News highlights on health security threats and countermeasures curated by Global Biodefense
This week’s selections include the Ebola outbreak in Uganda; African Swine Fever vaccine development; Strategic National Stockpile inventory risks; the White House’s pandemic preparedness ‘moonshot’ items; and lessons learned for building out acute febrile illness surveillance systems.
POLICY + GOVERNMENT
GAO: HHS Should Address Strategic National Stockpile Requirements and Inventory Risks
GAO’s analysis of the Strategic National Stockpile reviews shows the SNS contained most medical countermeasure types recommended, but often not in the recommended quantities. HHS officials noted that gaps in quantities are due to budget constraints and acknowledge these gaps present risks. However, the reviews lack key information needed for managing these risks and communicating them to stakeholders, including to Congress. Risk management principles include guidance related to the management and communication of risk. Without an approach for regularly managing risks, HHS and Congress lack assurance the department is most effectively preparing for public health emergencies. Until HHS updates its procedures, the agency risks not meeting the statutory requirements designed to give Congress additional information about the SNS inventory. GAO
We Advised Biden on the Pandemic. Much Work Remains to Face the Next Crisis.
Op-ed from members of President Biden’s Covid advisory board in the weeks before he took office: “We have since followed and been part of the public health response to the pandemic. We are deeply dismayed by what has been left undone…There is still no comprehensive reporting system for individuals to easily submit their at-home test results to public health agencies, rendering a broad swath of infections across the country invisible to officials trying to slow their spread. Likewise, the national reporting system for collecting and testing samples from wastewater treatment systems for Covid remains limited, uncoordinated and insufficiently standardized for a robust national surveillance system…Perhaps the most important missed opportunity was the failure to prioritize systematic improvement of indoor air quality. All sorts of respiratory infections, including flu and common colds, as well as asthma and other medical conditions, arise because of airborne pathogens and particulate matter.”
The authors also hit on the poor response to Long Covid, failure to ensure stable domestic PPE material supply chains, NIH’s failure to implement needed changes to clinical research systems, and massive gaps in connecting to hard-to-reach populations. New York Times
Russia’s Unfounded Claims of Secret U.S. Bioweapons Linger On and On
In Geneva this week, Russia commanded an international forum of nations party to the Biological Weapons Convention to air its unsupported assertions again. Because the treaty has no verification or enforcement provisions, there will be no official ruling on Russia’s claims, but the U.S. and other nations were able to formally state their position on the Russian allegations on Friday. The EU categorically condemned the Russian accusations directed at the U.S. and Ukraine of running offensive biological laboratories in Ukraine and for the spread of disinformation. New York Times
Biological Weapons Convention Should Endorse the Tianjin Biosecurity Guidelines
“The Tianjin Biosecurity Guidelines for Codes of Conduct for Scientists are a set of ten principles designed to promote responsible science and strengthen biosecurity governance. They should be broadly adopted, including being endorsed by the Biological Weapons Convention at its 9th Review Conference in November 2022.” Trends in Microbiology
Biden’s Biodefense Strategy Aims to Combat Future Pandemics
The new plan released this week, which encompasses 20 federal agencies, aims to detect early warnings of pandemics and biological threats, prevent epidemics and biological incidents and prepare to reduce the impacts of epidemics. The strategy lays out plans for “moonshot” efforts such as transforming early warning of pathogens through next-generation technologies, launching diagnostics for any new pathogen within 12 hours of an outbreak and developing novel vaccines within 100 days. The Hill
Biden Administration Outlines Ambitious Strategy to Prevent and Prepare for Pandemics
The administration officials said they were starting to pursue some of these goals with agencies’ baseline funding but noted that President Biden has asked Congress to allocate $88 billion over five years for pandemic preparedness. One aspect of the administration’s plan calls for international mechanisms that can help strengthen lab safety and biosecurity practices around the world. The pandemic has led to heated questions about the risks and benefits of research into potentially dangerous viruses. STAT
White House Aims for Bio-Defense ‘Moonshots’ In New Strategy
The strategy aims to boost the number of local healthcare workers—including lab technicians, epidemiologists, veterinarians, and community-based health workers—in all 50 states. But with an estimated shortage of 29,400 nurse practitioners by 2025 and shortages of other healthcare workers looming, it’s not clear how the government can overcome current trends. The senior official said bringing in more traditional frontline healthcare workers is a key focus, but many of the positions the strategy seeks will be related to research and data collection. That will require expanding the CDC’s epidemiology field officer program, bringing more epidemiologists to every state, and expanding state public health veterinarians and staff across the country and territories. Defense One
A Fireside Chat with Dr. Raj Panjabi on the National Biodefense Strategy and Implementation Plan
“You asked about what’s different from both 2018 and the last time there was a National Biodefense Strategy and what is also different from the American Pandemic Preparedness Plan that we released last year… There are more concrete and bold targets, number one. Number two, there is clarity. You mentioned over 20 federal agencies helped develop this plan. Each of them have also put themselves on the record for which one will be in charge of each one of those targets. So every target has a lead federal agency, and then several support federal agencies. The third big difference is the advent of the National Security Memorandum 15, which places, through the national security adviser, the White House in charge of the federal policy and coordination around biodefense and the number of associated activities in that; number one, that federal agencies will commit to, as the president has now ordered, provide reports against those targets on a quarterly basis…and hold accountable the biodefense enterprise.” CSIS
The PPE Procurement Scandal—Who Pays and Who Profits?
A health professional whose actions kill a patient can expect to be investigated and potentially disbarred by their professional regulator. But what about the politicians who implemented the creation of a deeply flawed system for procurement during a pandemic that failed to consistently supply stocks of usable personal protective equipment (PPE)? Civil servants were over-ruled when attempting to raise safety concerns about ineffective PPE. Companies that provided equipment found unfit for use—such as Ayanda Capital, who won a £250m contract for 50 million unusable masks—are now registered offshore where they can avoid scrutiny. Meanwhile Liz Truss (briefly elevated as UK prime minister until resigning today), whose adviser facilitated that deal, was later promoted to foreign secretary. Ignoring corruption comes at a cost, particularly during pandemics and economic crises when the NHS budget is already stretched. The BMJ
MEDICAL COUNTERMEASURES
An Introduction to the Marburg Virus Vaccine Consortium, MARVAC
The emergence of Marburg virus (MARV) in Guinea and Ghana in 2021 triggered the assembly of the MARV vaccine “MARVAC” consortium representing leaders in the field of vaccine research and development aiming to facilitate a rapid response to this infectious disease threat. With case fatality rates of up to 88% and the lack of licensed medical countermeasures, there is an urgent need for action to accelerate the evaluation and approval of MVD vaccines and therapeutics. PLOS Pathogens
Efficacy of Co-Trimoxazole Against Experimental Melioidosis
The efficacy of co-trimoxazole against melioidosis acquired by different routes of exposure was assessed in postexposure prophylaxis (PEP) and treatment studies in marmoset models of melioidosis. All animals that received antibiotics at the onset of fever completed the treatment, but 10%, 57%, and 60% of those with ingestion, subcutaneous, and inhalation challenge relapsed, respectively. These data suggest the efficacy of co-trimoxazole, as measured in the incidence of relapse, differs depending on the disease-acquisition route. Antimicrobial Agents and Chemotherapy
Natural History of Marburg Virus Infection to Support Medical Countermeasure Development
This natural history study consisted of twelve cynomolgus macaques challenged with 1000 PFU of MARV Angola and observed for body weight, temperature, viremia, hematology, clinical chemistry, and coagulation at multiple time points. All animals succumbed to disease within 8 days and exhibited signs consistent with those observed in human cases, including viremia, fever, systemic inflammation, coagulopathy, and lymphocytolysis, among others. Viruses
African Swine Fever: Scientists Rush to Create Vaccine for World’s Biggest Animal Disease Outbreak
Tackling African swine fever – which has led to death of more than 100m pigs since 2018 – has proved an enormously difficult challenge. The current outbreak, believed to threaten around three-quarters of the world’s herds, is aided by the virus’ ability to survive up to 1,000 days in frozen meat and persist for long periods on clothing and vehicles. Against this background, pressure has grown to create an ASF vaccine. An EU-funded global consortium has homed in on three vaccine candidates with the potential for use on domestic pigs and wild boars. The focus is now on carrying out large-scale tests with the aim to have a vaccine roll out before 2025. Similar efforts are playing out around the world. The Guardian
FDA Seeks Feedback on Distributed and Point-of-Care Drug Manufacturing
Novel distributed manufacturing (DM) and point-of-care (POC) manufacturing technologies, and other related technologies such as end-to-end continuous manufacturing and the use of artificial intelligence have the potential to improve the reliability and robustness of the drug supply chain and enable rapid and localized response. FDA is seeking feedback on how the regulatory framework must be evolved for timely adoption of such technologies. FDA
Universal Flu Vaccine Protects Against Influenza A and B
The researchers designed a virus-like particle (VLP) that contains multi-subtype consensus neuraminidase (m-cNA) proteins and M2 ectodomain (M2e), called m-cNA-M2e VLP. Neuraminidase is an integral part of the influenza virus, that is particularly useful in disseminating viral particles. Neuraminidase-inhibiting antibodies derived from previous vaccination or exposure could independently confer protection and ameliorate disease burden. The preclinical study showed, for the first time, that this construct induced protection against influenza A subtypes H1N1, H1N2, H3N3, H5N1, H9N2 of human and avian origin, as well as the two lineages of influenza B. The Lancet Microbe
Versatility of Live-Attenuated Measles Viruses as Platform Technology for Recombinant Vaccines
An overview of the versatility of this vaccine vector as platform technology to target various diseases, as well as current research and developmental stages, with one vaccine candidate ready to enter phase III clinical trials to gain marketing authorization, MV-CHIK (Chikungunya virus vaccine). Vaccine candidates that utilize live-attenuated MeV as a platform directed against 22 pathogens representing diseases transmitted via fluids or sexual contact, insect vectors, or the respiratory route have been described. These, as well as three experimental cancer vaccines, have shown induction of robust humoral and cellular immunity and often impressive efficacy in animal models of disease. NPJ Vaccines
Evaluations of Rift Valley Fever Vaccine Candidate RVax-1 in Mosquito and Rodent Models
Rift Valley fever (RVF) is a mosquito-borne zoonosis endemic to Africa and the Arabian Peninsula, which causes large outbreaks among humans and ruminants. This study demonstrated the genetic stability of 566 silent mutations of RVax-1 during viral passages in Vero cells, a single dose vaccine potency of RVax-1, which can confer full protection of mice from lethal pathogenic RVFV challenge, and inefficient systemic dissemination of RVax-1 in mosquito vectors. The characteristic pattern of RVax-1 silent mutations, which are not found in natural RVFV strains, will be useful for tracing potential environmental spill-over of the RVax-1 strain upon field use (e.g., in natural reassortant or recombinant strains). NPJ Vaccines
BIOSECURITY + BIOPREPAREDNESS
The World is Unprepared for the Unthinkable
A biological attack anywhere would have profound and far-reaching political, military, and health consequences. If a biological attack were suspected, it would require a rapid public health response and if investigation suggested it was not a naturally occurring outbreak, a forensic investigation would be required to determine its source. While mechanisms for investigating a possible chemical or nuclear attack largely exist, there is no comparable mechanism for biological agents. Failing to establish clear processes to investigate and determine blame for a biological attack may inadvertently encourage the use of these weapons. The world makes clear: no one gets to use a biological weapon and gets away with it. Think Global Health
Lab Manipulations of Covid Virus Fall Under Murky Government Rules
As it turned out, the experiments, performed on mice, were not what the inflammatory media coverage suggested. The manipulated virus strain was actually less lethal than the original. But the uproar highlighted shortcomings in how the U.S. government regulates research on pathogens that pose a risk, however small, of setting off a pandemic. It revealed loopholes that allow experiments to go unnoticed, a lack of transparency about how the risk of experiments is judged and a seemingly haphazard pattern in the federal government’s oversight policy, known as the P3CO framework. New York Times
The U.S. is Moving to Tighten Oversight of Studies That Could Make Viruses More Dangerous. But How Far Should It Go?
Last month, an expert panel convened by NIH and its parent agency, the Department of Health and Human Services (HHS), released a draft report that recommends the GOF rules be broadened to include pathogens and experiments that are exempt from the current scheme. If the recommendation is adopted—which could come next year—researchers working with viruses such as Ebola, seasonal flu strains, measles, and even common cold viruses could face new oversight and restrictions. Science
Lab-Made SARS-CoV-2 Study Prompts Gain-of-Function Questions
Media reports about work on a hybrid SARS-CoV-2 virus at a Boston University’s biosafety level 3 (BSL-3) lab have inflamed more controversy about lab biosafety and raised questions about federal oversight, following the publication of the research team’s preprint (not peer-reviewed) study that described their findings. A story from the London Daily Mail claimed that researchers created a new deadly COVID strain, and other outlets picked up on the theme. In a statement, Boston University called the claims false and inaccurate, emphasizing that the school’s Institutional Biosafety Committee had reviewed and approved the study. CIDRAP
BU Lab Wasn’t Required to Clear Potentially Controversial Study with NIH, Director Says
The director of a Boston University laboratory that conducted potentially controversial research on the viruses that cause Covid-19 said his institution didn’t clear the work with the National Institutes of Health because it wasn’t funded by the federal agency. Ronald Corley said the research, which was designed to explore what makes some SARS-CoV-2 viruses more pathogenic than others, was paid for with money from the university itself. The work was approved by the institutional biosafety committee of BU’s National Emerging Infectious Diseases Laboratories, and by Boston’s Public Health Commission. STAT
Was a Study That Created a Hybrid COVID-19 Virus Too Risky?
A NIAID official said the research likely should have been evaluated to see whether it needed to go through a special review for gain-of-function studies. BU officials, however, say NIH funds weren’t used directly for the study and they are “in continued conversation” with NIAID. But several virologists argued that the study is not as alarming as it first appears. For one thing, the hybrid virus was less lethal than the early variant modified in the study. They also noted that other researchers have published the results of similar experiments that did not draw similar concerns. And it’s not clear the study is very different from other chimeric virus studies that NIAID has exempted from review. The dust-up is sure to add impetus to an ongoing review of the federal oversight policy for risky GOF research by a panel called the National Science Advisory Board for Biosecurity (NSABB). Science
Lessons Learned from the Public Health Workforce’s Experiences with the COVID-19 Response
Participants widely described that “the lack of adequate resources as well as political interference with decisions [the health department] tried to make” and “back of the napkin epidemiology from politicians” further exacerbated the challenge of implementing population-level control measures. Health Security
Disaster After Disaster, Hospital Preparedness Remains a Deficiency
In geographic areas, all health care assets should be linked when it comes to emergency preparedness and be parts of coalitions. Primary care offices, pharmacies, dialysis centers, nursing homes, methadone clinics and the like should all be explicitly part of emergency planning at a regional level. State and local health departments and emergency management agencies should be seamlessly integrated as well. Hospitals should review their infrastructure and identify major and minor vulnerabilities (such as backup generators being below sea level) and work to remedy them. The Hill
Pandemic Preparedness and Response: Exploring the Role of Universal Health Coverage Within the Global Health Security Architecture
There has been insufficient consideration of the vital role of universal health coverage in sustainably mitigating outbreaks, and the importance of robust primary health care in equitably and efficiently safeguarding communities from future health threats. This Health Policy paper outlines major (although often neglected) gaps in pandemic preparedness and response, which are applicable to broader health emergency preparedness and response efforts, and identifies opportunities to reconceptualize health security by scaling up universal health coverage. The Lancet Global Health
Disease X: Time to Act Now and Prepare for the Next Pandemic Threat
The current pandemic is not necessarily the last or worst, since risk factors for the emergence of EIDs persist and increase, including population growth and aging, environmental contamination, climate change, loss of biodiversity, changing vector habitats and globalization. Global preparedness strategies should be integrated and coherent with national frameworks, and based on a One-Health approach, including the contrast to the antimicrobial resistance, and the prevention of environmental changes. European Journal of Public Health
SELECT AGENTS + PRIORITY PATHOGENS
The Time is Now: A Call to Contain H9N2 Avian Influenza Viruses
In the past century, we have seen four pandemics caused by human influenza A: H1N1 Spanish influenza (1918–1920), H2N2 Asian influenza (1957–58), H3N2 Hong Kong influenza (1968–69), and H1N1 swine influenza (2009–10). Since 2013, there have been many novel avian influenza viruses that were identified from humans, including H7N9, H6N1, H10N8, H5N6, H7N4, H10N3, and H5N8 avian influenza viruses (figure). Notably, H7N9 viruses have caused more than 1500 laboratory-confirmed human cases of avian influenza worldwide. The continuous emergence of novel avian influenza viruses capable of human infection highlights the increasing pandemic risk that they pose. The Lancet Microbe
Pathogenic Bacilli as an Emerging Biothreat?
Some clinical strains of B. cereus harbor anthrax-like plasmid genes (pXO1 and pXO2) associated with non-human primate and human infections, with the same clinical presentation of inhalation anthrax and mortality rates. Although currently restricted to certain limited areas of circulation, the emergence of these new strains of B. cereus extends the list of potential agents possibly usable for bioterrorism or as a biological weapon. It is therefore important to improve our knowledge of the phylogeny within the B. cereus sensu lato group to better understand the origin of these strains. Pathogens
Responding to the Threat Posed by Anthrax: Updated Evidence to Improve Preparedness
Since the 2001 Anthrax attacks in the U.S., new countermeasures were developed, including polyclonal and monoclonal antitoxins. Although developed in response to bioterrorism concerns, these antitoxins have been used to treat rare naturally acquired cases and newly described forms of anthrax, including injection anthrax and welder’s anthrax (frequently fatal pneumonias caused by other Bacillus species expressing anthrax toxins). The potential for B. anthracis to be weaponized, including the possibility that a strain could be genetically engineered to resist 1 or more classes of antimicrobials, continues to be a concern. Clinical Infectious Diseases
Clinical Features of Patients Hospitalized for All Routes of Anthrax: A Systematic Review
Since 1960, adult anthrax mortality has ranged from 31% for cutaneous to 90% for primary meningitis. Median incubation periods ranged from 1 day for injection to 7 days for inhalation anthrax. Most patients with inhalation anthrax developed pleural effusions and more than half with ingestion anthrax developed ascites. Treatment and critical care advances have improved survival for those with systemic symptoms, from approximately 30% in those untreated to approximately 70% in those receiving antimicrobials or antiserum/antitoxin. Clinical Infectious Diseases
Algorithms for the Identification of Anthrax Meningitis During a Mass Casualty Event
During an anthrax mass casualty event, prompt identification of patients with anthrax meningitis is important. Fever or chills, nausea/vomiting, headache and severe headache, and all neurological findings were significant predictors of meningitis in both adults and children. Clinical Infectious Diseases
An Uncommon Presentation of Pulmonary Tularemia: A Case Report and Literature Review
Tularemia has been classified as a Category A bioterrorism disease, with as few as 10-25 F. tularensis bacteria enough to cause human disease via cutaneous or inhalation routes. The significant difficulties in diagnosing tularemia are its complex presentation and the time taken for culture. These factors make tularemia a budding public health crisis. This case report presents a patient with a delayed diagnosis of pulmonary tularemia in the setting of severe headaches and fever of unknown origin. Cureus
Post-Ebola Symptoms 7 Years after Infection: The Natural History of Long Ebola
Lingering symptoms have been reported by survivors of Ebola Virus Disease (EVD). There are few data describing the persistence and severity of these symptoms over time. This study looked at more than 300 survivors from 2015 EVD cases. Over a median follow-up of 5.9 years, reporting of any symptom declined. However, even 5 years after acute infection, a majority continue to have symptoms and, for many, these continue to greatly impact their lives. These findings call for investigations to identify the mechanisms of post-EVD sequelae and therapeutic interventions to benefit the thousands of effected EVD survivors. Clinical Infectious Diseases
CHEMICAL + RADIOLOGICAL THREATS
Iodine Pills in Short Supply After Finland Updates Guideline
Many Finnish pharmacies ran out of iodine tablets Wednesday, a day after the Nordic country’s health ministry recommended that households buy a single dose in a case of a radiation emergency amid increasing fears of a nuclear event due to Russia’s war in Ukraine. The ministry said the iodine tablet recommendation is limited to those aged 3-40 because of the potential risks that radiation exposure poses to that age group. Washington Post
Establishing a Murine Model of the Hematopoietic Acute Radiation Syndrome
The hematopoietic system is one of the most sensitive tissues to ionizing radiation, and radiation doses from 2 to 10 gray can result in death from bleeding and infection if left untreated. Hematopoietic Stem Cells
AFRRI / USU Perspective on Space Radiation Countermeasure Discovery
There is a need to develop and deploy medical countermeasures (MCMs) to support astronauts during space missions against excessive exposures to ionizing radiation exposure. Overall, researchers here expect that MCMs previously developed and approved for terrestrial use will be of immense value for extraterrestrial pursuits. For example, the recombinant hematopoietic growth factors/cytokines, rhuG-CSF (Neupogen), PEG-rhuG-CSF (Neulasta), thrombopoietin receptor agonist (Nplate) and rhuGM-CSF (Leukine), have already been approved by FDA under the ‘New Animal Rule’ for general use in mitigating the potentially deadly effects of accidental/unwanted radiation exposures. There is serious discussion by NASA and the FDA to have these agents incorporated as standard medicinals within NASA’s space program. The question at hand is whether or not strategies and associated drugs designed for terrestrial-based radiological environments will be applicable for the highly complex radiation environment of outer space. Some of these MCMs may prove to be useful, but only under a select set of circumstances. Personalized molecular profiling will be helpful to improve the understanding of how deep space radiation affects humans, and to develop novel MCMs to prevent or mitigate these effects. Life Sciences in Space Research
Fluorescent Probes for the Detection of Chemical Warfare Agents
Small molecule fluorescent probes have emerged as attractive chemical tools for CWA detection, due to their simplicity, ease of use, excellent selectivity and high sensitivity, as well as their ability to be translated into handheld devices. This includes the ability to non-invasively image CWA distribution within living systems (in vitro and in vivo) to permit in-depth evaluation of their biological interactions and allow potential identification of therapeutic countermeasures. The limitations and challenges of currently developed fluorescent probes are discussed providing insight into the future development of this research area. Royal Society of Chemistry
Nerve Agents Surrogates: Synthetic Approaches for Analytical and Toxicological Purposes
In the field of Chemical Defense toward Nerve Agents, the development of analytical methodologies for analysis of different sample matrices, training of human resources in handling, detection of such toxic chemicals, and design of more effective medical countermeasures may be hampered by the lack of infrastructure. Nerve Agents Surrogates may be an invaluable alternative to accomplish such tasks, as these compounds present similar behavior and are easier to handle in comparison to actual nerve agents, being useful analytical and toxicological tools for technical purposes. Book: Sensing of Deadly Toxic Chemical Warfare Agents
SURVEILLANCE + DETECTION
COVID-19 Genomics UK Consortium: Final Report
RAND Europe evaluated how the COVID-19 Genomics UK Consortium (COG-UK) contributed to the pandemic response in the UK, increased sequencing capacity and data infrastructure, and also influenced international SARS-CoV-2 sequencing initiatives. This report outlines key enablers to respond to the urgent nature of the pandemic and challenges to overcome for longer-term resourcing. Rand Health Quarterly
Incorporating COVID-19 into Acute Febrile Illness Surveillance Systems
Existing acute febrile illness (AFI) surveillance systems can be leveraged to identify and characterize emerging pathogens, such as SARS-CoV-2. The US CDC collaborated with ministries of health and implementing partners in Belize, Ethiopia, Kenya, Liberia, and Peru to adapt AFI surveillance systems to generate COVID-19 response information. Paper demonstrates opportunity for AFI surveillance systems to be used to build capacity to detect and respond to both emerging and endemic infectious disease threats. Emerging Infectious Diseases
Metagenomic Pathogen Sequencing in Resource-Scarce Settings
Metagenomic next-generation sequencing (mNGS) is the process of sequencing all genetic material in a biological sample. The technique is growing in popularity with myriad applications including outbreak investigation, biosurveillance, and pathogen detection in clinical samples. However, mNGS programs are costly to build and maintain, and additional obstacles faced by low- and middle-income countries (LMICs) may further widen global inequities in mNGS capacity. Using lessons learned from the COVID-19 pandemic, LMICs can leverage current momentum to design and build sustainable mNGS programs, which would form part of a global surveillance network crucial to the elimination of infectious diseases. Frontiers in Epidemiology
Breath Biomarkers of Influenza Infection
A breath test for VOC biomarkers accurately identified influenza-like illness patients with PCR-proven influenza. These findings bolster those of others that a rapid, accurate, universal point-of-care influenza diagnostic test based on assay of exhaled-breath VOCs may be feasible. Open Forum Infectious Diseases
Development of Rapid Strip Test for Detection of Porcine Circovirus 2
Porcine circovirus type 2 (PCV2) is a member of genus circovirus, the causative agent of the porcine multi-system wasting syndrome (PMWS). This study established an efficient detection method with high sensitivity and specificity for the clinical diagnosis of PCV2 antigen, that will facilitate a rapid and convenient way to evaluate the infection status of vaccinated pigs. BMC Veterinary Research
Aerosol Test Chambers: Current State and Practice During the COVID-19 Pandemic
There are countless aerosol test chambers (ATCs) worldwide and this number along with numerous high containment biological laboratories underscores the need for technical standards, regulatory and dual-use compliance. ATCs are often not under governmental oversight, which make it difficult to estimate their exact numbers. Further work is needed to define methods according to perspectives of health-risk to humans, product-performance of detectors and efficacy of treatments. Frontiers in Bioengineering and Biotechnology
POC Vertical Flow Immunoassay for Multiplex Biothreat Agent Detection in Biological Fluids
This paper presents simple, fast, and sensitive detection of multiple biothreat agents by paper-based vertical flow colorimetric sandwich immunoassay for detection of Yersinia pestis (LcrV and F1) and Francisella tularensis (lipopolysaccharide; LPS) antigens using a vertical flow immunoassay (VFI) prototype with portable syringe pump and a new membrane holder. Biosensors and Bioelectronics
First Molecular Detection of Aedes albopictus in Sudan Associates with Increased Outbreaks of Chikungunya and Dengue
This is the first report and molecular characterization of Ae. albopictus from Sudan. Our sequences cluster with populations from the Central African Republic and La Réunion. Worryingly, this finding associates with a major increase in chikungunya and dengue outbreaks in rural areas of the study region and might be linked to the mosquito’s spread across the region. International Journal of Molecular Sciences
Integrating Single Domain Antibodies into Field-Deployable Rapid Assays
Single domain antibodies (sdAb) are the recombinant variable heavy domains derived from camelid heavy-chain antibodies. While they have binding affinities equivalent to conventional antibodies, sdAb are only one-tenth the size and possess numerous advantages such as excellent thermal stability with the ability to refold following denaturation, and inexpensive production in Escherichia coli or yeast. It is often necessary to re-optimize the protocols and tailor the recombinant sdAb through protein engineering to function efficiently in handheld assays, which currently are utilized for point of care testing and field applications. Antibodies
ANTIMICROBIAL RESISTANCE
Resistant Aspergillus fumigatus and Dermatophyte Species: A One Health Perspective on an Urgent Public Health Problem
Recent evidence has identified the agricultural use of triazole fungicides as an important driver of triazole-resistant A. fumigatus infections. Antifungal-resistant dermatophyte infections are likely driven by the inappropriate use of antifungal drugs and antibacterial and corticosteroid creams. This review highlights the need for a One Health approach to address emerging antifungal resistant infections. Current Clinical Microbiology Reports
Antibiotic-Resistant Infections Among Inpatients with COVID-19 in US Hospitals
Bacterial coinfections are commonly identified among patients with influenza and other viral respiratory infections. However, estimated rates of bacterial coinfections and secondary bacterial infections among inpatients with COVID-19 are low, despite findings of frequent antibiotic use among inpatients with COVID-19. In this retrospective study, less than 10% of inpatients with COVID-19 had bacterial/fungal coinfection, indicating that empiric antibiotic therapy should not be used to treat patients with COVID-19. Longer lengths of stay, critical care stay, and mechanical ventilation contribute to increased incidence of hospital-onset infections among inpatients with COVID-19. Clinical Infectious Diseases
Urging Health Collaboration to Combat Antimicrobial Resistance Between China and B&R Countries
AMR has remained a global public health concern, and its effects vary considerably in B&R countries. Countries should adopt the One Health strategy, pay great attention to AMR issues, provide financial and human resource assistance, utilize joint laboratories and a cross-border AMR monitoring database to promote health cooperation, and prioritize ecological governance in accordance with other B&R cooperation plans. This report’s suggestions serve as a guide for future B&R public health cooperation and policy development. Infectious Diseases of Poverty
PUBLIC HEALTH
Ensuring Remote Diagnostics for Pathologists: An Open Letter to the US Congress
During the COVID-19 pandemic of the past 30 months, one of the early regulatory exemptions enabled the (optional) use of remote work in clinical laboratories and pathology. This has allowed pathologists to continue to provide care for our patients in a safe environment — for example, by enabling remote review of microscopic slides, which is essential for cancer diagnostics. The regulatory exemptions during COVID-19 included one key catalyst: they removed the need to obtain and maintain a separate home license for remote review of diagnostic materials as long as certain conditions are met. These conditions ensure all other requirements of the Clinical Laboratory Improvement Amendments (CLIA) are maintained. This open letter calls on legislators to ensure that the regulatory exemptions implemented during the pandemic remain in place until Congress can amend the Public Health Service Act by updating the 34-year-old CLIA statutes to account for non-traditional diagnostic modalities and the last three decades of medical progress. Nature Medicine
CDC Officials Describe Intense Pressure, Job Threats from Trump White House
Former CDC director Robert Redfield, former top deputy Anne Schuchat and others described how the Trump White House and its allies repeatedly“bullied” staff, tried to rewrite their publications and threatened their jobs in an attempt to align the CDC with the more optimistic view of the pandemic espoused by Donald Trump, the House select subcommittee on the coronavirus crisis concluded in a report released this week. Public health officials detailed a months-long campaign against Anne Schuchat, a 32-year CDC veteran, sparked by Trump appointees’ belief that her grim assessments of the pandemic reflected poorly on the president. Washington Post
The Strongest Signal That Americans Should Worry About Flu This Winter
Australia recently wrapped an unusually early and “very significant” season with flu viruses. After skipping two seasons in the Southern Hemisphere, flu spent 2022 hopping across the planet’s lower half with more fervor than it’s had since the COVID crisis began. The U.S. population is starting at a lower defensive baseline against flu—especially young children, many of whom have never tussled with the viruses. It’s “very, very likely” that kids may end up disproportionately hit, Webby said, as they appear to have been in Australia. Vaccination fatigue may also work against public health efforts. The Atlantic
HISTORICAL REFLECTIONS
How the ‘Black Death’ Left Its Genetic Mark on Future Generations
It turns out that certain genetic variants made people far more likely to survive the plague. But this protection came with a price: People who inherit the plague-resistant mutations run a higher risk of immune disorders such as Crohn’s disease. The researchers found that carrying two protective versions of a gene called ERAP2, for example, made people 40 percent likelier to survive the Black Death — the largest evolutionary advantage ever found in humans. The study was particularly compelling thanks to the way the scientists ruled out genetic drift. New York Times, Nature
SPECIAL INTEREST
WTP Resources: Disaster Preparedness Booklets
The National Clearinghouse has developed safety and health awareness booklets for emergency responders and cleanup workers for topics including Avian Influenza, Mold Cleanup, and Flood Response. These pocket-sized guides can be distributed and used as a resource when workers are on a disaster site. The booklets address a variety of disaster types, and some are available in more than one language. Booklet Order Form
At Last, A Prestigious Prize for Global Health
The prize is envisioned to support the United Nations’ efforts to preserve the health of people and the planet through the UN’s sustainable development goals for 2030. Anyone with a desire to improve the health of the world’s population, whether through academic, political, social, economic, or industrial innovation, can now aspire to this prestigious award. The selection of the laureate or laureates is by majority vote of the independent Virchow Prize Committee, whose members are elected by the Virchow Foundation for Global Health Council. The BMJ
Countering Failures of Imagination: Lessons We Learnt from Paul Farmer
Paul Farmer, physician, activist, academic, humanitarian, and teacher died in Rwanda on February 21, 2022. Few people in the field of global health have had a bigger impact than him. “Until we all understand how social pathologies like racism and gender inequity get in the body and how we get them out, we’ll always struggle with health disparities.” Forbes
TWiV 948: Breathless with David Quammen
David Quammen returns to TWiV to discuss how he wrote his new book ‘Breathless’, a story about the science and the scientists behind the race to understand the pandemic coronavirus SARS-CoV-2. This Week in Virology
Emerging Leaders in Biosecurity Fellowship
Applications are open for the Johns Hopkins Center for Health Security’s Emerging Leaders in Biosecurity (ELBI) Fellowship Class of 2023. ELBI is an opportunity for talented career professionals to deepen their expertise, expand their network, and build their leadership skills through a series of sponsored events. Applications deadline: 11 November 2022. Center for Health Security
OUTBREAK NEWS
COVID-19 PANDEMIC
With Government Funding Running Out, Americans Could Soon Face New Challenges in Accessing COVID-19 Treatments and Testing
The Biden Administration has announced that it will have to end its purchase and distribution of COVID supplies as government funding is depleted. The public health emergency was recently extended for 90 additional days but is widely expected to end next year. This transition to the commercial market could curtail access to vaccines (including boosters), treatments, and tests. Without the federal government’s guaranteed “market” for these products through their advance purchase, it is uncertain whether manufacturers will have an incentive to produce enough. People who are uninsured and underinsured stand to lose the most. KFF
FDA Issues EUA for First OTC Saliva Molecular Test for COVID-19
This week the FDA issued an emergency use authorization (EUA) for the first over-the-counter molecular test authorized for use with saliva specimens to Aptitude Medical Inc. for their Metrix COVID-19 Test. This test is authorized for non-prescription at-home use with anterior nasal (nares) swab and saliva sample, self-collected from people aged 14 years or older, or adult-collected from people aged 2 years or older. FDA
Biden Covid Officials Scramble as New Omicron Subvariants Seem to Evade Treatments Used for Vulnerable Patients
The variants — known as BQ1 and BQ1.1 — have spread swiftly throughout the U.S. over the past few weeks, and now account for more than 11 percent of all cases nationwide, roughly double the proportion they represented a week earlier. The rapid growth of the variants puts them on track to become the dominant strains of Covid within the next month. While the vaccines and the administration’s main Covid treatment, Paxlovid, still work against those strains, the development could leave hundreds of thousands of people with compromised immune systems vulnerable to a winter wave without the two therapies that they’ve come to rely upon: Evusheld and bebtelovimab. Politico
Prolonged COVID Test Positivity in Symptomatic, Omicron BA.2 Infections
Among a group of vaccinated college athletes who tested positive for COVID-19 and underwent rapid antigen testing 7 days later, 27% were still positive—a proportion that climbed to 35% in symptomatic athletes and 40% in those infected with the Omicron BA.2 subvariant. These findings could call into question the current guidelines allowing for exit of isolation after 5 days without requiring additional testing to prevent further spread, particularly in the setting of newer variants. CIDRAP
NIH Long COVID Computational Challenge (L3C)
The primary objective of the Challenge is to spur and reward the development of AI/ML models and algorithms that serve as open-source tools for using structured medical records to identify which patients infected with SARS-CoV-2 have a high likelihood of developing PASC/Long COVID. This Challenge invites solutions that explore the probability of developing PASC/Long COVID among patients who have tested positive for SARS-CoV-2 in an outpatient or inpatient (ICU or non-ICU) setting. Models will be evaluated using patients who have an ICD code U09.9 recorded in the dataset to label true positive of patients with PASC/Long COVID. Challenge.gov
Novavax Shot Scores Eligibility in Prior mRNA Vax Recipients. Will It Help Uptake?
The FDA announced Wednesday that it has authorized a booster shot for Novavax’s Covid-19 vaccine. Unlike the latest boosters from Pfizer-BioNTech and Moderna, which target both the original strain of SARS-CoV-2 and the Omicron BA.4/5 variants, the Novavax booster only targets the original strain. The company announced in late May that it was studying an Omicron-targeting strain, as well as a bivalent booster. But results of that work have not been revealed to date. In July, when Novavax received the green light for its two-dose primary vaccine, the company touted Nuvaxovid as a long-awaited alternative to the mRNA formulations of Moderna and Pfizer. But uptake has been disappointing as CDC data show that only 35,300 people have received the shots. Fierce Pharma, STAT
Omicron Boosters Could Arm You Against Variants That Don’t Yet Exist
Booster shots against current SARS-CoV-2 variants can help the human immune system to fight variants that don’t exist yet. That’s the implication of two new studies analyzing how a booster shot or breakthrough infection affects antibody-producing cells: some of these cells evolve over time to exclusively create new antibodies that target new strains, whereas others produce antibodies against both new and old strains. The findings provide reassurance that new vaccines targeting the Omicron variant will provide some benefit. Nature
Estimated Protection of Prior SARS-CoV-2 Infection Against Reinfection with the Omicron Variant Among mRNA-Vaccinated and Nonvaccinated Individuals
How much does prior heterologous non-Omicron SARS-CoV-2 infection, with and without messenger RNA vaccination, reduce Omicron reinfection risk? In this test-negative case-control study with 696,439 participants aged 12 years and older, prior non-Omicron SARS-CoV-2 infection was associated with 44% and 81% reductions in the risk of Omicron infection and associated hospitalization, respectively. Protection against Omicron-associated hospitalization was sustained and improved among individuals who received 1 (86%), 2 (94%), or 3 (97%) mRNA vaccine doses. JAMA Network Open
Fauci Urges US to Resume Long Covid Research Funding Efforts
“It’s a very insidious beneath-the-radar-screen public health emergency… When you say right now in the United States 400 people a day die from Covid – several months ago that number was 3,000 to 4,000 – that’s a number that catches your attention and it’s very real and very acute. But to say that 7 million to 20 million people are really tired after Covid, people say, well, what does that mean? It’s not very concrete. And yet for the individual patient, it could be debilitating.” The WHO estimates that between 10% and 20% of Covid-19 survivors have been left with mid- and long-term symptoms including breathlessness, fatigue and cognitive dysfunction. Fauci noted estimates that anywhere from 7.5 million to 23 million Americans have developed long Covid and roughly 1 million people are out of the workforce at any given time. The Guardian
Survey: A Third of US Military Find Exercise Difficult 1 Month Post-COVID
A third of US active-duty military service members who tested positive for COVID-19 reported new-onset or more difficulty with exercise and daily activities 1 month after diagnosis, but these symptoms diminished to pre-infection levels after 6 to 9 months. The most common symptoms were shortness of breath and fatigue. CIDRAP
EBOLA OUTBREAK – UGANDA
Ebola Outbreak in Uganda, as of 21 October
According to the World Health Organization (WHO), as of 19 October 2022, there have been 64 confirmed cases of Ebola virus disease (EVD), including 25 deaths (Case fatality rate: 39%; including probable deaths: 54%). Among these, at least 11 healthcare workers were infected, of whom five died. There are also 20 probable deaths among individuals who passed away before a sample could have been taken but who were linked to confirmed cases. All cases reported outside of Mubende as of 12 October 2022 have an epidemiological link to the cases initially reported in this district. There have been 25 cases who recovered, including six healthcare workers. ECDC
Uganda Has Locked Down Two Districts in a Bid to Stem the Spread of Ebola
Ugandan authorities imposed a travel lockdown on two Ebola-hit districts (Mubende and Kassanda) as part of efforts to stop the spread of the contagious disease. All entertainment places, including bars, as well as places of worship are ordered closed, and all burials in those districts must be supervised by health officials. A nighttime curfew also has been imposed. The restrictions will last at least 21 days. Ugandan authorities have documented more than 1,100 contacts of known Ebola patients, according to the Africa Centers for Disease Control and Prevention. The Sudan strain of Ebola, for which there is no proven vaccine, is circulating in the country of 45 million people. NPR
U.S. Sends Experimental Antibody, Antiviral Drug to Uganda for Ebola Outbreak
The U.S. sent Gilead Sciences’ remdesivir and Mapp Biopharmaceutical Inc’s experimental Ebola antibody drug MBP134 to Uganda last week to help safeguard healthcare workers. Uganda health minister Jane Ruth Aceng disclosed the U.S. shipments at a meeting of African region health officials last week in Kampala. San Diego-based Mapp Biopharmaceutical received a $110 million contract from the U.S. government’s Biomedical Advanced Research and Development Authority (BARDA) on Oct. 4 for advanced development and potential purchases of MBP134, a combination of monoclonal antibodies. Reuters
Existing Rapid EVD Tests Not Effective Against Rare Ebola Strain in Uganda
The rare strain of Ebola circulating in Uganda does not have an approved vaccine, and rapid tests to confirm cases are also not available for the strain. This means suspected cases must more resource-intensive PCR testing, delaying results. While the COVID-19 pandemic prompted a build-up of PCR platform capacity in Uganda, the priority is now on getting needed reagents to these labs so they can perform testing and streamlining processes for sample handling and results reporting during the outbreak. DevEx
Serum Institute to Produce Ebola Vaccine for Use in Uganda Outbreak
The Serum Institute of India plans to manufacture 20,000 to 30,000 doses of an experimental Ebola vaccine by the end of November for use in trials against an outbreak in Uganda, its developers and a company source said. The response to Uganda’s outbreak has been blunted by the absence of a proven vaccine against the Sudan strain of the virus. There are at least six vaccines in development for the Sudan strain, including three with Phase 1 data, according to WHO. Reuters
CHOLERA CRISIS
WHO Switches to One-Dose Cholera Vaccine Strategy as Outbreaks Spread
The exceptional decision reflects the grave state of the cholera vaccine stockpile. The global trend is moving towards more numerous, more widespread and more severe outbreaks, due to floods, droughts, conflict, population movements and other factors that limit access to clean water and raise the risk of cholera outbreaks. The one-dose strategy has proven to be effective to respond to outbreaks, even though evidence on the exact duration of protection is limited, and protection appears to be much lower in children. With a two-dose regimen, when the second dose is administrated within 6 months of the first, immunity against infection lasts for 3 years. Of the total 36 million doses forecast to be produced in 2022, 24 million have already been shipped for preventive (17%) and reactive (83%) campaigns and an additional 8 million doses were approved by the ICG for the second round for emergency vaccination in 4 countries, illustrating the dire shortage of the vaccine. World Health Organization
Dismay as Key Cholera Vaccine is Discontinued
The manufacturer of one of only two cholera vaccines for use in humanitarian emergencies is to halt production at the end of this year, just as the world faces an “unprecedented” series of deadly outbreaks. Shantha Biotechnics, a wholly owned Indian subsidiary of the French pharmaceutical company Sanofi, will stop production of its Shanchol vaccine within months and cease supply by the end of 2023, causing alarm among health officials. This year it made up about 15% of the global emergency stockpile’s doses. The Guardian
MONKEYPOX
Monkeypox Cases in the U.S. Are Way Down — Can the Virus Be Eliminated?
Monkeypox cases have declined since a peak in early August – from 440 cases a day, down to 60 – and they’re the lowest they’ve been since June. Still, new infections have not declined evenly across all cities, and the proportion of cases among men of color is rising. CDC data show that cases are down dramatically in white men, but nearly 70% of cases are now being detected in Black or Latino men. Health officials have acknowledged that these populations are getting vaccinated at lower rates. There are still key unknowns that could affect the trajectory of the outbreak, such as whether people without symptoms (or only mild symptoms) are spreading monkeypox unknowingly, and how well the vaccines work – both at preventing monkeypox infections and transmission. NPR
Army Researchers Seek Authorization to Expand Use of Monkeypox Test
USAMRIID researchers are working to get an EUA from the U.S. Food and Drug Administration to expand where their monkeypox diagnostic tool can be used. Frederick News-Post
Air and Surface Sampling for Monkeypox Virus in a UK Hospital
Surface swabs of high-touch areas in five isolation rooms, of PPE of health-care workers in doffing areas in three rooms, and from air samples collected before and during bedding changes in five rooms were analyzed using quantitative PCR to assess monkeypox virus contamination levels. Widespread surface contamination was detected (93% of samples were positive) in occupied patient rooms, on health-care worker PPE after use, and in PPE doffing areas. Of 20 air samples taken, five (25%) were positive. Three (75%) of four air samples collected before and during a bedding change in one patient’s room were positive. Replication-competent virus was identified in two (50%) of four samples selected for viral isolation, including from air samples collected during bedding change.
Detection of virus, even replication-competent virus, in environmental samples does not mean that transmission leading to infection would necessarily occur if someone were exposed to that virus, as there are many factors that can influence successful infection of a human. These factors include routes of transmission, host susceptibility, environmental factors that could weaken the virus’ ability to infect cells and replicate, and the amount of virus to which one is exposed. The infectious dose of monkeypox virus in humans is not known, and could vary according to the site of the body exposed to virus. The Lancet Microbe
Ocular Monkeypox – United States
This report describes five cases of ocular monkeypox identified in the U.S. during July–September 2022. Patients with ocular monkeypox, including those with HIV-associated immunocompromise, have experienced delays in treatment initiation, prolonged illness, hospitalization, and vision impairment. Health care providers and public health practitioners should be aware that ocular monkeypox, although rare, is a sight-threatening condition. MMWR
Study Shows Low Antibody Response to Monkeypox Vaccine
A new study in Nature Medicine from a group of researchers at Erasmus University Medical Center in the Netherlands shows a low antibody response to the two-dose Jynneos monkeypox vaccine in non-primed people, or those who had not previously received a smallpox vaccine. The same research group previously showed a poor antibody response to subcutaneous doses of Jynneos, which have been administered as dose-sparing strategy during the current global monkeypox outbreak. The role of neutralizing antibodies in preventing disease and transmission is currently unknown, and more cohort studies following vaccinated individuals are needed to assess vaccine efficacy. CIDRAP
Retrospective Detection of Monkeypox Virus in the Testes of Nonhuman Primate Survivors
MPXV viral DNA has been detected in semen of human patients in the ongoing 2022 outbreak. It remains unclear whether MPXV replicates in the testes or is transmitted via semen to produce an active infection. This NHP research found that MPXV was cleared from most organs during convalescence, including healed skin lesions, but could be detected for up to 37 d post-exposure in the testes of convalescent macaques. Findings highlight the potential for sexual transmission of MPXV in humans. Further studies are now needed to understand the origins, dynamics and implications of shed MPXV DNA in semen, as well as to confirm whether semen from convalescent monkeypox patients contains infectious MPXV, especially after skin lesions heal. Nature Microbiology
ALSO READING
The Future of Infodemic Surveillance as Public Health Surveillance. Emerging Infectious Diseases
Atypical B cells and impaired SARS-CoV-2 neutralisation following booster vaccination in the elderly. MedRxiv
ChAd155-RSV vaccine is immunogenic and efficacious against bovine RSV infection-induced disease in young calves. Nature Communications
Pandemic origins and a One Health approach to preparedness and prevention: Solutions based on SARS-CoV-2 and other RNA viruses. PNAS
Evaluation of Five Buffers for Inactivation of Monkeypox Virus and Feasibility of Virus Detection Using the Panther Fusion® Open Access System. Viruses
The effects of the COVID-19 pandemic on community respiratory virus activity. Nature Reviews Microbiology
Discovery and validation of circulating miRNAs for the clinical prognosis of severe dengue. PLOS Neglected Tropical Diseases
Assessment of performance for a key indicator of One Health: evidence based on One Health index for zoonoses in Sub-Saharan Africa. Infectious Diseases of Poverty
Human preparedness: Relational infrastructures and medical countermeasures in Sierra Leone. Global Public Health
The Light Chain Domain and Especially the C-Terminus of Receptor-Binding Domain of the Botulinum Neurotoxin (BoNT) Are the Hotspots for Amino Acid Variability and Toxin Type Diversity. Genes