Pandora Report 10.20.2017

Happy Friday and welcome to our weekly rundown of all things health security!

Smallpox Could Again Be A Serious Threat
GMU Biodefense professor, graduate program director, and all around health security grand master, Dr. Gregory Koblentz, is working to make sure we’re not ignoring the threat of smallpox due to synthetic biology. The problem isn’t just within the amazing capabilities of synbio, but its dual-use nature, meaning that it has the potential to be misused by nefarious actors. This concern has become even greater with the horsepox recreated by Canadian researchers who demonstrated not only capability, but also the low cost of such work. It’s not a far jump from horsepox to smallpox, especially when we have mail-order DNA fragments available at prices that continue to lower. Koblentz notes just how much of a disaster a re-emergence of smallpox would be on a global level, especially since it’s highly contagious and routine immunization has long been gone. “If resurrecting horsepox virus provides a roadmap to synthesizing smallpox virus, then why would anyone try to synthesize it? Because there are potentially legitimate uses for. Tonix claims that the horsepox virus is a good candidate for developing a new, safer smallpox vaccine. Unfortunately, the current legal and technical safeguards against the synthesis of smallpox virus are weak and fragmented. There is no clear international legal or regulatory framework to prevent the synthesis of smallpox virus. The WHO has a policy banning the synthesis of the smallpox and regulating who can produce and possess large fragments of smallpox DNA, but it hasn’t been widely adopted by states. Furthermore, there is no mechanism—at either the national or international level—for detecting or punishing violations of this policy.” Aside from some substantial gaps in regulations, there are some voluntary industry screening processes however, these are pretty limited and tend to be minimal at best. Koblentz points out that there is still time to get ahead of the pox in this case – specifically by rallying international organizations, national governments, the DNA synthesis industry, and the synbio community. Check out his recommendations and comments in the article here!

Global Health Security Supplement – CDC’s EID Journal
Don’t miss out on this ahead-of-print alert for the December edition of the CDC’s Emerging Infectious Disease journal. Volume 23 will include a section on global health security, with articles on the contributions made by the CDC and other partners, establishment of the CDC Global Rapid Response Team, and Joint External Evaluations. There’s also a great commentary by Dr. Michael T. Osterholm on the unfinished journey of global health security. “All countries need to have the laboratory, trained workforce, surveillance, and emergency operations capabilities to prevent, detect, and respond to disease threats. Only when these accomplishments are realized can we truly be on the road to global health security for infectious diseases. Until then, the goal of global health security remains an unfinished journey.”

GMU Biodefense PhD Info Session – October 26th!
Don’t miss your last chance to catch our biodefense PhD info session before applications are due! On Thursday, October 26th at 7pm at our Fairfax campus, we’ll be hosting this session where you can meet with professors, current students, and find out how much fun getting a PhD can be. Where else can you study everything from synbio to Ebola and even how to stop biological threats? GMU Schar School’s Biodefense program is just the place for all things health security.

The Worrying State of Epidemic Preparedness & Global Spread of Hemorrhagic Fever Viruses: Predicting Pandemics
University of London professor Sanjeev Krishna studies neglected infectious diseases and like so many, wasn’t surprised at the 2014/2015 Ebola outbreak. He notes that globally, we could’ve been better prepared to handle the outbreak and that vaccine development, among other things, is critical. “At the start of this year an organisation was launched to lead the way, the Coalition for Epidemic Preparedness Innovations (CEPI). Its mission is to bring politicians, academics, drug firms and philanthropists together to help prepare for the next epidemic. It was launched at the World Economic Forum in Davos in January, and is backed with $620m (£466m) from the governments of Norway, Germany, Japan, Canada, Belgium and Australia and the world’s two largest health charities the Wellcome Trust and the Bill and Melinda Gates Foundation. It is working to establish the lab and distribution infrastructure and access to funds needed to rapidly develop vaccines in a crisis.” CEPI Chief Executive Richard Hatchett has continually emphasized the importance of recognizing warning signs and investing in prevention efforts. Hatchett points out that the biggest lesson from Ebola, like so many outbreaks, is that we simply can’t be complacent about diseases with epidemic potential. Vaccine development can take a while and is costly (some say it’s about $1 billion per vaccine) and it’s taken groups like the Bill and Melinda Gates Foundation and Wellcome Trust to really support some of these efforts when government investments have been lacking. These gaps in preparedness and funding are worrisome in the event of a pandemic flu. “Sir John Bell, scientist at Oxford University and author of the UK’s life sciences industrial strategy, agrees on the threat posed by flu, noting that the last flu pandemic in 1918 killed 50m to 100m people, around 3-5pc of the world’s population at the time. ‘The experience of the epidemic in 1919 should give ample cause for concern about the impact of such an event globally,’ he says.” The truth is that we’re still working to prepare and respond to these biological events, but the real question is – will we learn from our mistakes? You can also read Dr. Alaa Murabit’s comments on the challenges of securitizing health and how this UN High-Level Commissioner is tackling global health issues. Epidemics usually occur when health systems are unprepared.” These words ring especially true this week, during International Infection Prevention week (read below). Hemorrhagic viruses and hantavirus have shown an uncanny ability for epidemic expansion, whether it be through people or rodents across significant geographical areas. “The ultimate goal is to develop a resilient global health infrastructure. Besides acquiring treatments, vaccines, and other preventive medicine, bio-surveillance is critical to preventing disease emergence and to counteracting its spread. So far, only the western hemisphere has a large and established monitoring system; however, diseases continue to emerge sporadically, in particular in Southeast Asia and South America, illuminating the imperfections of our surveillance. Epidemics destabilize fragile governments, ravage the most vulnerable populations, and threaten the global community.” The truth is that we so frequently follow the pattern of poorly prepared health systems responding to epidemics and governments re-alligning preparedness efforts only after the event. The current world is in a state of flux to fix these health issues despite constant external stressors like conflict, growing populations, migration, climate change. Despite these challenges, it is vital we strengthen our health systems to more effectively and efficiently identify biological threats, prevent them, and respond to them.

Measuring Radiation Doses in Mass-Casualty Emergencies                 We’re getting a double-dose of GMU biodefense in this fascinating article on radiation measurement. GMU biodefense professor and graduate program director Dr. Gregory Koblentz and doctoral candidate Mary Sproull (who is also a radiation guru at the Radiation Oncology Branch of the National Cancer Institute at the National Institutes of Health) are teaming up to address diagnostic challenges and technologies in the event of a nuclear attack. This article is especially relevant with tensions rising between the United States and North Korea in the wake of nuclear tests. In the event of something this horrific, one of the challenges is to appropriately and accurately diagnosis and treat radiation-related injuries. “Fortunately, new types of diagnostics to address this critical need are being developed in the field of radiation biodosimetry. Radiation biodosimetry is the estimation, through observation of biological variables, of received dose from previous radiation exposure; the new diagnostics use changes in various biological markers to estimate the severity of radiation doses.” Koblentz and Sproull highlight several gaps within U.S. preparedness related to biodosimetry, especially in terms of surge capacity and how such diagnostic capabilities may be challenged in a large-scale event. They also point to research into new assays, like those using newly identified radiation biomarkers. Lastly, Koblentz and Sproull focus on recommendations to better integrate biodosimetry, whether it be integrating medical management of radiation injuries into healthcare provider education or equipping federal response teams with deployable point-of-care biodosimetry diagnostic capability.

Meeting of the Blue Ribbon Study Panel on Biodefense – National Biodefense Strategy: Implementation and Implications
Don’t miss this event at the Hudson Institute on Thursday, November 2nd from 10:30am to 2pm. “This meeting of the Study Panel will address implementation of the National Biodefense Strategy and its implications for the Office of Management and Budget, congressional authorization and appropriation, leadership, coordination, collaboration, and innovation. Thought leaders will draw upon current and previous experiences with implementing national strategies and high-level policy directives. These speakers will also share their thoughts on: (1) the biological threat, the priority they place on biodefense, and efforts to address their concerns; (2) what the Administration should consider as it goes about populating the Implementation Plan for the National Biodefense Strategy; and (3) how Congress should use the Strategy and its Implementation Plan to inform its biodefense oversight and legislative activities.” Make sure to RSVP here by October 30th if you’re attending in person – the event will also be webcast.

Doreen and Jim McElvany Nonproliferation Challenge
Don’t miss out on this wonderful opportunity through the James Martin Center for Nonproliferation Studies (CNS) to encourage innovative thinking and help address nonproliferation. “The James Martin Center for Nonproliferation Studies (CNS) and its journal, the Nonproliferation Review, aim to spur new thinking about nonproliferation and disarmament.To advance this goal, the Doreen and Jim McElvany Nonproliferation Challenge will recognize the most outstanding new ideas and policy proposals published in Volume 25 (2018) of the Nonproliferation Review. The Challenge will award a grand prize of $5,000, a $3,000 runner’s-up prize, and a $1,000 honorable mention prize.”

The Evolution of the Islamic State’s Chemical Weapons Efforts               The Islamic State has grown increasingly comfortable with using chemical weapons and Columb Strack is taking us through the evolution of their practices. While their use of chemical weapons seems to have been abandoned since the loss of Mosul in June 2017, intelligence sources have suggested that a new chemical weapons cell has been established within the Euphrates River Valley. “The Islamic State’s use of chemical agents in Iraq and Syria is characterized by three phases. During the initial phase, which encompasses the first year of the caliphate’s existence (between June 2014 and June 2015), chemical attacks drew on tried and tested techniques, adapted to include widely available industrial chemicals—mainly chlorine and phosphine—from stockpiles captured as part of the group’s territorial expansion. These attacks were carried out using crude delivery mechanisms, in most cases adding canisters of chemicals to roadside or vehicle-borne improvised explosive devices (IEDs). The second phase, from July 2015 to January 2017, represents the enhanced capability the group had achieved by combining the production of sulfur mustard agent with the means to deliver it using projectiles, such as mortar bombs and improvised rockets. During this period, chemical attacks were carried out simultaneously across the caliphate, from Syria’s Aleppo province in the west to Iraq’s Kirkuk province in the east, indicating the existence of multiple operational units with the required expertise. Attacks peaked in April 2016, with eight separate recorded chemical attacks in one month. The third phase began with the last recorded chemical attack in Syria on January 8, 2017, and ended with the Islamic State’s apparent abandonment of its CW production following the loss of Mosul in July 2017.” Strack traces the history of intent and methodology development from two decades of experimentation by other militant groups. Strack also discusses experiments and sources for the weapons, including the seizure of military sites where chemical weapons could have been stored. Lastly, he discusses the slow degradation of capability that occurred following airstrikes against facilities and individuals, but that ultimately, the Islamic State has “the capability not only to transfer the know-how to produce toxic chemicals via secure online communications to operatives already living in target countries, but also to ship materials, including explosives, undetected.”

Blue Ribbon Study Panel on Biodefense- Animal Agriculture Vulnerabilities
Diseases that impact animals and have the potential to cross over to humans, let alone impact the agriculture industry, can be devastating. The Blue Ribbon Study Panel on Biodefense has just released their report evaluating the threats to animal agriculture and how this can not only impact human health, but also the U.S. economy. “In December 2014, a highly pathogenic strain of avian influenza entered the United States via migrating wild birds. The ensuing outbreak resulted in the largest animal health disaster ever experienced by the United States. Federal and state governments spent $879 million on outbreak response. The outbreak impacted 21 states, lasted until the middle of 2015, and led to the depopulation of more than 50 million birds on 232 farms. Subsequent trade bans impacted as many as 233,770 farms. The total cost to the U.S. economy was estimated at $3.3 billion. In 2015, the agriculture, food, and related industries contributed $992 billion (5.5%) to U.S. gross domestic product (GDP), making it one of the largest sectors of the U.S. economy. Given its critical importance to food safety and availability in the United States and around the world, protecting this sector is a matter of national security.” The report covers the threat to food and agriculture, zoonoses, how federal response is organized, collaborative efforts like biosurveillance, and the innovative work within next-generation medical countermeasures.

Why You Should Be Celebrating International Infection Prevention Week                                                                                                                                         Are you celebrating infection control this week? GMU Biodefense PhD student Saskia Popescu is pointing out how vast the role of infection prevention is across healthcare and why we should all be celebrating it. “October 15-21, 2017 marks International Infection Prevention Week and while this may seem like a week where we rally around hand hygiene, it’s much bigger than that. Infection prevention goes beyond the nuances of hand hygiene and expands to almost every corner of medical care and healthcare. Whether it be a dental clinic, operating room, or even an outpatient treatment center, infection prevention plays a vital role in keeping patients and healthcare workers safe. Not convinced? On any given day, the Centers for Disease Control and Prevention estimates that roughly 25 people in the United States will acquire a healthcare-associated infection (HAI). In a given year, it’s estimated that 722,000 HAIs occur, of which 25,000 of those patients die due to the infection. Realistically, it’s believed that the annual number of HAIs within the United States is closer to 2 million, which is astounding.”

Monkeypox in Nigeria
Nigeria is currently experiencing an outbreak of monkeypox after confirming three cases. “Since Sep 22, there have been 60 reports of suspected monkeypox cases from across Nigeria. The laboratory analysis showed that 12 suspected cases from the Bayelsa state were not positive for monkeypox. The NCDC said that all patients with suspected and confirmed monkeypox are currently receiving supportive medical care and improving. The NCDC offered no further details on the confirmed cases, besides noting that they were from Bayelsa state. The agency said the likely source of infection is through primary zoonotic transmission, and cautioned Nigerians to avoid contact with squirrels, rats, and any animals that appear sick.” Samples are currently being analyzed at the WHO regional office in Dakar, Senegal.

Stories You May Have Missed:

  • Did Disease Impact the Fall of Rome?– We know that disease can have devastating consequences on societies and even ancient Rome experienced several outbreaks of smallpox and plague, but just how impacting were these biological events? “Rome was far from the only advanced society shaken to its core by the explosive force of infectious diseases. The medieval Black Death sent some leading-edge polities (like the communities of Italy) backward, while opening the space for the ascent of others, such as England. The lethal role of pathogen exchange in the European conquest of the New World is relatively famous, if still imperfectly understood.”
  • Supportive Care Recommendations for Ebola Patients– Treatment for patients afflicted with Ebola can be tricky and there’s often little time to get the right mixture. “The study, by a team of international experts, was published yesterday in The Lancet. The authors write that at the beginning of the outbreak in 2013, case-fatality rates were 70%, but that number was lowered significantly (to 40%) as supportive care practices improved over the course of the outbreak. Using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, the authors present evidence-based recommendations for patient care during the next Ebola outbreak. Oral hydration and intravenous hydration had the strongest recommendation. When administered properly, the measure carries no risk of transmission to healthcare workers, the experts say. and making sure patients, especially the very young, are adequately hydrated is a necessary supportive measure.”

Thank you for reading the Pandora Report. If you would like to share any biodefense news, events, or stories, please contact our Editor Saskia Popescu (biodefense@gmu.edu) or via Twitter: @PandoraReport

Pandora Report 6.30.2017

Happy Friday to all our amazing readers – we hope you have a lovey holiday weekend! Don’t miss the July 1st deadline for an early registration discount to the Summer Workshop on Pandemics, Bioterrorism, and Global Health Security.

Preventing Pandemics and the Necessity of Funding Prevention
Next January will mark the centenary of the 1918-1919 pandemic influenza, but what have we really learned since then? The looming threat of antimicrobial resistance is slowly surrounding us, as is the increasing biothreat of zoonotic disease. Globalization, encroachment into animal habitats, and recent models that predict a 60-day global spread for a virulent strain of airborne flu virus, all paint a rather gloomy reality for the future of health security. So what are we doing? Not enough. That’s usually the answer in public health- a field of which you can comfortably say society likes to contribute the bare minimum. A highly pathogenic influenza virus that could engulf the globe in a pandemic isn’t the storyline for a horror movie, but rather something that even UN panels note is “not an unlikely scenario”. “Pathogens are not only terrifying, they’re expensive. The 2003 SARS epidemic cost $30 billion in only four months. A flu pandemic of a severity that occurs every few decades could contract the global economy by 5 percent — some $4 trillion”. Here’s where the economics of preventative public health come into play – vaccines are expensive to make and there’s little incentive when we’re not in the eye of a disease storm. Moreover, global health security is challenging. Politics makes disease response and preparedness a sensitive topic, especially during an outbreak. The key lesson to remember though, is that an outbreak anywhere is really an outbreak everywhere. So what preparedness tactics can we start utilizing? “The project is called CEPI — the Center for Epidemic Preparedness Innovations. After the world’s failure to control Ebola quickly in 2014 and 2015 cost 11,000 lives and at least $6 billion, three global experts proposed a vaccine development organization with $2 billion in start-up funding. Harvard, the National Academy of Medicine and the United Nations all created commissions that proposed ways to avoid another catastrophe. Among other steps, all endorsed vaccine development.” CEPI aims, in the next five years, to develop vaccine candidates for Lassa fever, Nipah, and MERS. “Creating vaccines is not the same as guaranteeing that people who need them can get them. CEPI will require its awardees to sell vaccines to the poorest and lower-middle-income countries (more likely, to donors who will buy vaccine for them) at the lowest possible price.” Perhaps one of the most poignant comments from this article was that the threat to this goal is not scientific, but rather political, highlighted by short attention spans. The World Bank has initiated it’s “pandemic bond” to aid in outbreak response should there be a public health crisis like that of Ebola in 2014. “The catastrophe bond, which will pay out depending on the size of the outbreak, its growth rate and the number of countries affected, is the first of its kind for epidemics. It should mean money is disbursed much faster than during West Africa’s Ebola crisis.” The Pandemic Emergency Fund (PEF) will offer coverage to those countries eligible for financing from the IDA (International Development Agency), which is dedicated to helping the poorest countries. Head of derivatives and structured finance at the World Bank’s capital markets department, Michael Bennett, noted that “if a trigger event occurs, instead of repaying the bond in full, some or all of the principal is transferred to the PEF trust fund. So essentially the investors are acting like insurance companies. The objective of offering the risk in both forms is that the bonds and swaps appeal to different types of investors, and therefore … we are creating the broadest possible investor pool for this risk,”. The PEF would provide more than $500 million in coverage over the next five years. Efforts to provide financial support to outbreaks before they reach pandemic potential are vital. It is estimated that had the PEF been available during the 2014 Ebola outbreak, $100 million could have been mobilized as early as July 2014, which may have prevented the outbreak spreading so rapidly and costing $2.8 billion. “The annual global cost of moderately severe to severe pandemics is estimated at roughly $570 billion, or 0.7 percent of global income, the World Bank said.”

Ebola Burial Teams 
The 2014/2015 Ebola outbreak in West Africa was not only the worst in history, but taught us a great many lessons about outbreak control. One of the most extraordinary lessons learned was just how valuable burial teams could be. Funerals became a significant source for disease exposure and transmission, especially for loved ones of the deceased, as washing and handling the body was customary. In effort to combat this high-risk activity, public health responders established burial teams comprised of paid volunteers, who would collect the bodies from homes and aid in their burial. The teams would don PPE and work with families to ensure they avoided exposure. Dignified burial through these teams helped ease much of the concern for families regarding the treatment of their loved one. A recent study published in the PLOS Neglected Tropical Disease Journal evaluated the impact of these burial teams using modeling and data from 45 unsafe community burials and 310 people who were identified as having contact with the infected bodies. Researchers found that those who cared for the Ebola patient just before their death were at greatest risk, meaning that caring for an infected loved one at home was far riskier than bringing them to a healthcare facility. The study estimates that the safe and dignified burials performed by Red Cross volunteers (the burial teams) prevented between 1,411 and 10,452 cases of Ebola. “Hundreds of paid volunteers took on the grim task of collecting bodies from people’s homes in full personal protective gear, while also having to manage the grieving families and communities. They were ordinary West Africans, such as teachers and college students. Many carried out the relentless and dangerous work for months. Some were stigmatised in their communities, because people became scared they might bring the virus home with them. In reality, they were helping to stem world’s worst ever Ebola outbreak.” In the end, the Red Cross burial teams managed over 47,000 burials, carried out more than 50% of all burials during the outbreak, and consisted of 1,500 volunteers.

Instructor Spotlight – Workshop on Pandemics, Bioterrorism, & Global Health Security
We’re nearing the last few weeks before our workshop and your opportunity to get the early registration discount, so don’t miss out! This week we’re happy to show off not only the director of this workshop, but also of our GMU biodefense graduate program – Dr. Gregory Koblentz. If there was a biodefense Jeopardy, Dr. Koblentz would not only be the reigning champion, but would also have Alex Trebek doubled over in laughter. Gregory Koblentz, PhD, MPP, is an Associate Professor in the Schar School of Policy and Government and Director of the Biodefense Graduate Program at George Mason University. During 2012-2013, he was a Stanton Nuclear Security Fellow at the Council on Foreign Relations. Dr. Koblentz is also a member of the Scientist Working Group on Chemical and Biological Weapons at the Center for Arms Control and Non-Proliferation in Washington. He previously worked at Georgetown University, the Executive Session for Domestic Preparedness at Harvard University, and the Carnegie Endowment for International Peace. He is the author of Strategic Stability in the Second Nuclear Age (Council on Foreign Relations, 2014), Living Weapons: Biological Warfare and International Security (Cornell University Press, 2009) and co-author of Tracking Nuclear Proliferation (Carnegie Endowment for International Peace, 1998). He serves on the editorial boards of Nonproliferation Review, World Medical and Health Policy, and Global Health Governance. His teaching and research interests focus on international security, weapons of mass destruction, terrorism, and homeland security. He received his PhD from the Massachusetts Institute of Technology, his Master in Public Policy from the John F. Kennedy School of Government, and his BA from Brown University. For more information, see https://schar.gmu.edu/about/faculty-directory/gregory-koblentz. Don’t miss your chance to not only learn from Dr. Koblentz, but also chat with him and other experts in the field at our workshop July 17-19th!

Can CRISPR Tackle Zika?
GMU Biodefense PhD student Saskia Popescu is looking at CRISPR and its application as a vector-borne disease prevention tool. “Whether it be the latest announcement that CRISPR reversed Huntington’s Disease in mice or that it could provide rapid diagnostic improvements, the technology is being considered a breakthrough for many diseases and conditions, including vector-borne diseases.” Drawing on a recent TED Talk by famed molecular biologist, Dr. Nina Federoff, she highlights the potential for GMO mosquitoes to be used as a biological control tool. Federoff points to the public perception issues that come with GMO products, which was seen in Key Haven, Florida when GMO mosquitoes were to be trialed as a means to prevent dengue and Zika cases. “Concluding her talk with a plea to the audience, Dr Federoff emphasized the need to dig past misinformation and hype to truly look at the science of this work and the substantial benefits that can come from biological control efforts and the science of genetic modification.”

The Case of the Missing Sarin
Dugway Proving Ground is under the spotlight again for mishandling of dangerous substances. The same Army lab was responsible for mishandling Anthrax in 2015, during which they sent 575 shipments of live samples across the U.S. Unfortunately, the latest reports are looking to Dugway as the source for potentially losing a small amount of sarin. The inspector general for the DoD released a report highlighting the findings that a contractor used by the facility was not maintaining inventory properly. “Dugway stored its sarin in a two-container system. The sarin was stored in a primary container, which is then stored inside a secondary container. But officials only checked the secondary containers when doing inventory, and did not check inside the primary container, so they did not know if all the sarin was still in the containers, the inspector general found. ‘Therefore, custodians cannot identify and account for leaks, evaporation, or theft that may have occurred,’ the inspector general found. ‘Furthermore, Dugway officials did not immediately notify the chemical materials accountability officer of a 1.5-milliliter shortage of … sarin identified during an April 19, 2016, inventory nor did they properly document the results of that inventory,’.” The report found that the contractor and Dugway used varying methods for container sealing but that the amount missing is relatively small. Fortunately, sarin evaporates and degrades very quickly. Overall the report highlights the operations and procedures for handling the chemical agent put workers at an increased risk and encouraged the Army to evaluate and improve practices immediately.

The Moral Question of Bioengineering
The financial and technical hurdles for biotechnology and gene-editing have been decreasing over the years and Stanford is taking a unique approach to their budding bioengineers – asking moral questions. During their final exams for the university’s Intro to Bioengineering course, the students are asked several questions – at what point will the cost of printing DNA to create human life equal the cost of teaching a student at Stanford?  If you and your partner are planning to have kids, would you start saving for college tuition, or for printing the genome of your offspring? These questions represent much of the debate and concern regarding gene editing – the rapid decrease in cost and the morality of just how far the technology can and will take researchers. Many note that just because we can, doesn’t mean we should. Stanford professor Drew Endy emphasizes the decrease in costs, which was initially prohibitive when the technology was developing. Regarding the last question, “about 60 percent say that printing a genome is wrong, and flies against what it means to be a parent. They prize the special nature of education and would opt to save for the tuition. But around 40 percent of the class will say that the value of education may change in the future, and if genetic technology becomes mature, and allows them to secure advantages for them and their lineage, they might as well do that. There is clearly no right answer to the second question, and students are graded on their reasoning rather than their conclusion. But when both questions are considered together, they suggest, Endy says, that ‘in the order of a human generation, we’ll have to face possibilities that are much stranger than what we’re prepared for’.”

Stories You May Have Missed:

  • John Oliver Takes on Anti-Vaxxers – If you’re a fan of the HBO host, make sure to check out his recent episode of  “Last Week Tonight” in which he points out just how dangerous the anti-vaccine movement really is. “Some have even developed an ‘alternative vaccine schedule’ in which the inoculations can be delivered less frequently and over a longer period of time. ‘That sounds like a decent compromise because it’s the middle-ground position, right?”’Oliver said on ‘Last Week Tonight’ on Sunday. ‘The problem is, it’s the middle ground between sense and nonsense. It’s like saying, ’It would be crazy to eat that entire bar of soap, so I’ll just eat half of it’.”
  • Yemen’s Growing Cholera Outbreak– Yemen is currently experiencing the worst international outbreak of cholera, with 200,000 suspected cases and an average of 5,000 new cases reported daily. The WHO and UNICEF have gotten involved as there have already been 1,300 deaths in the past two months. “By calling the outbreak the “world’s worst” UNICEF and WHO hope to speed international aid efforts to the war-torn country. “This deadly cholera outbreak is the direct consequence of two years of heavy conflict,” said a press statement from UNICEF. ‘Collapsing health, water and sanitation systems have cut off 14.5 million people from regular access to clean water and sanitation, increasing the ability of the disease to spread.’ In addition to a lack of public health infrastructure, UNICEF estimated that 30,000 dedicated local health workers who play the largest role in ending this outbreak have not been paid their salaries for nearly 10 months.”

 

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 5.19.2017

Your weekly dose of all things biodefense is here to fill you in on Ebola in the DRC, antibiotic resistance, the role of the U.S. in global health response, and more!

Ebola Rears Its Ugly Head in the DRC
Sadly, Ebola has returned as cases are sprouting up in the Democratic Republic of the Congo (DRC). On Friday, May 12th, the WHO confirmed an outbreak of the Zaire strain involving nineteen cases and three deaths. “WHO and partners are completing the epidemiological investigation to better understand the extent of the current outbreak and who are potentially at risk of Ebola,” WHO spokesperson Tarik Jasarevic told CIDRAP News. “If pertinent, ring vaccination, as used in the phase 3 study in Guinea, would be the recommended delivery strategy.” These new cases will truly be a test to see if response efforts have changed since the 2014/2015 outbreak in West Africa. Between the WHO response and the potential for real-world testing of the new Ebola vaccine, many are hoping this will be the game-changer. The Global Outbreak Alert and Response Network (GOARN) has been activated and per the WHO website, “the need and feasibility of potential Ebola ring vaccination is being discussed.” Reuters reported that “the GAVI global vaccine alliance said on Friday some 300,000 emergency doses of an Ebola vaccine developed by Merck could be available in case of a large-scale outbreak and that it stood ready to support the Congo government’s efforts to bring the epidemic under control.Under an agreement between GAVI and Merck, the developer of an Ebola vaccine known as rVSV-ZEBOV, it said up to 300,000 doses of the shot would be available in case of an outbreak.” MSF (Medicins sans Frontieres) announced, shortly after the WHO confirmation of cases, that they would be sending a team of 14 people to Likati to launch “an emergency intervention” and that a team of 10 people from the Ministry of Health would also be joining. MSF noted that “the team will be made up of doctors, nurses, logisticians, water and sanitation experts, health promoters and an epidemiologist. Along with organisations already present in the area, the MSF emergency team will conduct an assessment of the situation and may construct an Ebola treatment centre and help care for those suspected or confirmed to be affected by the virus. Fifteen tonnes of medical and logistical supplies will be sent by cargo plane from Kinshasa to allow the team to immediately begin their intervention in Likati.” You can read more about the outbreak timeline here and check out this latest article on how the WHO is preparing to use the experimental vaccine.

Summer Workshop Instructor Spotlight: Andrew Kilianski
As we get closer to the July 17th start date for the Summer Workshop on Pandemics, Bioterrorism, and Global Health security, we’d like to show off some of the wonderful instructors. Dr. Kilianski is currently a GMU professor and biological scientists at the Depart of Defense. His work focuses on combating current and future threats from weapons of mass destruction in addition to teaching classes on biosurveillance and virology in the GMU Biodefense graduate program. Dr. Kilianski was previously a National Research Council fellow with the US Army at Edgewood Chemical Biological Center. During his tenure at ECBC, his research focused on biosurveillance and the identification and characterization of novel agents that threaten today’s warfighter. Dr. Kilianski’s research interests also included emerging viral pathogens and public health and biodefense policy, and he was selected as an Emerging Leaders in Biosecurity Initiative Fellow for 2015.  His research has been published in peer-reviewed journals such as PLoS Pathogens, Journal of Virology, and Emerging Infectious Diseases while also publishing multiple commentary and op-ed articles.  He received his Ph.D. in Microbiology and Immunology from Loyola University Chicago where his dissertation research involved uncoupling virus-host interactions important for coronavirus pathogenesis and developing antiviral compounds against emerging coronaviruses (SARS-CoV and MERS-CoV). During the workshop, Dr. Kilianski will be lecturing on biosurveillance and its role as an integral component of any biodefense strategy and how U.S. policy has mandated that such efforts be accelerated. He notes that “this construct, and how the US and international entities engage in biosurveillance will be covered, as well as how recent Ebola and Zika virus outbreaks have tested the system. Emerging technologies and their role in biosurveillance will also be reviewed. Finally, paths toward integrated biosurveillance for the US and international communities will presented for group discussion discussion.” Dr. Kilianski is a wonderful instructor and his lectures are both engaging and thought-provoking. Don’t miss out on the early-bird registration discount (10%) being offered until June 1st!

GMU Biodefense PhD Student’s Research Could Change Disease Response, Especially When Air Travel Is Involved
Have you ever wondered about the role of air travel during outbreaks? Nereyda Sevilla will be graduating this month with her PhD in biodefense after looking into this very issue. “She believes she has a way to change how authorities and the public respond to disease outbreaks perceived to be transmitted by air travel. If she’s right, it could potentially save billions of dollars in misdirected federal and state money and give millions of air passengers more precise information about infections.” A civilian aerospace physiologist for the Medical Research and Acquisitions Division in the Office of the Air Force Surgeon General, and all around biodefense fan, Nereyda focused her research on the role of air travel and the spread of disease. Utilizing outbreaks like SARS, H1N1, and Ebola, she looked at air travel as a potential incubator for disease transmission. “Sevilla pointed out that despite the numerous aircraft involved, no one became infected with Ebola on an airplane. And yet authorities spent billions on entry and exit screenings, which heightened fear among the general population. Sevilla used an open-source model to study what would happen during a possible future outbreak of pneumonic plague, an infectious lung disease that continues to rear its deadly head around the world. The model could be a game-changing tool, said her professor.” Nereyda says that she’s “found the airplane is not what’s going to get you infected with disease. You’re more likely to get sick from waiting in the boarding area next to some one with a cold.” You can also read this article she wrote regarding the open-source model. Nereyda is a great example of the diverse and passionate students within the GMU biodefense program and we’re excited to show off her amazing research and congratulate her on graduating!

Global Health and the Future Role of the United States
The National Academies of Science just released their report on global health and the role of the U.S. as a leader through efforts like PEPFAR (U.S. President’s Emergency Plan for AIDS Relief), etc. The U.S. has taken a major role in strengthening global health security, whether it be through efforts like the Global Fund to Fight AIDS, TB, and Malaria, or through collaborative international efforts to help strengthen national health systems like the Global Health Security Agenda. “However, resources are not unlimited, and the case for continued commitment must be made. Against the backdrop of the influential legacy of the United States on the global health stage, the new administration is now faced with the choice of whether or not to ensure that gains in global health—won with billions of U.S. dollars, years of dedication, and strong programs—are sustained and poised for further growth.” The report also notes that “approximately 284,000 deaths were attributed to the 2009 H1N1 influenza outbreak, for example, and 2 million excess deaths are projected for a future moderate influenza pandemic. In only a few short months in 2003, the outbreak of severe acute respiratory syndrome (SARS) cost the world $40–$54 billion, while in 2014, the United States alone committed $5.4 billion in response to the Ebola outbreak, $119 million of which was spent on domestic screening and follow-up of airline passengers.” Following a rigorous review, the committee established 14 recommendations that would aid in the delivery of a strong global health strategy and help the U.S. maintain its role as a leader in global health security. The 14 recommendations/actions are: improve international emergency response coordination, combat antimicrobial resistance, build public health capacity in low- and middle-income countries, envision the next generation of the President’s Emergency Plan for AIDS Relief, confront the threat of tuberculosis, sustain progress towards malaria elimination, improve survival in women and children, ensure healthy and productive lives for women and children, promote cardiovascular health and prevent cancer, accelerate the development of medical products, improve digital health infrastructure, transition investments toward global public goods, optimize resources through smart financing, and commit to continued global health leadership.

Would You Survive the Oregon Trail?
If you ever played the video game, you know the chances of making it through this covered-wagon adventure without snakebites, dysentery, or some other misery, were quite low. “The game, one of the earliest educational computer games to reach wide distribution, simulated a 1848 covered-wagon trip from Missouri through the wild frontier of the western US.” Diseases were common to those of us who ventured across the Oregon Trail, but now you can take a quiz to see just how much you really know about those historic bugs.

GAO Report: U.S. Needs To Do More To Prevent Possible Bird Flu Pandemic
A recent Government Accountability Office report is pointing out just how vulnerable the U.S. would be if faced with an avian influenza pandemic. The GAO report focused on three areas – how outbreaks of avian influenza have affected human and animal health, and the U.S. economy, the extent to which the USDA has taken actions to address lessons learned from outbreaks in 2014 and 2016, and the ongoing challenges federal agencies face in their efforts to reduce the potential harm of such an outbreak. The report comes at a crucial time as China is currently battling an outbreak of the deadly H7N9 strain. Within the report there are several findings: “Unless the agency is responding to an emergency, the Agriculture Department doesn’t have the authority to require poultry producers to take preventive biosecurity measures to keep avian influenza from spreading from farm to farm.” The report notes that the USDA has found lessons learned from its responses to previous events however, they have not established plans for evaluating if these corrective actions actually resolved the issues. The topics within the lessons learned include biosecurity, communication, continuity of business, diagnostics, etc. Simply put, while they identified problems and took corrective actions, there has been virtually no evaluation as to their efficacy. Another issue raised within the GAO report focuses on vaccination and the challenges of egg-based vaccine manufacturing. DHHS stockpiles vaccines supplied by four companies, however only one has a U.S.-based manufacturing facility for egg-based vaccines. “We identified two other issues that federal agencies face associated with mitigating the potential harmful effects of avian influenza. First, outbreaks of the disease threaten the poultry that produce the eggs used in the production of human pandemic influenza vaccine. Second, funding for a voluntary surveillance program that gathers data on influenza A viruses in swine that could pose a threat to human health will be exhausted in fiscal year 2017”. Overall, the USDA must focus more on evaluation and working towards preparedness to combat the growing threat.

Getting Our Hands on Older Antibiotics & The Broken Chain of Hospital Reporting
A recent article in Clinical Microbiology and Infection looked at the recommendations and availability regarding older antibiotics. Researchers found that these antibiotics are not universally available or marketed, which means that physicians have to use other, less optimal, antibiotics that are broad-spectrum. “For example, in the treatment of sore throat, amoxicillin is used instead of penicillin. Fluoroquinolones are used instead of nitrofurantoin, fosfomycin or pivmecillinam for the treatment of cystitis, and co-amoxiclav or cephalosporins for the treatment of skin and soft tissue infections instead of appropriate oral formulations of antistaphylococcal penicillins. Additionally, some old antibiotics such as temocillin or i.v. fosfomycin are valuable alternatives for the treatment of some resistant bacteria. The limited access to these old antibiotics is a threat to antibiotic stewardship.” “In 2011, the ESCMID Study Group for Antimicrobial stewardshiP (ESGAP) showed that 22 out of 33 old but potentially useful antibiotics were marketed in fewer than 20 of the 38 included countries in Europe, USA, Canada, and Australia; economic motives were the major reason for not marketing these antibiotics. ESGAP and the international network ReAct (Action on Antibiotic Resistance) updated this survey in 2015. The situation was worse than in 2011, with even fewer antibiotics available in the included countries.” As if the battle of the resistant bug wasn’t bad enough, it seems that hospitals and their federal oversight systems are failing. Hospital reporting and CMS (Centers for Medicare and Medicaid) validation of such data was recently found to be not only poor, but often inaccurate. GMU biodefense PhD student, Saskia Popescu, looks at the process for which hospitals report healthcare-associated infections and drug resistant organisms for reimbursement through CMS and just how broken the CMS data validation process actually is. “During their annual data evaluation, CMS is supposed to randomly select 400 participating hospitals and request samples of medical records to evaluate the clinical-process-of-care measures and HAI measures. Additionally, they are encouraged to look at a targeted sample of 200 additional hospitals based off a certain threshold, which would be if they failed validation the year before or submitted data after the CMS deadline. CMS has several selection criteria for this ‘targeted’ sample, which includes ‘threshold-based criteria’—hospitals that fail to report half of their HAI’s, late reporting, a new hospital, etc.—or, ‘analysis-based criteria’—abnormal or conflicting data patterns and a rapid change in data patterns. Unfortunately, the report shows that CMS failed to use these measures when they did this targeted sample review in 2016 (which looked at data from 2013/2014). During this review, CMS only selected 49 hospitals and none of these hospitals were chosen from this analysis-based criteria (ie, they were not looking for those with aberrant data patterns or suspicious changes in reporting).”

Stories You May Have Missed:

  • Operation Whitecoat Documentary– Don’t miss out on the June 1st release of the post-WWII documentary on Operation Whitecoat (1954-1973). “During the Cold War, more than 2,300 non-combatant conscientious objectors from the Seventh-day Adventist church volunteered to serve their country by participating in U. S. Army medical experiments focused on developing defensive medical countermeasures against the Soviet Union’s bio-warfare capabilities. These volunteers were exposed to experimental vaccines and infectious pathogens.Operation Whitecoat tells the story of these patriots–their commitment to both their religious principles and desire to serve in America’s defense, their courage to participate in these tests, and their contributions that went far beyond Army biodefense.”
  • How Plagues Help Scientists Puzzle Out the Past –I imagine bioarchaeologists as a mix between Indiana Jones and one of the researchers from Contagion – learning about the past to prevent future pandemics. Plagues and pandemics carry with them a lot of information – how society at the time handled it, health and wellness, medical care, etc. “The tragedy of mass causalities exposes lives that would, statistically, rarely be unearthed, including the adolescents and adults who form the bulk of a living population, so rarely represented in a cemetery. Calamities such as plague that knock everyone into the grave with one indiscriminate sweep are one of the few chances bioarchaeologists have to overcome something known as the Osteological Paradox, a term coined by researcher James Wood and colleagues to cover the very awkward point that, in studying past lives, the evidence bioarchaeologists actually have to go on are past deaths. “

 

 

Pandora Report 10.23.2015

Happy Infection Prevention Week! Make sure to give any infection preventionists you know a big hug or at least a hearty handshake (only clean hands though!). Not only do we get to celebrate National Infection Prevention week, but it’s also National Biosafety Stewardship Month, so get your party hand sanitizer ready to go and let the frivolity begin! Foodborne illness is the name of the game this week and we’ll be discussing outbreaks. Friendly reminder – the influenza vaccine is available in most offices/clinics now, so get your flu shot as there have already been cases springing up across the US. Fun fact – did you know that a report published this week identified Yersinia pestis in the tooth of a Bronze Age individual, which means there were plague infected humans 3,300 years earlier than we thought!

National Biosafety Stewardship Month – October is National Biosafety Stewardship Month (thanks NIH!) to celebrate and encourage people to focus on biosafety policies, practices, and procedures. Given the lab biosafety issues we’ve seen recently, I think we can all safely (or should I say, “biosafely”?) agree that a little extra attention to these issues and the promotion of better practices is a great thing. Institutions are encouraged to use more of a just culture approach to incident reporting and to promote public transparency. Happy National Biosafety Stewardship Month!

Water Quality for the Olympic Games in Rio De Janeiro, 2016
The 2016 Summer Olympics are fast approaching and with any large event, health issues become a main concern. The WHO is providing technical advice to the Brazilian national authorities regarding public health concerns, as well as to the International Olympic Committee and the Local Organizing Committee. Clean drinking water, sewage pollution, and a host of other health issues can become a nightmare during such a large-scale event. While there aren’t recommendations for specific viral testing of the water, the WHO does encourage additional testing in the event of an outbreak. Sanitary inspections and other preventative procedures are being recommended to avoid outbreaks and public health issues. As we get closer to the 2016 Olympics, it is very likely concerns over vector-borne diseases will be addressed through vector control and public health education.

CDC Launches Redesigned FOOD Tool for Foodborne Outbreaks 

Courtesy of CDC FOOD Tool
Courtesy of CDC FOOD Tool

The CDC has updated their online foodborne illness outbreak investigation tool! The Foodborne Outbreak Online Database Tool (FOOD Tool) allows the user to search the outbreak database by state, food, ingredient, year, location of food preparation, and organism. The FOOD Tool also provides the case information related to the outbreak, so users can see the number of affected persons, hospitalizations, deaths and laboratory-confirmed organisms. This database pulls from CDC’s Foodborne Disease Outbreak Surveillance System (FDOSS) and allows users to not only look at data and trends over time, but also compare their cases to other outbreaks.

Syrian Refugee Resettlement and Why We Should Be Letting Them All In 
Dr. Trevor Thrall, one of our amazing GMU Biodefense professors, has written a piece for The Atlantic on the importance and benefits of taking in all Syrian refugees. Dr. Thrall discusses the limitations of addressing the root cause of the Syrian conflict and how the US and its European allies should take in refugees. Discussing the military alternatives to the Syrian crisis, he states, “going in militarily is not the answer, then. Instead, those civilians under threat should get out. Refugees typically receive support in the countries to which they flee, but the vast numbers involved in this case threaten to overwhelm Turkey, Jordan, and Lebanon, which have so far accommodated the vast majority of the outflow.” Dr. Thrall points out that while resettlement would cost a substantial amount of money, it would cost far less than military intervention and you simply can not ignore the moral superiority in aiding refugees.

Chipotle’s Bad Tomatoes Came From Nation’s Largest Field Producer
To our readers in Minnesota, did you happen to eat at a Chipotle in August? If so, we hope you weren’t one of the affected individuals that contracted Salmonella Newport as a result of contaminated tomatoes. The Minnesota Department of Health investigated the 64 cases resulting from this outbreak, however it was just released that the contaminated tomatoes were actually supplied by Six L’s Packing Co (doing business as Lipman Produce), which is actually one of the largest tomato suppliers in the US. Packing 15 million boxes of tomatoes this past year, Lipman was later dropped as a supplier by Chipotle after learning of the source of contaminated produce. The tomatoes were removed but it’s estimated that during the window of exposure, roughly 560,000 people consumed Chipotle. The good news is that we’re out of the incubation period, so if you happened to eat at a Minnesota Chipotle, you’re in the clear.

Stories You May Have Missed:

  • 80 Illnesses Linked to Shigella Outbreak; CA Seafood Restaurant Closed –  Mariscos San Juan in San Jose, CA is currently closed after the Santa Clara County Health Department connected a recent outbreak of Shigella to their food. While the exact source hasn’t been identified, over 93 people were sickened in relation to contaminated food at the restaurant.
  • Subway to Phase Out Poultry Products Raised With Antibiotics–  On Tuesday, Subway Restaurants announced that they will be transitioning to only serve poultry products that have been raised without antibiotics by early next year. Other chain restaurants, like Chick-fil-A and Chipotle, are jumping on the train to phase out chicken and turkey products that were raised with antibiotics.
  • Scottish Nurse and Ebola Complications – Pauline Cafferkey continues to battle post-Ebola complications. Reports last week noted neurological issues and it was recently reported that she has meningitis after the virus persisted in her brain and CSF after her initial recovery. Ongoing research is looking into the long-term effects of the disease as the West African outbreak was the largest in history and researchers have never had the opportunity to look at chronic issues associated with disease recovery.

Pandora Report 10.2

All this rain and grey weather (at least in DC) makes us want to curl up with a good book and luckily, we’ve got just the reading list! This week we’re sharing some top-notch work by our phenomenal faculty and alumni for you to enjoy. Earlier this week, straight out of a James Bond movie, Elon Musk presented Tesla’s Model X and its Bioweapon Defense Mode. Google had its 2015 Science Fair and a pretty amazing high school student took home top honors for her work on Ebola. Did I mention Kansas is prepping for the zombie apocalypse? Needless to say, there was a lot going on this week in the world of biodefense, so let’s venture down the rabbit hole….

 Zombie Preparedness Month Starts for Kansas 
I’m thinking we may need to take a class trip to Kansas since Governor, Sam Brownback, will be signing a proclamation to officially designate October as “Zombie Preparedness Month”! Brownback’s rationale is to emphasize preparedness in any form, stating, “If you’re prepared for zombies, you’re prepared for anything. Although an actual zombie apocalypse will never happen, the preparation for such an event is the same as for any disaster: make a disaster kit, have a plan, and practice it.” During Zombie Preparedness Month, state emergency management services will have activities and information for residents to help get their preparedness on. They’ll also be using social media to engage people people on these topics. The one thing we’ve learned in biodefense, Gov. Brownback, is to never say never!

Connecticut Teen Wins Google Science Award By Developing Affordable Ebola Test
High school junior, Olivia Hallisey, just took home the Google Science Fair top prize for developing an affordable and easy Ebola test in her project, “Ebola Assay Card”, which quickly (we’re talking 30 minutes quick!) detects the virus and doesn’t require refrigeration. Each test only costs $25 and picks up antigens on photo paper. Hallisey summarizes, “In this new device, that is stable and stored at room temperature, 30µl drops of water were used to dissolve silk-embedded reagents, initiating a timed-flow towards a center detection zone, where a positive (colored) result confirmed the presence of 500pg/ml Ebola(+)control antigens in 30min, at a cost of $25,” Hallisey hopes this project will encourage other girls to pursue their passions in science. Hallisey is truly an inspiration and we tip our hats to her passion for solving world problems while encouraging her peers!

Let’s Talk Dual-Use!
Come listen and chat with Dr. David R. Franz, former commander of USAMRIID, about balancing research and regulations when it comes to dual-use!
Date & Time: Monday, October 5, 2015, 4:30-6pm
Location: Hanover Hall, L-003 George Mason University, Fairfax, VA, see map

​Dr. Franz was the Chief Inspector on three United Nations Special Commission biological warfare inspection missions to Iraq and served as technical advisor on long-term monitoring.  He also served as a member of the first two US-UK teams that visited Russia in support of the Trilateral Joint Statement on Biological Weapons and as a member of the Trilateral Experts’ Committee for biological weapons negotiations.  He previously served as member of the National Science Advisory Board for Biosecurity (NSABB). Dr. Franz currently serves on several committees including the National Academy of Sciences Committee on International Security and Arms Control and the National Research Council Board on Life Sciences. Dr. Franz is a leader in the areas of cooperative threat reduction and health security and an expert in the development of U.S. regulations for biological threat reduction and biological security.  Dr. Franz will discuss the history and current debates related to U.S. and international regulations for select agents, dual use research of concern, and gain-of-function experiments.

1977 H1N1 Influenza Reemergence Reveals Gain-of-Function Hazards
Dr. Martin Furmanski discusses the gain-of-function (GoF) research hazards in relation to the 1977 H1N1 strain and it’s laboratory origins. Highlighting a previous article on the GoF debate, Dr. Furmanski notes that “separating the risks of vaccine development from those of basic GoF research is inappropriate, because GoF research seeks to discover antigenic and genomic changes that facilitate human-to-human transmission and/or augment virulence, with the aim of preemptively producing vaccines.” He also notes that while the 1977 H1N1 epidemic originated in a lab and it’s release was unintentional, the culprit laboratory matters little in the GoF debate.

Define Acceptable Cyberspace Behavior
GMU Biodefense alum, Dr. Daniel M. Gerstein, discusses the US-China cybersecurity agreement and the Friday announcement between Chinese Premier Xi Jinping and President Barack Obama. The agreement highlights the mutual desire to prevent cybertheft of business secrets. Dr. Gerstein emphasizes that while this agreement is a step in the right direction, it points to larger preparedness and response capability gaps. He notes, “So while a U.S.-China agreement is a welcome step, it also underscores the greater issues facing the United States, and indeed the international community, in this largely ungoverned space.” Dr. Gerstein highlights the necessity to define cyberspace boundaries, especially as there are delays in DHS security system deployments while US vulnerabilities continue to develop.

Implementation for the US Government Policy for Institutional Oversight of Life Sciences Dual Use Research of Concern
As of September 24, 2015, all institutions and USG funded agencies are now required to comply with the policies. Agencies now must have “a mechanisms in place to evaluate research that is potentially Dual Use Research of Concern (DURC).” Institutions must also organize an Institutional Review Entity (IRE) to review and manage compliance with these requirements.

Dr. Sonia Ben Ouagrham-Gormley’s  new book, Barriers to Bioweapons, received glowing reviews in the latest issue of Perspective on Politics. Her work, which is a staple for biodefense courses, and particularly this text, focusses on the perception of risk and lethality of bioweapons while addressing the realities of these assumptions. Ouagrham-Gormley discusses the key role of tacit versus explicit knowledge in the development and dissemination barriers for bioweapons. “The author identifies important factors internal to a weapons-development program- talented individuals and cohesive groups, corporate culture, communities of practice, organization structure- as critical nodes or ‘reservoirs’ of knowledge that must be configured to optimize the sharing of ideas and information.” The case studies of Iraqi and South African programs, as well as Aum Shinrikyo, lay the foundation for her points on the role of internal and external variables that can hinder or help a bioweapons program. Whether you’re reading  it for class (GMU Biodefense folks, I’m looking at you!) or you’re looking to brush up on nonproliferation, this book is a well-written and captivating necessity to understand bioweapon development. Did I mention how awesome the cover is?
Our very own GMU Biodefense PhD alum, Dr. Denise N. Baken, has a wonderful new book being released – let’s check it out! Al Qaeda : The Transformation of Terrorism in the Middle East and North Africa examines violence and the way it is marketed by the global terrorism industry.  Authors Denise Baken and Ioannis Mantzikos frame the violence discussion through the prism of its use by Al Qaeda, Al Qaeda in the Arabian Peninsula (AQAP) and Islamic State of Iraq and Syria (ISIS).Baken and Mantzikos look at the business parameters of violence –its cost, return on investment, efficiency, and effectiveness; They propose a new approach to that violence. One that looks at violence as a controlled commodity that evolved from Al Qaeda’s initial presentation of future possibilities, AQAP exploited those possibilities and ISIS pushed the boundaries of usability.
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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. 

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The Ebola Vaccine and the Ethics of Drug Trials

By Greg Mercer

The World Health Organization recently announced that a trial of the VSV-EBOV Ebola virus vaccine in Guinea has been “highly effective,” and that randomization in the trial would be stopped to allow for expansion of the range of subjects and protection of more people against the virus.  The trial began in March, and until recently, randomized subjects so that some received the vaccine immediately, while others received it later, after the virus’ gestation period.

A paper published in The Lancet details the study, and finds that the vaccine is highly effective and likely safe to use in the affected population.  The “recombinant, replication-competent vesicular stomatitis virus-based” vaccine is administered in a single dose via the deltoid muscle.  4,123 people received the vaccination immediately, while 3,528 people received the delayed vaccination (more on the study methodology in a moment). The researchers found that no subjects developed a case of Ebola after receiving the immediate or delayed vaccination, meaning that the vaccine proved 100% effective (with p=0.0036 at 95% CI).  These findings are excellent news for researchers, government officials, and those in the affected counties, and are fascinating from a scientific standpoint.

At The New Republic, Timothy Lahey, of Dartmouth, argues that these results, while promising, aren’t necessarily confirmed.  He notes that the lack of a placebo (because of the study’s particular methodology) makes it difficult to determine effectiveness, the vaccine could have failed to protect subjects from infection in a way that the study didn’t detect, and that a statistical aberration could mean that while the vaccine is not actually 100 % effective.  Regardless of whether these potential pitfalls affected the study or not, Lahey raises an important issue in drug testing for a disease like Ebola.  He is concerned that a lower standard for vaccines could mean that lower-income countries might not receive drugs of the same quality as rich countries, and points to past failed vaccines to illustrate the fallacy of believing that all vaccines work as intended.

The ethical dilemmas of drug testing have been front and center in the Ebola crisis.  Back in November, 2014, Nature reported on public health officials weighing the question of whether to use control groups when testing treatments for a disease with 70% mortality.  At the time, some advocated for applying experimental treatments (like the ZMapp antiviral cocktail, which had been used in patients but whose effectiveness was not entirely determined) to all patients, while others argued that these treatments might not be more effective than standard care, and that randomized trials guard against harmful side effects and provide a clearer picture of a drug’s effectiveness.

The VSV-EBOV vaccine was tested in the “ring” method that was previously used in the eradication of Smallpox.  This method eschews the double-blind placebo treatments commonly associated with drug trials.  Instead, this method creates a “ring” around new cases.  Contacts and contacts of contacts were identified by Guinea’s tracking system, and eligible adults were entered into randomization blocks, and received either the immediate or delayed vaccination.  This way, all of the subjects received the treatment, but in varying circumstances to establish effectiveness.  The full study is available via The Lancet.

Ethical drug testing is a crucial consideration, and has an imperfect past.  The National Institutes of Health’s own ethics guide cites a study that led to the United States’ ethics rules: a study that withheld syphilis treatment from 400 African-American men.  And for many, there’s good reason to be concerned about the actions of international organizations and multinational corporations.  In 1996, Pfizer conducted a study of an experimental drug on children with meningitis in Nigeria. While Pfizer maintained that the study was philanthropic, allegations arose from Nigerians and international organizations that children and parents were not informed that they were part of a study, and that Pfizer withheld treatment without consent or administered dangerous drugs.  The incident spawned a series of lawsuits and a panel of Nigerian medial experts condemned Pfizer’s actions in 2006, as reported by The Washington Post.

Epidemics and drug testing present a multitude of practical and ethical concerns, but careful consideration of the issues and sound methodology can, as they did in Guinea, produce exciting scientific and humanitarian results.

Image Credit: Psychonaught

Pandora Report 05.17.15

Yowza! That’s another semester in the books for the GMU Biodefense students. Please excuse the sparse activity on the blog, but with the semester over, things should be getting back to normal.

This weekend we have a updates on Ebola and the bird flu outbreak in the U.S., plus other stories you may have missed.

Have a great week, (enjoy the Mad Men finale!) and see you back here next weekend!

Ebola is (still) living in an American doctor’s eye

As an update, Liberia has (finally) been declared Ebola free, the number of cases in Guinea continue to rise due to transmissions at funerals, and those in Sierra Leone are dying less from Ebola than from other diseases due to the collapse of the healthcare system. It’s been over a year and we are still learning things about Ebola and its persistence on hospital surfaces, sexual fluids, and now, according to a study in the New England Journal of Medicine, the eye. WHO volunteer Ian Crozier was diagnosed in Sierra Leone and transported to Emory University where he was treated. Months later he returned to the hospital with symptoms like blurred vision and acute pain in his left eye. The cause? Ebola.

The Washington Post—“Ebola may have found refuge in patients’ eyes because, researchers said, the eye is walled off from the immune system. As the New York Times put it: “The barriers are not fully understood, but they include tightly packed cells in minute blood vessels that keep out certain cells and molecules, along with unique biological properties that inhibit the immune system.” This phenomenon is called “immune privilege” — and it means the eye can harbor viruses.”

America’s $45 Billion Poultry Industry Has a (Really) Bad Case of Bird Flu

The title says it all, frankly. Since early December 2014 three strains of highly pathogenic avian influenza have been circulating in North America. A state of emergency has been declared in Iowa (one of the hardest hit states) and over 21 million birds have been killed to contain and prevent the spread of the virus. Beyond the culling of birds, the outbreak is having an affect on business—China, South Korea, and Mexico have banned imports of U.S. poultry (to protect their own industries.)

The Motley Fool—“Falling exports could hurt farmers, but it could also help to offset domestic price increases from less supply. Although, with tens of millions of bird deaths and no end in sight to the pandemic, domestic food prices could be the largest casualty in the end.”

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Image Credit: 8thstar

Pandora Report 4.19.15

Sunday has to be the biggest brunch day of the week, so it is only fitting that our lead story looks at the many (delicious and nutritious) uses of maple syrup. We also look at Dengue fever in Brazil, missteps in the U.S. fight against Ebola, and other stories you may have missed.

Once you’re updated, get out there and enjoy the rest of your weekend and the beautiful weather! Have a great week!

Syrup Extract Found to Make Antibiotics More Effective Against Bacteria

It seems like we look at growing antibiotic resistance every week here at Pandora Report. This week, researchers at McGill University in Montreal reported that a “concentrated extract of maple syrup makes disease-causing bacteria more susceptible to antibiotics.” This finding suggests that combining the extract with antibiotics could increase their effectiveness and lead to lower antibiotic usage overall. Honestly, is there anything maple syrup can’t make better?!

Infection Control Today—“‘We would have to do in vivo tests, and eventually clinical trials, before we can say what the effect would be in humans,” [Professor Nathalie] Tufenkji says. “But the findings suggest a potentially simple and effective approach for reducing antibiotic usage. I could see maple syrup extract being incorporated eventually, for example, into the capsules of antibiotics.’”

Brazilian Teams on Alert because of Dengue Fever Outbreak

Brazilian soccer teams are on high alert because of a dengue fever outbreak that has already affected some of the country’s top teams. This week three players were diagnosed with the mosquito borne disease, which normally takes about two weeks to recover from. Players have been forced to use insect repellent during games and practices and health officials have been asked to check fields and training centers for mosquito breeding sites.

USA Today—“Cases of dengue fever have increased significantly across Brazil this year, with most of them reported in Sao Paulo state. Brazil’s health ministry said there have been more than 460,000 cases of the disease in the country in 2015, which accounts for almost 5,000 cases a day. More than 130 people have died so far this year, the ministry said.”

Empty Ebola Clinics in Liberia Are Seen as A Misstep in U.S. Relief Effort

After spending hundreds of millions of dollars and deploying 3,000 U.S. troops to build Ebola treatment centers (E.T.C.) in Liberia, the facilities have largely sat empty. Only 28 Ebola patients have been treated at the 11 E.T.C.s built by the U.S. military. Nine of the centers never had a single Ebola patient. Looking back, the emphasis on building E.T.C.s had far less of an impact than the “inexpensive, nimble measures taken by residents to halt the outbreak.”

The New York Times—“Had the Americans and other donors been more flexible, critics and some officials contend, the money could have been put toward rebuilding Liberia’s shattered health care system—or backing the efforts of local communities—instead of focusing on treatment centers that would scarcely be used.”

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Image Credit: Dvortygirl