News highlights on health security threats and countermeasures curated by Global Biodefense.
This week’s selections include ambitious changes at the CDC while facing budget cuts; DoD roll-out of Biodefense Posture Review; mAbs for treating advanced Lassa fever; and a market survey of mobile radiation detection systems.
POLICY + GOVERNMENT
ARPA-H Should Zero in on Pandemic Prevention
Instead of specific programs targeting single diseases, ARPA-H’s first priority is to seek tools that tackle multiple ills at once. Of the tools that prevent pandemics, several already exist: indoor toilets, water treatment, and pasteurization. Although these are all taken for granted as features of modern life, they should be understood as outbreak prevention technologies, stopping the spread of disease by food, water, and human contact without targeting any specific pathogen or even being explicitly considered an aspect of health care. Future platform technologies might include wearable sensors that detect infection noninvasively and before symptoms appear. This real-time monitoring could bring radical insights for quashing nascent outbreaks. Issues in Science and Technology
Senate Appropriations Bill Misses Opportunity to Fund Workforce Pilot Program
The Senate’s FY 2024 Labor, Health and Human Services and State and Foreign Operations appropriations bills largely flat fund ID programs at FY 2023 levels and provide a few modest increases. IDSA is disappointed that the bill did not provide resources for the Bio-Preparedness Workforce Pilot Program, a bipartisan effort to close growing ID workforce gaps that endanger patient care, public health and preparedness activities. IDSA
House Appropriations Bills Endanger Domestic and Global ID Programs
“We are… dismayed to see deep cuts in funding for domestic and global ID programs, including ID research, global health security and HIV efforts. While the bill includes increased funding for CDC’s Antibiotic Resistance Solutions Initiative, the bill’s stagnant funding for other key public health programs weakens our ability to care for patients, protect public health and bolster our readiness for future outbreaks and other emergencies.” $900 million is cut from USAID global health security efforts, effectively zeroing out the program. IDSA
The CDC Faces $1.5 Billion in Budget Cuts. Layoffs Will Almost Certainly Follow
The nation’s health faces a dual threat — one anticipated, the other, self-inflicted. What few realize is that more than three-quarters of the CDC budget goes to the states and contract research organizations in the form of public health and prevention activities by state and local health organizations and agencies, national public health partners and academic institutions. STAT
US Military at Pivotal Moment for Biodefense, Review Warns
U.S. officials examined biodefense threats through 2035 and advised modernization efforts across the Pentagon and military forces to address them. One way to do so is to shore up domestic production to be less reliant on global supply chains that can be rattled by a pandemic, the report says. Other recommendations include increasing medical research and development against infectious diseases and incorporating biothreat planning into Defense Department exercises. The Hill, Global Biodefense
Biotech Industry Could Face More CFIUS Scrutiny
The Department of Defense may soon be raising more red flags to the Committee on Foreign Investment in the United States that could affect the biotechnology industry. The Pentagon’s 2023 Biodefense Posture Review, released Thursday, recommends that the DoD perform more robust assessments of the potential risks posed by particular non-U.S. entities seeking to buy their way into American biotech firms. “To reduce national security concerns in the biodefense industrial base, DoD could improve assessment of CFIUS cases to more effectively communicate the risks posed by specific foreign investments.” Defense Scoop
Pentagon Biodefense Review Points to Chinese, Russian Threats
While the review is wide-reaching, its focus on China as a top priority is a departure from previous assessments. Beijing has called for the United States to release more details of its own biodefense research and has echoed unproven claims made by Moscow that the Pentagon is financing biological weapons labs in Ukraine. In March of last year, the White House labeled the claims “preposterous” and warned that Russia could employ its own bioweapons in Ukraine. Washington Post
Outrage Over Chicago Mayor’s Firing of Public Health Leader
During his campaign for mayor, Brandon Johnson promised to fire Dr. Allison Arwady, an expert in infectious diseases with degrees from Harvard, Yale and Columbia universities, saying they had different views of public health. Last Friday night, he did just that, nearly three months after taking office, setting off a wave of recriminations and outrage that served to increase pressure on his administration to deliver on his vision of public health for Chicago — while coping with the continuing pandemic. CBS Chicago, Chicago Tribune
Can a WHO Pandemic Treaty Help Poorer Nations in Future Outbreaks?
The WHO’s member states have agreed to work on a legally binding treaty on how to respond to the next pandemic to avoid repeating the damage caused by Covid-19, which not only caused almost 7 million deaths but, especially in poorer countries, led to increases in poverty and hunger, and disrupted health systems. The most recent meetings were held in July and are being followed up with more throughout this year, with the goal of presenting a final draft to the World Health Assembly in May 2024. The Guardian
MEDICAL COUNTERMEASURES
Ebola Vaccine Uptake and Attitudes Among Healthcare Workers in North Kivu
Overall uptake of the Ebola vaccine was high among HCWs, but uptake at the first offer was substantially lower, which was associated with mistrust of the vaccine source. Future Ebola vaccination efforts should plan to make repeated vaccination offers to HCWs and address their underlying mistrust in the vaccines, which can, in turn, improve community uptake. Frontiers in Public Health
Perspectives on Advancing Countermeasures for Filovirus Disease: Report from a Multi-Sector Meeting
Although there are now approved treatments and vaccines for Ebola virus disease, the case fatality of EVD remains unacceptably high even when treated with the newly approved therapeutics; furthermore, these countermeasures are not expected to be effective against disease caused by other filoviruses. The greatest challenge to completing development for newer countermeasures is the implementation of well-designed clinical trials of safety and efficacy during filovirus disease outbreaks. The Journal of Infectious Diseases
Human Monoclonal Antibody Combination Rescues NHP from Advanced Lassa Virus Disease
Study shows combinations of two or three broadly neutralizing human monoclonal antibodies known as Arevirumab-2 or Arevirumab-3 can protect up to 100% of cynomolgus monkeys against challenge with two of the major lineages of Lassa virus when treatment is initiated at advanced stages of disease on day 8 after Lassa virus exposure. PNAS
A Brief Overview of Emerging Vaccine Technologies for Pandemic Preparedness
With so many aspects of pandemic preparedness tied to public health, national security, and economic competition, understanding the key technology and policy trends of the major country stakeholders in this space provides valuable insights into pandemic preparedness gaps and ways of addressing them. China has a strong and stable vaccine industry, while Russia falls behind the United States, Japan, and China. There have been well-founded questions about the efficacy of both the Chinese and Russian COVID-19 vaccines. While Japan’s rapidly aging population makes it particularly vulnerable to pandemics, many other nations also have growing numbers of older people; Japan is a harbinger rather than an outlier. RAND
FDA Extends Approval Deadline for Valneva’s Chikungunya Vaccine by 3 Months
According to Valneva, the FDA extended the Prescription Drug User Fee Act (PDUFA) action date from late August to late November to “allow sufficient time to align and agree on the phase 4 program necessary under the accelerated approval process.” VLA1553 would be the first vaccine against the mosquito-borne virus. Healio
US Regulatory Approved Pharmacotherapies for Nuclear Reactor Explosions and Anthrax-Associated Bioterrorism
Two potential mass public health disasters are aerosolized anthrax dissemination and radiological incidents. Five agents authorized for anthrax emergencies only have FDA approval for this indication, five antibiotics have FDA approvals as antibiotics for common infections and for bacillus anthrax, and four agents have regulatory approvals for supportive care for cancer and for radiological incidents. Expert Opinion on Drug Safety
BIOSECURITY + BIOPREPAREDNESS
Convergence: Artificial intelligence and the New and Old Weapons of Mass Destruction
Last October, congresswoman Anna G. Eshoo issued an open letter to the national security advisor and the Office of Science and Technology Policy (OSTP) urging them to address the biosecurity risks posed by the use of artificial intelligence (AI) in both civilian and military applications. “AI has important applications in biotechnology, healthcare, and pharmaceuticals, however, we should remain vigilant against the potential harm dual-use applications represent for the national security, economic security, and public health of the United States, in the same way we would with physical resources such as molecules or biologics.” Bulletin of the Atomic Scientists
Years in the Works, National Bio and Agro-Defense Facility Comes Online with New Capabilities
Nearly 20 years in the works, the $1.25 billion facility will ultimately replace the Plum Island Animal Disease Center where, for more than half a century, USDA scientists led efforts to protect the nation from foot-and-mouth disease and other devastating foreign animal diseases, such as African swine fever (ASF) and classical swine fever. The transfer of science programs from Plum Island to NBAF will occur in phases over the next few years. NBAF must first go through select agent registration and other necessary clearance processes. AVMA News
Britain Underprepared for Chemical and Biological Attacks, Experts Say
“Police, fire brigades, and NHS organisations that are barely capable of doing their job on a good day, due to systemic running-down of their resources and hence their resilience, are going to struggle with chemical or biological terrorism happening on their patch. We simply do not do emergency planning well and we generally lack resilience.” The Telegraph
HHS Launches ‘Digiheals’ Project to Better Protect US Hospitals From Ransomware
ARPA-H is launching an the Digital Health Security (Digiheals) to find and help fund the development of cybersecurity technologies that can specifically improve defenses for digital infrastructure in US health care. For more than a decade, health care providers have been plagued by criminal cyberattacks, particularly ransomware attacks. Health care attacks occur regularly, disrupting vital services and endangering patients. Wired
SELECT AGENTS + PRIORITY PATHOGENS
Select Agent Grams: C. Burnetti Update
The CDC has determined that an excluded attenuated strain, Coxiella burnetii Phase II, Nine Mile Strain, plaque purified clone 4, has, in one instance, been shown to spontaneously mutate when passaged in vivo. The resulting mutant has enhanced pathogenicity and virulence. Federal Select Agent Program
The Multiple Origins of Ebola Disease Outbreaks
The origins of Ebola disease outbreaks remain enigmatic. Historically outbreaks have been attributed to spillover events from wildlife. However, recent data suggest that some outbreaks may originate from human-to-human transmission of prior outbreak strains instead of spillover. Improving access to diagnostics as well as identifying groups at risk for resurgence of ebolaviruses will be crucial to preventing future outbreaks. The Journal of Infectious Diseases
Bacillus anthracis Spore Internalization in Human Lung Epithelial Cells
Understanding the initial interaction between B. anthracis spores and alveolar epithelial cells (AECs) is critical for identifying new treatment strategies to combat inhalational anthrax. This is the first report that shows B. anthracis spore internalization by macropinocytosis in human epithelial cells. Several Rab GTPases are involved in the process. Microbial Pathogenesis
Crimean–Congo Haemorrhagic Fever in Iraq
Iraq continues to report an uptick in Crimean–Congo haemorrhagic fever as the confirmed cases increased to 377 from January to mid-July this year and the mortality rate reached 14%, raising concerns on how effectively the Iraqi Government can control the current outbreak. The Lancet Microbe
AVIAN INFLUENZA
First Known Human Death After Infection with Avian Influenza (A/H3N8) Virus
A case of human infection with the H3N8 avian influenza virus, who had multiple myeloma and died of severe infection. Genome analysis showed multiple gene mutations and reassortments without mammalian-adaptive mutations. This report suggested that avian influenza (A/H3N8) virus infection could be lethal for person who were immunocompromised. Clinical Infectious Diseases
CHEMICAL + RADIOLOGICAL THREATS
Construction of Europe’s Largest Doomsday Stockpile Quietly Gets Underway
Finland is stockpiling CBRNE emergency supplies to help prepare for a potential nuclear catastrophe, in an EU-funded project spurred by the threat posed by Russia’s invasion of Ukraine. Finland was given funding worth €242 million ($263 million) for the project at the start of 2023. Newsweek
Colorimetric Gas Detection Tubes: Limits of Detection and Evaluation Using Active Chemical Warfare Agents
Being that commercial companies are only able to use chemical agent simulants during sensor development, it is imperative to determine limits of detection using active agent. US Army DEVCOM Chemical Biological Center evaluated two colorimetric gas detection tubes, developed by Draeger Inc., for sarin and sulfur mustard chemical warfare agents and determine their limits of detection using active chemical agent. ACS Sensors
Mobile Radiation Detection Systems Market Survey Report
Mobile radiation detection systems are used for the detection and measurement of photon – and optionally neutron – radiation for the purposes of detection, interdiction, and hazard assessment. Between July 2021 and November 2022, the Systems Assessment and Validation for Emergency Responders (SAVER) program – run by the DHS Science and Technology Directorate (S&T) National Urban Security Technology Laboratory (NUSTL) – conducted a market survey of commercially available Mobile Radiation Detector Systems. This market survey report covers detector systems that are designed to take geo-referenced measurements while carried in manned, moving ground-based, maritime, or aerial vehicles. This market survey describes 24 mobile radiation detection products from 16 manufacturers. DHS S&T
SURVEILLANCE + DETECTION
The CDC Works to Overhaul Lab Operations After COVID Test Flop
An independent panel say the CDC’s flawed diagnostic test released in the early days of SARS-CoV-2 pandemic was one of the “most consequential” of the agency’s pandemic missteps because it stymied national efforts to contain COVID-19 as the disease spread. The advisory group made 10 recommendations for how the CDC could prevent future failures when developing diagnostic tests, such as consolidating all lab operations into a new center with its own leadership, separating research labs from those that develop clinical tests, and having independent experts review tests made for pathogens with pandemic potential. Recommendations for the agency to physically separate its clinical labs from its research labs will be heavy lifts because they require continuous funding. CBS
Assessment of the Public Health Surveillance Strategy During Three Major Pandemic Waves of COVID-19 in Brazil
In Brazil, unlike most developing countries, the nation’s comprehensive and universal public health system includes a network of public health laboratories. Notwithstanding these resources, since the onset of the pandemic in 2020, Brazil has faced many challenges which limited its capacity to conduct molecular testing for SARS-CoV-2. This article analyzes the Ministry of Health’s efforts to expand the laboratory network to meet pandemic surge and assesses how resource allocation decisions panned out as the spread of SARS-CoV-2 continued to exert a heavy toll during the subsequent waves. PLOS Global Public Health
Development of a Specific MPXV Antigen Detection Immunodiagnostic Assay
Two semi-quantitative assays were developed in parallel and standardized with infectious mpox virus (MPXV) cell culture fluid and MPXV NHP sera samples. These assays detect viral antigen in serum, were highly specific toward MPXV as compared to other infectious orthopoxviruses (vaccinia virus, cowpox virus, and camelpox virus), and correlated to quantitative PCR results from an NHP study. Frontiers in Microbiology
Design and Validation of a Diagnostic Assay for Monkeypox Virus
Outlines the development and validation of a real-time PCR test for MPXV confirmation. This test was successfully used for diagnosis of mpox-suspected persons in KU Leuven, Belgium in the initial stage of the mpox outbreak in 2022. Virus Genes
INFECTIOUS DISEASE ALERTS
Chikungunya Virus Surges In South America. But a New Discovery Could Help Outfox It
Most viruses make us sick by turning our cells into virus-making machines. They release loads of new viral particles that can go on to infect new cells. Chikungunya does that, but it’s got another trick. “The virus induces the infected cell to generate these very dramatic long extensions that can go from the infected cell to neighboring cells.” One or two tendrils, sometimes as long as the cell itself, snake outwards, at times toward uninfected cells. And these tendrils can escape attack by the immune system. “It’s early days, but it suggests this might be one mechanism by which the virus can get established, maybe in joint tissues. That may be important in causing the arthritis. We’ll see.” NPR
Deadly Listeria Outbreak Linked to Tacoma Restaurant’s Milkshakes
Six people became ill between February and July with the bacterial infection, which compromised their immune systems’ abilities to fight off disease. All were hospitalized and three died. Symptoms of listeria infections range from fever, a headache, stiff neck, confusion, loss of balance, seizures, and flu-like symptoms such as muscle aches and fatigue. Seattle Times
COVID-19 PANDEMIC
Phase III Pivotal Comparative Clinical Trial of Intranasal and Intramuscular COVID 19 Vaccine
Study found that two weeks after a second vaccination with BBV154, an intranasal, adenoviral-vectored SARS-CoV-2 vaccine, neutralization titres against wild-type (D614G) SARS-CoV-2 virus were superior to those observed two weeks after two doses of the intramuscular Covaxin vaccine. Similarly, the intranasal vaccine induced significantly higher cross-neutralizing responses against the BA.5 sub-lineage of the Omicron variant. In this study, the combined incidence rates of local and systemic adverse events after the first and second doses of BBV154 are strikingly lower than the rates reported for other SARS-CoV-2 vaccine platform candidates. NPJ Vaccines
How Bad Is a Second (or Third or Fourth) Case of Covid?
For many people who get Covid multiple times, subsequent infections will be as mild as or milder than their first, emerging data shows, likely because of partial immunity from previous infections, vaccination and the fact that the latest circulating variants generally cause less severe symptoms. There are a few exceptions — notably, among some people who are immunocompromised, older or had particularly severe previous infections. People who had a severe first infection seem more likely to end up hospitalized or to require medical attention for a reinfection. The chances you will get long Covid from a reinfection are fairly unpredictable — several experts interviewed for this story used the metaphor of Russian roulette. New York Times
What to Know About EG.5, the Latest SARS-CoV-2 “Variant of Interest”
The Omicron descendant EG.5 is the latest to be labeled a variant of interest by the WHO, joining the current ranks of XBB.1.16 and XBB.1.5. The new designation reflects its “notable rise” in global prevalence during recent weeks. For now, the new variant doesn’t seem to pose a greater public health risk than others that are circulating. That said, variant surveillance isn’t representative and variant reporting isn’t reliable. JAMA Network, ECDC
Safety Monitoring of Novavax COVID-19 Vaccine
During July 13, 2022–March 13, 2023, a total of 69,227 Novavax doses were administered to persons aged ≥12 years in the US and 230 reports of adverse events after Novavax vaccination were received by the Vaccine Adverse Event Reporting System (VAERS). Most VAERS reports (211; 91.7%) were classified as nonserious (dizziness, fatigue, and headache). 19 of the 230 reports (8.3%) were classified as serious (including one case of thrombosis, two of pericarditis, one of Guillain-Barré syndrome, and two of seizure). VAERS data generally cannot be used to determine whether a vaccine caused an adverse event. In addition, approximately one half of the reports representing adverse events of special interest lacked medical records for CDC review. MMWR
Viral Fitness and Intrinsic Pathogenicity of Dominant SARS-CoV-2 Omicron Sublineages BA.1, BA.2, and BA.5
Results suggested that the Omicron sublineages might be gaining intrinsic replication fitness in the upper respiratory tract, therefore highlighting the importance of global surveillance of the emergence of hyper-transmissive Omicron sublineages. On the contrary, replication and intrinsic pathogenicity of Omicron is suggested to be further attenuated in the lower respiratory tract. eBioMedicine
HISTORICAL REFLECTIONS
How 10,000 Years of Plagues Left Their Mark on Our DNA
When biologists compare modern genomes to DNA extracted from ancient bones, they can see how genetic variants that enabled people to fight off pathogens have increased in frequency over millennia. In work published in the journal Cell Genomics, researchers found that many of the protective variants that have increased in frequency also raise the risk of autoimmune diseases, in which the immune system turns on the body. It’s an intriguing thought: Over the course of human evolution, what saves you might come back to haunt your descendants. Washington Post
SPECIAL INTEREST
One Health Coloring Book
A new coloring book explaining the concept of One Health is available from CDC’s One Health Office. The coloring book is currently online and will be available for order via CDC On Demand within the coming weeks. CDC
How I Use Artificial Intelligence as an Infectious Diseases Clinician
How can generative AI, specifically chatGPT in its current iteration, ChatGPT-4, help the everyday ID physician? Here an ID clinician gives examples of their efforts to use chatbots to speed routine tasks. IDSA
ALSO READING
Sensitive poliovirus detection using nested PCR and nanopore sequencing. Nature Microbiology
In Search of a Vaccine for Leishmaniasis. Nature
Why Blood Type Seems to Be Linked with COVID-19 Risk. JAMA Network
Revisiting the minimum incubation period of Zaire ebolavirus. The Lancet Infectious Diseases
Mounting Evidence Suggests Leprosy is Endemic in Florida. JAMA Network
Epidemiology, surveillance and diagnosis of Usutu virus infection in the EU/EEA, 2012 to 2021. Eurosurveillance
Infection prevention and control guideline for Ebola and Marburg disease. WHO
New standard on cutting risk of infectious aerosol spread sets high bar for building ventilation but is work in progress. CIDRAP
Deep spatial profiling of Venezuelan equine encephalitis virus reveals increased genetic diversity amidst neuroinflammation and cell death during brain infection. Journal of Virology
Enhanced detection of mpox virus in wastewater using a pre-amplification approach. Science of the Total Environment
Texas Bats Face a Pandemic of Their Own. Undark
Advancements in Marburg (MARV) Virus Vaccine Research: A Scoping Review. Cureus
In Silico–Ex Vitro Iteration Strategy for Affinity Maturation of Anti-Ricin Peptides and the SPR Biosensing Application. Toxins
Structural and functional characterization of the Sin Nombre virus L protein. PLOS Pathogens