News highlights on health security threats and countermeasures curated by Global Biodefense
This week’s selections include looting of Sudan’s National Public Health Laboratory; preparations for a Phase 2 Marburg vaccine trial; the potential of mucosal vaccines and gaps in understanding correlates of durable protection; and Acute Radiation Syndrome medical countermeasure development.
POLICY + GOVERNMENT
Pandemic Influenza Preparedness Framework: Partnership Contribution High-Level Implementation Plan III 2024-2030
High-Level Implementation Plan III (HLIP III) outlines the strategy for strengthening global pandemic influenza preparedness from 2024 to 2030. order to address gaps in pandemic influenza preparedness. The success of HLIP III relies on the availability of funding through the Partnership Contribution (PC). The PC is a mechanism for financing pandemic preparedness activities funded by the influenza product manufacturers that make annual voluntary cash contributions in return for using GISRS. These are voluntary cash contributions paid annually to WHO. The PC is a key component of the Framework and showcases joint efforts between the public and private sectors to prepare the world for a future influenza pandemic. World Health Organization
Responding to Future Pandemics: Biosecurity Implications and Defense Considerations
In an evolving and expanding biothreat landscape caused by emerging biotechnologies, increases in global infectious disease outbreaks, and geopolitical instability, the Department of Defense now faces challenges that alter its traditional approach to biothreats and prompt the need for modernized, improved preparedness for—and response to—potential biothreat scenarios. These challenges further complicate specific weaknesses revealed by the COVID-19 pandemic, including the Department’s inability to sustain the military mission while meeting intragovernmental expectations to assist with civilian public health resources and services. US Army War College Quarterly
Why An Interdepartmental Coordination Group Should Be Part of the CDC’s Reforms For Future Pandemics
“To improve future decisionmaking in public health crises, we propose that Congress set up an interdepartmental coordination group that would include the CDC as well as the FDA, HUD, and the Departments of the Treasury, Education, Transportation, and Homeland Security, and the National Security Council in the White House. This would integrate the CDC’s expertise into the development of guidance and regulations related to pandemics and other public health emergencies. Such a body would establish a formal mode of communication between the scientists who research pandemics and transmissible disease and the institutions that make policy decisions. Though the coordinating group would not hold any inherent power in issuing regulations on its own, it would bring together technical expertise to facilitate coordinated problem solving across agencies and provide each agency with a direct line to the latest scientific research to help develop and justify pandemic-related policies.” Brookings Institute
Keys to Better Pandemic Preparedness: Strengthen Primary Care, Harness New Technologies
Speaking at the Global Health Summit Regional Meeting, the Director of the Pan American Health Organization, Dr. Jarbas Barbosa, reiterated that collaboration, renewed attention to primary care and innovation will be key to bridge gaps in access to health and overcome inequalities painfully exposed during the COVID-19 pandemic. PAHO
ASPR Releases Public Health Emergency Medical Countermeasure Enterprise Multiyear Budget Assessment
On March 28, the Administration for Strategic Preparedness and Response (ASPR) released the Public Health Emergency Medical Countermeasure Enterprise (PHEMCE) multiyear budget (MYB) for fiscal years 2022 through 2026. The PHEMCE MYB assesses budget needs to support medical countermeasure priorities that would allow the U.S. government to prepare for the next public health threat. The multiyear budget projects an estimated overall funding need of $64 billion over the five-year period. The PHEMCE is an interagency body that reviews the current threat landscape and makes recommendations to the Secretary of the HHS on available or future medical countermeasures. HHS/ASPR
The Promise of the $5 Billion Investment in ‘Project Next Gen’
The Biden administration last week announced Project Next Gen a new $5 billion initiative intended to create better vaccines and monoclonal antibody treatments against COVID-19. In an ideal world, such a program would have been put in place a year or two ago, but domestic politics hindered access to the required funds. Many “next generation” vaccines were designed in 2020-2021, as American and international academic research groups rapidly adapted existing methodologies to take on the COVID-19 pandemic. But 3 years later, very few of the pan-coronavirus and nasally delivered vaccines have made it into clinical trials, and some high profile concepts seem to have stalled out. Why is this? The answer is that the basic science involved in vaccine development — lab-based studies and initial tests in animal models — is the “easy” part. More challenging is vaccine translation: taking a promising concept from the laboratory into early stage human trials. Med Page Today
Why The Pentagon Should “Surge” Investments in Pathogen Early Warning Systems
The Pentagon may soon release its first-ever Biodefense Posture Review, a study that will assess how prepared the Department of Defense is for future pandemics or the threat of bioweapons use. In our past work, we supported an early wave of efforts to dramatically expand US government biosurveillance capabilities—systems to detect and understand biological threats as rapidly as possible. Given how impressively (and cost-effectively) such capabilities have advanced and scaled since that time, the forthcoming review is an opportune time to kick off a new surge to dramatically accelerate the US military’s pathogen early warning efforts. Bulletin of the Atomic Scientists
ASM Requests Increased Funding for DOE Office of Science
“ASM urges Congress to increase funding for the DOE Office of Science to $9.5 billion in fiscal year (FY) 2024, an increase of 16 percent above FY 2023 and consistent with the authorized level in the bi-partisan CHIPS and Science Act. We also request $92 million in funding for the Joint Genome Institute, including at least $10 million for the National Microbiome Data Collaborative and provide an additional $480 million, totaling $1.07 billion to support the Bioenergy Research Centers (BRCs) and $14 million for the Office Biopreparedness Research Virtual Environment (BRaVE) within the Biological and Environmental Research (BER) Directorate. Funding from the DOE Office of Science through the National Laboratories, universities and other programs has generated some of our most economically important innovations and is the primary driver of basic research, including critical areas of genome-scale, quantitative analysis of microbial research.” American Society for Microbiology
The Pandemic Treaty Should Oblige Governments to Report Data on Imprisoned People
Historically, prisons have been incubators for infectious diseases because of overcrowding in confined spaces, poor ventilation, under-resourced healthcare, and the poor physical and mental health of those incarcerated. Such conditions placed prisoners at a high risk of covid-19 and increased the threat of outbreaks among the communities to which they returned. During the first six months of the pandemic, the Covid-19 death rate in US prisons was reported to be 39 deaths per 100,000 prisoners, compared with 29 per 100,000 people in the general population. The draft Pandemic treaty, released in February 2023 recognises the underlying principles of equity, transparency, and accountability and acknowledges that nationally determined priorities must “take into account the rights of individuals and groups at higher risk and in vulnerable situations.” However, while refugees, migrants, and asylum seekers are acknowledged as being in vulnerable situations, prisoners have been omitted. The BMJ
MEDICAL COUNTERMEASURES
Phase 2 Monovalent Chimpanzee Adenoviral-Vectored Marburg Virus Vaccine in Healthy Adults
This is a multi-center, double-blinded, placebo-controlled, Phase II study to evaluate safety, tolerability, and immunogenicity of a single dose of cAd3-Marburg vaccine in healthy adults up to 70 years of age, in Uganda and Kenya. The study will enroll 125 eligible participants. (NCT05817422) and is slated to begin in August. ClincalTrials.gov
Mucosal Vaccines for SARS-Cov-2: Scientific Gaps and Opportunities
Researchers and vaccine developers from around the world discuss the potential of mucosal vaccines to block SARS-CoV-2 transmission. A better understanding of mucosal immunity and the key components that contribute to protection at the mucosal level is needed to inform the selection of vaccine platforms and adjuvants, route of delivery, and mucosal immune markers that should be measured in clinical trials. The current established immune correlate of protection against symptomatic disease is neutralizing antibody titers measured from blood. Importantly there are numerous basic research questions related to correlates of durable protection against the more recent variants of concern and how this would inform optimal next-generation vaccine design which could include mucosal delivery as well as clinical evaluation. Such topics include a better understanding of which cells, whether stimulated by natural infection or vaccination, are most critical for short- and long-term immunity and the nature of interactions among immune cells in the upper and lower airways, and gut. NPJ Vaccines
A Novel Rift Valley Fever Vaccine
Results of a phase 1 study of a new ChAdOx1 vector vaccine against Rift Valley fever (RVF), a mosquito-borne viral zoonotic disease. Safety and immunogenicity of a single dose of the vaccine were characterized in a first-in-human, open-label trial of 15 healthy volunteers from the UK aged 18–55 years. The vaccine was tested in three doses, of which the two highest showed more pronounced immunogenicity. It induced both antibodies and T cells, which persisted during the 3-month follow-up. The vaccine was well tolerated with mild to moderate adverse events, more frequently occurring in the higher dose groups. The favorable safety and immunogenicity data from this vaccine candidate in UK adults clearly support advancement of this vaccine to phase 2 clinical evaluation in RVF-endemic countries. The Lancet Infectious Diseases
mRNA Technology Transfer Programme Moves to Next Phase of Development
Over 200 international participants working with the mRNA Technology Transfer Programme met in Cape Town this week for their first face-to-face meeting, reviewing the progress since WHO and Medicines Patent Pool (MPP) launched it in June 2021. During the five-day meeting, participants will share progress and discuss critical enablers for the sustainability of the Programme such as intellectual property issues and regulatory aspects, as well as the science of mRNA technologies and key applications relevant to LMICs in other disease areas such as HIV and tuberculosis. World Health Organization
Acute Radiation Syndrome: Developing Drugs for Prevention and Treatment
The FDA is seeking comments on draft guidance entitled “Acute Radiation Syndrome: Developing Drugs for Prevention and Treatment.” The draft guidance provides information and recommendations to assist sponsors and other interested parties in the development of drugs to prevent or treat acute radiation syndrome (ARS) caused by exposure to ionizing radiation from accidental or deliberate events. Generally, drugs developed for such indications will require approval under the Animal Rule. Submit comments by 19 July 2023. U.S. Food and Drug Administration
Animal Models: Radiosensitivity of Nonhuman Primates
Animal models are vital for the development of radiation medical countermeasures for the prophylaxis or treatment of acute radiation syndrome and for the delayed effects of acute radiation exposure. Nonhuman primates (NHPs) play an important role in the regulatory approval of such agents by the FDA following the Animal Rule. Reliance on such animal models requires that such models are well characterized. This study examines differences in response based on sex and body weight. Expert Opinion on Drug Discovery
Combination of Acetylcholinesterase Inhibitors and NMDA Receptor Antagonists Increases Survival Rate in Soman-Poisoned Mice
Organophosphorus nerve agents pose a global threat to both military personnel and civilian population, because of their high acute toxicity and insufficient medical countermeasures. Commonly used drugs could ameliorate the intoxication and overall medical outcomes. This study tested the drugs able to alleviate the symptoms of Alzheimer’s disease (donepezil, huperzine A, memantine) or Parkinson’s disease (procyclidine) administered to mice before soman intoxication to measure their protection potential against soman toxicity and influence on post-exposure therapy consisting of atropine and asoxime Their pretreatment effect was not significant, when administered alone, but in combination (with an acetylcholinesterase inhibitor such as denepezil or huperzine A with NMDA antagonist such as memantine or procyclidine) they lowered the soman toxicity more than twice. These combinations also positively influenced the efficacy of post-exposure treatment in a similar fashion. Toxicology Mechanisms and Methods
Comparative Aspects of Ricin Toxicity by Inhalation
The pathogenesis of ricin toxicity following inhalation has been investigated in many animal models, including the non-human primate (predominantly the rhesus macaque), pig, rabbit and rodent. The toxicity and associated pathology described in animal models are broadly similar, but variation appears to exist. There are advantages and disadvantages to the different models of pulmonary fibrosis. Understanding the variables and comparative aspects of acute and chronic ricin toxicity by inhalation is important to enable meaningful comparison of results from different studies, and for the investigation of medical countermeasures. Toxins
Role of KatG in Francisella tularensis Susceptibility to Resazurin
The CDC classifies Francisella tularensis as a Category A bioterrorism agent. Due to the risk of potential release of antibiotic-resistant F. tularensis strains, new therapeutics against F. tularensis must be developed. Resazomycins are resazurin (Rz)-based compounds that exhibit antimicrobial activity against F. tularensis and other gram-negative bacteria. The mode of action of resazomycins is not understood, but potential targets of the antibiotic were identified in a high throughput screen for Rz-resistant isolates. Here researchers hypothesize KatG plays a role in the susceptibility of F. tularensis to resazurin. Proceedings of the West Virginia Academy of Science
Efficacy of Intravenously Administered Gepotidacin in NHP Following a Francisella tularensis Inhalational Challenge
F. tularensis strains have been evaluated as potential biological weapons worldwide since the 1930s. Early treatment with effective antibiotics can reduce patient mortality. Gepotidacin is a novel, first-in-class triazaacenaphthylene antibiotic that inhibits bacterial DNA replication by a distinct mechanism of action. In this study, Gepotidacin treatment resulted in 100% survival. Antimicrobial Agents and Chemotherapy
Design Strategies for Cellular Nanosponges as Medical Countermeasures
The interest in using therapeutic nanoparticles to bind with harmful molecules or pathogens and subsequently neutralize their bioactivity has grown tremendously. Among various nanomedicine platforms, cell membrane-coated nanoparticles, namely, “cellular nanosponges,” stand out for their broad-spectrum neutralization capability challenging to achieve in traditional countermeasure technologies. BME Frontiers
BIOSECURITY + BIOPREPAREDNESS
‘High Bio-Hazard Risk’ in Sudan After Laboratory Seized, WHO Says
There is a “high risk of biological hazard” in Sudan’s capital Khartoum after one of the warring parties seized a laboratory holding measles and cholera pathogens and other hazardous materials. The WHO’s technicians were unable to gain access to the National Public Health Laboratory to secure the materials. Fighting erupted between the Sudanese armed forces and Rapid Support Forces (RSF) paramilitaries on April 15 and has killed at least 459 people and injured 4,072, according to the WHO’s latest figures. Abid said this was an undercount, adding that he had seen two bodies in the street himself in recent days. The clashes have paralysed hospitals and other essential services, and left many stranded in their homes with dwindling supplies of food and water. The WHO has reported 14 attacks on health facilities since the clashes began and is relocating its staff to safety. Reuters
2022 Preparedness Profile Preview Report
In 2022, fewer local health departments reported having formal mechanisms in place to address administrative preparedness activities (procure and allocate goods and services; staffing up or reallocation of existing staff; funding emergency staffing needs) than in 2018 – except in the case of receiving and using emergency funding. Major barriers to administrative preparedness were a lack of dedicated resources, leadership buy-in challenges, and outdated technology. More than half of local health departments reported no activities related to climate change/adaptation, critical infrastructure protection, and terrorist threats. NACCHO
Health Care Facility Viral Hemorrhagic Fever Preparedness Checklist
In April 2023, NETEC experts reviewed and expanded the scope of the original Ebola Checklist for Health Care Facilities to include guidance for other Viral Hemorrhagic Fevers (VHFs), including Crimean-Congo Hemorrhagic Fever (CCHF), Ebola Virus Disease (EVD), Lassa Fever, and Marburg Virus Disease (MVD). Health care facilities can use this tool to assess their readiness to identify, isolate, inform, and provide initial treatment for patients suspected or confirmed to be infected with a viral hemorrhagic fever. It guides facilities through a review of their immediate care capabilities and links to resources that will help improve or fill gaps in preparedness. NETEC
We’re Still Getting Our Pandemic Preparation Horribly Wrong
Once the SARS-CoV-2 virus breached biosafety systems that had been lauded as impenetrable, it encountered decrepit social infrastructure. It found “essential workers” laboring in meatpacking plants, shipping facilities, and grocery stores. It followed them home to multigenerational households in disproportionately Black and brown communities. Those low-paid workers made up most of the deaths among working-age Americans in the first year of Covid-19. The pandemic also ripped through neglected nursing homes, whose medically fragile residents accounted for up to 80 percent of total deaths in some states in 2020. It engulfed prisons in devastating outbreaks that functioned as “epidemic engines,” sending the virus on into neighboring communities. We are failing to invest meaningfully in reforms that could serve as future firebreaks. Plans to develop a vaccine in 100 days have taken center stage at global forums and in “next pandemic” conversations. But plans to protect poor, minority, and medically vulnerable populations, all overwhelmingly represented among the more than 100,000 Americans that died in the pandemic’s first 100 days, remain conspicuously absent. The Nation
COVID-19 Has Left The World Less Prepared for an Influenza Pandemic
Countries are legally required to immediately notify the WHO of any “human influenza caused by a new subtype” as a potential public health emergency of international concern under the International Health Regulations (2005). However, the broad adoption of travel restrictions during COVID-19, and the potential risk that travel bans will be imposed after a notification, means that countries are currently disincentivized to rapidly report future outbreaks of pathogens of pandemic potential. Incomplete surveillance and delayed notification may result in wide transmission of a novel pathogen before the international community is alerted and global responses can be mounted. Nature Medicine
Britain’s Isolation Tent for the World’s Deadliest Diseases
The technology behind these units, known as a Trexler isolator, was first developed in the 1970s as means for creating a positive pressure environment, free of bugs and germs, in which pure lines of animals could be bred. Over time, it has been evolved to keep medics safe when treating patients with deadly infections. The Telegraph
Asia’s First Mobile Biosafety Lab Can Serve Remote Areas
The mobile BSL-3 laboratory, named the Rapid Action Mobile BSL-3 Advanced Augmented Network (RAMBAAN), was recently showcased at the G-20 Health Working Group Meeting. The lab is equipped with deep cold refrigeration, biosafety cabinets, RNA extraction systems, and RT-PCR machines. Times of India
NBAF Tour Sheds Light on Swine Health Capabilities, Priorities
In early April 2023, leadership from the National Bio and Agro-Defense Facility (NBAF) provided a facility and research update to staff leaders from the American Association of Swine Veterinarians, National Pork Board, National Pork Producers Council and the Swine Health Information Center. USDA will own and operate the Manhattan, Kansas, state-of-the-art NBAF facility, intended to help protect the nation’s agriculture industry, farmers and citizens against the threat and potential impact of serious animal diseases. National Hog Farmer
SELECT AGENTS + PRIORITY PATHOGENS
Marburg Cases Rise in Equatorial Guinea
Equatorial Guinea has 17 lab-confirmed cases of Marburg disease since the beginning of the outbreak, including 12 deaths. 23 probable cases of MVD fatalities have also been reported. Officials are monitoring 116 contacts. The latest WHO update suggests the country is struggling to monitor and quarantine cases – and trace how the infection may be spreading. “The country surveillance system remains suboptimal with few alerts reported and investigated. “Several epidemiological links and transmission chains have not been detected, thus there might be contacts not identified.” Reuters, The Telegraph, CIDRAP
Two Individuals with Potential Monkeypox Virus Reinfection
Over 80 000 mpox (formerly known as monkeypox) cases have been confirmed worldwide and recovered individuals are considered protected against reinfection. Here clinicians describe two individuals with potential mpox reinfection at San Raffaele Hospital, Milan, Italy. Following clinical and virological healing of the first episodes, they observed high cycle threshold values and short-lasting symptoms for both second episodes, with clinical characteristics consistent with mpox, and detectable neutralising antibodies. The cycle threshold values were high for new-onset mpox and suggest low viral loads. Possible alternative explanations to reinfection include relapse from tissue reservoirs or sexual contamination. Both patients had co-infections, which could have caused or exacerbated symptoms, or could have eased reinfection. The Lancet Infectious Diseases
US Poultry Farms Reduce Avian Flu Outbreaks as USDA Begins Vaccine Testing
Federal officials last week said improved biosecurity has reduced the number of outbreaks at commercial farms compared with a year ago. In March 2022, there were 51 avian flu outbreaks at commercial farms, and poultry losses by the end of the year soared past the previous record high of 50.5 million birds. However, last month there were only 7 outbreaks, a decline of 85% from a year ago. USDA ARS officials also detailed the work of their science groups on a poultry vaccine against the disease. It said initial data on a single dose of the vaccine are expected in May, with results from two-dose challenge studies expected in June. CIDRAP
Opinion: Bird Flu is Killing Off the World’s Birds
Experts are concerned that a new global disease outbreak, possibly worse than Covid-19, might begin any day. The virus that worries them is H5N1, a form of avian influenza, or bird flu. Some researchers have warned that with just a few mutations, or maybe a sudden swapping of gene segments, this deadly flu virus could gain the ability to spread from human to human. But in fact, the next pandemic has already begun. To use a more accurate term, a panzootic — a widespread outbreak of disease among nonhuman animals — is underway. To appreciate this catastrophe, we’ve got to move the focus off humans, at least for a bit. H5N1 is devastating the world’s birds. New York Times
Human Infection with Highly Pathogenic Avian Influenza A(H5N1) Virus in Chile
The Chilean patient was a 53-year-old man with symptom onset on March 13. He was hospitalized with severe illness and remains in respiratory isolation under multidisciplinary management, with mechanical ventilation due to pneumonia. After hospital admission on March 22, the patient received antiviral treatment with oseltamivir and antibiotic treatment. Viral RNA sample analysis showed the virus was 99% identical to many viruses identified in A(H5N1) virus-infected wild birds in Chile. CDC
ECDC Highlights Measures to Mitigate Possible Increase in Mpox Cases During Spring and Summer
“The number of mpox cases have greatly decreased since the peak in July last year. However, there is risk of an increase in the coming spring and summer season due to festivities and increased holiday travel. Early diagnosis, isolation, partner notification and contact tracing remain key for the effective control of this outbreak and should be supported by appropriate vaccination- and behaviour change strategies.” Vaccination programs must be backed by thorough surveillance and contact tracing and accompanied by a strong information campaign and robust pharmacovigilance. Preliminary data indicates that as of 3 March 2023, more than 300,000 vaccine doses have been administered in 25 EU/EEA countries. Testing should be made widely available to improve rapid access, particularly in clinical settings that serve MSM, as this is where the populations at highest risk are likely to access care. European Centre for Disease Control and Prevention
Computed Tomography Imaging for Monitoring of Marburg Virus Disease
The pathogenesis of MVD remains poorly understood, partially due to the low number of cases that can be studied, the absence of state-of-the-art medical equipment in areas where cases are reported, and limitations on the number of animals that can be safely used in experimental studies under maximum containment animal biosafety level 4 conditions. Medical imaging modalities, such as whole-body computed tomography (CT), may help to describe disease progression in vivo, potentially replacing ethically contentious and logistically challenging serial euthanasia studies. Microbiology Spectrum
CHEMICAL + RADIOLOGICAL THREATS
Neutralization and Decontamination of Chemical Warfare Agents using Homogeneous Chemical Solutions
In this study, the conversion rates achieved and products obtained for various CWAs upon reaction with different homogeneous chemical solutions (acting as neutralizers) under the same conditions are systematically examined using gas chromatography. The results allowed for identification of the chemicals that exhibit excellent neutralization performances for the various CWAs, while also providing fundamental kinetic data that can be used to predict the tendencies of the reactions between CWAs and other chemicals. Industrial & Engineering Chemistry Research
CBRNResponder: FEMA’s One-Stop Shop for CBRN Incident Management and Data Sharing
CBRNResponder is a secure platform for chemical, biological or radioactive/nuclear (CBRN) incident data sharing and multi-hazard event management. It serves as a hub and one-stop shop for all-hazards planning, preparedness, operational tools and resources. U.S. Fire Administration
Review of Possible Therapies in Treatment of Novichoks Poisoning and HAZMAT/CBRNE Approaches
The review includes data on treating poisoning caused by OPs which could be used as guidelines for the therapy in case of Novichok exposure and HAZMAT/CBRNE approaches. Novichoks pose a severe threat due to their toxicity; however, there is insufficient information about the identity of A-series nerve agents. Journal of Clinical Medicine
The Bromine Analog of Sulfur Mustard: Synthesis and Reactivity Studies
This paper presents a synthesis of the bromine analog of sulfur mustard, as well as a detailed description of its hydrolysis reactions under changing polarity conditions. Due to the risk of illegal use of chemical substances, there is a need to thoroughly examine the methods of neutralizing not only chemical compounds on the lists of the Convention on the Prohibition of Chemical Weapons but also compounds of a similar structure, considered to be a nontoxic or little threatening. Moreover, to better understand the chemical properties of a particular CWA, it is often necessary to study the reaction of several analogs of a given substance under the same physicochemical conditions. Journal of Molecular Structure
SURVEILLANCE + DETECTION
Methods to Enable Wastewater-Based Biosurveillance of All Infectious Diseases
While COVID-19 brought an increased utilization of wastewater-based biosurveillance (WBE), this usage is specific to surveillance of a single pathogen at a time, detecting and quantifying the SARS-CoV-2 virus through qPCR or digital droplet PCR (ddPCR). To unlock the power of WBE to provide a wholistic understanding of the communicable disease landscape within a region, the method to detect pathogens must be high throughput and multiplexed to detect any human pathogen. To enable established COVID wastewater tracking networks to transition into a pathogen surveillance network, we recommend development of a targeted hybridization panel to detect all reportable disease pathogens and AMR genes from RNA extracts. Future work will include development of control materials, and optimization of RNA extraction methods to ensure pathogen detection from different wastewater samples with known limit of detection, sensitivity, and specificity for each pathogen. Frontiers in Public Health
Tick-Borne Encephalitis Virus IgG Antibody Surveillance
Tick-borne encephalitis virus (TBEV) is the most important tick-borne flavivirus on the Eurasian continent with 10,000–12,000 reported human cases per year. Findings from this study in an area in south-western Germany conclude the risk of TBEV infection is much higher than previously assumed. In addition, the proportion of infected people developing severe infection seems to be smaller than estimated in earlier studies. This higher risk of infection implies changes in the environment affecting the virus’ transmission cycle and/or changes in human behaviour which increase the infection risk. Eurosurveillance
Metagenomics for Epidemiological Surveillance in One Health
Metagenomics approaches continue to become less expensive, and now represent a potentially cost-effective approach to conduct biosurveillance and monitor molecular epidemiology. Compared to PCR, which only detects pathogen based on specific primers, metagenomic agnostic sequencing allows for the identification of known and unknown microbes (viruses, bacteria and protozoans) from a single sample. The nine publications presented in this Research Topic capture a wide range of settings that metagenomics can be applied to through a One Health lens, including outbreak response, clinical management, biosurveillance, and disease monitoring within the human animal interface. Frontiers in Microbiology
WildHealthNet: Supporting Sustainable Wildlife Health Surveillance Networks In Southeast Asia
WildHealthNet (WHN) operationalizes a One Health approach to build national wildlife health surveillance systems, addressing a need for health monitoring and early outbreak detection and response. Adaptability is possible for use in other countries outside the pilot program areas and by governments, wildlife conservation actors, civil society organizations, and communities. Science of the Total Environment
A New Method for Near Real-Time, Nationwide Surveillance of Nosocomial COVID-19 in Norway
Few surveillance systems capture nosocomial COVID-19 in an easy and timely manner. In anticipation of further COVID-19 waves and winter respiratory virus seasons, hospitals and national authorities will need updated and quality-assured data on healthcare-associated respiratory infections. Automated surveillance using existing databases provides quality data down to the level of the individual without increasing the workload for frontline caregivers. It will be important to agree on definitions for nosocomial COVID-19 internationally. Eurosurveillance
HEALTH BEHAVIOR + RISK
Michigan County Moves to Replace Public Health Director with HVAC Guy
It had been a difficult three years for Adeline Hambley and her team. First came the pandemic, then the backlash over the mask mandate and coronavirus vaccines, which led to death threats and a police car stationed in their parking lot. Now they felt as if they were being demonized simply for doing their jobs. “We’ve never had a county leadership opposed to the principles of public health and opposed to its own departments.” Washington Post
New Data Indicates Declining Confidence in Childhood Vaccines of Up to 44 Percentage Points
The public perception of the importance of vaccines for children declined during the COVID-19 pandemic in 52 out of 55 countries studied, UNICEF warned this week in a new report on immunization. Alarmingly, the decline in confidence comes amid the largest sustained backslide in childhood immunization in 30 years, fueled by the COVID-19 pandemic. The report shows 67 million children missed out on one or more vaccinations over three years due to service disruption caused by strained health systems and diversion of scarce resources, conflict and fragility, and decreased confidence. In 2022, for example, the number of measles cases was more than double the total in the previous year. The number of children paralysed by polio was up 16 per cent year-on-year in 2022. When comparing the 2019 to 2021 period with the previous three-year period, there was an eight-fold increase in the number of children paralysed by polio, highlighting the need to ensure vaccination efforts are sustained. UNICEF
Public Perceptions of Ebola Vaccines and Confidence in Health Services
A cross-sectional household survey was implemented in six districts in Uganda using multi-stage cluster sampling to randomly select participants. Among 3,485 respondents, 18% were aware of Ebola vaccines. Of those, 92% agreed that the vaccines were needed to prevent Ebola. Participants aged 15-24 years were 4% more likely to perceive such need compared to those 60 years and older. Overall, 81% of those aware of the vaccines believed that everyone or most people in their community would get vaccinated if offered, and 94% said they would likely get vaccinated if offered. Confidence in health services to treat Ebola was lower compared to treating malaria or tuberculosis (55% versus 93% and 77%, respectively). MedRxiv
A Multifaceted Campaign to Combat COVID-19 Misinformation in the Hispanic Community
At the height of the COVID-19 pandemic, the Public Good Projects, Hispanic Communications Network and World Voices Media joined forces to launch a nationwide, multifaceted campaign which aimed to increase vaccine confidence and decrease misinformation on social media within Hispanic communities. Journal of Community Health
ANTIMICROBIAL RESISTANCE CRISIS
WHO/ECDC Report: Antimicrobial Resistance Threatens Patient Safety in European Region
The latest Surveillance of Antimicrobial Resistance in Europe report shows high percentages of resistance to last-line antibiotics, such as carbapenems, in several countries of the WHO European Region. The report features data from 2021. Current patterns, such as increases in carbapenem-resistant Acinetobacter species that are difficult to eradicate once endemic, underline the need to further enhance efforts to prevent and detect resistance” European Centre for Disease Control and Prevention
A Clinically-Oriented Antimicrobial Resistance Surveillance Network
Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicenter protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. The main goal is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalized patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Wellcome Open Research
In Low-Resource Nations, Lack of Diagnostics Hampers Fight Against Antimicrobial Resistance
In a study published last year in The Lancet, an international team of researchers estimated that 1.27 million people died in 2019 from an antibiotic-resistant infection, and nearly 5 million deaths were associated with antimicrobial resistance. The study, along with many others that have been conducted in LMICs, cited several reasons why AMR has a disproportionate impact in low-resources settings. Among them: inappropriate use of antibiotics that can be easily purchased without a prescription, counterfeit and substandard antibiotics, and poor sanitation and hygiene. All play a role in driving up resistance rates. But perhaps the biggest factor is the lack of the diagnostic tools that can determine the right antibiotic needed for a patient’s infection—or if an antibiotic is needed at all. CIDRAP
The Window is Closing to Stop Deadly Drug-Resistant Fungi Like Candida auris
Twenty-seven states and Washington, D.C. have reported cases of the deadly fungal infection that often doesn’t respond to common antifungal drugs, with southern Nevada emerging as a hotspot of infections. Clinical cases have risen each year since it was first publicly reported in 2016, with 2,377 reported in 2022, and the CDC notes that based on limited information, 30–60% of those infected with C. auris have died. STAT
COVID-19 PANDEMIC
XBB.1.16 Picks Up Speed in US
The Omicron XBB.1.16 SARS-CoV-2 subvariant fueling India’s surge is gaining traction in the United States, but so far the nation isn’t seeing increases in cases, deaths, or hospitalizations, the CDC said in its latest updates. XBB.1.16 now makes up 7.2% of US samples, up from 3.9% the previous week. However, XBB.1.16 already makes up 21.3% of viruses in the south-central region of the country, which includes Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. At the global level, overall cases and deaths continued to drop over the past 4 weeks, but some regions and individual countries are seeing notable case rises. CIDRAP
FDA Authorizes Changes to Simplify Use of mRNA COVID-19 Vaccines
This action includes authorizing the current bivalent vaccines (original and omicron BA.4/BA.5 strains) to be used for all doses administered to individuals 6 months of age and older, including for an additional dose or doses for certain populations. The monovalent Moderna and Pfizer-BioNTech COVID-19 vaccines are no longer authorized for use in the United States. U.S. Food and Drug Administration
Risk of Death in Patients Hospitalized for COVID-19 vs Seasonal Influenza in Fall-Winter 2022-2023
This study found that, in a VA population in fall-winter 2022-2023, being hospitalized for COVID-19 vs seasonal influenza was associated with an increased risk of death. This finding should be interpreted in the context of a 2 to 3 times greater number of people being hospitalized for COVID-19 vs influenza in the US in this period. However, the difference in mortality rates between COVID-19 and influenza appears to have decreased since early in the pandemic; death rates among people hospitalized for COVID-19 were 17% to 21% in 2020 vs 6% in this study, while death rates for those hospitalized for influenza were 3.8% in 2020 vs 3.7% in this study. The decline in death rates among people hospitalized for COVID-19 may be due to changes in SARS-CoV-2 variants, increased immunity levels (from vaccination and prior infection), and improved clinical care. The increased risk of death was greater among unvaccinated individuals compared with those vaccinated or boosted—findings that highlight the importance of vaccination in reducing risk of COVID-19 death. JAMA
White House Launching $5 Billion Program to Speed Coronavirus Vaccines
“It’s been very clear to us that the market on this is moving very slowly,” Ashish Jha, the White House coronavirus coordinator, said Monday. “There’s a lot that government can do, the administration can do, to speed up those tools … for the American people.” The new effort will focus on three goals: creating long-lasting monoclonal antibodies, after an evolving virus rendered many current treatments ineffective; accelerating development of vaccines that produce mucosal immunity, which is thought to reduce transmission and infection risks; and speeding efforts to develop pan-coronavirus vaccines to guard against new SARS-CoV-2 variants, as well as other coronaviruses. Washington Post
High Risk Of Autoimmune Diseases After COVID-19
The full picture of post-COVID-19 autoimmune diseases and their prevalence is lacking despite numerous case reports and small series. Two studies that use large cohorts now highlight that SARS-CoV-2 infection is linked to a substantially increased risk of developing a diverse spectrum of new-onset autoimmune diseases. Various theories have been proposed to explain the molecular basis of COVID-19-related immune dysregulation, which include molecular mimicry by viral proteins, systemic manifestation and multiorgan involvement of COVID-19 due to widespread expression of the SARS-CoV-2 receptor ACE2, bystander activation of immune cells, release of autoantigens from tissue damaged by the virus, superantigen-mediated activation of lymphocytes and epitope spreading. Nature Review Rheumatology
HISTORICAL REFLECTIONS
Confronting a Pandemic, 1957
The first cases were reported in Guizhou province in southwestern China in 1956. By February 1957, the disease, a form of influenza that caused typical flu symptoms such as a sore throat and fever, had arrived in Singapore. Weeks later, it hit Hong Kong. Maurice Hilleman, a microbiologist at the Walter Reed Army Institute of Research in Maryland, read about the outbreaks in The New York Times on April 17 of that year. An article entitled “Hong Kong Battling Influenza Epidemic” stated that 250,000 people there were receiving treatment for the infection. Lines of people, including “many women” carrying “glassy-eyed children,” were forming outside health clinics, the article noted. She thought “My God, this is the pandemic. It’s here.” The Scientist
Chemical Warfare in Ancient Greek Ionia: Mass Intoxication With Hecate’s Deleterium
The rich land of Erythrae in the coast of Asia Minor attracted the attention of the Ionian king Codrus. An oracle demanded the presence of the murky deity Hecate for him to conquer the city. Priestess Chrysame was sent by Thessalians to set the strategy of the clash. The young sorceress poisoned a sacred bull who turned mad, later to be released toward the camp of Erythraeans. The beast was captured and sacrificed. In the feast that followed, all ate a piece of his flesh and went crazy, stimulated by the poison, an easy prey for the army of Codrus. The deleterium used by Chrysame is unknown, but her strategy shaped the origin of biowarfare. Military Medicine
SPECIAL INTEREST
Celebrating Laboratorians Who Get Results
April 23–29, 2023 is Medical Laboratory Professionals Week—an annual celebration to highlight and show appreciation for laboratory professionals. Clinical laboratorians play a critical role in patient care, performing foundational work to support screening, diagnosis, monitoring, and treatment of disease. Lab Week is sponsored by the American Society for Clinical Laboratory Science (ASCLS) and coordinated by 17 national clinical laboratory organizations. NETEC
The Making of a Biosafety Officer
“The potential risks for accidents and misuse increase as biotechnology becomes more sophisticated, less expensive, and increasingly distributed. During my 28 years as a biosafety officer, I have dealt with laboratory explosions, fires, spills, needlesticks, eye contamination, accidental releases, and lost or unaccounted-for inventory—along with the day-to-day anxieties of keeping labs safe. Biosafety professionals are responsible for mitigating risks at universities, federal laboratories, health care facilities, nonprofits, and pharmaceutical and other commercial operations. While we—I am one of only a few thousand in the United States—have similar job titles, our backgrounds run the gamut from microbiology to chemistry, from high school or associate degrees to PhDs.” Issues in Science and Technology
Online Survey to Update WHO Bacterial Priority Pathogen List
This study is led by the Impact Initiatives and Research Coordination (IRC) Unit, part of the AMR Global Coordination Department, of AMR Division. The aim of this study is to revise the 2017 WHO Bacterial Pathogen Priority List (WHO-BPPL). The end goal is to ensure that the list is up to date and continue to guide research and development (R&D) investments and programs for new antibacterials based on public health needs. Survey deadline is 27 April 2023. World Health Organization
Artificial Intelligence in Drug Manufacturing
The FDA is soliciting public comments on a specific area of emerging and advanced manufacturing technologies. The discussion paper presents areas for consideration and policy development identified by the Center for Drug Evaluation and Research (CDER) scientific and policy experts associated with application of artificial intelligence (AI) to pharmaceutical manufacturing. Submit comments and information by 1 May 2023. Regulations.gov
Consultant for Project Public Health Ready (PPHR) Criteria Updates and Quality Improvement
NACCHO, with support from the Centers for Disease Control and Prevention (CDC), is pleased to offer a funding opportunity for a consultant to lead efforts to update criteria elements and support continuous quality improvement for Project Public Health Ready (PPHR), a public health preparedness criteria-based, recognition program that assesses a local health department’s capacity and capability to plan for, respond to, and recover from public health emergencies. PPHR aims to protect the public’s health and strengthen the public health infrastructure by equipping local health departments with sustainable tools to plan, train, and exercise using a continuous quality improvement model. Proposals due 28 April 2023. NACCHO
2023 SSI/ISID Infectious Diseases Fellowship Now Open
The purpose of the SSI/ISID Fellowship program is to support infectious disease physicians and scientists from under-resourced countries through multidisciplinary clinical and laboratory training in Zurich, Switzerland. Applicants should have an MD or PhD in a relevant field and should hold a position at a medical, research, or public health institution. Deadline for submission is 16 June 2023. International Society for Infectious Diseases
Fellowship Opportunities in Medical Countermeasures Research & Development
The ORISE Research Participation Program has announced new fellowship opportunities at the Biomedical Advanced Research and Development Authority (BARDA). Fellows will conduct research on projects related to medical countermeasure (MCMs) development, including preclinical model development, non-clinical testing and evaluation, and clinical trials. Application deadline: 31 May 2023. ORISE
ALSO READING
Guidance for clinical management of Thrombotic Thrombocytopenia Syndrome (TTS) following vaccination to prevent COVID-19. WHO Pharmacovigilance Team
Monoclonal antibodies for malaria prevention: Preferred product characteristics and clinical development considerations. WHO Global Malaria Programme
Measuring the Monetization of Online Discourse with Application to Pro- and Anti-Vaccine Communities. OSF Preprints
COVID-19 Vaccination Attitudes and Intentions Among U.S. Soldiers: Results from the U.S. Army Behavioral Health Advisory Team (BHAT). Journal of Community Health
Can Africa Get Close to Vaccine Independence? Here’s What It Will Take. New York Times
Human monkeypox infection threat: A comprehensive overview. PLOS Neglected Tropical Diseases
Emerging SARS-CoV-2 variants: Genomic variations, transmission, pathogenesis, clinical impact and interventions. Frontiers in Medicine
Tick-borne encephalitis: epidemiology, diagnosis and prevention. UK Health Security Agency
Effect of remdesivir post-exposure prophylaxis and treatment on pathogenesis of measles in rhesus macaques. Scientific Reports