of which are confirmed, and a total of 245 deaths. This outbreak is now the second largest ever. Health centers have been a source for transmission, as nosocomial transmission tends to be a theme in Ebola outbreaks. Additional efforts have been directed to infection prevention and control measures, as well as training and disinfection products. Unfortunately, cases have also been seen in babies – on November 20th, 7 newborn babies and 6 children 2-17 years of age were identified as cases. Approval was given to test experimental treatment as well. “The health ministry said in a Nov 24 announcement that an ethics committee at the University of Kinshasa has approved a protocol for testing four experimental Ebola treatments, which are currently being used on an emergency basis in Ebola treatment centers. They are mAb114, Zmapp, remdesivir, and Regeneron’s REGN-EB3 antibody. The authorization for emergency or compassionate use, however, doesn’t provide for the standardized collection of data on the efficacy and safety of each treatment the health ministry said. The ministry statement indicates that the clinical trial started last week on three of the four treatments (Zmapp, mAb114, and remdesivir) at Beni’s Ebola treatment center. Future trials could be extended to other sites and include REGN-EB3. However, for now, the other Ebola treatment centers will continue to administer the drugs on a compassionate basis.”

The Red Box- A New Healthcare Approach to Infection Control?
GMU Biodefense doctoral student and infection preventionist Saskia Popescu discusses a new approach to improving patient interactions without decreasing isolation precautions during hospitalization of infectious patients. “Although these methods are pivotal to patient and staff safety, donning and doffing PPE is time-consuming, and therefore, often a barrier for health care workers to make frequent visits to a patient’s room. This can often leave patients feeling isolated and create a negative association with isolation precautions for both the staff and patients during their hospitalization. It can also negatively impact medical care. To circumvent these issues, investigators on a new study tested a strategy for supporting isolation precautions while encouraging more health care worker-patient interaction through the use of a ‘red box’. Just like a red line in the operating room and peri-op areas, the red box was a visual reminder. It was a designated area on the floor of a patient’s room created using red duct tape that extended 3 feet beyond the door of the room, but stopped more than 6 feet from the patient. The use of PPE was required outside of the red box; however, while inside, the health care workers could communicate with the patient without the use of PPE, while still maintaining a safe distance from the patient and contact with the environment.”

Unseen Interactions Play An Important Role in Disease Transmission
Sometimes, all it takes is a small moment in time for a disease to spread. A recent study looked to these tiny, often ignored moments in bat populations to see how disease may be transmitted by unseen interactions. “A new study by investigators at the University of California–Santa Cruz set out to find out more about this moment by evaluating disease transmission in bats frequently impacted by the fungal infection, white-nose syndrome. This infection can devastate bat populations and the investigators were hoping to understand the under-the-radar (pun intended) connections between bats that might facilitate the spread of the disease. For the study, the investigators dusted bats with a fluorescent powder that glowed under ultraviolet light to track ‘cryptic connections.’ They evaluated 8 bat hibernation sites in the upper Midwest (fun fact: abandoned mine tunnels are prime bat spots!) in which they found up to 4 different bat species. Prior to ‘dusting’ the bats with the powder, the team observed the bats’ social networks and measured direct physical contacts between bats that were hibernating together in groups, as well as contact between those bats that moved between groups.”

Foundation of Evidence Base for Health Security Implementation – Special Supplement of Healthy Security
In the latest supplement of Health Security, joint efforts with CDC and partners are described. “The foundation of this work is detailed in a series of articles and commentaries in a special supplement to Health Security, “Building the Evidence Base for Global Health Security Implementation,” published Nov. 27 and produced in collaboration with the Johns Hopkins Center for Health Security. In the articles, CDC and global health security partners describe outcomes and lessons learned from multiple countries throughout Africa, Asia, and Latin America that are implementing activities to enhance public health capacities in disease prevention, detection, and response. CDC and partners have gathered and are sharing these lessons on specific approaches and interventions that are most effective in enhancing a country’s capacity for health security. The world has, in recent years, seen a series of alarming public health emergencies that have resulted in thousands of lives lost and billions of dollars in economic losses.”

Stories You May Have Missed:

• AFM Task Force Created – “The Centers for Disease Control and Prevention (CDC) announced yesterday the creation of the Acute Flaccid Myelitis (AFM) Task Force, which will search for the cause of the mysterious polio-like condition. ‘I want to reaffirm to parents, patients, and our Nation CDC’s commitment to this serious medical condition,’ said CDC Director Robert Redfield, MD, in a press release. ‘This Task Force will ensure that the full capacity of the scientific community is engaged and working together to provide important answers and solutions to actively detect, more effectively treat, and ultimately prevent AFM and its consequences’.”
• GMU Biodefense PhD Student Spotlight – Curious about our array of biodefense doctoral students? Check out this spotlight on Saskia Popescu. “It was her strong interest in both the medical side of the field and the policy side that drew her to Mason’s Biodefense Program. ‘The program brings it all together to understand the complexities of health security,’ she says. ‘We have experts from both fields coming to the classroom who can speak to all aspects, which is huge’.”

 

 

We hope you had a lovely Thanksgiving! Salmonella is always a risk with turkey but since our readers are fellow biosafety gurus, we’re pretty sure you’ve already scrubbed the kitchen down to the last microbe! Have you reserved your spot for Dr. Robert Kadlec’s talk Preventing Pandemics and Bioterrorism: Past, Present, and Future on December 4th?

Biosecurity in the Age of Genome Editing
In 2013, researchers demonstrated the use of a new genome editing tool called CRISPR, which allows scientists to add, delete, or modify genes more precisely, faster, and cheaper than ever before. This technology promises major beneficial contributions, yet it has the potential to radically alter the security landscape. A new report, “Editing Biosecurity: Needs and Strategies for Governing Genome Editing,” based on two years of study by researchers from George Mason University, Stanford University, and New America examines the issue and provides concrete and actionable options for policy makers. To discuss the results of the study, New America welcomes Gregory Koblentz, Associate Professor and Director of the Biodefense program at the Schar School at George Mason University; Edward Perello, a research fellow at the Institute for Philosophy and Public Policy at George Mason University; Jesse Kirkpatrick, a New America International Security Program Fellow and Assistant Professor at George Mason University, Megan Palmer, Senior Research Scholar, Center for International Security and Cooperation, Stanford University, and David Relman, Professor of Microbiology & Immunology, Senior Fellow at the Freeman Spogli Institute for International Studies at Stanford University, and Chief of Infectious Diseases at the Veterans Affairs Palo Alto Health Care System. This even will be held on Monday, December 3rd, 2018, from 1-2:45pm EST, at New America. You can RSVP here.

Chemical Weapons – OPCW Meetings 
No, we’re not talking about the strong cologne/perfume a family member wore to holiday dinner, but rather the truly horrifying weapons that utilize chemicals to cause harm. This week the OPCW (Organisation for the Prohibition of Chemical Weapons) is hosting the Conference of the States Parties (CSP23) to the Chemical Weapons Convention & Review Conference (RC4). The CSP23 involves all 193 members of the OPCW and “oversees the implementation of the CWC, promotes the treaty’s objectives and reviews compliance with the treat” while the RC4 is every five years and “is an opportunity for all States Parties to review the operations of the Chemical Weapons Convention and set a strategic direction for the OPCW for the next five years and beyond.” You can find webcasts of the events here. If you’re looking for in-depth reviews of each day, get the scoop from CBW Events, which provides detailed accounts of the day’s events. Alicia Sanders-Zakre of the Arms Control Association is live tweeting as well (@Azakre) throughout the meetings. On Monday, it was reported that the U.S. and the UK were clashing with Russia regarding the new investigation team. “The U.S. and Western powers on Monday clashed with Russia and others over whether the global chemical weapons watchdog could start apportioning blame for poison gas and nerve agent attacks. At a heated session of the Organization for the Prohibition of Chemical Weapons’ annual conference, both sides bitterly fought over a June decision for the group to set up a new investigative team which could name the perpetrators of chemical attacks — a major change in the group’s rules.” An interview with the new Director General of the OPCW, Fernando Arias, was recently published here, where he noted that “I am committed to working with our member-states to protect, defend, and uphold the CWC. This means implementing the mandate given to the organization by the convention, as well as the decisions adopted by the executive council and the plenary body, the Conference of the States-Parties. I will also respect and develop the important work undertaken by my predecessors and their teams.” If you’re needing a refresher on CW, check out the latest book published by the Royal Society for Chemistry, Preventing Chemical Weapons: Arms Control and Disarmament as the Sciences Converge. There was also a publication in Science on preventing chemical weapons as sciences converge – “Concerns about such malign applications of chemical technology are exacerbated by the unstable international security environment and the changing nature of armed conflict, ‘where borderlines between war, civil war, large-scale violations of human rights, revolutions and uprisings, insurgencies and terrorism as well as organized crime are blurred’. It is thus essential that the global community regularly review the nature and implications of developments in chemistry, and its convergence with the life and associated sciences, and establish appropriate measures to prevent their misuse.”

E coli Outbreak – Don’t Eat Romaine Lettuce!
The CDC is warning people not to eat any romaine lettuce amid an E coli O157:H7 outbreak. “So far 32 illnesses have been confirmed in 11 states, and the Public Health Agency of Canada (PHAC) has identified 18 people in Ontario and Quebec infected with the same E coli fingerprint. California (10) and Michigan (7) have reported the most cases, with smaller numbers reported by Connecticut, Illinois, Massachusetts, Maryland, New Hampshire, New Jersey, New York, Ohio, and Wisconsin. Regarding the US cases, the CDC said illness onsets range from Oct 8 to Oct 31, and 13 people have been hospitalized, including one with hemolytic uremic syndrome, a potentially fatal kidney complication. No deaths have been reported.” Reminder – officials have expanded the warning to all romaine lettuce – bagged, mixes, etc.

Review of the Blue Ribbon Study Panel “Biodefense Indicators: Progress in Implementing the National Blueprint for Biodefense”
GMU Biodefense graduate students Michael Krug and Alexandria Tepper have provided us with a recap of this November 14th meeting. “The panel’s initial remarks involved assessing the progress of the federal government to the threat of a biological element, whether it be naturally-occurring, man-made, or accidental, since the release of the panel’s  Blue Ribbon Blueprintin 2015. Senator Lieberman was determined to reinforce the idea that the Blue Ribbon Blueprint should ‘provide a roadmap to improving how we prepare for, defend against, and respond to biological threats of all natures.’ The tone reflected by the chairs acknowledged that the progress made by the federal government has been promising but incomplete.”

Ebola Outbreak Updates & A Tour of the NIH Special Clinical Studies Unit
More peacekeepers and aids have been killed by armed rebels near the Ebola hotspot in the DRC (Beni). Seven UN peacekeepers were killed this weekend. “The action against the armed rebels, who have been responsible for several attacks against civilians in Beni that have stymied response activities, involved the UN mission known as MONUSCO and government armed forces. Their target was the Allied Democratic Forces (ADF).” On Thursday, 13 new cases were reported in the DRC, including 7 cases in Katwa. This brings the total case count  to 386 (339 confirmed, 47 probable, and 219 deaths). “Five of the new cases from Katwa were family members of a confirmed case-patient who died earlier this month. According the Ministry of Health, the family refused vaccination and follow-up before agreeing to be treated in a Butembo Ebola treatment center. The single cases from Oicha and Mutwanga are related to cases from Beni, officials said.” Care for these patients can be tricky when it comes to maintaining infection prevention practices. The NIH just gave a tour of their Special Clinical Studies Unit (SCSU), which is a special isolation unit used for the medical care of patients with high consequence pathogens, like Ebola. ” There, protected by negative air pressure and varying levels of biosecurity, volunteers can be safely exposed to the flu, respiratory syncytial virus (RSV), mosquitoes, or other infectious diseases or vectors for study purposes, without risk to other patients in the Clinical Center. They can also receive care while researchers study their reactions to pathogens in experiments that may lay the foundation for improved vaccines and treatments.”

Review Essay – Rhodeshia’s Improbably Dirty War
Kathleen M. Vogel is reviewing Glenn Cross’s (he’s a GMU Biodefense PhD alum!) account of the Rhodesian use of biological weapons. Vogel points to the recent Salisbury incident – “There are ongoing deliberations by the Organisation for the Prohibition of Chemical Weapons (OPCW), the implementing body of the Chemical Weapons Convention, to determine an international response to this breach of the global norm against chemical-weapons use. The Salisbury incident has underscored long-standing domestic and international concerns about the use of chemical and biological (CB) agents by state and non-state actors.” Cross’s book discusses the sordid history of Rhodesian use of chemical and biological weapons from 1975-1980 – “Dirty War is the culmination of nearly two decades of painstaking research and interviews of dozens of former Rhodesian officers who either participated or were knowledgeable about the top secret development and use of CBW. The book also draws on the handful of remaining classified Rhodesian documents that tell the story of the CBW program. Dirty War combines all of the available evidence to provide a compelling account of how a small group of men prepared and used CBW to devastating effect against a largely unprepared and unwitting enemy. ”

Global Health Security Meets Infection Prevention 
GMU Biodefense PhD student and Global Health Security Ambassador Saskia Popescu gives us a preview of the 5th Ministerial Meeting for the GHSA (more to come, so keep an eye out in the coming weeks!). “Overall, the 5th Ministerial Meeting of the GHSA was a profound experience, not only for an infection prevention epidemiologist like myself, but as a person dedicated to public health and preventing the spread of infectious diseases. It was inspiring to see participants from private industry to government working to help facilitate capacity building from the ground up.  The GHSA is a particularly unique effort in that it brings together so many different people—from private companies to government health officials and even academia. In many ways, this is a perfect example of the diverse efforts needed to address health security vulnerabilities. In a single day, I was fortunate to chat with Swiss health officials on antimicrobial resistance and bioterrorism, university professors on hospital infection prevention as a preparedness tool, and GE healthcare on their efforts to fund health care capability building.”

Stories You May Have Missed:

• WHO Reports on Global Antibiotic Consumption – “The WHO has been working to strengthen national capacity to monitor antimicrobial consumption across 57 low- and middle-income countries. These efforts have focused on workshops and educational sessions, as well as technical support, to help better understand consumption trends on an international level. In the case of this report, the WHO defined consumption as ‘estimates of aggregated data, mainly derived from import, sales, or reimbursement databases’ while use was defined as ‘data on antibiotics that were taken by individual patients’.”