This week’s selections include failures in responding to the mpox public health emergency, security screening considerations for gene synthesis providers, a human H5 flu case in Missouri not directly linked to animal contact, and a pretend Ebola alert gets an IT department in hot water.
FEATURED
Covid Lessons Need to be Learned and Applied to Containing Mpox
Ensuring sufficient quantities of vaccine reach the most vulnerable populations in Africa is at the heart of this emergency. DRC has been doing its best to control the outbreak without access to vaccines and only started to receive a small number of doses. The price of an mpox shot has been estimated at US$100. That puts mass vaccination programmes far beyond the reach of governments in countries experiencing mpox surges. Acts of generosity on the part of richer countries have so far been small-scale and inadequate. The US has pledged 50,000 shots, but has the capacity to provide far more of the millions of doses that will be required. The Guardian, Undark, Nature, Georgetown University
Is That DNA Dangerous
It took 18 years for the government to mandate DNA screening for federally funded entities, and many gaps in security remain. Different policy options include facilitating screening outside the U.S. (where a large fraction of gene synthesis providers are based), developing methods for customer screening that draw upon the plethora of Know-Your-Customer tools used in the financial sector, exploring authorization structures to verify who can order which sequences, and establishing logging mechanisms that provide an audit trail in the event of new outbreaks. Effective Altruism Forum
First Case of Bird Flu Not Directly Linked to Sick Animals is Found in Missouri
This is the 14th human case of H5 reported in the United States during 2024 and the first case of H5 without a known occupational exposure to sick or infected animals. H5 outbreaks in cattle have not been reported in Missouri, but outbreaks of H5 have been reported in commercial and backyard poultry flocks in 2024. Other possible routes of exposure could include contact with wild birds or bird droppings (e.g. while cleaning a bird feeder), or from drinking raw milk. CDC, NPR, STAT
University Criticized for Using Ebola Outbreak Lure in Phishing Test
A phishing exercise conducted by the IT department of the University of California Santa Cruz on 18 Aug falsely claimed that a staff member had tested positive with the Ebola virus, after returning from a trip to South Africa. The email caused unnecessary panic amongst students and staff. Brian Hall, UCSC’s chief information security officer, apologized for the incident, acknowledging the phishing simulation email was “not true and inappropriate” and that it potentially undermined trust in public health alerts. Bitdefender
POLICY + GOVERNMENT
AI and Biosecurity: The Need for Governance
Great benefits to humanity will likely ensue from advances in artificial intelligence (AI) models trained on or capable of meaningfully manipulating substantial quantities of biological data, from speeding up drug and vaccine design to improving crop yields. But as with any powerful new technology, such biological models will also pose considerable risks. Voluntary commitments among developers to evaluate biological models’ potentially dangerous capabilities are meaningful and important but cannot stand alone. Science
Two Men Sentenced for Roles in Border Blockade Protest of COVID Mandates
One of two men sentenced Monday to 6½ years for firearms violations and mischief at the Coutts border crossing in southern Alberta says the time he has already spent behind bars has changed him. The blockade tied up traffic at the important Canada-U.S. border for two weeks in early 2022. It was among several nationwide protests against COVID-19 rules and vaccine mandates, which had polarized public opinion. The men were charged after law enforcement found guns, ammunition and body armour in trailers near the blockade. A jury found them not guilty of the most serious charge they faced — conspiracy to murder police officers at the blockade. CBC
Another Suit Filed Against FDA Over Lab-Developed Test Rule
The Association for Molecular Pathology has filed suit against the FDA over its plan to regulate lab-developed tests. It’s the second legal challenge to the rule, following the American Clinical Laboratory Association’s suit in May. STAT
Pandemic Proof: Negotiating a Global Pandemic Agreement
Precious Matsoso, co-chair of the Intergovernmental Negotiating Body discusses the remaining difficult topics and how they can be resolved, and to reflect on the negotiations process and what must change for this round of negotiations to be successful. “These are issues that are solvable,” says Matsoso on the podcast. “And in fact, the question we may ask ourselves is: can we really afford not to solve them given what we’ve gone through, given the number of lives lost and the economic devastation we’ve seen in a number of countries? I don’t think there’s any country that was spared…. We have no option but to solve these problems.” Center for Global Development
Financing the Pandemic Cycle: Prevention, Preparedness, Response, and Recovery and Reconstruction
This paper lists the pandemic financing instruments used for health during the COVID-19 pandemic, identifying 23 different tools, and utilized the IHME 2024 Financing Global Health database to estimate that US$91.6 billion was spent for COVID-19 health support, primarily for response financing, over 2020 to 2023. The COVID-19 pandemic wrought significant economic impacts on the order of trillions of dollars, even as investments in pandemic preparedness to mitigate future risks is relatively small, on the order of $10 billion annually. Center for Global Development
MEDICAL COUNTERMEASURES
Emergent Bio’s Smallpox Vaccine Gets US Approval for Mpox
The FDA clearance makes the vaccine the second approved shot against mpox in the U.S. after Bavarian Nordic’s Jynneos. Emergent’s scarification vaccine, called ACAM2000, however, cannot be administered to those with weakened immune systems, including people with HIV. It found limited use during the 2022 mpox outbreak in the United States, despite being part of the country’s stockpile. Fierce Pharma, Reuters
The Future of Threat Agnostic Therapy is Host Directed
With the growing understanding of immune function a new generation of Host-Directed Therapies (HDTs) for the treatment of disease could allow targeting specific pathways to augment or diminish the host response, dependent upon disease profile, and allow for bespoke therapeutic management plans. This review highlights promising and approved HDTs that can manipulate the immune system. Frontiers in Immunology
US is Beefing Up Mpox Testing, Vaccine Access Against New Strain, Officials Say
In a briefing on Friday, senior U.S. administration officials said doctors can now order an mpox test, which can be processed through national laboratory chains. Positive tests that are not the older strain of mpox will be sent to the U.S. CDC. The U.S. government also has added testing for any form of mpox to its wastewater surveillance system, and said there is good coverage in most major cities. The government is working to add clade I-specific testing. Reuters
Rift Valley Fever Vaccine Candidate Shows an Extreme Attenuation Following Intranasal Inoculation in Immunodeficient Mice
Vaccines that use attenuated viruses are highly effective in terms of providing protection, duration, breadth, and quality of the immune response. However, they may pose a risk to immunosuppressed individuals or in certain situations, such as during pregnancy. It is therefore important to analyze the residual virulence of attenuated vaccines to ensure their safety. Study results confirmed the hyperattenuation of RVF virus in mouse models therefore its potential as a safe vaccine candidate. PLOS Neglected Tropical Diseases
Long-Term Cellular Immunity of Vaccines for Zaire Ebola Virus Diseases
Five-year follow-up of the PREVAC randomized trial reports the long-term memory T-cell responses induced by three vaccine regimens: Ad26–MVA, rVSV, and rVSV–booster. Nature Communications
Evaluation of Human Antibodies from Vaccinated Volunteers for Protection Against Yersinia pestis Infection
Study identified three human monoclonal antibodies (from Phase II trial volunteers a month post-immunization) with a high affinity to F1 protein of Y. pestis. The findings support the additional novel protective human anti-F1Abs for potential therapeutics against plague. Microbiology Spectrum
Progress on the Research and Development of Plague Vaccines with a Call to Action
“Global funding and health security systems should work urgently to translate some of the efficacious vaccines reviewed herein to expedite clinical development and to prevent future disastrous plague outbreaks, particularly caused by antimicrobial resistant Y. pestis strains.” NPJ Vaccines
Defining Bottlenecks and Opportunities for Lassa Virus Neutralization
Researchers establish an epitope mapping workflow that enables structural characterization of polyclonal antibodies to the Lassa virus glycoprotein complex (GPC). As more attention is drawn to combatting Lassa fever, and as several vaccine candidates are moving to the clinic, the careful and robust assessment of humoral responses may be more important than ever. Cell Reports
BIOSECURITY + BIOPREPAREDNESS
Fur Farming a ‘Viral Highway’ That Could Spark Next Pandemic, Say Scientists
Infectious-diseases researchers are calling for stricter biosafety measures in farms that breed animals for fur, to stop dangerous pathogens from jumping from animals to people. Fur farms can be a bridge between people and the viruses circulating in wildlife, says Eddie Holmes, a virologist at the University of Sydney, Australia. “This is how pandemics happen.” The warnings come off the back of one of the largest studies of viruses harbored by fur animals in China. Nature
Making Pandemic Planning Part of the Everyday
For any potential pandemic disease, mitigation has to include improving housing quality, improving access to safe green spaces, improving indoor and outdoor air quality, and improving sick pay provision. The benefits of these mitigation measures are twofold: they improve population health (and so reduce the severity of illness when people become infected) and they improve the ability of people to respond to pandemic measures, such as isolation or social distancing, that reduce exposure to infectious aerosols (so that people can avoid infection altogether). The BMJ
Clinical Management of Hospitalized Patients with High-Consequence Infectious Diseases in England
In this case study, the authors describe the airborne and contact high-consequence infectious diseases (HCID) treatment center networks in England, including their formation and structures, their approach to safe and effective clinical management of patients with HCIDs in the United Kingdom, and challenges they may face going forward. Health Security
Strategic Stockpiling: How New State Policies Will Impact Emergency Preparedness
To date in 2024, several states have proposed or enacted policies to bolster preparedness efforts through stockpiling, including at least four states considering bills that would change how stockpiling is managed at the state level. ASTHO
SELECT AGENTS + PRIORITY PATHOGENS
Lassa Fever to Have a Fearsome Toll Without Vaccination
The first-ever detailed estimate of the real damage done by Lassa fever, a virus endemic to West Africa, has found that it infects 2.7 million people a year, ten times more than health agencies had assumed. A study published in Nature Medicine found vaccinating high-risk populations could avert up to 4,400 deaths in West Africa and save societal costs, including labour losses and healthcare, of almost US$129 million a year. SciDevNet, Nature
Ebola and Marburg Disease Outbreaks: Infection Prevention and Control Research Priorities in Health Care Settings
The objective of this research prioritization exercise was to identify the short- to medium-term (over the next two years) priority research questions for IPC in health care settings based on the gaps identified during the EBOD/MARD IPC guideline development process. WHO, Devdiscourse
Anthrax Outbreak Kills 50 Cattle and a Moose in Wyoming, Officials Say
Dozens of cattle and a moose dropped dead amid an anthrax outbreak in southeastern Wyoming, officials say. The bacterial disease was detected in multiple beef herds for the first time since the 1970s and in a moose for the first time since 1956. Phys.org
Tularemia Associated with Harbor Seal Necropsy — Kitsap County, Washington
In 2023, tularemia occurred in a wildlife volunteer after exposure to a deceased, infected harbor seal, the first known report of tularemia acquired through contact with a marine mammal, and the first detection of F. tularensis in a marine mammal. MMWR
Fatal Meningoencephalitis Associated with Ebola Virus Persistence in Two Ebola Survivors
Case study of two previously vaccinated and mAb-treated survivors of Ebola virus disease in the Democratic Republic of the Congo who developed second episodes of disease months after initial discharge, ultimately complicated by fatal meningoencephalitis associated with viral persistence. The Lancet Microbe
Mucosal Immunity in Upper and Lower Respiratory Tract to MERS-CoV
This intensive review explores the human immune responses and their immunological mechanisms during MERS-CoV infection in the mucosa of the upper and lower respiratory tracts. Frontiers in Immunology
Anthrax in Humans, Animals, and the Environment and the One Health Strategies for Anthrax Control
Anthrax, despite being an ancient disease, remains endemic and enzootic in many parts of the world. This persistence is due to several factors, including inadequate public health services, ineffective policies, insufficient research, and poor coordination in addressing sporadic outbreaks. Pathogens
Contact Tracing for Mpox Clade II Cases Associated with Air Travel
During 2021–2022, 113 persons traveled on commercial flights while they were infectious with clade II mpox. Among 1,046 traveler contacts followed by U.S. public health agencies, CDC identified no secondary cases. Traveling on a flight with a person with mpox does not appear to constitute an exposure risk or warrant routine contact tracing activities. MMWR
AVIAN INFLUENZA
Broad-Spectrum Vaccine Candidate Against H5 Viruses Bearing Different Sub-Clade 2.3.4.4 HA Genes
Study mapped the antigenic sites of H5 HPAIVs, leading to the discovery of a vaccine candidate that is stable in chicken embryonated eggs for at least five passages and offers broad-spectrum protection against clade 2.3.4.4 viruses. Study demonstrated that antigenic cartography-guided vaccine design is a promising strategy for selecting a broad-spectrum vaccine. NPJ Vaccines
H5 Influenza Vaccines—Moving Forward Against Pandemic Threats
Although human cases remain limited, the current US outbreak raises alarming questions about preparedness for a pandemic. At this critical juncture, decisions about vaccine development, stockpiling, and deployment will shape the ability to respond to immediate and future pandemic risks. JAMA
Pathogenicity of H5N1 Viruses Isolated from Cats in Mice and Ferrets
During 2023, outbreaks of HPAI H5N1 virus infections were reported in cats in South Korea. The H5N1 clade 2.3.4.4b viruses isolated from 2 cats harbored mutations in the polymerase basic protein 2 gene encoding single amino acid substitutions E627K or D701N, which are associated with virus adaptation in mammals. Researchers analyzed the pathogenicity and transmission of cat-derived H5N1 viruses in other mammals. Both isolates caused fatal infections in mice and ferrets. MMWR
CHEMICAL + RADIOLOGICAL THREATS
Effects of Chemical & Biological Warfare Agent Decontaminants on Trace Survival
This study examines forensic challenges with chemical and biological agents, focusing on enhancing the recovery of biological traces. It examines how 16 decontamination methods affect DNA profiling of blood and saliva samples. Combining quantitative and degradation Index values can help adapt amplification strategies and prioritize samples in chemical and biological incidents. Forensic Science International
SURVEILLANCE + DETECTION
Updated Hospital Reporting Requirements for Respiratory Viruses
Beginning November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) will require hospitals and critical access hospitals (CAHs) to electronically report information, like confirmed infections and bed capacity, related to flu, COVID-19 and RSV, on a schedule specified by the Secretary of Health and Human Services. These data will complement data that CDC collects and disseminates from other sources, such as wastewater, laboratory, and emergency department data. CDC
Ebola Experience Informs Sierra Leone’s Early Warning Disease Surveillance
“At that time, we could not detect the [Ebola] outbreak on time. By the time we detected it, the disease had spread to communities infecting many with lives lost. I lost over 55 healthcare workers. From that time to now, almost 10 years, I have been passionate about being part of work involving early warning disease surveillance systems so that what happened in 2014 and 2015 in Sierra Leone would not be repeated,” said Dr. James Squire, who worked as a District Medical Officer at the epicenter of the 2014 Ebola outbreak in the Eastern Province in Sierra Leone. Task Force for Global Health
Global Wastewater Surveillance for Pathogens with Pandemic Potential: Opportunities and Challenges
This review discusses the sensitivity and public health value of wastewater surveillance for viral families of concern and the challenges faced in establishing a global wastewater surveillance network for pandemic prevention. The Lancet Microbe
Streamlined Detection of Nipah Virus Antibodies Using a Split NanoLuc Biosensor
This anti-NiV glycoprotein “mix-and-read” assay was validated using the WHO’s first international standard for anti-NiV antibodies and more than 700 serum samples from the NiV-endemic country of Bangladesh. Emerging Microbes & Infections
Applying MALDI-TOF MS to Resolve Similarities Between Tick Species of Public Health Importance
MALDI-TOF MS has been introduced as a cost-efficient method for the identification of various organisms, as it balances performance, speed, and high data output. This paper describes the use of this technology to validate the distinction of two closely related Dermacentor tick species based on the development of the first nationwide MALDI-TOF MS reference database described to date. This integrative taxonomic tool can facilitate vector and vector-borne pathogen surveillance programs in the United States and elsewhere. Scientific Reports
Comparison of Commercial Anti-Dengue Virus IgG Tests to Identify Persons Eligible for Dengue Vaccination
Since 2022, Dengvaxia (the only dengue vaccine approved for use in the United States) has been available only to those who have laboratory-confirmed previous dengue virus infection. The Advisory Committee on Immunization Practices (ACIP) recommended that dengue pre-vaccination screening tests for Dengvaxia administration have at least 98% specificity and 75% sensitivity. This study evaluates the performance of commercial anti-DENV IgG tests to identify tests that could be used for pre-vaccination screening. Journal of Clinical Microbiology
Evaluation of the Laboratory Response Network and Testing Access During the First 10 Weeks of the Mpox Response
Challenges included variability among LRN laboratories in self-reported testing capacity, barriers to accessing the NVO assay for health care providers, and gaps in LRN function during surges of testing needs. Public Health Reports
INFECTIOUS DISEASES
Polio Shots Begin in Northern Gaza Despite Israel’s Detaining U.N. Convoy
United Nations officials said that health workers began vaccinating children in northern Gaza against polio on Tuesday, but noted that convoys carrying critical supplies of fuel and medicine were facing increasing obstruction and delays caused by Israeli forces. The main U.N. aid agency operating in Gaza said that the Israeli military had detained a convoy of international and local staff members from various U.N. bodies at gunpoint for about eight hours on Monday as they traveled to northern Gaza to help roll out the polio vaccination campaign. New York Times, Reuters
Live-Attenuated Chikungunya Virus Vaccine Phase III Interim Results
This study assessed the immunogenicity and safety of the vaccine VLA1553 in adolescents in Brazil, with favorable safety data in adolescents who were seropositive at baseline. The Lancet Infectious Diseases
1 in 4 Nursing Homes Not in Compliance with Federal Requirements Regarding the Infection Preventionist Position
More than 1.3 million people live in nursing homes nationwide, and are a population which are at increased susceptibility to a high number of health care-associated infections. This audit estimates that 2,568 for-profit nursing homes nationwide (approximately 1 in 4) may not have complied with Federal requirements pertaining to Infection Preventionists (IPs) during the audit period. The OIG recommends State-level survey agencies focus their oversight on verifying that nursing homes designate an IP and that the IPs complete specialized training prior to filling that position. HHS Office of Inspector General
Oropouche Cases in the Americas Near 10,000
Since early August, six countries in the Americas region have reported 1,774 more Oropouche virus cases, mostly from Brazil, Peru, and Cuba. CIDRAP
Oropouche Virus Disease Among U.S. Travelers — United States, 2024
As of August 16, 2024, a total of 21 Oropouche virus disease cases among U.S. travelers returning from Cuba have been reported. Most patients had self-limited illness. At least three patients experienced recurrent symptoms after resolution of the initial illness. MMWR
Lymphatic Filariasis in Soldiers Exposed in INDOPACOM
Although historical reviews state that the military needs to remain aware of the risk of lymphatic filarial infections in U.S. Indo-Pacific Command (INDOPACOM), based on the U.S. Second World War experience in Polynesia, recent evidence of service member infection is vanishingly rare, and likely to remain so, due to the great decrease in disease burden from mass drug administration in Polynesia and Melanesia. Currently, the Australian Defence Force gives both albendazole and ivermectin to soldiers returning from Melanesian field exercises, whereas the New Zealand Defence Force and U.S. military forces do not. Those living within endemic populations for extended periods such as Special Forces members may be exceptions, but use of prophylactic anti-filarial medications should no longer be part of health planning for modern military units in the INDOPACOM region. Health.mil
COVID-19 PANDEMIC
FDA Approves and Authorizes Updated mRNA COVID-19 Vaccines to Better Protect Against Currently Circulating Variant
On 22 Aug the FDA approved and granted emergency use authorization (EUA) for updated mRNA COVID-19 vaccines (2024-2025 formula) to include a monovalent (single) component that corresponds to the Omicron variant KP.2 strain of SARS-CoV-2. FDA
SARS-CoV-2 Rapidly Evolves in People with Advanced HIV
Some studies suggest that when people who are immune compromised get SARS-CoV-2, their bodies provide conditions that can promote variants by allowing the virus to linger during a weakened immune response. These prolonged infections could provide a sort of sandbox for different gene mutations to arise and test the body’s defenses, allowing for more new variants to evolve and spread. A new NIAID study found that people with advanced HIV—as defined by reduced numbers of immune cells called CD4+ T cells—had dozens of SARS-CoV-2 variants in their bodies, compared to just one major variant in most people without HIV and people with HIV who had higher numbers of CD4+ T cells. NIAID
HISTORICAL REFLECTIONS
Tooth Samples Reveal Scope of Justinianic Plague
Scientists analyze DNA from tooth samples collected from dig sites across Europe, dating to the Late Roman Empire, and identify Yersinia pestis – the bacteria that causes the Black Plague. Gradually they map where they’re finding plague, noting that, based on the succession of waves of illness, the epidemic lasted roughly a century. PBS
SPECIAL INTEREST
CSR Announces its Second Cohort of Mid-Career Biodefense Bootcamp Fellows
Nine exceptional individuals have been accepted into this cohort of Fellows. Through virtual training modules, direct mentorship, and an in-person exchange of ideas with key leaders in the field, this hybrid fellowship enables Fellows to learn and engage with leading experts committed to biological threat reduction and increasing biosecurity. Council on Strategic Risks
Disease Intervention Specialist (DIS) Certification Program Funding Opportunities
ASPPH is seeking member responses to a new Request for Proposal for Recommendations and Frameworks to Guarantee a DIS Certified Workforce. ASPPH members would collaborate in support of the CDC National DIS Certification Project. The Project contributes to CDC’s workforce capacity efforts to improve public health services provided to communities by disease intervention professionals. ASPPH
ALSO READING
H5N1: The Race to Catch Up. Contagion Live
Clade Ib Mpox in the Democratic Republic of the Congo (DRC): Clinical and Virological Report of the First Case in Kinshasa. Virological
Implementation of a High-Level Isolation Unit Readiness Checklist in the Irish Setting. Health Security
2023 Biorisks, Biosecurity and Biological Disarmament Conference Report. UNIDR
Surprising New Research Links Infant Mortality to Crashing Bat Populations. New York Times
Selecting the Most Relevant Mouse Strains for Evaluating Radiation-Induced Multiple Tissue Injury. Radiation Research
Onward Virus Transmission after Measles Secondary Vaccination Failure. Emerging Infectious Diseases
Broad Protection and Respiratory Immunity of Dual mRNA Vaccination Against SARS-CoV-2 Variants. NPJ Vaccines
Risk Factors of Crimean-Congo Haemorrhagic Fever in Sindh Province, Pakistan. International Journal of Infectious Diseases
Strengthening International Collaboration for Global Health Security: The Role of the Infectious Disease Emergency Specialist Training Program and NETEC Partnership. Health Security
Microevolution and History of the Plague Bacillus, Yersinia Pestis. PNAS
Nanoparticle Elicits Broadly Neutralizing Antibodies and Protects Against Lethal Nipah Virus Infection. NPJ Vaccines