Thursday, July 24, 2014

CDC Statement On Formation Of An External Lab Safety Workgroup




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In the wake of two serious breaches in biosecurity at CDC labs involving anthrax and H5N1 avian flu, and a third incident involving long forgotten and improperly stored smallpox at an FDA lab  (see FDA Statement On Additional 300 Vials Discovered At NIH Campus Lab), the CDC has promised a complete review of their safety procedures. 


Earlier in the week CDC Director Thomas Frieden indicated an external committee of experts would be formed.  Today, the CDC has posted the following announcement, whereby eleven outside experts will provide advice and guidance to the CDC’s new Director of Laboratory Safety.


In a related story, the CDC also released an announcement on the lifting of the moratorium on shipping inactivated TB samples out of one of their CDC’s Clinical Tuberculosis Laboratory after completing  a safety review (see New safety protocols in place, first CDC lab resumes transfer of inactivated materials out of high-containment laboratory).



CDC announces the formation of an external laboratory safety workgroup

CDC announced today the formation of an external laboratory safety workgroup of the Advisory Committee to the Director of CDC. This group will provide advice and guidance to the CDC Director and CDC’s new Director of Laboratory Safety. The specific charge and functions of the workgroup include, but are not limited to:

  • Reviewing and providing input into corrective actions for CDC’s laboratories. These include actions identified by the U.S. Department of Agriculture’s Animal and Plant Health Inspection Services and CDC’s Office of the Associate Director for Science following investigations conducted in response to the June 2014 transfer of potentially viable Bacillus anthracis from a CDC BSL-3 facility to CDC BSL-2 facilities; actions identified in follow up to an inadvertent shipment of an H5N1 influenza-containing laboratory specimen to an external BSL-3 laboratory; and other necessary actions identified through ongoing procedural reviews.
  • Prioritizing implementation of additional safeguards across all CDC laboratories.
  • Identifying potential weaknesses and necessary safeguards based on experiences of non-CDC (e.g., private and/or academic) laboratories.
  • Identifying training and oversight needs to promote and sustain a culture of laboratory safety at CDC.
  • Identifying ways to provide stronger safeguards for laboratories across the United States.
  • Examining HHS lab protocols and reporting to the Secretary through the ACD on:
    • Whether current biosafety and biosecurity rules, processes, and procedures are appropriate.
    • Whether implementation or execution of the current protocols is adequate.
    • Recommendations for improving these protocols or their implementation.

The group is set to meet for the first time in early August and will meet as frequently as needed.


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OIE: Foot & Mouth Disease In South Korea




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Foot & Mouth Disease (FMD) is a highly contagious viral disease that primarily afflicts cloven-hoofed animals (including cattle, sheep, goats, pigs, deer, etc.) and poses a serious threat to agricultural interests around the world. It is caused by a picornavirus, and has no relation to HFMD, which is a childhood disease in humans caused by a number of non-polio enteroviruses.


There are seven known types and more than 60 subtypes of the FMD virus, and different types are to be found in different parts of the world. 


Overnight South Korea has reported their first case of FMD in 3 years, at a pig farm in Uiseong, North Gyeongsang Province (see Korea Herald report S. Korea reports first outbreak of foot-and-mouth disease).   The OIE report (see below) lists the serotype as O (PanAsia Strain), which raised international concern between 1998-2011 when it spread rapidly across Asia, Africa, & parts of Europe (cite). 



At this point, only one farm is known to be affected, and the following control measures are being implemented.



This return of FMD comes just months after S. Korea began a prolonged battled against the H5N8 avian flu virus in poultry, which resulted in the culling of millions of chickens and ducks. 


Both Japan and Korea detected FMD in the spring of 2010, and after the destruction of 290,000 head of livestock, Japan declared their FMD crisis over in August. In South Korea, however, the outbreaks continued into 2011, with 155 outbreaks reported.


2010-2011 FMD – Credit OIE


FMD is endemic in many parts of the world (Africa, Asia, South America, some parts of Europe), but has been eradicated in many others.  The last outbreak of FMD in the United States was in 1929 – but vigilance is maintained to prevent its return.



OIE Disease Outbreak Map – Current FMD

Although South Korea hasn’t reported FMD in over three years, neighboring North Korea has reportedly been doing battle with the disease for several years (see Xinhua News: Extensive H5N1 Outbreaks In North Korean Poultry).


We’ll have to wait to see if this latest outbreak is limited to just one farm, or has already spread.

WHO Ebola Update – July 24th


@WHO & Partners Ebola Response In Guinea



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Despite the concerted efforts of international agencies and local governments, the Ebola outbreak in West Africa continues to expand, with nearly 1,100 cases and 660 deaths recorded to date. 


To try to put this outbreak into perspective, it is nearly 2 1/2 times larger than the next biggest outbreak on record (Uganda 2000-2001 with 425 cases & 224 deaths), and shows no signs of abatement.


Here is the latest World Health Organization  GAR (Global Alert & Response) update.


Ebola virus disease, West Africa – update

Disease outbreak news
24 July 2014

Epidemiology and surveillance

WHO continues to monitor the evolution of the Ebola virus disease (EVD) outbreak in Sierra Leone, Liberia, and Guinea. Between 18 – 20 July 2014, 45 new cases and 28 deaths were reported from Guinea, Liberia, and Sierra Leone. These include suspect, probable, and laboratory-confirmed cases. The respective Ministries of Health continue to work with WHO and its partners to implement outbreak containment measures.

Health sector response

The Regional Director, WHO African Region, began official visits to the three West African countries of Guinea, Liberia, and Sierra Leone on 21 July 2014. On the first leg of his mission, the Regional Director visited Liberia from 21 - 22 July 2014. The goal of the visit is to make a first-hand assessment of the EVD outbreak, review the current outbreak response and challenges, and explore the best ways to rapidly contain the EVD outbreak in West Africa. The Regional Director held official meetings with the President of Liberia and the Minister of Health, including senior government officials. The President and the Regional Director also participated in the Ebola national coordination meeting at the Ministry of Health. During this meeting, the Regional Director emphasized the need to step up implementation of key outbreak containment strategies, including community engagement and involvement, effective contact tracing, cross-border collaboration and effective coordination. Discussions were also held with international and local non-governmental organizations, UN agencies, and other stakeholders to enhance collaboration and effective coordination. The Regional Director called upon all partners to be fully involved in the EVD outbreak response. Following his visit to Liberia, significant financial contributions and commitments were made, including from the Government and partners.

In Liberia, the Minister of Health launched the national strategic plan for accelerated response to the EVD outbreak. The plan is aligned to the inter-country strategy for accelerated response to the outbreak, adopted in the Accra Ministerial meeting. It is expected that the launch and subsequent implementation of this strategic plan will bring tangible improvement and scale up effective outbreak containment measures at field level. Similarly, the Ministry of Health and partners in Guinea and Sierra Leone are conducting planning meetings to re-strategize and come up with concrete, action-oriented national operational plans to accelerate the response to the EVD outbreak response.

Efforts are currently ongoing to scale up and strengthen all aspects of the outbreak response in the three countries, including contact tracing, public information and community mobilization, case management and infection prevention and control, and coordination.

WHO does not recommend any travel or trade restrictions be applied to Guinea, Liberia, or Sierra Leone based on the current information available for this event.

Disease update

New cases and deaths attributable to EVD continue to be reported by the Ministries of Health in the three West African countries of Guinea, Liberia, and Sierra Leone. Between 18 – 20 July 2014, 45 new cases of EVD, including 28 new deaths, were reported from the three countries as follows: Guinea, 5 new cases and 4 deaths; Liberia, 28 new cases with 11 deaths; and Sierra Leone 12 new cases and 13 deaths. These numbers include laboratory-confirmed, probable, and suspect cases and deaths of EVD.

As of 20 July 2014, the cumulative number of cases attributed to EVD in the three countries stands at 1 093, including 660 deaths. The distribution and classification of the cases are as follows: Guinea, 415 cases (304 confirmed, 98 probable, and 13 suspected) and 314 deaths (204 confirmed, 98 probable, and 12 suspected); Liberia, 224 cases (77 confirmed, 68 probable, and 79 suspected) and 127 deaths (56 confirmed, 44 probable, and 27 suspected); and Sierra Leone, 454 cases (405 confirmed, 35 probable, and 14 suspected) and 219 deaths (182 confirmed, 32 probable, and 5 suspected).


The total number of cases is subject to change due to reclassification, retrospective investigation, consolidation of cases and laboratory data, and enhanced surveillance. Data reported in the Disease Outbreak News are based on best available information reported by Ministries of Health.



For some extended background on Ebola, you may wish to revisit:

A Brief History Of Ebola

Xinhua News: Plague Quarantine Lifted In NW China

Plague signs

Credit CDC



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Last Friday, while writing about the Colorado DPH Statement On 4 Cases Of Plague, I also mentioned the report of a single case of pneumonic plague in Gansu Province in North Central China (see CHP notified by NHFPC of plague case in Gansu ).


Yesterday it was widely reported that parts of one (or more) cities were `sealed off’ or under quarantine (see Reuters Parts of Chinese city in quarantine after plague death: Xinhua). 


While they make great copy, reports such as these out of China are difficult to verify. In researching this report, I found several conflicting stories in the Chinese press going back 5 or 6 days.  


Today Xinhua News is reporting that – after 9 days – that quarantine has been lifted, while appearing to downplay (or omit) the size of the quarantine action. 


Plague quarantine lifted in NW China   2014-07-24 11:53:15

LANZHOU, July 24 (Xinhua) -- Yumen City in northwest China's Gansu Province on Thursday lifted a nine-day quarantine on an area in which plague caused one death.

A total of 151 people who had close contact with the infected man had been put in quarantine and under medical observation. None of them has reported symptoms of the disease, according to a report submitted by the local authorities and approved by the provincial government.

Plague is categorized as a Class A infectious disease, the most serious under China's Law on the Prevention and Treatment of Infectious Diseases.

A 38-year-old man in Yumen died of plague on July 16. He had been in contact with a dead marmot, a member of the squirrel family.

During the quarantine, local authorities aided with disease prevention, and control specialists sent by the National Health and Family Planning Commission carried out disinfection and rat extermination and educated locals on how to guard against plague.

The experts said plague is currently in a communicable, "active" phase among the local rat population.



As the Chinese press often indulges in euphemisms, so `disinfection, rat extermination & educating locals’ could entail a litany of strong, proactive steps by local public health authorities. 


Whatever the truth of the matter, for now this event appears to be under control.

Wednesday, July 23, 2014

EID Journal: H3N2v Swine To Human Transmission At Agricultural Fairs – 2012




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I hadn’t planned on writing another swine variant influenza-related blog again so soon (see yesterday’s blog CDC: Measures to Minimize Influenza Transmission at Swine Exhibitions, 2014), but today the CDC’s EID Journal has posted an analysis of the 2012 outbreak of H3N2v associated with attendance of agricultural fairs in Ohio in 2012.


Although only 19 swine variant flu infections were reported last year,  in 2012 more that 300 cases were reported, with nearly all linked to fairgoers, mostly in Indiana & Ohio.


State & local  fairs have instituted inspections for any signs of illness in livestock – but as we’ve discussed previously (see Asymptomatic Pigs: Revisited) - pigs can sometimes carry these viruses without showing any outward signs of infection.


The concern with these variant swine flu infections, as it is with any animal flu that jumps to humans, is that it gives the virus another opportunity to better adapt to human physiology.


While humans have a long history of exposure to seasonal H3N2 flu viruses, research has shown only limited community immunity to these variant strains (see CIDRAP: Children & Middle-Aged Most Susceptible To H3N2v). The good news is that while several hundred infections were recorded in 2012, sustained and efficient community transmission was not observed, and for the most part, the virus only caused mild to moderate illness.


Today’s study confirms the link between fairs with H3N2v infected pigs, and human cases, and confirms that the strains detected in humans, and those detected in pigs, were > 99.7% identical.  Follow the link below to read:.


Swine-to-Human Transmission of Influenza A(H3N2) Virus at Agricultural Fairs, Ohio, USA, 2012

 Andrew S. BowmanComments to Author , Sarah W. Nelson, Shannon L. Page, Jacqueline M. Nolting, Mary L. Killian, Srinand Sreevatsan, and Richard D. Slemons

Author affiliations: The Ohio State University, Columbus, Ohio, USA (A.S. Bowman, S.W. Nelson, J.M. Nolting, R.D. Slemons); Ohio Department of Health, Columbus (S.L. Page); US Department of Agriculture National Veterinary Services Laboratories, Ames, Iowa, USA (M.L. Killian); University of Minnesota, Saint Paul, Minnesota, USA (S. Sreevatsan)


Agricultural fairs provide an opportunity for bidirectional transmission of influenza A viruses. We sought to determine influenza A virus activity among swine at fairs in the United States. As part of an ongoing active influenza A virus surveillance project, nasal swab samples were collected from exhibition swine at 40 selected Ohio agricultural fairs during 2012.

Influenza A(H3N2) virus was isolated from swine at 10 of the fairs. According to a concurrent public health investigation, 7 of the 10 fairs were epidemiologically linked to confirmed human infections with influenza A(H3N2) variant virus. Comparison of genome sequences of the subtype H3N2 isolates recovered from humans and swine from each fair revealed nucleotide identities of >99.7%, confirming zoonotic transmission between swine and humans.

All influenza A(H3N2) viruses isolated in this study, regardless of host species or fair, were >99.5% identical, indicating that 1 virus strain was widely circulating among exhibition swine in Ohio during 2012.

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Swine are highly susceptible to a variety of flu viruses (human, swine, avian) - and are viewed as excellent `mixing vessels’, allowing viruses to reassort into new hybrid strains.

Reassortant pig[6]


While a handful of novel swine variant flu infections that don’t appear to transmit efficiently may not sound like a big deal, as the authors of this paper point out, Agricultural Fairs provide a favorable environment for multiple swine flu viruses to get together. They write:


Swine-to-human transmission and human-to-swine transmission of influenza A virus are known to occur at fairs (28), highlighting the fact that swine in this setting are potentially exposed to multiple lineages of influenza A viruses simultaneously, making fairs ideal locations for genomic reassortment and novel virus formation.


And not only can swine pass flu viruses on to people, people can pass flu viruses on to swine.  Something we saw happen around the world after the 2009 H1N1 pandemic virus emerged and began transmitting in humans. 


This bi-directional transfer of influenza viruses allows for even greater mixing and matching of genes, and explains how the H3N2v virus picked up the M (matrix) gene from the 2009 H1N1pdm virus in 2012.


The authors write:


The results of this study support previous calls for enhanced surveillance of influenza A viruses among swine, especially at high-risk swine–human interfaces

For more on swine variant influenza viruses, and why they matter, you may wish to revisit:


J. Virol: Continued Reassortment Of Swine Flu Viruses With Genes From pH1N1 In China
Keeping Our Eyes On The Prize Pig
Study: Novel & Variant Swine Influenzas In Korean Pigs
Seroprevalence Study: Avian Flu In Chinese Pigs

NASA: The Solar Super Storm Of 2012


Credit NASA



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Although it sounds like science fiction, two years ago today the earth narrowly (by cosmic standards) missed being hit by a massive solar storm that had the potential to knock our technology-dependant society back a hundred years. 


Back in 2010 we looked at the granddaddy of all known solar storms, the Carrington Event of 1859, and have revisited the topic a number of times since then, including:


NASA: Solar Max Is Finally Here

Solar Storms, CMEs & FEMA

NASA Braces For Solar Disruptions


While this solar cycle has produced the weakest solar maximum in living memory, it also produced – on July 23rd, 2012 – the largest known solar flare in 155 years.  A double-whammy solar flare that rivaled, or perhaps even exceeded, the power of the 1859 Carrington event.


One that - had it erupted a week earlier – would have directly impacted earth.


A Solar Flare is the brief, sudden release of radiation energy (X-Ray, Gamma Rays, & energetic particles (protons and electrons)) from the surface of the sun, generally in the vicinity of an active sunspot.


Solar flares are rated as either C Class (minor), M Class (Moderate), or X Class (extreme), and while the electromagnetic radiation they release can reach earth in only about 8 minutes time, their effects are mostly limited to disrupting communications and potentially damaging satellites.


A CME (Coronal Mass Ejection) is the ejection of a massive amount of plasma (electrons and protons & small quantities of helium, oxygen, and iron) from the the sun that may last for hours. Some of this plasma falls back into the sun, but trillions of tons can escape and if aimed in their direction, impact surrounding planets.


A CME may arrive on earth – 93 millions miles distant from the sun – 48 to 72 hours after it is observed, and spark a Geomagnetic Storm.   


While they pose no direct physical danger to us on the earth’s surface (we are protected by the earths magnetic field and atmosphere), a large CME can wreak havoc with electronics, power generation, and radio communications.


All of which brings us to a report, and 4 minute video, from NASA on this second anniversary of the earth almost getting clobbered by a `Carrington class’ solar storm.  First the links, and excerpts, and then I’ll be back with more.


Near Miss: The Solar Superstorm of July 2012

July 23, 2014: If an asteroid big enough to knock modern civilization back to the 18th century appeared out of deep space and buzzed the Earth-Moon system, the near-miss would be instant worldwide headline news.

Two years ago, Earth experienced a close shave just as perilous, but most newspapers didn't mention it. The "impactor" was an extreme solar storm, the most powerful in as much as 150+ years.

"If it had hit, we would still be picking up the pieces," says Daniel Baker of the University of Colorado. 


A ScienceCast video recounts the near-miss of a solar superstorm in July 2012. Play it

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From my perspective, that wasn’t a `near miss’ . . .  that was more of a `near hit’.

And even more sobering is this assessment, suggesting the odds of earth being struck by one of these solar super storms is actually a lot higher than we’ve previously thought.  Again from the NASA article:


In February 2014, physicist Pete Riley of Predictive Science Inc. published a paper in Space Weather entitled "On the probability of occurrence of extreme space weather events."  In it, he analyzed records of solar storms going back 50+ years.  By extrapolating the frequency of ordinary storms to the extreme, he calculated the odds that a Carrington-class storm would hit Earth in the next ten years.

The answer: 12%.


FEMA takes these solar storms seriously, and in 2010 held a major table-top exercise in anticipation of the upcoming solar maximum. According to a tweet from FEMA Director Craig Fugate back in 2011, they now include a solar weather update in their daily briefings.


A 30 page PDF file is available for download from the FEMA library on this exercise which envisioned a `near worst-case scenario’.

Managing Critical Disasters in the Transatlantic Domain - The Case of a Geomagnetic Storm


In 2009 the National Academy of Sciences produced a 134 page report on the potential damage that another major solar flare could cause in Severe Space Weather Events—Understanding Societal and Economic Impacts.


You can download the PDF for free from the National Academies Press at the above link.


In November of 2012 the U.S. National Intelligence Council released a report called  "Global Trends 2030: Alternative Worlds" that tries to anticipate the global shifts that will likely occur over the next two decades (see Black Swan Events). Making their top 10 list was:


7. Solar Geomagnetic Storms

"Solar geomagnetic storms could knock out satellites, the electric grid, and many sensitive electronic devices. The recurrence intervals of crippling solar geomagnetic storms, which are less than a century, now pose a substantial threat because of the world's dependence on electricity," the report says.


And last year Lloyds of London issued a risk assessment for the insurance industry called Solar storm Risk to the north American electric grid which calls another `Carrington’ class event inevitable, and the effects likely catastrophic, but the timing is unknowable.


Solar storms are among a number of plausible low-probability, high-impact events that – while not anything I would lie awake at night worrying about – are nevertheless worth considering as part of a balanced `All Hazards’ approach to preparedness.


In the 2011 OECD Report: Future Global Shocks report, the authors concentrated most of their attention on five highly disruptive future shock events.


  • A Pandemic
  • A Cyber Attack
  • A Financial Crisis
  • A Geomagnetic Storm
  • Social Unrest/Revolution

While all of these are difficult to prepare for, the truth is -  if you are well prepared for an earthquake or a hurricane - you are automatically in a better position to deal with the disruptions caused by these more exotic threats. Some resources to get you started on the road to `all threats’ preparedness include:






And some of my preparedness blogs, including:

When 72 Hours Isn’t Enough

The Gift Of Preparedness: 2013

In An Emergency, Who Has Your Back?