News highlights on health security threats and countermeasures curated by Global Biodefense
This week’s selections include the convening of the World Health Assembly, updates on the bird flu response, more human H5N1 influenza cases, securing health care facilities from cyber attacks, and strategic national stockpile oversight and management issues.
POLICY + GOVERNMENT
Pandemic Accord Negotiations Fall Short, Outcomes to Be Shared at World Health Assembly
The two-year effort to produce a global pandemic treaty did not meet its deadline. On Friday, Tedros Adhanom Ghebreyesus, director general of the World Health Organization, announced that the negotiators – from the group’s 194 member nations – couldn’t find consensus in time for the World Health Assembly. The goal had been to draw up a document that could be adopted at the meeting and then sent to countries for ratification. Global Biodefense
Global Health Authorities Convene at 77th World Health Assembly to Deliberate Pandemic Preparedness, Climate Change and Other Priority Health Topics
The Seventy-seventh session of the World Health Assembly (WHA77) will take place from 27 May to 1 June 2024 in Geneva, Switzerland. Public WHA77 meetings (plenary, Committees A and B) will be webcast live. PAHO
Regulation of Toxins and Bioregulators Under the Chemical Weapons Convention and the Biological and Toxin Weapons Convention
The two Conventions both cover and prevent weaponization of toxins (arguably including bioregulators), and other substances of biological origin, and their synthetic analogues – and hence such substances have been collectively termed mid-spectrum agents. However, as this paper shows, the assumed overlapping protection provided by the CWC and BTWC in reality hides a significant regulatory lacuna, with the danger that neither Convention will be properly implemented so as to stop development of toxin or bioregulator weapons. Journal of Biosafety and Biosecurity
Fresh Scrutiny of Post-Covid Spending Reignites Yearslong Tension Over Emergency Stockpiles
A more recent challenge stems from HHS elevating ASPR to an operating division, a technical move that nevertheless gave the assistant secretary for preparedness and response more authority over stockpile contracts and the budget — and more direct contact with OMB. While some saw it as a small — and necessary — change that facilitated quicker deals for emergency supplies, HHS reportedly did not “clear” the change with OMB officials, straining the relationship. STAT
Cities Are the Canaries in the Public Health Coal Mine
The sentinel cases for brooding public health threats, whether infectious or not, are often in cities. Cities are the canaries in the public health coal mine, for everything from mental health and homelessness, climate change to forced migration, substance use to sex trafficking. The way these challenges play out across our cities should not only drive national policy, but also serve as an important corollary for how to respond in less dense, less diverse, more rural areas. Yet when we consider the multilateral institutions where decisions are made and policymaking happens, cities rarely have any role in governance. Foreign Policy
The West Should Be on a War Footing for the Next Pandemic
People have been quick to forget how bad the pandemic was, but it’s important to remember the scale of the crisis. It’s estimated that 25 million people worldwide lost their lives. Now the emergency has passed, policy makers are keen to move on. With climate change, globalization, a growing global population – and the increased capacity for man-made bioterror through the combination of synthetic biology and AI – the risk of a new pandemic has actually increased. “Our risk modelling estimates there is a 27.5 per cent chance of a Covid like pandemic in the next 10 years.” The Telegraph
MEDICAL COUNTERMEASURES
Short- and Long-Term Outcomes of Pulmonary Exposure to a Sublethal Dose of Ricin in Mice
In the short-term, sublethal exposure of mice to ricin resulted in acute lung injury, including interstitial pneumonia, cytokine storm, neutrophil influx, edema and cellular death. Mice recovered from acute lung damage and restored pulmonary and physiological functionality, but the reparative process was associated with lasting fibrotic lesions. Therefore, restriction of short-term acute phase of the disease and management of long-term pulmonary fibrosis by medical countermeasures is expected to facilitate the quality of life of exposed survivors. Scientific Reports
In Light of H5N1 Outbreak, U.S. in Talks with mRNA Vaccine Makers on Bird Flu
Nearly 5 million doses of H5 vaccine stored in bulk in the National Pre-Pandemic Influenza Vaccine Stockpile will be put into vials over the next couple of months in case it is needed. Talks are also proceeding with messenger RNA vaccine makers about potentially making batches of H5 vaccine that could be tested and stockpiled. STAT
Impact of Ebola Virus Nucleoprotein on VP40 Virus-Like Particle Production
NP is an important viral protein in the EBOV life cycle. These study results show how EBOV NP affects viral assembly by influencing filament stability and budding rate constants; how the timing and proportion of NP vs. VP40 expression from the viral genome is potentially optimized for maximal functional virion production; and how viral protein interactions impact drug efficacy. Communications Biology
Decorporation Dilemma: Interplay of Prussian Blue and Potassium Iodide in Radioactive Contamination
Researchers propose that concurrent administration of Pru-Decorp™/Pru-Decorp-MG and potassium iodide (KI) could synergistically reduce the levels of Cesium-137 and block uptake of iodine 131, respectively, in nuclear incident scenarios. Journal of Environmental Radioactivity
Promising Results for Preclinical mRNA Avian Flu Vaccine
NIAID-backed research at Penn Medicine demonstrated an experimental mRNA vaccine against avian influenza virus H5N1 as highly effective in preventing severe illness and death in preclinical models. The H5 mRNA-LNP vaccine elicits strong T cell and antibody responses in female mice, including neutralizing antibodies and broadly-reactive anti-HA stalk antibodies. Global Biodefense
Vaccines for Pneumonic Plague: Sex Differences in Immune Protection in Mice
Y. pestis is not known to impact males and females differently in mechanisms of pathogenesis or severity of infection. However, one previous study reported sex-biased vaccine effectiveness after intranasal Y. pestis challenge. As part of developing a safe and effective vaccine, it is essential that potential sex differences are characterized. Frontiers in Immunology
Next-Generation Polyvalent Vaccine Against Multiple Strains of Monkeypox Virus and Other Related Poxviruses
This in-silico formulation utilized a reverse vaccinology approach to retrieve conserved epitopes for monkeypox virus and construct a vaccine that could provide cross-protection against related viruses with similar antigenic properties. Both constructs were found to be highly antigenic, non-allergenic, nontoxic, and soluble. PLOS One
University of Oxford Pandemic Computer Simulations to Guide Future Vaccine Trials
Having pre-established clinical trial frameworks in place ahead of an outbreak is key to executing the 100 Days Mission. The PREpare using Simulated Trial Optimisation (PRESTO) project will simulate real-life scenarios of deadly disease outbreaks in order to model how possible vaccine clinical trials could run and what outcomes they could produce. The infectious threats that will be tested are Nipah, Chikungunya, Lassa, Rift Valley fever, Ebola and related viruses, Coronaviruses and a new or as-yet-identified ‘Disease X’. Data from existing CEPI-funded research will be fed into the computer model alongside evidence from previous outbreaks to create hypothetical scenarios looking at how a selected virus could spread, who it could impact and its potential severity. CEPI
BIOSECURITY + BIOPREPAREDNESS
ARPA-H Announces Program to Automate Cybersecurity for Health Care Facilities
Cyberattacks that hamper hospital operations can impact patient care while critical systems are down and can even lead to facility closure. The new Universal PatchinG and Remediation for Autonomous DEfense (UPGRADE) program is a cybersecurity effort that will invest more than $50 million to create tools for information technology teams to better defend the hospital environments they are tasked with securing. ARPHA-H
How Foes Can Defeat a Common Enemy: U.S.-China Collaboration to Combat Ebola
As intense geostrategic rivalry becomes an enduring feature of the U.S.-China relationship, CSIS and the Brookings Institution have launched a joint project, Advancing Collaboration in an Era of Strategic Competition, to explore and expand the space for U.S.-China collaboration on matters of shared concern. This essay discusses the threatening appearance of the Ebola virus in the mid-2010s and how the United States and China came together to address the crisis. CSIS
China, Biotechnology, and BGI: How China’s Hybrid Economy Skews Competition
Using BGI Group as a case study, this report dives into the complex world of China’s hybrid economic system that blurs private and public, civilian and military to meet the goals of the State. This system creates market distortions and undermines the global norms of science by leveraging researchers as well as academic and commercial entities to further national priorities, rather than open, mutually beneficial collaborations or fair commercial competition that fosters innovation and is free from market-distorting subsidies and restrictions. Center for Security and Emerging Technology
SELECT AGENTS + PRIORITY PATHOGENS
Yersinia pestis Can Infect the Pawlowsky Glands of Human Body Lice and Be Transmitted by Louse Bite
The body louse’s high level of susceptibility to infection by gram-negative bacteria and their potential to transmit plague bacilli by multiple mechanisms supports the hypothesis that they may have played a role in previous human plague pandemics and local outbreaks. PLOS Biology
New Strategic Framework for Mpox Outbreak Control and Medical Countermeasures
This framework recognizes that MPXV is one of many priorities competing for constrained health system resources in some regions, and outlines some steps that can be taken without substantial additional investment. Global Biodefense
Optimization and Evaluation of New Decontamination Procedures Inactivating Human Prions
Infectivity bioassays based on hamster-adapted sheep scrapie prions allowed the identification of processes able to inactivate prion that may be present on medical devices. Unfortunately, a 2016 publication showed that some detergent formulations fully effective on these hamster strain had, in reality, poor efficacy on human strains. Governmental guidelines were modified accordingly. They outlined the needs for formulations able to overcome the human strain challenge but also to optimize and validate in vitro and in vivo protocols required for their robust evaluation. SSRN
Global High Consequence Infectious Disease Event Summary
Recent outbreak summary: Between 1 January and 30 March 2024, the WHO reported 64 suspected cases of Crimean-Congo hemorrhagic fever (CCHF), including one death from Afghanistan. For Lassa fever, Nigeria has reported 5,295 suspected, 17 probable and 806 confirmed cases (1 Jan-31 Mar), including 150 deaths. This is an increase for the equivalent reporting period the year prior. Between 6 Jan 2022 and 13 February 2024, Liberia has reported a total of 110 confirmed Lassa fever cases, including 32 deaths (CFR of 29%). Marburg virus outbreaks were reported for the first time in Equatorial Guinea in February 2023 and in Tanzania in March 2023. No outbreaks of Marburg or Ebola virus have been reported YTD in 2024. UK Health Security Agency
Draft Genome Sequence of Moroccan Camelpox Vaccine Strain
Prevention and control of camelpox can be achieved by efficient vaccination. A limited number of homologous attenuated vaccines have been commercialized. In this study, we report the draft genome sequence of camelpox virus vaccine strain “CAMPOX vaccine” after 175 passages of attenuation in Vero cells. Microbiology Resource Announcements
Underreporting or Failed Notification? Global Botulism Reporting, 2000-2022
This study aimed to establish an international benchmark for case frequency to determine estimated global rates of underreporting of botulism cases. Data on botulism cases were unavailable for most countries globally, with only 59 countries having any case numbers available. A total of 6,932 botulism cases from 59 nations were identified in the literature, with a global case fatality rate of 1.37%. Based on comparisons with the US standard, an estimated 88.71% of botulism cases worldwide were unreported in 2016. Health Security
AVIAN INFLUENZA
Update on U.S. Bird Flu Response
On May 22, CDC reported an additional human case of avian influenza A(H5) virus infection in a dairy worker in Michigan who had work exposure to infected cows. By May 23, the agency had confirmed the neuraminidase of the virus as N1. On the animal health side, USDA is reporting that 63 dairy cow herds in nine U.S. states have confirmed cases of A(H5N1) virus infections in dairy cows. CDC
First Human H5N1 Case Reported in Australia
A child returning from overseas has been confirmed as Australia’s first recorded human case of a strain of bird flu. The child, who returned to Victoria from India in March, experienced a “severe infection” after contracting the H5N1 strain but has since made a full recovery, Victoria’s chief health officer confirmed on Wednesday. SBS News, Victoria Department of Health
Michigan Reports a Human Case of Bird Flu, the Nation’s Second Linked to H5N1 Outbreak in Dairy Cows
On 22 May, health officials announced a second human case of bird flu infection linked to the current H5N1 outbreak in dairy, this time in a Michigan farm worker who had exposure to infected cows. “If there’s any takeaway from this finding it’s that this is probably the tip of the iceberg because this is the one state that we know of that has done the most in terms of testing on farms of both cows and also monitoring workers that are on the farms where they found cattle infections.” STAT, NY Times
Cows Have Almost Certainly Infected More Than Two People with Bird Flu
For weeks, anecdotal reports of sick farmworkers have been trickling in from around the nation, where H5N1 has been detected in dozens of herds in nine states, according to federal counts. Testing among humans and animals remains limited, and buy-in from farms is still spotty. The gap between reality and what the government can measure is hindering the world from realizing the full scope of the outbreak. And it may hamper experts’ ability to detect human-to-human spread, should that someday occur. “I wouldn’t be surprised if there have been dozens of cases at this point.” The Atlantic
US Orders Restrictions on Poultry from Victoria, Australia Due to H7N3
The order was prompted by an avian influenza outbreak on two farms in Victoria’s south-west. More than 500,000 chickens were culled after cases of H7N3 were detected at properties that share management, staff and machinery. The US Department of Agriculture imposed restrictions on avian products originating or transiting through Victoria as of 22 May. The restrictions apply to certain fresh poultry products, commercial birds, hatching eggs, by-products and several other bird products. “The direct impact of the US trade restrictions will be very limited as Australia does not export fresh chicken meat to the US.” The US has also placed restrictions on bird products from other areas with flu outbreaks including parts of Japan and Canada. The Guardian
Promising Preclinical Findings for mRNA Vaccine Against Global H5N1 Avian Flu Clade
A preclinical study of a monovalent mRNA vaccine that targets the H5N1 avian flu clade currently circulating prompted a robust antibody response. CIDRAP
Raw Milk Containing Bird-Flu Virus Can Sicken Mice
Unpasteurized milk contaminated with H5N1, the bird-flu virus that has turned up in dairy herds in nine states, has been found to rapidly make mice sick, affecting multiple organs, according to a study published on Friday. The research also suggests that H5N1 in refrigerated raw milk may remain infectious for several weeks. New York Times, NEJM
We Don’t Know How Bad Bird Flu Is Getting
“Wastewater ended up being one of the most effective tools we had around infection in the United States. And I do think that’s one thing that survived from the pandemic de-escalation. But activating that for an entirely different disease comes with its own questions. Is this human or animal wastewater? If it is animal wastewater, how is it getting into our wastewater system? Is it milk-dumping? Is it infected feces? There are so many questions. And it’s imperfect, especially since we’re just testing flu A, not H5. Which will be highly problematic come fall if this is continuing to spread…Because that’s when the flu starts ramping up again. And so we won’t be able to differentiate whether these signals are just your normal flu that we see every year, or H5.” Intelligencer
Many US Dairy Workers Yet to Receive Protective Gear for Bird Flu
Many U.S. dairy farms have not yet increased health protections against bird flu for employees during an outbreak in cows, according to workers, activists and farmers, worrying health experts about the risk for more human infections. New York state said it is assessing CDC’s recommendation and has not yet distributed equipment. Texas, New Mexico and Colorado, where cattle were infected, said they distributed equipment to eight dairies combined. Kansas, Idaho and Wisconsin said they have equipment, but no farmers asked for it. Reuters
Listen: Avian Flu Update
Mati Hlatshwayo Davis discusses the latest information on avian influenza with Demetre Daskalakis, MD, MPH, director of CDC’s National Center for Immunization and Respiratory Diseases, Andrew Bowman, DVM, PhD, a veterinarian, epidemiologist and influenza expert at Ohio State University, and Katelyn Jetelina, MPH, PhD, an epidemiologist and data scientist. IDSA
CHEMICAL + RADIOLOGICAL THREATS
Host Microbiome Depletion Attenuates Biofluid Metabolite Responses Following Radiation Exposure
The purpose of this study was to determine which biofluid biomarkers may be independent from variations in the host microbiome and provide a stronger case for biodosimetry assays in the event of a radiological emergency. PLOS One
Analysis of Large Japanese Field Mouse Testes Exposed to Radiation after the Fukushima Nuclear Power Plant Accident
Ultrastructural analysis of the testis of the wild large Japanese field mouse inhabiting the area near the ex-evacuation zones of the FDNPP and chronically exposed to various levels of low-dose-rate (LDR) radiation, to evaluate the effects of ionizing radiation on the male reproductive system and the possible consequences for future generations. Biology
SURVEILLANCE + DETECTION
House Members Question FDA Officials on Lab-Developed Tests, Missed Deadlines
One topic that had interest from members on both sides of the aisle was the FDA’s recent issuance of a final rule regulating laboratory-developed tests (LDTs) — in vitro diagnostic products designed, manufactured, and used within a single clinical laboratory. “I’ve heard concerns that FDA regulation of LDTs could slow the approval process for all drugs and devices in addition to LDTs,” said Rep. Raul Ruiz (D-Calif.). “While FDA will not collect user fees for LDTs for years, there’s significant work that must begin now, including issuing guidance documents related to the rule.” He asked whether FDA had enough resources to carry out the new rule. MedPage Today
Lessons From COVID-19 Testing Research: The Power of Rapid Response
The RADx-UP program supported community-engaged and clinical research to evaluate and enhance COVID-19 testing across vulnerable and underserved populations with a total of 142 community-engaged research projects awarded to date. The RADx-UP Safe Return to School Diagnostic Testing Initiative sought to understand and address access, facilitators, and barriers to COVID-19 testing in schools in underserved communities in the context of remote learning for many students. With a focus on rapid launch, many of the studies are now reporting results. American Journal of Public Health
INFECTIOUS DISEASES
Measles in the United States
As of May 16, 2024, a total of 139 measles cases were reported by 21 jurisdictions: Arizona, California, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York City, New York State, Ohio, Pennsylvania, Vermont, Virginia, Washington, West Virginia, and Wisconsin. There have been 10 outbreaks (defined as 3 or more related cases) reported in 2024, and 70% of cases (97 of 139) are outbreak-associated. For comparison, 4 outbreaks were reported during 2023 and 48% of cases (28 of 58) were outbreak-associated. American Academy of Pediatrics
Haiti’s Collapsing Health System in a Time of Conflict and Cholera
Most hospitals are barely operational, essential medical supplies are hard to come by, and around 40 percent of all medical staff have left the country due to extreme levels of insecurity. 82,000 suspected cholera cases have been reported since the latest outbreak began less than 2 years ago. Global Biodefense
Meningococcal Disease Cases Linked to Travel to the Kingdom of Saudi Arabia
The U.S. CDC issued an alert on 20 May to healthcare providers to cases of meningococcal disease linked to Umrah travel to the Kingdom of Saudi Arabia (KSA). Since April 2024, 12 cases of meningococcal disease linked to KSA travel for Umrah have been reported to national public health agencies in the United States (5 cases), France (4 cases), and the United Kingdom (3 cases). Two cases were in children aged ≤18 years, four cases were in adults aged 18–44 years, four cases were in adults aged 45–64 years, and two cases were in adults aged 65 years or older. Of nine patients with known vaccination status, all were unvaccinated. The isolates from the one U.S. Neisseria meningitidis serogroup W (NmW) case and two NmW cases (one U.S., one France) were resistant to ciprofloxacin; based on whole-genome sequencing, the remaining eight NmW isolates were all sensitive to penicillin and ciprofloxacin. CDC Health Alert Network
Continuing Development of Vaccines and Monoclonal Antibodies Against Zika Virus
While the current incidence and testing for ZIKV are low globally, ZIKV has not disappeared, and future large-scale outbreaks are possible. This report describes the workshop proceedings from a NIAID-hosted workshop of experts to review the latest ZIKV research and develop recommendations for advancing vaccines and mAbs. NPJ Vaccines
A Simplified Vaccine for Cholera Outbreak Control
WHO has prequalified three oral cholera vaccines: Dukoral (Valneva), Shanchol (Sanofi), and Euvichol-Plus (EuBiologicals). However, only Shanchol and Euvichol-Plus are currently available for mass vaccination campaigns through the global oral cholera vaccine stockpile with the support of Gavi. Such a stockpile has been insufficient to meet the needs of the increasingly recurrent outbreaks of cholera. In 2023, the production of Shanchol stopped permanently, further challenging the provision of enough vaccine doses to control cholera outbreaks. Thus, it was welcome news when on April 12, 2024, WHO prequalified a new vaccine, the killed whole-cell monovalent vaccine Euvichol-S. The Lancet Infectious Diseases
Another New Disease
“Recently I was contacted by an acquaintance regarding persistent nausea, vomiting and abdominal pain. He was an otherwise healthy young male in his early thirties. He went to a reputable ER, had all the tests done after the appropriate keyboard click and everything came back negative. He was told he drank too much beer. When we talked further, it turned out that I drink more beer than he does. No comments please. He remained unable to keep down any food and had random episodic severe abdominal pain in association with nausea and vomiting and ended up in another reputable ER several days later. Same process, slightly different conclusion…” American Journal of Medicine
IN MEMORIAM
Dr. Paul Parkman, Who Helped to Eliminate Rubella, Dies at 91
Dr. Paul D. Parkman, whose research was instrumental in identifying the virus that causes rubella and developing a vaccine that has prevented an epidemic of the disease in the U.S. for more than 50 years, died from lymphoblastic leukemia on May 7. In 1964 and 1965, rubella caused about 11,000 pregnancies to be miscarried, 2,100 newborns to die and 20,000 infants to be born with birth defects. That was the worst outbreak in three decades — and the last rubella epidemic in the United States. New York Times
ALSO READING
Cow’s milk containing avian influenza A(H5N1) virus — heat inactivation and infectivity in mice. NEJM
Cyanomethylquinolones as a new class of potential multitargeting broad-spectrum antibacterial agents. Journal of Medicinal Chemistry
Review of poliovirus transmission and economic modeling to support global polio eradication: 2020–2024. Pathogens
Monkeypox virus infections after 2 preexposure doses of JYNNEOS vaccine. MMWR
Biosafety initiatives in the Division of Laboratory Systems. CDC
Global distribution and molecular evolution of bat coronaviruses. Zoonotic Diseases
Combination influenza mRNA vaccine candidate provided broad protection against diverse influenza virus challenge. Virology
Polyvalent mpox mRNA vaccines elicit robust immune responses and confer potent protection against vaccinia virus. Cell Reports
Pandemic lessons must spur federal action to protect nursing home residents. STAT
5 things to know about mRNA capping for next-generation vaccines and therapies. NIH CREX
We need more accuracy in Crimean-Congo hemorrhagic fever diagnosis upon initial presentation in endemic areas. Vector-Borne and Zoonotic Diseases
Molecular insights into the Ebola virus life cycle. Nature Microbiology