Pandora Report 3.24.2017

Welcome to the start of the weekend and World TB Day! The WHO estimates that just in 2015, 1/3 of people with TB missed out on quality care and 480,000 people developed multidrug-resistant TB.

Public Health Concerns in Trump’s New Budget
President Trump’s newly released proposed budget blueprint makes drastic cuts to many programs, of which, one of the hardest hit is HHS. On top of the cuts to science and public health, there is something buried within the budget that is concerning ex-CDC director, Dr. Tom Frieden. Frieden worries about the proposal to award block grants to states, which would allow them to decide how to respond to public health issues (think Ebola, Zika, etc.). “That proposal is ‘a really bad idea,’ according to Dr. Tom Frieden, who until this past January was director of the U.S. Centers for Disease Control and Prevention. Currently, the CDC experts work with state and local governments to devise evidence-based plans to respond to public health issues, such as foodborne and infectious disease outbreaks. With a block grant, states can use the federal money to replace their own spending in certain areas or spend the money unwisely, ‘and never have to report what they have done or be held accountable for it,’ Frieden said.” A withdrawal of one fifth of NIH’s budget would mean a deep slash to biomedical and science research funding.  These cuts will also impact foreign aid, which has many worried about the role of public health interventions in foreign countries. Bill Gates recently talked to TIME magazine regarding the safety implications of cutting foreign aid. “I understand why some Americans watch their tax dollars going overseas and wonder why we’re not spending them at home. Here’s my answer: These projects keep Americans safe. And by promoting health, security and economic opportunity, they stabilize vulnerable parts of the world.” Gates points to the role of overseas public health work like polio eradication, Ebola outbreak response, and America’s global HIV/AIDS effort (PEPFAR), which points to the stabilizing role that strengthening public health can have in a country.

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
From Anthrax to Zika, we’ve got the place to be in July for all things biodefense. This three-day workshop will provide you with not only seminars from experts in the field, but also discussions with others interested in biodefense. You can check out the flyer and register for the event here. The best part is that we’re doing an early-bird registration discount of 10% if you sign up before May 1st. A returning participant, GMU student/alumni, or have a group of three or more? You’re eligible for an additional discount! Check out the website to get the scoop on all our expert instructors and the range of topics the workshop will be covering.

Unseen Enemy Documentary 
Mark your calendars for this upcoming infectious documentary on the lurking pandemics that worry experts. Airing on April 7th, Unseen Enemy will follow researchers looking for the early warning signs of diseases that could cause the next pandemic. The National Academy of Medicine will be hosting a special D.C. premiere of the film on April 2nd, that you can even attend.

Expert Views on Biological Threat Characterization for the U.S. Government: A Delphi Study 
Biological threat characterization (BTC) is mixed bag of risk and reward. The laboratory research involving deadly pathogens as a means for biodefense can translate to better risk assessments but also the potential for biosafety failures. To better address this issue, researchers performed a Delphi study to gather opinions from experts around the country. “Delphi participants were asked to give their opinions about the need for BTC research by the U.S. government (USG); risks of conducting this research; rules or guidelines that should be in place to ensure that the work is safe and accurate; components of an effective review and prioritization process; rules for when characterization of a pathogen can be discontinued; and recommendations about who in the USG should be responsible for BTC prioritization decisions.” Following their assessment, the researchers found that experts agree that BTC research is necessary, but there is also a need for continued oversight and review of the research to reduce as much risk as possible. “It also demonstrates the need for further discussion of what would constitute a ‘red line’ for biothreat characterization research—research that should not be performed for safety, ethical, or practical reasons—and guidelines for when there is sufficient research in a given topic area so that the research can be considered completed.”

GMU Schar School PhD Info Session
If you love global health security and have been wanting to further your education, come check out our PhD info session next Wednesday, March 29th at 7pm in Arlington. You can come learn about our biodefense PhD program from the director, Dr. Koblentz, and hear from several students about their experiences. The info session is a great way to find out what a GMU Schar PhD entails, the application process, and what current students think!

What Biosecurity and Cybersecurity Research Have In Common
Kendall Hoyt is looking at the similarities between these two research fields and how work into the unknown can often expose and create vulnerabilities. Did I mention Kendall is one of the instructors at our biodefense Summer Workshop? Hoyt provides two examples to really hone in on this point – to defend against a dangerous pathogen, we have to isolate and grow it to try and develop treatment or a vaccine and to defend against a cyberattack, we need to know how to break into the computer system. That whole dual-use dilemma creates a lot of risk-versus-reward scenarios for biosecurity and cybersecurity researchers. While the research is highly relevant and necessary, government efforts to control or maintain oversight have been challenging. Do we pull back the reigns on innovation or run the risk of a security breach or a big “whoops” moment? “Intellectual property and cybersecurity legislation—namely the Digital Millennium Copyright Act and the Computer Fraud and Abuse Act—has similarly stifled legitimate scientific and commercial activities and delayed defensive applications. In one well-known example, fear of prosecution under DMCA deterred a Princeton graduate student from reporting a problem that he discovered: Unbeknownst to users, Sony BMG music CDs were installing spyware on their laptops.” Hoyt also points out the biosecurity efforts that have begun looking not just at the pathogens and publications, but the laboratory techniques that are used for such research. Certain experiments (like gain of function work) have the capacity to increase transmissibility or host range. “For all of their similarities, key differences between biosecurity and cybersecurity risks and timelines will dictate varied regulatory strategies. For example, zero-day exploits—that is, holes in a system unknown to the software creator—can be patched in a matter of months, whereas new drugs and vaccines can take decades to develop. Digital vulnerabilities have a shorter half-life than biological threats. Measures to promote disclosures and crowd-sourced problem-solving will therefore have a larger immediate impact on cybersecurity. Still, both fields face the same basic problem: There are no true ‘choke points’ in either field. The U.S. government is not the only source of research funds and, thanks in large part to the internet itself, it is increasingly difficult to restrict sensitive information.” In the end, Hoyt notes that both fields and their regulations will need to relax the governance process and be a bit more flexible and mobile with how they control items. Both fields are constantly evolving, which means regulators need to be just as fluid.

How To Prepare For A Pandemic
NPR decided to create a “Pandemic Preparedness Kit” based off the continuous questions related to the ongoing news of increasing infectious disease threats but little info in terms of practical things people can do. While these aren’t things you can go out and buy for your home, the list hits close to home in terms of things we should be focusing our efforts and funding on. Firstly, vaccines. This is a no brainer and yet, we’ve become the habitual users of the theme “create it when we’re struggling to contain an outbreak”. Secondly, virus knowledge. “One of your best weapons during a disease outbreak is knowledge, says Dr. Jonathan Temte of the University of Wisconsin. ‘Keep up with the news and try to understand what threats might be out there,’ he says. For example, new types of influenza are one of the biggest threats right now — in terms of pandemic potential, Temte says. But if you know how to protect yourself from one type of influenza, you can protect yourself from all of them.” Lastly, and my personal favorite, is very clean hands. While every disease is different, one of the most basic and fundamental truths for infection prevention and control is hand hygiene. These three are solid ways to better prepare for future outbreaks, pandemics, emerging infectious diseases, and just about anything infectious that makes you a bit worried.

CARB-X MissionWhen I first read the name of this group, I thought it was some kind of fitness fuel, but I was pleasantly surprised to see this initiative is working to fight antibiotic resistance. CARB-X is a collaboration between NIAID and BARDA to help accelerate the development of antibacterials over the next 25 years. The goal is to help combat antimicrobial resistance through a diverse portfolio and partnership. Make sure not to miss their March 30th meeting from 11am-noon on antibiotic resistance. “CARB-X (Combating Antibiotic Resistant Bacteria Accelerator) was launched in August 2016 to accelerate pre-clinical product development in the area of antibiotic-resistant infections, one of the world’s greatest health threats. CARB-X was established by BARDA and NIAID of the U.S. Department of Health and Human Services along with Wellcome Trust, a global charitable foundation dedicated to improving health. This partnership has committed $450 million in new funds over the next five years to increase the number of antibacterial products in the drug-development pipeline.” While CARB-X may not be the latest workout supplement, it’s definitely a boost to performance in the fight against antimicrobial resistance.

New Roles and Missions Commission on DHS Is Urgently Needed
GMU biodefense PhD alum, Daniel Gerstein, is looking at DHS and pointing to the need for a Roles and Missions Commission. It’s been almost 15 years since DHS was created under rapid and urgent circumstances, which means that it’s time to look introspectively. “More generally, a roles and missions review could also examine whether the department is properly resourced for all its missions. For example, a joint requirement council was recently established for the department composed of less than 10 government civilians. Is this adequate for supporting requirements development activities for a department of over 240,000 personnel?” Gerstein looks at some of the big issues that require a comprehensive review, like centralization versus decentralization, management of R&D and engineering, and critical infrastructure issues related to national security and safety. Another component needing review is the human factors issue that impacts homeland security. How are the relationships between departments, with state and local authorities, or with the public? “The effort should not necessarily be viewed as a requirement for change, but rather an opportunity to reexamine DHS and its relations with the rest of government, the nation and its citizens, and even with our international partners across the globe. Finally, a homeland security roles and mission commission would be an ideal lead-in to a much needed update to the original 2002 authorizing legislation.”

Deadliest Enemy: Our War Against Killer Germs
Don’t miss this event on Thursday, March 30th, hosted by New America with speakers Michael T. Osterholm and Mark Olshaker. “In today’s world, it is easier than ever for people and material to move around the planet, but at the same time it is easier than ever for diseases to move as well. Outbreaks of Ebola, MERS, yellow fever, and Zika have laid bare the world’s unpreparedness to deal with the threat from infectious diseases. In Deadliest Enemy: Our War Against Killer Germs Dr. Michael Osterholm and Mark Olshaker marshal the latest medical science, case studies, and policy research to examine this critical challenge.”

Stories You May Have Missed:

  • The Feds Are Spending Millions to Help You Survive Nuclear War – North Korea’s recent firing of four ballistic missiles from Pyongyang into the ocean off Japan’s coast has brought back worries of nuclear attacks. While the days of stocking a bomb shelter are in the past, the U.S. government isn’t slowing down efforts to protect Americans. “Over the last ten years the US has poured millions of dollars into technologies and treatments it hopes to never have to use, but could, in the event of a nuclear catastrophe. From assays that measure radiation exposure to cell therapies that restore dwindling blood cells to liquid spray skin grafts, government officials are now far better equipped to deal with diagnosing and treating people if the unthinkable were to happen. And the next generation of treatments are being funded right now.” DHHS projects like BARDA and Project BioShield are just some of the sources for ongoing research to strengthen protection, whether it be a nuclear blast or reactor melt-down.
  • Disinfection and the Rise of the Superbug – GMU biodefense PhD student Saskia Popescu is addressing the growing disinfection needs as we teeter on the edge of the antibiotic abyss. Disinfection is already a challenge in healthcare however, the rise of more resistant germs means that efforts often need to be ramped up. The recent influx of Candida auris infections that we talked about last week really brings this issue to point in that this emerging infection is difficult to get rid of via traditional disinfection routes. “As new organisms are identified and existing ones become resistant to antimicrobials, the availability of strong disinfecting products has become even more pivotal.”
  • China and EU Cut Brazilian Meat Imports Amid Scandal– If you’re a fan of importing Brazilian meat, you may have to hold off for a while. A recent police anti-corruption probe is accusing inspectors of taking bribes to allow the sale of rotten and salmonella-contaminated meats from the largest exporter of beef and poultry. As the news unfolds, the Brazilian government is criticizing gate police as alarmist. “As the scandal deepened, Brazil’s Agriculture Minister Blairo Maggi said the government had suspended exports from 21 meat processing units.”
  • Study on Interferon for Treatment of Ebola Infection – The common hepatitis treatment is now being tested out on Ebola patients to help alleviate their symptoms. The pilot study was performed from March-June of 2015 and  had some interesting results. “When compared to patients who received supportive treatment only, 67 per cent of the interferon-treated patients were still alive at 21 days in contrast to 19 per cent of the former patients. Additionally, the viral blood clearance was faster in those patients treated with Interferon ß-1a. Many clinical symptoms such as abdominal pain, vomiting, nausea and diarrhea were also relieved earlier in the interferon-treated patients. A further 17 patients in other Guinean treatment centres who matched the interferon-treated patients based on age and the amount of Ebola virus in their blood were included in the analysis. These added patients, who did not receive interferon, more than doubled their risk of dying as a result of not being treated with the drug.”

Pandora Report 3.17.2017

Happy Friday! In honor of  John Snow‘s birthday (the father of epidemiology), our featured image is the Broad Street pump map he used to combat cholera in the 19th century. Don’t miss out on the early registration discount for our biodefense summer workshop!

NAS Calls for Increased Federal Regulatory Agency Preparation for Growing Biotechnology Products 
The National Academies of Science (NAS) recent press release is emphasizing the need for federal regulatory agencies to prepare for greater quantities and ranges of biotechnology products. As the biotech world constantly evolves, regulatory agencies have struggled to keep up and this latest report states that in the next five to ten years, the pace will outmatch the U.S. regulatory system. According to the report, biotechnology, like CRISPR, has a rapidly growing scale and scope, which already stresses existing staff, expertise, and resources available at agencies like the EPA, FDA, and USDA. “To respond to the expected increase and diversity of products, the agencies should develop risk-analysis approaches tailored to the familiarity of products and the complexity of their uses, the report says. For biotechnology products that are similar to products already in use, established risk-analysis methods can be applied or modified, and a more expedited process could be used. For products that have less-familiar characteristics or more complex risk pathways, new risk-analysis methods may need to be developed.  Regulatory agencies should build their capacity to rapidly determine the type of risk-analysis approaches most appropriate for new products entering the regulatory system.” Within the report, NAS notes that the federal government needs to develop a strategy to combat the current issues and strengthen their ability to scan for future biotechnology products to better prioritize.

GMU Schar School Master’s Open House 
Have you ever wanted to study topics like CRISPR, bioterrorism, global health security, and pathogens of biological weapons? Good news – we’ve got just the program for you! Come check out GMU’s biodefense MS program at our Open House on Wednesday, March 22nd at our Arlington Campus, Founders Hall (Room 126) at 6:30pm. You can talk to some of our biodefense faculty and learn about our program. Whether you’re looking to take classes in person or earn a degree online, the biodefense MS is the best for the intersection of science and policy.

DARPA Works Towards “Soldier Cell” To Fight Bioweapons 
A bio-control system to fight off invading pathogens? Sounds like something out of a science fiction movie! Well, researchers at Johns Hopkins University just received funding from DARPA to develop the capacity to “deploy single-cell fighters” that would target and eliminate the lethality of certain pathogens. “‘Once you set up this bio-control system inside a cell, it has to do its job autonomously, sort of like a self-driving car,’ said Pablo A. Iglesias, principal investigator on the project. Iglesias, a professor of electrical and computer engineering in the Whiting School, shifted his research focus from man-made to biological control systems about 15 years ago. ‘Think about how the cruise control in your car senses your speed and accelerates or slows down to stay at the pace you’ve requested,’ Iglesias said. ‘In a similar way, the bio-control systems we’re developing must be able to sense where the pathogens are, move their cells toward the bacterial targets, and then engulf them to prevent infections among people who might otherwise be exposed to the harmful microbes’.” This angle, which is being focused on bacteria outside of the body, is just one potential tool in the biodefense arsenal.

Yellow Fever Outbreak in Brazil 
Since December of 2016, Brazilian health officials have reported an ongoing outbreak of yellow fever. The CDC has moved the alert to a  Level 2 – Practice Enhanced Precautions. A report recently published in the New England Journal of Medicine looks at the outbreak and the potential for cases in U.S. territories. In Brazil, there were 234 cases and 80 deaths reported between December and February. “Although it is highly unlikely that we will see yellow fever outbreaks in the continental United States, where mosquito density is low and risk of exposure is limited, it is possible that travel-related cases of yellow fever could occur, with brief periods of local transmission in warmer regions such as the Gulf Coast states, where A. aegypti mosquitoes are prevalent.”

GMU Biodefense Represented At Biothreats Conference
If you missed out on our coverage of ASM’s 2017 Biothreats conference, here’s a spotlight on GMU biodefense students attending this captivating three-day event. GMU’s biodefense program sent four graduate students to experience and report on the conference, which addressed biothreat research, policy, and response. “The program was exciting, according to the George Mason students in attendance. Mercer and Goble recall that the conference engaged topics of specific interest to them, their degree, and their futures. ‘I attended a panel that was very closely related to disease forecasting, my graduate thesis topic,’ Mercer said. ‘I was able to hear some of the cutting-edge research in that field, which was really helpful’. ‘I didn’t really have a part I didn’t like,’ Goble said. ‘I enjoyed the niche topics that were presented in both panel discussions and poster  sessions, from emergency operations to the FDA. All of these specific topics were extremely interesting to hear about and to know they are being researched’.”

Just How Well Did the 2009 Pandemic Flu Vaccine Strategy Work?
Researchers from the University of Nottingham recently looked at the success of vaccines in terms of preventing pandemic flu and reducing hospitalizations. Their work looked at the 2009 WHO-declared pandemic of the novel A(H1N1) virus, which infected around 61 million people around the world. Vaccines against the virus were rolled out globally between September and December of 2009, with the majority being inactivated A(H1N1)pdm09 influenza virus. Their work involved reviewing 38 studies between June 2011 and April 2016 regarding the effectiveness of the inactivated vaccine, which covered around 7.6 million people. “We found that the vaccines produced against the swine flu pandemic in 2009 were very effective in both preventing influenza infection and reducing the chances of hospital admission due to flu. This is all very encouraging in case we encounter a future pandemic, perhaps one that is more severe,” noted Professor Van Tam said. “Of course, we recognize that it took five to six months for pandemic vaccines to be ready in large quantities; this was a separate problem. However, if we can speed up vaccine production times, we would have a very effective strategy to reduce the impact of a future flu pandemic.” The 2009 pandemic A(H1N1) vaccine was 73% effective against laboratory confirmed cases and 61% against preventing hospitalizations. Interestingly, when looking at the vaccines’ effectiveness in different age groups, “they were shown to be less effective in adults over 18 years than in children, and effectiveness was lowest in adults over 50 years of age. Adjuvanted vaccines were found to be particularly more effective in children than in adults against laboratory confirmed illness (88 per cent in children versus 40 per cent in adults) and hospitalization (86 per cent in children versus 48 per cent in adults).”

Deadly Fungal Infection Arrives in U.S. 
While many are asking if surveillance methods for tracking the deadly CRE bacteria are adequate, a new issue is emerging in U.S. hospitals. Despite WHO’s recent plea for increased R&D surrounding certain resistant pathogens, it seems that more and more organisms of concern are springing up in U.S. hospitals. Since last summer, roughly three dozen people have been diagnosed with a highly resistant Candida auris infection. The fungal infection has caused worry ever since it was identified in 2009 due to its capacity as an emerging and resistant organism. Candida yeast infections are pretty common and known to cause urinary tract infections however, this strain is especially concerning because it easily causes bloodstream infections, has a stronger capacity for transmission between people, and is much more hardy in terms of living on skin and environmental surfaces. “Of the first seven cases that were reported to the CDC last fall, four patients had bloodstream infections and died during the weeks to months after the pathogen was identified. Officials said they couldn’t be sure whether the deaths were caused by the infection because all the individuals had other serious medical conditions. Five patients had the fungus initially isolated from blood, one from urine, and one from the ear.”

CDC Director Warns Loss of DHHS Funds Could Weaken Infectious Disease Prevention
Acting CDC director, Anne Schuchat, recently testified before Congress to make the case for for increased funding for several programs (one being the DHHS’s Prevention and Public Health Fund). Among other things, the Prevention and Public Health Fund is responsible for 12% of the CDC’s budget. Dr. Schucat’s testimony emphasized the previous usage of these funds in terms of vaccine delivery, disease surveillance, monitoring of water supplies, and tracking hospital-acquired infections. The growth of antibiotic resistance made her testimony and plea to Congress that much more relevant and urgent. “The CDC and other government agencies have in recent years cited the numerous public health threats posed by infectious diseases in general, and have lobbied officials for increased funding for research and development of novel vaccines and treatments as well as programs to effectively distribute interventions as needed. In 2016, for example, the CDC, DHHS, and National Institutes of Health requested federal funding to combat Zika, a request that was not approved until late in the year.”

Stories You May Have Missed:

  • Science on Screen – Don’t miss this great event hosted by Lawrence Livermore National Laboratory! On March 18th, you can watch the second installment of the Science on Screen series, featuring “Lawrence Livermore scientists Monica Borucki and Jonathan Allen, who will present ‘Reconstructing a Rabies Epidemic: Byte by Byte.’ This informative and entertaining lecture will explain how biologists and computer scientists used cutting-edge, ultra-deep sequencing technology to study the dynamics of a 2009 rabies outbreak. This case study, based on a dramatic increase (more than 350 percent) in the gray fox population infected with a rabies variant for which striped skunks serve as the reservoir hosts, will be used to help illustrate the changes in the viral genome during cross-species viral transmission. This lecture is appropriately paired with the feature-length film, “Contagion” (PG-13).”
  • Clorox Gets Spot on EPA A-Team – Clorox just earned its varsity spot on the team against hospitality-acquired infections. The EPA approved two of the company’s products in killing clostridium difficile spores. C-diff is a constant battle in healthcare facilities, so having the new tool in the infection prevention and environmental disinfection toolkit, is a huge advantage for many. “In addition, the cleaners and wipes recently become EPA-registered to disinfect against other bacterial infections, such as those caused by Staphylococcus epidermidis, Candida glabrata, and Enterococcus hirae. Moreover, the products are also effective against several viral pathogens, such as Middle East Respiratory Syndrome (MERS), and Severe Acute Respiratory Syndrome (SARS), measles, and Influenza A and B, among others.”

 

ASM Biothreats 2017

screen-shot-2017-02-15-at-9-40-26-amGMU Biodefense sent four graduate students to give you a “boots-on-the-ground” viewpoint for the 2017 ASM Biothreats conference. In our special edition post we have a full range of coverage for this three-day conference on biological threats and safety.

Zach Goble is looking at international collaboration against biological threats and the importance of recognizing foreign organizations for their help in aiding research endeavors. Next, he looks to the symposium on national bioterrorism emergency response. Pointing to the work done by different states and the proposed model by David Ladd, he emphasizes that these are definite steps in the right direction, but will need continued work.

Greg Mercer reviews the panel session “Predicting Emergence by Understanding the Past: Methods that Move Us Towards Predictive Biology“. In his overview of this panel on efforts to get ahead of the evolutionary curve, Greg discusses each speaker and their contributions to the field, as well as where they think the future will take us.

Stephen B. Taylor covers Dr. Fauci’s talk on pandemic preparedness and his experience throughout the years. In this overview, Dr. Fauci points to the unique challenges that followed each health crisis and how certain administrations responded. Stephen also takes us through the melioidosis panel regarding this neglected tropical disease. He notes the high cost of treatment and the inability for most endemic countries to support response and prevention efforts.

HyunJung (Henry) Kim– takes us on a journey through the FDA Animal Rule and its path to success. Henry uses this plenary sessions to discuss the PEP, PrEP, and Passive Transfer aspects of animal modeling.

Pandora Report 12.9.2016

Happy Friday and welcome to your weekly source for all things biodefense! Can you guess the 37 viral species that may have epidemic potential? Like something out of a horror movie, a team of researchers found the oldest  known smallpox virus sample in a naturally mummified child in Lithuania.

Learning From Ebola – Workshop Proceedings from NAS & Laboratory Battles
17649_phil_who_on_site_ebola_outbreak_2014This week was rich with information from the 2014/2015 Ebola outbreak and the lessons we’re still extracting from it. The National Academies of Science released their 136 pages proceedings from a workshop on the Ebola epidemic in West Africa. This is an extremely in-depth review of the situation, the failures, and what we’re doing to prevent it from happening again. If you don’t have time to read the full 136 page (too bad they don’t have it as a book on tape, right?), they’ve broken it down into sections- the outbreak, global preparedness and response, current and future research, etc. The actual body of the paper is about 65 pages but there are some gems in the appendixes – EVD preparedness in Germany, the view from the national institute of allergy and infectious diseases, and more. I found the outbreak section particularly interesting as it discussed the differences with previous outbreaks. This section noted the weakening of the affected countries through ongoing civil unrest and relative inexperience when dealing with ebola. Another great resource this week comes from the African Journal of Laboratory Medicine. They’ve just released a special edition that focuses on global health security during the Ebola outbreak. You can find articles on building laboratory capacity to combat diseases in Africa, the lab health system and its response to the EVD outbreak in Liberia, Sierra Leone’s lab system now and in the future, etc. The article on building lab capacity points to issues with Ebola, but also notes the challenge that several countries have in meeting the GHSA as their national disease programs are fragmented and have not yet joined the national lab networks, surveillance systems, and health research institutes. Interestingly, the focus then turns to antibiotic resistance and emphasizes the critical role of labs in detection and containment of AMR’s, which is a serious deficiency in Africa.

Since we’re already talking about Ebola, the CDC just released an article in their Emerging Infectious Diseases journal, regarding media messages and the perception of risk for ebola in the U.S. I think many of us can appreciate the significance of this article as media representation and messaging of risk during this outbreak was just another in a long list of mis-information and avoidable hysteria. The researchers reviewed U.S.-focused news about Ebola from July1-November 30, 2014 and found an abundance of risk-elevating messages. “Overall, 96% of print and television news stories that covered EVD in the context of the United States included >1 risk-elevating messages, 55% of stories contained >1 risk-minimizing messages, and 53% contained both message types. The most common risk-elevating messages (72%) concerned foreigners or travelers bringing Ebola virus to the United States. The most frequent risk-minimizing messages (32%) described scientific knowledge about EVD (Table).” When it comes to responding to ebola and other emerging infectious diseases, aside from the change in media habits, there’s a lot we still need to learn. Some of the more high-priority recommendations DHHS is trying to focus on include the role of the U.S. in aiding countries with limited surveillance and response capabilities (GHSA!), forming a pot of discretionary funds, capacity to call on the necessary public health experts, and clear guidelines for when the U.S. will send medical personnel to other countries.

antimcrresukreview2Farm Animals Are Now Resistant to Antibiotic of Last Resort
Is this the start of the antibiotic apocalypse? A recent study found the presence of carbapenem-resistant (carbapenems are antibiotics that are last-line drugs for severe bacterial infections) bacteria in agricultural settings. Firstly, it’s important to note that because there is concern over this issue, carbapenems are not supposed to be used in agriculture. The samples that revealed the presence of the resistant microbes were taken during a study of a pig farm over the course of five months, and were collected from the floors, walls, fecal samples etc. The good news – none of the resistant bacteria were found in pigs, however it was found in sows and piglets. Dr. Wittum, chair of veterinary preventive medicine at Ohio State University, noted that “farms do not use carbapenem antibiotics not only because doing so is illegal, but that it’s also very expensive. ‘How the [resistant bacteria] got onto the farm we really don’t know,’ said Wittum in an email exchange with TIME. ‘But probably it was introduced from the outside from movements of wildlife, people, equipment, etc.’ He says it’s possible that other legal antibiotics used on the farm could be contributing to the maintenance and spread of the bacteria, but more research needs to be done.”

CRISPR Mortal Combat 
Before we get into the battle that is the CRISPR patent world, Cold Spring Harbor Laboratory (CSHL) just announced the creation of a new molecular tool to change the genomes of plants that will strengthen harvest yields and expand their geographical range. CSHL researchers established a process to make two kinds of tomato plants flower and produce ripe fruit two weeks faster than what is currently possible. “The impact of this discovery cannot be overstated, as the potential impact could mean more plantings per growing season and thus higher yield. Moreover, it also means that the plant can be grown in latitudes more northerly than currently possible. Attributes that are extremely important as the earth’s climate warms and population continue to burgeon.” On to the battle of CRISPR patents! Things have been getting nasty in these hearings and Tuesday morning saw the first and only oral arguments over a patent. “The nasty dispute pits the University of California against the Broad Institute of Harvard and MIT for rights to key patents on CRISPR genome-editing. Since April 2014, the Broad has received 13 CRISPR patents, based on work led by its bioengineer Feng Zhang, but UC believes it deserves some of the most foundational ones, reflecting earlier work by its biochemist Jennifer Doudna and her collaborator Emmanuelle Charpentier.” STAT highlighted three very crucial questions that are being asked by so many as we sit in the audience of this gladiator-like spectacle- should we even be here, what are we arguing about, and why hasn’t there been a settlement? While there are potentially billions of dollars at stake, this could also change the nature of the exclusive and non-exclusive licenses to CRISPR technology. The patent dispute also comes at an interesting time for patent laws. “On March 16, 2013, the U.S. patent system switched the way patents are awarded: Previously, a patent was granted to the very first party to invent something; now, a patent simply goes to whoever files a patent application for an invention first. As it happened, Berkeley filed its initial patent just one day before the March 16 switchover. So here we are trying to figure out who invented CRISPR first.”

Enhancing BioWatch Capabilities Through Tech & Collaboration
The latest National Academies of Science publication looks to BioWatch and how we can improve it. In response to the 2015 Government Accountability Office (GAO) report Biosurveillance: DHS Should Not Pursue BioWatch Upgrades or Enhancements Until System Capabilities Are Establisheda NAS workshop was requested by DHS to further explore the findings and impact they may have on the future of BioWatch. The report reviews the recommendations from GAO and the DHS response, and then discusses the BioWatch collaborative planning process. One particularly interesting section focused on future opportunities for state and local collaboration. Several participants noted their state and local health departments deemed homeland security as a top issue and were open to participate on special projects but often met barriers when working with security and the Secret Service. The publication is definitely worth the read in terms of the issues encountered with BioWatch and what future goals might be. It’s also a breath of fresh air to hear accounts from local public health sources regarding their experiences.

Spanish Minister of Foreign Affairs Chairs High Level Security Council WMD Debate 
On December 15th, the Spanish Minister for Foreign Affairs, H.E. Mr. Alfonso Dastis, will be chairing a high level open debate of the Security Council on the topic of “Preventing catastrophe: A global agenda for stopping the proliferation of weapons of mass destruction by non-state actors”.  The debate will focus on the process to strengthen a preventative system to avoid humanitarian, political, and economic catastrophe that the use of WMD’s by non-state actors would entail. “The debate will take into account the conclusions of the report of the Comprehensive Review of Resolution 1540 (2004), which will be sent to the Security Council by end November and sets the basis of a global agenda to achieve full implementation of resolution 1540 (2004) by 2021, when the current institutional arrangements adopted by the Security Council in this field will expire. Particularly, the debate aims at reflecting on the practical measures that the Security Council and the UN System, Members States, international organisations and relevant sectors of civil society can adopt to prevent non-State from accessing or using WMD. The debate will have a practical and action-oriented approach that connects the discussion with real life, thus creating momentum for an improvement of the effectiveness of the preventive system in the fight against the proliferation of WMD, perhaps the biggest threat the world faces presently. Participants in the open debate are also encouraged to announce specific commitments for implementing the main recommendations of the Comprehensive Review, including financial support for those with the capacity to do it, to push forward the global non-proliferation agenda and directly contribute to a safer world.” The best part? The debate will be open to the public and broadcast over the internet!

Zika Virus Updates
The CDC has reported 4,575 case in the U.S. as of December 7th. The daily Florida Department of Health counts can be found here, in which you’ll see three new travel-associated cases and five new locally acquired cases reported on December 8th. The CDC has released a new article in their EID journal regarding the characteristics of US travelers to Zika-virus affected countries in the Americas from March 2015-October 2016.  They found that 3/4 of the travelers were men or women of reproductive age. The New York City department of health just announced that a 5th baby has been born with Zika-linked brain developmental issues. This makes five babies since July to be born with neurological development symptoms, like microcephaly, related to maternal infection. Arthur Caplan is talking to Forbes about how the Zika outbreak foretold Trump’s win.

Stories You May Have Missed:

  • Big Data & Analytics for Infectious Disease Research, Operations, and Policy – You can now download this NAS workshop document for free! Get the latest news on how big data is a tipping point for global health and surveillance systems. The book includes information on utilizing big data, combating antimicrobial resistance with it, and some great case studies. It points to the range of opportunities for use, however there are several challenges to really access the full potential – like usage, access, interoperability, analysis, validation, liability, security, etc.
  • Responding To The Next Ebola – Will Your Smartphone Play A Role?– Just when you thought we were done talking about Ebola…one of the greatest strengths technology has given us is speed. Coincidentally, that’s something we desperately need when fighting an infectious disease in an area with constantly moving people. Researchers tested this out by logging the number of calls from individual cell towers and then mapping the movement of people throughout the country. “Already, we’re getting immensely valuable insights about what happens during epidemics, and where we need to target our treatment efforts. For example, mobile mapping has confirmed that, in the wake of an epidemic or natural disaster, people head home to their families. So if you’re planning for worst-case scenarios, you can make a surprisingly good forecast by loading up migration data from national holidays such as Chinese New Year, Christmas or Diwali.”
  • Re-emergence of Syphilis Traced to Pandemic Strain Cluster– the past few decades have seen a growth in syphilis cases globally. Researchers led by the University of Zurich analyzed low levels of DNA to delve into the history of syphilis strains. They found that all strains from modern patients share a common ancestor from the 1700s. In fact, the dominating strains of today originated from a pandemic cluster following the 1950s. The concerning aspect of these strains is their ability to fight off the second-line antibiotic, azithromycin.

 

Pandora Report 11.4.2016

Happy Friday! We’ve got some great news – you can now watch our book launch and panel from the Biological Threats in the 21 Century event via YouTube here. Whether you missed out on attending or want a recap, you can get all the biodefense goodies there. UNMC was recently awarded $19.8 million to build an Ebola and advanced infectious disease training center. Their new center will include a training, simulation, and quarantine section, with the hope of training healthcare workers to treat patients with Ebola and other highly infectious diseases. A recent study found that limited access to Ebola diagnostic and supportive pathology assays facilitated the failure of initial 2014 outbreak control efforts, regardless if the setting was a resource-rich or resource-poor location.  Shocking news – hand hygiene is one of the biggest issues in norovirus infections.

3rd Annual Summit on Global Food Security and Health 
GMU’s Schar School of Policy and Government will be hosting this informational event on Wednesday, November 16th from 10:30am-5:30pm. Speakers include experts from organizations such as the Association of Public Land Grant UniversitiesBread for the World, the International Medical Corps and the US Agency for International Development: Academics will discuss their research on Food Security with an eye to improving access, addressing challenges and developing partnerships to improve global food security and related health outcomes. Organized with the support of the Center for Strategic and International StudiesThe Farm Journal FoundationThe Global Harvest Initiative, Policy Studies OrganizationWorld Medical & Health Policyjournal; Center for the Study of International Medical Policies and Practices (CSIMPP) in the Schar School of Policy and Government at George MasonUniversity; American Public University; and World Food Policy. The conference is free and open to the public, but registration is required. Contact Professor Bonnie Stabile bstabile@gmu.edu with any questions.

FDA Manipulation of Media
A new report from the Scientific American is drawing attention to the FDA’s arm-twisting of journalists “into relinquishing their reportorial independence”. Their investigators found that NPR and a series of other news outlets had a deal with the FDA-  get news announcements early but the FDA would dictate whom their reporters could and couldn’t interview. “This kind of deal offered by the FDA—known as a close-hold embargo—is an increasingly important tool used by scientific and government agencies to control the behavior of the science press. Or so it seems. It is impossible to tell for sure because it is happening almost entirely behind the scenes. We only know about the FDA deal because of a wayward sentence inserted by an editor at the New York Times.” The Scientific American was able to obtain supportive documents via the Freedom of Information Act, which revealed that despite their public demeanor, the FDA denies many reporters access and grows their own group of journalists that will follow their rules. Much of this is held together with the journalistic practice of embargo – a deal between source and journalist that the story won’t be published prior to a specific date/time. This is actually pretty common in the science world, but it can actually create an aura of favoritism and bias. The issue with the FDA situation is far deeper though – aside from getting early access to stories and agreeing not to publish before the agreed date/time (embargo), the other rules stated that journalists could not seek outside comment and in a nutshell, had to give up the ability to do independent reporting. In the end, this kind of control of the media and journalistic favoritism reveals things about both sides of the agreement, but also emphasizes the need for transparency and re-thinking of the embargo system.

BWC 8th Review Conference sheet-1
The eighth RevCon is fast approaching and if you’re behind as to what’s happened since the last RevCon, check out UNLOG’s (The United Nation’s Office at Geneva) Think Zone and the latest information. You’ll also find some great articles from GMU’s Biodefense faculty in there – like Dr. Koblentz’s article on dual-use and Dr. Sonia Ben Ouagrham-Gormley’s article on gene drive. Better yet, check out the BWC RevCon Series from the International Law and Policy Institute. These three papers discuss a series of issues related to the BWC and RevCon. The first, Divide and Delegate: the Future of the BWC, focuses on the pursuit of BWC aims outside RevCons and the normative strengths and operational weaknesses. LPI2, Keeping Up With the Science, looks to support enhanced science and technology review processes. LPI3, is a joint effort by GMU’s very own Biodefense Director, Gregory Koblentz, and the author of your favorite new book (Biological Threats in the 21st Century), Filippa Lentzos. The third paper, Risks, Trade-Offs & Responsible Science , looks at the security trade-off risks of the increasing volume of labs and scientists working on dangerous pathogens. They note that “the 2016 BWC Review Conference must encourage states to implement stringent national biosafety, biosecurity and dual-use research regulations; task the science advisory group to develop clear, internationally- recognized guidelines governing dual-use research of concern (DURC); establish a working group to revise the CBMs; and encourage states to participate in the CBM mechanism as well as more interactive information exchanges such as peer review and compliance assessment.”

RevCon will take place from November 7-25th in the Palais des Nations and a general agenda is available here. Gabrielle Tarini writes that this RevCon will be a “pivotal opportunity for countries to take action to ensure that the treaty remains a relevant and useful tool for preventing the development, spread, and use of biological weapons. A failure by member states to invest the necessary attention, time, and political capital in the conference could mean decreased interest and weakened multilateral engagement in a treaty that was the first to ban an entire category of weapons of mass destruction.” Moreover, the BWC should have a dedicated process, like that of the CWC, to inform and advise member states, pointing to the need for a great capacity to have expert-led meetings and continuous monitoring. Lastly, Tarini highlights that this RevCon will be an opportunity to strengthen and revise the intersessional process and framework. “The treaty should be restructured, with a stronger steering body and increased time for preparation and multilateral engagement. Adding more meetings, and limiting what gets discussed at each of those meetings, would allow the BWC to begin operating more like an international organization and would provide oversight equivalent to that for other nonproliferation treaties.” Can everyone help verify the BWC? Some are saying open source monitoring may just be that sweet spot.

Increasing Transparency in Biodefense: A 2016 Visit to a German Military Medical Biodefense Facility  screen-shot-2014-09-22-at-21-57-41
Filippa Lentzos is taking us on a journey through German biodefense practices and why transparency is so vital for these programs. Citing Germany as a prime example of countries going above and beyond their voluntary BWC efforts, she delves into the world of Germany’s biodefense activities. She notes the visitors were highly encouraged to review Germany’s most recent CBM submission and briefed on the Institute of Microbiology’s safety and health regulations. “Few restrictions were placed on us other than those related to safety and security. We were free to view rooms, lab equipment and installations. The type and scope of access was to be determined by Institute staff on a case-by-case basis. Any access denials could derive from national security, biosafety and health regulations, data privacy issues, unpublished scientific results or ongoing lab work. If access or certain information was refused, the Institute would explain the particular considerations and o er alternatives.” The Bundeswehr institute focuses on three main CBRN tasks – ensuring protection and an ability of the armed forces to act under CBRN threats, preventing vulnerability to potential CBRN threats and weapons via preventative measures, and limiting the consequences should a CBRN event ever occur. The medical biodefense responsibilities focus more on the ability to rapidly diagnose and identify pathogens, distinguishing natural outbreaks from intentional, and controlling outbreaks. The official noted on their visit that within the institute, there are 65 staff and 18 externally funded fixed-term positions over three departments (bacteria/toxins, viruses/intracellular pathogens, and medical biological reconnaissance and bioforensics). From genome sequencers to electron microscope rooms, check out Filippa’s report for a virtual tour of this amazing biodefense facility.

Assessing the Epidemic Potential of RNA and DNA Viruses  screen-shot-2016-11-02-at-7-19-56-am
Researchers from the University of Edinburgh are looking at zoonotic viruses and their transmissibility. The Ebola outbreak in 2014 highlighted the needed to better understand what kinds of pathogens, especially zoonotic, were likely to emerge as potential epidemics. Given the vast diversity and high rates of viral evolution, this was no easy task. “Of human transmissible virus, 37 species have so far been restricted to self-limiting outbreaks. These viruses are priorities for surveillance because relatively minor changes in their epidemiologies can potentially lead to major changes in the threat they pose to public health.” Researchers used the basic reproductive number, R0, as a means of answering this question. They looked at hundreds of viral species and then categorized them into 4 levels with epidemic potential in humans. They found that the taxonomic diversity is wide, but bounded and most human infective viruses are closely related to viruses of other mammals. Transmissibility within the human population is a key determinant, as well as the R0 threshold of>1. “We currently have few clues to help us predict which mammalian or avian viruses might pose a threat to humans and, especially, which might be transmissible between humans. One argument in favor of experimental studies of these traits, including controversial gain of function experiments, is that they could help guide molecular surveillance for high-risk virus lineages in nonhuman reservoirs.The first line of defense against emerging viruses is effective surveillance. A better understanding of which kinds of viruses in which circumstances pose the greatest risk to human health would enable evidence-based targeting of surveillance efforts, which would reduce costs and increase probable effectiveness of this endeavor.”

Spikes in C-diff and MDRO’s 
Halloween may be over but the rise of the resistant bugs is still going on. A recent study looked at the changing epidemiology of MDRO’s (multi-drug resistant organisms) within a specific healthcare network. While they were able to observe a significant reduction in MRSA, there was a sharp rise in other MDRO’s and C-diff (Clostridium difficile). Examining eight years of data from a Utah-based health network, researchers looked at 22 hospitals clinics to establish trends in C-diff and other MDRO’s. Of the 900,000 patient admissions, 1.4% tested positive for an MDRO and/or C-diff. MRSA was by far the most common MDRO (51% of MDRO infections) but they did see a 32% decrease in MRSA infections over the eight years. “Researchers, however, observed a 222% increase in C difficile and a 322% increase in ESBL-positive bacteria. The data also showed that 70% of all MDROs and C difficile cases originated from an ambulatory setting.” There has also been a significant rise in ESBL’s, which points to a need to refine and revise screening protocols. Overall, this points to the complexity and ever-changing habits of infection prevention and control.

Zika Updates
A recent study is showing that Zika infections have caused reduced fertility and low testosterone in male mice. The ECDC has updated their Zika epidemic rapid risk assessment, noting that “although continuing, vector-borne transmission seems to be slowing down in Central American countries and the Caribbean. The outbreak continues to evolve in Mexico and the southern part of the US, as weather conditions still favour seasonal vector activity. In addition to the Americas, cases have been reported in some Asian countries.” Researchers are working to use the Wolbachia bacteria (which naturally infect several mosquito species) against diseases like Zika and dengue. Overcoming the hurdle of infecting Aedes (a species not naturally infected with Wolbachia), they found that the bacteria was able to survive in the mosquito and then was a passed down through generations…but the best news is that those mosquitoes infected with Wolbachia weren’t able to pass dengue. When the Wolbachia-infected mosquitoes were infected with dengue, the virus couldn’t replicate and spread in the mosquito’s salivary glands (i.e. couldn’t be transmitted). This new technique shows some pretty remarkable abilities to reduce the capabilities of Aedes species to spread diseases like Zika, chikungunya, and yellow fever. The CDC has reported, as  of November 2nd, 4,128 cases in the U.S.  Interestingly 53 people in Minnesota have been found to be infected.

Stories You May Have Missed: 

  • Pandemic Simulations – The Ebola outbreak in 2014/2015 taught us a great many lessons regarding international preparedness and response to infectious disease outbreaks. As a result of this, the World Bank Group and the Bill and Melinda Gates Foundation is starting a new project to conduct the first set of pandemic simulation exercises. “President Jim Yong Kim, Bill Gates and Chancellor Angela Merkel of Germany will jointly host simulation exercises on pandemic preparedness for the Heads of State and private sector leaders during the next World Economic Forum in Davos in January 2017 and the G-20 Heads of State meeting in July 2017.  In preparation for the two major events, the World Bank will collaborate with the technical team from WHO, WEF and the German government to conduct similar exercises for G20 technical staff and and G20 Ministers of Health. Simulation exercises help make a theoretical possibility real, by allowing policymakers to role-play and map out gaps and concrete solutions to those gaps along with their peers.”
  • New Genetic Mutations in Antibiotic BW Agent– Researchers at Lawerence Livermore National Laboratory (LLNL) recently found a new genetic mutation in antibiotic-resistant tularemia (Francisella tularensis). Tularemia is a Category A Select Agent, which means it is a prime concern for bioterrorism and public safety. “This perspective allows you to see mutations that are new that we didn’t know about. If you don’t do this type of study, you’re going to miss other mechanisms that cause resistance in the bacteria. So by doing a genome-wide study, it gives you a much more complete picture about what’s going on,” said LLNL biologist and lead author Crystal Jaing. “The study found resistance-conferring mutations in a hypothetical protein, an asparagine synthase, and a sugar transamine/perosamine synthetase in addition to observing known variants.”

Pandora Report 10.14.2016

The Biological Threats in the 21st Century book launch is hours away and we’ll be live tweeting the event, so make sure to follow us on Twitter @PandoraReport. The event will also be recorded and we’ll let you know when you can watch in case you aren’t able to attend. Check out how virus hunters are using epigenetics and big data to map epidemics and trace the origins of viral outbreaks.  You can also read the WHO’s Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines here. The global CRISPR-Cas9 Market Outlook 2022 is now available here.

Biotechnology: An Era of Hopes and Fears
GMU Biodefense PhD alum, Douglas R. Lewis, writes for Strategic Studies Quarterly on the increasing pace of biotechnology capabilities. Lewis notes that while this isn’t a good or bad thing, it’s crucial to acknowledge that as capability and knowledge grows, so does the potential for bioweapons development. “Every new treatment represents a potential new weapon”. Advances like the manipulation of viral genetics allow researchers to create chimeric viruses that often bring out fears like those following the publication of The Cobra Event. While there was substantial effort during the height of the bioweapons development renaissance, it is unknown if programs, like the Soviets, succeeded. It’s important to remember that “while viral chimeras are a routine tool in laboratory practice, they are becoming common in therapeutic roles, for instance in vaccine production. A live, nonattenuated vaccine constructed from Eastern equine encephalitis (EEE) virus and Sindbis virus has demonstrated the ability to protect primates from EEE.” Despite these advances, we often create at a faster rate than we learn or question. Understanding the genetic components of diseases allows researchers to mimic miRNA’s behavior and to make rapid advances in CRISPR-Cas9, but many are pointing to the slow rate of cautionary learning. Every advancement allows us to understand the world of genetics and medicine that much better, and the deeper we go, the more we’re able to develop extremely specific treatments. “Effective weaponization and large-scale employment of these new capabilities as a weapon would require a dedicated effort by a state sponsor. It is one thing for a medical provider to inject an experimental therapy into a patient but a much more difficult matter to deliver that substance simultaneously to thousands of people in a diverse environment.” Lewis emphasizes that the goal of his work is to inform the biodefense community of the evolving nature of biotechnology, emphasizing the need for continued support within the U.S. biodefense program. Keeping up with the biotechnology revolution is no easy task, however biodefense efforts must be as nimble as the science they seek to monitor.

Mighty Taco Outbreak logo-mighty-taco
Not the tacos! Sadly, at least 160 people have been sickened after eating at Mighty Taco locations in New York. The culprit? Refried beans. Public health officials are working with the state’s health and agriculture departments to identify the organism causing the illnesses. We’ll keep you updated as more information becomes available, but if you live in the New York area and frequent this taco establishment, rest assured they have thrown away the specific lot numbers of refrained beans.

GMU Biodefense MS Program Open HouseBiodefense_133x400
Don’t miss the next biodefense MS open house on October 19th! We invite you to attend an open house to learn more about the Schar School of Policy and Government. The session will provide an overview of our master’s degree programs, an introduction to our world-class faculty and research, and highlights of the many ways we position our students for success in the classroom and beyond. Our admissions and student services staff will be on hand to answer your questions. Check out the next MS info program on Wednesday, October 19: 6:30pm-8:30pm- Arlington Campus, Founders Hall, Room 126

 

Mayaro – Why Scientists Are Keeping An Eye on A Little-Known Virus 
Since the Ebola and Zika outbreaks, the concept of emerging infectious diseases is becoming much more well known and discussed. Mayaro disease may just be the next hot topic. Similar to chikungunya and spread by a tree-dwelling species of mosquito that is typically found in South America, this virus just popped up in a young boy in rural Haiti. While this may be an isolated case, it’s important to learn the lessons of past emerging infectious disease outbreaks and just how quickly things can spiral out of control. Moreover, since Mayaro is so similar to chikungunya and dengue, it may be under diagnosed. “The newly detected case of Mayaro in Haiti needs to be seen as a pattern of waves of viruses moving across continents, merging, changing and evolving,’ Morris says. ‘It reinforces the idea that there is a constant battle between humans and the microorganisms that infect humans.’ Diseases frequently emerge and re-emerge, says Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the National Institute of Health. And one case doesn’t necessarily indicate an imminent epidemic. But Mayaro is worth keeping an eye on.” Researchers are now keeping an eye on at several mosquito and tick-borne viruses  – Mayaro, Rift Valley Fever, Crimean-Congo Hemorrhagic Fever, and Usutu.

International Infection Prevention Week
screen-shot-2016-09-17-at-6-13-12-pmHelp stop the chain of infection by celebrating Infection Prevention week from October 16-22! Believe it or not, you don’t have to be a healthcare worker to stop the spread of germs. On antibiotics? Take them as recommended and finish your dose! Visiting the hospital or being admitted? Ensure you and your visitors wash their hands and avoid visiting ill patients if you’re sick. There’s a lot we can do to prevent the spread of infection and fight the battle of the bug, so make sure to check out how you can get involved!

Weekly Zika Updates
Houston-based Legacy Community Health Services is frustrated over lab delays in Zika testing. The Legacy CMO has stated that pregnant women have had to wait as long as a month to know if their pregnancies are at risk as the turnaround time from the state public health department is so long. Public health departments in Zika-hit places are struggling to meet the testing demands, which is causing more of a delay in surveillance and diagnosis. The Florida Department of Health has released their Zika updates. Despite aiding the fight against the virus, the FDA won’t be getting any of the designated Zika funds. A new study is shedding light on the evolution and spread of Zika – “Their analysis revealed two distinct genotypes of the virus, African and Asiatic, and two separate clades (biological groupings that include a common ancestor and all the descendants of that ancestor). Clade I represented African gene sequences and Clade II, sequences of Asiatic and Brazilian origin. The Brazilian sequences were found to be closely related to a sequence from French Polynesia. This lends support to the hypothesis that the virus might have been introduced to Brazil during the Va’a World Sprint Canoeing Championship in Rio de Janeiro in 2014, which included a team from French Polynesia, rather than the World Cup in which no teams from Pacific countries participated.” Many are speaking about the experience of having a child with Zika-related microcephaly and the complications associated with the infection.  The CDC has reported 3,9836 cases of Zika in the U.S. as of October 12th.

Stories You May Have Missed:

  • Human H5N1 Cases in Egypt– Egypt has reported 356 cases of avian influenza A (H5N1) since early 2006, including 121 deaths, however they’ve already seen 10 cases in 2016. Unfortunately, four of these patients have died. The cases are concerning many international public health officials as the MOH has been largely silent, which may point to limited surveillance and testing, but also minimal reporting of cases on an international level.
  • The Case of the Traveling Surgical Scrub– We’ve all seen medical professionals in scrubs ordering a coffee or smoking a cigarette outside the facility. Sadly, this common practice is pretty gross from an infection control standpoint. While scrubs aren’t considered PPE, it’s still good to avoid taking them outside of the operating room. Fomites love to travel on clothing, which has led many physicians to avoid wearing ties and re-think the white coat habit. New guileless from the American College of Surgeons are pushing for scrubs to be changed once a day for this very reason – let’s  keep the OR as sterile as possible!
  • Modeling the Economic Burden of Adult Vaccine-Preventable Diseases in the U.S. – It’s easy to forget the importance of vaccination and boosters in adults however, a recent study revealed just how costly vaccine-preventable diseases in adult are. The researchers “estimated the total remaining economic burden at approximately $9 billion (plausibility range: $4.7–$15.2 billion) in a single year, 2015, from vaccine-preventable diseases related to ten vaccines recommended for adults ages nineteen and older. Unvaccinated individuals are responsible for almost 80 percent, or $7.1 billion, of the financial burden.”

Pandora Report 9.2.2016

Welcome to September! Let’s start the month off with a yellow fever timeline and the history of this misunderstood disease. If a gin and tonic is your go-to drink, you’ll be pleased to hear it was actually born to combat malaria. Many are questioning if Syria has retained a stockpile of chemical weapons, pointing to continued contradictions and discrepancies regarding inventories and more. While the topic of sanctions is being debated, findings from recent international reports determined that both the Syrian government and ISIS were responsible for chemical attacks in 2014 and 2015.  On Tuesday, the French ambassador to the UN pushed for unified action at the Security Council, emphasizing that within the report, the Assad regime and the Daesh terrorist group have been responsible for several attacks.

Next Gen Global Health Security Agenda (GHSA) Happy Hour
Please join the newly elected Coordinator, Jamechia Hoyle, for a happy hour and networking event. Come engage with a network of talented Global Health Security professionals. Share ideas, connect, and learn how to join the world of global health security! You can RSVP to nextgenghsa@gmail.com by September 5th – the event is Friday, September 9th, from 5-7pm, at District Commons DC, 2200 Pennsylvania Avenue Northwest, Washington, DC 20037.

Is Accessible Synthetic Biology Making DIY Bioweapons More Likely?
The biotech industrial revolution and advances with CRISPR-Cas9 have raised many red flags about the risk for do-it-yourself (DIY) bioweapons. Dr. Koblentz and several others discussed the role of gene-editing technologies in the UN Security Council meeting last week, with General-Secretary Ban noting that these advances have made the production and application of WMD’s easier. These advances have the potential to move the playing field away from solely state-sponsored or university-level programs, to lower levels of necessary tacit knowledge. The dilemma surrounding dual-use technologies of concern and biosafety failures compound these concerns – are we becoming more and more vulnerable to intentional or accidental events? Antibiotic resistance is also a growing dilemma, and not just what we’re facing now, but also the risk that synthetic biotechnology could make the development of a highly resistant organism possible for malicious persons. The tricky part is combating the risk for mis-use while not stifling innovation – any takers? The growing threat potential of synthetic biology has many commenting that “Zika is just the first front in the 21st century biowar”. We so easily think nuclear or cyber warfare when it comes to large-scale threats, but the truth is that biological threats have been looming in front of us for years. James Stavridis notes that there three key components to preparing for the biological revolution. “First, we need an international approach that seeks to limit the proliferation of highly dangerous technologies (much as we try to accomplish with nuclear weapons) and fosters cooperation in the case of contagion or a transnational biological threat.” Second, U.S. government interagency practices need to strengthen their capacity to address both scientific advances and security threats from the biological research sector. Lastly, there must be private-public cooperation. He points to the need for a stronger marriage between government and academia, but in such a manner that doesn’t deter innovation. In the end, there is a imperative need for more frequent and frank discussions about the impending realities of biological threats.

GMU Biodefense Graduate Program Open Houses! Screen Shot 2016-04-21 at 1.28.57 PM
If you enjoyed reading about Dr. Koblentz and his work in biodefense, consider joining GMU’s Biodefense graduate program as a MS or PhD student! We’ve got some great Open Houses coming up- there is a PhD Information Session next Wednesday, September 7th at 7pm at our Arlington Campus in Founders Hall in room 134. If you’re interested in a MS in Biodefense (we offer both online and in-person!), come to our next Open House on Thursday, September 15th, at 6:30pm in our Arlington Campus Founder’s Hall, Room 126. Dr. Koblentz will be leading the information sessions, which will give you both some insight into the program, but also the range of student research and careers.

Disease Detection and the Outbreak Hunters
Venturing through the caves of South Africa, virus hunting researchers take us through the journey that is zoonotic disease tracking. The CDC has ten global disease detection centers and programs, like PREDICT, are all working to study the early signs of outbreaks and how we can prevent them from happening. “We were tracking almost 300 infectious disease outbreaks of concern in 145 countries,” says Dr. Jordan Tappero, director of the Global Health Protection Center at CDC. This was during a 2-year period. “Only about 30% of countries even self-report [and] are able to prevent, detect, and respond to infectious disease outbreaks,” Tappero says. “We are working around the world to try and improve capacity so that we have partners everywhere to respond quickly.” Bats are one of the primary animals studied, as they tend to be a reservoir for many diseases. Much of the research looks to test animals to identify what diseases are circulating within them, which acts as an early warning system for potential outbreaks. Outbreaks like MERS-CoV and Ebola have taught us the importance of early warning systems within the germ world. Cheers to those brave researchers who are crawling through caves and bat guano – we applaud and thank you!

The Growing Vaccine Refusal in Pediatrics Usmap
After the measles outbreak in California and Arizona related to Disneyland in 2015, there was a surge of national attention to pediatric vaccination exemptions. While California is taking strides to reduce non-medically indicated exemptions, many doctors are still reporting that parents are refusing to vaccinate their children. A recent study was published using data from the American Academy of Pediatrics Periodic Surveys from 2006 and 2013, looking at parental noncompliance and the frequency of requests for vaccine delays and refusals. Researchers also looked at the impact on US pediatrician behavior as a result of parental refusal or requests to delay. The study found that the proportion of pediatricians reporting parental vaccine refusal increased from 74.5% in 2006 to 87.0% in 2013. “Pediatricians perceive that parents are increasingly refusing vaccinations because parents believe they are unnecessary (63.4% in 2006 vs 73.1% in 2013; P = .002). A total of 75.0% of pediatricians reported that parents delay vaccines because of concern about discomfort, and 72.5% indicated that they delay because of concern for immune system burden. In 2006, 6.1% of pediatricians reported “always” dismissing patients for continued vaccine refusal, and by 2013 that percentage increased to 11.7% (P = .004).” Sadly, these findings indicate that pediatricians are reporting more vaccine-refusing parents and while they provide vaccine education, they’re dismissing patients at a higher rate.

Get the Scoop on Zika Virus
The FDA has announced that all U.S. blood banks will test blood, regardless of the presence of Zika in the state, for the virus. Here’s a guide to help pregnant women reduce their Zika risk. A new report found that Zika was linked to congenital hearing loss in infants with microcephaly. This week, CDC Director, Dr. Tom Frieden, commented that the agency is almost out of funds for Zika. “Basically, we are out of money and we need Congress to act,” Frieden told reporters. “The cupboard is bare.”  Florida may be the perfect place for Zika transmission, but where else should we consider within the U.S.? Singapore is quickly becoming a Zika hot spot, with it being the only Asian country to have active transmission. The growing volume of cases is signaling that Singapore could easily be a new epicenter for Zika, triggering surrounding countries to ramp up their preparedness efforts. Many are wondering if Zika is a sleeping giant in Haiti. The country has all the ingredients for rapid and sustained transmission but hasn’t seen many cases yet, leaving many to wonder if it’ll hit. The CDC has reported, as of August 31st, 2,722 cases of Zika virus in the U.S. Yesterday, the Florida Department of Agriculture and Consumer Services officially announced that, for the first time, mosquitoes trapped in the continental U.S. were positive for Zika virus.

Event: The Elimination of Weapons of Mass Destruction: Lessons Learned from the Recent Past 
Attend the Nonproliferation Review’s Monday, September 12th event to discuss nonproliferation! The event will be held at the James Martin Center for Nonproliferation Studies CNS Washington office at 1400 K Street, NW, Suite 1225, on Monday, 9/12,  from 1-3 pm. Speakers include Rebecca Hersman, director of the Project on Nuclear Issues at the Center for Strategic and International Studies; Robert Peters, senior research fellow at the Center for the Study of Weapons of Mass Destruction at National Defense University; and Dr. Philipp Bleek, assistant professor at the Middlebury Institute for International Studies at Monterey and a fellow at CNS. Dr. Chen Kane, director of CNS’s Middle East nonproliferation program, will chair the event, with NPR Editor Joshua H. Pollack providing welcoming remarks.

Stories You May Have Missed:

  • ABSA Risk Group Database App! Biosecurity – there’s an app for it! The American Biological Safety Association has created an app for the ABSA Risk Group Database. You can find it in Apple or Android app stores under “Risk Group Database app” and it’ll allow you to access the database on your mobile devise. “The ABSA Risk Group Database consists of international risk group classifications for Bacteria, Viruses, Fungi, and Parasites. In many countries, including the United States, infectious agents are categorized in risk groups based on their relative risk. Depending on the country and/or organization, this classification system might take the following factors into consideration: pathogenicity of the organism; mode of transmission and host range; availability of effective preventive measures (e.g., vaccines); availability of effective treatment (e.g., antibiotics); and other factors.”
  • Possible Transmission of mcr-1–Harboring Escherichia coli between Companion Animals and Human– The growing reports of colistin-resistant E. coli findings have been raising the stakes in the fight against antibiotic resistance. A recent report found mcr-1 (the gene harboring the colistin-resistant mechanism) E. coli isolates in three separate patients admitting to a urology ward in China. One of the patients was found to work in a pet shop, so researchers collected fecal samples from 39 dogs and 14 cats where he worked. Six were positive for the mcr-1 gene by PCR (4 from dogs and 2 from cats). “These findings suggest that mcr-1–producing E. coli can colonize companion animals and be transferred between companion animals and humans. The findings also suggest that, in addition to food animals and humans, companion animals can serve as a reservoir of colistin-resistant E. coli, adding another layer of complexity to the rapidly evolving epidemiology of plasmid-mediated colistin resistance in the community.”
  • Frozen Strawberry & Hepatitis A Outbreak – Virginia is currently experiencing a Hepatitis A outbreak related to frozen strawberries used in Tropical Smoothie Cafe locations. There have been 40 reported cases, of which 55% have been hospitalized. “There are more than 500 of the smoothie franchises across the country, and Virginia is not the only state affected. All the potentially contaminated Egyptian-sourced berries were pulled from the 96 Tropical Smoothie Cafe locations in Virginia no later than Aug. 8 or Aug. 9.”
  • Foreign Policy Classroom – U.S. Efforts to Combat Zika – Catch the series featuring Gwen Tobert, Foreign Affairs Officer, Office of International Health and Biodefense. You must be a student enrolled in a U.S. academic institution or faculty to attend the September 8th (2-3pm) event at the U.S. Department of State.

Pandora Report 8.26.2016

A new report by the Organization for the Prohibition of Chemical Weapons (OPCW) is pointing to a harsh reality that despite incomplete and inaccurate Syrian disclosures, there are traces of nerve agents in their laboratories. While they promised to destroy their entire arsenal, there is a growing concern that Damascus has not followed through on commitments to destroy all of its armaments.   Feel like a biodefense arts and crafts project?  You can learn to make a plague doctor’s mask here. Chem-Bio warfare suits may be getting a fashionable upgrade as companies like Lululemon and Under Armor are competing to revolutionize the protective equipment. 

UN Security Council – Calls for Eradicating WMD’s  689139
On Tuesday, GMU Biodefense Graduate Program Director and Professor, Dr. Gregory Koblentz, briefed the UN Security Council on how terrorists could exploit advances in science and technology to acquire weapons of mass destruction. He delivered the briefing as part of a Security Council open debate on WMD nonproliferation that is part of the comprehensive review currently being conducted of Resolution 1540. You can read the summary of the meeting here, but the focus was on the evolving threat of WMD’s falling into the hands of non-state terrorists and actors. Emphasizing the threat of biological weapons, Secretary-General Ban Ki-Moon “questioned the international community’s ability to prevent or respond to a biological attack.  He also suggested giving a closer look at the nexus between emerging technologies — such as information and communication technologies, artificial intelligence, 3-D printing and synthetic biology — and weapons of mass destruction.” Dr. Koblentz (27 minutes into the broadcast of the meeting here) pointed to the Fourth Industrial Revolution as a source for huge gains in both productivity and prosperity, but also a darker potential for mis-use by non-state actors. Within his talk, Dr. Koblentz noted the five advances in science and technology that “increase the risk of CBRN weapons proliferation to non-state actors”. The advances include unmanned aerial vehicles (UAVs), 3D printing, accessibility of illicit items on the Dark Web, malicious software and cyber attacks, and genetic engineering tools like CRISPR-Cas9. While these advances reveal the diverse technology, there are also seven deadly traits within these emerging technologies – dual-use, disruptive, diffusion, reliance on a digital component, decentralization, deskilling, and the DIY (do-it-yourself) movement. Simply put, these seven characteristics make emerging technologies that much more challenging to prevent mis-use. “The international community faces a continuous challenge of encouraging innovation and maximizing the benefits of such innovation with the need to mitigate the security risks posed by these new technologies. I hope the Security Council will take advantage of the Comprehensive Review of Resolution 1540, which this open debate is an important contribution to, to update the resolution to take into account the impact of scientific discoveries and technological breakthroughs on the proliferation of weapons of mass destruction to non-state actors.” There was substantial discussion regarding the strengthening of Resolution 1540, especially to consider the implications of a biological attack in light of recent outbreaks like Ebola, MERS, and SARS.  During her remarks, Ambassador Michele J. Sison, U.S. Deputy Representative to the United Nations, described Dr. Koblentz’s briefing as, “a very interesting, but also very sobering intervention.” Hopefully, with the focus on these evolving threats, the current review of Resolution 1540 can be further strengthened and focused to reduce the risk of terrorists acquiring WMD’s.

A Tribute to D.A. Henderson
There are few times in the history of public health that we can say we’ve eradicated a disease. D.A. Henderson, smallpox guru and disease detective, led such efforts within the WHO and his absence has been felt throughout the health community. A legend among public health and biodefense students, his dedication to the field inspired generations. As an epidemiologist, his work in both infectious diseases and bioterrorism gave me hope that such a career was not only possible, but also filled with the kind of adventure that many only dreamed about. Having just read Scourge (and I would highly encourage you to read it), the dedication to the smallpox eradication efforts is still an inspiration. After conquering what many considered impossible, Henderson worked as Dean of the Johns Hopkins School of Public Health, founding director of the Johns Hopkins Center for Civilian Biodefense Strategies (now UPMC Center for Health Security), and following 9/11, led the Office of Public Health Preparedness. Described as a “Sherman tank of a human being- he simply rolled over bureaucrats who got in his way”, Henderson’s death is truly felt throughout the international community. In the wake of his death, we take a moment to truly applaud and appreciate all he’s given and inspired within global health security.

How Far Will the U.S. Luck Run?
With the anticipation and preparations for Zika having started months before it reached U.S. soil, many are wondering if our luck with infectious disease is running out. We were lucky with Ebola- a handful of cases and once we hit the panic button, we were able to overcome the crisis. Despite insufficient funds and battling diseases we had little to no experience in handling, U.S. efforts have been fortunate in their successes. Zika may be a different kind of ball game though – mosquito control efforts are flawed at best and with a disease that is often asymptomatic, we may have finally hit a wall. Did we really learn from Ebola? Have we strengthened our surveillance and response practices? Dr. Johnathan Fielding notes that “HHS must play a greater role in coordinating the global public health response through implementation of the Global Health Security Agenda, a cooperative arrangement launched in 2014 by over 50 nations, nongovernmental organizations and other stakeholders; better coordination with other government agencies, and state, local and private sector partners; and clear delineation of roles and responsibilities within and among HHS offices.” We need both the monetary and personnel support to properly address the failures from Ebola, but also implement the recommendations that so many have made following the crisis. The contingency funding that has been pushed recently is an indication of our potentially faltering luck – have we reached such an impasse in which our politics will override our disease response capacity or capabilities?

A Lot of Zika Goes a Long Ways 
Palm Beach is seeing its second case of Zika virus, with active transmission continuing in Florida. Florida Governor, Rick Scott, has expressed frustration that the promised federal support of antibody tests and lab support has not been delivered. “In a teleconference on Wednesday, Scott made a plea for more support in fighting Zika, complaining that ‘Congress and the White House have not been good partners.’ Scott said he asked the U.S. Centers for Disease Control and Prevention for 5,000 Zika antibody tests last week, but so far had only received less than 1,200.” Johns Hopkins is opening the first multidisciplinary Zika center, the Johns Hopkins Wilmer Zika Center, which is dedicated to caring for affected patients. As of August 24, the CDC has reported 2,517 cases of Zika virus in the U.S. The CDC has also awarded $6.8 million to partners to help support Zika response. “This funding will help enhance surge capacity for Zika case identification and mosquito surveillance. It will also help improve communications to key populations, by developing focused educational materials, sharing mosquito control guidance, and refining community public awareness campaigns.”

Human Mobility and Epidemics
Tracking infectious disease cases is never an easy task – whether it be an asymptomatic patient, mosquito-spread disease, or global travel, epidemiology and case tracking is not for the faint of heart. An increasingly mobile population is only adding to this difficulty. The first few days of an infection with Dengue or Zika are often so mild that many don’t even seek medical care. How many times have you had a fever and it didn’t stop you from traveling or going about your day? Disease ecologists are now looking at the impact of a fever on human mobility and the shock this may have during an outbreak of a vector-borne disease. “We’ve found that people with a fever visit 30 percent fewer locations on average than those who do not have a fever, and that they spend more time closer to home. It may sound like stating the obvious, but such data have practical applications to understand how human behavior shapes epidemics,” says Gonzalo Vazquez-Prokopec, an assistant professor in Emory University’s Department of Environmental Sciences, and senior author of the study. “No one had previously quantified how a symptom such as fever changes mobility patterns, individually and across a population, in a tropical urban setting like Iquitos.” Not surprisingly, human mobility is a huge driver for spreading these diseases in urban settings. With the ongoing spread of Zika, researchers are continuing to learn about the impact of human behavior and mobility on the spread of these mosquito-spread diseases.

Stories You May Have Missed: 

  • Global Reaches of Antibiotic Resistance – Check out my latest comments on the global implications of antibiotic resistance for first responders and security personnel. It’s a topic we’ve so frequently cited as an international health emergency, and yet it gets so little attention. In this article, I point to the obvious implications, but also the worries that dual-use technologies of concern and genetic modification could allow for increased resistance for a more sinister reason.
  • South Sudan Crisis Calls for Additional WHO Surveillance  – the continued chaos and violence in South Sudan has translated into the WHO ramping up disease surveillance efforts. More than 1.6 million internally displaced persons (IDP) have been caught in the conflict, leaving the region more susceptible to malaria and diarrheal illnesses. “The conflict has exacerbated existing challenges with the health system and disease surveillance,” Dr Usman says. “With so many health workers and partners moving to safety, data is more difficult to collect and challenges have emerged as humanitarian access remains limited.” The WHO is coordinating with the Ministry of Health to strengthen surveillance efforts to help detect and respond to outbreaks.
  • FBI WMD Directorate Marks 10 Years – A program we’d rather have and not need than need and not have, the WMD Directorate within the FBI has been imagining worst-case scenarios for over a decade to better prepare and protect the U.S. “The Directorate has three sections: countermeasures, investigations and operations, and intelligence. In its first five years, the Directorate established itself as a central hub for WMD subject-matter expertise.” Assistant Director, John Perren, notes that while they’re intelligence driven, the things that keep him up at night aren’t what he knows, but what he doesn’t know.

Pandora Report 6.10.2016

Summer temperatures are soaring (Arizona hit 115F last week, so I guess it’s time to start baking cookies on the dashboard again- just make sure not to use General Mills flour!) and we’ve got your weekly biodefense cool down. Check out this global outbreak monitor, where you can keep an eye on all your favorite cases. The DoD is currently conducting market research to identify vaccine developers for medical countermeasure manufacturing. They’re looking for “advanced manufacturing platforms which are adaptable to incorporating known antigens for use as a prophylaxis countermeasure against weaponizable biological agents.” Before we venture down the biodefense rabbit hole, the Pandora Report will be on hiatus next week (June 17th), but don’t fear- we’ll return the week of June 24th!

Infectious Disease Threat Management
Are emerging infectious disease outbreaks an anomaly or are these events the new norm? Dr. Daniel M. Gerstein points to a 2014 study on the global rise of these outbreaks, which point to the growing threat of zoonotic disease spillover. Gerstein discusses the common trend of failure to predict such events but also the poor response in medical countermeasures and diagnostics. Between West Nile Virus, Ebola, H1N1, and now Zika, we’ve had ample time to get both preparedness and response right. “A recent commentary by Ronald A. Klain — a former White House Ebola response coordinator — should be required reading on the United States’ lack of preparedness for responding to the Zika virus. In it, Klain provided both a dire assessment of Congress’ uncertain funding support for the current response, and made longer-term recommendations for improving our rapid response to infectious disease outbreaks. Yet while these recommendations are spot on, including calls for a dedicated organization with specialized capability to respond to disease outbreaks, more must be done to ensure adequate preparedness against emerging infectious disease in the future.” U.S. preparedness measures utilize epidemiology and biosurveillance, however these are both passive methods that rely on reactive measures, rather than proactive. “This reactive approach to emerging infectious disease should be augmented with an anticipatory model that accounts for the dramatic changes occurring through globalization, greater interactions between human and zoonotic populations, and changes to the environment and climate patterns.” He points to the need for predictive analytical tools and modeling to better focus research and development efforts in order to control and prevent such events. Gerstein acknowledges the long-term and challenging realities of such efforts though, pointing to the need for private sector contributions and strategies to focus on anticipating infectious disease threats.

CDC Biosafety Failures – “Like a Disaster Movie” 
The stories of biosafety failures in U.S. labs working with select agents is enough to send chills through even the toughest of pathologists. Reporters recently gained access to records from the CDC regarding the 2009 events in which safety mechanisms in a CDC biosafety level 4 lab failed. “The gasket seal around the exit door to the changing room deflated to the point that the scientists could see light coming in. And as they held that door shut and started an emergency chemical deluge, things got even worse.” Records include emails that hoped to avoid federal lab regulatory reporting. While these reports are shocking to biosafety experts like Richard Ebright from Rutgers University, CDC officials claim there was no risk from the equipment failures. The release of these records draws further attention to the failures but also the CDC response and challenges in even getting the records released under the Freedom of Information Act. You can read more of the records released to USAToday here and here.

Back to the Future in Global Health Security? 
People frequently think back to the days of the Black Death as a reminder of the progress we’ve made in disease defense. Are we really in a better position though? Globalization, growing populations, rising global temperatures, urbanization, and easy international travel all make it possible for diseases to jump around in a matter of hours. WHO Director-General Margaret Chan noted that “For infectious diseases, you cannot trust the past when planning for the future. What we are seeing is a dramatic resurgence of the threat from emerging and reemerging infectious diseases. The world is not prepared to cope.” The lessons from Ebola, H1N1, and even Zika haven’t truly sunken in yet and there are more outbreaks on the horizon. “International mechanisms must be established to coordinate the upstream research and development (R&D) of new medical tools to respond to priority pathogens and the downstream testing, manufacturing, and delivery of those tools as part of the larger humanitarian response to an ongoing outbreak.” Researchers have suggested four lessons from our past to encourage technological innovation to better prevent and respond to health crises – ensure adequate and sustainable long-term investment, coordinate R&D around a roadmap of priority goals, engage and energize a network of geographically distributed multi-sector partners, and remember that sustainability depends on adequate systems and equitable access. Establishing an environment of coordination and sustainability will be vital to move from a reactive to a proactive practice of global health security.

DoD Biosafety Report
GMU Biodefense MS student, Stevie Kiesel discusses the report the DoD Inspector General published regarding the biosafety and biosecurity failures within DoD labs that work with biological select agents and toxins (BSAT). Stevie’s deep dive into this report addresses the systematic failures that led to such events. Inconsistent internal or external technical or scientific peer reviews and even inspection standards led to not only missing inspections, but also duplicative ones. “Some inspectors failed to review specific vulnerability assessments for their assigned labs to ensure that shortcomings identified during previous inspections had been mitigated.  In some cases, these vulnerability assessments were not reviewed because they had never been conducted, or had not been conducted annually as required.”

Immune System Education and the Realities of the Antibiotic Resistance
Autoimmune diseases and antibiotic resistance have risen in the past half-century…but what does this really mean? The human microbiome (your body’s own community of microbes that help run your immune system) is now being considered as a potential puzzle piece for the increase in autoimmune issues. Have these microbiome communities changed so largely that our entire society is being impacted? “To test this possibility, some years ago, a team of scientists began following 33 newborns who were genetically at risk of developing Type 1 diabetes, a condition in which the immune system destroys the insulin-producing cells of the pancreas. After three years, four of the children developed the condition. The scientists had periodically sampled the children’s microbes, and when they looked back at this record, they discovered that the microbiome of children who developed the disease changed in predictable ways nearly a year before the disease appeared. Diversity declined and inflammatory microbes bloomed. It was as if a gradually maturing ecosystem had been struck by a blight and overgrown by weeds.” Coupled with several other studies, there is a growing thought that toughening the immune system early in life can alter our response later in life or that the kind of microbiome you have will determine your response to viral infections. So what happens if our immune systems begin to fail us and antibiotics are a thing of the past? That’s a pretty devastating notion and it’s right before the weekend, so let’s scale it back to just consider a world without antibiotics – would you still shake hands or take an international flight? Physiologist Kevin Fong notes “If we are to avoid a return to the pre-antibiotic landscape with all its excess mortality we must be bold. To squander the advantage we have so recently gained against microorganisms in the fight for life would be unthinkable.”

The Race Against Zika Screen Shot 2016-06-09 at 1.40.13 PM
The debate regarding the 2016 Rio Olympics took a turn this week as the WHO stated it will look again at the Zika risk during the games.  150 international experts penned an open letter to the WHO regarding their “irresponsible” actions and that the organization was rejecting calls to move or postpone the games due to it’s official partnership with the International Olympic Committee. What are the actual risks? Will the Rio Olympics put the rest of the world at risk for Zika? Here is an interesting infographic and article on that exact question. Bringing thousands of people from different countries together is definitely a gold medal strategy for spreading infectious disease. The ECDC has posted their epidemiological data here, as well as their risk assessment. A new study looks at sexual transmission and the persistence of Zika virus in semen, finding that RNA can persist in semen for 62 days. Researchers found a case of a woman with Zika virus presenting 44 days after the onset of symptoms in her partner, which “corresponds to a sexual transmission occurring between 34 and 41 days after the index case.” This announcement comes after there were no previously reported secondary cases more than 19 days after the onset of signs in a man. Concerns regarding congenital eye issues in babies without microcephaly were also raised after a case was identified. As of June 8th, the CDC has reported 691 travel-associated cases within the U.S.

Stories You May Have Missed:

  • CRISPR’s Gene-Editing Skills on RNA – researchers have now established a method for targeting and cutting RNA. “The new cutting tool should help researchers better understand RNA’s role in cells and diseases, and some believe it could one day be useful in treatments for illnesses from Huntington’s to heart disease.” The process involves using CRISPR to create “blades”. Given the concerns around CRISPR and dual-use technologies of concern, researchers are pointing out that there are far less ethical concerns regarding manipulation of RNA.
  • Legionnaires’ On the Rise – sadly this isn’t the name of a new historical action flick, but rather a public health concern that has the CDC looking into water system integrity. Cases of Legionnaires’ disease have quadrupled since 2000. The CDC has stated that the reason for such a stark increase is most likely due to aging building water systems, an aging population, and better surveillance/reporting systems.
  • Ebola Stability Under Hospital and Environmental Conditions – a new study looks at the role of fomites in EVD transmission, especially in healthcare settings. “To assess the potential contribution of fomites to human infections with EBOV, we tested EBOV stability in human blood spotted onto Sierra Leonean banknotes and in syringe needles under hospital and environmental conditions.” Researchers found that the virus survived more than 30 days in blood in syringes, despite hot/humid conditions, and six days on paper money under experimental conditions.

 

Pandora Report 5.27.2016

Before you start your holiday weekend, what’re your thoughts on Usain Bolt outrunning a mosquito? The Jamaican sprinter jokingly responded to questions regarding athlete concerns over Zika virus, noting that he’s not worried “because I’m fast – they can’t catch me”. (Hint – it looks like he can outrun a mosquito with his 22 mph capabilities versus the 1.12-3.35 mph of an Aedes mosquito). Sticking with the Olympian theme..bacterial teams? Researchers recently found that two strains of E.coli, resistant to different antibiotics, can protect each other in an environment containing both antibiotics. The phenomenon is called mutualism and researchers at MIT are now looking looking into the range of this practice and the potential for population synchronization. At the 69th World Health Assembly this week, the WHO revealed plans to revamp itself however, many point out that for an agency better at giving advice than taking action, it’s too little too late. In the case of the WHO, critics are calling for acta non verba. 

The World Bank Rolls Out the Pandemic Insurance Plan
Following the Ebola outbreak in West Africa, the World Bank has announced a new program that will enable funds to rapidly be mobilized during outbreaks. In hopes of ensuring a more speedy response to infectious disease disasters, World Bank President Jim Yong Kim stated that “pandemics pose a serious threat to global health and economic security.” The new Pandemic Emergency Financing Facility (PEF) is “a combination of catastrophe insurance and bonds, is a direct reaction to the sluggish donor response to the outbreak of Ebola”. Presented at the G7 meeting for finance advisors, Japan has already committed support with a $50 million contribution. The insurance will cover several classes of infectious disease outbreaks most likely to cause epidemics – ranging from new influenza or coronavirus strains, filoviruses like Marburg and Ebola, and other zoonotic diseases. The initial plan is to have a total of $500 million  and hopefully avoid outbreaks, like Ebola, rapidly growing due to poor financial support and response.

Antibiotic Apocalypse
As much as I’d love to say this title is a dramatic take on the issue of antibiotic resistance, the truth is pretty startling. A report done by the Review on Antimicrobial Resistance  (commissioned by the UK government and reviewed by officials including economist Jim O’Neill), estimated that by 2050, 10 million lives per year and $100 trillion are at risk due to drug-resistant infections. That’s quite a stark estimate, but as many have pointed out “the problem of drug-resistant microbes isn’t just about biology and chemistry; it’s an economic problem at heart, a catastrophic and long-bubbling mismatch between supply and demand. It’s the result of the many incentives for misusing our drugs, and the dearth of incentives for developing new ones.” Can we really tackle this issue though? It still amazes me hearing people in an emergency department or urgent care asking for an antibiotic and the physician having to explain that they have a viral infection or that antibiotics simply aren’t warranted. In many ways, when we are sick enough to go to the doctor, we want to walk away with some “cure” and the notion of bedrest and hydration isn’t all that comforting. So what can we do? The report notes some steps to help prevent this impending reality – massive global public awareness campaigns, improve hygiene, improve global surveillance of drug resistance and antimicrobial consumption in humans and animals, promote development and use of vaccines, promote new, rapid diagnostics to cut out the unnecessary use of antibiotics, better incentives to promote investment for new drugs and improve existing ones, improve the numbers, pay, and recognition of people working in infectious diseases (hear, hear!), etc. Other recommendations include improving sanitation and a global innovation fund for early-stage research. Scientists were recently startled to find for the first time in the U.S., a patient with a bacteria that is resistant to antibiotics that are used as a last resort. While the predictions are daunting, the threat of antibiotic resistance is one we can get ahead of if we make the commitment and start immediately.

The Growing Threat of Spillover Screen Shot 2016-05-23 at 9.38.18 AM
The United Nations Environmental Programme (UNEP) released their 2016 Frontiers Report “Emerging Issues of Environmental Concern”. One of the six major issues was zoonosis. “There is a worldwide increase in disease emergence and epidemics particularly from zoonoses – diseases that can be passed on between animals and humans. The report illustrates how the emergence and re-emergence of zoonotic diseases are closely interlinked with the health of ecosystems. The risk of disease emergence and amplification increases with the intensification of human activities surrounding and encroaching into natural habitats, enabling pathogens in wildlife reservoirs to spill over to livestock and humans.” The report notes that around 60% of all infectious diseases in humans are zoonotic and 75% of emerging infectious diseases are zoonotic. You can also find several great infographics that paint a very surprising picture regarding the emerging zoonotic disease events from 1940-2012 and the top three reported zoonoses for specific continents. The growing Zika epidemic is just another in a long list of spillover cases including those of MERS, SARS, Ebola, and Rift Valley fever.

A Need To Rebalance
GMU Biodefense professor and Program Director, Dr. Gregory Koblentz, is pointing to the need for the U.S. to refocus its nonproliferation efforts on South Asia. Given the region’s high risk for nuclear crisis as a result of territorial disputes, cross-border terrorism, and increasing nuclear arsenals, there is a crucial need to re-allign nonproliferation efforts to include South Asia. “As of 2015, India was estimated to have 120 nuclear warheads while Pakistan was believed to possess 130 weapons. Both countries have also continued to develop, test, and deploy new missiles designed to deliver nuclear warheads. Pakistan has tested seven different types of nuclear-capable ballistic and cruise missiles, including the 2,750-kilometer range Shaheen-3 ballistic missile. Meanwhile, India has tested nine different types of nuclear-capable missiles, including the Agni-V intercontinental ballistic missile with a range of over 5,000 kilometers.” Dr Koblentz points to the impacting introduction of tactical nuclear weapons in South Asia and their ability to be deployed on short-notice – also concerning is India’s planned development of strategic missile submarines, which will likely trigger development from Pakistan. He notes that the international community can help restrain this dangerous competition by encouraging both countries to adopt confidence-building measures (limits on development of tactical nuclear weapons, etc.) and engage in high-level talks with “other nuclear weapon states to discuss measures that could further reduce the risk of nuclear weapons being used deliberately, by accident, or in an unauthorized manner.”

Rebuilding Trust in Biology 
Between the gain-of-function talks and biosecurity failures at major U.S. labs, there’s been a subtle shifting in the trust and support for biological sciences. New regulations could change oversight for sciences within the U.S. and many are wondering how we can restore trust back into this field. While we can all agree that forgotten smallpox vials and an accidental bird flu release translates to a need to revamp practices and facilitate more effective and efficient oversight, there’s been little mention of how we can combat the trust issues. This week the National Science Advisory Board for Biosecurity (NSABB) met to conclude their 18-month deliberation on select pathogen research practices and regulations. Let’s hope that with more effective and efficient practice recommendations, they are also looking into repairing the reputation of science and biology. Dr. Filippa Lentzos and Dr. Nicholas Evans recommend four ways to rebuilt this trust- transparency in process and outcome of experiments and review, life scientists need to play their part in monitoring and preventing deliberate misuse of biology, accountability needs to be built into scientific norms, and decisions on pursuing dangerous experiments need more transparency in regards to their process. “There should also be clear, internationally-recognized red lines about the sorts of experiments—such as attempting to make Ebola virus transmit like the flu, or modifying an extinct virus like smallpox—that simply should not be done.”

Energy & Commerce Subcommittee Looks at U.S. Biological Threat Preparedness
The Energy and Commerce Subcommittee on Health held a hearing regarding H.R. 3299, Strengthening Public Health Response Act, last week to discuss and review legislation that would enable the U.S. to prepare and defend against biological attacks. The act was presented in response to the October 2015 Blue Ribbon Study on Biodefense that highlighted the general lack of preparedness against emerging biological threats. “Thirty-three recommendations to improve the U.S. response to biological threats were made by the Blue Ribbon Study on Biodefense, which was led by former U.S. Sen. Joe Lieberman (I-CT) and former Pennsylvania Gov. Tom Ridge, the first Secretary of Homeland Security. The panel’s report was based on meetings, interviews and research.” Acting Biomedical Advanced Research and Development Authority (BARDA) Director Dr. Richard Hackett noted that “the array of threats for which we must be prepared is vast. Such threats include bioterrorist agents such as anthrax, smallpox and botulism; evolving and emerging threats causing substantial regional disruption such as Ebola and Zika; and highly communicable diseases with pandemic potential such as influenza.” This act would also expand the Priority Review Voucher program within DHS and work to facilitate BARDA’s partnership with the private sector.

Weekly Zika Updates
On Monday, WHO Director-General Dr. Margaret Chan pointed to the failure to maintain mosquito-control efforts and the spread of Zika. “Let me give you a stern warning. What we are seeing now looks more and more like a dramatic resurgence of the threat from emerging and re-emerging infectious diseases. The world is not prepared to cope. Above all, the spread of Zika, the resurgence of dengue, and the emerging threat from chikungunya are the price being paid for a massive policy failure that dropped the ball on mosquito control in the 1970s,”. The European Centre for Disease Control and Prevention (ECDC) released a risk assessment for European travelers to the Olympic Games, finding that they’re most at risk for gastrointestinal illness and vector-borne diseases. Researchers are also considering the association between Zika virus and eye problems in babies that have microcephaly. During your holiday weekend, take a minute to learn about the Scottish professor who discovered Zika virus. Experts are also pointing to the role of misinformation (via social media conspiracy theories) in prevention efforts.  “The researchers behind the study—from Johns Hopkins University, George Washington University, and the University of Georgia—say the misinformation they detected by analyzing thousands of Twitter posts could cause many vulnerable people to refuse future Zika vaccinations.” The CDC has estimated that a fetus infected with Zika virus during the first trimester has a 1-13% risk of developing microcephaly. As of May 25th, the CDC has reported 591 travel-associated and 11 sexually transmitted cases in the U.S.

Stories You May Have Missed:

  • Why Victorian Diseases Are Making a Comeback – Scarlet fever and TB have been on the rise in the UK and many are pointing to the growing threat of antibiotic resistance and poor vaccination compliance. Many of these diseases have been under control for centuries so any uptake can cause a sensational public response, however it’s important to remember the recent plethora of measles outbreaks and just how vital vaccination is. Antibiotic resistance alone could bring back these diseases and take us back to a time where infectious diseases were the major cause of death.
  • The Threat of Agroterrorism and Zoonotic Disease in the U.S. –  Gary Flory, Agricultural Program Manager of the Virginia Department of Environmental Quality, discusses the threat of these diseases for the Non Conventional Threat CBRNe Meeting. “The threat of agroterrorism and naturally occurring disease outbreaks in the United States continues to expand as new diseases emerge and existing diseases become endemic in many parts of the world. The food and agricultural sector is one of the easiest sectors of any nation’s economy to disrupt and its disruption could have catastrophic consequences both nationally and regionally. Both developing and developed countries will be impacted by a disease outbreak or agroterrorism attack.”
  • The Awful Diseases on the Way– check out this overview of Sonia Shah’s book, Pandemic: Tracking Contagions from Cholera to Ebola and Beyond, that also discusses the impact of infectious disease outbreaks from smallpox to Ebola. The review is done by a pediatric physician who has worked with UNICEF and the Global Fund to Fight AIDS across three continents. Aside from the wonderful points on infectious disease outbreaks and the importance of public health, Annie Sparrow gives a delightful segment on the corrupt schemes of outbreak coverups.