Pandora Report 7.28.2017

Happy Friday! As we close out the month of July, Texas has reported its first local case of Zika in 2017. If you’re not convinced about the threat of antimicrobial resistance, check out this video on the ability for bacteria to resist even new antibiotics.

The Reality of Trump’s R&D Cuts 
There’s been a steady stream of reports regarding the hits to global health spending that the new administration is making. The proposed 2018 “A New Foundation for American Greatness” budget hits financing of global health security, which is already poorly funded. While Bill Gates met with president Trump several times in efforts to persuade him of the importance of investing in global health and the R&D that goes into it, it seems that the continued assaults to funding aren’t going anywhere. A recent report by the Global Health Technologies Coalition and the Policy Cures Research of Australia took a different approach to swaying the president – money and fear. “The report explains that between 2007 and 2015 an investment of $14 billion (£10.7bn) in global health R&D resulted in a $33 billion injection back into the economy and the creation of 200,000 jobs. Spending since 2000 resulted in 42 successful products, including 11 for malaria and ten for TB. Want to ‘Make America Safe Again?’ Start by investing in R&D.” Just like the Nuclear Threat Initiative highlighted last week in their focus on the GHSA and importance of investment in global health, this report drives home the economics of global health security. We know that an outbreak anywhere is an outbreak everywhere, but for many, it can be difficult to see that when we’re not experiencing a major outbreak on American soil. Despite the impact of Ebola cases in the U.S. in 2014, the rise of antimicrobial resistance, and growing concerns regarding dual-use research and biosafety, there is a consistent struggle to truly get support for not only global public health, but also the R&D that supports biodefense efforts. The report notes that “Between 2007 and 2015, the US government invested nearly US$14 billion dollars in R&D for global health. In comparison, in 2015 alone, the US government spent $1.05 trillion on Medicare and health, $609 billion on the military, and $102 billion on education. Despite relatively limited investment, US government support was essential in helping advance 42 new technologies approved since 2000 – including 11 new products for malaria, 10 for tuberculosis (TB), and 1 for HIV/AIDS.” The U.S. is not an island – we rely on global cooperation and R&D alliances to help fight off current and future microbial threats. Global health security means that we must invest in efforts at home and abroad and to decimate an already limited budget for such efforts would have worldwide ramifications. FYI – the DoD released their guidance on global health engagement  (hint: global health cooperation and engagement is important).

Worry About Water Bugs, Not Sharks
While everyone is up in arms about Michael Phelps not really racing a great white shark, some are saying, “hey…there’s actually a lot of microscopic water germs that are way scarier!” “You’re 75 times more likely to be killed by lightning than by a shark. On average, one person dies of a shark attack every other year in the United States.” The real danger rests in our love of water activities during the summer, whether it be a public pool, water park, private pool, or lake. FYI, I’ve seen one too many presentations on outbreaks associated with splash pads…they are diarrheal disease hotspots.  Here are some of the bugs you should actually be worried about in water – crypto, pseudomonas, shigella, legionella, norovirus, cyanobacteria, and the brain-eating amoeba Naegleria fowleri. How can we dodge these party-crashers? Avoid swallowing the water…don’t go swimming if you’ve had diarrhea recently, check those chlorine and pH levels, and make sure to rinse off from time to time.

Emergent Biosolutions Goes On A Spending Spree
While the future of global health R&D is a little bleak, Emergent Biosolutions is sprinkling some funding around to expand its drug portfolio. “Five days after the company agreed to pay $97.5 million to acquire the smallpox vaccine assets of pharmaceutical giant Sanofi it handed another $96 million to GlaxoSmithKline, one of biggest healthcare providers in the world, to acquire raxibacumab, an antibody that treats a form of anthrax that can be inhaled. Both deals are part of a broader expansion plan that Emergent’s executives hope will turn it into a $1 billion-a-year company by 2020.” These investments are more in the direction of defense against high-consequence biothreats, and their Chief Executive, Daniel Abdun-Nabi, is pointing to not just nefarious biological events, but also those related to climate change. Abdun-Nabi notes that “There’s a real worry starting to grow across the globe about the re-emergence of pathogens that we might not have seen for a number of years,”.

Infection Control vs. MERS
Not surprisingly, infection control failures are a big source for MERS-CoV transmission. Despite ongoing outbreaks and training on PPE and isolation precautions, there’s a pretty significant trend in healthcare – poor infection control practices. A recent WHO report revealed the findings of a risk assessment regarding 199 MERS cases in four countries. Since December, 1/3 of MERS cases have been linked to healthcare facilities and while initial signs and symptoms are non-specific, they found that simply improving standard precautions (also known as universal precautions) could make a difference. Using basic infection control practices, like putting a mask on a patient with a cough, or utilizing isolation precautions when caring for a febrile patient, are all easy and critical components to preventing the spread of disease. “How MERS-CoV spreads in hospitals still isn’t clear and is the topic of scientific studies. The WHO, however, said observations suggests transmission occurs before infection prevention and control steps are applied and patients are isolated. The agency added that hospital outbreak investigations suggest that aerosolizing procedures done in crowded emergency department or medical wards without adequate control measures may have led to human-to-human spread and environmental contamination.” This is an interesting finding for several reasons. Firstly, infection control steps should be applied the second a patient walks into a healthcare facility. During measles outbreaks (and influenza season), many hospitals put kiosks in the hospital entrance that contain alcohol-based hand sanitizer and masks, with signs highlighting the importance of such practices and to wear one if you have a cough. Secondly, utilize your triage staff. Either isolate or ask patients to wear masks during their triage process to prevent the spread of infection. We often wait until patients are in rooms to use PPE but the truth is that it can start a lot earlier. Also, emphasizing hand hygiene from the beginning can be monumentally helpful for everyone involved in patient care. Yes, healthcare workers are a significant part of the transmission chain, but visitors and the patients themselves play a big role. Overall, this study draws attention to infection control failures however, these aren’t new for those of us working in healthcare, and MERS is just a good example of how we can improve them. Preemptively isolating a patient won’t hurt, but delayed isolation can kill.

First Human Embryos Edited in U.S. 
Researchers in Oregon are now the first team to attempt creating a genetically modified human embryo in the U.S. “The effort, led by Shoukhrat Mitalipov of Oregon Health and Science University, involved changing the DNA of a large number of one-cell embryos with the gene-editing technique CRISPR, according to people familiar with the scientific results.” Such work has not been previously done in the U.S. and Mitalipov’s team has shown it can be successful. While the embryos weren’t allowed to develop past a few days and there were never intentions of implantation, the altering of DNA codes within human embryos is a significant leap for biotechnologies like CRISPR. While many highlight concerns with the future of such work and the risk of “designer babies”, the NAS report in February has been seen as a green light to test germline modification. “The advisory committee drew a red line at genetic enhancements—like higher intelligence. ‘Genome editing to enhance traits or abilities beyond ordinary health raises concerns about whether the benefits can outweigh the risks, and about fairness if available only to some people,’ said Alta Charo, co-chair of the NAS’s study committee and professor of law and bioethics at the University of Wisconsin–Madison. In the U.S., any effort to turn an edited IVF embryo into a baby has been blocked by Congress, which added language to the Department of Health and Human Services funding bill forbidding it from approving clinical trials of the concept.”

MSF Lessons Learned During the DRC’s Recent Ebola Outbreak
There have been dozens of analyses since Ebola burned through West Africa in 2014/2015 however, a latest report from Médecins Sans Frontières/Doctors Without Borders (MSF) is providing insight regarding the 2017 outbreak in the Democratic Republic of Congo. The small outbreak (which seems odd to say about a disease like Ebola, but that was until 2014) resulted in the deaths of four people in a remote part of the DRC. When news first sprung up that cases were identified, the world waited with bated breath as the memories of the the last horrible outbreak were all too fresh. Fortunately, rapid field team and resource deployments aided in the quick response that halted the disease in its tracks. MSF was a part of such efforts and since the outbreak was declared over, they have identified five major lessons. Firstly, train frontline health workers. This one is music to my ears, especially in terms of the poor infection control practices among healthcare workers that made them 21-32 times more likely to acquire the diseases. “Healthcare workers play a crucial role not only for the health of the people they serve directly, but also for general epidemiological surveillance for outbreaks like Ebola, but also for more common deadly infectious diseases such as measles and cholera. A health system cannot rely on just one person to play the crucial role of on-the-ground surveillance. What is needed are proper surveillance systems in resource-poor countries, which were clearly lacking in West Africa at the beginning of the epidemic.” Secondly, a forgotten disease finally taken seriously – this is all too true in that many did not know of Ebola until it sent shockwaves through West Africa. Now, the disease is top of the agenda and rapid mobilization is triggered. Third, back to basics, which means that while we can focus on vaccines and new drugs, we can’t forget the basic pillars of outbreak control, like surveillance, isolating and treating the sick, looking for new cases, contact tracing, burying the dead safely, and engaging and mobilizing the local community. Fourth, location matters. The recent outbreak occurred in a very remote and forested area, which impacts movement of contacts, as well as acquisition of supplies. “As in all previous outbreaks before West Africa isolation played a key factor for the containment of the virus.” Lastly, medical interventions are not the magic bullet. “MSF was willing and actively preparing to use the Ebola treatments that are still in development. However the outbreak was over before the process to allow the use of experimental products was complete, so none could be used this time. This outbreak however acted as a booster to speed up the process of preparing medical protocols so that new drugs, still in the experimental phase, can be used in a way that is as safe and ethical as possible.” In the end, the rapid control and early response measures, coupled with the limited size of the outbreak, helped prevent its spread before the vaccine could even really make a difference.

Global Catastrophic Biological Risks Definition – Center for Health Security
The Johns Hopkins Center for Health Security released their working definition for global catastrophic biological risks (GCBR) in efforts to draw attention to this special category of global threats and focus future efforts to combat them. The definition is: “Those events in which biological agents—whether naturally emerging or reemerging, deliberately created and released, or laboratory engineered and escaped—could lead to sudden, extraordinary, widespread disaster beyond the collective capability of national and international governments and the private sector to control. If unchecked, GCBRs would lead to great suffering, loss of life, and sustained damage to national governments, international relationships, economies, societal stability, or global security.” You can read the article and ten commentary pieces written by a variety of leading scientists and public health experts here.

How Infectious Diseases Shape Culture
When we think of infectious diseases, we tend to imagine morbidity and mortality. While this is accurate, there’s a lot more that these microbes impact, like language, culture, etc. We know that during the European bubonic plague in the 14th century, urbanization and economic development were slowed, but those skilled laborers who survived were highly valued. Consider even the food we eat, which has several cultural dynamics within it. We avoid raw meat, raw milk, and even stopped eating raw cookie dough or cake batter (ok, let’s be honest, we still lick the bowl, right?). “Many words and expressions commonly used in English have origins linked to an infectious disease. One such common phrase, used for a person who may not have symptoms of an infectious disease but can transmit it, is to call them a Typhoid Mary. In 1906 Mary Mallon, a cook, was the first healthy person identified in the USA as a carrier of the typhoid bacilli that causes typhoid fever, a serious disease for the Western world in the 19th century (but which globally exists and has often existed in poor communities).” Consider even the term, “feeling lousy”, which originated in conjunction to those with lice who became anemic and experienced general malaise. “In the late 1880s Tunisia experienced severe infectious disease epidemics of cholera and typhoid, and famines, which so badly depleted its economy that it was unable to pay off its debts. This made it vulnerable to French occupation and then colonisation.” There’s been a substantial body of literature that looks to the security implications of disease and how it may leave countries open to political and military disputes (check out Andrew Price-Smith’s Contagions and Chaos). The recent outbreak of Ebola has even changed the way American healthcare handles preparedness. Long thought a rare disease that we would never see, hospitals around the country now have Ebola Response plans and work to train front-line staff in case an outbreak occurs again.

Reports of Pediatric Deaths Following UN Sanctions Is Untrue 
A recently article in BMJ Global Health is highlighting the fictitious statements made by Saddam Hussein’s government during the UN sanctions in 1990. “The United Nations Security Council imposed the sanctions in 1990 following Iraq’s invasion of Kuwait. The sanctions remained in place after the Iraqi army was expelled, on the grounds that Iraq’s weapons of mass destruction would need to be destroyed before they could be lifted. The sanctions greatly restricted Iraq’s ability to export oil and therefore to import supplies of food and medicines, prompting international concerns that the country’s children were being particularly hard hit.” Following these sanctions, a 1999 national survey was conducted by UNICEF and the Iraqi government, which reportedly found that “children in the centre and south of the country were dying at over twice the rate of 10 years earlier”. These results were used by several outlets for either support or refusal to invade Iraq. The researchers in BMJ Global Health have found that the results were “a deception” and studies done since 2003 have found no evidence of such high rates. The researchers concluded that “The rigging of the 1999 Unicef survey was an especially masterful fraud. That it was a deception is beyond doubt, although it is still not generally known.”

Stories You May Gave Missed:

  • CARB-X Awards $17.6M To Fight Global Antimicrobial Resistance – the private initiative, CARB-X, was established with the purpose of facilitating global efforts to combat antimicrobial resistance. This week they announced $17.6 million will fund research efforts by scientists in India, Ireland, France, Switzerland, the U.S., and the U.K. “The seven supported projects include five potential antibiotics targeting Gram-negative bacteria, a new treatment for drug-resistant gonorrhea, a new drug molecule that targets resistance in cystic fibrosis infections, and Phase I development of an oral, broad-spectrum antibiotic. The latest round of awards is part of a $455 million commitment by the U.S. Government and the Wellcome Trust over five years. The first 11 projects to receive funding were confirmed in March, and additional funding announcements are expected later this year.”
  • Biodefense World Summit – If you missed this event in June, check out some of these highlights that include talks on pathogen detection, food safety, and the importance of biodefense in the U.S.!
  • Papaya-linked Salmonella Outbreak – Just went you thought it was safe to go back to the summer fruit salad…. Sadly, salmonella is a current risk for papaya-lovers across the U.S. as an outbreak of Salmonella Kiambu has sickened 47 people across 12 states. “Most of the cases were reported in five eastern states: New York (13), New Jersey (12), Virginia (6), Maryland (5), and Pennsylvania (4).  Seven states across a wide swath of the country, however, have each reported 1 case: Iowa, Kentucky, Louisiana, Massachusetts, Minnesota, Texas, and Utah. So far, 12 people have been hospitalized. The death involved a person from New York City. Illness onsets began May 17, with the most recent on Jun 28.Patient ages range from less than 1 year to 95 years, with a median age of 27. About two-thirds are female, and, of 31 patients with available information, 18 (58%) are Hispanic. The epidemiologic and lab investigations both point to tainted papayas as the source of the outbreak. Interviews with 25 sick patients found that 11 (44%) had eaten papayas, a significantly higher proportion of papaya consumption than in healthy Hispanic people (16%) interviewed around the same time.”

Pandora Report 6.16.2017

Temperatures may be soaring but we’ve got all your biodefense news, including a frosty story on frozen diseases coming to life!

Big Data Takes on Epidemics
The potential applications for big data are vast and we’re just now starting to get a taste for how it can be utilized during an outbreak. Rapid access to data sets and available personnel to handle modeling is a challenge during emergent situations however, many are pointing out just how the data science revolution can be used to fight diseases. Metabiota Senior Director of Data Science Nita Madhav has put together a list of the five ways big data analytics are changing the fight against epidemics. First, better genetic data through genome sequencing that can help speed up genetic analysis during an outbreak. Second, cell phone mobility data. This is particularly interesting as it was used during the Ebola outbreak in 2014, which allowed experts to tract contacts of cases as a means of prevention. Cell phone mobility data also provides information on movement during outbreaks. Third, social media data, which can be used to predict peaks and perform sentiment analysis (think vaccination skepticism), but also as a means of pushing public health messaging. Fourth, mapping high risk areas. “Machine learning techniques can now yield global, high-resolution maps pinpointing where epidemics are likely to emerge and take hold. These techniques make use of remotely-sensed and other geographic data about environmental, human and animal factors to estimate how many people live in the riskiest places. For example, this type of analysis helped map likely locations for Zika virus to thrive and even identified areas where the virus would later establish itself, including southern Florida.” Last but not least, large-scale simulations, which allow epidemiologists to take all the data we currently have and generate tons of simulations to reveal gaps in response mechanisms. “These simulations help fill in gaps in observed data using synthetic outbreaks and deliver novel insights into possible outcomes of outbreaks, including expected numbers of illnesses, hospitalizations, deaths, employee absences and monetary losses. Ultimately, these insights can help inform the world about epidemic risks and the best ways to mitigate them.”

Chemical Weapons & ISIS
New analysis from Conflict Monitor by IHS Market is drawing attention to a significant reduction in chemical weapons used by ISIS in Syria in 2017 as well as a concentration of the chemical attacks in Iraq. The report highlights that 71 allegations of ISIS CW attacks have occurred since 2014 (41 in Iraq and 30 in Syria) however, the only alleged use in Syria in 2017 was on January 8th at Talla al-Maqri. “The operation to isolate and recapture the Iraqi city of Mosul coincides with a massive reduction in Islamic State chemical weapons use in Syria”, said Columb Strack, senior Middle East analyst at IHS Markit. “This suggests that the group has not established any further CW production sites outside Mosul, although it is likely that some specialists were evacuated to Syria and retain the expertise.” In response to ISIS use of chemical weapons, the U.S. Department of the Treasury’s Office of Foreign Assets Control (OFAC) is taking action against ISIS leader, Attallah Salman ‘Abd Kafi al-Jaburi (al-Jaburi), who was involved in several attacks ranging from vehicle-borne improvised explosive devices (VBIEDs) to the development of chemical weapons. OFAC is also taking action against Marwan Ibrahim Hussayn Tah al-Azaw, an Iraqi ISIS leader. “As a result of today’s action, all property and interests in property of these individuals subject to U.S. jurisdiction are blocked, and U.S. persons are generally prohibited from engaging in transactions with them.” OFAC Director John E. Smith noted that “today’s actions mark the first designations targeting individuals involved in ISIS’ chemical weapons development,” and that “the Department of the Treasury condemns in the strongest possible terms the use of chemical weapons by any actor, and will leverage all available tools to target those complicit in their development, proliferation, or use.”

Pandemics, Bioterrorism, & Global Health Security Workshop Instructor Spotlight
This week we’re excited to share that Sanford Weiner will be our instructor spotlight! Sanford is a Research Associate in the Center for International Studies at the Massachusetts Institute of Technology, and a Visiting Fellow at Imperial College, University of London. For several decades he has done international comparative policy studies of public health agencies, and research on national security policies and environmental policies. He has published on policymaking at the Centers for Disease Control, the phase-out of CFCs, toxic substance control, and innovation in the Air Force. He is currently studying responses to pandemic flu in Europe and the United States, and the politics of alternative energy projects. He directs a Professional Education summer course at MIT on “Technology, Innovation and Organizations.” He has also taught in professional education courses for the Royal Society Technology Fellows (London), the National University of Singapore, UC San Diego, and in Stockholm. Before MIT he was on the research staffs of the School of Public Policy at UC Berkeley, the Health Policy Center at Brandeis, and the Harvard School of Public Health. Sanford looks to the need for organizational innovation and adaptation to address new threats, the politics of public health emergencies, and the importance of risk assessment and making evidence-based public health decisions. If you’re looking to talk about taking lessons from pandemic flu and applying them to polio, Zika, bioterrorism, and even Ebola, you won’t want to miss his lecture during our workshop!

The Awakening of Frozen Permafrost Diseases
Climate change has an undeniably impact on infectious diseases. Whether it be the vectors that spread them, movement of animals that act as hosts, or an increasing encroachment of humans into animal habitats, we simply can’t deny that the two are wholly interconnected. Unfortunately now we get to add zombie diseases to the list. Well, maybe not a zombie virus, but a bacteria or virus that has been trapped in the icy permafrost for thousands of years and is now waking up. “Climate change is melting permafrost soils that have been frozen for thousands of years, and as the soils melt they are releasing ancient viruses and bacteria that, having lain dormant, are springing back to life.” Last year we saw anthrax cases in the Arctic Circle due to exposure from infected reindeer carcasses that were exposed due to the melting of the frozen soil and snow. “As the Earth warms, more permafrost will melt. Under normal circumstances, superficial permafrost layers about 50cm deep melt every summer. But now global warming is gradually exposing older permafrost layers. Frozen permafrost soil is the perfect place for bacteria to remain alive for very long periods of time, perhaps as long as a million years. That means melting ice could potentially open a Pandora’s box of diseases.” Nothing like a good permafrost to keep the bacteria happily frozen and alive! What is so worrying about the melting permafrost is a range of threats – buried bodies of people who died from smallpox, unknown viruses or bacteria that we’ve never seen before, or even a resistant organism that changes the course of antibiotics forever.

Angry Birds – The Flu Version
While this isn’t the title of the latest game, the projectile you should be worried about is actually avian influenza droplets. China is currently battling against HPAI H7N9  outbreaks in poultry across three provinces. “Chinese health officials detailed four outbreaks in two OIE reports. Two occurred in different locations in Inner Mongolia province in the north, one at a large layer farm that began on May 21, killing 35,526 of 406,756 susceptible poultry. The remaining birds were culled to curb the spread of the virus.The other outbreak began Jun 5 at a poultry farm in Inner Mongolia’s Jiuyuan district, which led to the loss of 55,023 birds, including 2,056 that died from the disease.” These outbreaks spark fear for a number of reasons – the mass culling of birds is always economically devastating, the risk to human life, and really, the potential for sustained human-to-human transmission due to a few genetic tweaks that could result in a pandemic. That’s right, just three mutations should switch H7N9 into a lethal human-killing virus that has pandemic potential. H7N9 is one of the more concerning avian influenza strains because it’s already been known to do damage in terms of human cases (of the 1,500 cases, 40% died). “‘As scientists we’re interested in how the virus works,’ says Jim Paulson, a biologist at The Scripps Research Institute. ‘We’re trying to just understand the virus so that we can be prepared.’ That’s why he and his colleagues recently tinkered with a piece of the H7N9 flu — a protein that lets the virus latch onto cells. It’s thought to be important for determining which species the virus can infect. ‘So it’s not the whole virus,’ says Paulson. ‘It’s just a piece — just a fragment — that we can then study for its properties’. What they studied is how different changes affected the virus’ ability to bind to receptors found on the surface of human cells.” Paulson’s group found that just three tiny mutations made it able to sustain human transmission. This brings about the dual-use research of concern (DURC) and gain-of-function (GoF) research dilemma though – while we’re using it for good, couldn’t a person with bad intentions come along and turn it into a weapon? Or a lab error that results in an outbreak? While some argue for the need of GoF research, others agree with the 2014 White House moratorium that halted federal funding for such work. Ron Fouchier of Erasmus Medical Center in the Netherlands notes that, “‘The rest of the world is moving forward with this type of experiment already,’ says Fouchier, whose genetic experiments with a different bird flu virus sparked a public outcry in 2011. And so the U. S. can either join or not join. It’s up to them, but the work will continue,’.” Topics like avian influenza, pandemics, and dual-use/GoF research are all issues we’ll be discussing in the workshop this July, so don’t miss out!

Boston University’s BioLab Nears Approval
This hotly debated BSL-4 lab has been a source of contention between researchers and surrounding neighbors for over a decade. Boston University received a $200 million federal grant nearly 15 years ago to build the regional lab as a new source for work with deadly pathogens however, neighborhood activists have been halting work since the beginning. Despite the ongoing debate, the lab is just one vote away from approval. “Supporters say it will speed the development of new vaccines and cures.  But after 15 year of fighting, the neighborhood that’s home to the lab is making a final push to keep the diseases away from the busy urban hub.”

The Scary Reality Behind WHO’S Updated Essential Medicine List
GMU Biodefense PhD student, Saskia Popescu, is taking a deeper dive into the recent announcement by the WHO regarding their reformatting of the EML list. The antibiotics sections haven’t seen an overhaul like this for 40 years, so what’s really afoot? Last week we discussed the changes- the categorization of antibiotics into three groups (ACCESS, WATCH, and RESERVE). Each list has a series of antibiotics and recommendations (i.e. for RESERVE, these are antibiotics which should be treated as the last resort of accessible antibiotics and should be used in “tailored” situations when other medications have failed. RESERVE antimicrobials should be targeted in national and international stewardship programs). While the updates make sense, they reveal a much deeper concern for developing countries and the growing threat of microbial resistance. “This extensive change to the EML highlights the dire situation that we are progressing towards in terms of microbial resistance. The EML provides the most basic medicine needed for patient care and its focus on antibiotic stewards highlights the stark reality even in the most dire of environments.”

Stacking Countermeasures for Layered Defense 
DTRA’s Joint Science and Technology Office’s (JSTO) Toxicant Penetration and Scavenging (TPS) research program is working to better defend us against chemical and biological weapons. “One such weaponized threat is the use of organophosphonates in an attack. These nerve agents inhibit acetylcholinesterase (AChE), an essential enzyme responsible for neurological function. Irreversible inhibition of AChE may lead to muscular paralysis, convulsions, bronchial constriction and death by asphyxiation. One of the projects in the TPS uses engineered DNA-enzyme nanostructures to create multi-enzyme pathway biocatalysts. These new biocatalysts are designed to process the destruction of chemical agents and their degradation compounds.”

Stories You May Have Missed:

  • MERS and Infection Control – There are endless opportunities when working in infection prevention & control to say, “I told you so” and the ongoing hospital MERS outbreaks only fuels that fire. “The World Health Organization (WHO) today provided new details on three MERS-CoV clusters in Saudi Arabia involving 32 out of the 35 cases reported between Jun 1 and Jun 10. The clusters are in three different hospitals in Riyadh. Cluster 2 is related to cluster 1, as the first case-patient in a second hospital initially visited the emergency room of the hospital implicated in cluster 1. According to the WHO, he was asymptomatic following the visit in hospital 1, and he continued to receive kidney dialysis sessions in the second hospital. The cluster involves the index case plus five healthcare workers and household contacts.The third cluster is not related to clusters 1 or 2. To date four cases are associated with this hospital; the index case involves a patient who had camel contact. Three healthcare workers have also been diagnosed.”

Pandora Report 6.9.2017

Hunting For Ebola and The Outbreak In The DRC
The hunt for Ebola’s hiding place has eluded scientists since its identification in 1976. Believing that bats are a natural reservoir, many are tracking them throughout the DRC. While we’ve picked apart the virus in BSL-4 labs for decades and continue to learn about its genomics, we’re tragically unable to truly understand the virus in its natural habitat. “But the virus’s natural history is a mystery, says virologist Vincent Munster, sitting outside his tent in the darkening jungle. ‘We know everything about its replication cycle but fricking nothing about where it comes from and how it causes outbreaks’. Earlier in his career, at the Erasmus Medical Center in Rotterdam, the Netherlands, Munster took part in the controversial ‘gain of function’ experiments that engineered the lethal H5N1 bird flu virus to spread more readily among mammals-including, presumably, people. These days, however, Munster talks less about viral genes and proteins than about virus ecology: the web of interactions that allows a zoonotic virus to travel between species. Logging, hunting, and other human encroachment on pristine environments all play a role, bringing people into contact with the microbes that lurk there.” Researchers, like Munster, are sampling animals (especially bats) to try and find a pattern that would explain why they’re most likely to carry the virus and if that might fluctuate. Trying to find the virus in bats is equally challenging despite knowing that they carry it. Interestingly, the virus is wholly dangerous to primates and many consider it the biggest threat to gorillas apart from poaching. During their work, the researchers were alerted to a chimpanzee carcass and throughout their response, they note just how careful they must be when handling it. “It was covered in maggots, Munster says-‘just a huge, pulsating mess.’ Ebola may be scarce in living animals, but carcasses like that one practically explode with virus. ‘We’ve done those studies,’ Munster says. ‘Every cell, every orifice of that carcass is loaded with Ebola.’ To minimize the risk to researchers, Munster helped develop a protocol for collecting samples from dead animals: swabbing the outside instead of using sharp instruments to collect blood or tissue.” While their work continues, so does the latest outbreak of Ebola in the DRC. The most recent WHO situation reports noted a new suspected case and 15 contacts for monitoring. Currently, there are 5 confirmed cases, 3 probable, and 1 suspected. Four patients have died and four have survived, translating to a 50% case-fatality rate. You can also read the latest WHO new report on response efforts in the DRC here.

Pandemics, Bioterrorism, & Global Health Security Workshop Instructor Spotlight
Our instructor spotlight this week will shine on FBI Supervisory Special Agent Edward You. Mr. You is like the action hero of the biological countermeasures world (ok, that might be a tad of an exaggeration, but wait until you read about all the amazing things he does with the FBI!). Mr. You is responsible for creating programs and activities to coordinate and improve FBI and interagency efforts to identify, assess, and respond to biological threats or incidents. These efforts include expanding FBI outreach to the Life Sciences community to address biosecurity. Before being promoted to the Weapons of Mass Destruction Directorate, Mr. You was a member of the FBI Los Angeles Field Office Joint Terrorism Task Force and served on the FBI Hazardous Evidence Response Team. Mr. You has also been directly involved in policy-making efforts with a focus on biosecurity. He is an active Working Group member of the National Security Council Interagency Policy Committee on Countering Biological Threats and an Ex Officio member of the NIH National Science Advisory Board for Biosecurity. He also serves on two committees for the National Academies of Sciences, the Institute of Medicine’s Forum on Microbial Threats and the Committee on Science, Technology, and Law’s Forum on Synthetic Biology. Prior to joining the FBI, Mr. You worked for six years in graduate research focusing on retrovirology and human gene therapy at the University of Southern California, Keck School of Medicine. He subsequently worked for three years at the biotechnology firm AMGEN Inc. in cancer research. Special Agent You works to keep the communication channels open between the synthetic biology community and law enforcement to help identify threats and strengthen relations with the biohacker community. Don’t miss the opportunity to learn from Mr. You and pick his brain during our summer workshop in July!

South Africa’s History of Chemical & Biological Weapons
GMU biodefense alum Glenn Cross is taking a deep dive into the Rhodesian use of chemical and biological weapons from 1975-1980. His recent book, Dirty War, investigates the prevalence of such weapons during the Rhodesian War. During periods of manpower and material shortage, the army would use such unconventional techniques that included planting contaminated food and beverages, medicine, and other goods into guerrilla supplies. “Some of these supplies were provided to guerrilla groups inside Rhodesia; some were transported to guerrilla camps in Mozambique. In all, deaths attributed to CBW agents often exceeded the monthly guerrilla body count claimed by conventional Rhodesian military units – demonstrating the utility of CBW agents in a counterinsurgency campaign against an elusive enemy.” Cross’s investigation is particularly valuable in that knowledge has been spotty and few insiders have been willing to talk. “All (insiders willing to talk) share a consistent story about Rhodesia’s development and use of chemical and biological agents during the Bush War; they even chillingly admit that chemical and biological agents were used in experiments on captured insurgents.”

Tracking Microbes and Inspiring Antibiotic Development
The June 6th WHO statement on the Essential Medicines List (EML) is sending ripples throughout the public health community in regards to antimicrobial resistance. The changes to the EML include the creation of three new categories for antibiotics – ACCESS, WATCH, and RESERVE. These categories include recommendations regarding use and aims to shift prescribing to a more accurate practice. “Initially, the new categories apply only to antibiotics used to treat 21 of the most common general infections. If shown to be useful, it could be broadened in future versions of the EML to apply to drugs to treat other infections. The change aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections. It should enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of ‘last resort’ antibiotics that are needed when all others fail.” The revision to this list highlights a growing need for antibiotic innovation. BARDA director, Joseph Larsen, hopes to change this and speed up the pace of antibiotic development in the face of growing microbial resistance. Current antibiotic development can take years, cost millions of dollars, and often only generates a profit after 23 years. Larsen notes that there hasn’t been a new class of drugs for treating gram-negative bacilli for over fifty years and that the volume of candidate antibiotics in phase 3/4 trials is barely 10% of those in oncology trials. BARDA is hoping to facilitate innovation through their CARB-X program, “which is one of the world’s largest public-private partnerships focused on developing new antibacterial products. When they started this program, BARDA expected 50 grant applications, but received 368 applications within the first 2 cycles. The goal is to deliver at least 2 antibacterial products to clinical development within 5 years. BARDA is planning on investing $250 million over the next five years to CARB-X.” Antibiotic innovation will become increasingly important as resistance grows, which highlights the importance of tracing microbial movement. GMU biodefense PhD student, Saskia Popescu, is looking at a recent study on hospital bacterial tracing and what that means for infection prevention efforts. Researchers sampled patient rooms prior to a new medical center opening and continued sampling for nearly a year, finding that microbial communities had some interesting trends. While hospital disinfection failures are frequently a source for transmission, it was found that the microbial community shifts after the patient has been in a room for 24 hours. Moreover, researchers found that a majority of admitted patients were on antibiotics and that those with longer stays tended to show an evolutionary shift to resistance. “Overall, this new study highlights the movement of microbes within healthcare and how we can start improving our tactics to help reduce the risk of healthcare-associated infections and blossoming bacterial resistance.” Worst case scenario, we could just always stop shaking hands

Bioterrorism Budget Cuts & DoD Chemical & Biological Defense Annual Report
GMU biodefense PhD alum Daniel M. Gerstein is focusing on just how vulnerable the proposed budget would make the U.S. in the event of a bioterrorism attack. The budgetary cut to NBACC at Ft. Detrick would mean that laboratory and science response to bioterrorism would be significantly gutted without a replacement plan. “The NBACC’s scientists also are capable of conducting experiments to determine what level of concern is warranted if a potential threat is identifiedThe NBACC also has bioforensics analysis capabilities. This provides the ability to understand how and potentially where a pathogen was prepared, its virulence and physical characteristics and even what medical countermeasures and decontamination techniques might be the most effective.” This is especially vital as even the decontamination of a site can be challenging and expensive. The 2001 Amerithrax attacks highlighted these gaps – between responsibility, practices, protocols, and cost, the decontamination of the office buildings and postal handling facilities cost roughly $320 million and pointed out some pretty significant gaps within U.S. bioterrorism response. Gerstein implores policymakers to take a second look at this proposed budgetary cut and decide if leaving the US without these critical capabilities is truly a wise decision. “They should assess whether NBACC’s capabilities, as an insurance policy, is a price worth paying when weighed against the potential cost in human terms of even a limited bioterror attack.”

The 2017 DoD Chemical and Biological Defense 2017 Annual Report to Congress has just been released, which includes specific comments on response to ISIS and synthetic biology activities. Within the report you can find sections on advanced diagnostics, advanced medical countermeasures (check out the section on the cocktail of three monoclonal antibodies developed to fight Ebola), advances in non-traditional chemical agent defense, and more! One of my favorite sections was actually on information systems – “The Global Biosurveillance Portal (G-BSP) program achieved IOC. This capability will provide a web-based, cloud-hosted enterprise environment that will facilitate collaboration, communication, and information sharing in support of the detection, management, and mitigation of man-made and naturally occurring biological events. G-BSP also facilitates the fusion of multiple unclassified information sources for greater situational awareness and decision support.” A recent study published in The Lancet, highlights the importance of diagnostic preparedness. Citing the 2014/2015 Ebola outbreak as a prime example, researchers note that while the diagnostic response eventually worked, it was slow and expensive, which severely impacted outbreak response. “If a focused mechanism had existed with the technical and financial resources to drive its development ahead of the outbreak, point-of-care Ebola tests supporting a less costly and more mobile response could have been available early on in the diagnosis process. A new partnering model could drive rapid development of tests and surveillance strategies for novel pathogens that emerge in future outbreaks. We look at lessons learned from the Ebola outbreak and propose specific solutions to improve the speed of new assay development and ensure their effective deployment.”

Committee on Strategies for Identifying and Addressing Biodefense Vulnerabilities Posed by Synthetic Biology
Don’t miss this July 6th workshop held at the National Academies of Sciences, Engineering, and Medicine’s Keck Center at 500 5th Street NW, Washington DC.  Attendees will hear from several experts and discuss four main topics: human modulation, public health and military preparedness, efficacy of design, and emerging technologies to overcome existing technical barriers. The meeting won’t be webcast or made available virtually, so you’ll want to attend in person.

China’s Battle Against An H7N9 Outbreak
While the outbreak may be slowing, eight new cases were reported this past week. What worries many though are the recent studies published that point to the highly pathogenic variant that was infecting poultry. Currently in its fifth wave of H7N9 activity, Chinese cases are showing a shift to impact more middle-aged adults in rural areas. “In the second report, a team from China described the clinical course and genetic findings in a 56-year-old Guangdong province man who died from a highly pathogenic H7N9 virus that showed a marker for resistance to neuraminidase inhibitors (NIs), the antiviral drugs commonly used to treat influenza.” You can read the press release from the Government of the Hong Kong Special Administrative Region here.

Stories You May Have Missed:

Pandora Report 5.26.2017

Summer is in full swing and that means the mosquitoes are out in force. Before you make those pesky bugs your biggest enemy, don’t forget about the threat of antibiotic resistance and the current MCR-1 Klebsiella outbreak in China!

Congrats GMU Biodefense Graduates 
Last week we saw several MS and PhD students graduate from GMU’s biodefense program and we couldn’t be more excited to show off their hard work! Earning their MS in biodefense, we’d like to celebrate Kathryn Ake, Rebecca Earnhardt, Nicholas Guerin, Andrew Joyce, Ryan Lockhart, Patrick Lucey, Alison Mann, Jonathon Marioneaux, Scott McAlister, Greg Mercer, Katheryn Payton, Dana Saft, Colleen Tangney, and Anupama Varma. Earning their PhD in biodefense, we’re celebrating Keith W. Ludwick (Dissertation title: The Legend of the Lone Wolf: Categorizing Singular and Small Group Terrorism), Nereyda Sevilla (Germs on a Plane: The Transmission and Risks of Airplane-Borne Diseases), and Craig Wiener (Penetrate, Exploit, Disrupt, Destroy: The Rise of Computer Network Operations as a Major Military Innovation). Congrats to our biodefense graduates – we can’t wait to see what wonderful things you’ll accomplish in global health security!

U.S. Investment in Global Health Security  – The Good and The Bad
Whether it be an intentional, accidental, or natural biological event, infectious diseases can devastate local economies and populations. “Catastrophic” is a term commonly used for such events. Disease knows no borders or boundaries, which means that our global health security is only as strong as the weakest link. To aid in the stability of global health security, the State Department funds projects around the world to help improve biosafety and biosecurity. The philosophy is that if we can train local trainers to establish expertise and biorisk programs, it would lay the foundation for biosecurity/biosafety for the future. “The State Department carefully evaluates and selects the most impactful projects for each region, pairing local needs with appropriate subject matter expertise. One source of such expertise is Sandia National Laboratories (SNL), which has received State Department funding to implement numerous health security projects. Just this April, Lora Grainger, working at the Labs’ International Biological and Chemical Threat Reduction (IBCTR), travelled to Algeria to train Algerian trainers on a project funded by the State Department. Participants included scientists working in Algeria’s national network of laboratories managed by the Ministry of Agriculture, the Institut National de Médecine Véterinaire (INMV).” This partnership is just one of many and involves education that is tailored to the skills and needs of those being trained. Global health security is bigger than any one country and it’s vital to not only strengthen our own practices, but also facilitate its development in countries that might not have all the resources needed. Speaking of U.S. health security efforts, don’t forget to catch the Operation Whitecoat documentary on the June 1st.                                                                                                                                                              

While these are great efforts the U.S. is putting forward, there is also an internal struggle to maintain public health during a hiring freeze. The freeze was imposed by President Trump’s executive order in late January, which covers currently open positions, blocks transfers, and prevents new positions from being created. It was recently reporting that nearly 700 positions within the CDC are vacant due to the ongoing hiring freeze. “Like HHS, the State Department and the Environmental Protection Agency have maintained the freeze as a way of reducing their workforces and reshaping organizational structures after a directive last month from the Office of Management and Budget that said all federal agencies must submit a plan by June 30 to shrink their civilian workforces. HHS, State and EPA also face significant cuts in the Trump administration’s budget proposal for the fiscal year starting Oct. 1. The administration, which unveiled a ‘skinny budget‘ for fiscal 2018 in March, is scheduled to release its full budget next week. A senior CDC official said unfilled positions include dozens of budget analysts and public health policy analysts, scientists and advisers who provide key administrative support.” A new CDC document notes that at least 125 job categories have been blocked from being filled, which includes positions in the Office of Public Health Preparedness and Response.

Ebola in the DRC – Updates
While we’re honoring researchers and workers for their efforts during the 2014/2015 West Africa outbreak, Ebola continues to rage through the DRC. You can find daily situation reports here from the WHO, as the numbers of reported cases are constantly changing. The WHO is reportedly optimistic that it can contain the outbreak and many are curious to see how the new director general will handle such challenges. The latest situation report from the WHO is pointing to six more cases of Ebola, bringing the total suspected cases to 43. 365 people are currently under monitoring in the DRC. Researchers have also made substantial progress towards understanding how Ebola disables the immune system so effectively. In response to this latest outbreak, the WHO is requesting funding to ensure adequate response to the DRC outbreak.

Pandemics, BT, & Global Health Security Workshop – Instructor Spotlight
We’re excited to announce that Kendall Hoyt is our instructor spotlight this week! Dr. Hoyt is an Assistant Professor at the Geisel School of Medicine at Dartmouth where she studies U.S. biodefense policy and biomedical R&D strategy. She is also a lecturer at the Thayer School of Engineering at Dartmouth College where she teaches a course on technology and biosecurity. She is the author of Long Shot: Vaccines for National Defense, Harvard University Press, 2012. She serves on the National Academy of Sciences Committee on the Department of Defense’s Programs to Counter Biological Threats and on the advisory board of the Vaccine and Immunotherapy Center at Massachusetts General Hospital. Kendall Hoyt received her Ph.D. in the History and Social Study of Science and Technology at the Massachusetts Institute of Technology in 2002 and was a Fellow in the International Security Program at the Belfer Center for Science and International Affairs at the Harvard Kennedy School of Government from 2002-2004. Prior to obtaining her degree, she worked in the International Security and International Affairs division of the White House Office of Science and Technology Policy, the Washington DC office of McKinsey and Company, and the Center for the Management of Innovation and Technology at the National University of Singapore. Did I mention that she’s also done work on Ebola and has written extensively about medical countermeasures for the disease? Dr. Hoyt is not only an expert on biosecurity and the impact of technology, but will take students through the journey of medical countermeasures and security.

The Finish Line in Ending Pandemics and The Future of the WHO
The recent election of a new WHO director-general highlights the current global shift in priorities, and yet the reality is that we’re still fighting an uphill battle against infectious disease and the threat of a pandemic. Recent decades have shown that outbreaks have been increasingly common, taking advantage of globalization, growing populations, and spillover. Avian influenza has been knocking at the door for a while…while bursts of Ebola and SARS have shaken global health security to its core. MERS has also triggered such events in hospitals, leaving no environment safe from emerging infectious diseases. The list of worrying viral diseases has also grown and taught us a rather painful truth – pandora’s box is already open and every time we think we’ve closed it…we realize the seal just isn’t that tight. “Dynamic, rapidly evolving viral threats emerge with increasing frequency, exploiting new pathways in endless pursuit of their biologic imperative. These viruses are the paradigm of adaptive learning. Pushing and probing at our defenses, they shift to new hosts, opportunistically hijack transmission routes, and acquire capacities to evade immune detection. They are subject to no rules of engagement, and their viral intelligence is anything but artificial”. Our new strategy is now to strengthen our detection efforts and to build up response processes. Many have highlighted that what we’ve seen is just a small percentage of what’s out there, but that doesn’t mean we have to keep our heads buried in the sand forever. The future of international disease response will change with the appointment of the new WHO director-general, especially for poor countries dependent upon resources. On Tuesday, it was announced that Ethiopia’s Dr. Tedros Adhanom Ghebreyesus was voted director-general. Dr. Ghebreyesus is the first ever African director-general and brings to the position a long history of health stewardship as a former health minister in Ethiopia. Not only is this election particularly significant as the future of the WHO will be heavily weighed against its failures in recent years, but recent accusations against the newly elected director-general have created further doubts as to the stability of the organization.

Double-edged Sword Research
A new report from the Swiss Academies of Art & Sciences is drawing attention to the need for continued conversation and engagement about the potential for misuse in life sciences. As a result of the workshop, a report was developed highlighting “six issues that should be considered when designing, conducting, and communicating research projects. Each issue is illustrated with examples from actual research projects.” In fact, CRISPR inventor, Jennifer Doudna, is drawing attention to the promises and perils of the gene-editing technology. She points to the worries of creating designer embryos while contrasting the promises of reducing mosquito-transmitted diseases. In fact, recent work has shown some promise in using CRISPR to fight HIV. “Part of the problem is HIV’s ability to squirrel itself away inside a cell’s DNA – including the DNA of the immune cells that are supposed to be killing it. The same ability, though, could be HIV’s undoing. ast week, a group of biologists published research detailing how they hid an anti-HIV CRISPR system inside another type of virus capable of sneaking past a host’s immune system. What’s more, the virus replicated and snipped HIV from infected cells along the way.” While this work has only been done in mice and rats, the concept is promising. Overall, these advances bring about exciting future possibilities, but it’s important to remember that there are dangers too – whether it be tampering with human evolution, contaminated CRISPR kits, nefarious actors using them for terrorism, etc. The complexities of CRISPR and genetic engineering are only growing, which makes the 2018 arrival of the peer-reviewed publication, The CRISPR Journal, even more relevant.

Stories You May Have Missed:

  • Model Systems and the Need For Curiosity-Driven Science– GMU Biodefense PhD student, Saskia Popescu, is looking at the importance of model systems and picking the brain of a top researcher in the field, Dr. Julie Pfeiffer. “Poliovirus is great to use to create model systems because not only does it grow easily, but it is also relatively safe due to vaccination for lab workers, not to mention that we have a pretty solid understanding of the virus based off a century of working with it. ‘We know a lot about poliovirus and we have great tools in our toolbox. If you’re going to tackle a tough problem, it helps to have a great toolbox. For other fields, the ideal toolbox may be fruit flies, worms, or yeast. Collectively, these model systems have illuminated biology and have led to major advancements in human health.’ stated Dr. Pfeiffer in her recent PLOS Pathogens article on the importance of model systems.” “Firstly, I asked if she thought there were other eradicated or ‘almost’ eradicated diseases that could make decent models. She replied, ‘No. We use poliovirus as a model system because of its great tractability, safety, and ease of use (not because it’s nearly eradicated). [Other eradicated diseases such as] smallpox and rinderpest would not be good model systems because they have been completely eradicated from circulation, making biosafety and tractability major issues. [That being said,] if the poliovirus eradication campaign is successful, the idea is to stop vaccination. If this happens, poliovirus will likely become a BSL3/4 agent and I will no longer work with it’.”
  • Is Your Daycare Prepared For a Pandemic?– Daycare centers may not be your first thought when it comes to pandemic preparedness, however a recent survey found that fewer than one in ten U.S. centers have taken steps to prepare for a pandemic flu event. “Researchers surveyed directors of licensed childcare centers in 2008 and again in 2016, to assess flu prevention measures before and after the 2009 pandemic outbreak of a new strain of H1N1 influenza. Among other things, they looked at flu prevention activities like daily health checks for kids, infection control training for staff, communicating with parents about illness and immunization requirements for children and staff.” Children are great sources for disease transmission and when guardians are needed at work, childcare capacity will be extremely important if a pandemic flu occurs.

 

Pandora Report 4.22.2016

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 9.11.15

Miss us? Good news – the Pandora Report weekly update is back! With a new school year comes new faces and some organizational change-up. Dr. Gregory Koblentz is now the Senior Editor of Pandora Report and Saskia Popescu (yours truly) will be taking over from Julia Homstad as the Managing Editor. I come from the world of epidemiology, public health, and infection control. Having just started in the GMU Biodefense PhD program, I look forward to venturing down the rabbit hole that is the Pandora Report!

There’s been some pretty fascinating news over the past few weeks, so let’s try and catch up…

Lab Safety Concerns Grow 

Our very own Dr. Gregory Koblentz, director of the GMU Biodefense program, was interviewed by USA Today regarding the lab security issues that now involve mislabeled samples of plague. “Since there are now concerns about the biosafety practices at multiple DoD labs there needs to be an independent review of the military’s biosafety policies and practices,” Koblentz said Thursday. He said the Critical Reagents Program is an important biodefense resource. “It’s crucial that all problems with handling and shipping inactivated samples be resolved quickly so the program can resume its important role in strengthening U.S. biopreparedness.”

Reviving a 30,000-Year-Old Virus…Isn’t This How the Zombie Apocalypse Starts?

You may recall last year that French scientists stumbled across a 30,000-year-old virus frozen in the Siberian permafrost. Considered to be a “giant virus” (doesn’t that give you a warm, fuzzy feeling inside?), this is actually the fourth ancient, giant viral discovery since 2003. The new plan is to try to revive the virus in order to better study it.

Dr. Claverie told Agency France-Presse, “If we are not careful, and we industrialise these areas without putting safeguards in place, we run the risk of one day waking up viruses such as smallpox that we though were eradicated.” Given the recent concerns over biosafety lab specimen transport, we’re all curious to see how this new organism, coined “Frankenvirus”, turns out!

Cucumbers and A Multi-State Salmonella Outbreak

CDC updates regarding the Salmonella Poona outbreak reveal the brevity of the potentially contaminated product. As of September 9th, there have been two deaths, 70 hospitalizations, and 341 confirmed cases across 30 states. Perhaps the most worrisome is that 53% of affected individuals are children under the age of 18. While the produce company, Andrew & Williamson, issued a voluntary recall of their “slicer” or “American cucumber on September 4th, there have been 56 additional cases reported since then. Isolated samples from cucumbers in question were found in Arizona, California, Montana, and Nevada. The California Department of Public Health issued a warning and pictures of the affected cucumbers. 

Stories You May Have Missed:

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.”

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Image Credit: CDC Global

Pandora Report 6.21.15

Changing things up this week, our lead story is a nuclear photo essay. We’ve also got Russian nuclear posturing and a bunch of other stories you may have missed.

Happy Father’s Day to all the dads out there and enjoy the rest of your weekend!

Next Exit, Armageddon: Photos of America’s Nuclear Weapons Legacy

I love a good photo essay, especially those focused on abandoned places—so this is the perfect* combination of that and nuclear history. Many times on the blog I’ve made somewhat flippant comments about visiting nuclear sites on summer vacation. However, evidently there is great public interest in this. As such, the National Park Service and the Department of Energy will establish the Manhattan Project National Historical Park that will include sites as Los Alamos, Oak Ridge and Hanford.

VICE News—“Elsewhere in the US, the ruins of the Manhattan Project and the arms race that followed remain overlooked. In North Dakota, a pyramid-like anti-missile radar that was built to detect an incoming nuclear attack from the Soviet Union pokes through the prairie grass behind an open fence. In Arizona, a satellite calibration target that was used during the Cold War to help American satellites focus their lenses before spying on the Soviet Union sits covered in weeds near a Motel 6 parking lot. And in a suburban Chicago park, where visitors jog and bird watch, nuclear waste from the world’s first reactor — developed by Italian physicist Enrico Fermi for the Manhattan Project in 1942 — sits buried beneath a sign that reads ‘Caution — Do Not Dig.’”

*Check out the photos. They’re truly extraordinary.

Putin: Russia to Boost Nuclear Arsenal with 40 Missiles

Everything old is new again, it seems. This week Vladimir Putin announced that Russia will put more than 40 new intercontinental ballistic missiles into service in 2015. It is said that the new missiles are part of a military modernization program. However, the announcement comes on the heels of a US proposal to increase its own military presence in NATO states in Eastern Europe.

BBC—“Nato Secretary-General Jens Stoltenberg said that the statement from Mr. Putin was “confirming the pattern and behaviour of Russia over a period of time; we have seen Russia is investing more in defence in general and in its nuclear capability in particular”.

He said: “This nuclear sabre-rattling of Russia is unjustified, it’s destabilising and it’s dangerous.” He added that “what Nato now does in the eastern part of the alliance is something that is proportionate, that is defensive and that is fully in line with our international commitments.’”

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Image Credit: Federal Government of the United States

Pandora Report 6.14.15

I’ve got brunch reservations this morning so the big story about the coming egg shortage is hitting close to home. We’ve also got a story about ISIS’ WMD and a bunch of stories you may have missed.

As a final reminder, the Early Registration Deadline for the Pandemics, Bioterrorism, and International Security is tomorrow, Monday, June 15. For more information and registration, please click here.

Enjoy the rest of your weekend!

Egg Shortage Scrambles U.S. Food Industries

The unprecedented outbreak of avian influenza in the U.S. has meant massive losses in the domestic poultry industry which has left experts warning that U.S. consumers are very likely to see an increase in egg prices. Cases of avian flu have been reported in 15 states, with Iowa and Minnesota being some of the hardest hit. “In Minnesota, the number of lost turkeys represent about 11 percent of our total turkey production…of the chickens we’ve lost that are laying eggs, 32 percent… have been affected by this” In Iowa, about 40 percent of the state’s egg-laying chickens and 11 percent of its turkeys have been affected. All these losses will mean a shortage of whole eggs and other egg-based products.

U.S. News and World Report—“Consumers haven’t felt the pinch too much just yet, but they are unlikely to emerge with their pocketbooks unscathed, [Rick] Brown [Senior VP at Urner Barry, a food commodity research and analysis firm]. He says two-thirds of all eggs produced in the U.S. remain in a shell, many of which are placed in cartons and sold in grocery stores. This stock of eggs has been hit significantly less by the avian flu outbreak than those used in the egg products industry, which Brown says encompasses “everything from mayonnaise to salad dressings to cake mixes to pasta to bread.”

Australian Official Warns of Islamic State Weapons of Mass Destruction

You may have already seen this, since this story was everywhere this week. Julie Bishop, Australia’s Minister for Foreign Affairs, said the Islamic State (ISIS) already has and is already using chemical weapons. Bishop made these comments in an address to the Australia Group—a coalition of 40 countries seeking to limit the spread of biological and chemical weapons. In a follow-up interview, Bishop also said that NATO was concerned about the theft of radioactive material and what that could mean for nuclear weapons proliferation.

The Washington Post—“‘The use of chlorine by Da’ish, and its recruitment of highly technically trained professionals, including from the West, have revealed far more seriou­s efforts in chemical weapons development,” Bishop said, using an alternate name for the Islamic State in a speech reported by the Australian. She did not specify the source of her information.  “… Da’ish is likely to have amongst its tens of thousands of recruits the technical expertise necessary to further refine precursor materials and build chemical weapons.’”

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Image Credit: Hannahdownes

Pandora Report 6.7.15

We’ve got stories this week about MERS spread in South Korea and Ebola drugs that may already be in your medicine cabinet. We’ve also got some stories you may have missed.

As a reminder, the Early Registration Deadline for the Pandemics, Bioterrorism, and International Security professional education course has been extended to June 15. For more information and registration, please click here.

Enjoy the rest of your weekend!

South Korea Grapples to Contain MERS as 1,369 in Quarantine

The big story this week is MERS in South Korea. Last week we reported that there were five cases. As of Friday, the number has jumped to 36 confirmed cases and three deaths. Hundreds of schools have closed in an effort to prevent further spreading of the disease, which arrived in a 68-year old index patient who had traveled in Saudi Arabia, Qatar, the United Arab Emirates, and Bahrain. Many in public health have been surprised by the extent of the outbreak in South Korea because the virus has not been shown to pass easily from human to human and the health care system is “considered to be sophisticated and modern.”

CNN—“‘This is quite unusual. I think this is the only country, apart from those in the Middle East, that has such a number of cases,” said [Dr. Leo] Poon [a virology expert at the School of Public Health at the University of Hong Kong, who worked on the SARS outbreak more than a decade ago]. “It’s not entirely surprising. In the Middle East, people in Saudi Arabia had hospital outbreaks where a few people got infected. It’s a similar situation at the moment.’”

Drugs to Fight Ebola May Already Be in Your Medicine Cabinet, Study Suggests

A team from USAMRIID, the University of Virginia, and Horizon Discovery Inc. have been working to determine if any existing drugs could be used to fight Ebola. Using 2,635 compounds, including FDA-approved drugs, amino acids, food additives, vitamins and minerals they discovered a possible answer could already be in your medicine cabinet—Zoloft and Vascor.

The LA Times—“But Zoloft (also known by the generic name sertraline) and Vascor (generic name bepridil) had more encouraging results. Of the 10 mice that got Zoloft, seven survived for 28 days. Even better, all 10 of the mice treated with Vascor were still alive 28 days after [Ebola] infection. For the sake of comparison, all of the untreated mice that served as controls were dead within nine days.”

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Image Credit: Shikhlinski