Pandora Report: 3.25.2016

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

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

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

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

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

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

Syria and the Future of the Chemical Weapons Taboo 

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

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

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

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

Stories You May Have Missed:

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

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Pandora Report: 3.18.2016

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

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

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

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

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

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

Stories You May Have Missed:

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

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Pandora Report 1.22.2016

In anticipation of the impending snow apocalypse (that may be a tad dramatic, but coming from this Arizona import, this snow business is quite harrowing), we’re serving up a warm cup of global health security news. While you’re staying inside, check out the upcoming book from Sonia ShawPandemic: Tracking Contagions from Cholera to Ebola and Beyond, which travels through time to investigate the impact of emerging diseases. Dreaming of warmer temperatures? You may want to avoid some tropic locations as imported cases of Zika virus are cropping up in the US, and the CDC issued warnings for pregnant women to postpone travel to Mexico, Puerto Rico, and other affected countries. Fun History Fact Friday: as we learned last week, on January 19, 1900 the bubonic plague reached Australia’s shores and on January 20, 1981, the Iran hostage crisis ended.

Dugway Insights Raise New(-ish?) Biosafety Concerns
Dugway Proving Ground is one of the largest Army biodefense labs and while lab biosafety issues are becoming a more prevalent headline, new findings point to the severity of these failures. GMU Biodefense professor and graduate program director (and all around biodefense-guru), Dr. Gregory Koblentz, noted that “the systemic disregard for biosafety at Dugway as revealed by the investigative report is appalling and alarming. Without strong leadership, an organizational culture that prizes safety and security, a well-trained staff, and a robust oversight mechanism, we can expect more such accidents to occur in the future.” Lacking accountability and oversight, Dugway is another in the laundry list of labs that became complacent (or as Dr. Richard Ebright stated, their actions are that of “criminal negligence”). It seems that the time of calling these biosafety failures, “serious mistakes”, has passed and we’re sadly moving more into an era of habitual practice. Dugway is a hotspot (pun intended) for chemical and biological defense work however, findings within the report note improper qualification of certain employees, erroneous environmental sampling of labs, etc. Brigadier General William E. King IV oversaw Dugway from 2009-2011 and was directly called out in the report – “Colonel King repeatedly deflected blame and minimized the severity of incidents – even now, Brigadier General King lacks introspection and fails to recognize the scope and severity of the incidents that occurred during his command at (Dugway).” If you have around 26 minutes to spare, you can also watch the Army media brief on the investigations here.

food-production-chain-650pxFarmers Markets and Food Safety
Farmers markets are often a great place to find local, organic vegetables and fruits. Growing in popularity, it’s not surprising that concerns over food-borne illness and safety issues would be raised. Researchers (applied economists in this case) are reporting preliminary data regarding the potential association between farmers markets and food-borne illness. Reviewing data from 2004-2011, they found “a positive relationship between the number of farmers markets per capita on the one hand, and on the other hand, the number of reported outbreaks of food borne-illness, cases of food borne-illness, outbreaks and cases of Campylobacter jejuni. Our estimates indicate that a 1% increase in the number of farmers is associated with a 0.7% (3.9%) increase in the total number of reported outbreaks of food-borne illness (Campylobacter jejuni), and a 3.9% (2.1%) increase in the total number of reported cases of food-borne illness (Campylobacter jejuni) in the average state-year.” While these correlations were found, there wasn’t a statistically significant relationship between farmers markets and reported outbreaks or cases of salmonella, E. coli, or staph. Given the recent Chipotle outbreaks, there has been increasing attention to the concerns over farm-to-table food safety. While some illness can be related to farm safety practices, a lot of food-borne illness is related to improper handling or cooking of food.

Retaking Ramadi and the “Afghan Model”
GMU Biodefense student, Greg Mercer, has mined through the internet to provide some commentary on the recapturing of Ramadi from ISIS control. In his recap, Greg points to works in the New York Times, via authors Phil Ewing and Stephen Biddle, and several other security studies gurus. Greg notes, “many questions remain about the conflict- where it will go, how it will resolve, the political effort it will require from intervening forces, and ultimately what kind of conflict this is.”

Ebola Updates- Quarantines After Sierra Leone Death 
The day after the WHO declared the three hardest-hit countries Ebola free, a death in Sierra Leone hit the panic button for public health officials. As of January 21, 2016, a second case was reported in an individual that cared for this initial case. Over 100 people archive been quarantined after coming into contact with the woman who died of Ebola last week. During the course of her illness, she is reported to have stayed in a house with 22 other people. Five people later helped to wash and prepare her body for burial. Many homes of those high-risk patients under quarantine were attacked, pointing to increasing frustration. Close observation is being maintained on the 100+ people involved in this exposure.

Stories You May Have Missed:

  • The Neglected Dimension of Global Security – The National Academies Press will soon be releasing this hard-copy publication as a Framework to Counter Infectious Disease Crises, but the good news is that you can download it today for free! Authored by the Commission on a Global Health Risk Framework for the Future; National Academy of Medicine, Secretariat, it discusses the Ebola outbreak’s far-reaching consequences that range from human rights to transportation and commerce disruption.
  • CBRN Crimes & The Sordid History of Litvinenko – GMU Biodefense PhD alum, Dr. Daniel Gerstein, discusses the recently released Owen Report and the details surrounding the finding of radioactive polonium-210 in Russian agent, Alexander Litvinenko’s body following his death. The troubling details surrounding the report “highlights the links between Litvinenko and the Russian government, even pointing the finger at President Vladimir Putin himself as likely having approved the alleged murder.” While CBRN weapons are not a new concept, these new details may shine light on the realistic applications and threats they pose.
  • ISIS Tularemia Plans – Recent Turkish intelligence reports revealed that that the group had plans to use biological weapons. Aimed at Turkish water supplies, the report noted that the main bioweapon discussed was Francisella tularensis, which causes tularemia.
  • Lassa Fever Hits Nigeria – 30 confirmed, 140 suspected, and 53 deaths have been reported in the outbreak of Lassa viral hemorrhagic fever hitting 14 states within Nigeria. The case fatality rate is being reported at 37.9%.
  • Online Drama in the CRISPR Universe – a recent perspective article by Eric Lander (president of the Broad Institute) in Cell noted the heroes in CRISPR but failed to account for a potential conflict of interest. Needless to say, the Twitterverse erupted in a scientific outcry with many also calling out Lander’s failure to include several key contributors to the biotechnology.

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Pandora Report 12.4.2015

This week, Washington, DC hosted the Summit on Human Gene Editing, where the ethical and legal implications of gene editing technologies, like CRISPR-Cas9, were heavily discussed. In this week’s report, Greg Mercer works his magic, revealing the internet and social media trends following the shootdown of a Russian SU-24 on November 24th. We’re also reporting updates in the Zika virus and dengue fever outbreaks as well as the Harvard-LSHTM Panel Report on Global Response to Ebola. France is currently experiencing an increase of highly pathogenic avian influenza cases while a Black Angus beef cow in Alberta was discovered to have bovine spongiform encephalopathy (BSE). Fun history fact Friday – on December 3, 1967, the first human heart transplant was performed in Cape Town, South Africa and on December 4, 1945, the Senate approved US participation in the UN. Before we start our weekly roundup, make sure to mark your calendars to attend GMU’s seminar on Ebola surveillance and laboratory response this Monday, December 7th from 4:30-6pm at our Fairfax campus (details below!).

Zika Virus Outbreak – Updates
The growing outbreak of Zika virus has now seen locally acquired cases reach ten countries, causing the Pan American Health Organization (PAHO) to issue an alert, “urging countries in the region to be on the lookout for the disease and to watch for unusual patterns in newborn.” Brazil has been hit hard with a rise from 739 on November 27th, to 1,248 cases reported on November 30th. Six of the ten countries saw cases occur in November, hinting that the outbreak could just be starting. The growing concerns regarding the outbreak are also related to the newest evidence linking microcephaly and maternal cases. Zika virus genome was found in the amniotic fluid of two pregnant women and fetal diagnosis of microcephaly was performed via ultrasound. Even more so, French Polynesian health officials reported an unusual spike in nervous system malformations in babies that were born during a Zika virus outbreak in the region from 2014 to 2015. The concern regarding neurological conditions raises red flags as Brazilian health officials are reporting neurological complications, like that of Guillain-Barre syndrome, in Zika virus patients. The WHO reported 739 Brazilian microcephaly cases in newborns and while there is only ecological evidence linking the virus and microcephaly, investigations are ongoing. The outbreak first started in February 2014, on Easter Island (Chile) and has seen been identified in Colombia, Guatemala, Brazil, El Salvador, Mexico, Paraguay, Panama (confirmed cases as of December 4, 2015), Suriname, and Venezuela. Spread by Aedes mosquitoes, this vector-borne organism has similar symptoms to dengue fever and illness tends to last between four and seven days.

Event: Ebola Surveillance & Laboratory Response – Lessons for Global Health SecurityScreen Shot 2015-12-03 at 9.34.57 AM
Time/Location: Monday, December 7, 2015 from 4:30pm-6pm in Robinson A-203 at George Mason University.
As the recently released Harvard-London School of Hygiene and Tropical Medicine Independent panel on the Global Response to Ebola indicates, the West African Ebola epidemic highlighted
many gaps in national and international health and response systems that are critical for protecting global health security.  Join leaders and experts who helped to lead the U.S. response for Ebola to discuss the international response to the epidemic, the importance of robust biosurveillance systems, and how the experience with Ebola influences our approach to Global Health Security. Speakers:

  • Dr. Matthew Lim, Senior Policy Advisor for Global Health Security, HHS, fmr Civil-Military Liaison Officer to WHO
  • May Chu, Ph.D. fmr Assistant Director for Public Health, Office of Science Technology and Policy, White House; Senior Science Advisor, CDC
  • Jeanette Coffin, Manager U.S. mobile laboratory deployment, MRIGlobal

It’s Definitely Maybe World War 3
GMU’s Greg Mercer breaks down the November 24th Turkish shootdown of a Russian SU-24. Greg reviews the media attention following the event and the “immediate buzz about declarations of war, what exactly NATO owes Turkey vis-à-vis Russia, and the possibility of military confrontation between Russia and the West.” Through his use of google trends and Twitter, Greg shows just how much hype and concern the notion of WWIII got during this time. Take a look at his recap and debunking of the WWIII buzz and how quickly it caught like wild fire.

Reporting from the Panel on the Final Report of the Harvard-LSHTM Independent Review of the Global Response to Ebola
If you missed the Center for Strategic & International Studies (CSIS) Global Health Policy Center’s Launch of the final report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola, don’t worry! I was fortunate to attend and a great deal of the report (we reported on last week) heavily emphasized “on the ground” capacity. Dr. Peter Piot, Director and Handa Professor of Global Health, London School of Hygiene and Tropical Medicine (LSHTM), joined via video link and started by saying that this would not be a WHO-bashing event. As one of the original researchers on Ebola during its 1976 discovery, he mentioned that the Democratic Republic of Congo (DRC) is a great example of local capacity in their success of ridding themselves of the disease within a few months of the outbreak starting. Dr. Piot heavily emphasized the work of several countries and how the WHO brought together multiple ethicists to review research during such a terrible outbreak. Lastly, Dr. Piot noted that “we risk focussing too much on global and not enough on local” in our future efforts. Dr. Suerie Moon, Research Director and Co-Chair of the Forum on Global Governance for Health at Harvard Global Health Institute, then spoke on the “weak coordination of global response” and how it severely aided the spread of Ebola. Dr. Moon highlighted the need for a global strategy to ensure adequate funding (external financing for the poorer countries and transparent tracking of financing) and the necessity for external assessment of country capacity. She pointed to the need for political and economic incentives and disincentives to not only report cases but also discourage the hiding of outbreaks. Reviewing each recommendation, the panel noted that “human health is a vital part of human security”. In one of her closing comments, Dr. Moon stated that “there are many unanswered questions regarding ebola response and we need to address a number of aspects that went wrong” and “a major theme is accountability at all levels, across all types of players.” Dr. Moon pointed out that the necessity of so many reforms shows just how much work is needed and that now is the time to see political support occur. Muhammad Pate, former Nigerian Minister of State for Health, expressed that “one of the lessons, at the national level, in terms of surveillance and accountability to respond, was missing and something that national leaders need to own up to is building their own public health systems.” Dr. Sophie Delaunay, Doctors Without Borders/MSF, then discussed the role of medical innovations and how the outbreak provided us with a unique opportunity to collect data. Dr. Delaunay said it will “be a complete nightmare to connect all the dots” in this outbreak and there is a desperate need for better R&D regarding disease outbreaks and response. “We ask for governments and policy makers to support collaboration on R&D to demonstrate their willingness to be more effective in the next outbreak” noted Dr. Delaunay. She heavily pushed for global financing efforts to facilitate investment in R&D and response. After the initial panel, there was a secondary group that shared their thoughts on the report, including Dr. Tom Frieden (CDC Director), Julie Gerberding (Exec. VP for Strategic Communications, Global Public Policy and Population Health, Merck) and Ron Klain (Former US Ebola Response Coordinator, White House and General Counsel, Revolution LLC). Ron Klain pointed to the failure of the WHO and “if institutions failed us, individuals shined. We did see extraordinary compassion from the rest of the world and tremendous outpouring of support. ” Mr. Klain mentioned that “the scariest thing about Ebola is the warning signs of how badly we failed this when the threat could’ve been worse and the epidemic we face could be much much more dangerous in the future.” Dr. Frieden emphasized the need of human resources management improvement at the WHO and how global outbreak response could work to support each other better. Lastly, Dr. Frieden emphasized a topic near and dear to my heart; infection control and it’s necessity in global disease prevention. Overall, the panel touched on several key points to the outbreak, emphasizing the need for the biggest players (including MSF) to lead by example via data sharing, etc. The push for political support on incentives and local capacity/accountability was perhaps one of the biggest recommendations and points emphasized from this event.

Gene Editing and CRISPR!
This was a busy week in the biotech world. The International Gene Editing Summit kicked off in Washington, DC. Bringing together experts from around the world, the summit touched on the newest technical innovations, ethical and legal concerns, and even social implications of genome editing advances. Genome Web has provided a great overview of the summit. Nature also published their Four Big Questions related to genome editing, touching on points related to editing the human germline and the ethical implications for technology that “researchers are still grappling with the known unknowns”. Recently, biologist, Emmanuelle Charpentier, discussed CRISPR-Cas9 and that it’s simply too early to begin gene editing as “the tools are not ready” and “as of today, I’m in favor of not having the manipulation of the human germlines. As long as they’re not perfect and ready, I think it’s good to have this ban against editing the germline.” Buzzfeed noted that over the course of the conference, there was a substantial push for a delay in the use of genetic engineering in fertility clinics due to the risk of making “designer babies”. Given the heavily debated nature of this topic it’s not surprising that the US National Academy of Sciences, Engineering and Medicine, the UK’s Royal Society, and the Chinese Academy of Science, all agreed that it “would be irresponsible to proceed with any clinical use of germline editing.” While the future is left open to gene editing on humans, there was heavy accentuation throughout the conference on the ethics and societal views of these scientific breakthroughs and the necessity to revisit their applications on a regular basis.

Dengue Fever Outbreak in Hawaii 
The Dengue fever outbreak on Hawaii Island is still growing. Now at 122 confirmed cases, this is one of the biggest outbreaks they’ve seen with local transmission. As of 12/2, the confirmed cases involved 106 Hawaii Island residents and 16 visitors. The Hawaii Department of Health (HDOH) has published information, hoping to aid prevention efforts, regarding the Aedes aegypti and Aedes albopictus mosquitos that are responsible for spreading the disease. There have been 313 reported potential cases and you can even find a map of the case distribution here!

Stories You May Have Missed:

  • 2015/2016 Flu Season- Where Are We?– The CDC 2015/2016 influenza activity showed a bit of a spike during the November 15-21 week. Influenza A (H3) is still the predominant species in laboratory confirmed cases. If you’re looking to keep an eye on seasonal flu, Google Flu Trends may no longer be operational, but you can still keep an eye on Flu Near You or the CDC’s page.
  • MERS-CoV Severity and Incubation Period– The CDC & Emerging Infectious Diseases published a report regarding the association of severe MERS-CoV illness and a shorter incubation period. Analyses of 170 patents in South Korea revealed a longer incubation period associated with a decreased risk for death while “patients who died had a shorter incubation period.” This mirrors the results of a previous study that had similar results with SARS coronavirus.
  • Salmonella Outbreak Associated With Recalled Nut Butters – The CDC is currently investigating 11 illnesses across nine states that may be linked to recalled nut butters. The Salmonella serotype is Paratyphoid B variant L (+) tatrate (+) (previously called Salmonella Java) and has caused illness in California, Colorado, Georgia, Hawaii, Idaho, Illinois, North Carolina, and New Jersey.
  • Taiwan CDC Holds Bioterrorism Drill – Involving 70 participants, the course utilized a subway union station to allow people to simulate first responders and real-life operations. “CDC bioterrorism teams are tasked with the investigation and identification of biological threats and attacks. Members take on containment and mitigation of damage for any individuals that are harmed during and as a result of an attack.” Go Taiwan!

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Pandora Report 10.16.2015

What a busy week in the world of biodefense! First, let’s give a round of applause for Global Handwashing Day (and now, go wash your hands!). This week we saw a nurse from the UK experience Ebola-associated complications months after her recovery. The CDC released a report stating that 17 states exceeded their recommendations for Ebola screening/monitoring and a recent study discussed vaccination rates and herd immunity. Let’s not forget that we’ve got another segment on 2016 Presidential candidate chatter on nonproliferation, a call for papers, and an open house on GMU’s Master’s program. Grab your morning coffee/tea and let’s explore this week’s biodefense news!

Global Handwashing Day 
Global Handwashing Day was Thursday, October 15th, but really we should be celebrating it every day! It may seem like a simple thing but the truth is that hand hygiene is one of the most important things you can do to prevent the spread of infection. Whether it’s a hospital-acquired infection or avoiding illness in the workplace, hand hygiene is the first line of defense. The WHO estimates that hand hygiene, just in healthcare, saved millions of lives in the last years. The CDC even calls it the “do-it-yourself” vaccine – five simple steps (wet, lather, scrub, rinse, dry) to help prevent the spread of infections. Many people think it’s a small or “easy” thing, but coming from an infection preventionist, it’s the small things that make the biggest difference. You’d be surprised how many organisms we carry around on our hands and on fomites, so using alcohol-based hand sanitizer or washing with soap and water is the only way to get rid of those. University of Arizona professor, Dr. Gerba, (we lovingly referred to him as Dr. Germ – funny enough, he even gave one of his children the middle name of Escherichia!) has focussed much of his research on the household and public objects we may not realize are covered in germs. Perhaps the most important take-away from Global Handwashing Day isn’t just its importance in healthcare, but its role as an important part of disease prevention everywhere. In the U.S.  we’re fortunate to have access to the resources that allow us to have phenomenal hand hygiene practices however, it’s the behavior we tend to fall short on. From today forward, I encourage you to make a personal decision to be vigilant in hand hygiene.

Last 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

Presidential Candidates on Nonproliferation Part II
GMU’s Greg Mercer has put together a wonderful second part to his series on one of our favorite topics (nonproliferation) and what the 2016 presidential candidates are saying about it. Check out Greg’s review of these candidates’ stance so we can track how they might change over the course of the election.

west-africa-distribution-map
Source: CDC

Updates and Mapping Ebola
BBC recently published a nice overview of the Ebola outbreak in West Africa. Since the first case 18 months ago, it has been a whirlwind, in more ways than one, for those of us in the public health/global health security world. Cheerfully, the outbreak region has officially gone two weeks without a new case! Unfortunately, Pauline Cafferkey, the Scottish nurse who was treated and recovered from Ebola in December of 2014, is in critical condition due to a late Ebola-related complication. It was just released that her complications are neurological, including severe central nervous system (CNS) disorder and that the virus was detected in her spinal fluid. Scottish public health officials did identify 58 close contacts and offered them the SV-EBOV vaccine.

Master’s Open House
Learn more about the GMU School of Policy, Government, and International Affairs Masters’ programs on Wednesday, October 21, 2015 at 6:30pm at our Arlington Campus, Founders Hall, Room 126. This informational sessional will discuss our Master’s programs ranging from Public Administration, Biodefense, Political Science, Health and Medical Policy, etc.

Imported Measles and Need for Vaccination –This past week at the IDWeek 2015 meeting, scientists reported on a study reviewing measles vaccination rates in the US and susceptible children in relation to the number of measles cases that have occurred. They noted, “this analysis highlights the need for high measles vaccination coverage to support population-level immunity and prevent reestablishment of indigenous measles transmission in the United States.” The Daily Beast also incorporated this into an article on diminishing herd immunity and anti-vaxxers.

Avian Influenza Vaccine Added to National Veterinary Stockpile
APHIS (United States Department of Agriculture’s Animal and Plant Health Inspection Services) awarded contracts to two companies to ensure manufacturing of the vaccine for avian influenza. The goal is to strengthen the Agency National Veterinary Stockpile. “This action is being taken to develop the Agency’s National Veterinary Stockpile., and does not signal a decision to vaccinate for highly pathogenic avian influenza (HPAI). While APHIS has not approved the use of vaccine to respond to HPAI, the Agency is preparing to ensure that vaccine is available should the decision be made to use it during a future outbreak.”

Stories You May Have Missed:

  • International Infection Prevention Week is next week! October 18-24, 2015 will celebrate the importance of infection prevention and control in healthcare. Let’s celebrate by not just washing our hands, but also considering all the small ways we can prevent the spread of germs in our homes and workplaces!
  • Salmonella Cucumber Outbreak – The CDC has released new data on the Salmonella Poona outbreak related to imported Mexican cucumbers. As of October 14th, there have been 757 people infected across 36 states and 4 deaths related to the outbreak.
  • DHS Wants to Revive Terrorism Alert System – In wake of the attacks in Chattanooga, President Obama’s security officials are initiating a review of the nation’s terrorism alert system to support what many consider a growing threat of domestic attacks. DHS wishes to revise and restart the National Terrorism Alert System to better respond to these evolving attacks.

Ebola 2014: The Infection Preventionist Perspective

By Saskia Popescu

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

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

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

Courtesy of USA Today
Courtesy of USA Today

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

 

Pandora Report 3.15.15

For those of us at Mason, Spring Break is nearing its end. For the rest of us, however, it’s business as usual. This week we’ve got stories about engineering nuclear worries in South Africa, the eradication of guinea worm, the lasting health impacts of Ebola, and other stories you may have missed.

Have a great week, enjoy the longer daylight hours, and we’ll see you back here next weekend!

U.S. Unease about Nuclear-Weapons Fuel Takes Aim at a South African Vault

Located in a former silver vault at a nuclear research center near Pretoria, South Africa, is enough nuclear weapons explosive to fuel half a dozen bombs. Roughly 485 pounds of highly enriched uranium exist as remnants of the apartheid regime’s nuclear weapons program. U.S. officials worry that not only does this stockpile give South Africa the theoretical ability to regain its status as a nuclear-weapons state, but the stockpile’s vulnerability makes it a target for terrorist thieves. This isn’t a far-fetched concept, because in November 2007 two teams of raiders breached the fences at the nuclear center, entered the site, and broke into the central alarm station. Obama has urged President Jacob Zuma to transform the nuclear explosives into benign reactor fuel—with U.S. assistance—to no avail.

The Washington Post—“‘The bottom line is that South Africa has a crime problem,” [arms control expert Jon] Wolfsthal said. “They have a facility that is holding onto material that they don’t need and a political chip on their shoulder about giving up that material. That has rightly concerned the United States, which is trying to get rid of any cache of HEU [highly enriched uranium] that is still out there.’”

Tug of War: On the Verge of the Greatest Public Health Triumph of the 21st Century

As people work around the world to eradicate Polio, another public health enemy is about to be eliminated first—guinea worm. This parasite, found in rivers and streams, enters the body in larval form through contaminated drinking water. The larvae mature inside the body and move towards the skin’s surface in the form of a burning blister. When the infected human puts water on the blister, the worm bursts out into water, continuing the source infection cycle. However, the number of cases of guinea worm is way down—from 3.5 million cases in 1986 to 126 cases in 2014—thanks to a simple nylon filter attached to a drinking straw. The weave on the nylon is tight enough to filter out the larvae from drinking water.

Slate—“Vanquishing guinea worm would be arguably the first great public health triumph of the 21st century. It would also give new life to the human disease eradication movement, which suffered through 35 mostly frustrating years following the conquest of smallpox in 1980. The victory would prove to governments and private foundations that we can still accomplish eradication.”

Ebola Could Cause Thousands More Deaths—By Ushering in Measles

As Liberia removed their Ebola crematorium—with the declaration that the outbreak is contained—new cases of the disease are still popping up in Sierra Leone and Guinea and have resulted in nearly a dozen American volunteers returning to U.S. facilities for treatment.  And this week, in Science, researchers from NIH and four universities have warned that Ebola’s interruption in other health services—like immunization campaigns—could result in epidemics of preventable diseases with larger fatality numbers than Ebola. Specifically, they warn that up to 100,000 cases of measles could result in 16,000 additional deaths.

Wired—“Measles is already present in West Africa, so the team is not arguing that Ebola will revive an eradicated disease — although, poignantly, hard work in the three countries had recently forced measles incidence way down. “Between 1994 and 2003, the countries reported — and this is just how many they reported, not necessarily how many occurred — about 100,000 cases of measles,” Lessler said. “Whereas in the last decade, they’ve only reported 7,000. So they’ve done an excellent job of controlling the virus compared to the previous (decade).’”

Stories You May Have Missed

 

Image Credit: FEMA

Pandora Report 11.2.14

For this edition of the Pandora Report we look at Jonas Salk, avian influenza in China, TB and diabetes as a co-epidemic, and, of course, an Ebola update. As the weather is turning cooler, don’t forget to get your flu shot, and remember to protect yourself by washing your hands!

Have a great week!

On Jonas Salk’s 100th Birthday, A Celebration of his Polio Vaccine

If you visited Google.com on Tuesday you may have seen one of their famous doodles dedicated to Jonas Salk. Salk’s polo vaccine was declared safe and effective in 1955 and was, interestingly enough, never patented. “The notion handed down to us is that Salk decided not to patent the vaccine as a noble act of self-abnegation.”

The Los Angeles Times—“But the more important reason the vaccine went unpatented, as related by David M. Oshinsky in his 2005 book, “Polio: An American Story,” is that legally it was thought to be unpatentable. The National Foundation and the University of Pittsburgh, where much of the work was done, had looked into patenting the vaccine. They were dissuaded by Salk, who informed them that his techniques weren’t novel and his work had been based on years of prior work by others.”

Five Strains of H5 Avian Flu Reported Across China 

The Chinese veterinary authority reported outbreaks of five different subtypes of Highly Pathogenic Avian Influenza (HPAI) to the World Organization of Animal Health (OIE) on October 24. There were a total of 51 positive findings of the following strains; H5N3, H5N8, H5N2, H5N6, and H5N1. A map of all strain outbreaks is available here.

CIDRAP—“Two of the strains—H5N8 and H5N3—have not been reported by China to the OIE before. Two outbreaks of the former were reported in September, each involving one bird (a duck and an unspecified bird) sampled during a national surveillance plan. One was at a slaughterhouse and the other in a wetland area; both were in Liaoning province in the northeast.”

Unlikely Marriage of Diseases: TB and Diabetes Form a ‘Co-Epidemic’

A white paper presented on Wednesday at the 45th Union World Conference on Lung Health in Barcelona, Spain, warns, “diabetes is fueling the spread of TB.” The paper warns that having diabetes increases the risk that a person will become sick with TB will make TB more difficult to manage, adding that a patient with both diseases is more likely to have complications that do not exist when only one disease is present.

NPR—“The TB/diabetes double-whammy has at least two important differences from the TB/HIV co-epidemic. [1.] It involves the interaction of an infectious disease (TB is the world’s second-deadliest, next to HIV/AIDS) and a non-communicable chronic disease, rather than two infections. [2.] It has potentially more global impact. The TB/HIV co-epidemic was concentrated in sub-Saharan Africa, where 18 countries saw TB rates quadruple because of HIV. Many more countries have high rates of TB and, increasingly, of diabetes.”

This Week in Ebola

Not sure if it was because of Halloween or what, but it seemed to me there were fewer Ebola stories this week. Dallas nurse Amber Vinson, was finally released from Emory Hospital, free of the Ebola virus. Many other stories this week focused on quarantine. Kaci Hickox, the nurse who worked treating patients in Sierra Leone, first protested over her isolation in New Jersey, and then broke her quarantine in Maine, was reportedly ‘humbled’ when a judge in her home state of Maine ruled she can come and go as she pleases. She was still in this news this weekend as it was reported that her roommate in Africa tested positive for Ebola and there was a skit about her on SNL. President Obama has said that quarantines may dissuade doctors and nurses from traveling to West Africa, while Secretary of Defense Chuck Hagel has said that U.S. military personnel returning from West Africa will be subject to a 21-day quarantine. The WHO reported that Ebola infections are slowing in Liberia, and the New England Journal of Medicine says they have a suspect zero for this whole outbreak.

Stories You May Have Missed

 

Image Credit: Google