U.S. Germ Detection System Active in 31 Cities

14 November (Reuters Health [Deborah Charles])—The US government has set up a $60 million network to help detect a biological attack in 31 cities across the country, Homeland Security officials said.…

The BioWatch system collects air samples at about a dozen sites in each of the cities. The samples are then checked for potentially deadly diseases that could be used in a biological attack. The goal of BioWatch, located mostly in major urban areas such as Washington, New York City, and Houston, is to discover if any bacteria or viruses have been released into the air as part of a biological attack. If so, the department would then mobilize public health and law enforcement officials. Detection will allow officials to identify the germ and dispense drugs to treat the disease, possibly before any symptoms appear among those infected.

Since it was launched, BioWatch has analyzed more than half a million samples with 1 positive result—in Houston last month, when the air sensors detected fragments of tularemia. Air samples are collected at least once a day and taken to special laboratories where technicians extract DNA samples to do genetic testing for a number of diseases.

The tests are specific for each germ that is viewed by the government as a likely biowarfare or terrorism agent. Officials would not say what they screen for, saying only that it was less than a dozen diseases. Experts have said they could include anthrax, tularemia, smallpox, plague, botulism, and hemorrhagic fever.

Officials said the system covers half the US population, but some experts have questioned the amount of air that is tested. They say sensors need to be correctly positioned to accurately detect an attack.

Need To Regulate “Dangerous” Research Debated

12 November (Reuters Health [Marilynn Larkin])—A “spirited” debate on the need to regulate researchers who are involved in “sensitive” research related to potentially dangerous pathogens highlighted a half-day symposium, “National Security and Biological Research: Where Are the Boundaries,” held at the New York Academy of Sciences.

“We need to take a bottom-up approach—looking at what we're doing and deciding how we, as scientists, can best protect society while preserving scientific integrity,” argued Dr. Ron Atlas, codirec-tor of the Center for the Deterrence of Biowarfare and Bioterrorism at the University of Louisville, Kentucky, and past president of the American Society of Microbiology.

Dr. Atlas endorsed the recently released National Research Council (NRC) report, “Biotechnology Research in an Age of Terrorism,” which concluded that existing regulations and self-monitoring by scientists are sufficient to protect against misuse of research findings by “hostile individuals.”

Not so, countered Elisa Harris, senior research scholar at the Center for International and Security Studies at Maryland (CISSM). Harris and colleagues have developed a “biological research security system” that, she says, addresses “shortcomings” in the NRC approach.

CISSM calls for national licensing of researchers and institutions involved in potentially dangerous research; a global, rather than US-based regulatory scheme; and more “teeth”—that is, powers of enforcement, rather than guidelines.

Other speakers addressed the difficulties in deciding whether to publish research that might be useful to bioterrorists and the importance of a team approach—researchers working with public health officials and law enforcement—in identifying and containing potentially harmful outbreaks.

William Zinnakis, Weapons of Mass Destruction Coordinator for the Federal Bureau of Investigation's New York office, and the sole law-enforcement representative at the symposium, commented that academic researchers need to “come out of their ivory towers” and be more aware of the possible real-world consequences of their work. Very often, “there's more to it than meets the eye,” he concluded.

Editor's comment. This is more than just an academic discussion. Involvement in “‘sensitive’ research related to potentially dangerous pathogens” can cover a multitude of research projects commonly performed by the members of the Infectious Diseases Society of America. It does not require too much reading between the lines to see where this could go. Some of us who have worked with viral, bacterial, or fungal pathogens, for instance, could potentially find ourselves restricted from investigating and/or publishing data on important aspects of pathogenesis and other areas of interest.

Rules to Stop Monkeypox Spread in U.S. Finalized

4 November (Reuters Health)—US health officials … finalized rules to prevent future outbreaks of monkeypox by strictly limiting the transportation of certain animals, including prairie dogs and rodents from Africa. The US Food and Drug Administration and Centers for Disease Control and Prevention in June banned the import and transportation of prairie dogs and several rodents from Africa, including tree squirrels, rope squirrels, dormice, Gambian pouched rats, brush-tailed porcupines, and striped mice.

The new rules further restrict the movement of the animals within US states and across state lines, as well as bar the capture and distribution of the animals to prevent further transmission of the disease. The rules did provide for some exceptions to these restrictions, mainly for research purposes or if someone owned a prairie dog and was moving.

Probable Transfusion-Transmitted Malaria Reported in Texas

6 November (Reuters Health)—An elderly patient in Texas appears to be the first case of transfusion-transmitted malaria in the United States since 1998, according to a report released by the Centers for Disease Control and Prevention (CDC). The case is described in the 7 November issue of Morbidity and Mortality Weekly Report.

The 69-year-old patient was admitted to a Houston-area hospital earlier this year. Seventeen days after a transfusion, the patient developed a fever and became confused. Diagnostic work-up revealed the presence of Plasmodium falciparum parasites in the patient's blood. The patient was discharged after being hospitalized for 3 weeks and successfully treated with intravenous quinine and doxycycline.

With the exception of the recent transfusion, the patient reported receiving no blood products in the 12 months before hospitalization. Moreover, the patient reported no travel outside the Houston area since 1995.

With the assistance of the Texas Department of Health, the CDC was able to track down the 2 donors of the transfused units. One was a middle-aged Texas woman who had never traveled outside the United States, whereas the other was a young man originally from Ghana. Both history and lab test results suggested that the Ghanian donor was the source of malaria.

Current guidelines recommend that people from nonmalarious areas who travel to a malarious region should not donate blood for at least 1 year after their return, provided that they have no symptoms. For people from malarious areas or those who have been diagnosed with malaria, the recommended deferral period is longer—at least 3 years.

The Ghanian donor “did not tell the screener about having malaria during the previous 3 years, and the screener did not defer the donor for immigrating within 3 years from an area with endemic malaria,” the CDC notes. “The case described in this report underscores the importance of close cooperation between managers of blood collection centers and state and federal public health officials whenever transfusion-related illness occurs,” the group adds.

Source: MMWR Morb Mortal Wkly Rep CDC Surveill Summ 2003;52:1075–6.

Editor's comment. The surprising fact to me is how successful the screening procedures have been or how lucky we have been. One case in 5 years is not a bad record, considering the size of the pool of travelers and immigrants who were potential sources of infected blood and who must have donated or attempted to donate blood during this time.

Novartis To Develop Children'S Form of Malaria Drug

5 November (Reuters Health)—Novartis AG and a nonprofit group that combats malaria aim to help children with the tropical disease by developing a new form of a potent Novartis drug, the Swiss health care company said. Officials from Novartis and the Geneva-based Medicines for Malaria Venture (MMV) announced a pact to develop jointly a pediatric formulation of Coartem.

Coartem is a fixed-dose artemisinin-based combination treatment, a therapy that has helped control malaria in places where improper administration of other drugs had allowed drug-resistant parasites to emerge. MMV is a foundation formed in 1999 to discover, develop, and deliver new drugs that treat the parasitic disease.

One of the world's leading killers, malaria seriously sickens more than 300 million people each year and kills at least 1 million, most of them children. Health officials estimate 9 deaths of every 10 occur in Africa.

Editor's comment. Despite the great need in developing countries, there are few drugs for treatment of resistant falciparum malaria available as pediatric formulations. Artemether/lumefantrine (Coartem) is being recommended by the World Health Organization for treatment of malaria, especially for malaria due to meflo-quin-resistant Plasmodium falciparum, although some studies indicate that it is inferior to mefloquin for treatment of me-floquin-susceptible strains. Its availability in a pediatric formulation would be of value.

First Death from Raccoon Rabies in U.S. Reported

13 November (Reuters Health [Megan Rauscher])—A previously healthy man from northern Virginia has become the first known fatality linked to raccoon rabies, federal health officials report.

According to Dr. Charles Rupprecht of the US Centers for Disease Control and Prevention, the 25-year-old man died on 10 March 2003 after being ill for 3 weeks.

Through DNA testing, the investigators identified a rabies virus variant associated with raccoons, but how the patient became infected remains a mystery. “The patient did not have a history of animal contact,” Rupprecht told Reuters Health. But that's not altogether surprising, he added, as “the majority of human rabies cases reported in the US over the last decade did not have a history of animal exposure.”

During the late 1970s, rabid raccoons were found in the Virginias after probable migration of infected animals from Florida and other southeastern states. Today, rabid raccoons are found all the way from Ontario down to Florida. While human-to-human transmission of rabies is a concern, there have been no documented cases reported to date among health care workers exposed to a rabies patient.

Source: MMWR Morb Mortal Wkly Rep 2003;52:1102-3.