Pandora Report: 11.27.2015

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.

Pandora Report 9.25.2015

You didn’t think a Papal visit would slow us down, did you? Even in the event of a zombie apocalypse, we GMU Biodefense folks would still find a way to get out the weekly report – perhaps pigeon carrier? Until that happens, don’t forget to check us out on Twitter! This week saw a lot of great focus on collaborations to fight public health threats like antimicrobial resistance and epidemics. Schools in Chicago were closed for concerns over Legionnaires’ disease, yours truly provided a piece on Ebola infection prevention, and we have a wonderful opportunity to contribute to World Medical & Health Policy regarding women’s health on a global stage.

Learned Lessons from Ebola in the US
Sylvia Burwell, Secretary of Health & Human Services, discusses the clinical complexity and reality that “our clinical approach to treating Ebola in a hospital setting posed different challenges.” Several key US health experts weighed in on the pivotal first patient, Thomas Duncan, to unknowingly bring Ebola to the US. The implications for healthcare and preparedness sent a tidal wave of response across US hospitals. Dr. Tom Frieden, director of the Centers for Diseases Control and Prevention (CDC), also highlights three main lessons from not only the cases in Dallas, but also the Ebola epidemic as a whole. He points to the necessity of a strong surveillance and response system, need for rapid international aid, and better infection control in hospitals….which segues beautifully into our next story.

The Infection Prevention Angle of the 2014 Ebola Crisis
Reports and analyses from a range of responders to the crisis have been trickling out for several months now, but there’s a constant in all of them – infection control. Given my background and experiences in this field, I wanted to take our readers down the rabbit hole of what exactly it was like to be an Infection Preventionist during this time. A hopeful start to a series of pieces on this subject, it will give you a taste of not only the daily struggles, but the brevity of what potential Ebola patients meant for US healthcare preparedness.

Partnerships to Support Antibiotic Development
564px-Penicillin_Past,_Present_and_Future-_the_Development_and_Production_of_Penicillin,_England,_1943_D16963The ASPR’s (Office of the Assistant Secretary for Preparedness and Response) Biomedical Advanced Research and Development Authority (BARDA) is part of a larger initiative to use Other Transaction Authority (OTA – flexible advanced research and development funding instruments) to start developing business relationships between government and private industry. The relationships are mutually beneficial, allowing both parties to invest and develop products for biodefense and the growing threat of antibiotic resistance. Given the slowing of new antibiotic development, this joint agreement comes at a pivotal time for antimicrobial resistance efforts.

Three Chicago-area Schools Close in Response to Legionnaires’ Disease Concerns
Three schools in the Illinois U-46 district were shut down on Wednesday and Thursday after cooling tower test results showed “higher than normal levels of Legionella bacteria”. The OSHA recommended threshold is no higher than 1,000 CFU/ml (colony-forming units per milliliter) and with the outbreak among residents of the Illinois Veteran’s Home, it’s not surprising to see many water towers being frequently tested, etc. The important thing to note is that Legionella pneumophila infections are a result of the intensity of the exposure and the immune status of the exposed person. Legionella can’t be totally eradicated from the water supply and a majority cooling towers will contain some amount of growth.

Call for Papers – Women’s Health in Global Perspective
Papers sought for a special issue and workshop of World Medical & Health Policy on “Women’s Health in Global Perspective,” to contribute to understanding and improve policy related to women’s health and wellbeing.  Forces ranging from the economic to the climactic have human repercussions whose genesis and solutions demand consideration of their global context.  A wealth of recent research and inquiry has considered the particular plight of women, who often suffer disproportionately from lack of education, compromised nutrition, poverty, violence and lack of job opportunities and personal freedom.  The Workshop on Women’s Health in Global Perspective will consider the broad ranging social determinants of health on a global scale that importantly influence health outcomes for women everywhere, which in turn has implications for economic, political and social development.
Abstract submission deadline (250 words): October 16, 2015 
Contact: Bonnie Stabile, Deputy Editor, bstabile@gmu.edu
Notification of selected abstracts: November 13, 2015
Workshop March 3rd, 2016
Completed papers due: March 11, 2016

Stories You May Have Missed:

  • Personal Microbial Cloud – researchers found that a person’s microbiome form a cloud around them, allowing scientists to identify a specific person just by sampling their microbial cloud. Food for thought: would this be our microbial cloud version of a fingerprint?
  • C. Difficile Drug Success – Researchers at Stanford University School of Medicine were successful in their ability to get rid of the deadly gastrointestinal toxin via a drug that didn’t focus on the organism, Clostridium difficile, but rather the toxin itself. C. difficile is responsible for 250,000 hospitalizations and 15,000 deaths per year while costing the US more than $4 billion in healthcare expenses. Yay for successful treatments!
  • EC, EU, and WHO Work To Better Share Private Drug Data – The European Commission, European Medicines Agency, and World Health Organization are working to “step up coordination” on EU medicines regarding safety, quality, and efficacy of new drug candidates. The first step in solving a problem is recognizing you have one, right? The new focus on global public health threats is one we can all appreciate!
  • WHO Makes Changes to Southern Hemisphere Flu Vaccine – The WHO committee recommended changes for two of the three trivalent influenza vaccines for the Southern Hemisphere next year due to changes in the circulating viral strains. They suggested using H1N1, H3N2 an A/Hong Hong/4801/2014-like virus, and for influenza B, the Brisbane/60/2008-like virus. In the quadrivalent vaccine, they recommended adding the influenza B Yamagata lineage component, with the A/H1N1 strain staying.

Pandora Report 8.9.15

My apologies for lack of update last weekend…but that means a SUPER UPDATE this weekend! This week marked the 70th anniversary of atomic bombs being dropped in Japan. Rather than find an insufficient story that attempted to address the gravity of that event, we’re focusing on a successful Ebola vaccine trial, UN consensus on Syrian chemical weapons, and airplane bathrooms (because I can’t help myself when I see a story like that!) We’ve also got stories you may have missed.

Have a great week!

Vaccine Success Holds Hope for End to Deadly Scourge of Ebola

Some great news from West Africa: an Ebola vaccine trial in Guinea has returned results that are 100% effective. 4,000 people who had been in close contact with a confirmed Ebola case showed complete protection after ten days. A ring vaccination strategy—where those who have close contact with an infected person—was used, and after success was demonstrated, the vaccine is now being extended to 13-17 year olds, and possibly 6-12 year old children.

Reuters—“The success of the Guinea trial is a big relief for researchers, many of whom feared a sharp decline in cases this year would scupper their hopes of proving a vaccine could work. Another major trial in Liberia, which had aimed to recruit some 28,000 subjects, had to stop enrolling after only reaching its mid-stage target of 1,500 participants. Plans for testing in Sierra Leone were also scaled back. That left the study in Guinea, where Ebola is still infecting new victims, as the only real hope for demonstrating the efficacy of a vaccine.”

U.N. Approves Resolution on Syria Chemical Weapons

The UN Security Council unanimously—yes, even Russia—adopted a resolution aimed at identifying those responsible for the use of chemical weapons in Syria over the past two years. The resolution established an investigative body that would assign blame for the attacks “so that the perpetrators can be brought to justice.”

Salt Lake Tribune—“‘Pointing a finger matters,” U.S. Ambassador Samantha Power told the council. “This sends a clear and powerful message to all those involved in chemical weapons attacks in Syria that the [new investigative body] will identify you if you gas people.” But she added that prosecuting perpetrators will take time because there is still no tribunal to investigate alleged crimes during the war in Syria, which has killed at least 250,000 people since it began in March 2011, according to the U.N.”

Airplane Toilets Can Help Researchers Find Disease Outbreaks

A recent study in Scientific Reports finds that researchers can tell what continent you’re from and give early indication of disease outbreaks, all from the poop left in airplanes. (I think this is the first time I’ve been able to say “poop” here on the blog.) The researchers gathered samples from 18 airplanes that departed from nine cities and landed in Copenhagen and were able to identify continental trends. Microbes from Southeast Asia had higher incidence of antibiotic resistance; food transmitted microbes were also more frequent in the Southeast Asian samples; and C. diff was much more common in the North American samples.

Popular Science—“These findings led the researchers to believe that they could start to create a typical microbiome for each continent. And any big shifts that happen in their makeup—say, the concentration of C. diff rises dramatically in samples from Southeast Asia—could indicate a growing public health issue. If it’s caught early enough, public health officials could take preventative action.”

Stories You May Have Missed

 

Image Credit: CDC Global

Bacteria that cause Legionnaires’ disease are not uncommon

By Chris Healey

Legionellosis is on the rise in the United States.

A recent study published in Environmental Science & Technology described the presence of Legionella pneumophila in nearly half of the 272 water samples collected across the United States. The presence of L. pneumophila in well water is alarming because it can infect humans if the water becomes aerosolized.

Widespread detection of L. pneumophila in well water coincides with increasing cases of the illness. Health departments across the U.S. have reported rising rates of legionellosis.

L. pneumophila causes Legionellosis—an overarching term given to two clinically and epidemiologically distinct illnesses. Legionnaires’ disease is characterized by fever, myalgia, cough, and clinical or radiographic pneumonia. Pontiac fever is characterized by milder versions of same symptoms of Legionnaires’ disease with no pneumonia. Infection occurs after inhalation of bacteria or bacterial antigen aerosolize in a mist or spray. The disease is noncommunicable; it cannot be spread from person to person.

Symptoms of Legionnaire’s disease begin 2 to 10 days after exposure, but symptoms often appear in 5 to 6 days. Most cases of Legionnaires’ disease can be treated with antibiotics, specifically fluoroquinolones or macrolides. Hospitalization is often required, with a case fatality rate as high as 15%. Most individuals exposed to Legionella will show no symptoms of infection, or only experience a mild illness.

Those at greatest risk of developing symptoms include the elderly, current or former smokers, those with chronic lung disease, immunocompromised individuals, and those taking immunosuppression drugs.

Pontiac fever is a self-limited, non-lethal febrile illness that does not progress to pneumonia. Symptoms of appear 5 to 72, but most often 24 to 48, hours after antigen exposure and usually lasts 2 to 5 days. Antibiotics do nothing to alleviate Pontiac fever. Patients recover spontaneously without treatment.

According to the CDC, L. pneumophila colonizes the lungs and is difficult to diagnose. Bacterial isolation, direct fluorescent antibody testing, urine antigen, and serology can all be used to test for infection.

L. pneumophila gets its name from its manner of discovery. The bacterium was isolated and identified among members of the Pennsylvania American Legion who were attending a conference in Philadelphia in 1976. Of the 182 members who developed acute illness, 29 died.

Although it was discovered and named in 1976, the bacterium was isolated about 25 years earlier. L. pneumophila has been confirmed as the causative agent of outbreaks dating back to 1959.

Since there is no vaccine for legionellosis, prevention stems from maintaining warm water sources. Commercial cooling towers should be drained and scale and sediment removed when not in use. Hot water tanks should be maintained at a temperature greater than 122 degrees Fahrenheit. Hot tub and whirlpool maintenance should follow manufacturer recommendations. Hot tubs, for example, should have bromide levels between 4 and 6 parts per million, while pH should be kept slightly basic – between 7.2 and 7.8.

The natural presence of L. pneumophila also poses a security concern. Soviet scientists working on the Soviet bioweapons program reported they had genetically modified L. pneumophila to be more lethal. The possibility exists that modern state or non-state actors could modify the bacteria in a similar way for malicious purposes.

 

Image Credit: Wikimedia Commons/ JJ Harrison