Tag: biosurveillance

Pandora Report: 3.4.2016

by spopescu, posted in Pandora Report

Dirty bombs, Zika virus, and biosecurity in Iraq? That’s just a taste of the biodefense news we’ve got in store for you this week. While norovirus hits the East Coast (thanks, oysters!) and an additional three cases were confirmed in the seven-month-long Listeria outbreak associated with Dole salads, it’s no wonder there’s been work to build a new US food safety system. Next month the CDC will be working with state and local officials to establish plans in the most hard-hit Zika areas.

Assessing America’s Soft Underbelly and The Threat of Agroterrorism
The House Committee on Homeland Security’s Emergency Preparedness, Response, and Communications Subcommittee held a hearing on Friday in which they discussed and reviewed the risk of agroterrorism or natural agro-disasters. Disruption to the agriculture infrastructure and economy could be devastating to the US. Regardless if it’s private or public sectors, preparedness is vital to reduce calamitous damage. “US food and agriculture accounts for roughly one-fifth of the nation’s economic activity, contributed $835 billion to the US gross domestic product in 2014, and is responsible for one out of every 12 US jobs, according to Subcommittee Chairman Martha McSally (R-AZ).” Consider the impact of bovine spongiform encephalopathy (BSE) or Highly Pathogenic Avian Influenza (HPAI) on their respective sectors and country economies. Some of the highlighted vulnerabilities and challenges were insufficient quantity of Foot and Mouth Disease (FMD) vaccine, gaps in US biosecurity, traceability, gaps in detection, data sharing for regulated disease, and more.

Strengthening Biosecurity in Iraq: Development of a National Biorisk Management SystemScreen Shot 2016-03-04 at 10.02.47 AM
GMU Biodefense director and professor, Dr. Gregory Koblentz, and Mahdi al-Jewari, director of the biology department for the Iraqi National Monitoring Authority in the Iraq Ministry of Science of Technology, have joined together to discuss the furthering of Iraqi biosecurity. Mahdi al-Jewari visited GMU in early 2015 to speak on global biorisk management, hosted by the GMU School of Policy, Government, and International Affairs. In their research, Dr. Koblentz and Mr. al-Jewari discuss Iraq’s implementation of its non-proliferation commitments, highlighting that since 2004 “Iraq has taken a series of practical steps to implement its obligations under international non-proliferation treaties to prevent the proliferation of weapons of mass destruction and their means of delivery to states and non-state actors.” The Iraqi National Monitoring Authority, established in 2012, strives to strengthen their biosecurity program through three primary functions: compliance, monitoring of dual-use materials, and capacity building. The National Biorisk Management System has also highlighted four priorities to “counter biological threats: establishing a national pathogen list, building laboratory capacity, developing the capability to conduct joint law enforcement–public health investigations, and establishing a biorisk management law. The NBMC has established sub-committees charged with developing new policies and programs to achieve these four objectives.” While sustainability will be the most challenging hurdle for Iraq, commitment to investments  in infrastructure, IT, biosecurity, and biosurveillance systems can help them overcome these difficulties.

Just How Far Down the Zika Rabbit Hole Are We So Far?
It seems like every week we’re learning new things about Zika virus and how much work needs to be done. I wonder, how far have we made it down the rabbit hole for Zika and how much more do we have to go? While the Aedes mosquito is the reigning king of Zika virus infections, what about animals? The CDC recently released information regarding the concerns over zoonotic cases. Originally discovered in a monkey in the Zika Forest in 1940’s Uganda , the CDC maintains that “at this time, animals do not appear to be involved in the spread” and that there is no evidence of zoonotic transmission. “Nonhuman primates (apes and monkeys) have shown the ability to become infected with Zika virus; but, only a few naturally and experimentally infected monkeys and apes have had any signs of illness at all, and then it was only a mild, transient fever without any other symptoms.” As international public health teams descend upon the outbreak regions, we will surely be learning more about this outbreak. Perhaps the most challenging issue is the dissemination of information, especially in regions of high transmission. University of Arizona Mel & Enid Zuckerman College of Public Health infectious disease professor, Dr. Kacey Ernst, is one of the top vector-borne researchers and she recently explained: “The Zika virus pandemic, thought to be primarily caused by transmission of the virus through Ae. aegypti requires urgent action to determine the role of the virus in neurological sequalea, including microcephaly as well as the relative transmission potential of Ae. albopictus. Given the important role of communities in preventing the proliferation of the peridomestic, anthropophilic Ae. aegypti, communication between the scientific communities and the public must be heightened to ensure timely dissemination of surveillance information. While much of the United States is currently too cold to allow high densities of the primary vector of Zika virus, Ae. aegypti, the growing evidence surrounding the role of sexual transmission in the spread of Zika could imply that outbreaks of disease are possible even when transmission by the mosquito is not. More research is needed to delineate the two modes of transmission and the role that sexual transmission may be playing in the explosive spread of Zika across Latin America and the Caribbean.” In more Zika updates, blood samples from French Polynesia patients with Guillain-Barré syndrome (GBS) during their Zika virus outbreak are revealing the first look into the reality that Zika may actually cause GBS. The CDC is also urging pregnant women to avoid the summer Olympics in Brazil due to the outbreak. The FDA also just issued their Emergency Use Authorization for a Zika diagnostic tool for qualified countries. As of March 2nd, the CDC has reported 153 travel-associated Zika virus cases within the US.

Education Gaps on Dirty Bombs
David Ropeik from Scientific American discusses the impact that poor education and fear regarding dirty bombs can pose during an emergency. “The prospect of such a bomb seems terrifying, but anyone who knows the basic science of radiation biology knows that it wouldn’t cause much health damage, because the dose of radioactivity to which most people might be exposed would be very low. And experts know, based on the 65 year Life Span Study of the survivors of atomic bomb explosions in Japan, that even at extraordinarily high doses, ionizing radiation only raises lifetime cancer mortality rates a little bit—just two thirds of one percent for survivors who were within three kilometers of ground zero.” Few people know that low doses from a dirty bomb exposure pose little (not zero, but minimal) health risks, but rather people tend to hear “radioactive” or “nuclear radiation” and run screaming to the hills like a zombie hoard is approaching. While Ropeik points out that there will of course be devastation and economic damage, the resulting stress, fear, and public outcry for retaliation can be just as damaging. So what can we do? He points to the US Nuclear Regulatory Commission (NRC) and CDC educational sites, but emphasizes that in the end, a communication campaign to combat fear would “take at least some power of a dirty bomb to terrorize us out of the hands of the terrorists”.

Stories You May Have Missed:

  • Biosurviellance Ecosystem- The DoD and DHS are currently working on a new system that would allow epidemiologists to “scan the planet for anomalies in human and animal disease prevalence, warn of coming pandemics, and protect warfighters and others worldwide.” The Biosurveillance Ecosystem (BSVE) is a brain child that would allow epidemiologists to customize and collaborate – better yet, it’s being developed using open-source software and works “as a dashboard-like service from the cloud, accessible through an Internet browser”.
  • Select Agent Guidance– The Federal Select Agent Program (FSAP) is asking for community members to submit comments regarding the Guidance for Nonviable Select Agents and Nonfunctional Select Toxins. If you’re a member of the regulated community, help the FSAP become more transparent and strengthen biosecurity efforts! Comments will be accepted through March 14, 2016.
  • Giant Virus Secret Weapon: An Immune System – Whether it’s Frankenvirus or one of the other hundreds of giant viruses researchers have been finding, they’re teaching us a lot about secret weapons within the virus arsenal. Researchers working with a few of the giant viruses reported on Monday that some of the genes actually provide an immune system. Even crazier? The immune system “works a lot like the CRISPR system in bacteria that scientists have co-opted as a powerful gene editing tool.”

Pandora Report 2.5.2016

by spopescu, posted in Pandora Report

Fear of mosquitoes continues to grow as Zika virus joins the list of burdening arbovirus infections. Perhaps the biggest surprise this week wasn’t that imported Zika cases continue to spring up across the US, but rather that the first sexually transmitted case occurred in Dallas, Texas. I’m starting to think Dallas, TX, could use a break from emerging infectious diseases… As influenza season picks up in the US, Avian influenza outbreaks are popping up in Taiwan, South Africa, and Macao. Good news- it’s safe to go back to your favorite burrito bowl! The CDC declared the Chipotle-associated E. coli outbreak over, however, their co-CEO has voiced frustration over delayed reporting. In the interview, he felt that it gave the “mistaken impression that people were still getting sick” and news was “fueled by the sort of unusual and even unorthodox way the CDC has chosen to announce cases.” Before we venture down the biodefense rabbit hole, don’t forget to stay healthy and safe this Super Bowl Sunday. Spikes in cases and flu-related deaths (in those >65 years of age) can jump by 18%  in the home regions of the two teams. Take care to avoid respiratory viruses and food-borne issues while cheering on your favorite team this weekend!

Medical Counter Measures for Children
Having worked in pediatrics, I was thrilled to see the American Academy of Pediatrics publish the updated guidelines. Throughout my work in infection prevention and collaborations with hospital emergency preparedness and local county health departments, it became increasingly evident that in many ways, this is a patient population that is easily forgotten. There is a woefully apparent gap in preparedness methodology to recognize and modify practices to meet the unique needs of children. While many may laugh at the notion that “children aren’t just little adults”, those who have worked in pediatrics can attest to these common misconceptions. Children are not only more susceptible to the devastation of disasters and CBRN attacks, the medical counter measures often do not account for pediatric dosages. The published report discussed their work over the past five years to better address and fill major gaps in preparedness efforts when it comes to medical counter measures (MCM) for children. “Moreover, until recently, there has been a relative lack of pediatric MCM development and procurement; many MCMs were initially developed for use by the military and have been evaluated and tested only in adults.” Some of the recommendations that were made from this report include: “the SNS and other federal, state, and local caches should contain MCMs appropriate for children in quantities at least in proportion to the number of children in he intended population for protection by the cache” and “federal agencies collaborating with industry, academia, and other BARDA partners, should research, develop, and procure pediatric MCMs for all public health emergency, disaster, and terrorism scenarios and report on progress made.” Perhaps one of the most interesting recommendations was that “the federal government should proactively identify anticipated uses of MCMs in children during a public health emergency and, where pediatric FDA-approved indications do not exist, establish a plan to collect sufficient data to support the issuance of a pre-event EUA that includes information such as safety and dosing information and the federal government should use existing entities with pediatric SMEs, such as the PHEMCE, PedsOB IPT, and the DHHS National Advisory Committee on Children and Disasters, and continue to collaborate with private sector partners offering pediatric expertise to provide advice and consultation on pediatric MCMs and MCM distribution planning.” Overall, these recommendations and the push for data collection and clear progress reporting are definitely a step in the right direction.

GMU Open House
Interested in a master’s degree that allows you to focus on bioweapons, global health security, and WMD’s? Check out GMU’s School of Policy, Government, and International Affairs (SPGIA) Open House on Thursday, February 25th at 6:30pm, at our Arlington Campus in Founders Hall, room 126. Representatives from our Biodefense program will be there to answer all your questions. Better yet, check out our Biodefense Course Sampler on Wednesday, March 2nd, at 7pm (Arlington Campus, Founders Hall, room 502). Dr. Gregory Koblentz,  director of the Biodefense graduate program, will be presenting “Biosecurity as a Wicked Problem”. Come check out our curriculum and get a taste of the amazing topics we get to research!

From Anthrax to Zikam6502e1f
Researchers at the University of Greenwich are finding a potential cancer-fighting strategy using the anthrax toxin. Lead scientist, Dr. Simon Richardson, is working with his team to convert the anthrax toxin into a delivery tool for medications.“This is the first time a disarmed toxin has been used to deliver gene-modulating drugs directly to a specific compartment within the cell. We’ve achieved this without the use of so called helper molecules, such as large positively charged molecules like poly(L-lysine). This is important as while these positively charged molecules, known as polycations, can condense DNA and protect it from attack by enzymes before it reaches the target, they are also known to be toxic, break cell membranes and are sent quickly to the liver to be removed from the body. In this study we demonstrate that using disarmed toxins without a polycation is effective, at a cellular level.” In the world of Zika virus….On Monday, the WHO Zika virus team met and announced that the outbreak should now be considered a public health emergency of international concern. Dr. Margaret Chan, WHO director general, stated, “I am now declaring that the recent cluster of microcephaly and other neurological abnormalities reported in Latin America following a similar cluster in French Polynesia in 2014 constitutes a public health emergency of international concern.” Given the level of uncertainty regarding the disease, many feel this was a justified classification of the outbreak. The first case of sexual transmission within the US also occurred in Dallas, Texas. The patient became sick after having sexual contact with an individual who became symptomatic upon return from Venezuela. Chile and Washington DC have just confirmed their first three cases this week. Mexico’s Health Ministry is trying to downplay the Zika impact on tourism, however as the outbreak unfolds, it will be interesting to see long-term tourism repercussions within the affected countries. The state of Florida is ramping up their mosquito elimination, control, and education efforts to combat the growing epidemic, as it is one of the mosquito-heavy states within the US. Governor Rick Scott recently declared a health emergency in four Florida counties. If you’re on the lookout for educational tools, there are several helpful CDC informational posters regarding mosquito bite prevention.

US Military and the Global Health Security Agenda
In effort to protect military members and support global public health, the DoD (specifically, the Military Health System in coordination with the Defense Health Agency’s Armed Forces Health Surveillance Branch) developed the 2014 Global Health Security Agenda (GHSA). The GHSA established a five-year plan with specific agenda items, targets, and milestones that would incorporate its 31 partner countries. The DoD’s Global Emerging Infections Surveillance and Response System (GEIS) will also support these efforts through their biosurveillance practices in over 70 countries. The international work is as varied as the challenges one might see in global biosurveillance. The Armed Forces Health Surveillance Branch (AFHSB) “leveraged existing febrile and vector-borne infection control efforts in Liberia to support the recent Ebola outbreak response. The Liberian Institute for Biomedical Research served as a central hub for Ebola diagnostic testing with the help of the Naval Medical Research Unit-3 in Cairo, Egypt and two Maryland-based facilities, the Naval Medical Research Center in Silver Spring and the U.S. Army Medical Research Institute of Infectious Diseases in Frederick.” Surveillance efforts will also look at antimicrobial resistance and the development of additional research laboratories to work in coordination with host-nations and certain regional networks. You can also read Cheryl Pellerin’s work on DoD Biosurveillance and the role it plays in maintaining global public health efforts. Pellerin reports on the duties of the GEIS and the US Army Medical Research Institute of Infectious Disease (USAMRIID) in not only global health security, but also protecting US military personnel from infections while abroad.

Norovirus Outbreak in Kansas
There are few things that will make a food-borne disease epidemiologist (or infection preventionist for that matter) as frustrated as a norovirus outbreak. It hits quickly, is highly infectious, and tends to leave you with stories from case-control interviews that will make you either laugh, cry, or need some fresh air. A Kansas City suburb is currently experiencing a 400 person outbreak of gastroenteritis associated with the New Theatre Restaurant. Initial lab reports have confirmed norovirus as the culprit. The Vice President of the restaurant said that three employees have also been confirmed as norovirus cases. To date, the almost 400 people who reported symptoms are said to have eaten at the restaurant between January 15 to present. Norovirus is a pretty unpleasant gastroenteritis (you’ve probably heard it called the “cruise ship bug”) as it has a low infectious dose (estimates put it as low as 18 viral particles, while 5 billion can be shed in each gram of feces during peak shedding). Norovirus outbreaks tend to spring up quickly and infect high volumes of people, making it difficult for public health officials to jump ahead of the outbreak. Perhaps one of the biggest components to stopping the spread of infection is good hand hygiene, environmental cleaning, and staying home when sick.

TB Transmission on Airplanes
We’ve all been there – you’re seated next to someone with a nasty cough or cold and you just know you’re going to get sick. But what happens if you’re on a plane and there’s a person a few rows away that has tuberculosis (TB)? The European Centre for Disease Prevention and Control (ECDC) reviewed evidence of TB transmission on airplanes to update their Risk Assessment Guidelines. Of all the records/studies reviewed, 7/21 showed some evidence for potential in-flight (all flights lasted more than 8 hours) TB transmission, while only one presented evidence for transmission in this environment. The interesting component is that this low transmission risk is considered only for in-flight, as they excluded transmission on the ground since the before and after flight ventilation system is not in full-function mode. The one study that did show transmission risk involved six passengers that were in the same section as the index case, of which, four were seated within two rows. After their review, they found that the risk for TB transmission on airplanes is “very low”. They noted that “the updated ECDC guidelines for TB transmission on aircraft have global implications due to inevitable need for international collaboration in contact tracing and risk assessment.”

Stories You May Have Missed:

  • Resistant HIV – A recent study published in The Lancet discusses drug resistance after virological failure with the first-line HIV medication, tenofovir-containing ART (antiretroviral  therapy). This treatment is used as both a prevention and pre-exposure prophylaxis (PrEP). Researchers found “drug resistance in a high proportion of patients after virological failure on a tenofovir-containing first-line regimen across low-income and middle-income regions”. This study highlights the growing need for surveillance of microbial drug resistance.
  • Active Monitoring of Returning Travelers – Ebola Surveillance – The CDC’s MMWR for the week of January 29, 2016, discussed NYC monitoring of returned travelers from October 2014-April 2015. Monitoring of returned travelers from Ebola-affected countries was one strategy the US employed to prevent imported cases. This report reviews the 2,407 travelers that returned from affected countries, of which no cases were detected. The NYC Department of Health and Mental Hygiene (DOHMH)’s active monitoring system proved successful, however it was very taxing on resources and reinforces the need to minimize duplication and enhanced cooperation. Speaking of Ebola, investigators from the University of Texas Medical Branch at Galveston, Vanderbilt University, the Scripps Research Institutem and Integral Molecular Inc., have performed research to establish that “antibodies in the blood of people who have survived a strain of the Ebola virus can kill various types of Ebola.” Further work will now seek to understand immune response to the virus and how we can modify treatments and potential vaccines to be more effective.
  • DoD BioChem Defense – take a glimpse into the global biosurveillance and defense efforts within the DoD Chemical and Biological Defense Program (CBDP). Working within several joint programs and striving to get ahead of outbreaks and attacks with early warning systems, this program faces the challenges of monitoring biochem threats on an international scale.

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Pandora Report 11.6.2015

by spopescu, posted in Uncategorized

Happy Friday! The world of biodefense and global health security has been busy this week – between a growing outbreak of E. coli associated with Chipotle restaurants, to a review of Select Agent lab practices, and a recap of the Ebola outbreak in West Africa, there’s more than enough to keep you busy! Fun history fact Friday (it’s our version of “flashback Friday”), did you know that on November 6, 1971, the US Atomic Energy Commission tested the largest US underground hydrogen bomb (code name Cannikin) on Amchitka Island?

CDC/Select Agent List- 90 Day Internal Review
We’ve seen a lot of news lately regarding lab safety and biodefense reform/recommendations. With so much scrutiny regarding biosafety practices, it’s not surprising the CDC would do a deep dive into “how the agency inspects select agent labs” with a 90 day review. The review notes that while it didn’t duplicate the recommendations from Presidential Order 13546, it did find several areas for improvement, leading to nine observations and ten actionable recommendations. The categories for recommendations are inspections, incident reporting, and transparency. The findings point to several areas for improvement, ranging from the standardization of risk assessments to identify high risk activities, to the sharing of inspection data to better encourage public understanding of the work practices performed with these agents. The report highlights several areas for improvement that will hopefully lead to more stable biosecurity and public understanding of how we handle select agents. You can also check out the Federal Select Agent Program for a list of the agents and regulations involved.

2016 Presidential Candidates on Nonproliferation
GMU’s Greg Mercer is at it again with round three of his review on 2016 presidential candidates and their comments on nonproliferation. As of now, he’s reviewed the Republican candidates, but now he’s delving into the Democratic candidates. Greg reviews Hillary Clinton, Bernie Sanders, and Martin O’Malley, noting that ” in contrast to Republicans, most Democrats support the Iran deal, and generally tend to favor international arms control regimes.” With the race only heating up, stay tuned  for more of Greg’s candidate-by-candidate reviews on nonproliferation in the 2016 election.

GMU Master’s Open House and Application Deadlines!
Considering a master’s degree? Come check out the GMU School of Policy, Government, and International Affairs (SGPIA) Open House on Wednesday, November 18th, 6:30pm at our Arlington Campus in Founders Hall (Room 126). There’s even a pre-session for veterans and active duty military at 5:45pm! The Open House is a great way to learn about our different Master’s programs (Biodefense, International Security, Political Science, etc.) and ask real-time questions with faculty. Our Biodefense Program Director, Dr. Koblentz, will be there to discuss global health security and tell you about the pretty amazing things we get to do at GMU! If you’ve already attended or are planning to apply, just a friendly reminder that PhD program applications are due December 1st, and Biodefense Master’s Spring applications are due December 1st as well.

Zika Virus Outbreak in Colombia
Nine new cases have been identified in Sincelejo, Colombia, with an additional three being investigated in Barranquilla. Zika virus is a vectorborne disease that is transmitted through Aedes mosquitos. The CDC notes that vertical transmission (from mother to child) can occur if the mother is infected near her delivery and Zika can be spread through blood transfusion (although no cases have occurred this way) and sexual contact (one case of sexually transmitted Zika virus has occurred to date). Common signs and symptoms are fever, rash, joint pain, and red eyes that last several days to a week. In the past, transmission has occurred in tropical Africa, Southeast Asia, and the Pacific Islands, however, there have been cases in 2015 in Brazil and Colombia. We’ll keep you updated if transmission continues in South America!

There have also been cases of Chikungunya springing up throughout the Caribbean and Americas. The Pan American Health Organization (PAHO) initially reported just over 2,400 cases a few weeks ago, however a new report is showing 13,476 new cases. Initially starting in December 2013, this epidemic began with a single locally acquired case on St. Martin island, and is now totaling 1, 760,798 cases.

Chipotle E.coli Outbreak 
Just when you thought it was safe to go back to Chipotle (we reported that Minnesota  Chipotle customers experienced a Salmonella outbreak in August), an E. coli outbreak is making headlines in Washington and Oregon. Public health officials updated the case total to 41 people as of 11/4, with 6 patients requiring hospitalization. The source of the outbreak hasn’t been identified yet but as a precautionary measure, they’ve closed 14 restaurants. So far, the identified cases have been tied to five restaurants across six counties.

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Stories you May Have Missed

  • CRISPR-Cas9 Utility Broadens – researchers at Massachusetts General Hospital have improved on the utility of CRISPR-Cas9 through application via bacterial sources. The team “reports evolving a variant of SaCas9 – the Cas9 enzyme from Streptococcus aureus bacteria – that recognizes a broader range of nucleotide sequences, allowing targeting of the genomic sites previously inaccessible to CRISPR-Cas9 technology.” The new application allows a more precise targeting within the genomic sequence, which may translate to therapeutic applications. CRISPR-Cas9 has been a hot topic within the science and biodefense community in relation to its potential labeling as dual use research of concern (DURC) and certain ethical debates.
  • Unvaccinated Babies Refused By Some Physicians– Vaccination status is something I’ve grappled with working in pediatrics and is one of the rare things that can turn a calm physician (or infection preventionist for that matter) red-faced and needing a breather. The Boston Globe reported on a recent survey from the American Academy of Pediatrics that touched on pediatricians dismissing families that refused vaccines. The study found that all pediatricians surveyed had encountered at least one parent refusing vaccination for their child and 20% of pediatricians “often” or “always” dismissed families who refuse one or more vaccine. Interestingly, researchers found that “doctors in private practice, those located in the South, and those in states without philosophical exemption laws were the most likely to dismiss families refusing to vaccinate their infant”.
  • Guinea Ebola Tranmission – Guinea continues to experience new cases. As we mentioned last week, the cluster of four patients from the Kondeyah village is being monitored by public health officials. An infected newborn, whose mother died from Ebola recently, is also under observation and care. The infant’s mother was a confirmed case prior to her delivery and died after giving birth. The WHO is currently monitoring 382 contacts in Guinea during this time.

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