The Pandora Report

Welcome to the last day of September! Brazil has reported 46,446 new cases of Chikungunya in the 5 weeks since it last reported cases to PAHO, which brings its total to 216,102 cases. Love photography and biodefense? Check out the Air Force patient decontamination exercise as told through photography. Japan is seeing a surge of measles with 100 cases reported in the past five weeks. On the other hand, the region of the Americas has been declared measles free.  Amnesty International has accused Sudan’s government of carrying out over 30 chemical weapons attacks in the Darfur area since January.

GMU Biodefense PhD Open House – October 12th! 
Don’t forget to mark your calendars for an upcoming PhD information session at our Fairfax Campus (Johnson Center, Room 334) on Wednesday, October 12th, from 7-8:30pm. We’ll be  discussing the nuts and bolts of the program, classes offered, and student perspectives on their PhD in biodefense!

GAO Recommendations on Select Agent Program Improvements  
A recent GAO report reviewed practices within HHS and USDA to improve the Select Agent Program’s oversight regarding inactivation of agents. The report draws attention to the uncertain number of incidents involving incomplete agent inactivation that occurred from 2003-2015. “One key reason is that the Select Agent Program—operated by the Departments of Health and Human Services (HHS) and Agriculture (USDA) to oversee certain dangerous pathogens, known as select agents—does not require laboratories to identify such incidents on reporting forms. According to the program, 10 incidents occurred from 2003 through 2015. However, GAO identified an additional 11 incidents that the program did not initially identify. Because the program cannot easily identify incidents involving incomplete inactivation, it does not know the frequency or reason they occur, making it difficult to develop guidance to help mitigate future incidents.” Many are pointing to limited federal guidance for researchers and validation of the inactivation protocols. GAO recommendations focused on revising reporting forms and practices, guidance for protocols, and establishing a more consistent process for incidents. Specific recommendations included: “HHS should direct the CDC and NIH to develop clear definitions of inactivation for use within their respective guidance documents that are consistent across the Select Agent Program, NIH’s oversight of recombinant pathogens, and the Biosafety in Microbiological and Biomedical Laboratories manual. USDA should direct APHIS to revise reporting forms to help identify when incidents involving incomplete inactivation occur and analyze the information reported to help identify the causes of incomplete inactivation to mitigate the risk of future incidents.”

GMU Biodefense Student Awarded Center for Global Security Research Internship
We’re very proud to announce that GMU Biodefense PhD student and Presidential Scholar, Yong-Bee Lim, will be starting a six-month internship with the Center for Global Security Research (CGSR) at Lawrence Livermore National Laboratory. CGSR  focuses on the nexus of science and technology (S&T) and policy to provide fresh insights for understanding and addressing important national security issues. They work to identify whether and how technically-based approaches can address new challenges to national and international security. Congrats Yong-Bee!

Global Health Security Threats: Are We Prepared?
Catch this Abt Associates hosted event on Thursday, October 27th, from 9am-noon at the Newseum! Speakers will discuss the causes and consequences of infectious disease pandemics. There will be two panels of experts – Panel 1: Causes, will include Peter Hotez, John Brownstein, and Irene Koek, and Panel 2: Consequences, will include Thomas Inglesby, Ambassador Bonnie Jenkins, and Jose Cordero.

The Post-Amerithrax World of Biodefense 
How much did we really learn from Amerithrax and has our biodefense game gotten any stronger? Matt Davenport looks into what biodefense was like during the harrowing days of the Amerithrax attacks and how American efforts have evolved (or not…). He first points to the “biodetection divide” noting that there is a marked contrast between not only the tools and training but more importantly, the oversight and scrutiny that first responders and public health labs are subject to. “Biotechnology used by public health labs and first responders has evolved tremendously since 2001. PCR assays are faster. Immunoassay performance has improved thanks to nanotechnology. High-throughput genetic sequencing now exists. But no single technology is perfect. The rates of false negatives and false positives can still be reduced. Analysis time can be driven down. Sensitivity can be ramped up. And so the biotechnology that can aid in biodefense continues to evolve.” Many in the field will tell you that there’s no end zone in global health security – biodefense and biodetection will always have an evolving horizon that requires the technology, training, oversight, and funding to match. The microarray and technologies (PCR and immunoassays) require a targeted approach, however many like Livermore Lab’s Tom Slezak point out that the practice of thinking agent specific is limiting and our potential lists just get longer. Aside from the challenges of agent identification (which are improving thanks to next-generation sequencing), many first responders and public health professionals are pushing for national standards for the equipment that’s used on site during a suspected bioattack. Unfortunately, standards take the commitment of time, money, and legislation, which means that we need to really dedicate ourselves to strengthening US biodefense efforts.

Zika Virus – What’s New This Week?
Thailand health officials are investigating reports of four microcephaly cases associated with Zika infections. Sanofi was recently awarded $43 million in funding by the DHHS to help push vaccine development. The CDC has issued a travel warning for St. Kitts and Nevis, so you may want to reconsider travel plans if you’re concerned for local transmission in the Caribbean. The flip-flopping regarding the competency of Culex mosquitoes to transmit Zika is still ongoing, but a recent study predicts that 35 species may be able to transmit the disease (7 of which are found in the U.S.). The speculation of Culex capabilities points to a growing need to better understand the vectors of Zika and potentially expand control measures. Finally, after hotly debating for the better part of seven months, Congress has agreed to allocate $1.1 billion to help fight Zika. A CDC whistleblower claims that the agency is using the wrong Zika test. “Robert Lanciotti is chief of the CDC lab responsible for developing tests to diagnose viral diseases such as Zika that are transmitted by mosquitoes, ticks and fleas. Lanciotti was demoted in May after he raised concerns inside and outside the agency about the CDC’s decision in the spring to recommend a new test for Zika. That test is substantially less effective than another established test, he said, and misses nearly 40 percent of Zika infections. He also said the agency withheld information about testing differences from state and local public health laboratories.” The CDC has reported 3,625 cases of Zika in the U.S. as of September 28, 2016.

Latest Analysis of Anthrax From the Era of Soviet Bioweapons
Sverdlovsk is a notorious event in bioweapons history – over sixty people were killed when wind blew deadly anthrax south through the town in 1979. “A Soviet industrial production facility in Sverdlovsk, USSR, proved deficient in 1979 when a plume of spores was accidentally released and resulted in one of the largest known human anthrax outbreaks.” In their analysis, researchers performed genomic sequencing on the autopsy specimens from the event as many have speculated that aside from mass production of the spores, Soviet bioweapon researchers were also manipulating the genes. The good news is that this recent report shows no genetic manipulation. This new analysis is a result of samples (lung and other tissues) brought back from a research investigation in 1992. The genetic analysis revealed that the strain responsible for the deaths in Sverdlovsk is genetically identical to a wild strain found in farms earlier that year. While this brings a sigh of relief, it also supports the reality that anthrax is deadly enough in its natural state and will most likely be the biological weapon of choice among terrorists.

Stories You May Have Missed:

• Handshake Stewardship and Battling Microbial Resistance – A recent study published in the Pediatric Infectious Disease Journal described the implementation of an antimicrobial stewardship program at Children’s Hospital Colorado. The program initiated a “rounding-based strategy, handshake stewardship. Handshake stewardship is distinguished by: (1) lack of restriction and preauthorization, (2) review of all prescribed antimicrobials and (3) a rounding-based, in-person approach to feedback by a pharmacist–physician team.” They found that overall antimicrobial use decreased by 10.9% during the 4 years of analysis, which also included a 25.7% decrease in the use of vancomycin. Decreased usage of antimicrobials was seen in both the hospital-wide analysis as well as individual units.
• Legionnaires’ Disease Hits Seattle and Memphis – the waterborne disease is popping up in a Seattle hospital and Memphis hotel. The UW Medical Center has diagnosed five patients with Legionnaires’ disease, two of whom died. Six cases of a respiratory disease were recently investigated in Memphis, with the local health department confirming that the first of the cases have been confirmed as Legionnaires’ disease. The Memphis cases are linked to a La Quinta Inn, which has been closed upon public health order.
• International Conference for Post Ebola Capacity Building for the Mano River Union – Check out the October 6, 2016 conference from 9am-3pm in Silver Spring, Maryland! The conference will look at healthcare infrastructure and capacity, environmental management and disaster/emergency management, maritime and ports, agriculture, and much more! “The International Conference for the Post Ebola Capacity Building Initiatives (ICPECBI) was borne out of an assessment conducted by the State of Maryland and Liberia Sister State Committee (MLSS) and Africa Environmental Watch (AEW) experts’ team. The team carried out an assessment within some immediate environs and the outskirts of Monrovia, Liberia, in November through December of 2015. The goal was to examine and understand the current state of post Ebola conditions from lessons learned throughout the entire ordeal, and how residents and communities were coping.”

Happy Friday! Spain has reported two cases of Crimean-Congo hemorrhagic fever – the first patient had a tick bite and died in the hospital, and the other is an ICU nurse who cared for the initial patient. A researcher at the Umeå University just got to enjoy the first CRISPR meal- yum!  Check out this video to see bacteria invade antibiotics and transform into resistant superbugs! If you’re interested in attending the Advancing Global Health Security: Driving Innovation through Partnership (where they’ll be talking about everything from Ebola to Zika, lessons learned, and what we still need to improve) on September 19th, make sure to RSVP here.

Aleppo Chemical Weapons Attack  
On Tuesday, the Syrian city of Aleppo experienced a chemical attack as regime warplanes are said to have dropped barrels with “poisonous gas”. Syrian activists are pointing to the incident involving government warplanes as just another attack in a long stream of chemical attacks.  More than 100 people are being treated for respiratory symptoms, with rescuers rushing children to the makeshift Basel Aslan hospital. “Rebel-held Aleppo has been pounded by the forces of President Bashar al-Assad’s regime, backed by Russian air power. Several cases of chlorine gas bomb attacks also have been reported there.”

FDA Wages War on Antibacterial Soap
The U.S. Food and Drug Administration (FDA) has issued a final rule regarding over-the-counter (OTC) antiseptic wash products containing 19 specific ingredients. This list of ingredients non grata includes the most commonly used ones – triclosan and triclocarban, and will effectively impact 40% of soaps. The FDA is also continuing to study the efficacy and safety of hand sanitizers and wipes. The ruling comes after health officials have been urging for restrictions on the ingredients due to concerns regarding pediatric hormonal functions and aiding the rise of resistant microorganisms. The irony is that research has shown that using the antibacterial soaps is no more effective than using regular soap and water. “It has boggled my mind why we were clinging to these compounds, and now that they are gone I feel liberated,” said Rolf Halden, a scientist at the Biodesign Institute at Arizona State University, who has been tracking the issue for years. “They had absolutely no benefit but we kept them buzzing around us everywhere. They are in breast milk, in urine, in blood, in babies just born, in dust, in water.” From an environmental standpoint, triclocarban takes a while to effectively disappear, with some researchers pointing out that it’s member of the older chemical family of organochlorines (like DDT).

Terror Suspects and Bioterrorism in Kenya
Last week, two terror suspects were arrested in Kenya as part of an extremist cell of medics who are loyal to ISIS. The Kenyan Anti-Terror Police Unit were tipped off that the suspects were planning a large-scale biological attack involving anthrax. Dr. Lawrence Roberge noted that, “I would be very concerned. This is an example of how developing countries with limited detection resources- and certainly less robust biodefense budgets-would become vulnerable to bioweapon attacks.” While information is still limited as to the extent and status of their plan, the growing rate of terrorist attacks in Kenya has many concerned that this may be the first of many indicators pointing to ISIS’ “scramble for Africa”.

Viral Genomes Unlock Secrets Behind Ebola’s Spread
Researchers investigating the 2013-2016 Ebola outbreak in West Africa have used a collaborative sequencing project to look at over 1600 Ebola virus genomes. Encompassing 5% of known cases, this analysis was able to reconstruct the “migration, proliferation and decline of Ebola virus throughout the region”. Their work looked at the association of various factors like geography, climate, demography, and more among 56 administrative regions. “Our results show that during the outbreak viral lineages moved according to a classic ‘gravity’ model, with more intense migration between larger and more proximate population centers. Notably, we find that despite a strong attenuation of international dispersal after border closures, localized cross-border transmission beforehand had already set the seeds for an international epidemic, rendering these measures relatively ineffective in curbing the epidemic.” Through their genomic sequencing they established that the outbreak was a spatially dissociated collection of transmission clusters that varied in size, duration, and connectivity.

Weekly Zika News
Funding issues aren’t the only thing plaguing U.S. Zika efforts, but rather an overall issue of a limited arsenal.  Pesticide issues and resistance have been challenging mosquito control efforts. Only two classes of pesticides against mature mosquitoes are approved, of which one has strict control limits and the other has become relatively ineffective due to mosquito resistance. “The outbreak highlighted gaps in the mosquito control arsenal that remain, according to pesticide makers, abatement officials and entomologists. Few companies make pesticides for use in public health outbreaks, a niche market that is expensive to get into, has a limited upside and varies season to season. Safety testing a new pesticide can cost up to $250 million and take 10 years, said Karen Larson, vice president of regulatory affairs at privately held Clarke Mosquito.” In attempts to spray for mosquitoes, millions of bees have been killed in a South Carolina county. “The apparently inadvertent extermination, the county administrator said, happened after a county employee failed to notify Ms. Stanley’s business, which the administrator said should have been alerted about the spraying strategy. Some hobbyists were also caught by surprise.” Will there be a Generation Zika? Many are wondering if there will be an increased associated with mental illness and long-term health effects due to congenital Zika infections. What does this mean for healthcare and the estimated cost of caring for children with these health issues though? As of September 7th, the CDC has reported 2,964 cases of Zika in the U.S. You can also read PAHO’s epidemiological update here.

Stories You May Have Missed:

• Small Changes, Big Dividends: A Global Look at Preparedness– Dr. Stephen Redd, Director of the Office of Public Health Preparedness and Response, is talking about the interconnectedness of preparedness and public health in this week’s Public Health Matters Blog. Dr. Redd notes that the U.S. recently invited a team of international experts to evaluate our ability to prevent, detect, and respond to public health threats in 19 different areas. The goal is to not only gain knowledge, but also be able to disseminate it across the globe as other countries work to strengthen their own capabilities.
• U.S. Failures at Tracking Antibiotic Resistant Bugs– It’s not just enough to know we have MDRO’s (multi-drug resistant organisms), but also the capacity to identify the individuals and perform proper infection control practices. ICU’s are a hot spot ICU’s are a hot spot but many patients are also unaware of this reality and many officials don’t inform them of what they can do to help prevent the spread of infection. On top of these stark realities, the presence of a MDRO not always communicated in the event of a patient’s death.”Drug-resistant infections are left off death certificates for several reasons. Doctors and other clinicians get little training in how to fill out the forms. Some don’t want to wait the several days it can take for laboratory confirmation of an infection. And an infection’s role in a patient’s death may be obscured by other serious medical conditions.”