Dr Ali A. Mohammadi
President
Global Health and Security Consultants
Global Health & Security Consultants4/19/2016
How Diseases occur Natural outbreaks
Accidental release
Deliberate use
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Our world is changing as
never before Populations grow, age, and move
Diseases travel fast
Microbes adapt
Chemical, radiation, food risks increase Health security is at stake
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H5N1: Avian influenza, a
pandemic threat
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Soldiers from Fort Riley, Kansas, ill with Spanish influenza at a hospital
ward at Camp Funston
The 1918 flu pandemic (January 1918 – December 1920)
Infected 500 million[2] people across the world, including remote Pacific
islands and the Arctic, and killed 50 to 100 million of them—three to five
percent of the world's population
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WHO travel recommendations removed
36 116
WHO travel recommendations2 April
14 670
13 May
102 165
25 May27 March 23 June
Screening of exit passengers
SARS: an unknown
coronavirus
• 8098 cases
• 774 deaths
• 26 countries affected
• trends in airline passenger
movement drop
• economic loss: US$ 60
billion
2003: SARS changes the world
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Comparative Virology
October 2015
And now ZIKA
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30 years of international health
in securityHIV/AIDS
CHERNOBYL
PLAGUE
EBOLA /
MARBURG
BSE/NvCJD
NIPAH
YELLOW FEVER
1 Disease
eradicated, Small
Pox
ANTHRAX
SARS
MENINGITIS
CHOLERA
CHEMICALS
AVIAN/SWINE FLU
XDR-TB
30 New Diseases
Emerged
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Transport of Infectious Diseases In 2006 a passenger was on board in a European airline which
was heading to Brussels from Africa. He was infected by Lassa
Fever Virus(a VHF) and while in the plane presented the
symptoms. The plane had to make emergency landing and took
the patient to two hospitals. As a consequence, 30 passengers,
crew members and hospital workers were infected and 6 people
died. The plane was out of service, all its seats were replaced,
this caused at least 1 million USD damage and loss of
credibility to the airliner.
Findings from the World Health
Report 2007 (1) . 685 verified events of international public health concern
occurred from September 2003 to September 2006 (a mean
of about 5 PHEICs each week)
• Infectious diseases emerged at a rate of one or more a year
since the 1970s, including Avian Flu, SARS, Ebola, Marburg
and Nipah viruses
• Depending on a number of factors, a highly pathogenic Flu
pandemic could affect more than 1.5 billion people or 25% of
the world population*
http://www.who.int/whr/2007/en/index.ht
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Spectrum of Microbial ThreatsNewly recognized pathogens
New geographical spread
Resurgence of endemic infections
Laboratory Acquired Infections (LAI)
Laboratory Escape
Antimicrobial-resistant infections
Infectious etiology of chronic diseases
Intentional use of biological agents
Global Health & Security Consultants4/19/2016
Leading Infectious Causes of
Death WorldwideCause Rank Number of Deaths
Respiratory infections 1 3,871,000
HIV/AIDS 2 2,866,000
Diarrhoeal diseases 3 2,001,000
Tuberculosis 4 1,644,000
Malaria 5 1,124,000
Measles 6 745,000
Pertussis 7 285,000
Tetanus 8 282,000
Meningitis 9 173,000
Syphilis 10 167,000 Source: WHO, 2009
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Recent Microbial Threats
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Factors in Emergence (1)
Human demographics and behavior
Technology and industry
Economic development and land use
International travel and commerce
Microbial adaptation and change
Breakdown of public health measures
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Factors in Emergence (2) Human susceptibility to infection
Climate and weather
Changing ecosystems
Poverty and social inequality
War and famine
Lack of political will
Accidental release (Laboratories, Stockpiles)
Intent to harm (Bioterrorism)
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The Human Population
ExplosionSource: UN, 1999
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World Urbanization Trends
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International Tourists Arrivals
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LABORATORY The Major component of disease campaign
The Most accurate and final judgement
The Main place for microbial stockpile
The Major source of microbial spread
Therefore, the priority need for implementation of
Biosafety and Biosecurity
Global Health & Security Consultants4/19/2016
Laboratory Accidents and Bio-Risks
Small Pox: UK, 1978
SARS: Singapore, 2003
SARS: Taiwan, 2003
SARS: China, 2004
Tularaemia: USA, 2004
Ebola: Russia, 2004
Influenza: USA, 2005
Accident:
unintended event giving rise to harm
NOTE: An accident is an incident which has resulted in harm
Incident:
event with a potential for causing harm
NOTE 1: An incident where no harm is caused may also be referred to as a
“near miss”, “near hit”, “close call” or “dangerous occurrence”.
NOTE 2: An emergency situation is a particular type of incident.
Source: Laboratory biorisk management standard, CWA 15793, February 2008
Definitions
Smallpox Accident in Birmingham Janet Parker (March 1938[1] – 11 September 1978) was a
British medical photographer who became the last person to
die from smallpox
She was exposed to the virus as a result of a laboratory
accident at the University of Birmingham Medical School The life and death of smallpox. Cambridge, UK: Cambridge University Press. p. 227. ISBN 0-521-84542-4
Smallpox Scares London Review of Books 24: 32–33 (accessed 16 February 2013
Accidental releases:
Anthrax release: Sverdlovsk, Russia 1979
Accidental release from anthrax drying plant
79 human cases
• All downwind of plant
• 68 deaths
• Some infected with multiples strains
Officials attributed this to consumption of
contaminated meat, but Western governments
believed it resulted from inhalation of spores
accidentally released from a nearby military
research facility.
Science. 1994 Nov
18;266(5188):1202-8
Accidental releases cont.:
Summer 2007:
Foot- and mouth disease virus escape
from Pirbright
Biosafety breaches in the media
Laboratory-Acquired Infections:
Acquired through laboratory or laboratory-related activity
regardless whether they are symptomatic or asymptomatic in
nature.
Resulting from occupational exposure to infectious agents.
Most common routes:
• Inhalation
• Percutaneous inoculation
• Contact
• Ingestion
Definitions cont.
Laboratory acquired infections still happen!
Emerg Infect Dis. 2006
Jan;12(1):134-7
2001: United-States, laboratory acquired Brucellosis after misidentification of blood culture isolates
2002: United-States, laboratory acquired West Nile Virus infection after using sharps
2003: Singapore, laboratory acquired SARS infection, inappropriate laboratory procedures and cross contamination
2004: Philadelphia, occular vaccinia infection in an unvaccinated laboratory worker
2004: A Russian scientist dies of Ebola infection
31
Laboratory-Acquired InfectionsLaboratory-acquired infectionsNumber of hits listed in ProMed-mail, 19.11.2008
“laboratory acquired” = 44The following of them were relevant (most recent):
Archive Number 20080117.0214
Published Date 17-JAN-2008
Subject PRO/AH> Brucellosis, lab workers, 2006 - USA: (IN, MN)
Archive Number 20050119.0175
Published Date 19-JAN-2005
Subject PRO/AH/EDR> Tularemia, laboratory-acquired - USA (MA): 2004
Archive Number 20021226.6129
Published Date 26-DEC-2002
Subject PRO/AH/EDR> West Nile virus update 2002 - USA (35)
Archive Number 20020404.3882
Published Date 04-APR-2002
Subject PRO/AH/EDR> Anthrax, human, laboratory worker - USA (Texas)(02)
32
Laboratory-Acquired InfectionsLaboratory-acquired infectionsNumber of hits listed in ProMed-mail, 19.11.2008
“laboratory associated” = 9The following of them were relevant (most recent):
Archive Number 20030730.1868
Published Date 30-JUL-2003
Subject PRO/EDR> Undiagnosed respiratory illness, death - Iraq (02)
Laboratory-acquired infectionsNumber of hits listed in ProMed-mail, 19.11.2008
“laboratory accident” = 24The following of them were relevant (most recent):
Archive Number 20070903.2898
Published Date 03-SEP-2007
Subject PRO/EDR> Salmonellosis, serotype Enteritidis, lab workers - USA (ME)
Archive Number 20040522.1377
Published Date 22-MAY-2004
Subject PRO/EDR> Ebola, lab accident death - Russia (Siberia)
Laboratory acquired infections 1979-1999:
Source: C.H. Collins and D.A. Kennedy, 1999
13%
16%
25%
27%
5%14%
Aspiration through pipette
Sharp obejcts, broken
glass
Needle + syringe
Spillages, splashes
Others, unknown
Bite, scratch, animal,
arthropod
Others
unknown
Needle
Syringe
Spillages
Splashes
Bite
Scratch
Animal
Arthropod
Aspiration
Through
Pipette
Sharp obejcts
Broken glass
Laboratory Acquired Infections
Historically:
only 20% from recognised accidents
80% unknown, ie no recognised accident or knowledge
of how transmission occurred
Remaining 80% of infections due
to aerosols
Vortexing
Sonication
Homogenisation
Dropping cultures of high titre/spills
Blowing out drops in pipettes
Removing needles from syringes/rubber seals
Withdrawing Syringe from Vaccine-
Stoppered Bottle
39
Laboratory-Acquired Infections
Route of Transmission
Susceptible HostInfection Source
Percutaneous inoculation
Inhalation of aerosols
Contact of mucous membranes
Ingestion
• Cultures and stocks
• Research animals
• Specimens
• Items contaminated with above
• Immune system
• Vaccination status
• Age
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A medical care clinic in ……working on
Crimean–Congo haemorrhagic fever (CCHF)Global Health & Security Consultants4/19/2016
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49 Global Health & Security consultant, KL. 7-10 Sep 2011
Transmission of Infectious
Agents Inhalation
Injection
Ingestion
50 Global Health & Security consultant, KL. 7-10 Sep 2011
Aerosol Infection
51 Global Health & Security consultant, KL. 7-10 Sep 2011
Aerosol Generation Sonicating, blending, mixing, vortexing
Centrifuging
Pouring, pipetting
Opening containers at non-ambient pressures, fermenters,
freezer vials
Loading syringes and injecting
Intranasal inoculation of animals
Changing bedding of shedding, infected animals
Harvesting tissue, eggs
Tissue grinders / homogenizers
Lasers
Cell sorters (FACS)
Dried / lyophilised cultures
52
Global Health & Security consultant, KL. 7-10 Sep 2011
Blood accidents with syringes
cuts
spills
aerosols
53 Global Health & Security consultant, KL. 7-10 Sep 2011
Animals bites
scratches
direct contact (hands mouth, eyes)
aerosols
Unapproved Rotor Explosion
The centrifugal force created
by high rotational speeds
generates the load or stress
on the metal of the rotor,
which causes it to stretch and
change in size.
Hand hygiene
„Five times hand washing reduces the
frequency to catch a cold by two-fold
“
Am J Infect Control 2000;28:340-6
Personal Protective Equipment
(PPE)
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How can it happen?
• Insufficient or inadequate education and training
• Inappropriate laboratory procedures
• Missing or insufficient biosafety programme and biosafety management
• Inappropriate financial and personal resources
• Malfunctioning or defective equipment
• No or insufficient preventive maintenance
• Communication problems
• No accident / incident investigation
• Missing medical monitoring programme
• No biosafety culture
• Stress – personal factors
Consequences?
• Infected laboratory worker(s) – death
• Disease outbreak
• Release of biological agent
• Loss of reputation
• Economic loss
• Stop of all activities
• Shut down of facility or parts of it
• Investigation of causes
• Stress – uncertainty
• Lack of credibility
How to prevent them?
• Biosafety management system
• Biosafety programme
• Good biosafety culture
• Knowledgeable staff - training
• Clear defined responsibilities and competencies
• Enough financial and personal resources
• Emergency and contingency planning and regular training
• Medical monitoring programme
• Accident – incident investigation
• Preventive maintenance programme
WHO Biosafety: "Laboratory biosafety" describes containment principles,
technologies and practices implemented to prevent
unintentional exposure to pathogens and toxins, or their
accidental release.
WHO Biosafety programme
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• Laboratory Biosafety Manual,
3rd edition- lab commissioning and certification
- lab biosecurity concepts
Biosafety:
To promote the use of safe
practices in the handling of
pathogenic microorganisms
•in the laboratory
•during transportation
•in field investigations
•in manufacturing
facilities
•in health-care facilities
Laboratory Biosafe
ty Manual
1st edition
19831993
2003
2004
WHO Laboratory Biosafety Manual
- translated into F, S, P, Ch, Ru
- available on web, CD-Rom, hard copies
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Public Health and security activities have
traditionally had minimal overlap
Public Health
issues
Security
issues
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Challenges to health and security
Public
Health Security
Intentional misuse of
biological agent
Ebola
Zaire
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Deliberate Use of Biological Agents represents a challenge to both Public
Health and Security
Public
HealthSecurity
Different roles and responsibilities,
different mandates
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Laboratory biosafety (working safely) describes containment
principles, technologies and practices implemented to prevent
unintentional exposure to pathogens and toxins, or their
accidental release. (Laboratory biosafety manual, 3rd edition,
2004)
http://www.who.int/csr/resources/publications/biosafety/WHO_C
DS_CSR_LYO_2004_11/en/
Laboratory biosecurity (keeping the work safe) describes the
protection, control and accountability for valuable biological
materials (VBM) within laboratories, in order to prevent their
unauthorized access, loss, theft, misuse, diversion or
intentional release.
(Biorisk management: laboratory biosecurity guidance, 2006)http://www.who.int/csr/resources/publications/biosafety/WHO_CDS_EPR_2006_6/en/in
dex.html
Laboratory biosecurity as a complement to laboratory biosafety
Available guidelines and guidance documents
EN
FR
SP
PO
CH
RU
IT
PE
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Laboratory biosecurity and biosafety work together to keep dangerous
biological materials safe and secure in the laboratory
Biosafety is the foundation for biosecurity
Biosafety is sufficient for certain risks
Biosafety needs to be augmented for unique higher risks
Combined Strength of
Biosecurity and Biosafety
Laboratory
Biosafety
Laboratory
Biosecurity
Overlap
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Components of Bioecurity Risk Assessment Physical security system Personnel Management Material Control and Accountability (MCA) Information security Transport Security Managing the Biosecurity Program
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UNCETDG ICAO IATA
TRANSPORT OF
INFECTIOUS
SUBSTANCES
Scientific background to the
13th revised edition of the
UN Model Regulations
regarding the requirements
for transporting infectious
substances
2003
Transport of infectious substances
• Transport of Infectious Substances
Biosafety:
To promote the use of safe
practices in the handling of
pathogenic microorganisms
•in the laboratory
•during transportation
•in field investigations
•in manufacturing
facilities
•in health-care facilitiesWHO 2007
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Bio-Risks from deliberate use
Molecular biology
biotechnology and
genetic engineering
Dual use nature of
Biotechnology
Low probability, high
consequence
“Biological weapons have recently attracted the attention and the resources of the nation. Discerning the nature of the threat of bioweapons as well as appropriate responses to them requires greater attention to the biological characteristics of these instruments of war and terror. The dominant paradigm of a weapon as a nuclear device that explodes or a chemical cloud that is set adrift leaves us ill-equipped conceptually and practically to assess and thus to prevent the potentially devastating effects of bioterrorism. Strengthening the public health and infectious disease infrastructure is an effective step toward averting the suffering that could be wrought by a terrorist’s use of a biological agent.”
Donald A. Henderson, The Looming Threat of BioterrorismScience 283:1279-1282, 1999
The Looming Threat of Bioterrorism
Biological Warfare History
•14th Century: plague at Kaffa•18th Century: smallpox blankets•1943: USA program established•1953: Defensive program established•1969: Offensive program disestablished•1979: Sverdlovsk Anthrax incident•1970: Vietnam: Yellow Rain•1978: London: Ricin•1985: Japan: Aum Shinriko
Advantages of BW:Are biologicals the ultimate weapon?
•Agents easy to procure•Inexpensive to acquire•Simple to use•Can disseminate at great distance•Agent clouds invisible•Detection quite difficult•First sign is illness•Overwhelms medical capabilities•Simple threat creates panic•Perpetrators escape before effects•Ideal terrorist weapon
Managing the health
risks of the deliberate
use of biological and
chemical agents or
radioactive material:
Guidance on capacity
assessment
being finalized
Guidance for public health preparedness
Global Health & Security Consultants4/19/2016
Bio-Risk management
Accidental release
Natural infectionDeliberate use
Accidental release
Biorisk Reduction Management
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Wishing You All a Healthy, Safe and Secure World
Thank you
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