Pandora Report: 8.2.2019

Greetings fellow biodefense friends! We hope your summer is winding down nicely and you’re ready for your weekly dose of all things health security. You might want to avoid pig ear dog treats as there’s currently an outbreak of multi-drug resistant Salmonella infections.

 Bioweapons Convention – Meeting of Experts
The BWC Meeting of Experts (MX) is currently under way and you can get detailed, daily reports via Richard Guthrie’s BioWeapons Prevention Project, which has been covering the BWC since 2006. Guthrie notes “The first Meeting of Experts (MX1) in the 2019 series opened on Monday morning with Ambassador Victor Dolidze (Georgia) in the Chair. Owing to refurbishment work in the Palais des Nations, MX1 opened in Room XX [renowned for its elaborately decorated ceiling] instead of the usual location for BWC meetings two floors below. One advantage of using Room XX is that the proceedings can be webcast via <<http://webtv.un.org/>&gt; After brief opening formalities, six sub-topics were covered during Monday, the full titles of which can be found in the agenda for MX1. There was a full day of activities which means that this report can only be a selective snapshot of proceedings. The background information document produced by the Implementation Support Unit (ISU) for the MX1 held in 2018 contains much information relevant to the discussions this year.” You can also find the Joint NGO Statements that were given here. “In her reflections on last year’s MX1, the Chair, Ambassador Almojuela of the Philippines, suggested several concrete proposals for further consideration at today’s meeting. These included: An action plan for Article X implementation; Guidelines on Article X reports; The creation of a BWC Cooperation and Assistance Officer position within the ISU; and An open-ended working group to monitor, coordinate and review activities of cooperation and assistance. These are all proposals that the NGO community strongly endorses, and which were also set out in our Position Paper last year. Ambassador Almojuela also proposed to further collaboration with INTERPOL, OIE and WHO; we would also wish to draw attention to the importance of further collaboration with non-governmental entities. We would also urge States Parties to facilitate regional S&T dialogues that are focused on regional BWC-related interests and problems, and that draw in regional and international expertise to share information and stimulate collaboration and cooperation.”

DRC Ebola Outbreak 
The outbreak has now hit the one year mark and it continues to worsen – with 41 new cases reported since the end of last week. “According to the World Health Organization’s (WHO’s) online Ebola dashboard, the outbreak total now stands at 2,671 cases. The dashboard also recorded a total of 1,782 deaths, an increase in 20 fatalities over the weekend. So far the DRC president’s office, which last week shifted outbreak response activities to its technical group, has not issued any detailed daily updates following the resignation of the country’s health minister.” A day later, the second case of Ebola was identified in the city of Goma. “Reports from DRC journalists and international media outlets said the case was announced at a media briefing where the head of a presidential expert committee, Jean Jacques Muyembe Tamfum, PhD, shared details about the development. The country’s president put the committee in charge of outbreak management on Jul 20, prompting the DRC’s health minister to resign. The infected man, a father of 10 children, is from Mongbwalu, about 43 miles from Bunia, the capital of Ituri province, according to a Tweet from DRC journalist Cedric Ebondo Mulumb. Goma and Bunia are about 347 miles apart, with road travel taking about 13 hours.” The WHO has recently noted how “relentless” this outbreak has been since it began one year ago.

 GMU Biodefense MS and PhD Open Houses
Have you been considering adding to your education and career through a graduate degree in biodefense? Check out one of our Schar School Open Houses to get a feel for what the MS and PhD programs are like – you can chat with faculty, students, and learn more about the coursework and application process. The Master’s Open House will be at 6:30pm on Thursday, September 12th, and the PhD Open House will be at 7pm on Thursday, September 19th – both will be held at our Arlington campus in Van Metre Hall.

MERS-CoV: Novel Zoonotic Disease Outbreak a Hard Lesson for Healthcare
“Middle East respiratory syndrome coronavirus (MERS-CoV) was first identified in 2012 and since then, sporadic but continued outbreaks have been occurring within the Arabian Peninsula. There have been 2,428 cases of the coronavirus since 2012, and 838 associated deaths. Reported across 27 countries, this has been a disease that seems to have found a stronghold and established itself as endemic. MERS-CoV challenges response in that while we have diagnostic testing now, there truly is not treatment outside of supportive measures. Spread through the respiratory secretions of infected individuals, there has also been transmission via close contact (i.e. caring or living with an infected person), and ongoing investigation into the role of camels in zoonotic transmission. The disease does circulate in dromedary camels in Africa, the Middle East, and southern Asia, but cases have tended to be related to healthcare exposures and household contacts, with some camel-to-human transmission occurring. Hospitals are encouraged to ensure adherence to Standard, Contact, and Airborne isolation precautions, meaning that the patient should be placed in a negative pressure isolation room and healthcare workers should wear a gown, gloves, eye protection, and N95 respirator. Given the need for these isolation precautions, it’s not surprising that exposures often come from delays in isolation and crowded emergency rooms.”

WHO Statement on Governance and Oversight of Human Genome Editing
The World Health Organization has released the statement from this expert advisory committee held in March of this year. “At this meeting the Committee in an interim recommendation to the WHO Director-general stated that ‘it would be irresponsible at this time for anyone to proceed with clinical applications of human germline genome editing.’ WHO supports this interim recommendation and advises regulatory or ethics authorities to refrain from issuing approvals concerning requests for clinical applications for work that involves human germline genome editing. ‘Human germline genome editing poses unique and unprecedented ethical and technical challenges,’ said WHO Director-General Dr Tedros Adhanom Ghebreyesus. ‘I have accepted the interim recommendations of WHO’s Expert Advisory Committee that regulatory authorities in all countries should not allow any further work in this area until its implications have been properly considered.’ WHO’s Expert Advisory Committee continues its consideration of this matter, and will, at its forthcoming meeting in Geneva on 26-28 August 2019. evaluate, inter alia, effective governance instruments to deter and prevent irresponsible and unacceptable uses of genome edited embryos to initiate human pregnancies.”

Breaking Down Resistant Rumors and C diff Disinfectants
GMU biodefense doctoral student and infection preventionist Saskia Popescu discusses how poor communication regarding resistant organisms can cause confusion and misleading headlines. A recent study noted resistance of Clostridioides difficile to disinfectants however, “The investigators sought to treat the gowns with disinfectant to test its efficacy and whether it would help with the bioburden. The research team found that after being treated with the 1000 ppm chlorine-based disinfectant for 10 minutes, the gowns still were able to pick up and hold the C diff spores. This concern over resistance sent shockwaves and many news outlets picked up on this as an indicator of what’s on the horizon. But an issue with the study was the disinfectant that was used. First and foremost, as an infection preventionist and the first to stand on my soapbox to shout about the perils of antimicrobial resistance, I know that the efficacy of our disinfectants will eventually fail. The issue with this study is that much of the media coverage speaks broadly of a chlorine-based disinfectant and goes into little detail about what exactly what used. For my infection prevention peers, you know that not all disinfectants are alike and, well, some just weren’t designed for combatting hardier bugs like C diff. This is the playbook we live by in health care.”

 Rinderpest, Smallpox, and the Imperative of Destruction
To destroy or not to destroy…that is indeed the question. “In June, The Pirbright Institute (UK) announced that it had destroyed its final archived stocks of rinderpest, the devastating viral disease of cattle that was declared eradicated in 2011. Rinderpest is only the second infection to be eradicated from the wild. The decision raises the question once again of what to do with the remaining stocks of the first eradicated virus—smallpox. The Pirbright Institute did not hold the final stocks of rinderpest in existence; samples are also known to be stored in a handful of facilities in China, Ethiopia, France, Japan, and the USA. Still, The Pirbright Institute is the World Reference Laboratory for rinderpest, previously storing more than 3000 viral samples. That it has taken the decision to destroy them represents a bold commitment to permanently ridding the world of the disease and should encourage others to do the same. France plans to destroy its remaining stocks, and discussions continue at other facilities.” The debate surrounding the survival and destruction of smallpox stocks has been ongoing for decades – some argue the risk of accidental or intentional release is too great, while others argue that destruction would remove the potential for research…however the Pirbright Institute’s practice countered this with their “sequence and destroy” policy, which is encouraging others to push for this policy regarding smallpox. “Smallpox stocks have been earmarked for destruction since eradication of the disease in 1980. Yet, successive meetings of the World Health Assembly have postponed making a final recommendation while the threat of re-emergence from elsewhere remains. At its last meeting in September, 2018, the Advisory Committee on Variola Virus Research told WHO that live virus is still needed for the development of new antivirals, with split opinion on whether it is needed for diagnostics. Huge strides have been made in these areas in recent years. New more advanced and safer vaccines have been developed; new diagnostic tests are in development; and the first specific antiviral for smallpox—tecovirimat—was approvedby the US Food and Drug Administration in June last year, after some innovative regulatory manoeuvres. The deliberations over smallpox stocks happen regularly, but the decisions are ad-hoc. For rinderpest, destruction seems only a matter of time. Smallpox stocks will also likely be destroyed once diagnostics are finalised and a second antiviral, with a different mode of action in case of resistance, is approved (many are in development).”

Stories You May Have Missed:

  • Surge in Drug-Resistant HIV Across Africa, Asia, and the Americas – “Surveys by the World Health Organization (WHO) reveal that, in the past 4 years, 12 countries in Africa, Asia and the Americas have surpassed acceptable levels of drug resistance against two drugs that constitute the backbone of HIV treatment: efavirenz and nevirapine. People living with HIV are routinely treated with a cocktail of drugs, known as antiretroviral therapy, but the virus can mutate into a resistant form. The WHO conducted surveys from 2014 to 2018 in randomly selected clinics in 18 countries, and examined the levels of resistance in people who had started HIV treatment during that period. More than 10% of adults with the virus have developed resistance to these drugs in 12 nations (see ‘Resistance rises’). Above this threshold, it’s not considered safe to prescribe the same HIV medicines to the rest of the population, because resistance could increase. Researchers published the findings this month in WHO report.”

Pandora Report: 6.28.2019

Summer Workshop – Early Registration Discount Ends Soon
Just a few more days to get your early registration discount and we’ve only got a few spots left – make sure to grab yours! We’re excited to have top professionals and researchers in the health security field speak to the biological threats we’re facing- from securing the bioeconomy to vaccine development and pandemic preparedness, you’ll want to be there for the 3.5 days of all things pandemics, bioterrorism, and global health security.

Re-thinking Biological Arms Control for the 21st Century
Dr. Filippa Lentzos discusses the challenges of biological arms control in the face of synthetic biology and technological advances. “Innovations in biotechnology are expanding the toolbox to modify genes and organisms at a stagger- ing pace, making it easier to produce increasingly dangerous pathogens. Disease-causing organisms can now be modified to increase their virulence, expand their host range, increase their transmissibility, or enhance their resistance to therapeutic interventions. Scientific advances are also making it theoretically possible to create entirely novel biological weapons, by synthetically creating known or extinct pathogens or entirely new pathogens. Scientists could potentially enlarge the target of bioweapons from the immune system to the nervous system, genome, or microbiome, or they could weaponize ‘gene drives’ that would rapidly and cheaply spread harmful genes through animal and plant populations.” Lentos notes that “The political backdrop to these technical advances in biotechnologies and other emerging technologies is also important. There is increased worldwide militarization, with global military spending at an all-time high since the fall of the Berlin Wall. Unrestrained military procurement and modernization is creating distrust and ex- acerbating tensions. In the biological field, the proliferation of increasingly sophisticated biodefense capacities, within and among states, can lead to nations doubting one another’s intentions.”

GAO – Biodefense: The Nation Faces Long-Standing Challenges Related to Defending Against Biological Threats
The GAO testified before a House committee on their efforts to identify and strengthen U.S. biodefense and here are their overall findings in a report. Despite President Trump signing off on the Pandemic and All-Hazards Preparedness and Advancing Innovations Act (PAHPA) on Monday, there is still a lot of work to be done. “Catastrophic biological events have the potential to cause loss of life, and sustained damage to the economy, societal stability, and global security. The biodefense enterprise is the whole combination of systems at every level of government and the private sector that contribute to protecting the nation and its citizens from potentially catastrophic effects of a biological event. Since 2009, GAO has identified cross-cutting issues in federal leadership, coordination, and collaboration that arise from working across the complex interagency, intergovernmental, and intersectoral biodefense enterprise. In 2011, GAO reported that there was no broad, integrated national strategy that encompassed all stakeholders with biodefense responsibilities and called for the development of a national biodefense strategy. In September 2018, the White House released a National Biodefense Strategy. This statement discusses GAO reports issued from December 2009 through March 2019 on various biological threats and biodefense efforts, and selected updates to BioWatch recommendations made in 2015. To conduct prior work, GAO reviewed biodefense reports, relevant presidential directives, laws, regulations, policies, strategic plans; surveyed states; and interviewed federal, state, and industry officials, among others.” GAO identified several challenges in the ability for the U.S. to defend against biological threats: “Assessing enterprise-wide threats. In October 2017, GAO found there was no existing mechanism across the federal government that could leverage threat awareness information to direct resources and set budgetary priorities across all agencies for biodefense. GAO said at the time that the pending biodefense strategy may address this. Situational awareness and data integration. GAO reported in 2009 and 2015 that the Department of Homeland Security’s (DHS) National Biosurveillance Integration Center (NBIC)—created to integrate data across the federal government to enhance detection and situational awareness of biological events—has suffered from longstanding challenges related to its clarity of purpose and collaboration with other agencies. DHS implemented GAO’s 2009 recommendation to develop a strategy, but in 2015 GAO found NBIC continued to face challenges, such as limited partner participation in the center’s activities. Biodetection technologies. DHS has faced challenges in clearly justifying the need for and establishing the capabilities of the BioWatch program—a system designed to detect an aerosolized biological terrorist attack. In October 2015, GAO recommended that DHS not pursue upgrades until it takes steps to establish BioWatch’s technical capabilites. While DHS agreed and described a series of tests to establish capabilities, it continued to pursue upgrades. Biological laboratory safety and security. Since 2008, GAO has identified challenges and areas for improvement related to the safety, security, and oversight of high-containment laboratories, which, among other things, conduct research on hazardous pathogens—such as the Ebola virus. GAO recommended that agencies take actions to avoid safety and security lapses at laboratories, such as better assessing risks, coordinating inspections, and reporting inspection results. Many recommendations have been addressed, but others remain open, such as finalizing guidance on documenting the shipment of dangerous biological material.”

ABSA 1st International Biosecurity Symposium Call for Papers
“You are now able to submit papers for ABSA’s 1st International Biosecurity Symposium. The symposium will take place May 12-15, 2020 in Minneapolis, Minnesota. We anticipate having attendees from all over the world and approximately 20 commercial exhibits. The professional development courses will take place Tuesday, May 12, 2020. The symposium presentations (platform/poster) will take place Wednesday, May 13 to Friday, May 15, 2020. The Call for Platform/Posters Abstract submission deadline is July 31, 2019 at 5pm Central.”

Blue Ribbon Panel – U.S. Is Not Prepared for Biological Incidents – Testimony
June 26th- “Dr. Asha George, Executive Director of the Blue Ribbon Study Panel on Biodefense, served as an expert witness this afternoon before the House Oversight and Reform Subcommittee on National Security. Chaired by Rep. Stephen Lynch (MA), the Subcommittee is evaluating the readiness of the U.S. government and healthcare system, including hospital and emergency professionals, to respond to naturally occurring pandemics and biological attacks that could be perpetrated by state and non-state actors. The Subcommittee also is investigating the growing threat of antimicrobial-resistance, as well as the implications of this challenge for U.S. national security. ‘Our Panel has assessed and continues to assess the state of our country’s biodefense. We scrutinize the status of prevention, deterrence, preparedness, detection, response, attribution, recovery, and mitigation – the spectrum of activities necessary for biodefense,’ said Dr. George. ‘As expected, we found both strengths and weaknesses, including serious gaps that four years after the release of our Panel’s Blueprint for Biodefense in 2015 continue to make the nation vulnerable. In short, the nation is not prepared for biological outbreaks, bioterrorist attacks, biological warfare, or accidental releases with catastrophic consequences’.” This is especially relevant as many are wondering what Congress is doing to respond to health security threats.

Ebola Outbreak – Updates
As of Wednesday, the outbreak has reached 2,277 cases and security threats are increasingly making response efforts challenging. “In its weekly situation report on the outbreak, the WHO said Ebola activity continues with steady and sustained intensity, with security incidents returning to Beni—one of the outbreak’s former major hot spots—and armed group movements in Musienene and Manguredjipa impeding access to a health area next to Mabalako’s hardest-hit area. Another concern it aired is a tense security situation in neighboring Ituri province cities Bunia and Komanda in the wake of attacks in early June. Over the past few weeks, indicators show hints of easing transmission intensity in the two biggest recent epicenters, Katwa and Butembo. However, the optimism is offset by new cases in previously affected areas, including Komanda, Lubero, and Rwampara. For example, over the past week, Komanda reported its first case after going 11 days without one.”

A Dose of Inner Strength to Survive and Recover from Potentially Lethal Health Threats
“Breakthroughs in the science of programmable gene expression inspired DARPA to establish the PReemptive Expression of Protective Alleles and Response Elements (PREPARE) program with the goal of delivering powerful new defenses against public health and national security threats. DARPA has now selected five teams to develop a range of new medical interventions that temporarily and reversibly modulate the expression of protective genes to guard against acute threats from influenza and ionizing radiation, which could be encountered naturally, occupationally, or through a national security event. The program builds from the understanding that the human body has innate defenses against many types of health threats, but that the body does not always activate these defenses quickly or robustly enough to block the worst damage. To augment existing physiological responses, PREPARE technologies would provide a programmable capability to up- or down-regulate gene expression on demand, providing timely, scalable defenses that are proportional to anticipated threats. Service members and first responders could administer these interventions prior to threat exposure or therapeutically after exposure to mitigate the risk of harm or death.”

Global Community Bio Summit 3.0
From October 11-13, you can attend this community biotechnology initiative at MIT Media Lab. “The Community Biotechnology Initiative at the MIT Media Lab is organizing the third annual Global Summit on Community Biotechnology this October 11 to 13, 2019! Our goal is to provide a space for the global community of DIY biologists / community biologists / biohackers / biomakers and members of independent and community laboratories to convene, plan, build fellowship, and continue the evolution of our movement. You can learn more about last year’s Summit, including our program, here. While all are welcome, space is limited, so we are prioritizing active practitioners in the community with an emphasis on diversity across geographic, cultural, ethnic, gender, and creative backgrounds. We will add accepted participants to the directory on a rolling basis with the goal of accepting everyone interested in joining.”

Stories You May Have Missed:

  • Tackling Dirty Sinks – Did you ever think your hospital sink could be a disease reservoir? “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. More and more, infection prevention is having to look at hospital faucets and sinks for their role in hosting microbial growth. This was also a topic of interest at last week’s annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC 2019). Investigators with the University of Michigan Health System discussed how they worked to identify vulnerabilities and potential sink designs that might contribute to bioburden and biofilm in hospital faucets. Assessing 8 different designs across 4 intensive care units, the research team ultimately found that those sinks with a more shallow depth tended to allow higher rates of contamination (ie, splash of dirty water) onto equipment, surfaces, and patient care areas. In some instances, the splash of contaminated water could be found up to 4 feet from the sink.”

 

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.
”

 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: 3.15.2019

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.”

Stories You May Have Missed:

  • 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: 9.14.2018

Happy Friday fellow biodefense gurus – we’re happy to have you read our weekly report on all things from anthrax to Zika.

George Mason Global Health Security Ambassadors Program
The Schar Biodefense program is excited to announce an opportunity for two current biodefense students (MS or PhD) to attend the  5th Annual Global Health Security Agenda (GHSA) Ministerial Meeting in Bali, Indonesia from November 6-8, 2018. The GHSA Ministerial Meeting provides an unparalleled opportunity to share experiences and engage in meaningful discussions on global health security with senior government officials from the GHSA member states and implementing partners from civil society and the private sector. One of the main goals of this year’s summit is to launch the GHSA 2024 Framework to guide GHSA members and partners in their collective effort to tackle current and future global health security issues. Therefore the theme of this year’s meeting is Advancing Global Partnerships. The two lucky biodefense students will participate in the meeting as members of a delegation representing the Next Generation Global Health Security Network which is led by Dr. Jamechia Hoyle. The Biodefense program is grateful to Dr. Hoyle and Dean of the Schar School, Mark Rozell, for providing this opportunity. If you’re interested in attending, please make sure to reference the email that was sent out on Friday as this opportunity is only available for current GMU Biodefense MS/PhD students. 

South Korean Man Infected With MERS
South Korea’s preparedness against MERS is being tested again as a man hospitalized in Seoul has tested positive for MERS following a trip to Kuwait. “‘As far as found by now, 20 people including flight attendants and medical staff have been in close contact with the patient and they are under isolation at home,’ KCDC director Jeong Eun-kyeong told a press briefing. The patient, who was suffering from diarrhea, headed directly to Samsung Medical Center from the airport, Jeong said. He is now in an isolation ward at Seoul National University Hospital. The KCDC director said all flights from Middle East countries have been put into quarantine. ‘The KCDC and local governments will do our best to prevent spread of the MERS,’ Jeong noted.” The last time South Korea experienced a MERS case, in 2015, a significant outbreak occurred due to poor infection control and hospital practices. A recent update found that the number of contacts was higher, at 21 people, all of whom are being monitored and are currently asymptomatic.

GMU Biodefense Master’s Open House
Next Thursday, September 20th, is your chance to learn about Schar School’s MS in Biodefense. Located in Arlington, this is a great chance to learn about the program requirements, curriculum, and how you can study biodefense online or in person! The session will provide an overview of our master’s degree programs, an introduction to our world-class faculty and research, and highlights of the many ways we position our students for success in the classroom and beyond. Our admissions and student services staff will be on hand to answer your questions.

Medical Countermeasures: Mission, Method, and Management
The latest issue of AJPH focuses on medical countermeasures (MCMs) and future innovations. “Medical countermeasures (MCMs) are critical for minimizing morbidity and mortality in the event of a large-scale public health emergency. MCMs involve a broad spectrum of medical assets, including biological products and personal protective equipment. Whether the emergency results from a chemical, biological, radiological, or natural disaster or from widespread infectious disease and contagions, a well-prepared public health community will readily access and deploy lifesaving MCMs. Ensuring appropriate distribution and dispensing of MCMs can be logistically complex, but coordinated planning between local, state, and federal agencies facilitates an efficient public health response.” The issue includes articles on MCM history, lessons learned by rapid deployment force 3, planning considerations, Taiwan’s annual seasonal flu mass vaccination program, etc.

ABSA International Call for Abstracts
“ABSA International announces the CALL FOR ABSTRACTS for posters for the USDA Agricultural Research Service (ARS) 5th International Biosafety & Biocontainment Symposium to be held February 11-14, 2019, in Baltimore, Maryland. We are anticipating over 200 attendees and over 30 vendors showcasing the latest biosafety and biocontainment products and services. ABSA International is pleased to offer funding support to help selected students and young professionals* (see definition at end of announcement) to attend the symposium. The selection will be made by a panel of judges who will evaluate the submitted abstracts and identify the top submissions. In addition, ABSA International/USDA ARS will present a Student and Young Professional Poster Award* and a Professional Poster Award for the best posters in the categories listed below. The awards will be announced during the reception on Wednesday, February 13th.”

Responding to Airline Outbreaks – A Hidden Safety Net
Helen Branswell lifts back the curtain on the hidden safety net we have regarding ports of entry and infectious diseases. The Emirates flight that was quarantined at NYC last week due to reports of 100 passengers becoming sick mid-flight, raised several questions regarding how we respond to such events. “The fact that a rapid and aggressive response involving a number of agencies and response teams could be pulled together so quickly is thanks to work that has been underway to build this safety net since the early 1990s. That’s when a seminal report from the Institute of Medicine — now called the National Academy of Medicine — issued a clarion call of the threat emerging infectious diseases posed to the U.S. Many such incidents happen over the course of any given year, but in most cases, the CDC does not get immediate word that someone who was on a plane had a disease such as active tuberculosis or measles. In those scenarios, the agency or its partners work to track down passengers who might have been at risk.” While the news of such events much be worrisome, it’s nice to know we have a strong response in place.

Releasing Genetically Modified Mosquitoes 
Africa will see its first release of GMO mosquitoes by researchers sometime this year or next, as the government of Burkina Faso granted permission for the experiment. “The release, which scientists are hoping to execute this month, will be the first time that any genetically engineered animal is released into the wild in Africa. While these particular mosquitoes won’t have any mutations related to malaria transmission, researchers are hoping their release, and the work that led up to it, will help improve the perception of the research and trust in the science among regulators and locals alike. It will also inform future releases. Teams in three African countries—Burkina Faso, Mali, and Uganda—are building the groundwork to eventually let loose “gene drive” mosquitoes, which would contain a mutation that would significantly and quickly reduce the mosquito population. Genetically engineered mosquitoes have already been released in places like Brazil and the Cayman Islands, though animals with gene drives have never been released in the wild.” Success isn’t just based off the scientific outcomes of the project, but also the consent of those living in the areas. 10,000 mosquitoes will be released and are not planned to have a lasting impact on the insect population as they have a “sterile male” mutation meaning that they are unable to procreate.

Skin Bacterium Gets Feisty With Antibiotics
Well, maybe not feisty, but the common skin commensal, Staphylococcus epidermis, has recently become resistant to almost all antibiotics and has spread around the world. “The researchers also found that some of the genetic mutations identified in these lineages confer resistance not only to an antibiotic called rifampicin but also to last-resort antibiotics such as vancomycin. Clinical guidelines often recommend co-administering both rifampicin and vancomycin for the treatment of Staphylococcus infections to prevent the development of drug resistance. But the authors’ findings suggest that the combination may instead fuel resistance in S. epidermidis.”

Stories You May Have Missed:

  • Bionic Bug Podcast with Natasha Bajema – Looking for a new podcast where fiction meets reality? Check out Dr. Natasha Bajema’s podcast on the latest tech news. The most recent episodes (19 & 20) discuss gene drive, mosquitoes, exoskeletons, and artificial intelligence!

Pandora Report 8.17.2018

Happy Friday fellow biodefense nerds! Welcome to your weekly roundup of all things global health security. If you’re finding yourself a food source for mosquitoes and ticks this summer, just a friendly heads up – the associated diseases are on the rise (hint: climate change may be a big reason).

The Lingering Scare of Smallpox
The recent FDA approval of TPOXX to treat smallpox, a disease eradicated since 1980, has many wondering, especially those of us born in a time where the vaccine was not necessary, why so much attention is being raised. It’s an easy thing to forget – the peril of a disease long since eradicated, but the threat of smallpox is very much still a concern in biodefense. Between the concerns of a laboratory biosecurity/biosafety incident at the two remaining stockpile locations or the chance that a frozen corpse (aka corpsicle) who died of smallpox could defrost as the Arctic permafrost melts. Did I mention the risk of a de novo synthesis like the horsepox one in Canada? These are the reasons we haven’t been able to shake the nightmare that is smallpox. “The greatest threat is advances in synthetic biology, which could permit a rogue lab to re-engineer a smallpox virus. In 2016, researchers in Canada announced that they had created horsepox using pieces of DNA ordered from companies. A synthetic smallpox virus could be even more dangerous than the original, because it could be designed to spread more easily or with ways to survive new therapies.” While we eradicated smallpox and proved that such a feat was possible, there is the painful reality that such efforts left an unvaccinated and inherently vulnerable population.

Biological Events, Critical Infrastructure, and the Economy: An Unholy Trinity
Biodefense graduate student Stephen Taylor is reporting on the latest Blue Ribbon Study Panel. “At its recent meeting about resilience, the Blue Ribbon Study Panel on Biodefense explored the potential impacts of a biological event on critical infrastructure in the United States, as well as the best way to approach risk mitigation.  Ann Beauchesne, former Senior Vice President of the National Security and Emergency Preparedness Department at the U.S. Chamber of Commerce, summed up critical infrastructure as ‘the critical services for our society and the backbone our economy.’  Projected increases in global travel, trade, and development all rely on critical infrastructure, magnifying the potential impact of insults to infrastructure systems.  Concurrently, biological threats are also on the rise. As the world warms and urbanizes, natural infectious disease outbreaks manifest in unexpected places.”

Ebola, Healthcare Workers, and the Pandemic Potential in Vulnerable Countries 
Every day brings news of the Ebola virus disease outbreak along the eastern border of the DRC. On Thursday, cases jumped by seven – one of whom is a healthcare worker. The outbreak is up to 73 cases, 46 of which are confirmed and 27 are probable. 43 deaths have been reported. Nearly a thousand people are under surveillance as contacts of cases and healthcare workers are again, experiencing increased risk of transmission. On Tuesday, it was reported- “that health worker Ebola infections could amplify the current outbreak in the Democratic Republic of Congo (DRC), the country’s health ministry today reported five more confirmed cases, including four involving health workers at a health center in Mangina. The other is a patient recently treated at that facility.” The hope is that the new vaccine can help put an end to the outbreak and curb the risk for healthcare workers. The recent outbreak draws attention yet again, to the inherent danger that infectious disease outbreaks pose in vulnerable countries. We’ve seen how fast and unexpectedly such outbreaks can spread beyond international borders (SARS, MERS, Ebola, etc.), which means that these are global health security issues. The 2013-2016 Ebola outbreak taught us a “great deal about how to respond in a fragile state setting. Traditional leaders and faith leaders played an important role in communicating necessary information and behavior change requirements to isolated groups who did not necessarily trust the government or health care workers.” Preventative measures like stronger public health and healthcare infrastructure can make a world of difference. “Preventative investments can mean the difference between life and death for people in those countries and the difference between an outbreak being contained or becoming an epidemic. As we face repeated outbreaks of infectious diseases, including new pathogens, it is essential that U.S. policy-makers continue funding the operations that make containment possible.”

BWC Meeting of Experts
Don’t miss out on the daily reports from Richard Guthrie on the latest MX. You’ll definitely want to check out days six and seven, where national implementation and preparedness were discussed. How would countries respond to a potential act of bioterrorism? Guthrie notes that “Concerns were raised about whether bodies such as the World Health Organization should be engaged with any assessment of the cause of an outbreak if there were indications it was deliberate in case this brought the health body into the security realm with potential negative consequences for other health work. A number of contributions to the discussion noted that health officials would have different roles to officials looking to attribute the cause of an attack and there was a need to ensure that effective ways of operating together were established. An example of the challenges was given in WP.10 from the USA in the section on ‘preservation of evidence’.” The response and preparedness measures for each country can be complex and challenging when considering the global context of the BWC. For example, Saudi Arabia discussed its own preparedness measures for natural events during times when influxes of people were expected (pilgrimages).

 The Economic Burden of Antimicrobial Resistance and the Drive For Intervention
A recent study enumerated the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use. Their model utilized three components – correlation coefficient between human antibiotic consumption and resulting resistance, economic burden of AMR for five key pathogens, and the consumption data for antibiotic classes driving resistance in these organisms. “The total economic cost of AMR due to resistance in these five pathogens was $0.5 billion and $2.9 billion in Thailand and the US, respectively. The cost of AMR associated with the consumption of one standard unit (SU) of antibiotics ranged from $0.1 for macrolides to $0.7 for quinolones, cephalosporins and broad-spectrum penicillins in the Thai context. In the US context, the cost of AMR per SU of antibiotic consumed ranged from $0.1 for carbapenems to $0.6 for quinolones, cephalosporins and broad spectrum penicillins.” Ultimately, they found that the cost of AMR per antibiotic frequently exceeded the purchase cost, which should encourage policy and consumption changes.

NASEM Report: Cooperative Threat Reduction Programs for the Next Ten Years and Beyond
The latest report from the National Academies is now available regarding the Cooperative Threat Reduction (CTR) Program. “The Cooperative Threat Reduction (CTR) Program was created by the United States after the dissolution of the Soviet Union to provide financial assistance and technical expertise to secure or eliminate nuclear weapons delivery systems; warheads, chemical weapons materials, biological weapons facilities, and nuclear, biological, and chemical weapons technology and expertise from the vast Soviet military complex. In a 2009 report, Global Security Engagement: A New Model for Cooperative Threat Reduction, the National Academy of Sciences (NAS) recommended adoption of a modified approach to thinking about CTR, including the expansion of CTR to other countries and specific modifications to CTR programs to better address the changing international security environment.” The report has insight from some of the time minds in the field of biological threats – Elizabeth Cameron, David Franz, James Le Duc, etc.

Stores You May Have Missed:

  • Key Global Health Positions and Officials in the USG – Have you ever wondered who is in charge for global health programs throughout the government? Look no further than this comprehensive list by the Kaiser Family Foundation.
  • CEPI Collaborative for Lassa Fever Vaccine“In a deal worth up to $36 million to advance the development of a vaccine against Lassa fever, the Coalition for Epidemic Preparedness Innovations (CEPI) today announced a new partnership with Profectus BioSciences and Emergent BioSolutions.”

Thank you for reading the Pandora Report. If you would like to share any biodefense news, events, or stories, please contact our Editor Saskia Popescu (biodefense@gmu.edu) or via Twitter: @PandoraReport

Pandora Report 6.22.2018

 US Military Asks – What Would A SynBio Weapon Look Like?
A new study ordered by the DoD seeks to evaluate the potential for synthetic biology to be a biodefense threat. The report, Biodefense in the Age of Synthetic Biology, was issued by the National Academies of Sciences, and provides an actual ranking of national security threats that genetic engineering technology, like CRISPR, pose. “’Synthetic biology does expand the risk. That is not a good-news story,’ says Gigi Gronvall, a public health researcher at Johns Hopkins and one of the report’s 13 authors. ‘This report provides a framework to systematically evaluate the threat of misuse’.” The report includes a framework for assessing synbio capabilities as well as concerns related to the production of chemicals or biochemicals, bioweapons that alter the human host, pathogens, etc. The report also includes a section on related developments that impact the ability to effect an attack using a synthetic biology-enabled weapon, where the authors note several mitigation challenges posed by synbio. Some of the challenges to deterrence and prevention include accessibility of biotechnology, pointing to DIY biohackers, the iGEM competition, and traditional pathways like academic laboratories. Regarding the challenges in recognizing and attributing an attack, they note that “synthetic biology could also confound the ability to identify the causative agent in a biological attack. Despite the breadth and depth of available repository resources, there would not always be a reference specimen to use as comparator, particularly if the agent is markedly different from natural pathogens or toxins.” “According to the report, the US must now also track ‘enabling developments’ including methods, widely pursued by industry, to synthesize DNA strands and develop so-called chassis’ organisms designed to accept genetic payloads.” Consider the recent de novo synthesis of the horsepox virus by researchers in Canada that has opened up Pandora’s box regarding synbio and biosecurity. GMU Biodefense professor and graduate program director Gregory Koblentz noted that “Synthetic biology has provided the tools necessary to recreate the smallpox virus,” and “Safeguards against the misuse of those tools are weak and fragmented.”  “The US government should pay close attention to this rapidly progressing field, just as it did to advances in chemistry and physics during the Cold War era,” says Michael Imperiale, a microbiologist at the University of Michigan. The recent tabletop hosted by the Center for Health Security (Clade-X) even presented some real-world scenarios and gaps for dealing with a bioterrorism event that involved an engineered organism.

Gene Drives and Frank Discussions With CRISPR Scientists
Speaking of gene editing…GMU Biodefense professor Sonia Ben Ouagrham-Gormley recently sat down with Vox to discuss the good and bad side of gene drives in the context of genetically modified mosquitos and their place in the fight against malaria. Malaria kills hundreds of thousands a year and despite eradication efforts, it’s still a monumental task for public health. “We have eliminated malaria from the rich world; it used to be endemic to France just as it is to Mali today. And now, with CRISPR gene drives, we have the potential to wipe it out globally and save millions of lives. Gene drives allow humans to change the genetic makeup of a species by changing the DNA of a few individuals that then spread the modification throughout an entire population. In the case of malaria, the idea is to change the three species of mosquito most responsible for its transmission — Anopheles gambiae, Anopheles coluzzii, and Anopheles arabiensis — so that all their offspring would be male, effectively leading to the species’ extinction.” The debate though is that if gene drive was used poorly, it could cause irreversible changes in the ecosystem. Many worry about the potential for weaponization of gene drives or nefarious actors using it, but several biosecurity experts have pointed to the limitations of gene drive when it comes to making diseases more potent. “The biosecurity experts I talked to are deeply skeptical of those nightmare scenarios. Sonia Ben Ouagrham-Gormley, a professor in the biodefense program at George Mason University, says she doubts gene drives will be militarily effective in targeting rival countries’ harvests. ‘Animals and plants that are raised for food are generally monitored, and a gene drive can be easily detected in the genome of the animal,’ she explained. ‘Because of that regular monitoring, I don’t think gene drives would be a good tool for affecting a country via agriculture.’ Biosecurity experts like Ben Ouagrham-Gormley and Filippa Lentzos have concerns that are more social. “What happens if one of the few thousand fruit fly biologists around the world decides to act unilaterally and throws international talks on the matter into chaos? What if a grad student creates a gene drive that can’t reliably hurt people but can reliably terrify them?” If she wasn’t busy enough, Sonia Ben Ouagrham-Gormley recently returned from a research trip to China where she met with several CRISPR scientists and toured their laboratories. She discussed CRISPR developments in China and gave a talk at the University of the Chinese Academy of Sciences in Beijing (UCAS) on the technological, regulatory and technical challenges of CRISPR.

Summer Workshop on Pandemics, Bioterrorism, and Global Health Security
We’re less than a month away from the workshop on all things health security, are you registered? Since we’re on the topic of biotechnology and biosecurity, our workshop is a great chance to hear from Supervisory Special Agent Edward You of the FBI’s WMD Directorate, Biological Countermeasures Unit. “Mr. You is responsible for creating programs and activities to coordinate and improve FBI and interagency efforts to identify, assess, and respond to biological threats or incidents. These efforts include expanding FBI outreach to the Life Sciences community to address biosecurity. Before being promoted to the Weapons of Mass Destruction Directorate, Mr. You was a member of the FBI Los Angeles Field Office Joint Terrorism Task Force and served on the FBI Hazardous Evidence Response Team.” Don’t miss Mr. You’s talk on the bioeconomy and biosecurity threats during this three-day workshop on all things biodefense!

WHO Releases New International Classification of Disease (ICD11)
The World Health Organization (WHO) released the latest ICD-11, which includes 55,000 codes for specific injuries, diseases, and causes of death. “The ICD is also used by health insurers whose reimbursements depend on ICD coding; national health programme managers; data collection specialists; and others who track progress in global health and determine the allocation of health resources. The new ICD-11 also reflects progress in medicine and advances in scientific understanding. For example, the codes relating to antimicrobial resistance are more closely in line with the Global Antimicrobial Resistance Surveillance System (GLASS). ICD-11 is also able to better capture data regarding safety in healthcare, which means that unnecessary events that may harm health – such as unsafe workflows in hospitals – can be identified and reduced.”

Ebola Virus Disease Outbreak Updates
The DRC has reported 5 more suspected cases in the Iboko health zone, which brings the total to 60 cases, included 28 deaths (38 confirmed, 14 probable, and 8 suspected) as of June 19th. The case fatality rate for this outbreak is at 47% and “‘The number of contacts requiring follow-up is progressively decreasing, with a total 1,417 completing the mandatory 21-day follow-up period,’ the WHO said. As of Jun 17, a total of 289 contacts were still being monitored.” WHO Director General Tedros Adhanom Ghebreyesus recently tweeted “Just over a month into the response in , further spread has largely been contained. In spite of progress, there should be no room for laxity and complacency until it’s finally over. This is a collaborative effort led by

 MERS Trends in Saudi Arabia – Hospitals and Households
Since January of this year, the WHO has reported 75 laboratory confirmed MERS-CoV cases and 23 deaths in Saudi Arabia. 21 of these cases were involved in four clusters (2 household and 2 healthcare) – “Cluster 1: From 2 through 4 February, a private hospital in Hafer Albatin Region reported a cluster of three (3) health care workers in addition to the suspected index case (four [4] cases in total). Cluster 2: From 25 February through 7 March, a hospital in Riyadh reported six (6) cases, including the suspected index. No health care workers were infected. Cluster 3: From 8 through 24 March, a household cluster of 3 cases (index case and 2 secondary cases) was reported in Jeddah. No health care workers were infected. Cluster 4: From 23 through 31 May, a household cluster was reported from Najran region with eight cases including the suspected index case. This cluster is still under investigation at the time of writing. As of 31 May, no health care workers have been infected and the source of infection is believed to be camels at the initial patient’s home.” The total number of MERS cases since 2012 is now 2,220. These clusters underscore the role of hospitals as amplifiers for MERS transmission during outbreaks and the importance of infection prevention efforts.

Infection Prevention Gaps Found Across Critical Access Hospitals
GMU Biodefense doctoral student Saskia Popescu addresses infection prevention failures and gaps within the United States and specifically in critical access hospitals. “These findings are not novel as staffing issues are problematic across the country in all types of hospital systems. The importance of having IPs within health care and ensuring they have access to training and the ability to focus on infection control activities—not just reporting tied to CMS reimbursement—is critical. IPs need time for activities such as education, rounding, antibiotic stewardship, and more. This study supports the notion that not only should hospitals be ensuring proper staffing and support for infection prevention programs, but that significant gaps exist across CAHs. In the areas where CAHs are the only health care patients may access, it is vital that infection prevention processes be supported and followed”

How Ready Is the United States For The Next Anthrax Attack?
This week the CDC reviewed their recommendations for mass vaccination in the event of an anthrax attack. “The way that people think about [nuclear weapons] is on a much, much grander scale than biological weapons, and I think that’s a misperception,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “If you use a contagious infectious disease, you really could create havoc on a different scale.” The Amerithrax attack was in 2001 and since then we’ve seen SARS, MERS, and Ebola as potential infectious disease threats that reveal a rather large spectrum of avenues for microbial events. “But there’s still a long way to go in terms of preparedness, Redlener said, adding that no city is fully prepared. Questions remain about what dosage of the vaccine to use for children, the safety of the vaccine for the general public, delivery and distribution of the vaccine and medications. ‘I think a vaccination program would be a nightmare. Who would administer it? Who would pay for it? Who would manufacture it? The cost of complications that may occur. I don’t think it would be practical,’ Redlener said.”

Stories You May Have Missed:

  • Gene-edited Farm Animals – “The team edited the animals’ DNA to make them resist the deadly respiratory disease known as PRRS – a move that could prevent billions of pounds in losses each year. However, consumers have traditionally been reluctant to eat genetically altered animals and crops. This poses a significant barrier to farmers owning gene-edited pigs. And because genome, or gene, editing (GE) is relatively new, the absence of regulation currently prevents their sale anyway.”
  • FDA Releases New Food Defense Guidance – “Today the US Food and Drug Administration (FDA) released the first of three installments of draft guidance on the intentional adulteration (IA) rule, part of the Food Safety and Modernization Act (FSMA). The rule is meant to guide the food industry on reducing the risk of exposing food facilities to IA, such as acts of terrorism. Unlike other FSMA rules that address specific foods or hazards, IA will require preventive measures for reducing vulnerabilities at all domestic and foreign companies that are required to register with the FDA as food facilities.”