Dr Ali A. Mohammadi President Global Health and …iacld.ir/DL/co/14/workshop/globalbiologicalrisksdraa...4/19/2016 Global Health & Security Consultants Soldiers from Fort Riley, Kansas,

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


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


H5N1: Avian influenza, a

pandemic threat



4/19/2016 Global Health & Security Consultants

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

http://en.wikipedia.org/wiki/Fort_Riley

http://en.wikipedia.org/wiki/Kansas

http://en.wikipedia.org/wiki/Camp_Funston

http://en.wikipedia.org/wiki/1918_flu_pandemic#cite_note-cdc2006-2

0

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Nu

mb

er o

f pas

senger

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


Comparative Virology

October 2015

And now ZIKA



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


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


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


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


Recent Microbial Threats


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


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)


The Human Population

ExplosionSource: UN, 1999


World Urbanization Trends


International Tourists Arrivals


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


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

http://en.wikipedia.org/wiki/Janet_Parker#cite_note-FBMD-1

http://en.wikipedia.org/wiki/Smallpox

http://en.wikipedia.org/wiki/University_of_Birmingham_Medical_School

http://en.wikipedia.org/wiki/International_Standard_Book_Number

http://en.wikipedia.org/wiki/Special:BookSources/0-521-84542-4

http://www.lrb.co.uk/v24/n17/hugh-pennington/smallpox-scares

http://en.wikipedia.org/wiki/London_Review_of_Books

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)


Published Date 19-JAN-2005

Subject PRO/AH/EDR> Tularemia, laboratory-acquired - USA (MA): 2004


Published Date 26-DEC-2002

Subject PRO/AH/EDR> West Nile virus update 2002 - USA (35)


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):


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):


Published Date 03-SEP-2007

Subject PRO/EDR> Salmonellosis, serotype Enteritidis, lab workers - USA (ME)


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








A medical care clinic in ……working on

Crimean–Congo haemorrhagic fever (CCHF)Global Health & Security Consultants4/19/2016


49 Global Health & Security consultant, KL. 7-10 Sep 2011

Transmission of Infectious

Agents Inhalation

Injection

Ingestion


Aerosol Infection


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


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)




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


• 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


Public Health and security activities have

traditionally had minimal overlap

Public Health

issues

Security

issues


Challenges to health and security

Public

Health Security

Intentional misuse of

biological agent

Ebola

Zaire


Deliberate Use of Biological Agents represents a challenge to both Public

Health and Security

Public

HealthSecurity

Different roles and responsibilities,

different mandates


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


http://www.who.int/csr/resources/publications/biosafety/WHO_CDS_CSR_LYO_2004_11/en/

http://www.who.int/csr/resources/publications/biosafety/WHO_CDS_EPR_2006_6/en/index.html

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


Components of Bioecurity Risk Assessment Physical security system Personnel Management Material Control and Accountability (MCA) Information security Transport Security Managing the Biosecurity Program


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


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


Bio-Risk management

Accidental release

Natural infectionDeliberate use

Accidental release

Biorisk Reduction Management


Wishing You All a Healthy, Safe and Secure World

Thank you

[email protected]


Documents

Dr Ali A. Mohammadi President Global Health and …iacld.ir/DL/co/14/workshop/globalbiologicalrisksdraa...4/19/2016 Global Health & Security Consultants Soldiers from Fort Riley, Kansas,