Tag: chemical weapons

Pandora Report 8.5.2016

by spopescu, posted in Pandora Report

August is here and so are the Zika cases…it does seems rather ominous that the Rio Olympics are starting a week after the confirmation of locally-acquired U.S. cases of Zika virus. Despite the outbreak and the concerns over water safety, the games must go on?

Syria Chemical Weapons Attack
Two chemical attacks were reported earlier this week in northern Syria. The first attack occurred in the city of Saraqeb, where chlorine gas-filled cylinders were dropped in a residential area. Russia has already begun denying any role in the attack and while officials haven’t formally called the Saraqeb incident a “chemical attack”, the evidence is mounting. “Evidence points to the Assad regime because the attack came from the sky and the opposition doesn’t have any aircraft, the source added. In the second alleged incident, the Syrian government claimed that ‘terrorist groups’ carried out a gas attack that killed five people in the old town of the besieged city of Aleppo on Tuesday afternoon, according to the state-run news agency SANA.” The second attack caused the death of five individuals and is considered a counteroffensive from Syrian regime forces and Russian allies. A physician tending to victims injured in Saraqeb noted that their symptoms are consistent with those of chlorine poisoning. On Wednesday, the Russian military informed the U.S. that “rebel forces were responsible” for the attacks.

Russia’s Frozen Anthrax Problem
Over ninety people are currently under healthcare observation and surveillance in the Yamalo-Nenets region of Siberia, related to an outbreak of anthrax. Eight cases have been confirmed and a young boy died on Monday from the outbreak that is believed to be associated with an infected reindeer carcass. While anthrax is a  naturally occurring bacteria in the soil and can be endemic in certain regions, the heatwave in Siberia is believed to have caused a decades-old reindeer carcass to become exposed. As a result of the exposure, thousands of reindeer have also been infected and officials are investigating the release of the anthrax spores into the environment from the carcass that was found in the 75-year-old permafrost. Siberia’s Governor, Dmitry Kobylkin, has declared a state of emergency and specialists from the Russian Chemical, Radioactive, and Biological Protection Corps have been called into assist with outbreak control and disposal of infected animals. A mass veterinary vaccination program is also underway to protect animals in northern Russia.

Spillover Special & Human Economic Activity
Wednesday night saw the premiere of the PBS documentary, Spillover, which focused on the impact and rise of zoonotic diseases. Given the recent Ebola outbreak and news of locally-acquired Zika virus cases, this documentary comes at an precarious time. Aside from a few dramatic moments, the documentary was both informative and visually captivating. It was refreshing to see the One Health approach to outbreaks within a documentary. The filmmakers appeared to have taken great care to present the complexity of the spillover process and the importance of global surveillance and the shock humans have on the environment. Between the documentary and Sonia Shah’s new article, the impact of human activity on microbes is becoming a much more prevalent and unavoidable topic. Shah points to an increasingly globalized economy and the glaring reality that sick people do in fact get on airplanes and spread their germs, These are the obvious points in the transmission chain though and she notes that we tend to forget the role of foreclosed homes, imported tires, and decorative bamboo as factors in disease transmission. “Today, abandoned properties and deteriorating infrastructure, brought on by housing crises and climate change, similarly threaten us with epidemics of mosquito-borne pathogens such as Zika.” Shah also points to the need to assess the public health implications of our “built environment the way we assess the environmental impact- before construction begins.” While we consider our carbon footprint, are we considering our epidemic one too?

UK’s HIV Gamechange with PrEP
A recent high court ruling that NHS England can pay for PrEP (pre-exposure prophylaxis) is being marked as a victory for HIV/AIDS campaigners in the UK. PrEP is a medication that can be taken daily to help people, who are at a very high risk of contracting HIV, lower their chances of infection. According to the CDC, “A combination of two HIV medicines (tenofovir and emtricitabine), sold under the name Truvada, is approved for daily use as PrEP to help prevent an HIV-negative person from getting HIV from a sexual or injection-drug-using partner who’s positive. Studies have shown that PrEP is highly effective for preventing HIV if it is used as prescribed. PrEP is much less effective when it is not taken consistently.” The court ruling is especially important as it will not only put pressure on pharmaceutical companies to lower the cost of the drug, but will now be available through the National Health Services (NHS), meaning that it will be widely available and accessible to a far wider range of people. “Condoms are cheap, but among some high-risk populations they are not used consistently. About 4,000 more people acquire HIV in the UK every year. The average cost of a lifetime of treating each one is put at about £360,000. The National Aids Trust brought the high court case following anger and consternation among campaigners after NHS England said it would not fund PrEP because it did not have the power to do so. It argued that it was the role of local authorities, which have been given control of public health measures including reducing smoking and family planning, as well as HIV prevention. Local authorities said they did not have the money to pay.” Accessible HIV prophylaxis is a huge step in prevention and despite the plans of NHS to appeal the decision, they are still putting aside funds for the cost of the medication.

Biodefense in Gaming Courtesy of Pandemic Inc game
Since we’re still reeling from the loss of prime-time contagion drama, nuclear systems engineer and aspiring biodefense wonk, Greg Witt, is helping us through this dark time via the enjoyable but inaccurate world of biodefense in gaming. Greg’s review of several popular video and board games will give you some great options for your next gaming adventure. “With pathogens like Zika, Ebola, and West Nile now household names, biodefense has rarely been more culturally relevant. Depictions of biodefense topics in popular culture are not limited to traditional media, though; numerous video games and board games have been released in the past few years in which biodefense plays an important role.” Discussing video games like Tom Clancy’s The Division and its underlying premise that is almost identical to Operation Dark Winter, to two of my personal favorites – Plague Inc. and Pandemic, Greg gives a tour through the minefield of biodefense gaming. Rest assured though, he points to the scientific failures and epidemiological snafus that plague these games, but do not ultimately deter our enjoyment while bringing biodefense to the general public.

Zika Updates 
Following last week’s news regarding a growing number of locally acquired cases in Florida, it was also reported that 41 U.S. military members have contracted Zika. “All cases were transmitted while abroad and one of the military service members is a pregnant female. Under Pentagon health policies, female service members are permitted to move out of countries where Zika exists.” Here’s a helpful little field guide for identifying the mosquitoes that are known to transmit Zika. A new model used by researchers from Northeastern University is pointing to a vastly underestimated amount of Zika in the U.S. They note that there is probably “way more Zika in the U.S. than has been counted”. Case counts are especially challenging in a disease that leaves many asymptomatic and unlikely to be tested. In response to the growing number of locally-acquired cases (currently at 14 cases) in Miami-Dade County, there will be aerial spraying for mosquito control.  The CDC has reported 1,825 total Zika infections in the U.S. as of August 3rd and has issued a travel warning for the Miami area. President Obama also pleaded with Congress to “do its job” and approve funding to fight the growing outbreak. Donald Trump was also recently asked about how he would handle the outbreak, noting that Florida Governor, Rick Scott, “seems to have it under control”. 

Stories You May Have Missed:

  • In Memoriam of Dr. Roger Gerrard Breeze– Dr. Breeze, a preeminent veterinary research scientist and biosecurity expert passed away in late June in Washington, D.C. We are grateful to have had Dr. Breeze as a professor for GMU’s agroterrorism courses and his contribution to the field of genetic engineering and molecular biology. “Dr. Breeze was a Member of the UK Royal College of Veterinary Surgeons and a member of the U.S. National Academies – Institute of Medicine’s Forum on Microbial Threats and National Academies – Committee on Biodefense Analysis and Countermeasures. For the past decade, Roger served as an advisor on biosecurity and biological/chemical weapons nonproliferation issues to the Defense Threat Reduction Agency (DTRA) and the Lawrence Livermore National Laboratory.”
  • GMU Biodefense PhD Awarded FAA Graduate Research Grant– Biodefense PhD student, Nereyda Sevilla, was recently awarded a grant from the FAA for her dissertation; Germs on a Plane: The Transmission and Risks of Airplane-Borne Diseases. The Graduate Research Award Program on Public-Sector Aviation Issues is a joint sponsorship from the Federal Aviation Administration of the U.S. Department of Transportation and administered by the Airport Cooperative Research Program (ACRP) of the Transportation Research Board/National Academies. You can read more about Nereyda’s work with the surveillance tool, Spatiotemporal Epidemiological Modeler (STEM), here.

 

Pandora Report: 7.22.2016

by spopescu, posted in Pandora Report

Those antibiotic-resistant bugs just won’t quit – researchers in Florida found drug-resistant organisms in the water and sediment from a sewer-line spill in 2014.  If you’ve got live poultry in your backyard, make sure to check out the advice from the CDC as there’s been a large outbreak associated with poultry. The recent Salmonella outbreak across 45 states has resulted in 611 cases, 138 hospitalizations, and 1 death. With the news of the first CRISPR human trials starting next month, many are wondering if the pro-CRISPR team has their heads in the sand regarding gene-editing safety.

The Soviet Biological Weapons Program in Today’s Russia
The Center for the Study of Weapons of Mass Destruction (CSWMD) at the National Defense University has published their first WMD case study, focussing on the driving factors for Russia’s offensive program following the termination of the U.S. program in 1969. Raymond Zilinskas discusses President Nixon’s decision to end the U.S. offensive biological weapons program and why the Soviet decision was in such a sharp contrast. Through a review of the generations of Soviet bioweapons programs, “the two authors of an extensive history of the Soviet BW program, one of whom is the author of this paper, were able to collect sufficient information from their interviews with Biopreparat employees, autobiographies written by weapons scientists, and articles written by investigative Russian reporters to describe and discuss important aspects of Soviet decisionmaking concerning BW.” In the second part of the paper, Zilinskas focuses on the driving force behind the massive Soviet push for an offensive program in the 1970s and Vladimir Putin’s historical comments on the development of “high technologies including genetics”. Zilinskas notes that given the secrecy, it’s possible that Putin may be instituting a third generation BW program.

The Rise of HIV Cases
HIV data over the past 10 years has revealed an increased rate of infection in 74 countries. While AIDS deaths have fallen, the rate of new infections is growing. Researchers reported countries like Egypt, Pakistan, Kenya, the Philippines, Cambodia, Mexico, and Russia, have all seen increased HIV infections since 2005. “The new research, released at the International AIDS Conference in Durban, South Africa, also found that while the global number of new cases continues to decline, the pace has greatly slowed. New infections of HIV fell by an average of only 0.7% per year between 2005 and 2015, compared to the 2.7% drop per year between 1997 and 2005.” The data raises concerns about meeting the UN’s Sustainable Development Goal to see the end of AIDS in less than 15 years, not to mention the startling reality that we’re still a ways off from ending the HIV/AIDS epidemic. The study also found that women tend to die at younger ages from HIV/AIDS, which matches the age-disparate relationships that are prevalent. A recent BBC article on cultural practices in Malawi may give some insight as to why younger women may be at risk for HIV infections and subsequent AIDS deaths. 

2016 Presidential Candidates on Nuclear Weapons
You can’t get much more on the agenda than a norovirus among GOP convention staffers, so here’s hoping global health security will make it to the agenda in this year’s presidential election. GMU Biodefense MS student Greg Mercer provides us with a recap of where the candidates stand on nonproliferation. Following the GOP convention, it’ll be interesting to see how the Democratic convention addresses WMD’s. “Working off draft copies of the two parties’ respective platforms, here’s a look at what the two-party system has to say about non-proliferation for the next four years. These are dramatic, confrontational texts, each calling out the opposing party’s leadership and policies.”

Zika Virus Outbreak – Weekly Status Updates
A study published in Science addresses the need for new control strategies with the most recent outbreak. “The rise of Zika after its long persistence as a disease of apparently little importance highlights how little we truly understand about the global spread of mosquito-borne viruses and other lesser known diseases,” says Justin Lessler, an associate professor of epidemiology at the Bloomberg School who led the study along with Lelia Chaisson, a student in the department. “Over the past decades, dengue, chikungunya, West Nile virus and now Zika have emerged or re-emerged across the globe. Yet why these viruses have expanded their range and others have failed to invade areas potentially ripe for their spread remains a mystery.” Within the paper, researchers touch on the two main theories as to why Zika is currently causing so many problems- the virus has mutated and become more infectious or pathogenic, or previous outbreaks were in small populations and produced little understanding of health effects. Senior Fellows with Results for America, Michael Gerson and Raj Shah, are discussing what the U.S. needs to do to fight Zika.  Aside from resources (financial and trained personnel), they’re pointing to the need for the U.S. to take on global leadership to help coordinate a strategy, especially in the wake of the post-Ebola reviews that have been released. Florida health officials are currently investigating two potential cases of local transmission. As of July 20, 2016, the CDC reported 1,404 cases of Zika virus in the U.S. 

E. coli Outbreaks Galore 18160_lores
Summer is the time for picnics and, sadly, food-borne illness. Twenty people have been hospitalized in Chicago as a result of an E. coli outbreak traced to the Carbón Live Fire Mexican Grill. Two customers who became ill have filed civil lawsuits against the company for compensation. There have been a total of 65 sickened from this particular outbreak. England has reported 151 cases of E. coli o157, including the deaths of two people. “PHE (Public Health England) has been working to establish the cause of the outbreak and has identified that several of the affected individuals ate mixed salad leaves including rocket leaves prior to becoming unwell. Currently, the source of the outbreak is not confirmed and remains under investigation; we are not ruling out other food items as a potential source.” As you previously read, Salmonella has also been quite present this summer via the 45-state outbreak involving backyard poultry.

Walmart Chemical Weapon?
Video footage was recently released that shows a man, police say, who has been accused of building a chemical weapon inside an Oxnard Walmart. Reports are saying that following his research online, the suspect, Martin Reyes, went into the store and began assembling a weapon from ingredients on the shelves and an electronic appliance. He used a store socket to plug in the appliance, which was designed to set off the weapon. Following his arrest, Reyes admitted the entire thing and told police how he had been planning to build the device. As more information is released regarding the event, we’ll keep you posted.

Stories You May Have Missed:

  • Agent X Concerns– Engineering of botulinum toxin during the height of bioweapon development was a major concern as the toxin is extremely lethal. Known as Agent X, researchers at the Defense Threat Reduction Agency’s Joint Science and Technology Office (JSTO) have been addressing the potential for weaponization. “Using tenants of Better Buying Power 3.0, a DoD initiative to achieve dominant capabilities through innovation, JSTO collaborated with the U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), the Israel Institute for Biological Research (IIBR) and Hawaii Biotech, Inc., to tackle this complex issue. By pooling resources, JSTO incentivizes productivity in industry and government, while creating a consortium aimed to develop the first novel small organic molecules BoNT inhibitors (SMIs) as well as provide proof-of-concept for regenerative medicine using insulin-like growth factor 1 (IGF -1)”
  • Yellow Fever Outbreak Situation Report: The WHO released their sit-rep on the yellow fever outbreak that started in Angola in December 2015. As of July 8th, there have been 3,625 cases in Angola and 1,798 cases in the DRC. Kenya and the People’s Republic of China have confirmed imported cases as a result of travel. There is currently a push for mass vaccination campaigns to help control the spread to the disease.
  • Headway in Ebola Vaccine– Soligenix, Inc. announced their positive preliminary proof-of-concept results in efforts to produce a heat stable subunit Ebola vaccine. “These studies identified a formulation that maintained the physical state of the Ebola subunit protein despite incubation at 40 degrees Celsius (104 degrees Fahrenheit) for 12 weeks.”
  • Silk Road Disease Transmission– Researchers found some of the first solid evidence of disease transmission along the Silk Road. Bamboo sticks used (by travelers) as “bottom wipers” from a 2,000-year-old Chinese latrine pit were analyzed. Fecal matter samples from these bottom wipers were positive for eggs from four species of parasites. The parasites, including the Chinese liver fluke, “needs marshy conditions to complete its life cycle, so could not have come from the desert area around the ancient Xuanquanzhi relay station.”

 

Pandora Report 4.29.2016

by spopescu, posted in Pandora Report

TGIF- We’ve got your weekly dose of biodefense and much more in this edition of the Pandora Report! Kurdish Peshmerga soldiers are saying that recent ISIS attacks have involved chemical weapons. Heads up- you may want to avoid a spiced herbal tea commonly sold at CVS due to a potential contamination with Salmonella. Check out a new study on biodiversity in swine flu and the potential for spillover.  Monday, April 25, 2016 was World Malaria Day! Lastly, here’s a chuckle to help start your weekend.

2016 Survey on U.S. Role in Global Health
A recent survey of Americans performed by the Kaiser Family Foundation addressed the public perception, knowledge, and attitude regarding the role of the U.S. in global health. The survey addressed topics like American awareness of Zika virus and the health issues that are most urgently facing developing countries. The survey found that a “majority of the public wants the U.S. to take either the leading role or a major role in trying to solve international problems generally, as well as in improving health for people in developing countries specifically.” Interestingly, the importance of improving health for developing countries was not ranked as a top priority like protecting human rights, etc. “Seven in ten Americans believe that the current level of U.S. spending on health in developing countries is too little or about right, yet the public is somewhat skeptical about the ability of more spending to lead to progress, with more than half saying that spending more money will not lead to meaningful progress. Republicans and independents are more skeptical than Democrats, and these partisan differences have increased over time. Another notable trend is the decreasing visibility of U.S. efforts to improve health in developing countries; just over a third of the public says they have heard “a lot” or “some” about these efforts in the past 12 months, a decrease of 21 percentage points since 2010.” The survey also found that while Americans believe the U.S. should help women in Zika-affected countries, there was a divide regarding involvement in their family planning and preventative health measures.

GMU Biodefense Alum Awarded Mirzayan Science & Technology Fellowship
Congrats to GMU Biodefense alum, Dr. David Bolduc, on being named a Christine Mirzayan Science and Technology Policy Graduate Fellow! David graduated from GMU with a PhD in Biodefense in 2011 and doctoral work focused on the threats and mechanisms of chemical, biological, radiological and nuclear (CBRN) agents and CBRN proliferation issues such as treaties, histories and the managing of related mass casualty incidences. David is currently a Principal Investigator at the Armed Forces Radiobiology Research Institute. The Mirzayan Fellowship is a very prestigious award – as a program of the National Academies, it is designed to provide mentorship and professional development opportunities to early-career leaders in the field of science and technology policymaking.

Global Health & Military Expenditure 2013_numbers_subregions_2
Last week we discussed the financing of global health versus military.  There was a recent publication by Sipri (Stockholm International Peace Research Institute) that looked at global military expenditure versus health expenditure (in 2015, it was $1676 billion or about 2.3% of the world’s Gross Domestic Product). They utilized the WHO’s recent estimates of government health expenditure as a share of GDP. They reviewed 2013 data and found that “governments worldwide spent just over two and a half times as much on health than on the military in 2013: 5.9% of global GDP went to public health spending, compared with 2.3% for the military.” Here’s the interesting part – it varied regionally. While the U.S. spends a lot on military, healthcare expenditure is still very high. Western and Central Europe spent 7.8% of their GDP on health and 1.5% on military. The Middle East spent 4.6% of their GDP on military versus 3.0% on health expenditures. The study also looks at reallocation of military spending and what that may translate to regarding the UN’s Sustainable Development Goals (SDGs). “Reallocating only around 10% of world military spending would thus be enough to achieve major progress on some key SDGs, supposing that such funds could be effectively channelled towards these goals and that major obstacles, such as corruption and conflict, could be overcome.”

Did Newcastle Disease Virus Sneak Out of the Lab?
Newcastle disease virus (NDV) is a highly infectious disease that impacts domestic poultry and other birds. Virulent NDV strains have been endemic in poultry throughout Asia, Africa, and some countries within South America. Current outbreaks continue to cause food safety and agricultural issue. In the 1940s, the first NDV panzootic occurred, specifically genotypes II, III, and IV. Other genotypes have continued to circulate and cause outbreaks. A recent study performed a complete genomic sequence of contemporary isolates from China, Egypt, and India. Researchers performed genetic analysis to distinguish historical isolates (the outbreak from the 1940s) from currently circulating genotypes (V, VI, VII, and XII through XVIII). Through their work, they found that isolates of genotypes II and IX (which are not normally circulating viruses in the environment) were found to be identical to the historical viruses that were isolated in the 1940s. “The low rates of change for these virulent viruses (7.05 × 10−5 and 2.05 × 10−5 per year, respectively) and the minimal genetic distances existing between these and historical viruses (0.3 to 1.2%) of the same genotypes indicate an unnatural origin.” The virulent strains isolated during the 1940s have been used in labs and research studies. Researchers noted that it is highly unlikely these viruses remained viable in the environment for over sixty years, which means its very possible (and scary…) that the source of these viral samples, taken from poultry and wild birds, may in fact be from a laboratory. So now we have to wonder…how did these specific virulent viral isolates find their way out of laboratories and into nature?

Is Open Science the Secret Weapon Against Zika and Future Pandemics?
Gene editing tools like CRISPR-Cas9 have the potential to combat diseases like HIV and malaria, but there’s also a potential dual-use for these technologies that is much more sinister. The price of laboratory equipment for some synthetic biology experiments is dwindling and many are becoming concerned about potential for misuse. Should science be left open and researchers ultimately allowed to make the call about potential dual-use or should scientific work/publications be regulated to avoid publications of research that could be used to build a biological weapon? Some are saying that the best way to combat global issues is through global cooperation and communication and thus, open-source information. Should Zika be the first in the test subjects of open science and its application in the global health security toolbox? Many have argued that if a research project is receiving public funding, it should be open sourced (including the data). Would this have helped the Ebola outbreak? “When Ebola was raging through West Africa in the summer of 2014, a group at the Broad Institute in Cambridge, Mass. published open repository sequence data for 99 Ebola genomes taken from patients in Sierra Leone’s Kenema government hospital. This open sourcing of critical scientific data was the second instance in the outbreak. A team of international researchers had initially published three genomes from patients in Guinea in April. For the next three months, no more genomic data was released to the public data repositories that had become the go-to source for scientists studying Ebola. The silence puzzled many prominent scientists. A formidable array of genomic sequencing technology was aimed squarely at the virus. Yet the data was not shared.” Since this outbreak, many have pushed more for open science, especially in the wake of a global outbreak like Zika.

The Other Side of the Spectrum – How Genetic Editing Became a National Security Threat
You may recall in February, Director of National Intelligence, James R. Clapper, stated in his World Wide Threat Assessment testimony that gene editing had become a global danger and should be considered a weapon of mass destruction. The history of genetic research has seen a burst of developments since the discovery of the double helix in 1953. CRISPR-Cas9 is the newest in the genetic engineering arsenal…and at at a fraction of the historical price. If it were only so simple as to do away with malaria by genetically modifying mosquitoes to avoid carrying the parasite. Alas, the realities are a bit darker. The truth is that genome editing of wildlife can alter entire ecosystems, not to mention the risk for accidents and negligence, which is a very real possibility. Those concerns aren’t even touching on the frightening potential for biological weapons. “Gene editing techniques could produce forms of diseases that barely resemble their naturally occurring counterparts. Such engineered pathogens could sicken or even kill hundreds of thousands of people. Armed with the proper genetic sequences, states or bioterrorists could employ genome editing to create highly virulent pathogens for use in such attacks. They could, for example, change a less dangerous, non-pathogenic strain of anthrax into a highly virulent form by altering the genome, or recreate pathogens such as the deadly smallpox virus, which was eradicated in the wild in 1980. Or they could develop specific weapons that target either individuals or even entire races: With the right manipulations, a pathogen could be made to have greater invasiveness or virulence in a target population.” So where do we go from here? With no governance of do-it-yourself facilitates, no training for the at-home gene editing experimenters, and endless debate about the dangers of gain-of-function research, what is being done? Many are saying UN Resolution 1540 should be strengthened to consider this technology and the Dual-Use Research of Concern (DURC) policy shouldn’t just apply to research funded by the government, but also small labs and individuals. With the notion of open science and DURC still up for debate, the stakes will only get higher as global outbreaks, like Zika, continue to burn through countries.

Why We Should Be Afraid of Yellow Fever
Angola is getting hit hard by yellow fever and the vaccine shortages only amplified the outbreak. With all eyes on Zika and a century since Rio saw its last case of yellow fever, where’s the link? Global supplies of yellow fever vaccines are pretty much depleted and BioManguinhos/FioCruz in Rio (one of four…yes four… yellow fever vaccine producers in the world) is having production problems. All available vaccines are being rushed to Angola and cases are spilling over into the DRC, Mauritania, and Kenya. Here’s more – “What most people don’t know is that there are a lot of Angolans coming every year to Brazil, and the more who arrive here unvaccinated, but have been exposed to yellow fever in Africa and may be carrying the virus, the greater the risk that they will infect Rio mosquitoes, allowing them to transmit yellow fever to residents and tourists.” Brazil is already waging a massive war against Zika. Add in yellow fever and it’ll be like adding a gallon of gasoline to a house fire. Mosquito control is imperative and now we’re paying the costs of historically lackadaisical efforts.

Zika Updates
The WHO announced that the number of Zika virus cases is dropping in Brazil. A recent study reports that dengue virus antibodies enhance Zika virus infection. Researchers suggest that pre-existing dengue immunity will enhance a Zika infection in vivo and can increase the severity of disease. Many are calling for more research to be done regarding the relationships between Zika and dengue infections. You can also find a timeline of Zika virus here. There are growing concerns regarding blood donations as Zika spreads internationally. The Canadian Blood service noted that new rules to protect against Zika transmission are putting stress on the blood supply. A new study looks at the impact of Zika and the challenges we many face due to the increasing frequency of viral outbreaks. As of April 27, 2016, there were 426 travel-associated cases in the U.S.

Rewiring Outbreak Preparedness and Response
Let’s take more of a deep-dive into why we should apply U.S. biodefense practices to managing and preparing for outbreaks. Hoyt and Hatchett emphasized why we should learn from American biodefense strategies to better fight infectious disease outbreak. “SARS was responsible for 800 deaths but cost $40 billion globally and Ebola has cost West African economies $6 billion plus an additional $4.3 billion in international contributions. Now, consider the cost of developing a vaccine. Hoyt and Hatchett point out that at the most expensive point, it can cost $1.8 billion to develop a vaccine (others argue that is it much closer to $500 million).”

Stories You May Have Missed:

  • Neurological Problems in Ebola Survivors – a recent NIH study found that nearly all Liberian Ebola survivors reported neurological symptoms following their recovery. Symptoms were noted to have persisted for over a year, including headaches, difficulty walking, overall muscle weakness, loss of memory, and depression. Hallucinations during treatment in Ebola treatment units was prevalent in 25% of patients, with 4% having persistent hallucinations at follow up.
  • Ebola in America: Epidemic of Fear – The Center for Strategic & International Studies has put together a video on the fear and U.S. response to Ebola cases in the U.S. and in West Africa. The video discusses stigma and how Ebola was experienced in the Fall of 2014.
  • Biodefense World Summit – The 2016 event will be hosted in Baltimore, MD on June 27-30, 2016. The Knowledge Foundation’s Second Annual Biodefense World Summit brings together leaders from government, academia, and industry for compelling discussions and comprehensive coverage on pathogen detection, sample prep technologies, point-of-care, and biosurveillance. Across the four-track event, attendees can expect exceptional networking opportunities in the exhibit hall, across panel discussions, and shared case studies with members of the biodefense community from technology providers to policy makers

 

Pandora Report 4.22.2016

by spopescu, posted in Pandora Report

Happy Friday from your friends at GMU Biodefense! We’ve got some great updates in your weekly dose of global health security. First, check out this wonderful infographic on the hurdles ahead for Zika virus response. France, Myanmar, and Taiwan have all recently reported avian influenza outbreaks. Good news- researchers have found that a new technique of low-energy nuclear reaction imaging is able to detect concealed nuclear materials (weapons-grade uranium and plutonium).

Findings of Investigations into 2014 NIH Smallpox Discovery
Following the recent GAO report on security of U.S. bioresearch labs, the House Energy and Commerce Subcommittee on Oversight and Investigations released its own memo ahead of the hearing on Wednesday, April 20, 2016 (you can watch it here). The hearing addressed the investigations that surrounded the finding of potentially live smallpox in cardboard boxes in cold storage rooms within the NIH.  Some of the issues that were identified and discussed were: failure to account for regulated select agents, failure to conduct comprehensive inventory of all select agent material, and failure to restrict unauthorized access to select agents. “There’s a problem when the government somehow loses track of smallpox and other deadly agents, only to have them turn up in a soggy cardboard box. What’s worse, the urgency that should accompany such a discovery has failed to spur absolutely necessary changes,” said full committee Chairman Fred Upton (R-MI) and Oversight and Investigations Subcommittee Chairman Tim Murphy (R-PA). “Today serves as an important opportunity to ask some of the agencies in question about their next steps to ensure safety for those working in the labs, as well as the general public.”

Re-Wiring the Funding of Pandemic Response 
Jeremy Farrar, head of biomedical research charity, the Wellcome Trust, believes that governments should invest in fighting and defending against pandemics the same way they invest in the military. “We spend gazillions to defend ourselves from military attacks, but from the beginning of the twentieth century far more people have died from infection. We are hugely vulnerable from a public health perspective,”. He emphasizes that public health funding shouldn’t be left to private companies, as they will ultimately make decisions based upon commercial return. Globalization means that a disease can jump from one country to the next through a single flight and we need to be able to respond just as quickly. “We’ve had Ebola for the last two to three years, now Zika. Since 1998 I’ve been involved in about eight major epidemics including SARS and bird flu. This is the new world. These are not rare events,”. If nothing else, it’s important to consider the economics of an outbreak. The financial cost of an epidemic is staggering – cited at $60 billion annually. He notes that now is the time to share information and work towards quicker vaccine and diagnostic interventions.

Neglected Dimensions of Global Security
Researchers are discussing the Global Health Risk Framework Commission’s strategy to defend human and economic security from pandemic threats. Global health threats, like that of SARS and Ebola, have forced leaders to consider not just response, but also preparedness. “In each case, governments and international organizations seemed unable to react quickly and decisively. Health crises have unmasked critical vulnerabilities—weak health systems, failures of leadership, and political overreaction and underreaction.” Global coordination in the event of a health crisis is extremely challenging, as we saw with Ebola, and these authors are pointing to the need for “international norms and well-functioning institutions”. The recommendations also include public accountability for timely reporting and multilateral financing for pandemic preparedness and response resources.

GMU Biodefense Students Earn Prestigious Fellowship
We’re excited to provide an official announcement and interview with GMU Biodefense students, Fracisco Cruz and Siddha Hover, regarding their acceptance into the Emerging Leaders in Biosecurity (ELBI) Fellowship. Francisco earned his MS in 2015 and Siddha is a current PhD student in GMU’s Biodefense program. Check out their comments on both the ELBI Fellowship and their experiences within GMU’s Biodefense graduate programs. “For two George Mason Biodefense students to be selected for this prestigious fellowship is a great recognition of the contribution that our students and alums are already making to biodefense and global health security and the potential they have to play even stronger roles in the future,” said Associate Professor Gregory D. Koblentz, director of the Biodefense program in Mason’s School of Policy, Government, and International Affairs.

Federal Research Database on Genomic Data 
The new GenPort database will allow researchers to access enormous amounts of genomic data from research studies. The benefit of the new system is that it will allow people to review several studies at the same time and track individuals within different trials, creating “synthetic cohorts”. “The Health and Human Services Department is currently looking for small businesses who can help build that hub, so even researchers without informatics or genomics training can make ‘practical use’ of data from cohort studies other scientists have already conducted.” The plan is for GenPort to be open source, transportable, and freely shared via a cloud. Let’s just hope genomic data from certain deadly pathogens doesn’t make its way onto the cloud!

Drug-Resistant Gonorrhea Sparks Concern
While Zika virus and Ebola are quick to grab the headlines, there is another global health security threat we should be worried about. Antibiotic resistance may not have the hype that emerging infectious disease outbreaks do, but the realities of a world without effective antibiotics are pretty terrifying. Consider the re-emergence of diseases we had long eradicated and now have no effective treatment methods. With the rising incidence of multi-drug resistant organisms, the threat of a drug-resistant sexually transmitted infection is pretty terrifying. Public health officials in England are urging the public to practice safe sex with the growing rates of Azithromycin-resistant gonorrhea. Cases initially started in November 2014 however, they have been increasing. The CDC has also issued information about the threats of antibiotic-resistant gonorrhea.

The Fight Against Zika VirusScreen Shot 2016-04-19 at 8.59.38 AM
Where are we with Zika? What does the future hold for this ever-changing  outbreak? Some are saying that it is a delayed epidemic. The long-term effects of the disease means we’re all trailing behind it. The lack of a vaccine or commercially available test makes it even more challenging. “Human Zika virus infection appears to have changed in character while expanding its geographical range,” the WHO paper concludes. “The change is from an endemic, mosquito-borne infection causing mild illness across equatorial Africa and Asia, to an infection causing, from 2007 onwards, large outbreaks, and from 2013 onwards, outbreaks linked with neurological disorders.” With Zika, it seems like we’re constantly rushing to catch up. Shifting U.S. funds from Ebola to Zika is just another example of the reactive approach public health tends to take. Why are we constantly rushing from fire to fire? The recent cuts to public health funding are also being highlighted since the Zika outbreak began. Many are pointing to the inability to truly prepare or respond with limited public health resources. In the mean time, many cities, like New Orleans, are organizing preparedness plans as the rainy season approaches. There are also concerns regarding the growing threat of Zika as new maps reveal 2.2 billion people reside in “at risk” areas. The Senate may also be closer to an agreement regarding emergency funding for Zika virus response. 

Americans Want More Biosecurity Preparedness Investment
A survey performed by the Alliance for Biosecurity, the Blue Ribbon Study Panel on Biodefense and Trust for America’s Health, looked at the general public’s perception of preparedness and where they think we should be. Findings noted that eight out of ten Americans are concerned about naturally-occurring diseases like Ebola and Zika, and nine out of ten are concerned about the use of chemical or biological weapons by terrorists against the U.S. The survey found that only half of Americans have confidence that the U.S. government is prepared to address the next biosecurity threat. The survey also found that 88% of Americans support increasing the budget for preventative measures for biological threats.

Stories You May Have Missed:

  • Health Security Special Issue on Climate Change – Check out the special edition of Health Security that includes articles on adapting to health impacts of climate change and the potential for Zika and microcephaly epidemics in post-Ebola West Africa. 
  • Science Perfects the Art of Hand-Sanitizing Techniques – infection prevention researchers at Glasgow Caledonian University recently released a report on the most effective way to use alcohol-based hand sanitizer. Reviewing bacterial count, they published in hopes of reducing the spread of disease in healthcare through better hand hygiene.
  • MERS Contamination – MERS-CoV has caused considerable concern regarding transmission in healthcare settings since the large 2015 outbreak in South Korea. Researchers have found that MERS-CoV contamination occurred in the air and surrounding environment within the MERS outbreak units. MERS-CoV was found in 4/7 air samples from two patient rooms, one patient’s restroom, and one common corridor. “In addition, MERS-CoV was detected in 15 of 68 surface swabs by viral cultures. IFA on the cultures of the air and swab samples revealed the presence of MERS-CoV. EM images also revealed intact particles of MERS-CoV in viral cultures of the air and swab samples.”
  • California Salmonella Outbreak– California continues to investigate a five-month long Salmonella outbreak. Public health officials are considering a Mexican-style soft cheese and are currently testing samples from a woman’s home. These specific samples are being considered as the woman imported cheese from Mexico (via family members) and was selling it online.

Pandora Report: 4.8.2016

by spopescu, posted in Pandora Report

Happy National Public Health Week! The American Public Health Association is celebrating the importance of public health partnerships with a full week dedicated to increasing awareness and participation. Enjoy some vaccine history by taking a trip down memory lane with this great infographic. Before we get started, researchers have found a possible pathway for the emergence of zoonotic malaria.

GMU Master’s and PhD Open Houses!
Whether you’re looking to get a Master’s Degree (we have both online or in-person programs!) or a PhD in Biodefense, we’ve got you covered. Come check out the GMU’s School of Policy, Government, and International Affairs (SPGIA) open houses. The Master’s Open House is on Thursday, April 14, 2016 at 6:30pm in our Arlington Campus, Founders Hall, room 126. GMU Biodefense professor and graduate program director, Dr. Koblentz, will be there to answer questions and then lead a biodefense break-out (or should I say outbreak?) session afterwards. If you can’t attend in person, we’re offering the biodefense info session virtually around 7pm (give or take a few minutes) that night. The PhD informational session will be Thursday, April 21, 7-8pm in our Arlington Campus, Founders Hall, room 126. 

MSF Ebola Research
Medecins Sans Frontières (MSF) has released their report on the research they undertook throughout the Ebola outbreak in 2014. MSF was perhaps the strongest and most well coordinated response team on the ground during this outbreak. While their work heavily focused on medical care, they also performed a wide variety of research that ranges from public health to anthropology, and much more. “MSF carried out research in a number of areas including epidemiology (describing the disease and its spread), vulnerable patient groups, clinical trials for new treatments, community views of Ebola, operational issues and effects of the outbreak on general healthcare.” Their report ties together their research with the six pillars of Ebola control – isolation of cases and supportive medical and mental health care in dedicated ETC’s, contact tracing, awareness raising in the community, a functioning surveillance and alert system, safe burials and house spraying, and maintaining healthcare for non-Ebola patients. MSF research on vulnerable groups and community response to returned survivors is both fascinating and important for better response in future outbreaks.

Islamic State Hijacks Mosul University Chemistry Lab to Make Bombs
Having gained control of the “well-stocked university chemistry lab” in Mosul, Iraq, ISIS has been working for the past year to build “a new generation of explosive devices and train militants to make them”. General Hatem Magsosi, Iraq’s top explosives officers, notes that gaining control of this lab has highly strengthened the Islamic State’s capabilities. “They have found ‘peroxide-based chemical bombs and suicide bomb vests like the ones used in the Brussels attacks and by at least some of the Paris attackers.’ The lab also contained ‘nitrate-based explosives and chemical weapons.”

GMU Biodefense Student Awarded ASIS Scholarship
Congrats to Biodefense MS student, Rebecca Earnhardt for receiving the ASIS National Capital Chapter Scholarship! The ASIS scholarship helps support and encourage students to follow a career in the security field. We love getting to celebrate the awesome work and achievements of our biodefense students, and between her dedication to the global health security field, scholarship, and work at START, we’re so happy to have her apart of the GMU Biodefense program!

Leaked UN Report Highlights Poor Sanitation at Haiti Bases

Courtesy of The Haitian Times
Courtesy of Haitian Times

Despite consistent denial regarding their role in the cholera outbreak during the 2010 recovery efforts in Haiti, recent documents have supported the UN’s responsibility. “The report, which was commissioned a month into the cholera crisis in November 2010, found a series of alarming problems in several UN peacekeeping bases including sewage being dumped in the open as well as a lack of toilets and soap.” The authors of the report also alerted UN leadership regarding the ramifications of the sewage disposal failures and “and the poor oversight of contractors carrying out this work has left the mission vulnerable to allegations of disease propagation and environmental contamination.” The recently released report will not only add pressure upon the UN to admit internal failures, but also support the recent lawsuit that was brought forth from 1,500 Haitians. Sadly, the UN has maintained a steadfast refusal to accept liability, despite growing data to support their responsibility for the outbreak. The lawsuit focusses on UN failure to screen the peacekeepers from Nepal for cholera and how a UN-hired contractor neglected to ensure “sanitary conditions and adequate infrastructure” for the UN camps.

Your Weekly Dose of Zika
On Wednesday, it was announced that federal funds left over from Ebola response will be moved to fight Zika virus. $589 million will be provided to aid in research and help limit the spread of the disease. The use of unspent funds was planned for helping to implement the GHSA, however now the focus will now be on Zika virus R&D. For many, the greatest concern is reaching women in their child-bearing years. The WHO is highlighting a case study in Martinique, specifically their first case of Zika-related microcephaly.  You can read the letter here, but the goals of such case-studies are to help researchers better understand the infection, especially the high-risks associated with infection during pregnancy. Following the CDC Zika Summit, some are wondering if the U.S. can coordinate response efforts and cope with the impending advance of mosquitoes.  The Aedes aegypti mosquitoes require a unique approach to vector elimination due to their propensity to live in and around homes.  “CDC Director Dr. Thomas Frieden said health departments need to take a ‘four corners approach,’ targeting the Aedes aegypti mosquitoes indoors and outdoors as well as focusing on killing both larvae and adult insects.” As of March 7, there have been 346 travel-associated cases in the U.S.

Ebola vs. Zika- Why Did the WHO Respond So Differently?
Many have wondered, why was the WHO so quick with Zika, but so slow with Ebola? Interestingly, political science and the workings of international organizations are helping Amy Patterson from The Washington Post, ask these very questions. Firstly, it starts with an outbreak being declared a Public Health Emergency of International Concern (PHEIC). The WHO was slow to call Ebola a PHEIC, especially since it had only used the designation twice before. While the WHO blames the delayed response on budget cuts and poor communication between the ground teams and the WHO headquarters, it has also said that the quick response for Zika was due to a “need for greater scientific knowledge”, not to mention trying to repair their reputation from the slow Ebola response. “Political scientists would argue that the story is still more complicated. In ‘Rules for the World,’ Michael Barnett and Martha Finnemore show that international organizations’ internal workings and technical expertise influence their actions in ways that are sometimes at odds with the goals of the countries that set up these organizations to work on their behalf.” Patterson notes several factors – the WHO has six autonomous regional offices that behave differently, the WHO cares about its reputation among powerful countries, and the message matters. This last point drives home the role of health issue framing and the way messages are conveyed for audiences and policymakers. “What’s more, Ebola aligned with what Priscilla Wald terms the “outbreak narrative.” That’s the conventional view that poor countries have disease outbreaks, and that powerful states only care about those outbreaks when their spread threatens those states. Zika hit far closer to powerful countries — and hit “threat perception” level before Ebola.”

Stories You May Have Missed:

  • Global Health Impacts of Vector-Borne Diseases – The resurgence of vector-borne diseases in new locations and with new organisms has shown devastating global impacts. “Domestic and international capabilities to detect, identify, and effectively respond to vector-borne diseases are limited. Few vaccines have been developed against vector-borne pathogens.”
  • Angola Battles Yellow Fever – Over 450 people have been infected in the worst yellow fever outbreak Angola has seen in 30 years. There have been 178 deaths and the global shortage of yellow fever vaccine is alarming many in the world health community. There have also been imported, travel-associated cases in China and Kenya.
  • FDA Releases Final Rule to Ensure Food Safety During Transport- a new food safety rule was finalized by the FDA under the Food Safety Modernization Act (FSMA). The new rule “will help to prevent food contamination during transportation. The rule will require those involved in transporting human and animal food by motor or rail vehicle to follow recognized best practices for sanitary transportation, such as properly refrigerating food, adequately cleaning vehicles between loads and properly protecting food during transportation.”

Enjoying your weekly dose of the Pandora Report? Sign up to receive it every week so the fun never ends! 

How to (Make Chemical Weapons) Disappear Completely

by spopescu, posted in Commentary

By Greg Mercer

Let’s say you’ve just had an authoritarian leader surrender his chemical weapons stockpile to you, or you’re a major world power and you’ve agreed to eliminate your chemical arsenal. How do you destroy chemical weapons?

Chemical weapons became a global security issue in the early 20th century. They were most famously used in World War I, though some early international efforts were made to prevent their use before they were actually developed and used. The horrors of their use in World War I is frequently credited with preventing their use in later conflicts (though hardly comprehensively; the Holocaust saw their pervasive use, and Iraq is no stranger to chemical weapons, to name but two examples). The modern chemical weapons prohibition as we know it, however, came to be with the 1990 Chemical Weapons Accord and 1993 Chemical Weapons Convention. These agreements thoroughly strengthened the chemical weapons control regime, and the latter created the Organization for the Prohibition of Chemical Weapons.

So, when chemical weapons need destroying, there are a few options to turn to. Two methods are commonly employed in the U.S.: incineration and neutralization.

Incineration is the Department of Defense’s (DoD) preferred method. Chemical munitions are drained from their delivery mechanisms and burned, rendering the end products either harmless or controllable. Empty warheads and shells are treated to the same heat to ensure the offending substances are completely destroyed. Incineration takes place at a handful of sites in Utah, Alabama, Oregon, and the Johnston Atoll in the Pacific.

Alternatively, the DoD has neutralized chemical agents via chemical hydrolysis, where water and a caustic agent are mixed with the agent, rendering it inert. VX nerve agent being stored in Newport, Indiana was destroyed this way. Once the process is complete, the end product must be stored.

Chemical weapons weren’t always disposed of so carefully, though. The James Martin Center for Nonproliferation Studies (CNS) cites at least 74 instances of the U.S. dumping chemical weapons at sea from 1918 to 1970. Soviet dumping was prolific but poorly documented. This was banned internationally by a 1972 convention but could still have latent effects. Deaths and injuries from exposure to chemical agents have been recorded among fishermen. When militaries dumped chemical weapons into the oceans, little thought was given to whether they would stay in one place or be distributed by currents. In 2007, the Congressional Research Service prepared a report for Congress on dealing with future ramifications from the dumping. The latent effects remain to be seen.

Pandora Report: 3.25.2016

by spopescu, posted in Pandora Report

Happy Friday! Ready for some global health security news? Down the rabbit hole we go….the FDA has just approved ANTHIM injection, a new treatment for inhalation anthrax in adults and children. Researchers are considering the possibility that the highly virulent E. coli O104:H4 strain that hit Germany in 2011 may have been an intentional act. “The sudden and unexplainable emerging of a fast increasing number of cases and deaths from bloody diarrhea and HUS might have been caused naturally, accidentally, or intentionally,” a Serbian-German research team writes in the European Journal of Public Health Advance Access for April 15.

The Finances of A Pandemic
From SARS to Ebola and now Zika, the growing threat of emerging infectious diseases doesn’t seem to be slowing down. Has this become our new normal? Will we learn from these outbreaks and start putting the resources and support into prevention? “Ebola has infected almost 30,000 people, killed more than 11,000 and cost more than $2 billion in lost output in the three hardest-hit countries. SARS infected 8,000 and killed 800; because it hit richer places, it cost more than $40 billion. Predicting these losses is hard, but a recent report on global health risks puts the expected economic losses from potential pandemics at around $60 billion a year.” So how do we defend against these international security threats? America’s National Academy of Medicine recently made the suggestion that $4.5 billion a year solely dedicated to pandemic preparedness and defense could halt this impending reality. Even more interesting? This estimate accounts to roughly 3% of what “rich countries spend on development aid”, while the world spends about $2 trillion annually on defense.

U.S. Biothreat Defense Inadequate
American response to Ebola and now Zika reveals a startling trend of slow response, inadequate supplies, and poor cooperation and coordination between agencies. Director of National Intelligence, James Clapper states that “Gaps in disease surveillance and reporting, limited health care resources, and other factors contributed to the outpacing of the international community’s response in West Africa,”. The National Biosurveillance Integration Center (NBIC) is one such agency that was developed in 2007 in attempts to “be a hub of information and coordination for federal agencies tracking disease and biological threats”, however it has been frustrated by poor relationships and sharing from other agencies like the CDC. In essence, agencies that are developed for global health security, like NBIC, suffer from poor cooperation that then trickles into their reputation and capabilities in the eyes of their federal partners. “Congress has put forth a potential legislative fix. The CBRNE Defense Act of 2015 would create a new office within DHS, the Chemical, Biological, Radiological, Nuclear, and Explosives Office, which would place both NBIC and BioWatch under integrated new management.” Just as we reported from the Blue Ribbon Study Panel, federal biodefense efforts and resources need to be better organized and developed.

Rare Blood Infection Outbreak
Elizabethkingiam is currently causing dozens of cases in Wisconsin and now a Michigan resident is suffering from the bloodstream infection. The bacteria that causes the infection, Elizabethkingia meningoseptica, is commonly found in soil but has also caused infections in hospitals. Typical infections have resulted in bacteremia and neonatal meningitis related to the gram-negative bacillus, although it is naturally found in soil, fresh water, and salt water. Most of the 54 cases in Wisconsin have been in patients 65 years and older, of which 17 have died. Public health officials are working to identify the source of the outbreak and the links between the Michigan case and those in Wisconsin. The concerning aspects of this rising outbreak is also the difficulty in treating the organism and prevalence of multi-drug resistant organisms in seniors.

Complex Engineering by Violent Non-State Actors
Check out this special issue on complex engineering by violent non-state actors (VSNAs). “Why and how different VNSAs remain low-level and localized or undertake and achieve complex engineering tasks in pursuit of their objectives are at the heart of understanding the threat environment faced by states.” The authors address several terrorist groups like Aum Shinrikyo (the chapter was actually co-authored by GMU Biodefense Alum Benjamin Ash!), Hamas (also co-authored by GMU Biodefense Alum Alena James!), the Provisional Irish Republican Army (PIRA), etc.  “The approach of this collection moves beyond weapons and embraces facilitating or logistical aspects that support the operations and objectives of the various actors”. This special edition, with an introduction by Jez Littlewood, reviews these organizations and their resources and strategies. The authors also consider the attitudes of leadership regarding innovation in detail to assess the role of complex engineering by VSNAs. Through this close look into the VSNA use of complex engineering, further research and preparedness can occur to understand the threats posed by these actors.

All Roads Lead to Zika 
Now that Spring has officially begun, the impending summer rains are right around the corner, and with those – mosquitoes. Many worry about the potential for local transmission in countries where imported cases have already been identified. The US isn’t immune to these concerns as the CDC reports 273 travel-related cases. Dr. Nabel mirrors the sentiments of Sanofi’s global R&D head, Dr. Elias Zherouni, who emphasizes the need for changes in global public health outbreak response. He notes that “we just run from one crisis to another. It’s not an optimal way to respond. Not when the stakes are so high and when so many people can either lose their lives or have their whole lives changed because of one five-day infection. That’s no way to protect the world’s population. We have to step back and we have to say, ‘Is there a more systematic way to gather the intelligence that we have about these viruses, recognize where they stand in terms of the threat level, and then develop a systematic program where, when the next Ebola outbreak occurs, it’s not that we haven’t done anything since the last outbreak, that we’ve actually moved things forward?’ That’s all possible. It’s just that we have not had the collective will to do it.” Panama has also announced their first case of microcephaly linked to Zika virus outside of Brazil. Chris Mooney from The Washington Post discusses why Zika virus, among other diseases, could disproportionally impact America’s poorer populations.  He notes that scientists have found that more mosquitoes are found in lower-income neighborhoods due to persistent trash and abandoned buildings, which creates a ripe environment for standing water and thus mosquito breeding. Researchers found that when compared to wealthier neighborhoods in New Jersey, “poverty was positively correlated with number of [Asian tiger mosquitoes] captured and accounted for over half the variation”. Many are saying that the “U.S. is botching the Zika fight” due to the problems within the FDA and the Agriculture Department regarding turf. “A genetically tweaked mosquito could stop the illness, but regulators won’t test it. Why would that be?” The combination of worrying reasons, like “budgetary concerns and antagonism to genetic engineering among some senior USDA officials”, leave many feeling that instead of getting ahead of the outbreak, “the U.S. is falling behind, solely because of bureaucratic muddle.” On the other hand, on Friday, the WHO rallied for pilot projects on two projects that would involve genetically modified mosquitoes to help stop the spread of Zika virus. In the meantime, the FDA gave emergency approval for a 3-in-1 test for Zika, Chikungunya, and Dengue.

Syria and the Future of the Chemical Weapons Taboo 

Courtesy of E-International Relations
Courtesy of E-International Relations

Brett Edwards and Mattia Cacciatori tackle the responses that the international security community has taken regarding the use of chemical weapons in Syria and the resulting reinforcement of “a long standing prohibition norm.” The authors discuss the characteristics of chemical weapons taboo and and the significance that the international community gives to these weapons. “This alone does not support the claim episode has strengthened the global norm against chemical weapons. In this piece we have highlighted how this is not immediately apparent due to the fact that problem cases tend to be externalized from dominant institutional discourses, often justified in terms of the need to protect the sanctity of the chemical weapon norm, as well as those institution’s which embody the norm – especially the OPCW.” Overall, the more problematic cases, like those of incapacitating chemical agents, will grow to alter the existing foundation of chemical weapons norms if left ignored or unchecked.

New Ebola Flare Up
The west African Ebola outbreak is like a campfire that wasn’t put out properly – everyone thinks the flames are extinguished, but those hidden embers lurking in the ash end up causing a spark that leads to a massive forest fire. A fifth person has died from the recent flare in Guinea. The most recent death occurred in a man 200k from the initial four cases. Prior to this death, a young girl died from the village of Korokpara following her hospitalization in an Ebola treatment facility in Nzerekore. It’s still not clear how this specific surge began, but many worry about the lingering traces of the virus in the eyes, CNS, and bodily fluids. In response to the fifth death, Liberia has partially shut its borders. Emergency meetings are now underway and the WHO is sending specialist teams in to try and stop the outbreak before it grows beyond the 11,300 mortality count. On a positive note, Sierra Leone has gone two incubations periods (42 days) without a case, which means they’re Ebola-free since their last flare up.

GMU SPGIA Gettysburg Trip
GMU students interested in learning more about the battle of Gettysburg- the Center for Security Policy Studies (CSPS) will be hosting an informational session on April 6th from 4:30-6pm in Merten Hall 1203 regarding the April 9th trip! GMU students and staff will walk the battlefield, discussing the factors that caused the battle to unfold as it did. They will also link the battle into larger discussions about the causes of war and grand strategy.  The cost for the trip will be $35.  Bus transportation will be provided, and will pick up participants from both the Fairfax and Arlington campuses.

Stories You May Have Missed:

  • U.N. Sued Over Haiti Cholera Outbreak– starting in October of 2014, Haiti was hit with an intense wave of cholera that is believed to have started with U.N. peacekeepers. “Poor sanitation at a U.N. camp for peacekeepers allowed cholera-contaminated sewage to enter a tributary of Haiti’s largest river, the Artibonite. Within days, hundreds of people downstream, like Jean-Clair Desir and his mother, were falling ill. The disease subsequently spread to the entire country.” The case is currently being reviewed in US courts and the lawsuit was brought forth by the Institute for Justice in Democracy, asking that the U.N. “end cholera by installing a national water and sanitation system; pay reparations to cholera victims and their families; and publicly apologize for bringing cholera to Haiti.”
  • Exploiting the Challenges to Bioweapons Development – Janne E. Nolan discusses GMU Biodefense Professor, Dr. Sonia Ben Ouagrham-Gormley’s book, Barriers to Bioweapons, in regards to the misleading and often exaggerated notion of easy WMD development. Nolan discusses that understanding both the internal and external factors that impact BW program success would allow the international community to “devise better ways to realistically stem BW proliferation”. He notes that “Ben Ouagrham-Gormley’ s book is a fascinating study of the phenomenology of scientific knowledge, providing a compelling analysis of how knowledge is acquired, developed, transmitted, and, at the same time, diluted or lost as a result of organizational, social, economic, political, and ultimately very human factors that vary widely within countries and over time.” You can also access it here: Nolan final
  • Five Outbreaks That Stump Epidemiologists– As much as I’d love to say that all outbreaks are investigated and solved, the truth is that epidemiologists are often left with the nagging of an unresolved case. Outbreaks are squirrelly at best, often challenging even the best teams with confounders and biases. Here are some that have stumped public health teams over the years.
  • Lassa Fever Outbreak– Three people are suspected of having the viral infection after coming into contact with an infected American. The initial case was a medical director of a missionary hospital in Togo, who died last month. While there are conflicting reports of disease confirmation, several sources are saying the three contacts of this initial case have been diagnosed and are under observation. The outbreak in Nigeria and Benin has continued to grow, resulting in CDC travel warnings. In Nigeria there have been 254 cases and Benin has seen 71.

Enjoying your weekly dose of the Pandora Report? Sign up to receive it every week so the fun never ends! 

Pandora Report: 3.18.2016

by spopescu, posted in Pandora Report

Spring is upon us! Whether you’re suffering from allergies or enjoying the bloom of the cherry blossoms, we’ve got you covered from the biodefense side. Don’t forget to add our GMU SPGIA Master’s Open House to your calendar next week (Wednesday, March 23rd at 6:30pm at our Arlington Campus). We’ll also be hosting a biodefense breakout session at 7pm with Dr. Koblentz (bonus: you can attend virtually! Extra bonus: our MS program is offered online, so you can learn to be a biodefense guru from anywhere in the world!). Bioarchaeologists are at it again in their quest to determine the fall of ancient Rome (hint: Yersinia pestis may have played a larger role than you’d think). Here’s hoping that with the announcement of the new Indiana Jones movie we’ll see Indy doing some bioarchaeology on ancient biowarfare!

The Real Lessons of Ebola and Zika 
Emerging infectious diseases are not a new concept for global public health, so why did Zika and Ebola catch us so off guard? Where was prevention – the backbone of public health- in this fight? After the pledging of billions of dollars and deployment of countless health professionals, the reality of reaction versus proactive prevention was never more apparent than during the Ebola outbreak. As the old saying goes, “an ounce of prevention is worth a pound of cure”. Now, as we trudge our way through the Zika virus outbreak, many wonder why the Aedes mosquitoes are continuing to cause devastation when their role in outbreaks is so well known. “Controlling this mosquito would by itself ameliorate all these disease threats. Ironically, in South America, control of Aedes aegypti was largely successful earlier in the 20th century (with great expenditure of effort), only to be abandoned once the immediate threat receded.” So again, we must ask ourselves, why public health prevention measures are so frequently ignored. Inexpensive in comparison to the cost of an outbreak, these tools (surveillance, diagnostics, worldwide communication, etc.) are increasingly becoming stronger and more available. Zika and Ebola have proven the efficacy of these strategies and the damage of failing to use them, so what more will it take to get global public health measures a seat at the cool kids’ table? A recent study addressed the biosocial approaches to the Ebola outbreak, concluding that “biomedical and culturalist claims of causality have helped obscure the role of human rights failings (colonial legacies, structural adjustment, exploitative mining companies, enabled civil war, rural poverty, and the near absence of quality health care to name but a few) in the genesis of the 2013-16 pandemic.” Globally, we’re still struggling to recover from the outbreak – whether you’re on the the ground in the affected countries or in the public health agencies that attempted to help. In many ways, the lessons from this pandemic will continue to be identified and understood for years to come. The CDC has also just released an article regarding the perspectives on the outbreak here, where they discuss the factors that delayed disease detection, the role of civil instability, and the impact of historically limited ebola experience.

GMU Biodefense Alumni Career Services
Are you a GMU Biodefense alum? Don’t forget to sign up for the SPGIA CareersNow so you can get updates on job postings that are right up your alley! GMU has close ties within the biodefense industry and we love joining students with employers, so please make sure to sign up and utilize this great resource!

ISIS Chemical Weapons Attack
Officials are reporting on that on Saturday, terrorists linked to ISIS fired rockets into a residential part of Taza, a northern Iraqi town. These rockets are reported to have contained unspecified chemical substances that caused numerous deaths and injuries related to burns, dehydration, and suffocation. An American special forces team previously captured the lead ISIS chemical weapons engineer, however, “his capture has not stopped alleged chemical attacks by ISIS or other terrorists associated with the Islamist militant group. Earlier this week, for instance, officials in Iraq’s Kirkuk province claimed that around 100 people were injured in suspected chemical attack, also in Taza.” The attacks are recently reported to have injured 600 people and killed a 3-year-old girl. Many are now asking, where is ISIS getting their chemical weapons from?

Preventing “A Virological Hiroshima”: Cold War Press Coverage of Biological Weapons Disarmament
Since we’re in the middle of an election year, it has become even more apparent the massive role media plays in not just politics, but also security. A recent analysis was published utilizing written pieces from the US New York Times, UK Times, and the Guardian, during the period of the Biological Weapons Convention negotiation in 1972. Representations of biological weapons during this time not only reflect the societal ideologies, but the the high-stakes environment that the journalists were experiencing. “We argue that a conventional discourse can be found wherein biological weapons are portrayed as morally offensive, yet highly effective and militarily attractive. Interwoven with this discourse, however, is a secondary register which depicts biological weapons as ineffective, unpredictable and of questionable value for the military.” Interestingly, at the time of these news reports, journalists only knew of WMD’s via nuclear and chemical weapons. According to the authors, no biological attacks had been documented and the state sponsored programs were still buried in the depths of secrecy. Biological weapons could only be considered in terms of historical pandemics like the Black Death and the 1918 Influenza pandemic. The authors note that “this negative portrayal of biological weapons as unpredictable and ineffective was certainly flagged in the context of downplaying the significance or value of the BWC. But where it was put to more nuanced use, exemplified in the interview with Matthew Meselson in the wake of the Nixon decision to abandon the US offensive programme, biological weapons were indeed portrayed as useless, not because they were innocuous but because they were redundant: the USA already had access to the horrific, indiscriminate means to annihilate entire cities.”

A Little Bit of Zika Goes A Long Way
Recent CDC data reports 258 travel-associated cases within the US. Laura Beil with the New York Times describes the worry that pregnant women are now facing after they traveled to affected regions and later were found to have Zika. You can also find a timeline and map of the outbreak here. Here’s a spot of good news though – the European Commission announced on Tuesday that the European Union released $11.1 million for Zika virus research. Rob Stein from NPR discusses the unique cry of babies with Zika-associated birth defects and the stories from the pediatricians and health professionals that are working to help the affected families. “It’s not just that they cry more easily, and longer — which they do. There’s also something strange — harsher and more pained — about the cries of many of these babies.Screen Shot 2016-03-17 at 1.02.48 PM The realization that they even cry differently than normal babies drove home how many mysteries the world is facing because of the Zika virus.” Not surprisingly, ticket sales for the 2016 Summer Olympics have dropped since the announcement of the outbreak. Olympic-related event ticket revenues dropped 56.4% since mid-January. A new research article was just published regarding the seasonal occurrence and abundance of the Aedes mosquito and it’s role in potential Zika transmission within the US – specifically in regards to local transmission. Here’s a great map regarding the estimated risk of transmission within the US. 

Stories You May Have Missed:

  • Use of Microbial Forensics in the Middle East/North Africa Region – The Federation of American Scientists (FSA) prepared a report for the Department of State Bureau of Arms Control and Verification regarding the use of microbial forensics as a means of combating biosecurity challenges. Whether naturally occurring or man-made, biological threats can pose a major challenge. Source recognition is “the key pre-condition that determines how a country will respond to a biological event, or take action in order to interrupt a potential emerging threat, ultimately centers around the ability to properly attribute the culpable sources (pathogens); in other words, governments need to determine the return address of the culpable microbe(s), be they from countries, individuals, or nature itself.”
  • Rice Krispies Food Safety Attack? An employee was recorded urinating on the production line for the cereal manufacturing company in 2014. Kellogg is now under investigation regarding the criminal activity and potential impact of the employee’s actions. I wonder, would you consider this a small-time biological attack?
  • Determinants and Drivers of Infectious Disease Threat Events in Europe – Researchers identified 17 drivers of infectious diseases threat events (IDTEs), categorizing them into 3 groups: globalization and environment, sociodemographic, and public health systems. They found that a combination of two or more drivers was responsible for most of the IDTEs and the driver “category of globalization and environment contributed to 61% of individual IDTEs, and the top 5 individual drivers of of all IDTEs were travel and tourism, food and water quality, natural environment, global trade, and climate.”

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Pandora Report: 2.19.2016

by spopescu, posted in Pandora Report

TGIF! We hope you had a lovely week while avoiding RAW Meal Organic Shake and Meal Replacement products. The FDA recently reported an outbreak of Salmonella Virchow linked to the moringa powder within these products. 11 people across nine states were impacted by the outbreak, leading to an expanded recall due to the contamination. In this week’s Pandora Report, we’re covering Zika virus, CRISPR, GMU’s Biodefense Open House, ISIS use of chemical weapons, and much more. Before we begin, you’ll be happy to hear that as of today, airline passengers flying from Guinea to the US will no longer have to fly through designated airports and undergo screening for Ebola.

Zika Response Plans 
The WHO just released their Zika Strategic Response Framework & Joint Operations Plan for January-June 2016. Within the report, readers can find a timeline of the outbreak, a current situation report (sitrep) and the three objectives, which include surveillance, response, and research. Response strategies include community engagement, control efforts for the Aedes mosquito, and efforts to support and guide “the potential impact on women of childbearing age and those who are pregnant, as well as families with children affected by Zika virus.” The WHO estimates that the community engagement components requires $15.4 million, 10 partners, and will involve public health risk communication, community engagement, and health care personnel. Overall, the WHO estimates that to “kickstart” the international response, it will take $56 million. Fortunately, the World Bank announced it’s commitment of $150 million to combat the growing epidemic. The FDA just released blood donation recommendations related to the outbreak to mitigate risk of contamination. They are recommending that “those at risk of having been infected with the Zika virus should not donate blood for four weeks. These include those who have had Zika virus symptoms or sexual contact with people who have traveled to countries known to have ongoing transmissions.” According to the CDC, as of February 10th, there have been 52 travel-associated Zika virus associated cases in the US. On Thursday, Pope Francis suggested that women could justifiably use contraception to avoid pregnancy in Zika affected countries.

Upcoming Events: SPGIA Master’s Open House and Biodefense Seminar!Biodefense_320x180
Interested in furthering your education and getting to study topics like bioweapons, disease outbreaks, and terrorism? Check out the GMU Master’s Open House on Thursday, February 25th, 6:30pm at our Arlington Campus in Founder’s Hall, Room 126. Dr. Koblentz, GMU biodefense program director and one of our amazing professors, will also be holding an informational session at 7pm. You can even virtually attend if you’re looking to get more details on the biodefense graduate program and what kinds of adventures it entails. Once you’ve gotten your feet wet by attending one of the Open Houses, try our Biodefense Course Sampler on Wednesday, March 2nd, at 7pm in Founders Hall (GMU Arlington Campus), room 502. Dr. Koblentz will be hosting the event to discuss the unique challenges the US faces when it comes to global health security. Ranging from biosafety to natural disasters, and even zombies, this is a great way to get a taste of the GMU Biodefense program! Make sure to RSVP though, since space is limited.

Workshop on Women’s Health in Global Perspective
GMU’s School of Policy, Government, and International Affairs will be hosting this engaging and informational workshop on March 3, 2016 (8:45am-4:45pm), at our Arlington campus, in Founders Hall 111 and 1113. The keynote address will be from Dr. Nancy Lee, director of the Office of Women’s Health in the Department of Health and Human Services. Panels will discuss contraception and prenatal care, violence against women, dealing with disease, cross border concerns, and the role of gender disparities in women’s health outcomes. Lunch will be provided and while this event is free and open to the public, you’ll need to register here.

ISIS Use of Chemical Weapons
On Friday, CIA director John Brennan, confirmed that ISIS fighters have not only utilized chemical weapons, but also have the means and capabilities to make them. Reports indicate that ISIS is capable of making small quantities of chlorine and mustard gas. Brennan also pointed to potential exportation of chemical weapon to the West for financial incentives, noting that “there’s always a potential for that. This is why it’s so important to cut off the various transportation routes and smuggling routes they have used.” Confirmatory lab results from the Organization for the Prohibition of Chemical Weapons (OPCW) established the definitive presence of mustard gas in the attacks on Kurdish forces last year. “The OPCW will not identify who used the chemical agent. But the diplomat, speaking on condition of anonymity because the findings have not yet been released, said the result confirmed that chemical weapons had been used by Islamic State fighters. The samples were taken after the soldiers became ill during fighting against Islamic State militants southwest of Erbil, capital of Iraq’s autonomous Kurdish region.” Given their successful use of mustard gas and growing concerns over development capabilities, Brennan noted that “US intelligence is actively involved in being part of the efforts to destroy ISIS and to get as much insight into what they have on the ground inside Syria and Iraq.”

Ongoing Challenges and Future Considerations for DHS Biosurveillance Efforts 
The US Government Accountability Office (GAO) recently published their findings regarding the Department of Homeland Security’s (DHS) biosurveillance efforts, specifically the National Biosurveillance Integration Center (NBIC) and the BioWatch program. Initial findings in 2009 found that NBIC wasn’t “fully equipped to carry out its mission because it lacked key resources—data and personnel—from its partner agencies, which may have been at least partially the result of collaboration challenges it faced.” Recommendations were made and then in August 2012, NBIC released its Strategic Plan in response to the deficiencies, of which focal points included clarification of its mission and efforts to fulfill its roles of analyzer, coordinator, and innovator. Since 2012 though, GAO has noted several challenges DHS has faced in attempts to justify the BioWatch program. In 2015, “GAO found that DHS lacks reliable information about the current system’s technical capabilities to detect a biological attack, in part because in the 12 years since BioWatch’s initial deployment, DHS has not developed technical performance requirements for the system. GAO reported in September 2015 that DHS commissioned tests of the current system’s technical performance characteristics, but without performance requirements, DHS cannot interpret the test results and draw conclusions about the system’s ability to detect attacks.” Based off their findings, GAO recommended DHS not pursue the upgrades it was considering to the program. Some of the changes NBIC will be pursuing include its modification to the Daily Monitoring List  and better integration of projections and forecasts. You can find the report here, which also includes a table regarding benefits and challenges for structural changes within NBIC. Coincidentally, there was a webinar this week on “Defending Against Bioterror with Improved BioWatch Standards”. During the webinar, the presenters (Dr. Georges Benjamin and Dr. Bruce Budowle) emphasized that BioWatch is an integrated system that “needs to be used with care and caution, but it’s really a marvelous piece of technology.” They also spent time discussing how PCR results may pose problematic for end users and how BioWatch “is a good investment that should continue”.

Mental Health Challenges in Ebola Fighters
The 2014 outbreak left untold damages upon the affected countries. Unfortunately, mental health is one that may have gone unnoticed. While doctors and nurses raced to respond to the outbreak, the response to mental health was given little thought. Fighters in the Ebola battle are now fighting personal struggles with alcoholism, depression, and drug addiction. In countries that have even fewer mental health professionals than medical doctors, many are in desperate need. Some of these include young men that signed up to bury the bodies of Ebola patients in the grassy mud within Liberia. Drew Hinshaw discusses how these “burial boys” found themselves digging graves for their own children and are now left struggling to find work and are suffering from severe PTSD and the emotional effects of such an ordeal. “Liberia has just one psychiatrist for a population of four million, according to the health ministry. Sierra Leone, home to seven million, also has only one. The mental-health wing of the Liberian health ministry has just two staffers on payroll.” The truth is simple- the impact of an outbreak of this magnitude, especially within impoverished countries, has rippling effects that go on for years. Perhaps future outbreak response and preparedness models should include mental health support during and following the outbreak?

Stories You May Have Missed:

  • Future of CRISPR– CRISPR technology has been making headlines since it’s initial discovery, especially with Science naming it the Breakthrough of the Year. Its ease of use has raised many red flags for those within the science and biosecurity community. One of its discoverers, Jennifer Doudna, worked to answer questions and dispel concerns regarding mis-use, stating that “she considers it one of her responsibilities as a researcher to ensure that she educates people about the technology and listens to their questions and concerns about its use. She says one of her biggest fears is “waking up one morning and reading about the first CRISPR baby, and having that create a public backlash where people ban or regulators shut this down, and I think that could be very detrimental to the progress of the field.”
  • UK Parliament Report – Lesson Learned from Ebola – The UK Parliament has released their findings on the 2014 Ebola outbreak and the UK’s response efforts. Pointing to the necessity of strong and reliable communication, they emphasized that research must be started swiftly during such events. “The willingness of Government agencies, third sector organisations, health and aid workers, universities, and pharmaceutical companies to go above and beyond to help tackle the outbreak was phenomenal. The swift pace at which clinical trials were approved and conducted particularly stood out.” For updates on the outbreak, you can see the WHO sitrep here.
  • MERS-CoV Updates – A new report from Emerging Infectious Diseases discusses the infection of alpacas in a region where MERS-CoV is endemic. Given the susceptibility of alpacas, this could broaden the geographical distribution of potential cases. Walter Reed Army Institute of Research (WRAIR) has started a Phase 1 clinical trial (the first to be tested in humans) for a MERS-CoV vaccine.

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Pandora Report 12.11.2015

by spopescu, posted in Pandora Report

If you’re in Boston and enjoying a Chipotle burrito bowl, you may want to put the fork down. As many as 80 cases of norovirus were reported in association with a Boston Chipotle. The norovirus surge occurs just months after the multi-state Chipotle-linked E. coli 026 outbreak. This week we’re discussing superbugs Star Wars style, the decline of infectious disease specialists, Ebola lab stories from the field, and much more. Fun history fact Friday: on December 7, 1941, Pearl Harbor was bombed and on December 10, 1901, the first Nobel Prizes were awarded in Stockholm, Sweden 

“Phantom Menace” Superbug?
In a lab far, far away… How could we resist a Star Wars reference to antibiotic resistance? A recent CDC MMWR reported a growing incidence of a particularly concerning antibiotic-resistant organism. Carbapenem-resistant Enterobacteriaceae (CRE) are continuing to raise concerns due to cases related to endoscopic retrograde cholangiopancreatography (ERCP) scopes. Since it’s discovery, global health experts (including the CDC) have been keeping a close eye on CRE transmission and cases. A variant of CRE, called OXA-48-type carbapenemase, was seen in Enterobacteriaceae in Turkey in 2001. 52 isolates of CRE producing OXA-48-like carbapenemases were found in 43 patients in the US from June 2010-August 2015. A study in 2012 first referenced OXA-48-like carbapenemases as the phantom menace. The concerning issue with this particular CRE strain, aside from its known-resistance, is the growing emergence in the US. The difficulty in treatment and extreme care for isolation precautions makes patient care challenging. Interestingly, for those patients who provided a travel history, the majority (66%) had traveled internationally within the year before specimen collection and 55% were actually hospitalized outside the US for at least one night. The US cases involved several clusters and were spread across 19 states. Even more worrying, the laboratory diagnosis is tricky as “most U.S. clinical laboratories that test for CRE organisms wouldn’t identify this particular type of bacteria because it’s not part of standard testing.” The increase in cases and ease of hospital transmission are just a few more reasons why antimicrobial stewardship is so vital. May the force be with you!

Ebola Surveillance & Lab Response SeminarIMG_4700
In case you missed GMU’s seminar on global health security on Monday, 12/7, here’s a recap! Speakers included Dr. Matthew Lim (Senior Policy Advisor for Global Health Security, HHS, fmr Civil-Military Liaison Officer to WHO), Jeanette Coffin (Section Manager, Biosurveillance Division, MRIGlobal), and Phil Davis (Associate Scientist with MRIGlobal). Ms. Coffin and Mr. Davis discussed the operations, supported by the Defense Threat Reduction Agency’s (DTRA) Cooperative Biological Engagement Program (CBEP). The mobile lab was launched in December 2014. With only six weeks to train, prepare staff, acquire equipment, deliver, assemble, and much more, it’s a pretty impressive feat that this team pulled off. Ms. Coffin and Mr. Davis discussed how they were able to reduce much of the travel delay and time lag for Ebola testing results. Using equipment to perform RNA extraction and PCR’s, lab technicians were working in tight quarters in Moyamba and Lakka, Sierra Leone. To date, the DTRA-CBEP mobile lab operations tested 7,242 samples for Ebola. While they discussed many of the strengths like flexibility, relationship with vendors, and self-containment, there were also several challenges. Difficulties ranged from inadequate power and internet, to road reliability, food/water safety, haggling, and security issues related to petty theft and missing supply containers. Sustainability was heavily discussed as their expected withdrawal is June 2016 and the team hopes to provide education for ongoing surveillance. Next, Dr. Matthew Lim spoke of the history and impact this outbreak had on global health security. He emphasized “how much this has overturned the paradigm we have about health and security”. Dr. Lim’s discussion was fascinating in that he speaks from experience at both the WHO and HHS, pointing to the role of member states and how WHO funding cutbacks impacted outbreak response. He noted that the Global Health Security Agenda heavily emphasizes partnership of it’s 50 state members, NGO’s, and within the 11 action packages. He explained that global health affairs, in many ways, join foreign policy and health policy, highlighting the need for less siloing and more partnership to help encourage capacity measures. Overall, the standing-room-only seminar touched on both the operational struggles and the overarching role of global health security in both the Ebola outbreak, but also future preparedness efforts.

Daesh and Chem/Bioweapons?
The UK and France have moved to call ISIS, “Daesh”, to remove the association with Islam. Given Daesh’s use of mustard gas, is bioterrorism a stretch? Sandra Maksimovic-Sara of Outbreak News Today discusses their attempts to obtain biological and chemical weapons as a means of using non-conventional weapons to change their modus operandi. While she doesn’t mention tacit knowledge, Maksimovic-Sara notes that “for a biological and chemical terrorist attack, there must be some know-how and background and a professional approach, which is so far away from impatient aggressive Islamic terrorists gathered in Daesh. They want fast track acts and fast track results.” While preparedness efforts must account for a variety of attacks, it’s vital to remember technical limitations. As Dr. Sonia Ben Ouagrham-Gormley noted, tacit knowledge is a significant hurdle for non-state actors to overcome in their quest for bioweapons.

To Quarantine or Not To Quarantine? 
The fallout of the 2014 West Africa Ebola outbreak is still ongoing and while many US hospitals feel they are better prepared to handle cases, there are many that experienced negative treatment related to preparedness efforts. There have been several returned travelers from the affected countries that were put into quarantine upon arrival in their home country. While many were involved in patient care, there are several that had no interaction with patients and experienced what many would call, “fearbola“. While quarantine efforts are important for those that may have had patient interaction, risk assessments are vital. Sheri Fink of The New York Times notes that several states “have the legal authority to impose quarantines, often exceeded those guidelines, restricting the movements of returning health workers and others.” Many who were quarantined experienced public harassment, media scrutiny, and some have filed lawsuits for civil rights violations.

France’s Bioterrorism Preparedness
Given the November terrorist attacks in Paris, it’s not surprising that France is looking to ramp up their biodefense efforts. Following the arrival of a third generation vaccine, France has decided to revise its smallpox preparedness and response plans. Last revisited in 2006, the plan is to vaccinate first responders and healthcare professionals that are most likely to identify and care for smallpox cases. Smallpox has long been an organism of concern for bioweapon applications. In coordination with the Secrétariat Général de la Défense et la Security Nationale, (SGDSN- General Secretariat for Defense and National Security) these plans will include the new vaccine, Imvanex, that was developed by the Danish biotech company, Bavarian Nordic, “on behalf of the US under Bioshield”. While the new plan involves “circles” of people, the new transgenic vaccine has vastly decreased the side effects that were commonly associated with first and second generational variola vaccines. In the past, smallpox vaccines were associated with high volumes of side effects, which was a roadblock to previous mass-vaccination efforts as a biodefense strategy. France has several biopreparedness strategies that include a syndromic surveillance program, SurSaUD, a White Plan, and many other efforts to prevent, identify, and respond to health security threats. The updated French plans hope to “frustrate and deter terrorists” as well as respond to concerns of re-emerging infectious diseases. Elisande Nexon presents an overview of France’s biopreparedness efforts and the public health threats they may encounter. While the November attacks in Paris will most likely initiate additional changes to France’s biopreparedness, their existing methods are extensive and reveal national support for biodefense.

Stories You May Have Missed:

  • Infectious Disease Specialists on the Decline – The National Resident Matching Program (responsible for matching medical students with specialty training programs) announced that of the 335 infectious disease fellowship positions available, only 218 were filled. This is especially concerning as it follows several years of low matching for infectious disease positions. The Infectious Disease Society of America has even begun brainstorming recruiting tactics for what many consider a “thinking specialty” that may not have the glamor or pay that draws students into the field. Speaking from experience as an infection preventionist, the infectious disease physicians I have worked with were by far the most dedicated, intelligent, and passionate people. I think we can all safely agree that the world needs more infectious disease specialists, especially following outbreaks like those of Ebola and Zika virus.
  • USAMRIID Supported Study Traces Ebola Outbreak – a recent study lead by USAMRIID found that a majority of the Liberian Ebola cases “can be traced back to a form of the virus transmitted from Sierra Leone”. The sequencing of hundreds of isolates also supports the role of high-density neighborhoods as an accelerant for the outbreak. Interestingly, researchers found that the Ebola strain diversified in Liberia prior to being transmitted to cases in Guinea and Mali.
  • Yamuna River Harbors High Volume of Antibiotic-Resistant Organisms – Researchers found that the Yamuna river in Dehli, India, had an alarmingly high amount of resistant organisms. There were large quantities of several organisms found that showed resistance to many common antibiotics like ampicillin, streptomycin, etc.
  • MERS Was the Most 2015 Googled Word in Korea – also considered Korea’s “hottest” Twitter issue, MERS became the most searched topic after the first patient was confirmed on May 20th.