This edition includes a Marburg virus outbreak in Rwanda, the trajectory of the global H5N1 panzootic, and the public health emergency response to states hit by Hurricane Helene.
FEATURED
Rwanda Confirms Cases of Marburg Virus Disease, Steps Up Preventive Measures
On 27 Sep Rwanda confirmed its first cases of Marburg disease. The Ministry of Health said in a statement that it was investigating to determine the origin of infection, and that those infected had been isolated for treatment. 26 cases have been confirmed, with six fatalities reported to date. Twenty cases are in isolation and receiving treatment, while 161 people who came into contact with the reported cases have so far been identified and are being monitored. Cases of the virus have been reported in seven of the country’s 30 districts. WHO Director-General Dr Tedros Adhanom Ghebreyesus on Saturday affirmed a scaling up of support to government of Rwanda in response to the outbreak. WHO, Reuters, Barron’s, The New Times
The Global H5N1 Influenza Panzootic in Mammals
Two decades after H5N1 “bird flu” became established in poultry in Southeast Asia, its descendants have resurged, setting off an H5N1 panzootic in wild birds that is fueled by rapid intercontinental spread, fast evolution via genomic reassortment, and frequent spillover into terrestrial and marine mammals. The virus has sustained mammal-to-mammal transmission in multiple settings, including European fur farms, South American marine mammals, and US dairy cattle, raising questions about whether humans are next. Historically, swine are considered optimal intermediary hosts that help avian influenza viruses (AIV) adapt to mammals before jumping to humans. However, the altered ecology of H5N1 has opened the door to new evolutionary pathways. Could dairy cattle, farmed mink, or South American sea lions serve as new mammalian gateways to humans? Nature
Public Health Emergency Status Declared for Southeast States Hit by Hurricane Helene
U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra declared Public Health Emergency (PHE) status for Florida, Alabama, Georgia, and North Carolina this week to address the health impacts of Hurricane Helene. HHS/ASPR has pre-positioned approximately 200 medical providers and disaster management professionals in Florida, Alabama, with additional personnel in route to North Carolina.
ASPR’s deployed personnel include multiple Health Care Situational Assessment Teams (HCSAT) who stand ready to assess the storm’s impacts to hospitals, nursing homes, dialysis centers, and other health care facilities and four Health and Medical Task Forces and one Disaster Medical Assistance Team (DMAT) from the National Disaster Medical System (NDMS) for rapid response following assessment findings. HHS
POLICY + GOVERNMENT
WHO Report on the Responsible Use of the Life Sciences and Dual-Use Research
The WHO Technical Advisory Group on the Responsible Use of the Life Sciences and Dual-Use Research (TAG-RULS DUR) was established to provide independent advice to WHO on the monitoring and mitigation of biorisks, the advances in the life sciences and related technologies, the governance of dual-use research and the responsible use of the life sciences. This new report summarizes discussions from the first meeting of the group that took place in April. WHO
NTI | bio Briefs Capitol Hill on Innovative Solutions to Biotechnology Risks
NTI | bio and the Center for Arms Control and Non-Proliferation (CACNP) hosted a September 17 Congressional staff briefing on “Preventing Biological Catastrophe and Protecting the U.S. Bioeconomy.” The event, which explored opportunities for Congress and the White House to mitigate the risks, featured a panel discussion on safeguarding evolving capabilities that arise from the combination of artificial intelligence with biotechnology and providing oversight of dual-use life science research of concern. NTI
MEDICAL COUNTERMEASURES
US to Donate 1 Million Mpox Vaccine Doses to Halt Outbreak in Africa
U.S. President Joe Biden announced 24 Sep the donation of 1 million mpox vaccine doses and at least $500 million to African countries to support their response to the outbreak. Last week, Gavi said it will buy 500,000 doses of Bavarian Nordic’s vaccine, its first purchase to help battle the outbreak. Reuters
CSL Seqirus Picks Up $121M BARDA Contract For Bird Flu Pandemic Preparedness
Vaccine maker CSL Seqirus has lined up yet another contract with the U.S. government’s Biomedical Advanced Research and Development Authority (BARDA) to help with avian influenza preparedness, this one worth $121.4 million to boost supplies of the company’s MF59 adjuvant, used in some influenza vaccines to strengthen the body’s immune response. Fierce Pharma
2025 Southern Hemisphere Influenza Season Vaccine Composition
The World Health Organization (WHO) this week announced recommendations for the viral composition of influenza vaccines for the 2025 influenza season in the southern hemisphere. The announcement was made at an information session after a 4-day meeting on the Composition of Influenza Virus Vaccines. WHO
BIOSECURITY + BIOPREPAREDNESS
The Complexities of Bioterrorism: Challenges and Considerations
The COVID-19 case study serves as a stark example of how a biological agent can disrupt the world on a massive scale. The research will delve into the pandemic’s impact on Pakistan and beyond, exploring areas like tourism, public health, education, and the spread of misinformation. By analyzing the effects of COVID-19, this research aims to prepare for potential future bioterror attacks. Understanding how novel viruses or bacteria can spread and cause devastation is vital to developing effective prevention and response strategies. International Journal of Contemporary Issues in Social Sciences
Infection Control and Outbreak Preparedness When the Virus is Loose
“We often think of preparedness as stuff, having access to the right gear and material. Especially thinking back to the pandemic, everyone might remember the lack of face masks and other problems with PPE. And that’s obviously important. But preparedness is more than having the right things in stock. Not least, we need to have staff who can work and who have the right skills.” Karolinska Institute
MIDRP Focuses on Mitigating Disease Impacts in Large-Scale Combat Operations
Prolonged care, degraded MEDEVAC capability and overstretched lines of communication during large-scale combat operations could increase the prevalence of disease-related injury and death among Warfighters, risks that the U.S. Army Medical Research and Development Command’s Military Infectious Diseases Research Program (MIDRP) is working hard to mitigate. U.S. Army Medical Research and Development Command
SELECT AGENTS + PRIORITY PATHOGENS
Virulence of Burkholderia pseudomallei ATS2021 Unintentionally Imported to United States in Aromatherapy Spray
In the United States in 2021, an outbreak of 4 cases of Burkholderia pseudomallei, the etiologic agent of melioidosis and a Tier One Select Agent, resulted in 2 deaths. By using mouse melioidosis models, researchers determined median lethal dose estimates of the strain and analyzed the bacteriologic and histopathologic characteristics of the organism. Emerging Infectious Diseases
Mpox May Trigger Large Outbreak in One of Africa’s Biggest Cities
Mpox for the first time appears to be making serious inroads in Kinshasa, the capital city of 17 million people in the country hardest hit by the disease, the Democratic Republic of the Congo (DRC). A recent sharp uptick in suspected mpox cases in the capital—including some from a viral strain that has spread widely through sexual contact elsewhere—could portend a larger outbreak. Although many mpox cases in Africa go unreported, Kinshasa had largely been spared until now. Science
Co-circulation of Monkeypox Virus Subclades Ia and Ib in Kinshasa Province
The geographic range of Clade I, and predominantly subclade Ib within, is currently expanding, with cases reported in countries historically non-endemic for mpox, including Burundi, Kenya, Rwanda and Uganda. Characterization of complete MPXV genome sequences derived from mpox cases in Kinshasa, the capital city of the DRC, reveals co-circulation MPXV strains of subclades Ia and Ib in one health zone of the city. Moreover, phylogenetic analyses suggest multiple introductions of both subclades in the city. Eurosurveillance
Surge in Oropouche Fever: The Tip of the Iceberg in a New Public Health Challenge in Brazil
The number of cases Oropouche virus in Brazil has surpassed 7930 by August, 2024, which is already ten-fold of 773 cases reported throughout 2023. Miscarriages and fetal malformations have now been linked to the virus, and for the first time, two deaths with a direct correlation to the viral infection have been confirmed (in two young women without comorbidities). The absence of specific diagnostic tests and nascent genomic surveillance for acute febrile illnesses further underscore the need for renewed efforts concentrated in these two areas. The Lancet Microbe, Infectious Diseases
Protect the Prosciutto: Italy Battles Swine Fever
Pig farmer Alberto Cavagnini has slaughtered 1,600 of his hogs due to swine fever, a virus threatening the 20-billion-euro pork industry in Italy, including its world-famous prosciutto. The disease, which is fatal for pigs and disastrous for the economy, has particularly affected the northern regions of Lombardy, Piedmont and Liguria—and its spread is spooking neighbor France. Italy recorded cases of the virus in just under 25,000 pigs in 50 farms, and in nearly 2,500 wild boars, between January 2022 and September this year, official figures show. Phys.org
Addressing the Ripple Effect of Crimean-Congo Hemorrhagic Fever in Pakistan
This communication emphasizes the urgent need to curtail the annual outbreaks in the country and prevent further CCHF cases and associated mortality. Key measures include annual or biannual screenings of individuals, particularly in rural communities where the majority of cases occur. A surveillance system or local database should be established by the health district in order to maintain official records of cases and other statistics related to CCHF, which will aid in the early detection and prevention of future outbreaks. Sentinel surveillance should be included in the curriculum of all undergraduate programs that offer community medicine and health courses. Infectious Diseases & Clinical Microbiology
AVIAN INFLUENZA
CDC A(H5N1) Bird Flu Response Update
Since April 2024, 14 human cases of avian influenza A(H5) virus infection have been reported in the United States. Four of these cases were associated with exposure to sick dairy cows and nine were associated with exposure to avian influenza A(H5N1) virus-infected poultry. The source of the exposure in the most recent case, which was reported by Missouri on September 6, has not been determined. CDC
Missouri Human H5 Flu Case Health Care Worker Contact Monitoring
To date, only one case of influenza A(H5N1) has been detected in Missouri. No contacts of that case have tested positive for influenza A(H5N1). Missouri identified two health care workers who were exposed to the hospitalized case before droplet precautions were instituted and subsequently developed mild respiratory symptoms (among 18 workers with this higher risk exposure); one tested negative for influenza by PCR, as previously reported, and the second provided a blood specimen for testing by CDC for potential influenza A(H5N1) antibodies. Missouri has since identified four additional health care workers who later developed mild respiratory symptoms.
One of these workers was in the higher risk category and provided a blood specimen for H5 antibody testing. Three of these workers are among 94 workers who were exposed to the hospitalized case of avian influenza A(H5) after droplet precautions were instituted (i.e., lower risk exposure); blood specimens for those who became symptomatic have been collected for H5 antibody testing at CDC. Aside from the one health care worker reported to have tested negative for influenza by PCR, the five remaining exposed health care workers had only mild symptoms and were not tested by PCR for respiratory infections. PCR testing would have been unreliable at the time of discovery of these individuals’ prior symptoms. CDC
Case Study of the First HPAI Outbreak in the Subantarctic Region
Documented the detection, monitoring, and impact of the first known outbreak of H5N1 HPAI in the subantarctic region, at Bird Island in South Georgia. Deaths from HPAI were first suspected in September 2023 and later confirmed by genetic analysis (in several species including Gentoo penguins, Snowy Albatrosses, Antarctic Fur Seals and Brown Skuas. Bird Study
Thermal Inactivation Spectrum of Influenza A H5N1 Virus in Raw Milk
The spillover of highly pathogenic avian influenza (HPAI) H5N1 virus to dairy cows and shedding of high amounts of infectious virus in milk raised public health concerns. Here, researchers evaluated the decay and thermal stability spectrum of HPAI H5N1 virus in raw milk, and heat virus positive milk following different thermal conditions including pasteurization and thermization. BioRxiv
CHEMICAL + RADIOLOGICAL THREATS
Neutralizing the Threat: A Comprehensive Review of Chemical Warfare Agent Decontamination Strategies
This article reviews various decontamination methods, analysing their respective strengths and weaknesses against chemical warfare agents including vesicants: sulfur mustard, nitrogen mustards, and Lewisite; nerve agents sarin, soman, tabun and VX; and vomiting agent Clark I. Journal of Environmental Chemical Engineering
Interleukin-12 Sustained Release System Promotes Hematopoietic Recovery After Radiation Injury
This study demonstrated the advantages and possibilities of using an IL-12 sustained-release hydrogel for the treatment of H-ARS, while also elucidating the underlying mechanisms of this hematopoietic restoration. MedComm
SURVEILLANCE + DETECTION
BARDA-Supported Rapid COVID-19 Test Receives FDA Clearance
Developed with BARDA support, the SCoV-2 Ag Detect Rapid Test from partner InBios International recently received FDA 510(k) clearance and a CLIA waiver. The point-of-care lateral flow test qualitatively detects the presence of SARS-CoV-2 antigens in nasal swab samples from patients with signs and symptoms of upper respiratory tract infections. BARDA has previously partnered with InBios to develop other diagnostics for Zika virus, anthrax, and COVID-19. Medical Countermeasures
Malaria Rapid Tests, Febrile Illness Management, and Child Mortality Across Sub-Saharan African Countries
Increasing distribution of rapid diagnostic tests for malaria was associated with increased blood testing, use of antimalarial drugs, and antibiotic use and modestly improved child survival. The greatest benefits occurred in areas with a high prevalence of malaria. JAMA
Shining Light on Biosensors: Chemiluminescence and Bioluminescence in Enabling Technologies
The integration of chemiluminescence (CL) and bioluminescence (BL) into point-of-care devices has found applications in medical diagnostics, environmental monitoring, and food safety. This review highlights recent advancements in both CL and BL technologies, mainly focusing on their implications in biosensor development. TrAC Trends in Analytical Chemistry
Cross-Priming Amplification for Point-of-Care Detection of Tuberculosis
Cross-Priming Amplification (CPA) technology has been shown to rapidly and effectively detect Mycobacterium tuberculosis (Mtb) in sputum samples under isothermal conditions. Currently, POCT testing for Mtb in sputum specimens based on CPA technology, like many NAATs, still requires several manual steps for sputum processing. Another bottleneck is the that infectious and viscous sputum specimens used for tuberculosis diagnosis require complex and labor-intensive sample preparation steps. This study directly applied high concentrations of guanidine thiocyanate (GTC) to liquefy highly viscous sputum specimens, evaluating the effectiveness of GTC in liquefying sputum and inactivating Mtb in viscous sputum specimens. The aim was to simplify sputum sample preparation steps, enabling Mtb nucleic acid testing to be conducted without a BSL-2 laboratory, and to achieve POC testing for Mtb and non-tuberculosis mycobacteria using CPA technology on portable devices. Heliyon
A Comprehensive Approach to Assessment of the Tuberculosis Infection Screening Strategy Cost-Effectiveness
Given that Mycobacterium tuberculosis (Mtb) remains in a low replicative state during TBI, no reliable tool for the direct detection of bacteria is currently available. Instead, an indirect evaluation of infection based on measuring the Mtb-specific immune response is applied using tuberculin skin test (TST) and interferon-γ release assays (IGRAs). IGRA assays approved by the World Health Organization include QIAGEN QuantiFERON-TB Gold Plus, Oxford Immunotec T-SPOT.TB, and Beijing Wantai’s TB-IGRA. In 2022, newer Mtb antigen-based skin tests (TBSTs) based on the detection of ESAT-6 and CFP-10 antigens have also been approved by the WHO. Clinical Microbiology and Infection
INFECTIOUS DISEASES
Elevated Noroviruses Activity in Europe and the United States
During the 2023/24 norovirus season (July 2023 to June 2024), elevated norovirus activity with an increase of GII.17 noroviruses was reported in at least six European countries, including Austria, France, Germany, Ireland, the Netherlands and England. A similar trend was observed in the United States (US), where the proportion of GII.17 outbreaks exceeded the number of GII.4 outbreaks. Findings aim to raise awareness about an increase of the number of GII.17 norovirus infections. Eurosurveillance
As Concerns About Respiratory Diseases Among Public Drop to New Lows, US Health Officials Urge Vaccination
Following a summer wave of COVID-19 activity and a record number of reported influenza (flu) deaths among US children during the 2023-2024 respiratory season, new survey results released by the National Foundation for Infectious Diseases (NFID) show that few US adults intend to get vaccinated against flu, COVID-19, respiratory syncytial virus (RSV), or pneumococcal disease this fall and winter, citing concerns about vaccine side effects and a general distrust of vaccines. “Last flu season, an estimated 25,000 people in the US died from flu or related complications and 75,000 from COVID-19 in 2023, demonstrating how dangerous these diseases can be,” said CDC Director Mandy K. Cohen, MD, MPH. National Foundation for Infectious Diseases
Study on Effectiveness of Pneumococcal Vaccination Strategies
Comparative effectiveness of PCV13 and PPSV23 and their combinations for adults in preventing invasive pneumococcal disease (IPD) using population-based data from the Veterans Health Administration. In multivariate analysis adjusted for comorbidities of a large cohort, the combination of PCV13 and PPSV23, particularly PCV13 followed by PPSV23, was associated with a lower risk of IPD, indicating additional benefits in combined vaccinations with potential importance in vaccination order. Clinical Microbiology and Infection
Co-circulation of A(H1N1)pdm09, A(H3N2) and B/Victoria Lineage Viruses with Further Genetic Diversification in the 2022/23 Influenza Season
Influenza virus surveillance data provide an important mechanism for monitoring the evolution of influenza viruses over the season and provide crucial data for the vaccine composition decision which led to the change of the A(H1N1)pdm09 component for the NH 2023/24 influenza season. Efforts in standardizing the selection of specimens for sequencing and antigenic characterization across the countries could improve results and therefore future efforts should be made to improve randomness or representativeness of the sequences to improve quality of virological influenza surveillance data to inform the epidemiological picture and vaccine composition. Eurosurveillance
Unprecedented Dengue Outbreak in Los Angeles Signals Infection Tipping Point
Dengue cases have been identified in Los Angeles in the sprawling city’s first outbreak of the disease with no ties to international travel. Local health officials have described the outbreak as “unprecedented” in the area, where dengue has not been transmitted by mosquitoes before. The Los Angeles County Department of Public Health reported three cases to date in Baldwin Park, just a 30 minute drive from Hollywood. “Local dengue cases in LA are the canary in the coalmine indicating that this has truly come. Once Aedes have expanded their range, there’s no turning back.” The Telegraph
ANTIMICROBIAL RESISTANCE CRISIS
Better Late Than Never: Addressing Antibiotic Pollution
On Sept 3, WHO published Guidance on wastewater and solid waste management for manufacturing of antibiotics, its first such document on antibiotic pollution by manufacturers. This guidance is advisory and so does not compel manufacturers to meet its standards, but it is nonetheless a coherent text that can underpin regulations used by bodies that do have statutory power. However, responsible manufacturers will be motivated to pre-empt future regulations by ensuring that they meet the WHO standards. The Lancet Microbe
AI + CYBERBIOSECURITY
Machine Learning for Data-Centric Epidemic Forecasting
Forecasting epidemic progression is a non-trivial task due to multiple confounding factors, such as human behaviour, pathogen dynamics and environmental conditions. This paper discusses various methodological and practical advances and introduce a conceptual framework to navigate through them. Nature Machine Intelligence
SPECIAL INTEREST
A Decade Later, Nebraska Biocontainment Unit’s First Ebola Patient Returns for Emotional Reunion
10 years ago, medical missionary Dr. Rick Sacra high-fived his way out of Nebraska Medicine’s bio-containment unit after being treated for Ebola. The doctor who led the CDC’s clinical Ebola response team says there’s lasting impact from the hospital’s work caring for Ebola patients a decade ago. “This really contributed to optimizing supportive care of patients with Ebola everywhere,” said Tim Uyeki, who now is the CDC’s chief medical officer for the Influenza Division. Sacra remembers his three weeks in Omaha well, and not just because of how sick he was. “They just went above and beyond,” Sacra said of the unit’s care team. “You gave me my life back.” KETV Omaha, WOWT News
Tips to Localize News About National Infectious Disease Outbreaks
One of the challenges of covering infectious diseases is people are often burned out hearing about COVID-19 or flu — or the biggest news is an outbreak that’s not geographically relevant to most of them. But even when a disease feels, or literally is, distant from the region you cover, you can localize the news and inform readers, viewers and listeners about what they need to know. Health Journalism
Mpox in the DRC: Working at the Outbreak Epicentre
Agnese Comelli, who leads the mpox response team of Médecins Sans Frontières (MSF) in Goma, where concerns are heightened by hundreds of thousands of vulnerable people taking refuge in displacement sites from the ongoing conflict in North Kivu, outlines a typical day in the field. Nature Africa
Wartime Grant Brings Ukrainian Bat Biologists to Panama
Over the last two years, staff at the Ukrainian Bat Rehabilitation Center have worked to save bats from the dangers of the Russian full-scale invasion. Now, they join researchers at the Smithsonian Tropical Research Institute to study bat behavior in Panama. Smithsonian Institute
Call for Comments: Research Priorities to Inform Readiness and Response H5N1
Submit feedback or resource submissions to inform the National Academies’ workshop discussions on research about avian influenza virus transmission, mitigation of risks, and appropriate measures to prevent the spread of disease. Global Biodefense
Announcing the ISC Expert Group for the Biological Weapons Convention
In May 2024, the International Science Council (ISC) and the United Nations Office for Disarmament Affairs (UNODA) were jointly awarded a grant by the Geneva Science Policy Interface to strengthen the Biological Weapons Convention (BWC). This initiative is a significant step toward integrating scientific advancements into the operations of the BWC, addressing the critical need for a structured mechanism to review relevant science and technology developments. The ISC has assembled a panel of esteemed experts to interact with delegates, provide independent scientific advice, and produce knowledge products that facilitate understanding between scientists and policymakers. Activities will include online briefings, the production of informational videos, and participation in BWC meetings. International Science Council
Q&A with Virologist Rúbens Alves, Ph.D.
As a member of LJI’s Shresta Lab, Alves studied how T cells fight viruses such as SARS-CoV-2 and dengue virus. He is now leading an innovative project on wastewater surveillance for influenza viruses. La Jolla Institute for Immunology
Celebrating Public Health
Spectacular breakthroughs in science can’t benefit people without translation to populations. To quote Paul Farmer, “In an age of explosive development in the realm of medical technology, it is unnerving to find that the discoveries of Salk, Sabin, and even Pasteur remain irrelevant to much of humanity.” In the United States, public health leaders have been vilified and front-line workers have been threatened since the beginning of the Covid-19 epidemic. During each Ebola outbreak, public health workers have faced suspicion and attacks. And community health personnel providing polio vaccines continue to be killed in places such as Pakistan and Afghanistan. In this sense, there may never have been a more difficult time in public health. So let’s take this opportunity to celebrate the thousands of people who, working together, are trying to bring better health to our communities. New England Journal of Medicine
ALSO READING
Was it really a hot zone summer? New York Times
Aptamers: precision tools for diagnosing and treating infectious diseases. Frontiers in Cellular and Infection Microbiology
Ebola virus infection of Flt3-dependent, conventional dendritic cells and antigen cross-presentation leads to high levels of T-cell activation. The Journal of Infectious Diseases
Performance of Fujifilm Dengue NS1 antigen rapid diagnosis kit compared to quantitative RT-PCR. Pathogens
Challenges and opportunities for wastewater monitoring of influenza viruses during the multistate outbreak of highly pathogenic avian influenza A(H5N1) virus in dairy cattle and poultry. AJPH
Global age-stratified seroprevalence of enterovirus D68: a systematic literature review. The Lancet Microbe
Review of the highly pathogenic avian influenza in Argentina in 2023: Chronicle of its emergence and control in poultry. Pathogens
Identification of potent, broad-spectrum coronavirus main protease inhibitors for pandemic preparedness. Journal of Medicinal Chemistry
Fractional doses of pneumococcal conjugate vaccine — a noninferiority trial. New England Journal of Medicine