Pandora Report: 7.26.2019

 Summer Workshop on Bioterrorism, Pandemics, and Global Health Security – A Recap
“The spectrum of biological threats is often much wider than many realize. From the current Ebola virus disease outbreak in the Democratic Republic of the Congo to CRISPR-designed babies, there are a lot of biological issues that trickle over into health care and public health. This week, I attended the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security: From Anthrax to Zika, where conversations ranged from protecting the bioeconomy to vaccine development. Here are the key takeaways: First, it’s a startling truth, but biological threats aren’t just black and white, but a vast spectrum of gray. We no longer live in a world where it’s just pandemics and bioterrorism, but also conversations surrounding dual-use research of concern (DURC), gene drive worries with CRISPR-modified mosquitoes, pandemic response, vaccine development, and so much more. FBI Supervisory Special Agent Edward You discussed concerns of garage biohacking and how the US government has policies on oversight for life sciences DURC. Furthermore, You discussed synthetic biology and how the price for DNA synthesis kits (ie, biohacking kits) have dramatically dropped over the years.”

Bashar al-Assad is Waging Biological War – By Neglect
Going against the traditional definition of biological warfare, Annie Sparrow discusses how the deliberate efforts by the Assad regime to destroy public health and healthcare are actually a form of biological warfare. “Beyond being unpredictable and difficult to control, anthrax or sarin attacks are too visible and risk a global reaction. And in war, they kill in far smaller numbers and much less reliably than common diseases and wound infections. In contrast, the behavior of Assad’s preferred pathogens is predictable. Here lies the key to a far more insidious strategy: By deliberately degrading an already precarious public health situation, the new biological warfare is able to fly under the radar. Assad’s most visible mass atrocities include indiscriminate attacks on and the resulting forced displacement of civilians, devastating sieges, and assaults on hospitals. But an unappreciated dimension of his total-war strategy has been his attacks on public health infrastructure and programs in order to fast-track the epidemic diseases that thrive in the crowded living conditions created by mass displacement, while simultaneously withholding essential public health tools and medicines. The aim is to weaken the entire population in these areas and overburden the rudimentary medical facilities that were able to survive in an effort to punish populations opposed to Assad. While there is a brutal battlefield logic to these attacks on health care infrastructure, they are prohibited by the Geneva Conventions, which are designed to spare civilians—and the institutions on which they depend—from the hazards of war. Assad is deliberately engaging in war crimes.”

In Memory of Prof. Andrew Price-Smith
The biodefense world got a bit dimmer with the passing of one its greats – Dr. Andrew Price-Smith. The author of one of my personal favorites – Contagions and Chaos, “Professor Andrew Price-Smith, David Packard Professor of International Relations and Director of the Global Health Initiative, passed away last week after a lengthy illness. He is survived by his wife, Janell Price-Smith, and their two children. Our thoughts and prayers are with Drew’s family, colleagues, and friends. Professor Price-Smith joined the CC faculty in 2005 and served as chair of the political science department from 2013-2016 and as the founding director of our Global Health Initiative. Drew’s research focused on the effects of disease, environmental change, and energy scarcity on the security of nations and taught courses on the environment, health and security, and international relations.”

 UK Parliament Inquiry into Government’s Biosecurity Efforts
It’s been a year since the UK Government published their first ever Biosecurity Strategy, and the Joint Committee on the National Security Strategy is set to inquire how they’re approaching biosecurity and human health. “The strategy is intended to coordinate a cross-government approach to biosecurity threats, whether they materialise naturally, accidentally or deliberately in the form of a malicious attack. It cites globalisation and technology as key factors in today’s biosecurity risks. The Government has long prioritised public health as a national security issue, with pandemics and emerging infectious diseases categorised as a top-tier risk in the 2010 and 2015 National Security Risk Assessments. Attacks using biological weapons are categorised as a second-tier risk, along with attacks using chemical, radiological and nuclear weapons. In 2018, the Government’s National Security Capability Review elevated ‘diseases and natural hazards affecting the UK’ to one of six principal challenges likely to drive national security priorities over the coming decade.” You can read the UK Biological Security Strategy here,  which “recognises the importance of intervening early to prevent biological threats from emerging, or from spreading once they emerge. To this end, it sets out how we will make best use of our international activity to help reduce the risks to the UK and our interests, at home and overseas. This includes our engagement with international partners (at local, regional and national levels) and forums. Our investment in overseas biological security education and our international work on global health security, led by DHSC and DFID, is building resilience to health threats in developing countries.”

Ebola Outbreak Updates
The outbreak of Ebola virus disease in the DRC has been changing daily, but here’s an update to help catch you up. On Wednesday, it was reported that more violence has occurred in the outbreak region, “the Allied Democratic Forces (ADF), a rebel group, attacked two villages near Beni, killing 12 people who live in the heart of the Democratic Republic of the Congo’s (DRC’s) ongoing Ebola outbreak. The terrorists killed nine in Eringeti and three in Oicha, according to Reuters. ADF has not publically pledged allegiance to the Islamic state (ISIL), but that hasn’t stopped ISIL from claiming responsibility for the attacks.” This comes has the World Bank Group announced it would be mobilizing $300 million to help respond to the outbreak. “The US$300 million in grants and credits will be largely financed through the World Bank’s International Development Association (IDA) and its Crisis Response Window, which is designed to help countries respond to severe crises and return to their long-term development paths. The financing package will cover the Ebola-affected health zones in DRC and enable the government, WHO, UNICEF, WFP, IOM and other responders to step up the frontline health response, deliver cash-for-work programs to support the local economy, strengthen resilience in the affected communities, and contain the spread of this deadly virus. This amount is approximately half of the anticipated financing needs of the Fourth Strategic Response Plan (SRP4), which is expected to be finalized in the coming week by the Government and the international consortium of partners working on the response. The World Bank has been supporting programs to combat DRC’s ongoing battle with Ebola since May 2018, with resources going to the frontline response, health system strengthening, and preparedness to reduce the risk of spread.” This outbreak in particular has forced response efforts to change the way we approach not only outbreak control, but also vaccine deployment. “Every aspect of the outbreak is affected by the area’s long history of conflict and trauma. Residents have endured more than two decades of terror from armed groups, along with resource exploitation, political instability and neglect from the world at large. That has bred distrust of authorities — including foreign health workers — and conspiracy theories about why Ebola is thriving. One popular rumour alleges that Ebola responders inject people with deadly substances at treatment centres and vaccination sites. These false ideas have fostered nearly 200 attacks on Ebola responders and treatment centres so far this year, according to the WHO. Seven people have been killed and 58 injured.” You can check the latest case-counts here, which shows now 2,620 cases.

Defense Officials See Increased Threat from Chinese, Russian Chem-Bio Weapons
At a recent CBRN Conference, a hot topic of concern was the threat of Chinese and Russian CBW. In fact – Dr. Kilianski (GMU biodefense professor) spoke on this – “Much attention has been focused on Russia and China’s modernization of their nuclear and conventional forces. But there is growing concern at the Pentagon about those nations’ chemical and biological weapons, U.S. officials said July 23. There is now an increased focus on threats posed by near-peer adversaries, noted Andrew Kilianski, chief intelligence officer at the joint program executive office for chemical, biological, radiological and nuclear defense. ‘They’re in that emerging space … in terms of things we haven’t seen before or things that we don’t have a lot of information on,’ he said during remarks at the National Defense Industrial Association’s annual CBRN Conference and Exhibition in Wilmington, Delaware. The question now is, ‘how do we build capability against a threat space which … we don’t know much about?’ he added”.

DARPA Awards ASU Contract to Build Epigenetic-based WMD Exposure Measurement Tool
For $38.8 million, Arizona State University will get the chance to help build a measurement tool against WMDs. “Arizona State University announced today that it has been awarded $38.8 million by the US Defense Advanced Research Projects Agency (DARPA) to build a field-deployable, point-of-care device that can determine if a person has been exposed to weapons of mass destruction or their precursors, in 30 minutes or less. The grant, which will be funded over four years in phases and options, was awarded under DARPA’s Epigenetic Characterization and Observation (ECHO) program, which aims to identify epigenetic signatures created by exposure to threat agents and to develop technology that performs highly specific forensic and diagnostic analyses to reveal the exact type and time of exposure. ASU said the device it plans to develop will be capable of detecting the health effects of a number of substances associated with weapons of mass destruction — including biological agents, radiation, chemicals, and explosives — from a single drop of blood. The technology could also eventually be used for simple, low-cost monitoring of epigenetic changes to detect a broad range of human diseases.”

 Troublesome Ticks: Dispelling Bioweapon Rumors
“A government-owned island used for biodefense testing, a devastating vector-borne disease, and an amendment quietly slipped into major legislation—Although these might sound like scenes from the latest sci-fi movie, they are actually part of a current hot topic that stemmed from some rather poor information. Let’s start from the beginning as we tackle the misinformation circulating in today’s anti-vaccine movement. Plum Island, as idyllic as it sounds, is an island off the coast of Orient Point, New York. Purchased by the US government in the 1950s, it became the home for animal disease research, first for the US Army and then for the US Department of Agriculture. The island is now the site of the Plum Island Animal Disease Center (PIADC), which falls under the Department of Homeland Security (DHS) Science and Technology Office of National Laboratories (ONL). The island allows PIADC to maintain a safe, isolated area to develop biodefense efforts to defend against intentional, accidental, or natural animal diseases like foot-and-mouth (FMD), which can be devastating to cattle. Hundreds of investigators and employees come to the island to work on research, which can include efforts of treatment, diagnostics, vaccines, and bioforensics. Not surprisingly, rumors about the island and its work have swirled for decades. Like all the other biodefense laboratories, it maintains a heavy biosecurity and biosafety culture.”

Stories You May Have Missed:

  • Highly Resistant Malaria Spreading Rapidly in Southeast Asia – “An aggressive strain of drug-resistant malaria that originated in Cambodia has rapidly spread into neighboring countries, causing high rates of treatment failure to first-line treatment and complicating efforts to eliminate the disease, according to two studies published yesterday in The Lancet Infectious Diseases. One of the studies found that the KEL1/PLA1 strain of Plasmodium falciparum, the parasite that causes malaria, now accounts for more than 80% of the malaria parasites in northeastern Thailand and Vietnam, and has acquired new genetic mutations that have enhanced its fitness and ability to resist treatment. The strain is resistant to dihydroartemisinin-piperaquine, a form of artemisinin-based combination therapy (ACT) that has been the first-line treatment for malaria in Cambodia for more than a decade, and was more recently adopted as the preferred treatment in Thailand and Vietnam.”
  • Outbreak of Chapare-like Virus in Bolivia– “On June 28, 2019, the Bolivian Ministry of Health received notice of three cases of hemorrhagic fever syndrome. Two additional cases have since been reported. Current evidence suggests that the etiologic agent is Chapare virus or a similar virus, according to the US CDC”.

 

Pandora Report 7.19.2019

Ebola Outbreak Updates- From PHEIC Declaration to Vaccines 
On Wednesday, the WHO declared the outbreak a PHEIC (Public Health Emergency of International Concern). “‘It is time for the world to take notice and redouble our efforts. We need to work together in solidarity with the DRC to end this outbreak and build a better health system,’ said Dr. Tedros. ‘Extraordinary work has been done for almost a year under the most difficult circumstances. We all owe it to these responders — coming from not just WHO but also government, partners and communities — to shoulder more of the burden.’ The declaration followed a meeting of the International Health Regulations Emergency Committee for EVD in the DRC. The Committee cited recent developments in the outbreak in making its recommendation, including the first confirmed case in Goma, a city of almost two million people on the border with Rwanda, and the gateway to the rest of DRC and the world.” A new case of Ebola has been identified in the city of Goma, which represents what the WHO is calling “a game-changer” since the city is a major transportation hub. On July 11th, it was announced that “the Democratic Republic of the Congo (DRC) ministry of health and government officials have agreed that Merck’s rVSV-ZEBOV is the only vaccine that will be used during the current, ever-growing Ebola outbreak in North Kivu and Ituri provinces. ‘Due to the lack of sufficient scientific evidence on the efficacy and safety of other vaccines as well as the risk of confusion among the population, it was decided that no clinical vaccine trials will be allowed throughout the country,’ the ministry said in its daily update yesterday. As of yesterday, a total of 158,830 people have been vaccinated with rVSV-ZEBOV, which clinical data suggest has as high as a 97.5% effectiveness rate against the virus.”

Trump Administration Gutting WMD Detection Programs
Despite 2017 pledges to secure, eliminate, and prevent the spread of WMD and related materials, a new investigation has found that such efforts through the Department of Homeland Security, have been drastically impacted. “Among the programs gutted since 2017, however, was an elite Homeland Security ‘red team,’ whose specialists conducted dozens of drills and assessments around the country each year to help federal, state and local officials detect such potential threats as an improvised nuclear device concealed in a suitcase, or a cargo ship carrying a radiation-spewing ‘dirty bomb.’ Another Homeland Security unit, the Operations Support Directorate, had helped lead up to 20 WMD-related training exercises each year with state and local authorities. The directorate participated in less than 10 such exercises last year and even fewer so far this year, according to internal Homeland Security documents.” The Homeland Security’s National Technical Nuclear Forensics Center has also seen a hit as their leadership is out and staffing has dropped from 14 to 3. “A separate Homeland Security component, the International Cooperation Division, which worked closely with foreign counterparts and the United Nations nuclear watchdog agency to track and stop the smuggling of dangerous nuclear materials overseas, has been disbanded.” “Homeland Security also has halted work to update a formal ‘strategic, integrated’ assessment of chemical, biological and nuclear-related risks.” The investigation also notes that more than 100 scientists and policy experts who specialize in radiological and nuclear threats, have either been reassigned or pushed into jobs that are wholly unrelated to their works. ‘The changes have undermined the U.S. government’s multi-agency commitment since 2006 to build and maintain a ‘global nuclear detection architecture,’ according to the present and former officials.”

 Weaponized Ticks, Lyme Disease, and the Smith Amendment
Remember that time a conspiracy-theory book triggered an investigation into whether the DoD ever weaponized ticks? Well here we are…. Earlier this week the US House of Representatives voted on the Smith Amendment on Bioweaponization of Ticks – and it passed. A lot of this stems from stories of Plum Island and the whispers that Lyme disease actually originated from the testing site and ticks were either intentionally or accidentally released into the surrounding areas…triggering the disease a few decades ago. Since the release of a book on the “secret history of Lyme disease and biological weapons”, there’s been a renewed interest in the bedtime story of the disease’s sinister origin story. Unfortunately, the proposed investigation really doesn’t hit the nail on the head. For one, it’s been widely known for years that ticks, among other vectors, were a part of the bioweapons and biodefense research. Two, the “smoking gun” within the book that’s been used to reinvigorate interest, claims an interview with Dr. Willy Durgdorfer (the researcher who identified Lyme disease) gave confirmation of the true origin of the disease….alas, this was reported post-mortem, when he was not able to confirm or deny such statements. Third, Lyme disease actually has some pretty old origins. Last, but not least, this new amendment doesn’t even touch on Lyme disease…but rather focuses on if the DoD did experiments with insects and vectors as disease delivery systems…which we already know to be true. Ultimately, this does a disservice to not only the people with Lyme disease, but also encourages conspiracy theories.

Using “Outbreak Science” to Strengthen Usage of Models in Epidemics
If you’ve been on the frontlines of an outbreak, you’ve likely heard of disease modeling…but sometimes it can be hard to actually apply this technology to drive change. A new article has created “outbreak science” as an inter-disciplinary field to apply epidemic modeling in a way that can really help. “Nevertheless, the integration of those analyses into the decision-making cycle for the Ebola 2014–2016 epidemic was not seamless, a pattern repeated across many recent outbreaks, including Zika. Reasons for this vary. Modeling and outbreak data analysis efforts typically occur in silos with limited communication of methods and data between model developers and end users. Modeling “cross talk” across stakeholders within and between countries is also typically limited, often occurring within a landscape of legal and ethical uncertainty. Specifically, the ethics of performing research using surveillance and health data, limited knowledge of what types of questions models can help inform, data sharing restrictions, and the incentive in academia to quickly publish modeling results in peer-reviewed journals contribute to a complex collaborative environment with different and sometimes conflicting stakeholder goals and priorities. To remedy these challenges, we propose the establishment of ‘outbreak science’ as an inter-disciplinary field to improve the implementation of models and critical data analyses in epidemic response. This new track of outbreak science describes the functional use of models, clinical knowledge, laboratory results, data science, statistics, and other advanced analytical methods to specifically support public health decision making between and during outbreak threats. Outbreak scientists work with decision makers to turn outbreak data into actionable information for decisions about how to anticipate the course of an outbreak, allocate scarce resources, and prioritize and implement public health interventions. Here, we make three specific recommendations to get the most out of modeling efforts during outbreaks and epidemics.” From establishing functional model capacity and fostering relationships before things happen to investing in functional model capabilities, this guide could be a game-changer for outbreak response.

Building a Case of (non?)compliance Concern
Looking for a new book? Check out this review of Biosecurity in Putin’s Russia – “In the early 1990s, the world was rocked when defectors from the Soviet Union revealed the existence of a massive civilian and military biological-weapons program that had employed more than 65,000 people from 1928 to 1992, directly contravening the 1972 Biological and Toxin Weapons Convention (BWC). In 2012, Raymond Zilinskas, a leading biological- weapons expert, coauthored with Milton Leitenberg a comprehensive account of the program, The Soviet Biological Weapons Program: A History, a reference source so thorough that it ran to nearly a thousand pages. Last year, Zilinskas, in collaboration with Philippe Mauger, produced Biosecurity in Putin’s Russia, a sequel of sorts in which the cautionary note that Zilinskas and Leitenberg sounded earlier—that Russia’s relationship with biological weapons remained complicated, and that the current status of its old programs could not be verified—proved to have been foreshadowing.”

Modeling the Complexities of the Gut for Biodefense Application
“The Nutritional Immunology and Molecular Medicine Laboratory (NIMML), with research funding assistance from the Defense Threat Reduction Agency (DTRA), has developed a high-resolution model of the gut immune system to help solve emerging and re-emerging infectious diseases and biodefense challenges. The advanced model predicts new emerging behaviors and responses to biological threats. The gut ecosystem includes trillions of interactions between host epithelial and immune cells, molecules (cytokines, chemokines and metabolites) and microbes is a massively and dynamically interacting network, like a multidimensional jigsaw puzzle with pieces that are constantly changing shape. These interactions with cooperativity and feedback lead to nonlinear dynamics and unforeseen emergent behaviors across spatiotemporal scales. The NIMML agent-based modeling (ABM) of the gut uses an array of HPC-driven advanced computational technologies such as the ENteric Immunity SImulator (ENISI) – multiscale modeling (MSM). These models and tools simulate cell phenotype changes, signaling pathways, immune responses, lesion formation, cytokine, chemokine and metabolite diffusions, and cell movements at the gut mucosa.”

Radiation Injury Treatment Network Meeting 
Are you attending this event later this month? If so, check out GMU Biodefense doctoral student Mary Sproull discussing Radiation Biodosimetry – A Mass Screening Tool for Radiological/Nuclear Events.

MERS-CoV Clusters
New WHO insight into 14 cases has identified 2 clusters that involved 4 of the infected people. “Of the 14 patients, 3 had been exposed to camels, a known risk factor for contracting the virus. Ten were men and four were women, and patient ages ranged from 22 to 80. Eleven had underlying health conditions, which is a risk factor for MERS. Ten were from Riyadh region, with other cases reported from Jeddah, Medina, Najran, and Al Qassim. One of the clusters involved two people living in the same household in Al Kharj in Riyadh region, a 22-year-old woman who had diabetes and epilepsy and a 44-year-old woman who had no underlying health conditions. The other cluster consisted of a 65-year-old male patient and a 23-year-old female healthcare worker in Riyadh. Five of the people died from their infections.”

CDC Announces E Coli Outbreak Linked to Ground Bison
Put down your bison burger and take a slow step back….”The US Centers for Disease Control and Prevention (CDC) and US Food and Drug Administration (FDA) have announced that they are collaborating with the Canadian Food Inspection Agency to investigate a multistate outbreak of E coli O103 and E coli O121 infections. Early epidemiologic and traceback information point to ground bison products as the likely source of the outbreak. As of July 12, 2019, there have been 21 individuals infected with E coli in this outbreak. In total, 6 individuals have been infected with the O103 strain, 13 cases of the O121 strain have been confirmed, and 2 individuals have been found to be infected with both strains.”

Stories You May Have Missed:

  • Polio in Pakistan – “The Global Polio Eradication Initiative (GPEI) today reported nine new cases of wild poliovirus type 1 (WPV1), and, for the first time in more than a year, China has confirmed a case of vaccine-derived poliovirus. In addition, Angola has a new circulating vaccine-derived poliovirus type 2 (cVDPV2) case. The Pakistan patients reported symptom onset on dates ranging from May 28 to Jun 20. The total number of WPV1 cases recorded in Pakistan this year is now 41; last year, the country recorded 12 cases over the entire year. Five of the nine cases originated in Bannu province, where health workers have been targeted by anti-vaccine extremists.”
  • Food Defense and Intentional Adulteration Rule Training – “The Food Protection and Defense Institute is hosting a Food Defense and Intentional Adulteration Rule training on August 20-21 in Minneapolis, MN. This two-day course provides the convenience and interaction of a single, in person class to more comprehensively learn the breadth and interconnections of IA Rule requirements including how to: Prepare a Food Defense Plan Conduct vulnerability assessments including the full FSPCA Intentional Adulteration, Conducting Vulnerability Assessment Course (IAVA) Identify and explain mitigation strategies, Conduct reanalysis”

Pandora Report: 7.12.2019

 Summer Workshop Welcomes New Instructor
We’re excited to announce that Nancy Connell will be joining us for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security next week. Dr. Connell “is a Senior Scholar at the Johns Hopkins Center for Health Security and a visiting Professor in the Department of Environmental Health and Engineering at the Johns Hopkins Bloomberg School of Public Health. She is a microbial geneticist by training. Dr. Connell’s work at the Center is focused on advances in life sciences and technology and their application to a number of developments in the areas of biosecurity, biosafety and biodefense.  Her research projects analyze novel biotechnologies that might impact the development of Global Catastrophic Biological Risks (GCBR) in ecosystems, and the development of surge capacity for medical countermeasure manufacturing and other response mechanisms in the event of a global pandemic or other global catastrophic event.  Dr. Connell is a member of the Board on Life Sciences and is a National Associate of the National Academies of Sciences, and she completed a six-month sabbatical as Visiting Scholar at the Board on Life Sciences.  Dr. Connell is a member of the US-CDC’s Biological Agent Containment Working Group in the Office of Public Health Preparedness and Response and was recently appointed the serve on the National Science Advisory Board for Biosecurity. Before joining the Center, Dr. Connell was Professor and Director of Research in the Division of Infectious Disease in the Department of Medicine at Rutgers New Jersey Medical School and the Rutgers Biomedical Health Sciences.  Dr. Connell’s major research focus was antibacterial drug discovery in respiratory pathogens such as M. tuberculosis and B. anthracis. Dr. Connell chaired the Institutional Biosafety Committee of Rutgers University and directed NJMS’s biosafety level three containment laboratory beginning in 1997. Her recent work focused on the use of predatory bacteria as novel therapeutics for treatment of Gram negative bacterial infections, including MDR strains and select agents. Dr. Connell was continuously funded by the NIH, the Department of Defense and DARPA, industry, and/or other sources from 1992 to 2018.  She received a PhD in microbial genetics from Harvard University.” If you’re not able to make the workshop next week, keep an eye on the @PandoraReport twitter for updates.

Is the U.S. Ready for A Tech War?
GMU Biodefense doctoral alum Daniel Gerstein discusses technological priorities and how the US invests in technological advances related to national security. “Today, important technology development changes are underway that could dramatically affect world order. The continued shift in global research and development spending highlights how far U.S. dominance has eroded. In 1960, when considering federal, industry and academia, the United States accounted for 69 percent of the global R&D. By 2016, the United States accounted for only 28 percent of the global R&D. With such a shift, it is no wonder that U.S. technology leadership and superiority can no longer be assured.” Gerstein notes that “the Trump administration should develop technology priorities, and technologies considered vital to U.S. economic and national security should receive investments to stimulate advances and promote U.S. leadership. The administration’s recent call to have greater industry investment in basic research, in lieu of government funding, seems shortsighted and should be reconsidered given the emerging tech war. A reevaluation of programs such as export controls, programs for approving foreign investment transactions, and intellectual property protections would also be useful to both protect and promote U.S. technology.”

Ebola Outbreak – Cases Surge with Violence – and How the CDC Made a Synthetic Ebola Virus to Test Treatments
Recently, the WHO Director General, Dr. Tedros, warned that instability in the DRC is fueling the Ebola outbreak. “In an interview with The Guardian, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, said the political climate in the Democratic Republic of the Congo (DRC) is preventing an end to the current Ebola outbreak. ‘The root cause of the problem is lack of peace, the lack of a political solution. The incidence of Ebola, malaria and cholera is the symptom,’ Tedros told the British newspaper. ‘I know we can finish this Ebola outbreak…But at the same time it can come back because all the [political and security] conditions remain the same.’ The DRC outbreak expanded by 10 cases today, to 2,428 cases, according to the WHO’s online Ebola dashboard. Tedros’s comments come 1 day after the UK’s International Development Secretary, Rory Stewart, returned from a trip to the DRC and called on G7 world leaders to increase funding for outbreak response. ‘There is a real danger, that if we lose control of this outbreak, it could spread beyond DRC’s borders to the wider region and the wider world. Diseases like Ebola have no respect for borders and are a threat to us all,’ Stewart said in a Department for International Development (DID) news release.” Ebola has been challenging response efforts since 2013 and the CDC has been working to combat testing and treatment roadblocks through a unique strategy – a synthetic Ebola virus. Helen Branswell recently discussed how the CDC created a synthetic version of the Ebola virus to help guide diagnostic tests and experimental treatments…and it ended up working. “The research, conducted in the agency’s most secure laboratories — BSL4 — showed that even though the tests and two of the treatments being used in the field were developed based on earlier variation of Ebola viruses, they continue to be effective against the virus causing the current outbreak, the second largest on record. The results, reported Tuesday in the journal Lancet Infectious Diseases, are encouraging, but also raise questions about why outside research groups have not received direct access to viral specimens from the DRC and instead had to create a synthetic version. The paper noted that there have been no Ebola samples available to the scientific community from the past four outbreaks in the DRC. Those outbreaks occurred in 2014, 2017, and 2018.”

Mason Hosts Department of Homeland Security Centers of Excellence 2019 Summit 
“George Mason University will host Homeland Security Challenges: Evolving Threats and Dynamic Solutions, a Department of Homeland Security Centers of Excellence Summit, July 31-Aug. 1 at its Arlington Campus. The summit is an opportunity to gather some of the nation’s best academic, public, and private sector leaders to discuss strategies for advancing the DHS mission. Sponsored through the DHS Science and Technology Directorate Office of University Programs, the Department of Homeland Security Centers of Excellence network is a consortium of universities conducting groundbreaking research to address homeland security challenges by developing multidisciplinary, customer-driven, homeland security science and technology solutions and helping train the next generation of homeland security experts. The summit provides a platform for creating connections, fostering collaborations and inspiring new ideas to address homeland security challenges. It also provides an opportunity to highlight student research and innovative problem solving.”

ASPR Updates- the SNS and Biodefense Strategy Summit 
The Office of the Assistant Secretary for Preparedness and Response (ASPR) just released several good resources for the biodefense community. First, they’re celebrating the 20th anniversary of the Strategic National Stockpile (SNS) and you can find some great information on it here. “When state, local, tribal, and territorial responders request federal assistance to support their response efforts, the stockpile ensures that the right medicines and supplies get to those who need them most during an emergency. Organized for scalable response to a variety of public health threats, this repository contains enough supplies to respond to multiple large-scale emergencies simultaneously.” Next, ASPR provided the transcripts from the Biodefense Summit that occurred in April. “The Biodefense Summit, was held on April 17, 2019 in Washington, D.C.  The Summit aimed to engage the biodefense stakeholder community to inform national biodefense enterprise efforts to counter biological threats, reduce risk, prevent, prepare for, respond to, and recover from biological incidents. The Summit informed stakeholders of the implementation of the National Biodefense Strategy. “

Arizona Battles Hepatitis A
Arizona is working to contain an outbreak of hepatitis A and GMU biodefense doctoral student Saskia Popescu discusses how they’re incorporating healthcare providers into these efforts. “Despite making great strides in reducing the burden of HAV, Arizona is experiencing a growing outbreak that began in late 2018. Currently, there have been 424 cases and 3 deaths documented since November 2018, with a 79% hospitalization rate. The outbreak has spread to 7 counties within Arizona, including the largest—Maricopa. A total of 48% of Arizona’s HAV cases have occurred in those individuals who are homeless and report drug use, 25% of cases have been in those reporting using drugs (ie, no reported homelessness), and 22% of cases are in individuals with no identified risk factors. Public health investigators found that 28% of the cases have been in patients who are currently or were recently incarcerated. Five percent of the HAV cases in this ongoing Arizona outbreak have been reported in patients who report homelessness, but no drug use.  More recently, an employee at a restaurant in Maricopa County tested positive for HAV and may have exposed people visiting the restaurant over a 9-day period from late May to June. Public health officials are encouraging those patrons to get vaccinated against HAV to reduce the risk of transmission.”

Worldwide Reduction in MERS-CoV Cases Since 2016
In the latest CDC Morbidity and Mortality Weekly Report, they note the overall decline in MERS-CoV cases and mortality since 2016. “From 2012 through May 31, 2019, Middle East respiratory syndrome coronavirus (MERS-CoV) has infected 2,442 persons and killed 842 worldwide. MERS-CoV is currently circulating in dromedary camels in Africa, the Middle East, and southern Asia; however, most cases of human infection have been reported in the Arabian Peninsula. Large hospital outbreaks in 2014 and 2015 motivated affected countries to substantially invest in prevention and control activities. To estimate the potential number of MERS cases and deaths that might have been averted since 2016 had the risk levels of 2014–2015 continued, we analyzed case-based data on laboratory-confirmed human cases of MERS-CoV infections reported to the World Health Organization. We categorized cases as either secondary (human-to-human transmission) or community-acquired (presumed camel-to-human transmission). In addition, we used case-based data on date of onset (for symptomatic infections) or report (for asymptomatic infections), outcome (died/recovered), and dates and sizes of reported clusters of human-to-human–transmission cases”.

Self-destructing Mosquitoes and Sterilized Rodents: the Promise of Gene Drives
What might the consequences of this novel biotech be? In the face of potential eradication of disease and alteration of an entire animal population’s genome, researchers have very real concerns. “As soon as researchers began to make gene drives regularly in labs, animals developed resistance against them — accumulating mutations that prevented the drives from spreading. In tests of two drives inserted into fruit flies, for example, genetic variants conferring resistance formed frequently. Most commonly, mutations alter a sequence that CRISPR is set to recognize, preventing the gene from being edited. In experiments with caged mosquitoes, Crisanti and Target Malaria researcher Tony Nolan watched a gene drive gradually decrease in frequency over multiple generations owing to resistant mutations at the target gene. The results rocked the field. Would resistance render gene drives impotent? Not necessarily — if researchers select the right target. Some genes are highly conserved, meaning that any change is likely to kill their owners. Picking these genes as a drive target means fewer mutations and less resistance. In September 2018, Crisanti and his team crashed a population of caged Anopheles gambiae mosquitoes with 100% efficiency by making a drive that disrupts a fertility gene called doublesex. With the drive in place, female mosquitoes cannot bite and do not lay eggs; within 8–12 generations, the caged populations produced no eggs at all. And because it is crucial for procreation, doublesex is resistant to mutations, including those that would confer resistance to a drive construct.” “Before Kevin Esvelt ever built a single CRISPR-based gene drive, he’d wake up in cold sweats thinking about the ramifications. ‘I realized, oh hey, this isn’t just going to be about malaria, this is potentially going to be something any individual who can make a transgenic fruit fly could build to edit all the fruit flies.’”

Stories You May Have Missed:

  • UK Works to Test New Payment Model for Antibiotics – “In an effort to stimulate the development of new antibiotics, Britain’s National Health Service (NHS) yesterday announced the launch of a trial for a new pilot program that will pay drug companies for antibiotics using a subscription-style model. Under the program, NHS will pay pharmaceutical companies up front for access to effective antibiotics, rather than reimbursing them based on the quantity of antibiotics sold. The idea behind the program is to delink profit from the volume sold, pay for antibiotics based on their public health value, and encourage the development of new antibiotics.”

Pandora Report: 6.21.2019

Pandemics, Bioterrorism, and Global Health Security – From Anthrax to Zika Workshop 
Less than one month until our workshop and just a couple weeks to get your early registration discount…have you signed up? This 3.5 day workshop is the place to be to learn the challenges facing the world at the intersection of national security, public health, and the life sciences. The workshop faculty are internationally recognized experts from the government, private sector, and academia who have been extensively involved with research and policy-making on public health, biodefense, and national security issues. Topics range from protecting the bioeconomy, to biosecurity, vaccine development, disease risk assessments, and more!

Pandemic Preparedness in the Face of Fake News
Biopreparedness is challenging enough…but when you throw in the growing threat of mis/disinformation…this can seem like a feat requiring nothing short of a Herculean effort. “When the next pandemic strikes, we’ll be fighting it on two fronts. The first is the one you immediately think about: understanding the disease, researching a cure and inoculating the population. The second is new, and one you might not have thought much about: fighting the deluge of rumors, misinformation and flat-out lies that will appear on the internet. The second battle will be like the Russian disinformation campaigns during the 2016 presidential election, only with the addition of a deadly health crisis and possibly without a malicious government actor. But while the two problems — misinformation affecting democracy and misinformation affecting public health — will have similar solutions, the latter is much less political. If we work to solve the pandemic disinformation problem, any solutions are likely to also be applicable to the democracy one.” From misinformation regarding the source of a disease or outbreak, to that involving treatments that work…the implications can make or break “society’s ability to deal with a pandemic at many different levels.”

A Call for Cooperation in a New Cyberbiosecurity Landscape
Vulnerabilities within cyberbiosecurity range from biomanufacturing to farm-to-table enterprises, but it will take a true collaboration within these fields to drive change. “The life sciences now interface broadly with information technology (IT) and cybersecurity. This convergence is a key driver in the explosion of biotechnology research and its industrial applications in health care, agriculture, manufacturing, automation, artificial intelligence, and synthetic biology. As the information and handling mechanisms for biological materials have become increasingly digitized, many market sectors are now vulnerable to threats at the digital interface. This growing landscape will be addressed by cyberbiosecurity, the emerging field at the convergence of both the life sciences and IT disciplines. This manuscript summarizes the current cyberbiosecurity landscape, identifies existing vulnerabilities, and calls for formalized collaboration across a swath of disciplines to develop frameworks for early response systems to anticipate, identify, and mitigate threats in this emerging domain.”

Australian Health System Capacity to Handle a Bioattack
How well do you think the U.S. health system would handle a smallpox bioattack? Researchers in Australia tested out the health system capacity in Sydney against this very scenario. “We used a model for smallpox transmission to determine requirements for hospital beds, contact tracing and health workers (HCWs) in Sydney, Australia, during a modelled epidemic of smallpox. Sensitivity analysis was done on attack size, speed of response and proportion of case isolation and contact tracing. We estimated 100638 clinical HCWs and 14595 public hospital beds in Sydney. Rapid response, case isolation and contact tracing are influential on epidemic size, with case isolation more influential than contact tracing. With 95% of cases isolated, outbreak control can be achieved within 100 days even with only 50% of contacts traced. However, if case isolation and contact tracing both fall to 50%, epidemic control is lost. With a smaller initial attack and a response commencing 20 days after the attack, health system impacts are modest. The requirement for hospital beds will vary from up to 4% to 100% of all available beds in best and worst case scenarios. If the response is delayed, or if the attack infects 10000 people, all available beds will be exceeded within 40 days, with corresponding surge requirements for clinical health care workers (HCWs). We estimated there are 330 public health workers in Sydney with up to 940,350 contacts to be traced. At least 3 million respirators will be needed for the first 100 days. To ensure adequate health system capacity, rapid response, high rates of case isolation, excellent contact tracing and vaccination, and protection of HCWs should be a priority. Surge capacity must be planned. Failures in any of these could cause health system failure, with inadequate beds, quarantine spaces, personnel, PPE and inability to manage other acute health conditions.”

Developing a PPE Selection Matrix for Preventing Occupational Exposure to Ebola
Preparing your workplace for a potential Ebola patient? Check out this matrix for choosing PPE. GMU Biodefense alum Chris Brown co-authored this helpful article to guide healthcare workers, laboratories, and other work environments in avoiding occupational exposure to Ebola virus. “The matrix applies to a variety of job tasks in health care, laboratories, waste handling, janitorial services, travel and transportation, and other sectors where workers may be exposed to the Ebola virus during outbreak events. A discussion of the information sources and decision-making process for developing the matrix forms the basis of the recommendations. The article then emphasizes challenges and considerations for formulating the matrix, including identifying information sources to help characterize occupational exposures, aligning recommendations among stakeholders with varying viewpoints, and balancing worker protections with feasibility concerns. These considerations highlight issues that remain relevant for preparedness efforts ahead of future US cases of Ebola or other emerging infectious diseases. OSHA developed a personal protective equipment selection matrix to help employers protect workers from exposure to Ebola virus in the event of future US cases. Toward facilitating preparedness for cases associated with outbreaks, this article discusses the matrix of personal protective equipment recommendations, which apply to a variety of job tasks in healthcare, laboratories, waste handling, janitorial services, travel and transportation, and other sectors where workers may be exposed to the Ebola virus during outbreak events.”

NTI Report – A Spreading Plague: Lessons and Recommendations for Responding  to A Deliberate Biological Attack
“To address this preparedness deficit, NTI | bio, Georgetown University’s Center for Global Health Science and Security, and the Center for Global Development offer recommendations for urgent action in a new paper, A Spreading Plague: Lessons and Recommendations for Responding to a Deliberate Biological Event. Drawn from a senior leaders’ tabletop exercise held in advance of the Munich Security Conference on February 14, 2019, the paper presents key findings and organizers’ recommendations for critical improvements, including within the United Nations system, to prevent catastrophic consequences of deliberate and other high-consequence biological events.” Pulling from a tabletop exercise, the report highlights five emergent themes – international coordination, information sharing, investigation and attribution, and financing for response and preparedness.

Ebola Outbreak Updates 
With nearly 50 cases reported over 3 days, this outbreak is not showing signs of slowing. “Over the weekend, the ministry of health in the Democratic Republic of the Congo (DRC) recorded 28 new cases of Ebola, and will likely confirm another 20 new cases today. With nearly 50 cases in 3 days, the outbreak is experiencing another spike in activity following the discovery of cases in neighboring Uganda last week. According to the World Health Organization’s (WHO’s) Ebola dashboard, the outbreak total now stands at 2,168 cases. In addition to the newly confirmed cases, there were 19 fatalities over the weekend, including 8 that took place in the community.” As cases spilled over into Uganda, there is growing concern that the porous border will continue to made control measures unsuccessful. “The footpaths show the close kinship between the two countries, where most people have relatives on both sides of the border. But as Ebola rages they are a source of worry for health workers and local authorities trying to prevent any further cross-border contamination. Eastern Congo has battled the Ebola outbreak since last August and last week the disease spread to Uganda, where two people died of the hemorrhagic fever. ‘This border is very porous,’ said James Mwanga, a Ugandan police officer in charge of the Mpondwe border post. ‘You will not know who has passed if the person went through the unofficial border posts, in most cases. Now there is anxiety and so on. We have heightened our alertness’.” Moreover, there has been concern over hospital infections and a desperate call for financial support. “During recent meeting in Kinshasa, Tedros met with the DRC’s prime minister, opposition leaders, religious officials, and other partners, the WHO said in a statement yesterday. He also traveled to Butembo, which has been one of the main epicenters, to meet with community and religious leaders, business representatives, and nongovernmental organization representatives.Also, he strongly appealed to other countries across the world to support the health responders in the DRC. Tedros said the WHO needs $98 million to fund the response, but it has received only $44 million, leaving a $54 million gap, a shortfall he said must immediate be addressed. ‘If the funds are not received, WHO will be unable to sustain the response at the current scale,’ he said, adding that other partners face funding gaps and that response decisions risk being driven by financial capacity rather than operational needs.”
The Engineering Biology Research Consortium has just released this roadmap “to provide researchers and other stakeholders (including government funders) with a compelling set of technical challenges and opportunities in the near and long term. Our ongoing roadmapping process was initiated in response to the recommendations put forth in the 2015 National Academies report, Industrialization of Biology, and was partially supported by the National Science Foundation. With this inaugural release of the Roadmap, EBRC endeavors to provide a go-to resource for engineering/synthetic biology research and related endeavors. Further details can be found in the overview section, including a brief discussion of societal and security considerations. The EBRC Technical Roadmapping Working Group led the development of the roadmap scope and content. Collective insight and input was leveraged from more than 80 leading scientists and engineers, including academic, industry, and student members of EBRC and from the broader research community. Since mid-2018, the working group has held five workshops and countless teleconferences to develop the content and engage discussion around the roadmap. The result is a collaborative effort of the engineering biology research community and represents the community’s vision for the future of the field.”
Biodefense World Summit
If you missed this event over the last week, you can catch two articles covering a few talks. “At the 5th Annual Biodefense World Summit, Luther Lindler, PhD, science advisor for Bio Programs, Technology Centers, S&T Directorate of DHS, discussed the work that DHS has been doing to help beef up US biodefense efforts. Within the DHS S&T program, there are 5 major mission areas: prevent terrorism and enhance security; secure and manage our borders; enforce and administer our immigration laws; safeguard and secure cyberspace; and ensure resilience to disasters. Imagine trying to prevent microbial contamination or security threats from the Port of Los Angeles, which encompasses 7500 acres, with 30,000 containers arriving per day and $285 billion in cargo per year.”  “One of the hardest aspects of biodefense, though, is integrating new technology to truly make a difference. Every day, there are advancements in tech; yet, it can be challenging to truly discern how these new tools can help global health security and prevent the next pandemic. In a Biodefense presentation that called on the use of data technology and forecasting to help tackle the next epidemic, Dylan George, PhD, BS, vice president of technical staff at In-Q-Tel and associate director of BNext, discussed integrating novel and available data technologies into public health processes to not only help guide interventions, but also to establish more efficient response practices and improve situational awareness.”
Stories You May Have Missed:
  • Global Trust in Healthcare, Scientists, and Vaccines – “The Wellcome Global Monitor, conducted as part of the Gallup World Poll 2018, is designed to provide a baseline to gauge how attitudes evolve over time and to help guide policies to improve public engagement on science and health issues. The data were published today. The survey included more than 140,000 people ages 15 and older from more than 140 countries, Wellcome Trust said today in a press release. It added that the survey shows the first glimpse into what people think about the issues for many countries, including Colombia, Nigeria, South Africa, and Vietnam. Among the key findings were that three quarters of the world’s population trust doctors and nurses more than anyone else on healthcare issues. And 72% trust scientists.”
  • Dirty Hospital Sinks: A Source for Contamination – “For decades we’ve been taught that hand hygiene is the most critical aspect of infection control. Although that may be true, what about the sinks and faucets? These oft overlooked areas can easily pose infection control risks. How clean can your hands really be if the sink and faucet are heavily contaminated and dirty? The topic of slime and biofilm is increasingly being brought up as we focus more on vulnerabilities in health care and the role of environmental contamination. Earlier this year, there were studies that identified sink proximity to toilets as a risk factor for contamination. Bugs like Klebsiella pneumoniae carbapenemase-producing organisms tend to be prolific in moist environments and are often pervasive in intensive care unit sinks and drains. Researchers found that sinks near toilets were 4-times more likely to host the organisms than those further from toilets.”

Pandora Report: 6.14.2019

It’s nearly July, have you signed up for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security, to get your early registration discount? Also – as you enjoy the summer weather, practice bat safety, as the CDC has warned that they post the biggest rabies threat in the United States.

How World War II Spurred Vaccine Innovation
Dr. Kendall Hoyt discusses the link between war and disease, and how WWII helped bring forth a renaissance of vaccine development. Did we mention she’ll be speaking at our summer workshop next month? “As the Second World War raged in Europe, the U.S. military recognized that infectious disease was as formidable an enemy as any other they would meet on the battlefield. So they forged a new partnership with industry and academia to develop vaccines for the troops. Vaccines were attractive to the military for the simple reason that they reduced the overall number of sick days for troops more effectively than most therapeutic measures. This partnership generated unprecedented levels of innovation that lasted long after the war was over. As industry and academia began to work with the government in new ways to develop vaccines, they discovered that many of the key barriers to progress were not scientific but organizational.”

Ebola Outbreak – Expanding into Uganda 
By June 12th, the Ugandan Ministry of Health had confirmed three cases of Ebola along the DRC border. In many ways, this was the scenario public health officials had been expecting and fearing. “For 10 months, Uganda has closely monitored its porous border with the DRC for crossover cases, yet, despite numerous alerts, no cases have been detected until now. ‘In preparation for a possible imported case during the current outbreak in DRC, Uganda has vaccinated nearly 4,700 health workers in 165 health facilities (including in the facility where the child is being cared for); disease monitoring has been intensified; and health workers trained on recognizing symptoms of the disease. Ebola Treatment Units are in place,’ the WHO regional office for Africa said in a news release.” Given the growth of the outbreak and now cases in Uganda, many are wondering why the WHO has not declared this outbreak a PHEIC (public health emergency of international concern). This may change though, as the WHO Director-General Dr. Tedros has convened an Emergency Committee under the International Health Regulations for Friday (FYI, this is the third time the Emergency committee has met to discuss the outbreak and classification as a PHEIC). Concerns for the delay in declaring PHEIC have been present for months – “The legal criteria for a PHEIC have been met. The International Health Regulations (2005) (IHR) empower the WHO Director-General to declare a PHEIC. A PHEIC is an extraordinary event with public health risk to other countries that requires a coordinated international response. IHR criteria include public health impact, novelty and scale, and movement of persons. The WHO Director-General must also consider health risks, potential international spread, and EC guidance, among other factors.”

Fighting Global Pandemics By Starting One
In the latest video installment from the Bulletin of the Atomic Scientists’s Say What? series, the hot topic of gain-of-function research is being discussed. “Researchers say making new strains of the H5N1 flu virus in a secure lab can help them see what might happen naturally in the real world. Sounds logical, but many scientists oppose it because the facts show most biosafety labs aren’t really secure at all, and experts say the risks of a mutated virus escaping outweigh whatever public health benefit comes from creating them. But now the US government is funding these same labs again to artificially enhance potentially pandemic pathogens. In this installment of the Bulletin’s video series that provides a sharp view of fuzzy policy, Johns Hopkins University computational biologist Steven Salzberg explains why arguments by researchers in favor of risky viral research aren’t persuasive.”

Burden of Disease Exposures- Reasons to Invest in Hospital Response
GMU biodefense doctoral student and infection preventionist Saskia Popescu discusses the impact that communicable disease exposures have on hospitals. “The time spent responding to an exposure means less time for patient care and infection prevention, but can also result in health care workers having to stay home if they’re exposed and immuno-naïve. A new survey sought to understand the impact for infection preventionist and staff nurses when an exposure to a communicable disease occurs. Investigators wrote in the American Journal of Infection Control (AJIC) regarding this very issue and surveyed staff nurses in a New York hospital network and infection preventionists at the 2018 Association for Professionals in Infection Control and Epidemiology annual conference, as well as members of the Association for Professionals in Infection Control and Epidemiology chapters.  A total of 150 nurses and 228 infection preventionists responded with some insight into just how time-consuming these exposures are. Data regarding workload increase for each exposure was captured in 2 questions asking participants to rank the overall increase in daily workload for each of these exposures (0-3 scale, with 0 meaning not applicable and 3 meaning a dramatic increase in workload of more than 60 minutes), and to explain the 3 most time-consuming activities for outbreak and exposure activities. Infection preventionists reported the most time-consuming outbreaks/exposures resulted from mumps/measles, tuberculosis, gastrointestinal viruses, and multidrug-resistant organisms. For an exposure to Clostridioides difficile, lice or scabies, and influenza, there was a more than 60-minute workload increase for nurses.”

There’s Limited Time To Make America Safer From Epidemics
Dr. Tom Frieden and Margaret Hamburg shine a light on a harsh truth – we’re on tight window if we want to avoid a pandemic. “In one week, the World Bank will decide how to allocate more than $50 billion in development funding to lower income countries. The World Bank should dedicate some of its International Development Association (IDA) funds – say, 5 percent, or about $1 billion per year over three years – to help countries become better prepared for infectious disease outbreaks.” “Disease outbreaks can wipe out years of investments and severely damage development. Economic losses can dwarf the cost of response – the World Bank estimates that SARS cost the global economy $54 billion in little over half a year and that a severe flu pandemic could cost more than $3 trillion, nearly five percent of global GDP. Because of its global reach, the World Bank is in the best position to take the lead on this critical effort, but the United States delegation has one week to make sure it does so at its annual meeting on June 17. The total needed to close preparedness gaps is estimated at about $4.5 billion annually, less than $1 per person per year. An additional $1 billion infusion each year for the next three years will provide a tremendous jump start – and is a bargain the United States cannot afford to miss.”

Russian Biologist Plans for More CRISPR Babies
Just went you thought the CRISPR baby drama was over (or at least being managed)…. “A Russian scientist says he is planning to produce gene-edited babies, an act that would make him only the second person known to have done this. It would also fly in the face of the scientific consensus that such experiments should be banned until an international ethical framework has agreed on the circumstances and safety measures that would justify them. Molecular biologist Denis Rebrikov has told Nature he is considering implanting gene-edited embryos into women, possibly before the end of the year if he can get approval by then. Chinese scientist He Jiankui prompted an international outcry when he announced last Novemberthat he had made the world’s first gene-edited babies — twin girls. The experiment will target the same gene, called CCR5, that He did, but Rebrikov claims his technique will offer greater benefits, pose fewer risks and be more ethically justifiable and acceptable to the public. Rebrikov plans to disable the gene, which encodes a protein that allows HIV to enter cells, in embryos that will be implanted into HIV-positive mothers, reducing the risk of them passing on the virus to the baby in utero. By contrast, He modified the gene in embryos created from fathers with HIV, which many geneticists said provided little clinical benefit because the risk of a father passing on HIV to his children is minimal.”

Stories You May Have Missed:

  • Microbial House Designs– “There’s a little mischievousness about bringing all these things and making them visible,” said Mr. Pallrand’s wife, Rachel Mayeri, who based the tile designs on electron microscopy images. “These things we tend to think of as being kind of ugly and want to hide — mold spores and mildew growing in our bathtub, and bacterial colonies that are on all the surfaces of your house — they’re all noncharismatic animals, but they’re really crucial to our lives.”

 

Pandora Report: 6.6.2019

Happy Thursday! That’s right – you’re getting your weekly dose of biodefense news a tad early, but don’t worry, we’ll be back to our normal schedule next week! Have you registered for the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security? From anthrax to Zika, we’ll be covering all the topics, debates, and threats related to health security.

GMU Welcomes New Faculty Member – Dr. Ashley Grant
We’re excited to announce that Dr. Ashley Grant, a lead biotechnologist at the MITRE Corporation, is joining the Biodefense Program as an Adjunct Professor to teach BIOD 620: Global Health Security Policy. Dr. Grant was previously the Senior Biological Scientist at the Government Accountability Office where she led government-wide technical performance audits focused on biosafety and biosecurity issues. Dr. Grant was an American Association for the Advancement of Science (AAAS) Science and Technology Fellow in the Chemical and Biological Defense Program Office in the Department of Defense and also worked at the National Academies of Science on the Committee on International Security and Arms Control. Her work focused on international security, nonproliferation, and medical countermeasures against chemical and biological threats. She completed the Field Epidemiology Course at the Naval Medical Research Center (NMRC) in Lima, Peru and was a Visiting Graduate Researcher at the Instituto Nacional de Enfermedades Virales Humanas J. Maitegui (INEVH) in Pergamino, Argentina. Dr. Grant received her PhD in experimental pathology and a MPH in epidemiology from the University of Texas Medical Branch at Galveston. Her graduate work focused on investigating pathogenesis and potential countermeasures for viral hemorrhagic fevers under biological safety level (BSL)-4 conditions. In addition, she received a MA in National Security Studies from the Naval War College and a BS in Chemistry and a BS in Business Economics and Management from the California Institute of Technology.

Congress Passes the Pandemic and All-Hazards Preparedness and Advancing Innovation Act
On Tuesday, June 4th, the House “passed the Pandemic and All-Hazards Preparedness and Advancing Innovation Act. The bill reauthorizes existing statute governing public health efforts at the Department of Health and Human Services. Additions made by the bill – some of which were recommended by the Blue Ribbon Study Panel on Biodefense – address biodetection, hospital preparedness, medical countermeasures and response. Many of these programs will enable HHS to better defend the nation against biological threats. Both chambers of Congress have passed the bill, and it will now go to President Trump for signature. ‘Naturally occurring diseases and biological weapons continue to endanger our nation,’ said Governor Tom Ridge, Panel Co-Chair. ‘The Panel is pleased to see that Congress addressed 15 of our recommendations in this legislation, which will help the nation better prepare for, detect, respond to, and recover from large-scale biological events, bioterrorism or other biological events’.”

National Biodefense Science Board Public Meeting
“The June 10-11, 2019 meeting of the National Biodefense Science Board will focus on early results and progress reports from four new programs that were designed to strengthen disaster health preparedness, response and recovery: the Regional Disaster Health Response System; BARDA DRIVe; ASPR’s new Incident Management Team; One Health; and the National Biodefense Strategy. As part of the evolution of the National Disaster Medical System, NBSB will discuss disaster veterinary medicine and National Veterinary Response Teams. The board will also address issues facing the medical community, including disaster medicine training for community physicians and advance practice physicians and learn about ways to develop and operationalize core competencies for disaster medicine.”

 Exploring Lessons Learned from a Century of Outbreaks
Check out the latest from the proceedings of a 2019 NAS workshop on outbreak readiness. “In November 2018, an ad hoc planning committee at the National Academies of Sciences, Engineering, and Medicine planned two sister workshops held in Washington, DC, to examine the lessons from influenza pandemics and other major outbreaks, understand the extent to which the lessons have been learned, and discuss how they could be applied further to ensure that countries are sufficiently ready for future pandemics. This publication summarizes the presentations and discussions from both workshops.” Within this document, you can access sections on global preparedness progress for the next pandemic influenza, building local and national capacities for outbreak preparedness, pandemic vaccine considerations, etc. “The participants in this workshop examined the lessons from major outbreaks and explored the extent to which they have both been learned and applied in different settings. The workshop also focused on key gaps in pandemic preparedness and explored immediate and short-term actions that exhibited potential for the greatest impact on global health security by 2030. Workshop speakers and discussants contributed perspectives from government, academic, private, and nonprofit sectors. This workshop opened with a keynote address and a plenary presentation, followed by three sessions of presentations and discussions. Additionally, panelists, forum members, and attendees were given the opportunity to assemble into small groups and asked to consider potential priority actions and strategies for systematizing and integrating outbreak and pandemic preparedness so that it is a routine activity from the local to global levels.”

Inside Britain’s Top Secret Research Laboratory 
Have you ever wanted to tour Britain’s top secret laboratory? If Porton Down has been on your wish list, here’s your chance to get a virtual tour. “The BBC was given access inside Porton Down to see what the highly secretive facility was like and, for the first time ever, entered a cleansed version of a level four laboratory. This level is where the Defence Science and Technology Laboratory team analyse some of the world’s deadliest viruses – Ebola and Marburg.”

 DRC Ebola Outbreak Updates 
The outbreak has officially reached 2,000 cases and aid groups in “the region called for pushing the reset button on the response. In its daily update yesterday, the DRC said the outbreak passed the 2,000-case bar on Jun 2. Officials said that, although the landmark is concerning, the health ministry sees some positive signs, including a slight improvement in the security situation, though the situation remains volatile and unpredictable. The ministry added that most incidents related to community resistance have been resolved by community leaders, sensitizers, and psychosocial experts.” For many, the question is still – who is attacking Ebola responders and why? “The first is that local political figures are fomenting and even organizing the attacks as a way of undermining their rivals, presumably officials of the central government or local leaders aligned with them. Many analysts hold that it was actually the national government that set the stage for the use of the Ebola crisis as a political tool, and Gressly largely echoed that account. Last December, he noted, just days before presidential elections, national electoral officials announced that voting would be suspended in the two largest cities in the outbreak zone, Beni and Butembo.” “At least one type of attack appears very much linked: Many of the incidents seem to be outbursts by members of the community who have heard the rumors and believe them. An Ebola team will arrive in a neighborhood to bury a suspected Ebola patient or vaccinate their relatives, and people will throw rocks and chase the team out. Similarly, doctors and nurses at regular health facilities have been threatened by mobs, who are angry that the health workers refer Ebola patients to treatment centers. In one case, a nurse was killed. But there has also been an increase in seemingly well-coordinated assaults by well-armed assailants. More than half-a-dozen times, gunmen have shot up Ebola treatment centers and health facilities where Ebola teams are based, including on April 19, when a group of armed men burst into a hospital where an Ebola team was meeting and killed an epidemiologist with the World Health Organization.”

African Swine Fever and China’s Pork Industry
A highly virulent virus meets a $128 billion dollar industry and we’re not sure which will win. “The virus that causes the hemorrhagic disease is highly virulent and tenacious, and spreads in multiple ways. There’s no safe and effective vaccine to prevent infection, nor anything to treat it. The widespread presence in China means it’s now being amplified across a country with 440 million pigs—half the planet’s total—with vast trading networks, permeable land borders and farms with little or no ability to stop animal diseases.” Despite 50 years of efforts, there has been no vaccine for this devastating disease and “even if China is able to stop the virus transmitting from pig to pig, two other disease vectors may frustrate eradication efforts: wild boars and Ornithodoros ticks. These are the natural hosts of African swine fever virus and are widely distributed in China, though it’s not yet known what role they are playing in spreading the disease there. Zhejiang province, south of Shanghai, has about 150,000 wild boars.”

Stories You May Have Missed:

  • U.S. Measles Cases Top 1,000 – “Federal officials yesterday said US measles cases have reached 1,001, the first time since 1992 that cases have been in quadruple figures, while experts continued to urge vaccination and underscored the safety of the vaccine. Health and Human Services (HHS) Secretary Alex Azar said in an HHS news release, ‘We cannot say this enough: Vaccines are a safe and highly effective public health tool that can prevent this disease and end the current outbreak’.”
  • Nipah Virus in Indian Man – “The Indian government today confirmed that a 23-year-old man from Kerala has a Nipah virus infection, and another 86 case contacts are being monitored for the deadly disease, according to the Deccan Chronicle. Officials said the patient, a college student, is hospitalized and in stable condition. They also said two of the case contacts have fevers, and two nurses who took care of the 23-year-old were also experiencing fevers and sore throats.”
  • GM Fungus Kills 99% of Malaria Mosquitoes – “Trials, which took place in Burkina Faso, showed mosquito populations collapsed by 99% within 45 days. The researchers say their aim is not to make the insects extinct but to help stop the spread of malaria. The disease, which is spread when female mosquitoes drink blood, kills more than 400,000 people per year. Worldwide, there are about 219 million cases of malaria each year. Conducting the study, researchers at the University of Maryland in the US – and the IRSS research institute in Burkina Faso – first identified a fungus called Metarhizium pingshaense, which naturally infects the Anopheles mosquitoes that spread malaria. The next stage was to enhance the fungus. ‘They’re very malleable, you can genetically engineer them very easily,’ Prof Raymond St Leger, from the University of Maryland, told BBC News.”

 

Pandora Report: 4.5.2019

Good news- spring is in full effect and flu transmission is starting to slow. With summer around the corner, have you registered for our workshop on all things biodefense, from anthrax to Zika?

The Plague Years – How the Rise of Right-Wing Nationalism is Jeopardizing the World’s Health
Maryn McKenna is calling out a very real issue – politics, vaccines, and the reality that “As nativist appeals undermine public health systems and cooperation among countries degrades, the potential for catastrophe increases. We are always at risk of a new disease breaking out, or a previously controlled one surging back. What’s different now is that the rejection of scientific expertise and the refusal to support government agencies leave us without defenses that could keep a fast-moving infection at bay. Pathogens pay no respect to politics or to borders. Nationalist rhetoric seeks to persuade us that restricting visas and constructing walls will protect us. They will not. ‘Nationalism, xenophobia, the new right-wing populism in Europe and the United States, are raising our risk,’ said Ronald Klain, who was the White House Ebola response coordinator for President Barack Obama and now teaches at Harvard Law School. ‘There’s a focus not so much on stopping infectious diseases as much as there is on preventing the movement of people to prevent the transmission of diseases. And that’s not possible, because no matter what you do about immigrants, we live in a connected world’.” Moreover, that belief system can be seen in the White House, as President Trump tweeted during the 2014 Ebola outbreak – “Keep them out of here,” he tweeted about American missionaries who fell ill in West Africa. “Stop the Ebola patients from entering the U.S.” and “The U.S. cannot allow Ebola infected people back.” As McKenna notes “This is the perverse legacy of nationalism in power: By stigmatizing immigrants and segregating them, xenophobia can turn the lie of the ‘dirty foreigner’ into truth.
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 Hospital-Associated Conditions Penalties: What They Really Mean
Just how good is your local hospital at preventing infections in patients? GMU biodefense doctoral student and infection preventionist Saskia Popescu is breaking down what these quality metrics really mean and how hospitals are scoring. “In 2014, CMS established another rule tying health care quality of care and reimbursement—the HAC Reduction Program. Although this started with reporting of certain conditions, such as central-line associated bloodstream infections, these pay-for-performance programs were expanded over time. The program links hospital performance in certain categories with reimbursement. That’s right, if a hospital performs poorly, they can be hit where it hurts—the bank. Scores are determined by a hospital’s performance in 2 domains—1 includes indicators like pressure ulcers and in-hospital falls with injury, while the second domain focuses on health care-associated infections that include central-line associated bloodstream infections, catheter-associated urinary tract infections, certain surgical-site infections, methicillin-resistant Staphylococcus aureus bacteremia, and Clostridium difficile (C diff) infections. Considering there are 500,000 cases and 15,000 deaths a year related to C diff in the United States, it’s not surprising that CMS would want to crack down on those cases associated with hospitalization.” “There are just over 5000 US community hospitals that will likely receive CMS reimbursement in FY2019, and 800 (16%) of these institutions experienced financial penalties related to poor performance. That’s a pretty substantial amount, but the painful truth is that this number is likely higher considering there have been concerns for hospitals failing to report HACs and a general lack of CMS data validation.”

Ebola Continues to Hit the DRC
We’ve surpassed 1,000 cases and are now beyond the point where the WHO called a PHEIC in the 2014-2016. On Tuesday, the “World Health Organization (WHO) today reiterated that the outbreak in the Democratic Republic of the Congo (DRC) will be defeated only with local communities at the helm of response efforts. The message came from Ibrahima-Soce Fall, MD, WHO assistant director-general for emergency response, who held a brief teleconference this morning from Butembo. With 72 Ebola cases reported last week and 56 in the previous week, March was a low point for responders, as activity spiked and the outbreak topped the 1,000-case milestone.” On Thursday, it was reported that 7 new cases were identified, including a healthcare worker. “The healthcare worker in Musienene brings the total number of health workers infected during the outbreak to 82 (7.4% of all confirmed or probable cases), and 29 of them have died, the DRC said. In an update released late yesterday, the DRC recorded 8 new confirmed cases, and 7 deaths, including 5 community deaths. Butembo and Katwa each had a community death, and Mandima recorded 3. Community deaths have been a compounding factory of this outbreak, as they enable the virus to spread more easily among family members and funeral attendees.” Based off the latest case counts, three main areas have been the hotspots for the outbreak – Katwa, Vuhovi, and Mandima.

Next Generation Biosecurity Online Course
“An open online course exploring biosecurity and biological threats begins this week on FutureLearn. This course is for professionals working in public and global health, international security, politics and international relations. It may be of particular use to biosafety officers in academia, industry or government, and early-career science scholars in the life sciences.” You can access the course here.

 Why the Scientific Debate Over a UW Bird Flu Study Isn’t Going Away
“A University of Wisconsin-Madison laboratory is set to resume experiments that could build the foundation of an early warning system for flu pandemics. The research is based on altering a deadly type of the influenza virus in a way that could make it more dangerous, though, and critics say its approval lacked transparency and creates unnecessary risks. Yoshihiro Kawaoka is a virologist and professor at the UW School of Veterinary Medicine and the University of Tokyo who has figured prominently in Wisconsin’s long-term central role in flu research. Kawaoka’s work has been the focus of fierce debate among epidemiologists ever since he announced in 2011 that his lab had successfully altered the H5N1 subtype of the influenza A virus to be transmittable through the air among ferrets. These small mammals are a common laboratory stand-in for studying human flu transmission.” “That debate has lingered since 2011 and intensified in early 2019 after the federal government approved funding for Kawaoka to continue his research. Marc Lipsitch is a professor of epidemiology and director of the Center for Communicable Disease Dynamics at Harvard T.H. Chan School of Public Health. He’s a longtime critic of research that modifies flu viruses to be more dangerous in humans. ‘What worries me and my colleagues is the effort to modify viruses that are novel to humans and therefore to which there’s no immunity in the population, and where a laboratory accident wouldn’t just threaten the person who got infected … but potentially could be the spark that leads to a whole pandemic of infectious disease,’ Lipsitch told WisContext.”

New Plant Breeding Tech for Food Safety
Tackling the issue of food safety is up there with a universal flu vaccine – something we all want, but a task requiring a Herculean effort. A new insight to this problem has come forward though and the authors “argue that with careful deployment and scientifically informed regulation, new plant breeding technologies (NPBTs) such as genome editing will be able to contribute substantially to global food security. Previously, conventional plant breeding through cross- and self-pollination strategies played a major role in improving agricultural productivity. Moreover, the adoption of genetically modified (GM) crops by smallholder farmers has led to higher yields, lower pesticide use, poverty reduction, and improved nutrition. Nevertheless, so far only a few developing and emerging economies—such as China, India, Pakistan, Bangladesh, and South Africa—have embraced GM crops. Even though three decades of research show that GM crops are no more risky than conventional crops, many countries in Africa and Asia are hesitant to promote the use of GM crops, largely because of erroneously perceived risks and fears of losing export markets to Europe.”

Stories You May Have Missed:

  • Opioid Epidemic Increases Some Infectious Disease Rates – “The United States faces a converging public health crisis as the nation’s opioid epidemic fuels growing rates of certain infectious diseases, including HIV/AIDS, hepatitis, heart infections, and skin and soft tissue infections. Infectious disease and substance use disorder professionals must work together to stem the mounting public health threat, according to a new commentary in the Journal of Infectious Diseases. The article was co-authored by officials from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and the Institute of Human Virology at the University of Maryland School of Medicine in Baltimore. Since 1999, nearly 400,000 people in the United States have fatally overdosed on opioid-containing drugs, with 47,600 deaths in 2017 alone. Many people with opioid use disorder (OUD), who initially were prescribed oral drugs to treat pain, now inject prescribed or illegal opioids. High-risk injection practices such as needle-sharing are causing a surge in infectious diseases. Additionally, risky sexual behaviors associated with injection drug use have contributed to the spread of sexually transmitted infections.”
  • US Army Develops Fast-acting Spray for CW Decon– “Chemical and biological weapons experts earned the U.S. Army a patent on Tuesday for their groundbreaking work on rapid decontamination. Gregory Peterson, Joseph Myers, George Wagner, Matthew Shue, John Davies, Jr., and Joseph Rossin were listed as the inventors on U.S. Patent 10,245,456, “Process for Decontamination and Detoxification with Zirconium Hydroxide-Based Slurry.” (The patent is linked below). The research team works at the Army’s Chemical Biological Centerin Maryland, and has significantly reduced decontamination time down to less than 30 minutes and the amount of water needed to treat large amounts of equipment coated in deadly toxins.”

 

Pandora Report: 3.22.2019

Non-Medical Obstacles Impacting Public Health Responses
GMU Biodefense doctoral alum Jennifer Osetek is discussing non-medical challenges of public health preparedness and responses. “Clearly, for most populations, receiving medical therapies and supplies saves lives; however, medications unable to reach their intended targets prove worthless. ‘Vaccines that remain in the vial are 0% effective’ (Orenstein, Seib, Graham-Rowe, & Berkley, 2014). Outside obstacles stand between patients and the administration of critical health care resources (CHCRs) including medical countermeasures (MCMs), equipment, and supplies. These obstacles can, therefore, result in severe consequences. From a public health perspective, resources that do not reach those affected during an outbreak can mean the difference between a contained disease cluster or the disease spreading and threatening national or even global health security. This is especially relevant as ‘the problem of infectious disease is no longer only one of prevention, but also—and perhaps even more—one of preparedness’ (Lakoff 2008). Obstacles preventing sick people from accessing available resources is not a hypothetical concern any longer. Instead, it is one continually being played out both domestically and internationally in routine and emergency response situations. These obstacles are rooted in various causes and require more specific identification and analysis to prevent inadequate public health responses. Barriers to the delivery of care cost hundreds of thousands of lives simply because they are not defined or incorporated into public health planning and execution operations.”

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security 
Come spend 3.5 days with some of the top minds in the biodefense field this July at our summer workshop. From vaccine development to biosecurity as a wicked problem, we’ll be having frank conversations regarding the toughest issues in health security. Register before May 1st for an early discount and get another discount if you’re a returning student, GMU alum/current student/professor, or registering with a large group.

HHS’ BARDA Funds Its First Marburg Vaccine
In pursuit of making progress against those viruses causing hemorrhagic fevers, HHS has partnered with Public Health Vaccines to help develop a Marburg virus vaccine. “The Biomedical Advanced Research and Development Authority (BARDA), part of the HHS Office of the Assistant Secretary for Preparedness and Response, awarded an initial 2-year, $10 million contract to Public Health Vaccines, LLC to begin development of a vaccine to protect against Marburg infection. ‘This vaccine candidate is the first BARDA has funded against the Marburg virus, and it is an important step toward meeting an urgent public health and biodefense need,’ said BARDA Director Rick Bright, Ph.D. ‘We will leverage our experience in establishing public-private partnerships that bring results that are critical to saving lives and protecting Americans – and possibly people across the globe – from health security threats.’ The Public Health Agency of Canada initially developed the vaccine and licensed it to Public Health Vaccines, LLC. This approach is similar to the one Merck & Co. used to develop its Ebola vaccine. Under the agreement with BARDA, Public Health Vaccines will conduct preclinical development to demonstrate the proof of concept that the vaccine can protect against Marburg virus. If that initial development succeeds, BARDA has the option to provide additional funding for a total of up to $72 million to advance the Marburg virus vaccine through a Phase 2 clinical trial, and begin development of a vaccine candidate against the Sudan ebolavirus, a closely related virus, as well.”

Ebola Outbreak Updates
The outbreak in the DRC has been gaining speed in recent days at eight new cases were reported on Tuesday. “The illnesses lift the overall outbreak total to 968 cases, which includes 903 confirmed and 65 probable infections. Health officials are still investigating 234 suspected cases. Three more people died from Ebola, including two in community settings—one in Katwa and one in Mandima. The other fatality occurred at Butembo’s Ebola treatment center. The developments increase the overall number of deaths to 606. In its weekly diseases and health emergencies update, the WHO’s African regional office said though Katwa health zone is still the main epicenter, responsible for 44% of cases over the past 3 weeks, seven health zones have reported new confirmed cases over the past 3 days and remain a concern. Besides Katwa they include Masereka, Vuhovi, Butembo, Kyondo, Mandima, and Kayina.” Overall, there have been 44 cases reported in the last 5 days, which is deeply concerning and brought an end to the downward trend we were seeing. 

WHO Panel Calls for Registry of Human Gene Editing Research
Two days into a panel meeting of gene editing experts and the WHO is calling for a registry to facilitate transparency in human genome editing research. The panel was created as a result of CRISPR baby experiment and is in the process of setting up the registry to help guide work while ensuring safety. “The WHO panel’s statement said any human gene editing work should be done for research only, should not be done in human clinical trials, and should be conducted transparently. ‘It is irresponsible at this time for anyone to proceed with clinical applications of human germline genome editing.’ The WHO’s director-general, Tedros Adhanom Ghebreyesus, welcomed the panel’s initial plans. ‘Gene editing holds incredible promise for health, but it also poses some risks, both ethically and medically,’ he said in a statement. The committee said it aims over the next two years to produce ‘a comprehensive governance framework’ for national, local and international authorities to ensure human genome editing science progresses within agreed ethical boundaries.”

Lab Failures – How Dangerous Pathogens Are Escape Artists
Any research with dangerous pathogens brings with it an inherent risk, whether it be biosafety or biosecurity related. Unfortunately there are a lot of opportunities for failure during such work and recent efforts have looked to incidents to try and identify trends. “It looks like there are many different points of failure — machinery that’s part of the containment process malfunctions; regulations aren’t sufficient or aren’t followed. Human error means live viruses are handled instead of dead ones. Sometimes, these errors could be deadly. ‘If an enhanced novel strain of flu escaped from a laboratory and then went on to cause a pandemic, then causing millions of deaths is a serious risk,’ Marc Lipsitch, a professor of epidemiology at Harvard, told me.” Breaches can occur as a result of carelessness or just pure human error. “The blizzard of dangerous errors over only a few months in 2014, and the additional errors uncovered by subsequent investigations, inspired the US government to change its practices. The government called on all labs that handle secure substances to immediately improve their inventory policies and review their procedures, and to provide written documentation that they’d done so. It launched government-wide reviews to better understand how to safely regulate pandemic pathogens. The FDA began providing better training and conducting periodic audits to make sure that the safety procedures that were ignored in this case are being followed.”

 A Modern Take on the Broad St. Pump Outbreak
GMU Biodefense doctoral student and infectious disease epidemiologist Saskia Popescu is taking a look into an outbreak linked back to contaminated wells and how this reminds us all of the cholera outbreak in 19th century London. “A city, an outbreak, and a contaminated well. Surely this sounds like some kind of modern version of the John Snow cholera outbreak and the Broad St. pump. But unfortunately, it’s this week’s US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report with a much more recent example of how bad sanitation and contaminated water can affect a city. In 2017, a city in Nebraska experienced an outbreak of Campylobacter jejuni that drove home the realities of One Health, the theory that the health of humans, animals, and the environment are all connected. It all began on a March day in 2017, when the Southwest Nebraska Public Health Department got a call regarding a spike in campylobacteriosis cases—5. The condition, campylobacteriosis –infection due to Campylobacter jejuni, is reportable, indicating labs and hospitals are required to report them to the health department. Typically, a single case of Campylobacter was reported in this particular city every 3 years, making the infection quite rare. ”

How A Measles Quarantine Can Lead to Eviction
Vaccine-preventable diseases have been a topic of conversation lately with a surge of measles cases and presence of the anti-vaxxer movement. One particular aspect of public health and managing outbreaks of vaccine-preventable diseases though, is quarantine. A recent article discusses the need for paid medical/sick leave and how those quarantined during outbreaks have faced financial hardships. “The health department persuaded the restaurants where the families worked to not fire them, but the families nevertheless faced steep consequences from avoiding work, according to Archer and Edsall. One family missed so many paychecks that they were evicted. Several people had their phones shut off after unpaid bills racked up. Ultimately, the health department had a collection among its own employees to raise money to donate to the quarantined families. Much of this could have been avoided if the United States had a mandatory-paid-sick-leave policy, Archer and Edsall argue. The Family and Medical Leave Act of 1993 protects the jobs of some workers for up to 12 weeks for medical reasons, but it does not guarantee pay, and it doesn’t cover more than 40 percent of all American workers. Ten states and 33 cities have their own sick-leave policies, but still, 28 percent of American workers lack access to any kind of sick leave. The United States and South Korea are the only countries in the Organization for Economic Cooperation and Development that do not mandate paid sick leave.”

‘TIS the Way to Transport Highly Contagious Patients by Air
“U.S. Air Force personnel conducted training on the Transportation Isolation System (TIS), an enclosure the Defense Department can use to safely transport patients with highly contagious diseases, aboard a C-17 Globemaster III last week in South Carolina. First implemented after the Ebola virus outbreak in 2014, the TIS was engineered to ensure service members get the proper treatment in the event they get infected with any disease during relief missions to affected areas while protecting the aircrew and support personnel. TIS training takes place roughly three times a year and lasts for four days. The training goes from initial donning and doffing protocols for personal protective equipment to actual patient transport and care. This can include treating simulated patients at the “infection scene” all the way to securing them within the TIS unit and even taking part in a simulated in-flight transport.”

Antibiotics, Orchards, and A Citrus Scourge That Instigated Public Health Fear
I’m just going to say it – if I want to know what’s really going on in the world of antimicrobial resistance, I’m looking to Maryn McKenna. Call her our canary in the AMR coal mine. Yet again, she’s giving insight into a concerning avenue for antimicrobial resistance and over usage in the citrus world – this time combatting citrus greening. “The US Environmental Protection Agency (EPA) is in the process of allowing growers to use streptomycin and oxytetracycline as routine treatments, spraying trees several times per year, beginning with the ‘first flush’ of leaves this spring. Growers in the state could end up using as much as 440,000 kilograms of the drugs. Although the compounds, which are both used in human medicine, have been sprayed on other crops in the past and applied in limited amounts to citrus groves, the scale of this application has researchers and public-health advocates alarmed. ‘They are doing a huge experiment with limited monitoring,’ says Steven Roach, a senior analyst in Iowa City at Keep Antibiotics Working, a coalition of research and advocacy groups that has formally objected to the plan with the EPA.” That’s right, as mounting pressure has been focused on reducing antibiotic usage in agriculture, these farmers are planning to use more. Even more frustrating is the lack of evidence for both efficacy of use but also the implications of long-term use. As McKenna notes, “Academic researchers disagree on how much ecological harm or antibiotic resistance will result.” She further points out that “The EPA has specified certain rules to reduce the risk of resistance emerging. Spraying is limited to a few times per year; farm workers must wear full protective clothing; and groves cannot be fertilized with uncomposted manure. It has also set a deadline of seven years for re-evaluating the programme, half the time that it would normally impose for an agricultural chemical.”

Assessing the Need for and Uses of Sequences of Interest Database
You can now find the report on the proceedings from this two-day workshop here. “Over the past decade, the biotechnology economy has experienced remarkable growth, resulting in the rapid expansion of biological knowledge and application. Such advances have lowered the technical and financial barrier to entry for bioexperimentation outside the traditional environments of academia and industry. Together these developments provide exciting new opportunities for scientific growth. However, they create openings for actors with malicious intent to harness readily available tools and techniques to create biological threats or bioweapons. In this report, we present the results of a workshop designed to convene key experts from diverse stakeholder groups to understand how a genetic database of “sequences of interest” (SOIs) can best support stakeholders—government agencies, academic researchers, and commercial groups—to improve the utility, safety, and security of biotechnology research endeavors. The sessions consisted of a mix of presentations, panel discussions, and small and large group discussions. This report should be viewed as an exploratory first step in discussing a very complex topic with broad and often conflicting stakeholder interests.”

Attacks on Medicine Machine Learning: Cyberbiosecurity
“With public and academic attention increasingly focused on the new role of machine learning in the health information economy, an unusual and no-longer-esoteric category of vulnerabilities in machine-learning systems could prove important. These vulnerabilities allow a small, carefully designed change in how inputs are presented to a system to completely alter its output, causing it to confidently arrive at manifestly wrong conclusions. These advanced techniques to subvert otherwise-reliable machine-learning systems—so-called adversarial attacks—have, to date, been of interest primarily to computer science researchers (1). However, the landscape of often-competing interests within health care, and billions of dollars at stake in systems’ outputs, implies considerable problems. We outline motivations that various players in the health care system may have to use adversarial attacks and begin a discussion of what to do about them. Far from discouraging continued innovation with medical machine learning, we call for active engagement of medical, technical, legal, and ethical experts in pursuit of efficient, broadly available, and effective health care that machine learning will enable.”

Stories You May Have Missed:

  • H3N2 Cases Keep Flu Activity High – “Though flu activity decreased slightly last week, a wave of H3N2 virus activity has led to severe illnesses across the country and four more children have died from the disease, according to this week’s FluView report from the Centers for Disease Control and Prevention (CDC). This is the second week in a row the CDC recorded more H3N2 cases that H1N1, the virus subtype that dominated the first part of the 2018-19 flu season. ‘H3N2 viruses are typically associated with more severe illness in older adults, and flu vaccine may protect less well against H3N2 illness in older adults, making prompt treatment with flu antivirals in this age group especially important during the current period of H3N2 predominance,’ the CDC said today in a summary of the report.”
  • Changing the Game in Pediatric Diagnosis of Serious Bacterial Infections – “Figuring out why that 2-month-old with a fever is crying often includes spinal taps, which are painful and risky, alongside rapid antibiotic treatment to avoid meningitis. Bacterial meningitis can be deadly, especially in infants; the US Centers for Disease Control and Prevention (CDC) reports that between 2003 and 2007, there were 4100 cases of bacterial meningitis reported in pediatric patients in the United States, as well as 500 deaths. Given these rates and the risk of life-threatening infections, it’s not unusual that pediatricians would want to perform a spinal tap or administer antibiotics until further diagnostics can be performed. Fortunately, a new protocol has been developed that could not only make a diagnosis of bacterial infections in infants easier but would remove the need for spinal taps and unnecessary antibiotic treatments. Investigators from the Pediatric Emergency Care Applied Research Network (PECARN) created a new protocol from a study of more than 1800 infants seen across 26 emergency departments in the United States.”

Pandora Report: 3.15.2019

TGIF or beware the Ides of March? Either way, we’ve got some health security news for you, so grab your Caesar salad and enjoy this weekly dose of all things biodefense.

Summer Workshop – Are You Registered?
We’re offering an early-bird discount for registration prior to May 1st – have you signed up? Threats to global health security continue to evolve due to the changing nature of conflict, advances in science and technology, globalization, and the growing threat posed by emerging infectious diseases and pandemics. Pandemics, Bioterrorism and Global Health Security: From Anthrax to Zika is a three and a half-day workshop, non-credit summer workshop designed to introduce participants to the challenges facing the world at the intersection of national security, public health, and the life sciences. The workshop faculty are internationally recognized experts from the government, private sector, and academia who have been extensively involved with research and policy-making on public health, biodefense, and national security issues. Don’t miss out on an additional discount if you’re a returning attendee, GMU employee/student, or are registering with a large group.

Germline Gene-Editing – Do We Need a Moratorium?
In the wake of He Jiankui’s gene-edited babies, many are calling for a moratorium on germline gene-editing. In fact, the Chinese health ministry released draft guidelines at stopping rogue efforts with unapproved biotech. This topic is so important that Nature published a call for a moratorium by several top ethicists and researchers. “Whether or not a moratorium receives more widespread support, several things need to be done to ensure that germline gene-editing studies, done for the purposes of research only, are on a safe and sensible path. As a starting point, proposals for all ethically vetted and approved basic research studies that use gene-editing tools in human embryos and gametes, including those aimed at assessing efficacy and safety, should be deposited in an open registry. Second, researchers need to develop a system that allows early recognition of any research that risks overstepping predefined boundaries. A useful model to follow could be the WHO guidance for regulating research with a potential biosecurity risk. The system should include a mechanism — perhaps affiliated with the open registry — that allows researchers to flag up potentially dangerous research. Analysing whether He’s work could have been prevented will help. It’s important to hammer out whether, how and to whom scientists and ethicists who became aware of the project could have voiced their concerns — and how they could do so more easily in future. Raising the alarm would require a change of practice for researchers who, for the sake of scientific independence, often do not intervene in the choice of research projects undertaken by their peers.” In the joint statement, the researchers noted that “By ‘global moratorium’, we do not mean a permanent ban. Rather, we call for the establishment of an international framework in which nations, while retaining the right to make their own decisions, voluntarily commit to not approve any use of clinical germline editing unless certain conditions are met.”

Taking A Step Back in Staph
This common skin bug is becoming increasingly resistant to not only intervention efforts, but also antimicrobials. Saskia Popescu, GMU biodefense doctoral student and infection preventionist, discusses the latest CDC report on the concerning state of Staphylococcus aureus infections, including MRSA. “Staph infections can either be methicillin-resistant or methicillin-sensitive (MSSA) but, overall, staph is the leading cause of infections in US hospitals. Infection preventionists have been zeroing in on MRSA for decades in the health care industry, working tirelessly to stop the spread. Unfortunately, according to the CDC, progress in curbing MRSA has slowed, and findings indicate that MSSA rates are also not declining. One theory is that the opioid crisis may be connected, as 9% of all serious staph infections in 2016 occurred in patients who used injection drugs, a statistic that represented an increase from 4% in 2011. Consider this—right now, nearly 1 in 10 staph infections that occur are in people who use intravenous drugs.”

 MERS-CoV Outbreak
Speaking of healthcare-associated infections…Saudi Arabia’s Ministry of Health reported two more cases in an ongoing outbreak in Wadi ad-Dawasir. Unfortunately, most of these cases are linked to healthcare exposures and a handful are related to contact with camels. One particular study assessed camel infections, noting that “The investigators focused on 53 studies published from 2013 to December 2018, of which 33 were from the Middle East, 13 from Africa, and 7 from Spain, Australia, Japan, Bangladesh, and Pakistan. The team reported its findings yesterday in the preprint server bioRxiv. The team said another group unknowingly carried out a similar review, which covered studies published from 2013 to April 2018 and was published Feb 21 in Epidemiology and Infection by a team from Qatar and the Netherlands. The authors of the bioRxiv said their study confirms and updates the findings of the other study.The authors of the new review found that MERS-CoV seroprevalence in camels increases with age, up to 80% to 100% in adult dromedaries, which the team says suggests that the virus is widely endemic in camels on the Arabian Peninsula and in African countries that export dromedaries. However, they note variable patterns within some countries. Also, the experts found a high prevalence of active infection in juvenile animals and at sites where the animals mix, such as livestock markets and slaughterhouses. Other findings from the longitudinal studies they examined include reinfection despite high MERS-CoV antibody titers.”

Improving Global Health Security Through One Health Platforms
Don’t miss out on this March 21st even at the National Press Club, hosted by the USAID -funded Preparedness and Response project. “Over the past four and a half years, the USAID-funded Preparedness & Response project has worked across 16 countries to spread the vision of a multisectoral One Health approach — where human, animal, and environmental health assets join forces — becoming the standard way to prevent, detect, and respond to emerging pandemic threats. As the project approaches the end of its tenure, please join us as we bring together the One Health community of practice to share key learning, demonstrate successful approaches to country ownership, and discuss the future of multisectoral coordination for preparedness and response.”

Biodefense MS and PhD Open Houses
Looking to improve your biodefense knowledge while obtaining a graduate degree? The Schar school Biodefense program is the place for it – from anthrax to Zika, we’ve got you covered. We’ve got two events coming up that you won’t want to miss if you’re looking to invest in your education. On Wednesday, March 20th you can attend a Master’s in Biodefense Webinar (online) at 12pm EST and at 7pm there will be a PhD Open House at the Arlington campus. These are great opportunities to hear about the biodefense programs, meet faculty and students, and learn how you can become a biodefense guru through our in-person and online programs.

Ebola Outbreak Updates and An Epidemic of Suspicion 
On Tuesday, two new cases were reported, as well as two new deaths, bringing the case counts to 925, including 584 deaths. Vinh-Kim Nguyen recently wrote in NEJM regarding the violence and turmoil surrounding outbreak response efforts in the DRC. “As a medical team leader for Médecins sans Frontières (MSF), I work halfway between Butembo and Goma, North Kivu’s capital city and a transport hub. In late January, five Ebola cases were identified in Kayna and Kanyabayonga; MSF opened a center in Kayna to isolate patients with suspected cases and test them for Ebola virus disease (EVD). I soon suspected that most patients would turn out to have diseases other than EVD. The standard “isolate and test” model often leads to expectant management for such patients — the tendency is to “cover” patients with antimalarials and broad-spectrum antibiotics, wait for EVD test results, and then discharge patients without Ebola. We instead took a more active approach, treating severe cerebral malaria, typhoid, sepsis, and even cholera. I have witnessed how such active clinical management for all patients, along with MSF’s long-term presence in North Kivu, has contributed to the community’s acceptance of our Ebola unit. Having patients emerge from isolation in improved health is powerful evidence that we aim to make everyone better, not just to stop Ebola’s spread.” Nguyen further discusses the labeling of attacks as “resistance” are fundamentally wrong and how they are actually a bigger issue – persons against prevention activities aimed at them and those orchestrated, armed attacks against symbols of the international response. “The mistrust of authority in the DRC also reflects a growing global mistrust of experts and science. Vaccine refusals are a growing problem worldwide, and they have already resulted in measles epidemics in the United States and France and in outbreaks elsewhere. Mistrust of public health authorities may thus be the new norm, and smoldering epidemics merely a symptom.”

 Ambitious American AIDS Initiatives & Cutting Foreign Aid Programs
In the February State of the Union, President Trump pledged to end the HIV epidemic by 2030. This re-invigoration of HIV efforts was shocking, but exciting. The official pledge of $291 million to help end transmission of HIV within the United States will hopefully bring us closer to that goal through initiatives that increase access to pre-exposure prophylaxis (PrEP). While Congress still needs to approve the 2019 budget, there is a concerning proposal within it. Beyond the cuts to Medicare and Medicaid ($845 billion and $241 billion respectively) which are deeply worrisome, the budget seeks to drop US contribution to the Global Fund to Fight AIDS, Tuberculosis, and Malaria by one billion. “The US will contribute $3.3bn between 2020 and 2023, a reduction on its previous contribution of $4.3bn. In a statement the global fund said: ‘The United States is the leading supporter of the Global Fund, and we are confident that the U.S. Congress will continue the strong funding that is urgently needed to improve global health security by ending epidemics. Various proposals are being considered and we look forward to final budget decisions taken by Congress in the coming months.’ The fund is looking for at least $14bn for the next year and, as the US donates around a third of the total, its contribution will mark a significant reduction on previous years. Mr Trump also proposes a $12.3bn cut to the State Department and USAID, marking a 23 per cent cut from the previous year. USAID, through the President’s Emergency Programme for Aids Relief, is a key player in the United Nations programme to eliminate HIV around the world.”

WHO Launches New Global Influenza Strategy
Influenza continues to be not only an annual issue, but the lack of preparedness for severe seasons and potentially pandemic strains is also an international issue. The WHO released their Global Influenza Strategy for 2019-2030. “The threat of pandemic influenza is ever-present.” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The on-going risk of a new influenza virus transmitting from animals to humans and potentially causing a pandemic is real.   The question is not if we will have another pandemic, but when.  We must be vigilant and prepared – the cost of a major influenza outbreak will far outweigh the price of prevention.” This new strategies “is the most comprehensive and far-reaching that WHO has ever developed for influenza.  It outlines a path to protect populations every year and helps prepare for a pandemic through strengthening routine programmes. It has two overarching goals: 1. Build stronger country capacities for disease surveillance and response, prevention and control, and preparedness. To achieve this, it calls for every country to have a tailored influenza programme that contributes to national and global preparedness and health security. 2. Develop better tools to prevent, detect, control and treat influenza, such as more effective vaccines, antivirals and treatments, with the goal of making these accessible for all countries.”

How Africa Can Quell the Next Disease Outbreaks
How can African nations enable public health institutions (NPHIs) to help stop emerging and re-emerging infectious diseases from springing up and causing large outbreaks? Beyond waiting for outside intervention and emergency help from the West, John N. Nkengasong, head of the Africa Centre for Disease Control and Prevention, calls “on all 55 member states to establish or strengthen NPHIs. And I urge the private sector in Africa and worldwide, and bodies everywhere, to invest in these efforts. According to the World Bank, Africa needs between US$2 billion and $3.5 billion a year for epidemic preparedness; in 2015, 8 African nations received from various donors about $700 million for this cause.” Furthermore, he notes that “NPHIs should prioritize four broad areas. First, providing basic functions such as disease surveillance and coordinating emergency operations, even in remote areas. Second, creating lab networks that can quickly diagnose, track and pinpoint the origin of emerging infections. Third, developing a workforce to collect, assess, share and act on quality data, including advanced technologies such as genetic sequencing and informatics. Fourth, developing a strong capacity for social scientists to engage with communities and change behaviours. Sociologists and anthropologists were crucial in ending the Ebola outbreak in West Africa by, for example, promoting safe burials — which meant modifying long-standing traditions, such as washing the corpse of a loved one.”

Measles and the Threat of the Anti-vaccination Movement
From measles to polio, the threat of vaccine-preventable diseases is a real one that we’re slowly losing our headway in. “The anti-vaccination movement threatens to undo years of progress made against a range of preventable diseases. Mass immunization campaigns helped slash the number of measles deaths worldwide by 80 percent between 2000 and 2017, but that headway may now be stalling. Today, only 85 percent of the world’s infants receive the first dose of the treatment, and even fewer get the second dose. This is well short of the 95 percent vaccination rate that the WHO says is needed to prevent outbreaks. If the anti-vaccination movement continues to gain momentum, there could be more outbreaks in places such as the United States, where measles has been considered eliminated for nearly two decades. With more cases, there will be greater potential for measles to spread across borders. Until governments turn the tide of the anti-vaccination movement, health workers will face the dual challenge of containing measles in both countries where the disease is still endemic and those where it was thought long gone.”

Infectious Diseases Spike Amid Venezuela’s Political Turmoil
The crisis in Venezuela is leaving millions without clean water, access to hospitals,  safe food, and more. Unfortunately, it is also causing a spike in infectious diseases as public health and healthcare efforts have been all but decimated. “These so-called vector-borne diseases—transmitted by mosquitoes or other organisms—have increased by as much as 400 percent in Venezuela in the last decade, according to a review study published in The Lancet in February. Spiraling economic and political turmoil have worsened the situation, as has the government’s apparent hostility toward researchers who publish epidemiological data—with reports of pro-government paramilitary groups smashing labs and even stealing experimental mice. “’Last year we had more than 600,000 cases [of malaria] reported by the government,’ says study co-author Maria Eugenia Grillet, a tropical disease ecologist at Central University of Venezuela in Caracas. She and her co-authors estimated there were actually around 1.2 million cases, taking into account underreporting and disease relapses, Grillet notes. (Relapses occur when a patient has recovered but still carries the malaria-causing parasite and later suffers a recurrence of symptoms.) She blames the increase on a lack of antimalarial surveillance, treatment and control, partly due to funding cuts. ‘Research in our universities and laboratories is almost completely paralyzed because there are no financing programs that allow us to cover the basic needs to carry out our experiments or fieldwork,’ she says.”

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  • New Vaccine Manufacturing Innovation Centre Bolsters Pandemic Preparedness – “The first dedicated Vaccines Manufacturing Innovation Centre (VMIC) is coming to the UK in 2022, addressing gaps in late-stage vaccine manufacturing for clinical trials and emergency preparedness for epidemic and pandemic threats. Led by the the University of Oxford’s Jenner Institute, the new centre has been awarded funding by UK Research and Innovation of £66 million ($86 million USD) through the UK Government’s Industrial Strategy Challenge Fund (ISCF) Medicines Manufacturing challenge. ‘This is an exceptional opportunity for the UK to lead in the provision of vaccines against a wide range of outbreak pathogens which threaten to cause major epidemics,’ said Adrian Hill, Jenner Institute Director. ‘The lack of commercial incentive to develop these has now led to this exceptional partnership of major academic and industrial players in the vaccine field, to accelerate a range of vaccines towards large-scale manufacture and stockpile provision for vulnerable populations. In parallel, the Centre will develop innovative manufacturing technologies with UK companies and Universities to support the next generation of life-saving preventive and therapeutic vaccines’.”

Pandora Report: 12.28.2018

It’s our last Pandora Report newsletter of 2018 and what a year it has been! From horsepox synthesis to CRISPR babies and an Ebola outbreak, 2018 hasn’t been a boring one. As 2019 rolls in, we’d like to thank our readers for a great year of biodefense news (and nerdom) – we truly appreciate you!

Don’t Let Russia Undermine Trust in Science
Genetic editing has been a hot conversation topic lately and while there are arguments all along the spectrum, Jesse Kirkpatrick and Michael Flynn are drawing attention to a growing threat in the debate – disinformation. “Russia, or another U.S. adversary, could use the megaphone of social media to stoke worries about genome editing in the U.S. in a campaign timed with the next high-level meeting on gene drives. In fact, Russia has recently engaged in a disinformation campaign claiming—falsely—that the U.S. is developing biological weapons in neighboring countries, and it has also used state-funded news outlets to cast doubt in the U.S. about the safety of GMOs. These campaigns are concerning—they can impact national security, international relationships, and trade—yet haven’t received nearly the same level of exposure as discussion about misinformation campaigns designed to achieve political objectives. As a report prepared for the U.S. Senate shows, Russia used every major social media platform, including Snapchat, Pinterest, and Tumblr, to target specific demographic groups in an effort to influence the 2016 presidential election. Similar information warfare tactics could be used to exploit Americans’ lack of knowledge and opposition to particular forms of genome editing.” In fact, this concern is so significant that it was discussed in the recent report on biosecurity in the age of genome editing, which you can read here. There are legitimate concerns that disinformation regarding weaponized gene drive technology would be picked up by major news outlets and fuel false stories. A healthy dose of skepticism and making sure your news sources for science and tech are legitimate is important.

Piloting Online Simulation Training for Ebola Response
Maintaining competencies and training efforts can be cumbersome in preparedness efforts, but even more challenging during an outbreak in a resource-challenged area. A new article pilots a trial of internet-distributable online software to train healthcare workers in highly infectious diseases, like Ebola. “This study describes a pilot trial of the software package using a course designed to provide education in Ebola response to prepare healthcare workers to safely function as a measurable, high-reliability team in an Ebola simulated environment. Eighteen adult volunteer healthcare workers, including 9 novices and 9 experienced participants, completed an online curriculum with pre- and posttest, 13 programmed simulation training scenarios with a companion assessment tool, and a confidence survey. Both groups increased their knowledge test scores after completing the online curriculum. Simulation scenario outcomes were similar between groups. The confidence survey revealed participants had a high degree of confidence after the course, with a median confidence level of 4.5 out of 5.0 (IQR = 0.5). This study demonstrated the feasibility of using the online software package for the creation and application of an Ebola response course. Future studies could advance knowledge gained from this pilot trial by assessing timely distribution and multi-site effectiveness with standard education.”

CRISPR and DIY Biohacking – An Infectious Disease Threat to Consider in 2019
When you compile a list of the infectious disease concerns you might have for 2019, does CRISPR make the cut? “CRISPR has great potential to improve the human condition through research, medicine, agriculture, etc. With great power though, comes great responsibility; there is a real concern that the technology is moving too fast for its own good and too fast for governance, regulation, and oversight to keep up. Biosecurity experts have been raising the red flag about the disruptive nature of genome editing, pointing out that the manipulation of biological systems and processes can have untold consequences. A recent study published by investigators from George Mason and Stanford universities notes that the technology must be taken seriously and the broader and ever-evolving landscape of biosecurity must be considered. For instance, it is possible that genome editing could one day be used to create biological weapons—think of a totally resistant tuberculosis or an influenza with increased virulence. The growing popularity of genome editing also means that these technologies are no longer restricted to laboratories where there is some degree of oversight and regulatory processes; they now extend to the everyman’s garage. That’s right—there are people performing genome editing right in their own homes. DIY (Do It Yourself) biohacking allows people to play around with gene editing technologies at home, with zero supervision or guidance. It’s not difficult to think about what the repercussions could be if the wrong person experiments with the genomic modification of viral or bacterial DNA. ”

A Highly Hackable US Biodefense System
The efficacy of BioWatch as a biodefense tool has been questioned since it was first developed but new issues are arising surrounding the security of the data. “Operating in more than 30 cities, BioWatch gathers air samples, sends them to labs, and analyses them for DNA that would indicate a toxin or pathogen. But the program, which has cost more than $1 billion so far, turned up false positives and can take upwards of a day to report results. Earlier this fall, a Department of Homeland Security official said BioWatch would be replaced within the next couple of years. Until then, it’s a first line of defense against bioterrorism. But as Defense Onereports, the website that BioWatch uses to coordinate between health workers and government officials (called biowatchportal.org) is insecure, according to both the Department of Homeland Security inspector general and a former department employee. With access to the website, an adversary could find the sensor locations where air samples are gathered, target the professionals using it, or presumably simply take it offline.”

Ebola Outbreak Update
Over the holiday weekend, 22 more cases were reported, bringing the outbreak to 585 cases (537 confirmed). “Also, officials reported 13 more deaths, raising the overall outbreak fatality count to 356. Six of the latest deaths occurred in community settings, a factor that raises the risk of spread, given that the sick people weren’t isolated in Ebola treatment units and that viral levels are at their highest when patients are severely ill. As of today, health officials are still investigating 74 suspected Ebola cases. The World Health Organization (WHO) African regional office said yesterday in its weekly outbreak and health emergencies report that Katwa, Komanda, Beni, Butembo, and Mabalako are the main hot spots.”

Swine Fever Virus Found in Wontons and A New Outbreak in China’s Guangdong Province
Taiwan reports “The minced pork meat on wonton wrappers brought by a traveler into Taiwan has been found to contain the highly contagious African swine fever (ASF) virus, the Bureau of Animal and Plant Health Inspection and Quarantine (BAPHIQ) said Friday.” This is on the heels of a new outbreak of the African swine fever reported in China via their agriculture  ministry as 11 pigs were killed on a farm of 90. “China has already reported more than 90 cases of the incurable disease since it was first detected in the country in early August.” China has been hard hit with ASF and a new video shows 10,000 pigs killed by the disease in the province closest to Taiwan. The Chinese government has also been under fire for underreporting the outbreak in their state-run media.

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