Archive for July, 2014

Even the best of us...smallpox, anthrax, influenza and the CDC

Wednesday, July 16th, 2014
This is our premier laboratory

This is our premier laboratory

The Center for Disease Control and Prevention, AKA the CDC, America's central medical laboratory has recently had multiple problematic episodes. I was trying to follow up on the vials of smallpox virus that were found in an old refrigerator that the FDA apparently had forgotten, The question, of course, was whether the virus samples were long dead or still viable. They had been sent to the CDC to have that highly significant issue resolved.

Since then there has been a followup announcement, but also several articles on significant issues with procedures and safety at the CDC itself. The first was published in The New York Times, AKA NYT, (as well as in other papers, but I get the NYT daily on my iPad , so saw it there first). The startling title was "C.D.C. Closes Anthrax and Flu Labs after Accidents." The current director of the CDC, Dr. Thomas Frieden, called the lab/agency "the reference laboratory to the world," but admitted there had been a series of accidents (actually lapses in set safety procedures), in the recent past, that were quite frightening.

A month ago potentially infectious samples of anthrax, a bacteria found naturally in soil and commonly affecting wild and domesticated animals worldwide, causing an extremely serious, but rare illness in people, were sent to labs that were not equipped to deal with them (anthrax would normally be handled only with the highest level of protective biosafety gear and procedures (BSL-4). The CDC also has a rather simplistic YouTube video discussing anthrax's use as a potential bioterrorism weapon, but in this case 62 or more CDC employees were potentially exposed to the bacteria in the course of their work.

The good news is it appeared nobody was in danger; all those employees were given the anthrax vaccine and also begun on antibiotics. The background information available online says there has never been person to person spread of the disease.

It appears that it's exceedingly tough to get rid of anthrax in the environment; I'll go over the classic historical example of how careful government researchers have been with its spores..

In the 1940s, British scientists used a small Scottish island (Gruinard) for germ warfare research. That island, thoroughly contaminated with anthrax spores, remained off-limits for forty+ years before extraordinary efforts, begun in 1986, rendered it safe for ordinary use. The surface of the island was only 484 acres; it was sprayed with a herbicide, then all dead vegetation was burned off. Next 200 tons of formaldehyde solution was diluted in 2,000 tons of seawater and sprayed over the entire island. Perforated tubing was used to ensure that 50 liters of solution were applied to every square meter being treated.

Later the effectiveness of the decontamination process was assessed by taking two duplicate sets of soil samples. Each was tested at two major government labs. Anthrax spores were detected only in "small quantities in a few places." These specific areas were treated in July 1987, followed by further soil sampling in October 1987. No further traces of anthrax spores were found.

Blood samples from local rabbits were also tested for anthrax antibodies. No such antibodies were found.

Following these measures, a farmer grazed part of his flock of sheep on the island for six months. The sheep were inspected monthly by the District Veterinary Officer, and returned to the mainland in October 1987 in excellent condition.

On April 24, 1990, 4 years after the decontamination works had been completed, a Defense Minister visited the island and removed the safety signs, indicating that the island had finally been rendered safe. Then, per agreement  the island was sold back to the heirs of the original owner for the WWII sale price of £500.

But a senior British archeologist said he still wouldn't set foot on the island; he was concerned because of potentially infectious particles found in some of his digs.

Yet another NYT piece, "Ticking Viral Bombs, Left in Boxes," this one written by a distinguished physician, Lawrence K. Altman, M.D. recalls the irony of the outcry for mass smallpox vaccination of our entire U.S. population after 9-11 (when no Iraqi supply of the deadly bacterium was ever located), contrasted with the recent finding of six vials, two with live smallpox bugs, being found in in Bethesda, almost within "spitting distance" of our center of government.

In 2011 the Birmingham Mail reviewed a tragic lab accident which led to the last known smallpox death . The city, now England's second largest, was a site of a medical research laboratory associated with the local medical school. Viral particles got into an air duct and a photographer whose studio was one story up from the lab became the last known case of active smallpox and died from the disease in spite of having been vaccinated twelve years before

Dr. Altman discusses the pros and cons of eradicating the last two known stocks of the virus, one at the CDC, the other in a Russian lab in Siberia. Even if the natural virus is finally and totally eliminated , a rogue group may well be able to re-establish their own supply from the known genetic sequence of smallpox.

Lastly I saw a NYT article with an even more disturbing title, "After Lapses, C.D.C. Admits a Lax Culture at Labs." CDC workers had somehow shipped a dangerous strain of avian influenza to a poultry research lab run by the Department of Agriculture. Known as H5N1, the virus had killed more than half of the 650 people who had been infected with it since 2003. Again there were no deaths from this mistake.

After all of this recent furor plus the historical examples, I'm heartily in favor of the idea that's been broached saying such dangerous organisms should be confined to a minimal number of labs and even those clearly need to tighten up their standards.







Smallpox: vials found in NIH lab

Wednesday, July 9th, 2014

I was glancing through The Wall Street Journal. this morning (that period is intentional as I found out recently in their 150th anniversary issue) and saw an article about smallpox,  that old enemy of mankind. The CDC issued a media statement saying six vials labeled with the technical name of the disease, variola, had been found in an old storage room belonging to an FDA lab that is on the NIH Bethesda, Maryland facility. Forty-two years ago the FDA took over that lab, among others, and only now were those labs being moved to the main FDA location in the DC area. The vials themselves date back ~60 years and now will be tested to see if the material in them is viable (i.e., live smallpox viruses).

I reviewed the CDC's Bio-hazard Safety Levels; they range from 1 to 4 with more serious infectious agents occupying the higher levels. A BSL-3 agent can cause serious or deadly disease, but either doesn't spread from person to person (at least not easily) and/or has a preventive or treatment known. Plague, rabies virus and West Nile fit into this category. Smallpox is obviously a BSL-4 bug, the most dangerous kind and in the company of Ebola virus. A February 15, 2012 Reuters article, "How secure are labs handling the world's deadliest pathogens?" talked about the precautions used in such a lab in Galveston, Texas. The boss there got entry by swiping a key card, was scanned by 100+ closed-circuit cameras as he opened seven additional locked doors before he reached the lab where another card swipe and a fingerprint scan were necessary for entry. The Washington Post article on the recently found vials has a six-minute video on BSL-4 procedures with a comment that there are three over-lapping types of safety precautions: those for containment of the hazardous material; those for personal protection and overall administrative factors.

And this may get you into BSL-3/

And this may get you into BSL-3

The air flow and exhaust systems used in Galveston, the full-body suits with their own air supply and the intruder drills that are conducted all made me somewhat more comfortable. But that's in a government-funded laboratory. Even in the United States, a private-funded lab may not be subject to the same rules and regulations, Elsewhere the procedures that must be followed vary. In 2011 there were 24 known BSL-4 labs in the world with six in the U.S. (The GAO said we had considerably more.) In 2013 there was considerable protest in Boston over the proposed BSL-3 and BSL-4 lab there.

We don't see these anymore.

We don't see these anymore.

I've written about smallpox before, but a brief history, available online on a dermatology website was worth reviewing. The disease likely originated in Africa about 12,000 years ago. caused a major epidemic during an Egyptian-Hittite war in 1,350 B.C.E and left typical scars on the mummy of Pharaoh Ramses V who died in 1157 B.C.E. It got to Europe somewhere between the 5th and 7th centuries C.E.; millions died in Europe and the Western Hemisphere before Edward Jenner developed vaccination in 1796. The term came from the Latin word for cow (vaca), as Jenner used fluid from a cowpox-infected dairymaid's hand to inoculate an eight-year-old boy. In 1967 WHO estimated there were 15 million cases of smallpox and 2 million deaths from the disease. Total smallpox deaths over the past 12,000 years have been estimated at 300-500 million, more than all the world wars combined.

By 1980 the World Health Organization declared the globe smallpox-free. In this country, we quit vaccinating the general population in 1972 and stopped giving the inoculation to new military personnel in 1990.

My wife's old shot record shows she got her first vaccination against small pox in 1956 and the last booster in 1980. We were both assigned to bases in the Far East in the early and mid 80s. I can't find my military vaccination record from that time frame, but logically wouldn't have had a booster after 1986 when I got back to a base in Texas. Since immunity is unlikely to last more than ten years, at this stage we'd both be vulnerable to smallpox, like most everyone else.

The only known supplies of the virus remained in government laboratories in the United States and Russia. There has been considerable international protest against keeping those specimens alive starting in the early 1990s, but thus far neither country wants to give in to that pressure. One rationale was the genetic structure of the virus was known, so it could conceivably be recreated by terrorists.

In 2004 the CDC said they had stockpiled enough smallpox vaccine on hand to vaccinate everyone in the United States. I haven't found any updates on that statement. But the U.S. military was still giving those shots to personnel going to USCENTCOM areas (the Middle East and the "stans") until the middle of May, 2014, to Korea for another two weeks and to some special mission troops after that with an end date unspecified.

So now it's the middle of 2014 and, in one manner or another, smallpox is still lingering, fortunately not as an active disease. The CDC is testing those re-found vials of the virus  and we'll hear in a couple of weeks is they were still viable.