Biohazard: Who should you fear?

Plague of bioweapons accidents afflicts the US

Deadly germs may be more likely to be spread due to a biodefence lab accident than a biological attack by terrorists.

Plague, anthrax, Rocky Mountain spotted fever - these are among the bioweapons some experts fear could be used in a germ warfare attack against the US. But the public has had near-misses with those diseases and others over the past five years, ironically because of accidents in labs that were working to defend against bioterrorists. Even worse, they may be only the tip of an iceberg.

The revelations come from Ed Hammond of the Sunshine Project, a biosafety pressure group based in Austin, Texas, US, who after persistent requests got the minutes of university biosafety committees using the US Freedom of Information Act. The minutes are accessible to the public by law.

There are now 20,000 people at 400 sites around the US working with putative bioweapons germs, says Hammond, 10 times more than before the terrorist attacks of 9/11. Some scientists have warned for years that more people handling dangerous germs are a recipe for accidents.

Unreported incidents?

The fears have been borne out by publicised infections of lab workers with tularemia, brucellosis and Q fever.

The Q fever incident took place at Texas A&M University, which has now been ordered to stop research into potential bioweapons while an investigation takes place.

However, Hammond’s minutes contain further, previously unreported, slip-ups:

• At the University of New Mexico, one worker was jabbed with an anthrax-laden needle, and another with a syringe containing an undisclosed, genetically engineered microbe.

• At the Medical University of Ohio, workers were exposed to and infected with Valley Fever.

• At the University of Chicago, there was another puncture with an undisclosed agent normally requiring heavy containment, probably anthrax or plague.

• At the University of California at Berkeley, workers handled deadly Rocky Mountain Spotted Fever, which spreads in the air, without containment when it was mislabelled as harmless.

• At the University of North Carolina at Chapel Hill, and at Albert Einstein College of Medicine in New York City, workers were exposed to TB when containment equipment failed.

As yet, none of the accidents have been serious in outcome. But, Hammond fears, more such accidents may go unreported. "Instead of a 'culture of responsibility', the federal government has instilled a culture of denial" he says. "Labs hide problems, and think that accident reporting is for masochists"

Reporting essential

Without stringently enforced reporting rules, he says, labs have every reason to cover up accidents. They want to avoid losing research funds, and fear the massive official reaction to any accident – such as the imprisonment of plague researcher Thomas Butler in 2003. And he claims Texas A&M officials have said they now regret reporting the Q fever incident.

"I think the answer is to create a level playing field by having clear and absolutely mandatory reporting requirements," says Hammond. "Eliminate even the possibility of an institution claiming that it does not have to report infections."

"The labs will say, you can't do that because then people won't report accidents," says Hammond. "Well, I think it's pretty clear that people don't report accidents as it stands."

Original article posted here.

Playing God with questionable morals

Federal agencies investigate bioweapons exposure at Texas A&M

AUSTIN — Federal authorities are investigating the cases of four Texas A&M University researchers who tested positive for exposure to bioweapons agents last year and the school's delay in reporting the incidents.

Three researchers tested positive for exposure to the weapons agent Q fever in April 2006, two months after another researcher fell ill from contact with the another agent, Brucella, according to documents obtained by an Austin-based bioweapons watchdog group.

University officials waited one year to report the Brucella case to the Centers for Disease Control. The Q fever case still has not been reported. Federal law requires quick reporting of incidents.

The diseases, while rarely fatal in humans, cause high fevers and flulike symptoms. Both are difficult to cure.

There was little danger of an outbreak. Transmission of Q fever between humans is rare, and it hasn't happened with Brucella.

Edward Hammond, director of the watchdog group the Sunshine Project, said the exposure could indicate a broader problem in bioweapons research.

"A lot of this is done on an ad hoc, and sometimes even unsafe, basis," Hammond said.

In a written statement, Texas A&M Executive Vice President and Provost Jerry R. Strawser said the university is awaiting a CDC response on the investigations.

"In response to this unfortunate incident, we have greatly strengthened our safety, training and reporting procedures," he said.

Von Roebuck, a CDC spokesman, said the agency is still investigating the Q fever exposure and has passed on the Brucella investigation to the Health and Human Services inspector general.

Federal rules require those researching pathogens to report incidents within seven days of their discovery. Fines or penalties for not filing are determined by the Health and Human Services inspector general and could result in lost federal funding.

The Brucella incident happened during an experiment to expose mice to the agent. The researcher climbed into a chamber to disinfect it, a procedure that documents indicate has since changed. She was infected through her eyes, researchers believe, and was home sick for several weeks.

There were no details about how the three researchers were exposed to Q fever.

The Sunshine Project came across the infections while researching universities vying to host the new National Bio and Agro-Defense Facility. Texas A&M is among the applicants for the homeland security project.

Original article posted here.

Just what the government ordered: possible forced treatments for possible man-made disease

Can Government Force TB Treatments?

TB cases have steadily decreased over the past 10 years in the United States, falling to 13,767 last year.

by Rosalie Westenskow

Controlling tuberculosis requires a massive effort, and although many communities effectively track and treat the disease, success relies heavily on patient cooperation, experts say. In the aftermath of the highly publicized Andrew Speaker incident -- an Atlanta attorney who traveled across the Atlantic and back while infected with a rare strain of TB -- leaving compliance largely in the patients' hands may seem overly risky to some.

As an airborne disease, TB can spread rapidly if infected individuals fail to receive proper treatment. Treatment involves extensive therapy, and, if patients don't complete the entire regimen, the disease comes back -- often in a form resilient to traditional antibiotics.

As a result, local governments have stepped in and created TB-treatment programs to help stem the tide of infections.

States must strike a tricky balance between patients' rights and general welfare, however, said James Hodge Jr., executive director of the Center for Law and the Public's Health at Georgetown and Johns Hopkins University, during a panel discussion Monday hosted by the National Association of County and City Health Officials.

"Let's be sure to do what we can to protect the public's health while perpetuating a principle of volunteerism," Hodge said. "People with tuberculosis have committed no crime."

Each state has its own laws outlining the government's role in the process. Georgia, for instance, takes a less heavy-handed course of action.

"You see in Georgia a very consistent approach to respect the liberties and interests of the patient first," Hodge said. "At some juncture, a written order can be issued" mandating the patient's compliance.

But that action wouldn't occur until authorities felt certain the individual would not voluntarily participate.

"That's a last-ditch effort," Hodge said.

California, however, encourages greater legal intervention.

"What you see here is a strong concentration in local health authorities and the law to protect the public's health," Hodge said.

Authorities in California may issue orders to isolate patients during the contagious stage or mandate participation in therapy programs.

Relying on voluntary compliance works most of the time, said Hodge, calling Speaker, who took a commercial flight back to the United States against the requests of health authorities, an "outlier case."

However, some states should reexamine their stance on TB, said Karen Smith, public health officer for Napa County, Calif.

"There are some states that haven't looked at their legislation in a very long time and these are the states that might have significant pieces missing" which would impede local health officials, Smith said.

TB control comprises a major collaborative effort in any community, she said, and involves correct diagnosis of the disease as well as treatment.

"It's our responsibility to ensure local healthcare providers know when to suspect TB and how to accurately diagnose it," she said. "The healthcare provider also needs to know how to report both confirmed and suspected TB patients to the local TB program."

The TB program in Napa County, where Smith works, also must assist patients in overcoming numerous treatment barriers, including homelessness, transportation needs and mental health issues.

In addition, staff provide a support system to help patients get through the time-consuming treatment, which lasts six months to a year.

TB cases have steadily decreased over the past 10 years in the United States, falling to 13,767 last year. However, a decrease in funding could pose a threat to progress, said Michael Fleenor, chair of the Advisory Committee on Tuberculosis at the Centers for Disease Control and Prevention.

"There is a direct correlation between rates of TB in this country and the efforts, through funding, given to stop it," Fleenor said.

In 2006, Congress approved $138 million for TB mitigation, almost half of the $252.4 million the National Coalition for the Elimination of Tuberculosis estimates would be required to fully fund the country's TB control programs. This year's appropriation is expected to be 5 percent less than the 2006 figure.

This could mean bad news for the treatment of multi-drug resistant (MDR) or extensively drug resistant (XDR) strains of the disease.

"There's some indication that there's a beginning of an upturn in tuberculosis (cases), including MDR and now the spectrum of XDR TB," Fleenor said.

While treatment for a normal TB case costs about $6,000, a multi-drug resistant strain pushes the bill up to at least $25,000 and an extensively drug resistant case packs a $500,000 punch.

"That one case could drive the local health department to its knees," Fleenor said.

Original article posted here.

If at first you don't succeed, kill them some other way

Sharp rise in XDR-TB cases in Western Cape

Cases of extensively drug-resistant tuberculosis (XDR-TB) have more than quadrupled in the Western Cape in the past three months, the Cape Times reported on Thursday.

The newspaper cited provincial health department figures.

Also, the Brooklyn Chest TB Hospital has no room for more patients. It has 22 beds in the isolation wards to treat XDR-TB cases.

This comes as the City of Cape Town has drawn up contingency plans in the event of an XDR-TB outbreak.

Since World TB Day in March, 45 XDR-TB cases have been notified in the province. Eight people have died, according to department figures. In March, there were 10 known XDR-TB cases in the province.

XDR-TB, which withstands first- and second-line antibiotic treatment, is almost impossible to treat. It has killed 290 patients nationwide.

Department spokesperson Faiza Steyn said most patients with XDR-TB were admitted as quickly as possible to Brooklyn.

"At times, patients do have to wait for a bed at Brooklyn Chest Hospital," Steyn said.

Some patients were treated in side wards at the hospital, while the rest were in isolation at prisons in the province, she said.

City health director Ivan Toms said the department and clinics had implemented steps to reduce the health risk of TB and XDR-TB.

"These include clinic designs to separate waiting areas for TB clients, ensuring good airflow in TB areas, providing masks to coughing TB patients and respirators for all staff in the TB area," he said.

He said that in the last quarter, Cape Town achieved its best cure rate of 79% for TB.

According to XDR-TB statistics, 437 cases have been reported, with 290 deaths among them. Most were in KwaZulu-Natal, where the strain was first detected.

Original article posted here.

Interesting take on XDR-TB

U.S. leadership could eradicate global TB

by Ken Patterson

In early 2006, in a small clinic in South Africa, 52 of 53 patients died of XDR-TB (extensively drug resistant tuberculosis).

But it wasn’t until it came to light that Andrew Speaker got on a flight from Atlanta with XDR-TB in early May that most people, including the media, took notice.

The truth is that this disease storm has been brewing for some time, but because tuberculosis is primarily a disease of the poor, it has attracted little attention.

Without a serious commitment to diagnosing and controlling TB in the U.S. and around the world, it is likely that we will hear more stories like Speaker’s in the future.

So what is XDR-TB? Is it just some rare form of the disease that Speaker happened to picked up in some deep, dark cave?

No, XDR-TB is man-made — it is the common, treatable form of TB gone wild. It forms when dangerous MDR-TB (multi-drug resistant TB) is ineffectively monitored and treated.

In turn, MDR-TB arises when common TB is incorrectly or incompletely treated. So Speaker came into contact with someone who received ineffective treatment for his or her TB twice.

Millions affected

And it is not as rare as the media makes it sound. XDR-TB has been found in 35 countries, including the U.S. In the country of South Africa alone there are an estimated 600 cases of XDR-TB.

Most people do not know that there was an outbreak of around 300 cases of MDR-TB in the late 1980s and early 1990s that cost New York City more than $1 billion to control.

This seems incredibly costly given that common TB can be cured in the developing world for $20 to $100 (the drugs themselves costing only $16).

Probably the most alarming part of the TB story is that nearly one-third of the world’s population (2 billion people) carries TB latently, about 1.6 million people needlessly die of it each year, and around 9 million people develop active cases of TB each year, most in poor countries.

Each new case is an opportunity for someone to develop MDR- or XDR-TB if treatment is poor. And we have allowed many of the world’s people to live in situations where the likelihood of them completing treatment is not good.

In the U.S., an hourly worker with a family to support is unlikely to stay isolated during a six-week treatment period because he or she cannot afford to — who else will he or she infect?

In the developing world, side effects of the medicines are a deterrent to completing treatment for people who suffer of malnutrition. Also, inadequate health clinics, unsteady drug supply, too much expense or poor monitoring can also cause patients to cease treatment (patients may stop taking drugs because they feel better). The good news is that, although common TB is the greatest infectious killer worldwide, effective treatment will cure common TB 95 percent of the time.

A call to action

What now? Thankfully, because they understand the global threat of TB, certain members of Congress and organizations like the Gates Foundation, RESULTS and the international Stop TB Partnership have been working on TB for years. Last year Bill Gates helped introduce the Global Plan to Fight TB, an international business plan to improve TB diagnosis, monitoring and treatment around the globe, with the ultimate goal of eradicating TB by 2050. In the shorter term, the plan, if adequately funded, will save 14 million lives and treat 50 million people for TB, and will work toward new medical solutions for tuberculosis. But executing the plan will require leadership.

There are currently two bills in the U.S. House of Representatives (HR 1567 and HR 1532) and similar legislation in the U.S. Senate that address global and domestic TB. The domestic legislation will increase funding for U.S. TB control and bolster research into new medical solutions for TB. Global legislation will assure that the U.S. does its part in executing the Global Plan to Stop TB. Sens. Elizabeth Dole and Richard Burr, Rep. Shuler and other North Carolina representatives should co-sponsor this legislation. In addition, they should determine what other leadership measures should be taken to prevent a deadly, drug-resistant TB pandemic.

Other Facts on Tuberculosis:

¤ Ten million to 14 million Americans are infected with latent tuberculosis.

¤ TB is predicted to kill 30 million people in the next decade.

¤ TB is the leading global killer of women of reproductive age, ahead of HIV, heart disease and war.

¤ TB is also the leading killer of people with HIV/AIDS.

Ken Patterson is a former Peace Corps administrator and is currently national grass-roots manager for RESULTS.

Original article posted here.

More Problem-Respose-Solution propaganda to type the evisceration of rights in the wake of overblown TB case

TB Case Shows Need for Tighter Law

By KEVIN FREKING, Associated Press Writer

(AP) -- States should have the power to restrict the movement of patients with contagious diseases even before they have the chance to disobey doctors' orders, federal health officials say.

The need for such authority to order someone quarantined emerged as lesson No. 1 from the case of the Atlanta lawyer who went to Europe despite having a dangerous form of tuberculosis.

If we believe the patient has a strong intent to put others at risk, we need to have confidence we can take action absent documentation of intent to cause harm," Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention, told lawmakers last week.

Gerberding also mentioned outfitting a CDC plane so the government could fly patients long distances without fear of contaminating others on board and improving communications among government agencies.

Also cited by the Senate Appropriations subcommittee hearing was the lapse at the U.S.-Canadian border that allowed Andrew Speaker to enter the U.S. even though his name was on a watch list with instructions to detain him. Officials said a lone border agent made a bad decision.

The ability to require that someone be kept in isolation leads to legal and ethical questions about possible overreaching by the government.

"First of all, up front, before the patient left the United States, we believe that we could strengthen our states' ability to restrict the movement of patients before they demonstrate noncompliance with the medical order," Gerberding told lawmakers.

Peter Jacobson, a health law professor, had concerns about Gerberding's statement on two fronts.

"That's not the federal government's role and it's far, far too broad a statement. There has to be a credible threat, a direct threat of harm before you restrict someone's freedom to move, before you intrude on their individual liberties," said Jacobson, director of the Center for Law and Ethics and Health at the University of Michigan.

"For her to say in such a broad manner that a state should restrict people before they're noncompliant is extremely intrusive in my view," he said.

Also, the District of Columbia-based association representing state health officials noted that it is now up to the states, not the federal government, to determine when to issue an isolation order.

Even if Congress went along with Gerberding's idea, state legislatures seemingly would have to follow with their own changes for the proposal to take effect.

"Each governor does have the ability to quarantine. But the circumstances around it, how it's done and for how long, is tailored to each state," said Paula Steib, communications director for the Association of State and Territorial Health Officials, an organization that represents state health departments.

Besides granting states more power to isolate patients, Gerberding said the federal government should clarify its quarantine laws. Now, the laws focus on preventing sick people from coming into the country.

"Our statutes weren't really designed for this modern age of global travel," she said.

Gerberding said health officials in Fulton County, Ga., knew that Speaker had tuberculosis that was resistant to antibiotics and that he had travel plans. They met with him on May 10.

In the following days, county health officials tried to serve Speaker with written notice summarizing what was discussed at the meeting, including advice that he not travel. But they could not find him. He flew from the U.S. on May 12 for his wedding and honeymoon.

Speaker told lawmakers that doctors recommended he not travel, but they never said he was contagious or a threat to others. A county official disputed Speaker's recollection.

"I was not in the meeting, but the patient's chart indicates that he was told he was not highly contagious," said Dr. Steven Katkowsky, director of the county's Health and Wellness Department.

Sen. Tom Harkin, D-Iowa, questioned the CDC's ability to take quick and decisive action.

Harkin, the chairman of the Senate Appropriations subcommittee that questioned Gerberding, said the agency was notified May 18 that Speaker had multiple drug resistant tuberculosis, but the Homeland Security Department was not told until four days later. Speaker was not placed on a no-fly list until May 24.

"Again, with the rapidity of world travel today, it seems to me that this time frame should have been collapsed to just a few hours," Harkin said.

Said Gerberding: "I think we should have done it faster, and I think we'll be able to accelerate this next time. In retrospect, that was a mistake and I wish we had done it differently."

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On the Net:

CDC background on Extensively Drug-Resistant Tuberculosis: http://www.cdc.gov/tb/xdrtb/

CDC background on isolation and quarantine: http://tinyurl.com/33kohf

Original article posted here.