Tag: Ebola Virus Outbreak

Pandora Report: 11.27.2015

by spopescu, posted in News, Pandora Report

We hope you’re having a lovely holiday week and recovering from a day of full of tryptophan overload! This week we’re starting off with a look at the Government Accountability Office’s review of the BioWatch program. We’re discussing another panel review of the WHO Ebola response efforts, the role of tacit knowledge in bioweapons development, and how the Beagle Brigade is fighting bioterrorism one belly-rub at a time. Fun history fact Friday: on November 26, 1940, President Franklin Roosevelt declared the government would bar strikes “at plants under government contract to provide war materials for the US military and its allies” and on November 25, 1915, Albert Einstein published his equations on the Theory of General Relativity!

Government Accountability Office Finds BioWatch Unreliable
The BioWatch program was introduced in 2003 to perform active environmental surveillance for potential bioweapon use. The struggle has been to accurately discern between organisms that are naturally occurring and those that are being intentionally released. With several false alarms, the program has been under heavy scrutiny. Timothy M. Persons, chief scientist of the Government Accountability Office (GAO), states that authorities “need to have assurance that when the system indicates a possible attack, it’s not crying wolf. You can’t claim it works”. DHS official Jim H. Crumpacker, points out that the system is used as an early warning and there is an inherent level of uncertainty and limitation. The report (published in October but not publicly released until November 23, 2015), which you can read here, states that from 2003-2014, BioWatch made 149 mistaken detections that were “false positives”. The report says that “GAO recommends DHS not pursue upgrades or enhancements for Gen-2 until it reliably establishes the system’s current capabilities.”

Expert Review of Ebola Outbreak Response
A 19 member review panel, convened by the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine, reviewed the Ebola outbreak response as a gateway to “public debates alongside reports on outbreak response and preparedness”. Led by Dr. Peter Piot, one of the scientists to discover Ebola in 1976, the group pointed to several issues needing attention on a global scale. Findings pushed for the WHO to reorganize their disease outbreak functions and streamline processes to “avoid political pressure, build country core capacities, and ensure adequate funding”. The ten suggested reforms heavily emphasize the importance of core capacities within countries to be able to detect and respond to outbreaks. Strengthening a country’s capacity to do surveillance, response, and prevention is crucial in reducing the risk of multi-national outbreaks that spread like wildfire. The report also suggests incentives for early outbreak reporting and more science-based justifications for economic impacts like travel restrictions, etc.

Tacit Knowledge and the Bioweapons Convention
GMU Biodefense Professor, Dr. Sonia Ben Ouagrham-Gormley, takes on the August 2015 Biological Weapons Convention and the exciting inclusion of tacit knowledge in bioweapons development. Dr. Ben Ouagrham-Gormley has contributed heavily to the field of biodefense, specifically on the role that tacit knowledge plays as a key determinant of bioweapons development. In past nonproliferation efforts, tacit knowledge has been widely neglected. Tacit knowledge “consists of unarticulated skills, know-how, or practices that cannot be easily translated into words, but are essential in the success of scientific endeavors.” Simply put, it takes more than a manual or YouTube video to truly perform a scientific experiment, etc. Tacit knowledge is seen in scientists that have spent years not only learning, but experiencing the quirks and challenges of performing experiments. The lessons of failed endeavors, teachings of fellow scientists, and instincts built by years of experience, are all components in tacit knowledge. Dr. Ben Ouagrham-Gormley points to the role tacit knowledge has played in the history of failed bioweapons programs (state and non-state). While some analysts believe the advancing biotechnologies will “de-skill” the field and lower the bar for bioweapons development, Dr. Ben Ouagrham-Gormley highlights that tacit knowledge is a massive roadblock. Pointing towards the new focus on tacit knowledge, she notes that this will only help “advance key mandates of the bioweapons convention, naming the assessment of new technologies, the improvement of national implementation, and the strengthening of cooperation among member states.”

The New Line of Biodefense: Adorable Dogs

Courtesy of BarkPost
Courtesy of BarkPost

There are few times when I get to combine a love of rescue dogs and biodefense nerdom and fortunately, today is that day! The Beagle Brigade is a group of rescue beagles that have been specially trained “to sense for items used for bioterror which include contraband money, pests, and unlawful wildlife”. Even more, the Beagle Brigade is part of the USDA’s Animal and Plant Health Inspection Service (APHIS). They work in baggage-claim areas at international airports, wearing green jackets, to help identify any meat, animal byproducts, fruit, or vegetables that could be carrying any diseases or pests that have the potential to cause a devastating outbreak in the US. They’ve been specially trained to pick up “restricted” (fruit, vegetable, etc.) versus non-restricted items and have a 90% success rate! I think we can safely say the Beagle Brigade wins the award for “most adorable biodefense strategy”.

Genetically Engineered Mosquitoes Battle Malaria 
Recently published work shows how researchers used “a controversial method called ‘gene drive’ to ensure that an engineered mosquito would pass on its new resistance genes to nearly all of its offspring – not just half, as would normally be the case.” These “mutant mosquitoes” are engineered to resist the parasite that causes malaria infections. This particular work solves the issue that many were facing when it came to passing down resistant genes through a species. While this may mark the end of a long battle against malaria, many are pointing to the ethical and dual-use concerns of such work. The growing concern surrounds the high speed of such technological innovation and the lagging of regulatory and policy guidelines, especially regarding work in wild populations. The potential to alter an entire ecosystem has many concerned over the ramifications of such work. The research team is currently working to prepare mosquitoes for field tests, however they are non-native mosquitoes.

Stories You May Have Missed:

  • Stories From A Biodefense PhD Student- GMU Biodefense PhD student, Craig Wiener, discusses his journey from master’s student to PhD candidate. Craig explains what sparked his interest in not only biodefense, but GMU’s program, and how that’s translated into real-world experiences. “Mason has provided me the depth and breadth of knowledge that I needed to converse with senior policymakers, technologists, and scientists,” he says. “It bridged the gap between science and policy so I could be respected in both worlds because I knew what I was talking about.”
  • East Bronx Legionnaires’ Outbreak Traced to Psychiatric Center–  The New York City Health Department announced that the cooling tower at  the Bronx Psychiatric Centre was the likely source of the break that hit East Bronx earlier this fall. Samples from four cases matched those taken from the water tower. Remediation and disinfection is being performed on the water tower.
  • Liberia Reports Death of Boy – A boy who was part of the family cluster of Ebola cases in Liberia, has died of the disease. The 15-year-old boy was one of the three confirmed cases reported on November 20th, which marked the end of the Ebola-free period for Liberia since September 3rd. There are currently 153 contacts and 25 healthcare workers being monitored.

Ebola 2014: The Infection Preventionist Perspective

by spopescu, posted in News, Pandora Report, Uncategorized

By Saskia Popescu

Unlike many infectious diseases, especially ones with a relatively small number of occurrences, the Ebola outbreak that started in 2014 received a sensational amount of attention. While many in public health keep tabs on outbreaks (thanks ProMed!), it’s not uncommon for the rest of society to remain blissfully unaware unless the bug comes knocking on their front door. I’ve been captivated with Ebola (now called Ebola Virus Disease, or EVD) since a young age after Richard Preston’s sensational book, The Hot Zone got passed to me during a family vacation. The first whispers and later emails of the surging cases in West Africa were pretty astounding in early 2014. Usually these outbreaks occur in small blips and then die off a few weeks or months later. I was working in Infection Prevention & Control at a pediatric hospital at the time and, like many, didn’t think too much about the outbreak pertaining to the US and even if it did, our infection control practices should be able to handle an organism that required Contact/Droplet isolation. I put some updates in our monthly newsletter and continued to watch as West Africa became overwhelmed with EVD.

Like many public health issues, no one really starts hitting the panic button until a disease shows up and you’re scrambling (and trust me, most of the time, you find out retrospectively) to do damage control. The IP (infection prevention) world started to get worried in late July when Emory University Hospital accepted and began treatment the first two EVD patients transported into the US from their field assignments in West Africa. Questions about isolation and practices were asked, but again, no one really worried too much since these patients were flown directly to Emory due to their special infectious disease isolation unit. Suddenly, on September 30th, 2014 a media storm announced that a patient being treated at Texas Health Presbyterian Hospital in Dallas, Texas, was positive for EVD. I can personally tell you, this is when the proverbial crap hit the fan for just about every healthcare facility and IP in the US. A visiting your emergency department, being sent home, and then coming back with a highly infectious disease that few physicians know well enough to suspect, let alone diagnose or treat, is pretty much the equivalent of an IP nightmare. So what could we do?

First, I should say that every hospital with an IP team (most of them have at least one IP) experienced a massive level of panic, anxiety, and stress dedicated to avoiding this, so please, give them a pat on the back. I am fortunate that my IP team consists of not only enthusiastic, ridiculously talented and intelligent people, but they know how to respond to crisis in the flip of a switch. We quickly pulled together a committee to encompass all people that would play a role in the preparedness and response of an EVD patient. Fortunately, by this time, Emory had released an extremely helpful document that discussed their experiences and lessons learned. We met our committee (now filled with people from environmental services, facilities, nursing, medical staff, infectious disease, emergency preparedness, the emergency department, and many others) with this document and everything else the Centers for Disease Control and Prevention (CDC) had on EVD response. For many, the difficulty laid in where do we put this patient, what designated staff will care for them, and what will we do with the waste? You pretty much need to have a specific process for both your emergency department if there is a suspected case, but also a designated wing you can move patients out of and move this potential EVD patient into. Without going too much into detail, one of the trickier components became the PPE (personal protective equipment) and waste process of a potential patient. CDC PPE recommendations were changing almost daily (or at least that’s how it felt). Information was changing so rapidly it was a constant cycle of checking their website, talking with peers, and attempting to update instructional handouts and training tools for staff incase we happened to get a potential patient. Historically, EVD PPE recommendations came from outbreaks in Africa with little access to the equipment and capabilities we’re used to in the US. The ability to intubate a patient or insert a central line opened up a Pandora’s box of potential transmission scenarios, leading to difficulty in establishing a solid PPE process. Acquiring the PPE was another struggle. Our materials management team worked tirelessly to find the ever changing products we would need to not only have PPE kits in our emergency department and urgent cares, but also to sustain care for a patient for several days. The sustainability was a huge concern as staff were changing in and out of PPE every 45 minutes due to heat exhaustion and CO2 build-up from the N-95 masks. Once we were able to obtain the PPE, and this was a constantly changing cycle to follow CDC recommendations, training went into effect. One of the greatest struggles was training enough staff to have a proficient understanding of an extremely complex (and dangerous) process. The unique part about EVD PPE practices is that you utilize a buddy system with a checklist – something healthcare workers are not used to and something we had to remind them of (don’t try and memorize this)! We did several drills involving patients projecting a mixture of chocolate syrup and glitterbug to not only prepare healthcare staff, but also show their cross contamination when doffing the PPE.

Courtesy of USA Today
Courtesy of USA Today

The PPE struggles were one small piece of this EVD pie. Many IP’s could probably write a novel about the struggles and random problems that came up during this time. Our ridiculously long days were filled with preparedness meetings, educational trainings, hospital-wide communication, worried calls from people and staff (the comical relief of people calling to ask for an EVD vaccine but refusing to get their flu shot showcases the ridiculousness of what we experienced), educating physicians on signs and symptoms, identifying routes for patient transportation, and coordinating surveillance mechanisms like electronic mandatory travel history (from the affected countries) questions and alerts in the intake process of patients from the emergency department or urgent cares. The simple truth is that the US became so panicked and so obsessed with a disease no one really worried about a few months before, the amount of preparedness that was initiated simply couldn’t be maintained for an extended period of time. Emergency departments and hospitals are comprised of some of the most hardworking and intelligent people you’ll ever meet, but I can honestly say, something like what happened in Dallas could’ve happened in any hospital. Healthcare is an imperfect system and while we struggle to make it better and more robust, it always comes down to overworked staff and communication gaps. My experiences as an IP during the EVD 2014 outbreak, while exhausting, were truly eye opening to the ability of our healthcare infrastructure to respond to such an event. It revealed a lot of gaps in our practices and the state of our preparedness, but overall, it highlighted the growing need for better disease surveillance, preparedness, and attention to biosecurity.

 

Pandora Report 8.31.14

by juliadhomstad, posted in Pandora Report

Fall classes at George Mason have already started and this Labor Day weekend marks the official end of summer. This week, we have stories covering a wide range of topics—an Ebola update (of course), a fascinating article on vaccinia infections acquired through shaving, Haj precautions, and the ISIS “laptop of doom.”

Best wishes for a safe and enjoyable holiday!

Ebola Virus Outbreak Could Hit 20,000 Within Nine Months, Warns WHO

There were many stories this week covering the continuing Ebola outbreak in West Africa. Senegal saw its first (imported) case of the virus this week and has banned flights to and from the affected countries while shutting its land border with Guinea and Nigeria saw its first death outside of the capital city of Lagos. In the Democratic Republic of Congo, where Ebola first emerged in 1976, there have been reported cases of a hemorrhagic gastroenteritis similar to Ebola. I read conflicting accounts this week of the “patient zero” for the Ebola outbreak—a young boy or an older traditional healer. There were reports of some U.S. universities screening students from West Africa for Ebola. There was coverage of a Toronto medical isolation unit ready for patients and information about GlaxoSmithKline’s experimental ebola vaccine which would be tested on humans in the next few weeks.

All of this news came among World Health Organization estimates that this West African outbreak could affect 20,000 people over the next nine months and that half a billion dollars would be needed to stop the spread of the disease.

The Wall Street Journal—“The WHO program will likely cost around $490 million and require contributions from national governments, some U.N. and non-governmental agencies, as well as humanitarian organizations, it said.”

First Reported Spread of Vaccinia Virus Through Shaving After Contact Transmission

This week, reports in the August issue of Medical Surveillance Monthly Report from the Armed Forces Health Surveillance Center covered vaccinia virus infection—the virus used for smallpox vaccinations—within the U.S. Air Force. The infections in the report occurred in June 2014, and affected four individuals.

Infection Control Today—“Over the past decade, most cases of contact vaccinia (i.e., spread of the virus from a vaccinated person to an unvaccinated person) have been traced to U.S. service members, who comprise the largest segment of the population vaccinated against smallpox. Most involve women or children who live in the same household and/or share a bed with a vaccinee or with a vaccinee’s contact. Of adult female cases, most are described as spouses or intimate partners of vaccinees or secondary contacts. Of adult male cases, most involve some type of recreational activity with physical contact, such as wrestling, grappling, sparring, football, or basketball. Household interactions (e.g., sharing towels or clothing) and “unspecified contact” are also implicated.”

Government to Keep Haj Infection-Free 

This week, the Saudi Arabian Ministry of Health announced mandatory measures for Haj and Umrah pilgrims coming from countries with active outbreaks or high rates of infectious diseases. The Health Ministry sent information to embassies outlining health requirements for those seeking pilgrim visas.

Arab News—“‘Although we do not issue Haj visas for pilgrims coming from endemic countries, we will still be monitoring pilgrims coming from other African countries for Ebola symptoms,’ said [Sami] Badawood [Jeddah Health Affairs director.]

He said the ministry would also focus on diseases such as yellow fever, meningitis, seasonal influenza, polio and food poisoning.”

Is the ISIS Laptop of Doom an Operational Threat?

Discovery of a laptop, which has been linked to ISIS, raises new questions about the organization’s plans relating to use of WMD—specifically chemical or biological weapons. Over 35,000 files on the laptop are being examined and has offered new insight into ISIS and their WMD aspirations.

Foreign Policy—“Most troubling is a document that discusses how to weaponize bubonic plague. But turning that knowledge into a working weapon requires particular expertise, and it’s not clear that the Islamic State has it.”

 

Image Credit: Wikimedia Commons