Pandora Report 11.11.2016

The U.S. Election has concluded and whether your candidate is now our presidential elect or you’re just glad it’s all over, here’s something to celebrate – President Obama signed an executive order last week, cementing the GHSA as a national, presidential-level priority. Commitment to GHSA and fighting outbreaks on a global scale is a huge step forward to combating the health crises we’ve seen and will continue to battle in the future. Since researchers recently debunked the myth of Gaëtan Dugas as a primary source for HIV/AIDS in the U.S., check out more stories regarding the misunderstood “patient zero”.  World leaders are starting to realize that the antibiotic clock is ticking away.

Trump and the Issues Within Science
Donald Trump is the new president elect, but where does he stand on issues like Zika? Here’s a compilation of sources that cover his comments and plans for some of the top issues in science. NPR is looking at his comments on global health and humanitarian aid, while some are trying to figure out what Trump’s administration will mean for them and the need for a transition team tutorial. STAT is asking five questions regarding what the Trump administration will mean for science. Sources close to the Trump campaign have stated that two of the “best-known climate skeptics will lead his U.S. EPA transition team“.

It’s Time to Modernize the BWC 
GMU Biodefense graduate program director and professor, Gregory Koblentz teamed up with Filippa Lentzos to discuss why it’s so important for the BWC to modernize. They tackle the reality that while the convention isn’t failing, it’s definitely not flourishing. Despite its dedication to ban a whole class of weapons, the BWC is a somewhat toothless dog. “It lacks a dedicated forum to assess treaty implications of scientific advances, a robust institutional capacity, organized means of helping member nations meet their obligations, provisions for verifying compliance, and an operational role to respond in cases of a serious violations. The upcoming review conference provides a welcome opportunity to begin rectifying some of these shortcomings.” Koblentz and Lentzos point to the consistent challenges of science and technology reviews. Despite a rapidly evolving industry, the BWC hasn’t been able to keep up and maintain an international forum for the debates that are needed. Lagging behind the biotech times means the BWC is running the risk of irrelevance, not to mention the slow shift from the convention towards UNSCR 1540. In this climate, it doesn’t help that there is an even greater need for transparency. Biodefense programs have surged the last two decades, which means that transparency is increasingly important to ensure these programs aren’t biosecurity risks or being perceived as threats and becoming justifications for initiated offensive programs. The reform process is pivotal and this includes organizing a review of relevant S&T developments more systematically, renewing the mandate of an implementation unit, and setting up an Open-Ended Working Group on Providing Reassurance to encourage transparency and engagement in peer review exercises. “The Eighth Review Conference provides an opportunity to revitalize the bioweapons treaty by taking concrete actions to expand its relevance, enhance its capacity to review developments in science and technology, and strengthen the confidence of nations in the peaceful intentions of their fellow treaty members.”

RevCon began this week in Geneva and you can catch the U.S. opening statements by Thomas Countryman, Acting Under Secretary for Arms Control and International Security. You can also read Mr. Kim Won-soo’s remarks as High Representative for Disarmament Affairs. The International Committee of the Red Cross (ICRC) vice president, Christine Beerli, has also commented, noting that “States Parties should not become complacent; it remains their collective and individual responsibility to ensure that the treaty is implemented effectively. Over the past five years of annual meetings, a great deal of information has been shared and many proposals have been made on how to implement the treaty and improve its effectiveness. Disappointingly, however, there has been little collective agreement.” RevCon experts will also be focusing on new threats that may arise from technology. Guinea just became the 178th State Party to the BWC!

armas-biologicas-2NSABB Meeting on DURC and Other Hot Topics
On Friday, the National Science Advisory Board for Biosecurity (NSABB) hosted a call to review policy updates, new activities, updates from the working group on institutional oversight of the life sciences DURC policy stakeholder engagement, and updates from the Blue Ribbon panel that is currently reviewing the 2014 NIH variola incident. The conference call was fast-paced but covered substantial ground – most of it you can find on the Power Point slides. The policy updates focused on initiatives to strengthen biosafety/biosecurity stewardship. The 2016 NSABB report recommended additional, multidisciplinary evaluation prior to funding decisions and appropriate, ongoing oversight if funding were given to projects. It was noted that this is a particularly exciting time for science as we’re seeing so many advancements in human health, however the applications of these technologies are testing the oversight and policies we currently have in place to ensure science is performed safely (and securely). While they may or may not all be under the purview of the NSABB, the emergence of CRISPR and evolution of genomic sequences and gene drive techs, and abilities to create next gen of chimeras – are all examples of biotech that are evolving very rapidly and we may need to rethink how they fit our current policy and framework. NSAAB has been a part of the DURC conversation with policy focus on research responsibilities and institutional approaches. NSABB is also working on how to increase and approach stakeholder engagement in DURC polices. There were several listed strategies and topics, ranging from regional meetings at universities or panel sessions at conferences like ASM and ASV. The biggest focus was on getting dialogue and metrics across institutions, not to mention the need for feedback to evolve an objective oversight system. The Blue Ribbon panel is working on the review of the NIH variola incident but they did note that the event was handled very well and while there were obvious gaps, they were all addressed and that the interagency work between the FBI, NIH, and CDC went very smoothly.

Sverdlovsk, Three Mile Island, and Government Oversight of Biological Safety
Greg Witt is talking to us about government oversight of biological research and the lessons learned from the Three Mile Island nuclear accident (did I mention that Greg is a nuclear systems engineer?). Pointing to the biosafety failures that have happened recently (remember that time a Pasteur Institute employee improperly took MERS samples on a commercial airline???), Greg pulls together the pieces to paint a bigger mosaic of systemic failure to properly control biological agents. Pointing to similarities between these events (they even happened days apart) he notes that “both were caused, in large part, by errors in maintenance: at Sverdlovsk, technicians neglected to replace an exhaust system filter, while at TMI, staff had isolated an auxiliary feedwater pump during routine maintenance in violation of US Nuclear Regulatory Commission (NRC) rules.”

The Glamor of Bad Science02-ebola-w529-h352
Yours truly is talking about the disparaging addiction we have to dramatic science. I’m a fan of any movie that involves an outbreak, but the truth is that an overwhelming majority of these films depict infectious disease outbreaks so outrageously and dramatically, they have become anti-science. After watching the latest, Inferno, it became increasingly apparent that we’ve created a false threshold for science, specifically infectious diseases, in film. By painting the picture of diseases and outbreak response like that of Outbreak, I Am Legend, and more, we’re creating an increasingly de-sensitized culture. The result of this de-sensitization means that it takes a lot more for people to take infectious disease outbreaks seriously in real life. It’s not a genetically engineered airborne organism that will make flesh rot? Meh – not that big of a deal. Our love of bad infectious disease science in film and television could easily create a culture of poor public health support.

Ebola Was Just the Beginning…Are We Ready?
Peter Piot, Director of the London School of Hygiene and Tropical Medicine, is highlighting the realities that we simply aren’t ready for the next big virus epidemic. Piot discusses his work during the early days of Ebola in the 1970s, pointing to the challenges of attempting to figure out a novel virus while trying to put out the fires of an outbreak. Describing the 2014 outbreak as a perfect storm, he notes that the WHO response was too slow to act. The globalization of our interconnected world has made the capabilities of an outbreak much greater than 50 years ago. “Piot also believes there will be a ‘Big One’, a big influenza, similar to the likes of the Spanish Flu in World War One and we’re not quite ready for it. Yet. ‘Are we ready?’ Piot asked. ‘A little bit better than a few years ago but we’re not yet up to the job. We can’t afford to wait but we have a plan, and that’s the good news. The world has learnt from the problems of mobilisation around Ebola and we are now in a better situation; there is better technology to allow for more rapid diagnosis’.” Piot stresses the importance of investment in infrastructure, stronger global governance, and vaccine development incentives.

All Things Zika
The Florida Health Department has released their Zika updates here. PAHO has recommended that Bolivian women delay pregnancy to avoid Zika. “Fernando Leanes, PAHO representative in Bolivia, said at a press conference that it was one of several advised measures to avoid the proliferation of microcephaly cases. ‘The epidemic of Zika, from what we have seen in other countries, will have a rise and fall in Bolivia. Therefore, there are options such as delaying the decision to get pregnant in areas where Zika is spreading. This will avoid the dreaded microcephaly and the complications it represents,’ explained Leanes.” An $18 million plan was just announced to release Zika-resistant mosquitoes into urban areas of Colombia and Brazil.  “A swarm of Aedes Aegypti mosquitoes–the species that transmits dengue, yellow fever, chikungunya and Zika, have been modified to carry a bacterium called Wolbachia pipientis, which inhibits their ability to spread the viruses. Scientist released these ‘good mosquitoes’ in Brazil as part of a successful international program called ‘Eliminate Dengue’.” Many researchers are wondering why Colombia has had such few Zika-associated birth defects. They are the second largest outbreak in the world, yet have much fewer cases of microcephaly than Brazil. Researchers have noted that adult women in Puerto Rico were significantly more likely to develop Zika than men. The CDC has reported 4,175 cases of Zika in the U.S. as of November 9th, 2016.

Stories You May Have Missed:

  • How Trauma Explains Civil War– Don’t miss this event today at GMU’s Arlington campus, Founders Hall, Room 602. Eric Goepner will be discussing his research as to why “hurt people hurt people” and hypothesizing that a population’s prior traumatization predicts future civil war onset.
  • Searching for Ebola’s Hideout – The recent ebola outbreak is over, but this doesn’t mean the disease is gone. In fact, ebola is known for hiding out..so where has it gone? Leigh Cowart and other researchers are looking to stop future Ebola outbreaks by finding its hiding spot. “Such a long-term host, the quiet refuge of a pathogen, is known as a reservoir species. If a reservoir species is Ebola’s safe house, we are its luxury retirement property, a place for it to live out its last days with a bang. The trouble is that we aren’t sure where the safe house is. If we are going to be vigilant against Ebola’s re-emergence, we need to find it.”
  • The UK Forms Special Outbreak Response Team– with a five-year £20m funding, the UK is setting up a specialist team of health experts who will be able to respond to outbreaks around the world within 48 hours. “Public Health England will run the project with the London School of Hygiene and Tropical Medicine. Duncan Selbie, chief executive of Public Health England, said: ‘Speed is key in tackling infectious disease and with this new capability we can now deploy specialists anywhere in the world within 48 hours, saving and protecting lives where an outbreak starts and helping to keep the UK safe at home.'”

 

Pandora Report 10.14.2016

The Biological Threats in the 21st Century book launch is hours away and we’ll be live tweeting the event, so make sure to follow us on Twitter @PandoraReport. The event will also be recorded and we’ll let you know when you can watch in case you aren’t able to attend. Check out how virus hunters are using epigenetics and big data to map epidemics and trace the origins of viral outbreaks.  You can also read the WHO’s Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines here. The global CRISPR-Cas9 Market Outlook 2022 is now available here.

Biotechnology: An Era of Hopes and Fears
GMU Biodefense PhD alum, Douglas R. Lewis, writes for Strategic Studies Quarterly on the increasing pace of biotechnology capabilities. Lewis notes that while this isn’t a good or bad thing, it’s crucial to acknowledge that as capability and knowledge grows, so does the potential for bioweapons development. “Every new treatment represents a potential new weapon”. Advances like the manipulation of viral genetics allow researchers to create chimeric viruses that often bring out fears like those following the publication of The Cobra Event. While there was substantial effort during the height of the bioweapons development renaissance, it is unknown if programs, like the Soviets, succeeded. It’s important to remember that “while viral chimeras are a routine tool in laboratory practice, they are becoming common in therapeutic roles, for instance in vaccine production. A live, nonattenuated vaccine constructed from Eastern equine encephalitis (EEE) virus and Sindbis virus has demonstrated the ability to protect primates from EEE.” Despite these advances, we often create at a faster rate than we learn or question. Understanding the genetic components of diseases allows researchers to mimic miRNA’s behavior and to make rapid advances in CRISPR-Cas9, but many are pointing to the slow rate of cautionary learning. Every advancement allows us to understand the world of genetics and medicine that much better, and the deeper we go, the more we’re able to develop extremely specific treatments. “Effective weaponization and large-scale employment of these new capabilities as a weapon would require a dedicated effort by a state sponsor. It is one thing for a medical provider to inject an experimental therapy into a patient but a much more difficult matter to deliver that substance simultaneously to thousands of people in a diverse environment.” Lewis emphasizes that the goal of his work is to inform the biodefense community of the evolving nature of biotechnology, emphasizing the need for continued support within the U.S. biodefense program. Keeping up with the biotechnology revolution is no easy task, however biodefense efforts must be as nimble as the science they seek to monitor.

Mighty Taco Outbreak logo-mighty-taco
Not the tacos! Sadly, at least 160 people have been sickened after eating at Mighty Taco locations in New York. The culprit? Refried beans. Public health officials are working with the state’s health and agriculture departments to identify the organism causing the illnesses. We’ll keep you updated as more information becomes available, but if you live in the New York area and frequent this taco establishment, rest assured they have thrown away the specific lot numbers of refrained beans.

GMU Biodefense MS Program Open HouseBiodefense_133x400
Don’t miss the next biodefense MS open house on October 19th! We invite you to attend an open house to learn more about the Schar School of Policy and Government. The session will provide an overview of our master’s degree programs, an introduction to our world-class faculty and research, and highlights of the many ways we position our students for success in the classroom and beyond. Our admissions and student services staff will be on hand to answer your questions. Check out the next MS info program on Wednesday, October 19: 6:30pm-8:30pm- Arlington Campus, Founders Hall, Room 126

 

Mayaro – Why Scientists Are Keeping An Eye on A Little-Known Virus 
Since the Ebola and Zika outbreaks, the concept of emerging infectious diseases is becoming much more well known and discussed. Mayaro disease may just be the next hot topic. Similar to chikungunya and spread by a tree-dwelling species of mosquito that is typically found in South America, this virus just popped up in a young boy in rural Haiti. While this may be an isolated case, it’s important to learn the lessons of past emerging infectious disease outbreaks and just how quickly things can spiral out of control. Moreover, since Mayaro is so similar to chikungunya and dengue, it may be under diagnosed. “The newly detected case of Mayaro in Haiti needs to be seen as a pattern of waves of viruses moving across continents, merging, changing and evolving,’ Morris says. ‘It reinforces the idea that there is a constant battle between humans and the microorganisms that infect humans.’ Diseases frequently emerge and re-emerge, says Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the National Institute of Health. And one case doesn’t necessarily indicate an imminent epidemic. But Mayaro is worth keeping an eye on.” Researchers are now keeping an eye on at several mosquito and tick-borne viruses  – Mayaro, Rift Valley Fever, Crimean-Congo Hemorrhagic Fever, and Usutu.

International Infection Prevention Week
screen-shot-2016-09-17-at-6-13-12-pmHelp stop the chain of infection by celebrating Infection Prevention week from October 16-22! Believe it or not, you don’t have to be a healthcare worker to stop the spread of germs. On antibiotics? Take them as recommended and finish your dose! Visiting the hospital or being admitted? Ensure you and your visitors wash their hands and avoid visiting ill patients if you’re sick. There’s a lot we can do to prevent the spread of infection and fight the battle of the bug, so make sure to check out how you can get involved!

Weekly Zika Updates
Houston-based Legacy Community Health Services is frustrated over lab delays in Zika testing. The Legacy CMO has stated that pregnant women have had to wait as long as a month to know if their pregnancies are at risk as the turnaround time from the state public health department is so long. Public health departments in Zika-hit places are struggling to meet the testing demands, which is causing more of a delay in surveillance and diagnosis. The Florida Department of Health has released their Zika updates. Despite aiding the fight against the virus, the FDA won’t be getting any of the designated Zika funds. A new study is shedding light on the evolution and spread of Zika – “Their analysis revealed two distinct genotypes of the virus, African and Asiatic, and two separate clades (biological groupings that include a common ancestor and all the descendants of that ancestor). Clade I represented African gene sequences and Clade II, sequences of Asiatic and Brazilian origin. The Brazilian sequences were found to be closely related to a sequence from French Polynesia. This lends support to the hypothesis that the virus might have been introduced to Brazil during the Va’a World Sprint Canoeing Championship in Rio de Janeiro in 2014, which included a team from French Polynesia, rather than the World Cup in which no teams from Pacific countries participated.” Many are speaking about the experience of having a child with Zika-related microcephaly and the complications associated with the infection.  The CDC has reported 3,9836 cases of Zika in the U.S. as of October 12th.

Stories You May Have Missed:

  • Human H5N1 Cases in Egypt– Egypt has reported 356 cases of avian influenza A (H5N1) since early 2006, including 121 deaths, however they’ve already seen 10 cases in 2016. Unfortunately, four of these patients have died. The cases are concerning many international public health officials as the MOH has been largely silent, which may point to limited surveillance and testing, but also minimal reporting of cases on an international level.
  • The Case of the Traveling Surgical Scrub– We’ve all seen medical professionals in scrubs ordering a coffee or smoking a cigarette outside the facility. Sadly, this common practice is pretty gross from an infection control standpoint. While scrubs aren’t considered PPE, it’s still good to avoid taking them outside of the operating room. Fomites love to travel on clothing, which has led many physicians to avoid wearing ties and re-think the white coat habit. New guileless from the American College of Surgeons are pushing for scrubs to be changed once a day for this very reason – let’s  keep the OR as sterile as possible!
  • Modeling the Economic Burden of Adult Vaccine-Preventable Diseases in the U.S. – It’s easy to forget the importance of vaccination and boosters in adults however, a recent study revealed just how costly vaccine-preventable diseases in adult are. The researchers “estimated the total remaining economic burden at approximately $9 billion (plausibility range: $4.7–$15.2 billion) in a single year, 2015, from vaccine-preventable diseases related to ten vaccines recommended for adults ages nineteen and older. Unvaccinated individuals are responsible for almost 80 percent, or $7.1 billion, of the financial burden.”

Pandora Report 9.23.2016

Welcome to the first few days of Fall 2016! We need to really ramp up our investment in vaccines – an ounce of prevention is worth a pound of cure. Doctors in Saskatchewan are imploring the province to declare a medical state of emergency over a surge of HIV/AIDS cases. Johns Hopkins University is currently working on a study to assess why healthcare workers catch the flu – what’re your thoughts? Poor PPE use, isolation precautions, and/or hand hygiene is my guess. New research from the World Bank shows that antibiotic resistance is likely to increase poverty and by 2050, could cause global economic damage on par with the 2008 financial crisis. The Blue Ribbon Study Panel on Biodefense has received a $1.3 million grant to continue work on assessing American biodefense systems, informing policymakers, etc. Before we start with the latest in global health security, you can now access (for free!) the Global Health Impacts of Vector-Borne Diseases workshop summary here.

The Uncertain Future of Plum Island 
Established in 1945, Plum Island Animal Disease Center (PIADC) (Orient Point, NY), “has served as the nation’s premier defense against accidental or intentional introduction of transboundary animal diseases (a.k.a. foreign animal diseases) including foot-and-mouth disease (FMD). PIADC is the only laboratory in the nation that can work on live FMD virus (FMDV). The lab and its staff of nearly 400 employees provide a host of high-impact, indispensable preparedness and response capabilities, including vaccine R&D, diagnostics, training, and bioforensics among others.” Not immune to controversy or a theme in horror movies, Plum Island is a research facility that hosts BSL-2, BSL-3 Enhanced, and Animal Biosafety Level 3 and Biosafety Level 3 Agriculture laboratories and animal research facilities that maintain highly restricted access and trained security professionals. The nostalgia of Plum Island is fast approaching as the research center is set to be closed within the next decade. The research campus will move to Kansas and the 840-acre island is up for sale. “Located 100 miles east of New York City, with sweeping water views, the island has already drawn unsurprising interest from local real estate agents and developers, including, yes, Donald J. Trump. Many people in the area, however, want the island preserved as a nature sanctuary or perhaps a park. In July, a coalition of environmental groups and activists filed a federal lawsuit to stop the sale, and there is a similar legislative push in Congress.” Since its inception and through its new ownership in 2003, (when DHS took it over) the biggest concern of Plum Island has always been containment as the infectious livestock samples and animals could introduce diseases, like food-and-mouth disease, to a susceptible population. The facility takes great care to mitigate any risk through “stringent security clearances and background checks, the boiling of all water discarded from the lab and the requirement that anyone who works within the biocontainment lab must shower twice before leaving. As for the cattle, pigs and other animals used for vaccine and other kinds of testing, they are kept in indoor, secured living quarters, said Dr. Luis L. Rodriguez, who leads research at the center’s laboratories.” In the event a deer should swim onto the island, it’s killed and immolated. Aside from the “Island of Dr. Moreau” vibe that is often felt when discussing the island, it has water views and sandy beaches that are met with a green terrain. While the future of the island is up in the air, the zoning stipulates that it must be reconstructed for similar use (i.e. research). Any takers?

Don’t Miss the Biological Threats in the 21st Century Book Launch!
screen-shot-2016-09-12-at-8-00-42-pm
On October 14th, join us in celebrating the book launch of Biological Threats in the 21st Century! Biological Threats in the 21st Century introduces readers to the politics, people, science and historical roots of contemporary biological threats through rigorous and accessible chapters written by leading scholars and supplemented by expert point-of-view contributions and interviews. The book launch will feature a panel discussion on the threat of biological weapons and the role of scientists in bioweapons non-proliferation and disarmament. The event is free and open to the public. Lunch will be available beginning at 11:45 AM so please RSVP. Attendants will also be able to pick up the book at a 15% discount.

Screen Shot 2016-04-21 at 1.28.57 PMGMU Biodefense Graduate Program Informational Videos
Curious about a graduate degree in biodefense but unable to attend an information session? We’re happy to show off our new informational videos on both our MS and PhD biodefense programs at GMU. Check out what students are saying about our MS programs (we have both an online and an in-person tract) and our PhD program. You’ll also get to hear from biodefense guru and graduate program director, Dr. Koblentz, throughout the videos!

Bioresearch Labs and Inactivation of Dangerous Pathogens Hearing                                   

The Committee on Energy and Commerce, Subcommittee on Oversight and Investigations will be holding a hearing today at 9am regarding bioresearch labs and the inactivation of dangerous pathogens. While witnesses are by invitation only, the hearing webcast will be available here – don’t miss it! You can also read a recent GAO report on high-containment laboratories: improved oversight of dangerous pathogens needed to mitigate risk. 

The Global Implications of Antibiotic Resistance
I love a good zombie movie like the next person, but where are the horror movies about antibiotic resistance? Show me a film that depicts the global threat of losing all effective antibiotics – that is a real horror movie. The UN General Assembly held a high level meeting on Wednesday about the growing threat of antimicrobial resistance (AMR). Despite increasing surveillance and high-level attention to the rise of the resistant bugs, it will take more than the efforts of a few countries. We’ve passed the golden age of antibiotic development and the “pipeline of new antibiotics has been running dry”. Colistin-resistant bacteria continue to sporadically pop up, highlighting that once again, germs know no borders and are skilled in the art of travel. Hopefully, with the recent UN General Assembly meeting, it will send a clear message that the threat of antibiotic resistance is being taken seriously and for more world leaders to really hone in their efforts for surveillance and prevention through the GHSA. Sadly, a recent study found that antibiotic usage hasn’t changed in hospitals, despite the growing threat of AMR. Researchers looked at patient discharge records in over 300 US hospitals between 2006 and 2012 and “found that 55.1% of patients discharged received at least one antibiotic during their stay, with little change in that proportion between 2006 and 2012. The overall rate of antibiotic use for all study years was 755 days of therapy per 1,000 patient-days, a rate that also saw little change over the period of the study. But the study also showed significant increases in the use of carbapenem antibiotics, third- and fourth-generation cephalosporins, beta-lactam/beta-lactamase inhibitor combination antibiotics, tetracyclines, and vancomycin.”

Next Generation Global Health Security Network Webinar – Our Antimicrobial Anthropocene: UNiting against Pan-Epidemic AMR
As you know, a key component of responding to (and preparing for) outbreaks is the ability to treat them. But how can we make sure that the drugs we have to treat diseases will work? How can we combat the growing trend of antimicrobial resistance? In line with the recent high-level meetings by the Presidential Advisory Committee (see here) and the UN, the Next Generation Global Health Security Network is pleased to present the first of an ongoing series of webinars, this one focused on Antimicrobial Resistance (AMR). These webinars are intended to provide unique learning opportunities for global health security professionals through educational sessions about important GHS topics and situate emerging issues for a global health audience.  Please join the event on Tuesday, September 27 from 6:00-7:00pm EST as the Next Generation Global Health Security Leaders Network and CRDF Global host a webinar by Dr. Dan Lucey titled “Our Antimicrobial Anthropocene: UNiting against Pan-Epidemic AMR”.  There will also be limited in-person space for those in the DC metro area who wish to attend.  If you wish to attend in person, please RSVP by email (nextgenghsa@gmail.com)

Your Weekly Dose of Zika News
The Zika virus outbreak has pointed out several international challenges when it comes to infectious disease outbreaks – funding, vector control, long-term health effects, and international events. Sandro Galea points to the poet John Keats as a potential role model for how we should approach such events. Trained as a surgeon, Keats had a solid background in the scientific method, however the quality he “emphasized was not the scientist’s finely tuned analytic instrument, but the ability to exist comfortably amidst uncertainty and doubt.” Galea notes that the Zika outbreak is a prime example of how scientists should start thinking more like poets, living in the space of inevitable ambiguity and the new norm of the grey area. Here is the ECDC’s epidemiological update on Zika. The CDC is ramping up testing support in Florida to aid in rapid diagnostics. A recent study published in the Lancet points to a low risk of sexual transmission and questions the sustainability of Zika transmission without the presence of a vector. The CDC is reporting 3,358 cases of Zika virus in the US as of September 21st. Of these cases, 43 are locally acquired related to mosquitoes.

Stories You May Have Missed:

  • Are We Prepared For Another Ebola Outbreak? In response to last week’s Ebola and Zika: Cautionary Tales article, John LaMattina is digging into the realities of R&D. “Actually, a check of clinicaltrials.gov lists 71 studies ongoing in Ebola, the majority of which involve studying novel vaccines or drugs in humans. Furthest along appears to be Merck with planned regulatory filings for its vaccine in 2017.” He notes that while Ebola may not be making headlines, that shouldn’t be translated into a total lack of preparedness for another outbreak. You can also read the latest article in NaturePublic Health: Beating Ebola.
  • Glory in the Guts- If you’re a fan of Mary Roach’s books (Stiff, Spook, etc.), you’ll love hearing what GMU Biodefense MS student, Greg Mercer, thinks of her latest book, Grunt. Roach’s latest book looks at the life of soldiers and how the military keeps them alive. “The only gun that interests her is the one that fires chicken carcasses at military aircraft to test their birdstrike resilience. Roach isn’t squeamish, though. She participated in a training simulation as a victim of smoke inhalation burns, experienced a live-fire demonstration of the importance of hearing protection, and endured a treadmill trip in the 104-degree “cook box” to witness just how easy it is to become dehydrated while lugging 80 pounds of gear.”
  • Global Capacity for EID Detection – In the most recent CDC Emerging Infectious Disease online report, researchers are evaluating the global improvements of disease detection and communication during 1996-2014. “Improvement since 1996 was greatest in the Eastern Mediterranean and Western Pacific regions and in countries in the middle HDI quartiles. However, little progress has occurred since 2010. Further improvements in surveillance will likely require additional international collaboration with a focus on regions of low or unstable HDI.”

Pandora Report 9.16.2016

Is it time to outsource key tasks out of the WHO and into more capable agencies? On Monday, the U.S. carried out a massive airstrike on a suspected ISIS chemical weapons facility in Mosul, Iraq. Sri Lanka has made history by being declared malaria-free after three years since its last case. Sri Lanka had previously tried to eradicate malaria over fifty years ago, but the effort was met with failure and is frequently cited by malaria experts. Do you subscribe to the “five-second rule” when it comes to your food? You may want to give it a second thought as Rutgers researchers have recently disproven the notion – sadly, cross-contamination can’t be avoided in most cases. The CDC has added Bacillus cereus Biovar anthraces to the list of Tier 1 Select Agents.

GMU Biodefense Graduate Info Sessions
In case you missed last night’s MS Open House in Arlington, we’ve got plenty more graduate program information sessions. GMU will be hosting several more events this Fall, so make sure not to miss one! The next MS information session (for both in-person and online programs) is on Wednesday October 19th, 6:30pm in Founders Hall, room 126. If you’re looking at a PhD in biodefense, come to our information session on Wednesday, October 12th, from 7-8:30pm, at the Johnson Center in the Fairfax Campus, room 334. From Anthrax to Zika, we cover all the biodefense topics and applications in our information sessions.

Biological Threats in the 21st Century Book Launch!  
On October 14th, join us in celebrating the book launch of Biological Threats in the 21st Century! Biological Threats in the 21st Century introduces readers to the politics, people, science and historical roots of contemporary biological threats through rigorous and accessible chapters written by leading scholars and supplemented by expert point-of-view contributions and interviews. The book launch will feature a panel discussion on the threat of biological weapons and the role of scientists in bioweapons non-proliferation and disarmament. The event is free and open to the public. Lunch will be available beginning at 11:45 AM so please RSVP. Attendants will also be able to pick up the book at a 15% discount.

Identifying Future Disease Hot Spots
Check out the latest RAND report in which researchers are asking which countries might be particularly vulnerable to infectious disease outbreaks and how the U.S. can help support these countries to better prepare and respond to public health events. Pulling from a wide variety of literature and data, “authors created an index for identifying potentially vulnerable countries and then ranked countries by overall vulnerability score.” Researchers looked at the 25 most-vulnerable countries, which include the “disease belt” in the Sahel region of Africa. Of the 25 noted countries, 22 are in Africa, and the remaining are Afghanistan, Yemen, and Haiti. “Conflict or recent conflict is present among more-vulnerable countries. Seven of the ten most-vulnerable countries are current conflict zones. Of the 30 most-vulnerable countries, 24 form a solid, near-contiguous belt from the edge of West Africa to the Horn of Africa in Somalia — a disease hot spot belt. Were a communicable disease to emerge within this chain of countries, it could easily spread across borders in all directions.” The 25 least-vulnerable countries were found to be in Europe, North America, and Asia-Pacific. The least-vulnerable countries were found to have larger medical systems and expenditures, better health indicators, less corrupt and more stable governments, better human rights, and often technological sophistication.

Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) 
You can join (in listen-only) this teleconference and webcast on Monday, September 19th, to gain further insight into the battle of microbial stewardship. “With participation of Member States, non-governmental organizations, civil society, the private sector and academic institutions, the primary objective of this pubic meeting is to summon and maintain strong national, regional and international political commitment in addressing antimicrobial resistance comprehensively and multi-sectorally, and to increase and improve awareness of antimicrobial resistance.”

Ebola & Zika: Cautionary Tales 20988_lores
In the latest issue of Science, Michael T. Osterholm discusses the challenges of combating infectious disease outbreaks and the struggles to respond with vaccine development. Osterholm points to the need to drive development and funding mechanisms in coordination with surveillance of emerging infectious diseases (EID). Upon the indication that an EID is bubbling up, it would be prudent to have vaccines (even if they’re not licensed yet), ready for large trials. Moreover, the looming threat of EID’s should be the best motivator for developing candidate vaccines. “The handwriting is on the wall regarding the current Zika outbreak in the Americas. High human infection rates in the major impact regions, caused by virus-carrying mosquitoes and human sexual transmission, will continue for several more years. Eventually, the number of cases will drop as more of the community develops immunity. Zika vaccine trials in the Americas may be too late to be tested on the current high number of cases.” Pointing to the Coalition for Epidemic Preparedness Innovations (CEPI), he emphasizes the need to fill the vaccine preparedness hole. Current practices are slow and on an “as-needed” basis, but the truth is that we already have the incentives and EID presence to make the push towards correcting the insufficient process.

Weapons of Mass Destruction: A Dialogue with Students
The UN Security Council 1540 Committee and the UN Office of Disarmament Affairs collaborated with the Stimson Center to create an international essay contest for students. On September 30th, from 10:30am-4pm, they will be hosting an on-the-record discussion regarding the proliferation of WMD’s and honoring the winners of the essay contest.  The winners will be announced and some will even be presenting their ideas at this event. “The goals of the competition were to involve the younger generation in understanding and addressing the important issue of proliferation of Weapons of Mass Destruction (WMDs), i.e., chemical, biological and nuclear weapons, and to solicit innovative student approaches to implementing U.N. Security Council Resolution 1540 (2004) to support the Council’s Comprehensive Review of the resolution this year.” Panel discussions will include speakers such as Dana Perkins (Senior Science Advisor, U.S. Department of Health and Human Services, former 1540 Expert), Will Tobey (Senior Fellow, Belfer Center for Science and International Affairs, Harvard University), Craig Finkelstein (Coordinator for the Working Group of the 1540 Committee on Transparency and Outreach), and more! The event will be at Harvard University’s Tubman Building in Cambridge, MA. You can RSVP for all or part of the event here.

Latest Zika News
As more outbreaks occur, the question is quickly becoming – should government officials “allocate resources to support the advancement of traditional drugs and vaccines or emerging broad-spectrum therapies?” If you’re a Miami Beach resident, free Zika testing is now being offered at the Miami Beach Police Department. Utah is keeping public health investigators on their toes with a mystery Zika case.  CDC officials are investigating a man who contracted Zika but was not exposed via a mosquito or sexual contact. Recently published in the CDC’s MMWR, “Patient A was known to have had close contact (i.e., kissing and hugging) with the index patient while the index patient’s viral load was found to be very high,” CDC researchers said in the report. “Although it is not certain that these types of close contact were the source of transmission, family contacts should be aware that blood and body fluids of severely ill patients might be infectious.” If you need a laugh, the Daily Show’s Trevor Noah addressed Zika in a recent episode. Singapore is quickly becoming a Zika hot spot, leaving many researchers stumped about the strain. Experts are suspecting a significant mutation that ramped up the virus’s capability to spread. “What is most intriguing is the question as to whether some mutation has occurred in the Zika virus to make it more transmissible by the Aedes albopictus mosquito—this would be analogous to what happened with chikungunya,” said Paul Anantharajah Tambyah, the secretary-general of the Asia Pacific Society of Clinical Microbiology and Infection. The CDC has reported, as of September 14th, 3,176 cases of Zika virus in the U.S.

Stories You May Have Missed:

  • Biodefense in the Age of Synthetic Biology – the National Academy of Sciences (NAS) has a new contract with the U.S. DoD’s Office of the Deputy Assistant Security of Defense, Chemical, and Biological Defense (NCB/CBD) to assess the nature of biothreats given the innovations within synthetic biology. “NAS will appoint an ad hoc committee to study the manipulation of biological functions, systems, or microorganisms resulting in the production of a disease-causing agents or toxins. The study will start with development of a strategic framework to guide an assessment of the potential security vulnerabilities related to advances in biology and biotechnology, with a particular emphasis on synthetic biology.”
  • Evidence of Airborne H5N2 Found in Distant Barns – a recent study found H5N2 highly pathogenic avian influenza in air samples collected “inside, immediately outside, and up to 70 meters from affected barns during the 2015 outbreak in the Midwest”. The researchers also found H5N2 RNA in air samples collected 1 kilometer from the infected barns. “A total of 26 of 37 (67%) sampling events collected inside and 18 of 40 (45%) collected at 5 meters were positive for H5N2. Sampling at distances from 70 meters to 1 kilometer resulted in about 2% positives and 58% suspected findings. The researchers found HPAI H5N2 viruses in particles up to 2.1 micrometer in diameter.”
  • History of the War on Superbugs – The war on antibiotic resistance may seem new, but it’s actually been waging on for over 60 years. Even Alexander Flemming knew the potential for antibiotic misuse and resistance, noting that “There is the danger that the ignorant man may easily undergoes himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” Sadly, even the identification of penicillin-resistant germs didn’t scare people, simply because it was a time of antibiotic renaissance – developments were happening all around us and that calmed the fear that should have been brewing.

Pandora Report 9.2.2016

Welcome to September! Let’s start the month off with a yellow fever timeline and the history of this misunderstood disease. If a gin and tonic is your go-to drink, you’ll be pleased to hear it was actually born to combat malaria. Many are questioning if Syria has retained a stockpile of chemical weapons, pointing to continued contradictions and discrepancies regarding inventories and more. While the topic of sanctions is being debated, findings from recent international reports determined that both the Syrian government and ISIS were responsible for chemical attacks in 2014 and 2015.  On Tuesday, the French ambassador to the UN pushed for unified action at the Security Council, emphasizing that within the report, the Assad regime and the Daesh terrorist group have been responsible for several attacks.

Next Gen Global Health Security Agenda (GHSA) Happy Hour
Please join the newly elected Coordinator, Jamechia Hoyle, for a happy hour and networking event. Come engage with a network of talented Global Health Security professionals. Share ideas, connect, and learn how to join the world of global health security! You can RSVP to nextgenghsa@gmail.com by September 5th – the event is Friday, September 9th, from 5-7pm, at District Commons DC, 2200 Pennsylvania Avenue Northwest, Washington, DC 20037.

Is Accessible Synthetic Biology Making DIY Bioweapons More Likely?
The biotech industrial revolution and advances with CRISPR-Cas9 have raised many red flags about the risk for do-it-yourself (DIY) bioweapons. Dr. Koblentz and several others discussed the role of gene-editing technologies in the UN Security Council meeting last week, with General-Secretary Ban noting that these advances have made the production and application of WMD’s easier. These advances have the potential to move the playing field away from solely state-sponsored or university-level programs, to lower levels of necessary tacit knowledge. The dilemma surrounding dual-use technologies of concern and biosafety failures compound these concerns – are we becoming more and more vulnerable to intentional or accidental events? Antibiotic resistance is also a growing dilemma, and not just what we’re facing now, but also the risk that synthetic biotechnology could make the development of a highly resistant organism possible for malicious persons. The tricky part is combating the risk for mis-use while not stifling innovation – any takers? The growing threat potential of synthetic biology has many commenting that “Zika is just the first front in the 21st century biowar”. We so easily think nuclear or cyber warfare when it comes to large-scale threats, but the truth is that biological threats have been looming in front of us for years. James Stavridis notes that there three key components to preparing for the biological revolution. “First, we need an international approach that seeks to limit the proliferation of highly dangerous technologies (much as we try to accomplish with nuclear weapons) and fosters cooperation in the case of contagion or a transnational biological threat.” Second, U.S. government interagency practices need to strengthen their capacity to address both scientific advances and security threats from the biological research sector. Lastly, there must be private-public cooperation. He points to the need for a stronger marriage between government and academia, but in such a manner that doesn’t deter innovation. In the end, there is a imperative need for more frequent and frank discussions about the impending realities of biological threats.

GMU Biodefense Graduate Program Open Houses! Screen Shot 2016-04-21 at 1.28.57 PM
If you enjoyed reading about Dr. Koblentz and his work in biodefense, consider joining GMU’s Biodefense graduate program as a MS or PhD student! We’ve got some great Open Houses coming up- there is a PhD Information Session next Wednesday, September 7th at 7pm at our Arlington Campus in Founders Hall in room 134. If you’re interested in a MS in Biodefense (we offer both online and in-person!), come to our next Open House on Thursday, September 15th, at 6:30pm in our Arlington Campus Founder’s Hall, Room 126. Dr. Koblentz will be leading the information sessions, which will give you both some insight into the program, but also the range of student research and careers.

Disease Detection and the Outbreak Hunters
Venturing through the caves of South Africa, virus hunting researchers take us through the journey that is zoonotic disease tracking. The CDC has ten global disease detection centers and programs, like PREDICT, are all working to study the early signs of outbreaks and how we can prevent them from happening. “We were tracking almost 300 infectious disease outbreaks of concern in 145 countries,” says Dr. Jordan Tappero, director of the Global Health Protection Center at CDC. This was during a 2-year period. “Only about 30% of countries even self-report [and] are able to prevent, detect, and respond to infectious disease outbreaks,” Tappero says. “We are working around the world to try and improve capacity so that we have partners everywhere to respond quickly.” Bats are one of the primary animals studied, as they tend to be a reservoir for many diseases. Much of the research looks to test animals to identify what diseases are circulating within them, which acts as an early warning system for potential outbreaks. Outbreaks like MERS-CoV and Ebola have taught us the importance of early warning systems within the germ world. Cheers to those brave researchers who are crawling through caves and bat guano – we applaud and thank you!

The Growing Vaccine Refusal in Pediatrics Usmap
After the measles outbreak in California and Arizona related to Disneyland in 2015, there was a surge of national attention to pediatric vaccination exemptions. While California is taking strides to reduce non-medically indicated exemptions, many doctors are still reporting that parents are refusing to vaccinate their children. A recent study was published using data from the American Academy of Pediatrics Periodic Surveys from 2006 and 2013, looking at parental noncompliance and the frequency of requests for vaccine delays and refusals. Researchers also looked at the impact on US pediatrician behavior as a result of parental refusal or requests to delay. The study found that the proportion of pediatricians reporting parental vaccine refusal increased from 74.5% in 2006 to 87.0% in 2013. “Pediatricians perceive that parents are increasingly refusing vaccinations because parents believe they are unnecessary (63.4% in 2006 vs 73.1% in 2013; P = .002). A total of 75.0% of pediatricians reported that parents delay vaccines because of concern about discomfort, and 72.5% indicated that they delay because of concern for immune system burden. In 2006, 6.1% of pediatricians reported “always” dismissing patients for continued vaccine refusal, and by 2013 that percentage increased to 11.7% (P = .004).” Sadly, these findings indicate that pediatricians are reporting more vaccine-refusing parents and while they provide vaccine education, they’re dismissing patients at a higher rate.

Get the Scoop on Zika Virus
The FDA has announced that all U.S. blood banks will test blood, regardless of the presence of Zika in the state, for the virus. Here’s a guide to help pregnant women reduce their Zika risk. A new report found that Zika was linked to congenital hearing loss in infants with microcephaly. This week, CDC Director, Dr. Tom Frieden, commented that the agency is almost out of funds for Zika. “Basically, we are out of money and we need Congress to act,” Frieden told reporters. “The cupboard is bare.”  Florida may be the perfect place for Zika transmission, but where else should we consider within the U.S.? Singapore is quickly becoming a Zika hot spot, with it being the only Asian country to have active transmission. The growing volume of cases is signaling that Singapore could easily be a new epicenter for Zika, triggering surrounding countries to ramp up their preparedness efforts. Many are wondering if Zika is a sleeping giant in Haiti. The country has all the ingredients for rapid and sustained transmission but hasn’t seen many cases yet, leaving many to wonder if it’ll hit. The CDC has reported, as of August 31st, 2,722 cases of Zika virus in the U.S. Yesterday, the Florida Department of Agriculture and Consumer Services officially announced that, for the first time, mosquitoes trapped in the continental U.S. were positive for Zika virus.

Event: The Elimination of Weapons of Mass Destruction: Lessons Learned from the Recent Past 
Attend the Nonproliferation Review’s Monday, September 12th event to discuss nonproliferation! The event will be held at the James Martin Center for Nonproliferation Studies CNS Washington office at 1400 K Street, NW, Suite 1225, on Monday, 9/12,  from 1-3 pm. Speakers include Rebecca Hersman, director of the Project on Nuclear Issues at the Center for Strategic and International Studies; Robert Peters, senior research fellow at the Center for the Study of Weapons of Mass Destruction at National Defense University; and Dr. Philipp Bleek, assistant professor at the Middlebury Institute for International Studies at Monterey and a fellow at CNS. Dr. Chen Kane, director of CNS’s Middle East nonproliferation program, will chair the event, with NPR Editor Joshua H. Pollack providing welcoming remarks.

Stories You May Have Missed:

  • ABSA Risk Group Database App! Biosecurity – there’s an app for it! The American Biological Safety Association has created an app for the ABSA Risk Group Database. You can find it in Apple or Android app stores under “Risk Group Database app” and it’ll allow you to access the database on your mobile devise. “The ABSA Risk Group Database consists of international risk group classifications for Bacteria, Viruses, Fungi, and Parasites. In many countries, including the United States, infectious agents are categorized in risk groups based on their relative risk. Depending on the country and/or organization, this classification system might take the following factors into consideration: pathogenicity of the organism; mode of transmission and host range; availability of effective preventive measures (e.g., vaccines); availability of effective treatment (e.g., antibiotics); and other factors.”
  • Possible Transmission of mcr-1–Harboring Escherichia coli between Companion Animals and Human– The growing reports of colistin-resistant E. coli findings have been raising the stakes in the fight against antibiotic resistance. A recent report found mcr-1 (the gene harboring the colistin-resistant mechanism) E. coli isolates in three separate patients admitting to a urology ward in China. One of the patients was found to work in a pet shop, so researchers collected fecal samples from 39 dogs and 14 cats where he worked. Six were positive for the mcr-1 gene by PCR (4 from dogs and 2 from cats). “These findings suggest that mcr-1–producing E. coli can colonize companion animals and be transferred between companion animals and humans. The findings also suggest that, in addition to food animals and humans, companion animals can serve as a reservoir of colistin-resistant E. coli, adding another layer of complexity to the rapidly evolving epidemiology of plasmid-mediated colistin resistance in the community.”
  • Frozen Strawberry & Hepatitis A Outbreak – Virginia is currently experiencing a Hepatitis A outbreak related to frozen strawberries used in Tropical Smoothie Cafe locations. There have been 40 reported cases, of which 55% have been hospitalized. “There are more than 500 of the smoothie franchises across the country, and Virginia is not the only state affected. All the potentially contaminated Egyptian-sourced berries were pulled from the 96 Tropical Smoothie Cafe locations in Virginia no later than Aug. 8 or Aug. 9.”
  • Foreign Policy Classroom – U.S. Efforts to Combat Zika – Catch the series featuring Gwen Tobert, Foreign Affairs Officer, Office of International Health and Biodefense. You must be a student enrolled in a U.S. academic institution or faculty to attend the September 8th (2-3pm) event at the U.S. Department of State.

Pandora Report: 8.12.2016

In the event you find a skunk with an ice cream cup stuck on its head, you can use Ebola PPE like this Southern Ontario paramedic. The yellow fever outbreak is surging and yet again, the WHO is being called out for poor leadership and outbreak response. “An internal draft document sent from WHO’s Africa office to its Geneva headquarters in June cited a lack of senior leadership at WHO. It said the emergency outbreak response manager and team in Angola ‘are unable to lead or positively influence the operational direction and scale of containment efforts.” Science and technology issues truly impact voters, so are 20 questions many science organizations feel Presidential candidates should have to answer.

Medical Countermeasures Dispensing Summit: National Capitol Region
On-site attendance is full, but you can still enjoy the August 16-17 summit virtually. Organized by the U.S. Department of Health and Human Services Assistant Secretary for Preparedness and Response, the regional summit allows people “direct access to local best practices and MCM subject matter experts, as well as to create collaborative environments to address nationally identified target areas and hear directly from stakeholders at all levels of response planning.” The Washington, DC summit will have a dual-track agenda and allow each attendant to base their participation on topics they find most relevant.

Are Exotic Pets a New Biothreat?
Dr. Laura Kahn is making us second guess exotic pets and invasive species in the biodefense paradigm. While not the normal “go-to” when thinking of bioweapons, she notes that a handful of security experts are raising concerns over their ability to impact ecosystems and the agriculture sector. Pointing to a recent paper in Biosafety, Kahn draws attention to the potential biological attack using non-native species to infiltrate, impact natural resources, injure soldiers, transmit disease, etc. While this threat may seem unlikely, the truth is much more startling – we’re already under attack by non-native wild animals via the exotic animal market. “Invasive species—which can take the form of anything from microscopic organisms to plants, fish, and mammals—are those inhabiting a region where they are not native, and where they are causing harm. They displace native species by either eating them or eating their food. In part because they often have no natural predators in their new location, they can disrupt ecosystems, delicate webs of plants and animals that evolved to exist in balanced harmony. This can wreak havoc on environmental, animal, and human health.” A prime example would be Australia in the 18th century, which endured a rabbit invasion by way of European settlers. As a result of these furry invaders, Australia is reported to lose more than $87 USD per year. Delicate ecosystems and dangerous animals have a role in this compounding threat and it’s not just related to the illegal trade of animals. Dr. Khan notes that the legal importation of animals is a substantial source for risk – between 2005 and 2008, the U.S. imported more than one billion live animals. The regulatory agencies involved in oversight of these processes are spread across the Department of Agriculture’s Animal and Plant Health Inspection Service, the Department of the Interior’s Fish and Wildlife Service, the Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC), and the Department of Homeland Security’s Customs and Border Protection. Aside from the obvious challenges of legal importation, wildlife trafficking still occurs and when coupled with the exotic pet market, the volume of threats is far greater than we might consider. “It appears that exotic pets fall through the regulatory cracks much to the peril of our nation’s ecosystems and agriculture. In fact, they should be considered potential biological threats, and the regulation loopholes allowing their unfettered importation should be closed.”

Colistin-Resistance, Where Is It Now?
The Olympics may have taken over Brazil, but colistin-resistant bacteria are the latest arrival in the South American country. Making its debut, the MCR-1 gene that allows bacteria like E. coli to become resistant to the antibiotic of last resort (colistin), was found in the infected foot wound of a diabetic patient. “In earlier research, these investigators showed that E. coli harboring the mcr-1 gene had been present in food-producing livestock in Brazil since at least 2012. ‘In spite of this, we had previously recovered no isolates from humans that were positive for mcr-1,’ said coauthor Nilton Lincopan, PhD, Assistant Professor in the Department of Microbiology, Institute of Biomedical Sciences, Universidade de São Paulo, Brazil.” This news comes at an especially relevant time as the concerns over water quality and aquatic events are being voiced daily. The growing reports of MCR-1 genes are pushing for more global surveillance on antibiotic resistance. In the U.S., Minnesota is making strides to combat the rise of antibiotic resistance. Utilizing a One Health approach to antibiotic stewardship, their 5-year plan will incorporate “Minnesota’s departments of health and agriculture, along with the Board of Animal Health and the Minnesota Pollution Control Agency (MPCA), to work together to promote the judicious use of antibiotics in humans and animals and get a better sense of how antibiotic use is affecting environmental health.”

Aerosol Stability of Ebola Strains
Do you ever find yourself pondering the aerosol transmission capability of certain Ebola strains? Researchers are doing just that in the latest Journal of Infectious Diseases. During the 2014/2015 outbreak, there was a lot of concern over the potential for aerosol transmission, especially in the healthcare environment (invasive procedures, suctioning, etc.). Despite there being little epidemiological evidence to support this transmission route, there were substantial reports and media speculation to push researchers to go back to the drawing board regarding Ebola transmission. Looking at two Ebola strains (1976 and 2014 strains), researchers found that there was “no difference in virus stability between the 2 strains and that viable virus can be recovered from an aerosol 180 minutes after it is generated.”

The Latest on Zika
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The U.S. Department of Health and Human Services has awarded $4.1 million to Hologic, Inc. for the advancement of a Zika blood screening test. To aid in the fight against the growing outbreak, federal employees are deploying to help stop the outbreak. With Congress and the White House at an impasse, hundreds of employees from DHHS, the Defense Department, and the State Department are all deploying to help combat the outbreak. Florida has reported more infections, bringing their total local transmission cases to 25, while a Texas newborn has died from Zika complications. Texas has reported 99 cases, including two infants. You can read about the investigations into the local transmission cases hereUSAID has announced their investment of over $15 million to accelerate development and deployment of 21 innovations to combat Zika. “The award nominees range from deployment of mosquitoes infected with Wolbachia, a naturally-occurring bacteria that prevents the spread of disease to humans; to low-cost, insecticide-treated sandals; to a cell phone app that measures wing-beat frequency to not only distinguish different types of mosquitoes but potentially identify whether they are carrying disease.” In a letter to Congress, DHHS Secretary Sylvia Burwell pointed to the lack of federal support, resulting in $81 million having to be transferred to Zika from other programs. As of August 10th, the CDC has reported 1,962 cases of Zika in the U.S.

Stories You May Have Missed:

  • Impaired Growth & Campylobacter Infections – a recent study reviewed the impact of Campylobacter infections in children in eight low-resource settings. Addressing the role of enteropathogen infections on enteric dysfunction and impaired growth in children, researchers performed a multi-site cohort to look at Campylobacter infections in the first two years of life. Following their analysis, they found a high prevalence of the infection within the first year and that a high burden of Campylobacter was associated with a lower length-for-age Z (LAZ) score. Campylobacter infections were also found to bear an “association with increased intestinal permeability and intestinal and systemic inflammation.”
  • High School Student Awarded For Work on Ebola Proteins in Bats-While many of us were attending sporting events or getting into trouble with friends, Rachel Neff was contacting pathology professors and working on a project that would later translate to several awards. Neff’s project focuses “on a protein called VP35 that is found in both the Ebola virus and the bat genome. The Ebola version of VP35 suppresses the immune response in infected animals, allowing the virus to multiply. Bats are thought to carry the Ebola virus — and transmit it to humans — but are not sickened by it themselves. Scientists are exploring whether VP35 in bats may interfere with Ebola VP35, protecting the bats from disease.”

 

Pandora Report: 7.22.2016

Those antibiotic-resistant bugs just won’t quit – researchers in Florida found drug-resistant organisms in the water and sediment from a sewer-line spill in 2014.  If you’ve got live poultry in your backyard, make sure to check out the advice from the CDC as there’s been a large outbreak associated with poultry. The recent Salmonella outbreak across 45 states has resulted in 611 cases, 138 hospitalizations, and 1 death. With the news of the first CRISPR human trials starting next month, many are wondering if the pro-CRISPR team has their heads in the sand regarding gene-editing safety.

The Soviet Biological Weapons Program in Today’s Russia
The Center for the Study of Weapons of Mass Destruction (CSWMD) at the National Defense University has published their first WMD case study, focussing on the driving factors for Russia’s offensive program following the termination of the U.S. program in 1969. Raymond Zilinskas discusses President Nixon’s decision to end the U.S. offensive biological weapons program and why the Soviet decision was in such a sharp contrast. Through a review of the generations of Soviet bioweapons programs, “the two authors of an extensive history of the Soviet BW program, one of whom is the author of this paper, were able to collect sufficient information from their interviews with Biopreparat employees, autobiographies written by weapons scientists, and articles written by investigative Russian reporters to describe and discuss important aspects of Soviet decisionmaking concerning BW.” In the second part of the paper, Zilinskas focuses on the driving force behind the massive Soviet push for an offensive program in the 1970s and Vladimir Putin’s historical comments on the development of “high technologies including genetics”. Zilinskas notes that given the secrecy, it’s possible that Putin may be instituting a third generation BW program.

The Rise of HIV Cases
HIV data over the past 10 years has revealed an increased rate of infection in 74 countries. While AIDS deaths have fallen, the rate of new infections is growing. Researchers reported countries like Egypt, Pakistan, Kenya, the Philippines, Cambodia, Mexico, and Russia, have all seen increased HIV infections since 2005. “The new research, released at the International AIDS Conference in Durban, South Africa, also found that while the global number of new cases continues to decline, the pace has greatly slowed. New infections of HIV fell by an average of only 0.7% per year between 2005 and 2015, compared to the 2.7% drop per year between 1997 and 2005.” The data raises concerns about meeting the UN’s Sustainable Development Goal to see the end of AIDS in less than 15 years, not to mention the startling reality that we’re still a ways off from ending the HIV/AIDS epidemic. The study also found that women tend to die at younger ages from HIV/AIDS, which matches the age-disparate relationships that are prevalent. A recent BBC article on cultural practices in Malawi may give some insight as to why younger women may be at risk for HIV infections and subsequent AIDS deaths. 

2016 Presidential Candidates on Nuclear Weapons
You can’t get much more on the agenda than a norovirus among GOP convention staffers, so here’s hoping global health security will make it to the agenda in this year’s presidential election. GMU Biodefense MS student Greg Mercer provides us with a recap of where the candidates stand on nonproliferation. Following the GOP convention, it’ll be interesting to see how the Democratic convention addresses WMD’s. “Working off draft copies of the two parties’ respective platforms, here’s a look at what the two-party system has to say about non-proliferation for the next four years. These are dramatic, confrontational texts, each calling out the opposing party’s leadership and policies.”

Zika Virus Outbreak – Weekly Status Updates
A study published in Science addresses the need for new control strategies with the most recent outbreak. “The rise of Zika after its long persistence as a disease of apparently little importance highlights how little we truly understand about the global spread of mosquito-borne viruses and other lesser known diseases,” says Justin Lessler, an associate professor of epidemiology at the Bloomberg School who led the study along with Lelia Chaisson, a student in the department. “Over the past decades, dengue, chikungunya, West Nile virus and now Zika have emerged or re-emerged across the globe. Yet why these viruses have expanded their range and others have failed to invade areas potentially ripe for their spread remains a mystery.” Within the paper, researchers touch on the two main theories as to why Zika is currently causing so many problems- the virus has mutated and become more infectious or pathogenic, or previous outbreaks were in small populations and produced little understanding of health effects. Senior Fellows with Results for America, Michael Gerson and Raj Shah, are discussing what the U.S. needs to do to fight Zika.  Aside from resources (financial and trained personnel), they’re pointing to the need for the U.S. to take on global leadership to help coordinate a strategy, especially in the wake of the post-Ebola reviews that have been released. Florida health officials are currently investigating two potential cases of local transmission. As of July 20, 2016, the CDC reported 1,404 cases of Zika virus in the U.S. 

E. coli Outbreaks Galore 18160_lores
Summer is the time for picnics and, sadly, food-borne illness. Twenty people have been hospitalized in Chicago as a result of an E. coli outbreak traced to the Carbón Live Fire Mexican Grill. Two customers who became ill have filed civil lawsuits against the company for compensation. There have been a total of 65 sickened from this particular outbreak. England has reported 151 cases of E. coli o157, including the deaths of two people.PHE (Public Health England) has been working to establish the cause of the outbreak and has identified that several of the affected individuals ate mixed salad leaves including rocket leaves prior to becoming unwell. Currently, the source of the outbreak is not confirmed and remains under investigation; we are not ruling out other food items as a potential source.” As you previously read, Salmonella has also been quite present this summer via the 45-state outbreak involving backyard poultry.

Walmart Chemical Weapon?
Video footage was recently released that shows a man, police say, who has been accused of building a chemical weapon inside an Oxnard Walmart. Reports are saying that following his research online, the suspect, Martin Reyes, went into the store and began assembling a weapon from ingredients on the shelves and an electronic appliance. He used a store socket to plug in the appliance, which was designed to set off the weapon. Following his arrest, Reyes admitted the entire thing and told police how he had been planning to build the device. As more information is released regarding the event, we’ll keep you posted.

Stories You May Have Missed:

  • Agent X Concerns– Engineering of botulinum toxin during the height of bioweapon development was a major concern as the toxin is extremely lethal. Known as Agent X, researchers at the Defense Threat Reduction Agency’s Joint Science and Technology Office (JSTO) have been addressing the potential for weaponization. “Using tenants of Better Buying Power 3.0, a DoD initiative to achieve dominant capabilities through innovation, JSTO collaborated with the U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), the Israel Institute for Biological Research (IIBR) and Hawaii Biotech, Inc., to tackle this complex issue. By pooling resources, JSTO incentivizes productivity in industry and government, while creating a consortium aimed to develop the first novel small organic molecules BoNT inhibitors (SMIs) as well as provide proof-of-concept for regenerative medicine using insulin-like growth factor 1 (IGF -1)”
  • Yellow Fever Outbreak Situation Report: The WHO released their sit-rep on the yellow fever outbreak that started in Angola in December 2015. As of July 8th, there have been 3,625 cases in Angola and 1,798 cases in the DRC. Kenya and the People’s Republic of China have confirmed imported cases as a result of travel. There is currently a push for mass vaccination campaigns to help control the spread to the disease.
  • Headway in Ebola Vaccine– Soligenix, Inc. announced their positive preliminary proof-of-concept results in efforts to produce a heat stable subunit Ebola vaccine. “These studies identified a formulation that maintained the physical state of the Ebola subunit protein despite incubation at 40 degrees Celsius (104 degrees Fahrenheit) for 12 weeks.”
  • Silk Road Disease Transmission– Researchers found some of the first solid evidence of disease transmission along the Silk Road. Bamboo sticks used (by travelers) as “bottom wipers” from a 2,000-year-old Chinese latrine pit were analyzed. Fecal matter samples from these bottom wipers were positive for eggs from four species of parasites. The parasites, including the Chinese liver fluke, “needs marshy conditions to complete its life cycle, so could not have come from the desert area around the ancient Xuanquanzhi relay station.”

 

Pandora Report: 7.15.2016

Happy Friday! Don’t forget to read that Federal Select Agent Program report we revealed last week, as many are shocked to find the 199 lab mishaps that occurred. Check out these One Health researchers who are trying to predict and prevent the next disease that will run rampant like Ebola. You can also listen to Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, talk about how superbugs are beating us. Have we reached the end of the Golden Age of antibiotics? 

International Security & Foreign Policy Implications of Overseas Disease Outbreaks Screen Shot 2016-07-12 at 8.40.13 AM
A recent report by the International Security Advisory Board (a Federal  Advisory Committee) has been released regarding the security implications of infectious disease outbreaks and the efforts of the WHO, the Biological and Toxin Weapons Convention (BWC), international academies, etc. Within the report there is a heavy focus on how the Department of State should prepare for such global health challenges and a series of structural solutions, capacity issues, and opportunities that can be taken. The National Bureau of Economic Research recently found that a global pandemic would cost $570 billion per year. “The links between disease and security have become clearer as more disease threats have emerged and global interconnectedness makes a threat anywhere, a threat everywhere. There are few threats to the United States and its global interests that match the potential scale and scope of the threat to life and security and economic interests than those from infectious disease outbreaks, whether naturally occurring or intentionally caused.” Some of the recommendations emphasized the strengthening of U.S. government coordination through the development of plans for responding to such public health emergencies in areas out of control of a central government and/or hostile to U.S. government involvement. Additional recommendations included strengthening by fully integrating public health emergencies and the associated challenges into the national security agenda by “providing resources, developing organizational leadership within the U.S. and internationally, and developing and exercising appropriate plans for preparing for, preventing, and responding to threats.” Whether they are natural, deliberate, or accidental, globalization makes the threat of these outbreaks that much more dangerous.”Public health is now a national security challenge and must be treated as such in terms of planning, resources, and organizational support. It is essential to refocus the U.S. approach to this threat, and to invest in the appropriate level of ‘insurance’ just as we do for traditional defense related needs.”

The National Biodefense Strategy Act of 2016
Introduced in May by Sen. Ron Johnson, the bill amends the Homeland Security Act of 2002 “to require the President to establish a Biodefense Coordination Council to develop a national strategy to help the federal government prevent and respond to major biological incidents.” The bill defines biodefense as “any involvement in mitigating the risks of major biological incidents and public health emergencies to the United States, including with respect to- threat awareness, prevention and protection, surveillance and detection, response and recovery, and attribution of an intentional biological incident.” Within the bill, the President must establish a Biodefense Coordination Council and develop a National Biodefense Strategy in which there must be status updates to Congress every 180 days. The strategy must be updated at least every five years and the bill also requires that an annual report with detailed expenditures and their relevance to the strategy is submitted. The Congressional Budget Office (CBO) recently released its summary on the costs of S. 2967 – “CBO estimates that enacting S. 2967 would cost less than $500,000 annually and about $2 million over the 2017-2021 period; any such spending would be subject to the availability of appropriated funds.”

The Growing Cost of the Next Flu Pandemic
A recent study from researchers at the Society for Risk Analysis (SRA) utilized advanced methodology to calculate the total cost of an influenza outbreak. SRA’s work concluded that if the public used flu vaccines during the pandemic, the U.S. GDP loss would be $34.4 billion. In the event that flu vaccines weren’t used, the cost would rise to $45.3 billion. This particular study is unique in that it addresses public, government, and business responses to an epidemic. Conducted as part of a project by the the Department of Homeland Security’s National Biosurveillance Integration Center (NBIC), the study estimates “the relative prominence of the various economic consequence types,’ as well as complicating factors, many of them not addressed in any prior study. These complicating factors include different types of avoidance behavior, such as the already noted avoidance of public events and facilities.”

A New Case of Super Resistant E. Coli 
A second patient in the U.S. has been found to carry the colistin-resistant E. coli that raised concern in late May when it was also found in Pennsylvanian woman. Colistin resistance means that the antibiotic of last resort, colistin, is no longer effective at killing the organism. The most recent was reported to have had surgery in a New York hospital last year, which begs the question – is this where it was acquired? Were post-operative antibiotics not discontinued properly? The second case is fueling public health fear over the spread of this resistant gene, especially in regards to bacteria that are currently only susceptible to colistin. In the wake of these findings, many are pushing for increased surveillance and focus on antibiotic resistance. “The CDC is planning to establish seven regional laboratories this fall that will have the capacity to do better and faster testing for a broad range of antimicrobial resistance.”

One Health & Antimicrobial Resistance 
On Wednesday, the One Health Commission held a webinar on antimicrobial resistance in the environment. Led by Dr. Laura Kahn, the presentation focussed on the challenges of feeding billions, the growth of antibiotic use in meat, and the reality that antibiotic resistance is an integral part of 21st century challenges. In general, people are eating more meat, with China shouldering a 147% growth in meat consumption, while the U.S. has remained unchanged. Antibiotic usage in meat is not the only concerning source as sewage sludge can easily be a source of antibiotic exposure for animals. Dr. Kahn also discussed that from 2000-2010, global human antibiotic consumption has grown 37% and the top antibiotic consumers are India, China, and the U.S. Interestingly, India and Pakistan have some of the most resistance microbes in the world. A Dutch study looking at archived soil from 1942-2008 found that there were increasing concentrations of resistant genes as time progressed. Expanding human population and demand for animal proteins, rising human and animal waste production, poor sanitation, indiscriminate antibiotic usage, and land/water contamination are all fueling the rise of antibiotic resistance and altering the “global resistome”. So what can be done? Dr. Kahn noted the potential role of bacteriophages as a means of fighting bacteria and the growing threat of microbial resistance. Overall, we need to understand the microbial world better, decrease antimicrobial usage, and tap into the bacteriophage resource.

Weekly Zika News
As more Zika cases are found within the U.S., many are wondering why Congress is holding up funding. Here’s a map of California and where you can expect to find mosquitoes that have the potential to transmit Zika. The CDC has a national map you can also reference with estimated range of the Aedes mosquitoes. Infectious disease and mosquito control expert, Duane Gubler, notes that spraying may not be successful against the Aedes mosquito.  The difficultly lies in that the Aedes mosquitoes tend to live in harder-to-reach areas (garbage, closets, indoors, etc.) and spraying is most effective against mosquitoes living in floodwater. Olympic risk for Zika is considered low following a CDC analysis, which concluded that the visitors expected at the games represent less than 0.25% of the total travel volume to Zika-affected countries. “Estimated travel to the U.S. from Rio for the Games is 0.11% of all 2015 U.S. travel from countries where Zika is now spreading, the CDC said.” You can read the official MMWR release here. Colombia’s low volume of microcephaly and birth defects following Zika infection during pregnancy offer some home that the outbreak may not be as bad as early estimates suggested. A new study published in the Lancet looks to women as possible modes of sexual transmission for Zika. “Our findings raise the threat of a woman potentially becoming a chronic Zika virus carrier, with the female genital tract persistently expressing the virus RNA. Additional studies are underway to answer those essential questions and to assess what would then be the consequences for women of child-bearing age”. CDC Director, Dr. Tom Frieden, writes about the lessons we can learn from the fading Ebola epidemic and how we can apply these to Zika.  Researchers have also recently written that the epidemic in Latin America is “likely to run its course within the next 18 months” – you can read their article in Science here. The CDC has reported 1,306 cases of Zika virus in the U.S as of July 13, 2016. 

Stories You May Have Missed:

  • Malaria and the Duration of Civil War The Journal of Conflict Resolution recently published an article regarding the prolonging of civil war in relation to malaria. Just as geographical factors can impact the duration of civil war, researchers note that malaria can inflict costs and can “indirectly prolong civil war by helping to maintain a socio-geographic environment that is conducive to insurgency”. The rotation of government forces also means they’re likely to have exposures to malaria.
  • The Current State of Our Immunity – Infectious disease physician Dr. Amesh Adalja discusses 21st century immunity to disease. Drawing from points made in Taylor Antrim’s Immunity (set in a post-pandemic world following the 4% loss of global life due to a genetic recombinant of influenza and Lassa Fever), Dr. Adalja relates many of the lessons from his experiences during the West Africa Ebola outbreak and the impact of poverty on resilience. “Today, worldwide extreme poverty — in real terms — is at its lowest. Smallpox has been vanquished with polio and guinea worm about to follow suit. Even Ebola, because of major advances that have occurred in the basic understanding of the clinical illness as well as in vaccine technology since the last outbreak, has been substantially defanged.”
  • The Growing Misuse of Toxic Weapons: Attend the seminar on Monday, July 18th (3:30-5pm) at the James Martin Center for Nonproliferation Studies (1400 K St. NW, Suite 1225, Washington, DC). “We are witnessing today a global threat of toxic chemicals as a means of warfare or terror.  The recent use of chemical weapons and dual-use toxic chemicals in both Syria and Iraq, and possible terrorist attacks against chemical infrastructure, are visible confirmations of a growing threat of misuse of chemicals. This seminar, organized by Green Cross International and the Center for Nonproliferation Studies, will present the results of Chemss2016, an April conference in Poland, including its Summit Declaration which addressed challenges, goals, guidelines, and principles of global cooperation against chemical threats today.”

 

Pandora Report: 7.1.2016

Happy Friday from your favorite source for all things global health security – from Anthrax to Zika, we’ve got you covered…like germs on a kitchen sink! If you’re hoping to catch the Washington D.C. fireworks over the holiday, check out this article regarding the state of D.C.’s preparedness for anything from traffic issues to lone-wolf terrorism. You can also get some insight into the Strategic National Stockpile via an interview with the director of the program, Greg Burel. Ever wonder the economic impact of a pandemic influenza outbreak? A recent study analyzed the consequences of such a health emergency.

Behind the Scenes at Porton Down
BBC will be airing a new documentary on the work that takes place within the secretive site of Porton Down. Located in Wiltshire, England, this government military science park falls under the Defense Science and Technology Laboratory (also known as Dstl). Dstl is an Executive Agency within the Ministry of Defense. Dstl’s website states that it “ensures that innovative science and technology contribute to the defense and security of the UK” however the facility has a long and controversial history. Considered to be one of the sites for research regarding biological and chemical weapons, the work within the 7,000 acres is extremely sensitive and secretive. “Inside Porton Down will also take viewers inside some of the site’s most secure biological research labs, where scientists have been tasked to find out how Ebola – potentially one of the biggest public threats facing us today – has the power to spread.”

Why We Need to Start Worrying About Yellow Fever Screen Shot 2016-06-30 at 6.26.37 AM
It’s been a few months since we started reporting on the yellow fever outbreak in Angola and as much as we’d like to reveal that this outbreak was quickly put out….a more sinister accelerant was added to the epidemic – a vaccine shortage. The outbreak has spilled over into surrounding countries, with 1,000 suspected cases in the DRC. There are only four major manufacturers of the yellow fever vaccine…that’s right, four. These four manufacturers don’t have the capacity to make vaccine at the rate it would take should the outbreak jump to Asia, which is the growing concern as Chinese workers visit the affected areas. The WHO maintains a stockpile of 6 million doses however, this outbreak is already burning through them and the factories that can make the vaccines are only capable of 2.4 million doses per month. Simply put, the vaccine manufacturing capacity will not be effective if this outbreak spreads much further. This particular detail is why we should be worrying about yellow fever. While it may not be as deadly as Ebola or as contagious as influenza, it’s preventable through vaccination….and yet we’re running out of vaccines. Even scarier is the presence of fake vaccination certificates. Coupled with globalization, yellow fever could easily make its way back to the U.S. and remind us of a history we’d rather not relive. “A yellow fever epidemic might seem anachronistic to people in the United States and Europe, where the disease no longer poses a threat. But some of the most devastating urban outbreaks of yellow fever have occurred in America. In the 18th century, the disease was called the ‘American plague.'”

Who Isn’t Equipped For A Pandemic or Bioterror Attack?
Annie Sparrow of the Bulletin of the Atomic Scientists asks this question and points to the sad reality that the WHO is the front runner for this unfortunate title. Pointing to the origins of the WHO in the days of the early cholera epidemics, Sparrow notes that despite WHO claiming they were a catalyst for multilateral cooperation, the reality is much less prestigious. “But in fact, the first six International Sanitary Conferences were entirely unproductive due to conflicting interests: government fears about losing profits from trans-Atlantic trade took priority over the need to reduce the international death toll. Consensus was achieved only at the seventh conference in 1892, after the opening of the Suez Canal for use by all countries made standardized quarantine regulations necessary.” The slow WHO responses to Ebola and then Zika brought attention to the discrepancies between the WHO’s role as a front-line defense for pandemics (and bioterrorism) and what was actually happening. Many have called for a reform of the WHO and the necessity to address systemic and deep-rooted problems within the organization. Sparrow hits on several key obstacles the WHO needs to overcome if it’s going to truly serve its purpose – “increase its financial resources, eliminate the undue influence of donors and member states, and redress its subservient relationship with governments who are themselves responsible for health crises.” The WHO must also address its practices when dealing with health issues in conflict zones or transitioning states. Lastly, Sparrow highlights the suggestions that transferring global health programs to the UN would not be beneficial, but rather there needs to be a push for rehabbing the WHO. In the end, the world aspect of the WHO needs to provide some muscle behind this work, especially in times of political assertion of sovereignty.

The Up-Hill Battle of Antibiotic Resistance in the World of Infection Prevention
The recent findings of a Pennsylvanian woman with colistin-resistant E. coli in her urine sent title waves throughout the health community. It was the exact moment an organism that was so resistant we have no effective antibiotics to treat it, had reached U.S. soil. In truth, the presence of multi-drug resistant organisms (MDRO’s) isn’t new…they just aren’t as flashy as bugs like Zika or Ebola. In this article, I talk about the framing of MDRO’s and the infection preventionist perspective. “Public framing and hysteria brought Ebola to the forefront. But where is this sense of urgency for organisms so resistant that we have no means of treating them? The case in Pennsylvania received fleeting public attention but it has long been the concern and fear of those working in healthcare and biology. IPs have been working for years on MDRO surveillance and isolation. ”

WHO Appoints Emergency Unit Leader 
While we’re on the subject of WHO emergency response, it was recently announced that Peter Salama was appointed as the leader for the health emergencies unit. The Australian epidemiologist is currently with UNICEF in the Middle East and North Africa, but will lead the new team that was established following criticism of the WHO’s response during the West African Ebola outbreak. The new unit was set into place to provide rapid (not rabid…but there’s some infectious disease humor for you), support to a country or community experiencing a “health emergency arising from disease, natural or man-made disasters or conflict”. The WHO website has more information here, regarding the Health Emergencies Programme.

Brexit and Public Health
Unless you’ve been vacationing in a remote part of the globe, the Brexit referendum has been taking over the news. The British vote to leave the European Union (EU) has set into motion a global wave of economic uncertainty. While many are discussing the financial, trade, and labor force implications of the Brexit, there are also far-reaching public health outcomes. Just prior to the vote, an article was published in the Journal of Public Health regarding the impact of the EU laws on public health. Aside from environmental issues ranging from water quality to emissions, the EU has also focussed on tobacco cessation. The EU has developed strong skills for information exchange to better support a healthy public. “The EU has provided continued bold and effective action on public health policy and designed an excellent funding framework for collaborative health research. The loss of the UK’s strong participation and policy voice in the EU would, as Lord Hague, the former Conservative Foreign Secretary, recently quipped ‘not be a very clever day’s work’.” While globalization makes the spread of disease easier, it would make the new British isolation extremely impacting. The isolation via Brexit could create issues regarding cross-border information sharing, which becomes especially vital during outbreaks or in cases of public health emergencies.

The Scoop on Zika
I was recently gifted (as a joke) this amazing device to fend off the Zika-carrying mosquitos…what could possibly go wrong with an electric zapping racket? University of Michigan researchers performed an analysis looking at the political response to Ebola and how that may bubble over to Zika management. Reviewing the U.S. response to Ebola they looked at the “fragmented system with no clear leadership and considerable ‘strategic politicization’ due to the outbreak’s arrival during a midterm election year.” Scott Greer of the U-M School of Public Health noted that “Republicans are going to continue not to give Obama the federal dollars he seeks to combat Zika. They don’t trust him. But when the virus starts to affect people anywhere south of Indianapolis there will be an elaborate game of blaming the administration for not doing it right.” Good news- Cuba recently announced that they have had no Zika transmission since March and Dengue is all but eliminated due to their wide-spread, military supported fumigation efforts. New studies are looking to the efficacy of Zika transmission via urine and saliva as a research team from Brazil’s Fiocruz Institute isolated live virus from such samples. U.S. Zika funding is still in limbo as Senate Democrats derailed the $1.1 billion bill on Tuesday over “objections to attached measures such as birth control restrictions.” Florida health officials reported microcephaly in a baby born to a woman from Haiti. Researchers are also finding that microcephaly may be just the tip of the iceberg, as findings suggest other developmental delays in babies born without microcephaly. There is also concern for the impact of the Zika on fetal brain tissue, causing cell death.  Despite the hold-up on Zika funding, the U.S. National Institute of Allergy and Infectious Diseases has started work on a research study regarding the mechanisms that allow Zika to be sexually transmitted.  As of June 29, 2016, the CDC has reported 935 Zika cases within the U.S.

Stories You May Have Missed:

  • Stopping Lab-Created Global Disasters One Scientist at a Time – Biotechnologist Kevin Esvelt talks about the shaky future of genetic engineering technologies like CRISPR. Esvelt notes, “We are walking forwards blind. We are opening boxes without thinking about consequences. We are going to fall off the tightrope and lose the trust of public. Lots of people are going to die.” Since he and his colleagues first suggested, two years ago, that CRISPR could create gene drive, he has been working hard to warn how dangerous the technology is.
  • One Health and the Politics of Antibiotic Resistance– Check out this webinar on July 7, 2016 from 11am-noon EDT. Dr. Laura Kahn will discuss the rise of certain MDRO’s, the different policy approaches in Europe and the U.S., and the history behind low-dose antibiotic use in agriculture.
  • Healthcare Worker Gloves and Disease Transmission– Researchers recently revealed results from a study reviewing “cross-transmission rates between contained gloves of healthcare workers and hospital surfaces.” Not surprisingly, results showed that contaminated gloves increased the likelihood of transmission among healthcare workers and in the environment.

 

Pandora Report 6.24.2016

Welcome back to your weekly biodefense roundup! To start things off on a light note and since it’s official summer, enjoy this satirical piece on the existence of public pools. In truth, public pools are a mixture of fun and risk for waterborne diarrheal diseases, so remember to stay safe. The NIH has given the green light for CRISPR-Cas9 clinical trials for cell therapies related to cancer treatment. Japan is currently on alert for a possible North Korean ballistic missile launch. Lastly, even though the outbreak appears over, many are discussing the aftermath of Ebola and if it’s really behind us

Tales from the Front Lines of Disease Detective Cases
Foreign Policy‘s Laurie Garrett discusses epidemic fighters, especially the work of Ali Khan, and his quest to speak the truth about epidemics. Khan’s work as an EIS officer and former Director of the Office of Public Health Preparedness and Response (PHPR) has given him a wealth of knowledge from being in the trenches of global outbreaks. Khan’s new book, The Next Pandemic: On the Front Lines Against Humankind’s Gravest Dangers, discusses his experiences from the Amerithrax attacks to the debate on smallpox sample destruction. “Khan writes, the most vital problem-solving exercise has little to do with science, and everything to do with social customs. In 2015, Khan was involved in an out-of-control moment in the Ebola epidemic of Sierra Leone. Long after neighboring Liberia had its outbreak down to a handful of cases, the military-run campaign in Sierra Leone was losing the support of the people by imposing mass quarantines, shutting down entire regions of the country for long periods. Out of the discontent over loss of business, food, and trade arose false leaders claiming witchcraft practiced by the foreigners and magic were spreading the Ebola — not intangible things few could comprehend, like ‘viruses.'” The blend of public health preparedness and front-line outbreak response gives Khan a unique and appreciated perspective into the world of global health security.

Why Hasn’t Disease Wiped Out the Human Race?
University of Pittsburgh’s infectious disease physician, Amesh Adalja, discusses why an infectious disease event with the magnitude of the Andromeda Strain is a bit more unlikely than people realize. He notes that an “apocalyptic pathogen” needs to be in the right place at the right time – more specifically, a combination of having no existing treatment or vaccine and high transmissibility prior to the start of symptoms. “The three infectious diseases most likely to be considered extinction-level threats in the world today—influenza, HIV, and Ebola—don’t meet these two requirements. Influenza, for instance, despite its well-established ability to kill on a large scale, its contagiousness, and its unrivaled ability to shift and drift away from our vaccines, is still what I would call a ‘known unknown.’ While there are many mysteries about how new flu strains emerge, from at least the time of Hippocrates, humans have been attuned to its risk.” Adalja notes that beyond these three (I’ll call them the Big Three), all the other infectious diseases out there fall short of meeting the global extinction sweet spot. Perhaps one of the most crucial lessons to take away from Adalja’s comments isn’t that we should ignore or diminish the impact of infectious diseases, but that institutional failure and infrastructure instability can often do more damage during an outbreak than the disease. With the growing concern related to antibiotic resistance Dr. Adalja notes that “to me, antibiotic resistance represents the most pressing challenge in the realm of infectious disease and, if it is not overcome, we face the very real prospect of being dragged back to the pre-penicillin era in which even routine surgery was a gamble.”

Iceland, Horses, and Hendra
GMU Biodefense MS student, Greg Mercer, can’t even go on vacation without thinking about global health security, but lucky for us, that means we get to learn about Icelandic horses and Hendra! Fueling our fascination with all things related to One Health and spillover, Greg discusses the exportation of Icelandic horses (look at them, wouldn’t you want one?) but also that importation of horses is banned in Iceland. Even an Icelandic horse that was sent abroad for a short period of time can’t return home. Greg notes that its been this way for a hundreds of years and while the import rules maintain purebred status, the ban also protects against disease. “Iceland has few natural horse diseases, and the breeder I spoke to said that Icelandic horses are frequently unvaccinated, which would be very unusual in the rest of the world. When they’re exported, they have to be treated as if they don’t have any immune protection. The import ban prevents foreign diseases from entering the country (via other horses, anyway).” Check out Greg’s Icelandic experience and why horse diseases struck a cord during his travels.

Incorporating More One Health Into the Global Health Security Diet
Some may say we need more cowbell, but in the world of global health security, we need more One Health. The One Health Commission and the One Health Initiative are teaming up to help create and promote a global education plan that will focus on the “unifying interconnected health of humans, animals, and the environment that sustains all life on earth.” A recent paper looks to accumulate interested parties and help drive the project forward. The drive behind this partnership is to capture the younger generations and lay a strong foundation of One Health education and support. “The overall intent of the concept paper is to raise awareness about the urgent need for the development  and to explore the concept further through a small pre-project proposal conference (possibly off and/or on-line) with a view to fleshing out a strong plan to fund the envisioned global learning program.” The group is currently organizing the pre-project proposal conference, but in the mean time, if you’ve already got some great ideas or are interested in participating in spreading the One Health message, check out their website here.

Zika Weekly Updates
Inovio Pharmaceuticals announced on 6/20 that it received FDA clearance for the phase 1 clinical trials for its Zika vaccine. Clinical trials are set to begin by the end of this year for the DNA-based vaccine. A new study finds that the Zika epidemic can be fielded by climate variations on multiple timescales.  Researchers utilized a novel timescale-decomposition methodology and found that “the increasingly probable 2016-2017 La Nina suggests that ZIKV response strategies adapted for a drought context in Brazil may need to be revised to accommodate the likely return of heavy rainfall.” The CDC has also recently issued guidance for travelers visiting friends in areas with ongoing transmission of Chikungunya, Dengue, or Zika. The NIH is launching a large study in efforts to answer questions about Zika virus and pregnancy. Hoping to enroll 10,000 pregnant girls and women (ages 15 and older) in their  first trimesters, the study will look to long-term impacts on babies and the role that previous dengue infections play in birth defect frequency. You can find the recently published article regarding the history of a newly emerging arbovirus here, which summarizes “the history of Zika virus from its first detection to its current worldwide distribution.” In the early hours of Thursday morning, the House passed the $1.1 billion Zika funding bill. The White House threatened to veto the bill though. “The threat from deputy White House with press secretary Eric Schultz came as the Senate prepared for a vote next week, likely Tuesday, even though there’s no guarantee that the Senate can round up the 60 votes necessary to break a filibuster as Democrats call the bill partisan and inadequate.” Several studies have pointed to the linkage between earlier dengue infection and worsened Zika infections, however there is also a potential for a certain antibody against dengue being a target for a vaccine. The CDC has confirmed, as of June 22nd, there have been 820 cases within the U.S. and DC.

One Step Closer to the Zombie Apocalypse 
Researchers from the University of Washington recently reported that several hundred genes actually increase in expression after death. Scientists found that “the transcriptional abundance of some 500 genes was significantly changed after death in healthy zebrafish and in healthy mice. While gene expression overall declined after death, the expression of some genes increased shortly after death and others increased 24 hours or 48 hours later. These genes, the researchers note, were commonly involved in stress, immunity, inflammation, apoptosis, and cancer.” It’s believed that this post-mortem gene expression is a result of residual energy and this may happen in humans as well. This new discovery leaves many asking about the definition of death if a person’s genes are still active for up to 48 hours after they die.

Listeria Troubles Dozens of Schools  large-epi-curve-6-2-2016
Pre-prepared sandwiches are being recalled across 38 school districts as a result of a possible Listeria contamination. “The potentially contaminated food was produced at a facility where the U.S. Food and Drug Administration found Listeria monocytogenes ‘on multiple food contact surfaces where the products were produced on several different occasions’ during routine FDA environmental sampling, according to the recall notice.” While students have been let out on summer break, the concern is that Listeria can take 70 days for symptoms to appear. This latest food safety issue comes after Molly & Drew recalled some of its beer bread mix due to concerns over E. coli contamination.  E. coli outbreaks been plaguing the news lately as a result of the General Mills flour outbreak that sickened 38 people across 20 states.

Stories You May Have Missed:

  • CRISPR vs. Flaviviruses – researchers at the Washington University School of Medicine have found a “single-gene pathway that is vital for viruses like Zika to spread infection between cells”. Even better, the team found that when they shut down a gene in this pathway, flaviviruses aren’t able to leave the infected cell and thus replicate. Using CRISPR technology to selectively shut down a single gene in the pathway, they were able to shut down flavivirus infection without negatively affecting the cells.
  • DRC Declares Yellow Fever Outbreak– The DRC Heath Minister recently declared a localized epidemic of yellow fever after reporting 67 cases. 58 of these cases were considered imported as they were from Angola, where the outbreak has grown beyond 3,100 cases and 345 fatalities. The outbreak has crept across Angola, Uganda, and now the DRA as a result of vaccine shortages.
  • MER-CoV Outbreak in Riyadh Hospital –  the WHO released information regarding the outbreak that begin with a woman whose illness wasn’t detected until after her stay in a surgery ward. Her hospitalization exposed 49 healthcare workers and all but 2 of the 22 MERS cases reported in Saudi Arabia (June 16-18) are related to this outbreak.