• Producers and Producer Organizations Overlooked in Contingency Planning Discussions on Biosecurity: 5 November 2003
  

Slide 1: Biodefense & Agricultural Security
Protecting one of America’s Critical Infrastructures

Stephen M. Apatow
President, Humanitarian Resource Institute
Director of Research & Development

Reference Notes:

Biographical Sketch: Stephen M. Apatow, President and Director of Research and Development, of the nonprofit organization Humanitarian Resource Institute, is a specialist in strategic planning and project development of initiatives associated with human medicine, veterinary medicine and U.S. and international law. Current programs include the internet based Biodefense Reference Library, Foreign Animal and Zoonotic Disease Center, Bioinformatics: Pathobiological Diagnostics Center and Biodefense Legal Reference Library. Educational resource development for the veterinary and medical community include the Foreign Animal Disease Online Course and the Zoonotic Disease Online Review. To enhance collaboration between Humanitarian Resource Institute and the international community of scholars, the Humanitarian University Consortium was formed to enhance the development of initiatives associated with economic, social, cultural and humanitarian issues worldwide.

Slide 2: Background

•  NCADI: Strategic planning, project development and analysis 
•  GDSAIM: New York State Division of Substance Abuse Services 
•  Human Services U.S. Campaign
•  Formation of Humanitarian Resource Institute in 1994
•  Development of America's National Community Needs Database 
•  El Nino: FEMA Community & Family Preparedness Program

Reference Notes:

1990: National Clearinghouse for Alcohol & Drug Information Project 

Initiative opens the first the toll free hotline (1-800-Say-No-To-Drugs) providing public access to the Federal Resource for Drug & Alcohol Information. 

•  Strategic planning and development of the 6000 mile transcontinental campaign through 270 cities in 17 states. 
•  Grass roots networking encompassed federal, state and local elected officials, municipalities, state and county education departments, youth programs, interfaith community and media. 
•  Coordination of press conferences and media events. 
•  The initiative is the largest touch outreach campaign ever coordinated through the Office for Substance Abuse Prevention. 

1991: U.S.A. Education/Prevention Resource Campaign 

•  Strategic planning of pilot project coordinated in cooperation with the New York State Division of Substance Abuse Services to develop "Guidelines for the dissemination of Substance Abuse Information and Materials." 
•  The guideline was developed to help programs effectively network public health information down to the household level through multiple communication pathways that already exist in communities. 

1993: National Human Services Campaign 

•  U.S. House Select Committee on Hunger, facilitated coalition of 20 national organizations.
•  Initiative targets humanitarian relief efforts in the United States. 
•  Strategic planning and development of the 3000 mile transcontinental campaign through  133 cities in 11 states. 
•  Grass roots networking encompassed federal, state and local elected officials, municipalities, state and county education departments, youth programs, interfaith community and media. 
•  Coordination of press conferences and media events. 

1994-Present: Humanitarian Resource Institute:  Strategic planning, research and project development for all U.S. and International initiatives in cooperation with the Federal Emergency Management Agency, United States Department of Agriculture, American Red Cross, National 4-H, U.S. Chemical and Hazard Safety Investigation Board and United Nations programs. 

1999: Year 2000 Conversion Global Campaign 

•  Strategic Planning and development of an international education initiative to provide research reports, infrastructure risk statistics and resources relating to contingency planning for the Year 2000 conversion. 
•  Communication networks included corporate and inter-governmental programs, newspaper, radio, television and media networks in approximately 195 countries.

Slide 3: Current Projects

•  America's National Community Needs Database
       Grassroots network to county and municipal leadership 
•  Biodefense Reference Library: 
       Academic Discussion Platform
       Foreign Animal and Zoonotic Disease Center 
       Foreign Animal Disease Online Course
       Zoonotic Disease Online Review 
•  Bioinformatics: Pathobiological Diagnostics
•  Biodefense and Epidemiological Tracking 
•  Bioterrorism: Contingency Planning Resources
•  Medical & Veterinary Reference, Research & Publications 

Reference Notes:

Slide 4: Current Projects

•  Community & Family Preparedness Network
•  Emerging Infectious Disease Network
       West Nile Virus (WNV) Reference Library
       Foot and Mouth Disease (FMD) Reference Library 
       AIDS/HIV Reference Library
       Transmissible Spongiform Encephalopathies (TSE) Reference Library
       Bioterrorism: Contingency Planning Resources
       Medical & Veterinary Reference, Research & Publications 
•  Global Community Needs Database
•  International Disaster Information NetworkReference Notes:

Slide 5: Current Projects

•  Global Preparedness & Response Network
       News & Information
       Terrorism
       Emerging Infectious Diseases
       Chemical & Hazardous Materials Risks 
       Radiological Emergency Preparedness 
       Severe Weather:  Preparedness Resources 
•  HRI Legal Resource & Assistance Center
       U.S. & International Security Reference Library
       Biodefense Reference Library
       International Law 
       Human Rights 
       Treaties 

Reference Notes:

Slide 6: Current Projects

•  Humanitarian University Consortium: Founded in 2002 to support the development of  initiatives associated with economic, social, cultural and humanitarian issues worldwide.  Our mission is to serve as: 

       (1) an international community of scholars.
       (2) a bridge between Humanitarian Resource Institute and the international academic community.
       (3) a think tank in support of the United Nations programs.
       (4) the promotion of higher learning through both traditional and distance education.

Reference Notes:

Slide 7: Communication Networks

•  United States Networks:
       Grassroots Networks (Household Level)
       Corporate
       Municipal, State and Federal Government
       Community Action and Interfaith Organizations – approx. 3,100 Counties. 
•  International Networks: 
       Newspaper, Radio and Television 
       Corporate
       Intergovernmental, Non Governmental, United Nations
       Community Action and Interfaith Organizations- approx. 195 countries. 
•  Humanitarian University Consortium: UNESCO membership, college/university level, WHO, OIE, FAO.

Reference Notes:

International network development  led to the formation of the media company SMAMedia Communications in the early 90’s.  Focus strategic planning and project development, press release distribution and media integration. Continually working on  optimization of network/resource development, definition of target audiences, intact communication networks to key players on an international, national, grass roots level for educational initiatives, advocacy work, etc.

Slide 8: Biodefense & Epidemiological Tracking

•  West Nile Virus
•  Foot and Mouth
•  Severe Acute Respiratory Syndrome (SARS)
•  Monkeypox

Reference Notes:

Slide 9: West Nile Virus (WNV)

•  West Nile virus was first isolated in the West Nile District of Uganda in 1937. The ecology was characterized in Egypt in the 1950s. 
•  The virus became recognized as a cause of severe human meningoencephalitis (inflammation of the spinal cord and brain) in elderly patients during an outbreak in Israel in 1957. 
•  Equine disease was first noted in Egypt and France in the early 1960s. 
•  The first appearance of WNV in North America in 1999, in humans and horses, and the subsequent spread in the United States may be an important milestone in the evolving history of this virus.

CDC: West Nile Virus, National Center for Infectious Diseases,  Division of Vector-Borne Infectious Diseases. 

Reference Notes:

West Nile Virus, import export issues, trade restrictions were implemented from Europe and I proceeded to facilitate research and recommendations to the equestrian industry.

Slide 10: West Nile Virus – Equestrian Cases

•  In August 1999, 22 horses in the Riverhead area of Long Island began showing signs of an encephalitic infection: lethargy, weakness in the hindquarters, and convulsions. Local veterinarians suspected the horse deaths and illnesses were caused by equine protozoal myelitis.On Oct 19, after 13 of the horses had died or were euthanized, the USDA-APHIS announced they all tested positive for the West Nile virus.Horses are highly susceptible to the virus — a 1996 report from Egypt indicated 40 percent mortality. 
Reference Notes:

Ground zero for this outbreak was New York city.

Slide 11: West Nile Virus – Bird Migration

Reference Notes:

Scope of WNV spread: Epidemiology - USGS - Dr. Robert G. McLean, one of the sharpest scientists I have consulted with through the years, director of the USGS National Wildlife Health Center in Madison, Wis., -- Bird species/migration/spread discussion. 

12.14.99: West Nile Virus May Be New Deadly Strain, USGS Tells Congress: Recent crow die-offs suggest the West Nile virus which emerged in New York in late August could be more deadly to North American bird species than to species in Africa, the Middle East and Europe, where the virus is normally found, a USGS scientist reported today at a congressional field hearing held in Connecticut by the Senate Committee on Environment and Public Works.Map: Caribbean/Western North Atlantic migration pattern of the Common Tern (Sterna hirundo), as shown by band returns. 

Principal migration routes used by birds in passing from North America to winter quarters in the West Indies, Central America, and South America. Route 4 is the one used most extensively while only a few species make the 2,400 mile flight down Route 1 from Nova Scotia to South America.

•  Initiatives: 8.5.2001:  Tropical Storms, Hurricanes, Floods and Encephalitis Outbreaks.
•  West Nile Virus: Biopreparedness Through Community & Family Preparedness.

Slide 12: West Nile Virus: 2002 Statistics

•  4,156 Human Cases
•  284 Fatalities
•  44 States (2289 Counties)
•  111 bird species  - CDC's West Nile Virus avian mortality database.
w 14,358 equine cases in 40 states were reported to USDA APHIS - nearly 20-fold the case load reported by 20 states last year.

Reference Notes:

Widespread impact  throughout the North American Continent.

Slide 13: West Nile Virus- Human Cases as of October 17, 2003

Reference Notes:

•  West Nile Virus: 2003 Human Cases as of October 22, 2003, 3am MDT:
•  7386 cases reported to CDC
•  155 deaths

Slide 14:

Reference Notes:

USGS:CDC Epidemiological Maps
Demonstrate the progression of spread, demographic impact on human populations.

Slide 15:

Reference Notes:

USGS:CDC Epidemiological Maps
Demonstrate the progression of spread, demographic impact on avian populations.

Slide 16: 

Reference Notes:

USGS:CDC Epidemiological Maps
Demonstrate the progression of spread, demographic impact: veterinary.

Veterinary, primarily the equestrian industry:

This industry directly produces goods and services of $25.3 billion and has a total impact of $112.1 billion on U.S. gross domestic product.  Racing, showing and recreation each contribute more than 25% to the total value of goods and services produced by the industry.   The industry’s contribution to the U.S. GDP is greater than the motion picture services, railroad transportation, furniture and fixtures manufacturing and tobacco product manufacturing industries. It is only slightly smaller than the apparel and other textile products manufacturing industry. 

Slide 17: Communications / Resources

•  West Nile Virus: Biopreparedness Through Community & Family Preparedness
       Resource outlines topics of source reduction for mosquitoes and how to reduce risk of infection. 
       Developed in cooperation with the FEMA Community & Family Preparedness Program post discussion and recommendations with contacts at the World Health Organization, USGS, USDA, US Army Center for Health Promotion and Preventive Medicine and Center for Civilian Biodefense Studies at John Hopkins.

Reference Notes:

Engaged  the America’s National Community Needs Database Network to reach the Federal, State, County and municipal leadership levels.

Slide 18: West Nile Virus Reference Library

•  Biodefense and Epidemiological Tracking 
•  News and Information
•  Environmental Protection Agency Information
•  Research: Arboviral Encephalitides 
•  Public Health Alerts
•  Research and Reference Materials
 

Reference Notes:

Slide 19: Foot and Mouth Disease (FMD)

•  Foot-and-mouth disease (FMD) is a severe, highly communicable viral disease of cattle and swine. It also affects sheep, goats, deer, and other cloven-hooved ruminants. 
•  This country has been free of FMD since 1929, when the last of nine U.S. outbreaks was eradicated.

Reference Notes:

A report by the National Academies (Countering Agricultural Bioterrorism 2002) highlighted the vulnerabilityof the food supply.  Foot and mouth disease (FMD) was identified as the most important animal disease that the USA must be prepared for.

Slide 20: UK FMD Outbreak – Equestrian Industry

•  After the first reported case of FMD on 2/21/01, virtually all horse related sporting and recreational activity in UK ceased out of respect for the farming community, including racing.
•  British Horse Society stated, "Britain’s 1,800 riding schools were reporting losses of between 65-85% and some were completely closed.
•  According to Leo Jeffcott, Chairman of the FEI Veterinary Committee and dean of the veterinary school at the University of Cambridge in the United Kingdom, the financial damage to the industry was extraordinary; pervading more businesses than any thought possible.

“Those affected included the saddlers, farriers, veterinary surgeons, feed, horse show caterers, course designers, photographers, suppliers of tents, portable stables, cleaning services, and so many more. The industry’s losses were estimated to reach $141.6 million (£100 million) a month in March, April, and May 2001.”

Continuing in the focus of advocacy work on behalf of the equestrian industry in the United States, import/export issues.

Slide 21: UK FMD Outbreak – Index Case

•  Index case found 20 days after estimated start of the outbreak.
•  One month after the index case, the number of determined infected farms was 707, with 342 infected premises that had not yet been detected.

Reference Notes:

Sec. European Commission for the Control of FMD:When planning for an FMD outbreak, the “worst-case” scenario is a large, multi-focus, country wide outbreak involving many dealers & markets – Not a single focus or several regionalized foci. 

Slide 22: UK FMD Outbreak: Overview

•  The United Kingdom Ministry of Agriculture, Fisheries and Food (MAFF) contingency plan envisaged up to ten outbreaks (premises). 
•  To the extent that it was a conscious  decision, the cull was used because it was realized that actual tracing of the disease had become impossible.

Reference Notes:

Slide 22, 23,24: The Power to Panic: The Animal Health Act 2002:  David Campbell and Robert Lee, Cardiff Law School and ESRC Research Centre for Business Relationships, Accountability, Sustainability and Society (B.R.A.S.S.)

Slide 23: UK FMD Outbreak: Overview

•  The U.K. government did not initially plan to carry out the contiguous cull in 2001. It did so because its original policy for control of FMD completely collapsed.
•  In the end, of the over 7 million animals culled, perhaps 90% were uninfected, the result of what has been called "postcode slaughter" or "carnage by computer".

Reference Notes:

Slide 24: UK FMD Outbreak: Overview

•  The debate on the decision not to vaccinate was largely based on misunderstandings of the E.U. and W.T.O. biosecurity and trade policies maintained by certain special interest groups, notably the national leadership of the National Farmers' Union.
•  This issue should have been settled earlier in any at all competent contingency planning; but it still remains completely unsettled. 

Reference Notes:

Slide 25: UK FMD Outbreak: Statistics

•  10,472: (number of premises recorded on which animals have been or are due to be slaughtered, DEFRA, June 2003.) 
•  10,791,000 animals culled (Meat and Livestock Commission): the UK breeding flock was reduced by 13%  (in England alone, by 18%), the UK breeding cattle herd was reduced by 6%.
•  Economic cost: $20 billion (US) (Vannieuwenhoven , 2001 Convention News. American Veterinary Medical Association. Wednesday, July 18, 2001.)

Reference Notes:

This figure is but a remote expression of the concrete losses, which include: the premature deaths of over 10 million animals, killed in ways which were almost always unacceptably, indeed criminally, inhumane and very often so horribly cruel as to be an occasion of lasting national shame; the loss of irreplaceable special breeds; the horror experienced by those with a scrap of humanity involved in the cull; the misery of thousands of small farmers and small businesspersons in areas related to farming and tourism whose incomes were drastically reduced, some of whom were driven into bankruptcy; the (continuing) pollution caused by the disposal; the frustration of the enjoyment of the countryside for a year.

Slide 26: Communications / Resources

•  Foot & Mouth Disease Reference Library: a collaborative initiative of international veterinary, medical and scientific experts to share information and enhance academic discussion of emerging infectious diseases and issues associated with preparedness,  response, mitigation and policy. 
       News and Information
       Discussion Topics
       Research Papers and Reference Materials
       FMD Information Sources

Reference Notes:

Humanitarian Resource Institute facilitates the release of Tripartite Exercise 2000 Final Reports through USDA for contingency planning on the federal, state, county and municipal level.

Slide 27: Biodefense & Epidemiological Tracking

•  News and Information:
       EU Directive on FMD control: Adopted at Agriculture Council on 29 September. See also: The Institute of Animal Health, Pirbright Laboratory: Foot-and-mouth disease: scientific problems and recent progress 1st annual report. 
       Emergency Vaccination Moved to the Forefront of Control Measures Instead of Being Last Resort: Foot and Mouth in the EU: 12 June 2003. 
       FMD: Mexican-US Campaign 1947-1954:  Over 18 months, 76 million doses of vaccine were produced, every lot was quality controlled and then applied, resulting in eradication - Special thanks to J. Callis. 
•  Biodefense
•  Genomic
•  Education
•  Law

Reference Notes:

Slide 28: Severe Acute Respiratory Syndrome (SARS)

•  In contrast to the spread of West Nile Virus from the initial index case in New York City throughout the North American Continent during the period from 1999-2003, Severe Acute Respiratory Syndrome (SARS) has crossed international boundaries within a matter of weeks.

Reference Notes:

CDC Foundation: ” In early 2003, a worldwide outbreak of Severe Acute Respiratory Syndrome (SARS) swept the globe with remarkable speed and complexity. CDC scientists – and others around the world – continue to work around the clock to track the disease and find ways to prevent and treat it.”

Slide 29: SARS – Overview

•  The World Health Organization formally announced on 4/16/03 that a new pathogen, a member of the coronavirus family never before seen in humans, is the cause of Severe Acute Respiratory Syndrome (SARS).
•  The molecular phylogenies published 10 April in the New England Journal of Medicine were based on small fragments from the polymerase gene (ORF 1b), and have placed the SARS virus in a separate group somewhere between groups 2 and 3. However, antibodies to the SARS virus cross react with FIPV, HuCV229E and TGEV, all in Group 1. Furthermore, the SARS virus can grow in Vero green monkey kidney cells, which no other coronavirus can, with the exception of porcine epidemic diarrhea virus, also in Group 1. 

Reference Notes:

On the HRI Bioinformaics: Pathobiological Diagnostics web site we provide research associated with Comparative analysis of the SARS coronavirus genome from The Institute of Microbiology and Epidemiology of the Academy of Military Medical Sciences and the Beijing Genomics Institute of Chinese Academy of Sciences, CDC, Sequence information provided by collaborators at National Microbiology Laboratory, Canada, University of California at San Francisco, Erasmus University, Rotterdam and Bernhard-Nocht Institute, Hamburg facilitated this sequencing effort. 

Slide 30: SARS – Intelligence Community Assessment

Although the World Health Organization declared on 5 July that all transmission chains of SARS had been broken, many health experts fear it could return again in the fall when cooler temperatures return in temperate areas. We remain vulnerable.

•  The possible presence of animal reservoirs of the coronavirus that causes SARS and the lack of a reliable diagnostic test or a vaccine preclude eradication.
•  If a resurgence of SARS this winter coincides with the annual outbreak of influenza, identifying and isolating suspected SARS cases will be much more difficult. SARS also could mutate, altering the symptoms, transmissibility, or lethality of the disease.
•  nAs the first line of defense, healthcare systems and workers are particularly vulnerable. Moreover, most wealthy countries have little recent experience implementing large-scale quarantine and isolation programs, and poor countries already have inadequate health surveillance and infection control procedures.

SARS: Down But Still a Threat, National Intelligence Council. Intelligence Community Assessment, August 2003.

Reference Notes:

Slide 31: SARS – Impact

•  10.21.2003: Federal officials propose masks for anyone with cough 

Reference Notes:

Conflicting Messages:

WHO: No evidence SARS is airborne: Mon Oct 20, 4:01 AM ET 
By TERESA CEROJANO, Associated Press Writer 

ANILA, Philippines - There is no evidence to suggest that SARS is an airborne virus, the World Health Organization said Monday in a report that also found health workers to be at special risk and children rarely affected. 

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Clinicians Information Network: Updates to CDC information and guidance, September 26 - October 17, 2003:
CDC FACT SHEET: Guidance for SARS Preparedness for Infection Control

To prepare for the possibility of the reemergence of SARS, health care facilities need to plan now to create the infrastructure to deal with single or multiple cases of SARS.

Transmission Risks: Lessons Learned

Information from the spring 2003 outbreak suggests that SARS is transmitted primarily through close contact with infected persons. It is most likely spread via respiratory droplets; however, the possibility of airborne transmission and spread through contaminated objects cannot be excluded. Exposure to SARS patients around the time an aerosol-generating procedure (e.g., intubation, bronchoscopy, nebulizer treatment) is performed may increase transmission risks to healthcare workers......

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Federal officials propose masks for anyone with cough 

10/21/03: ROB STEIN: The Washington Post

-- The aggressive new approach is outlined in a draft of a comprehensive plan for how the nation should protect against and respond to a return of severe acute respiratory syndrome (SARS). 
-- To minimize the threat from SARS and other lung infections, federal health officials have proposed that anyone who comes into a hospital, doctor's office or clinic with a cough or other respiratory symptoms be required to immediately don a surgical mask and be isolated from other patients until they can be diagnosed. 
-- The draft contains an array of recommendations, including many measures the nation has not seen since the days when scourges like smallpox and tuberculosis were major public health threats. In the event of a major outbreak, one proposal calls for establishing separate hospitals to treat and segregate  large numbers of patients, in much the same way special TB sanitariums and smallpox hospitals existed early in the 20th century. 
-- That proposal also outlines procedures for isolating and quarantining large numbers of people, and for declaring the equivalent of "snow days" in which most public activities and large gatherings would be barred to prevent the deadly virus from spreading. 

Slide 32: Biodefense & Epidemiological Tracking

•  Statistics:
       World Health Organization (WHO)
       Centers for Disease Control (CDC)
•  News & Information
•  Research and Development
•  Bioinformatics: Pathobiological Diagnostics
       SARS: Findings by the Virology department of the University of Frankfurt - Research 
       Coronavirus Sequencing: 

Academy of Military Medical Sciences and the Beijing Genomics Institute of Chinese Academy of Sciences.

Sequence information provided by collaborators at National Microbiology Laboratory, Canada, University of California at San Francisco, Erasmus University, Rotterdam and Bernhard-Nocht Institute, Hamburg facilitated this sequencing effort 

Reference Notes:

Slide 33: Communications / Resources

•  SARS: Legal Resource and Information Center 
       International Law, Communicable Diseases and the Geopolitical Objective of Minimal Interference with World Trade and Travel.
•  SARS: Veterinary Public Health and Pandemic Disease 
•  SARS: Facing the Challenge of HIV/AIDS
       Locked Doors: The Human Rights of People Living with HIV/AIDS in China 
•  SARS: Lancet: Early online publication 
•  CDC: Preventing Spread of Severe Acute Respiratory Syndrome (SARS)
       Webcast.
•  Triage of Patients which may have Severe Acute Respiratory Syndrome (SARS) 
       Emergency Medical Response, Canada.

Reference Notes:

Slide 34: Monkeypox

•  At least 19 people in three Midwestern states have contracted a disease related to smallpox, marking the first outbreak of the life-threatening illness in the United States. – Washington Post, Pox-Like Outbreak Reported 19 Ill in Midwest; CDC Issues Alert, 6 June 2003

Reference Notes:

American Medical Association: Monkeypox Outbreak - First in Western Hemisphere. 

Slide 35: Monkeypox

•  Monkeypox is a rare viral disease that occurs mostly in central and western Africa. It is called “monkeypox” because it was first found in 1958 in laboratory monkeys. Blood tests of animals in Africa later found that other types of animals probably had monkeypox.

•  Scientists also recovered the virus that causes monkeypox from an African squirrel. These types of squirrels might be the common host for the disease. Rats, mice and rabbits can get monkeypox, too. Monkeypox was reported in humans for the first time in 1970. 

Reference Notes:

Monkeypox is believed to have a mortality rate of between 1 percent and 10 percent, compared with a mortality rate of about 30 percent for smallpox.

One of the key concerns  related to this outbreak and bioterrorism was the strain of the virus:

Monkeypox in Congo ( DRC ), Johannesburg, Thursday, October 01, 2002:  The current outbreak is considered by the WHO and MSF epidemiologists to constitute an epidemic in the region (mortality rate = 37.5 per 100) and therefore worthy of serious intervention.

Slide 36: Monkeypox

•  It was noted that the importation of 600 animals from Africa under the classification of pets, contributed to the transmission cycle.  Who issued the permit(s)? 

•  The United States Department of Agriculture's Animal and Plant  Health Inspection Service is only involved in permit issues related to import/transit of rodents that have been inoculated with a known organism or vector of animal health importance. Gambian Rats are not known to be vectors of pathogens of livestock and poultry and, therefore, a permit from APHIS would not have been required nor issued.   - Thomas E. Walton, USDA/APHIS, Director, Centers for Epidemiology and Animal Health 

Reference Notes:

Thomas Walton from USDA/APHIS was kind enough to answer this question presented to me from a retired veterinarian from USDA/ARS, who served on the USDA- APHIS-VS "Vectors. Organisms and Pathogens Committee" (5 questions and answers posted on ProMEDmail Network: Emerging Infectious Disease Surveillance - www.promedmail.org).

In the answer posted on ProMED, readers were advised to contact the Centers for Disease Control and Prevention or the U.S. Fish and Wildlife Service regarding their permiting requirements pertaining to this issue.
As for the possible source of monkeypox, APHIS currently is assisting the CDC and the FDA with their investigation into the outbreak. 

Slide 37: Monkeypox – Vaccination

•  Treatment: No specific treatment recommendations are being made at this time. Smallpox vaccine has been reported to reduce the risk of monkeypox among previously vaccinated persons in Africa. CDC is assessing the potential role of postexposure use of smallpox vaccine as well as therapeutic use of the antiviral drug cidofovir. -- American Medical Association Information Resource: Monkeypox Outbreak - First in Western Hemisphere

•  In the United States, approximately 25 percent (70 million) of the population would be excluded from smallpox vaccination due to risk factors that include eczema, immunodeficiency, or pregnancy, in themselves or in their close contacts. 

Reference Notes:

Kemper et al. did a "Back of the Envelope" presentation of possible risks associated with smallpox vaccination for the Effective Clinical Practice,  March/April 2002 issue for the American College of Physicians (ACP) journal [4]. They concluded: 

--  The prevalence of eczema is at least 10 percent, or more than 28 million people in the United States.
-- Immunocompromised persons are at high risk for progressive vaccinia. We know of no overall estimate for the number of immunocompromised individuals in the United States. This number would include recipients of organ transplants (184 000 solid-organ transplants in the 1990s), individuals with diagnosed and undiagnosed HIV infection or AIDS (850 000), and patients with cancer (approximately 8.5 million). 

Slide 38: Biodefense & Epidemiological Tracking

•  Quick Reference: Monkeypox: Related Articles/Research
       National Center for Biotechnology Information (NCBI)
       PubMed, Indexed for Medline
       CDC Updates and Advisories
       Legal Discussion: 
•  Public Health Legal Response and Preparedness: Centers for Disease Control 
•  Homeland Security in the United States: Humanitarian Resource Institute Legal Resource Center 
       Genomic
•  Poxvirus Bioinformatics Resource Center. 
•  Bioinformatics: Pathobiological Diagnostics
       Biodefense Discussions
       Bioweapons, Bioterrorism and Biodiversity: potential impacts of biological weapons attacks on agricultural and biological diversity.
       Monkeypox – Potential as Bioweapon: US Army Center for Health Promotion and Preventive Medicine. 
 

Reference Notes:

Slide 39: Emerging Infectious Diseases

•  80% of "emerging" infections are animal based, outlining the significance of the veterinary profession as a key player in collaborative research associated with the international threat of bioterrorism and emerging infectious diseases. -- Martin Hugh Jones, Director, WHO Collaborating Center for Remote Sensing and Geographic Information Systems for Public Health, LSU School of Veterinary Medicine.

Reference Notes:

Pandemic influenza:

CDC resource Influenza Pandemics: How They Start, How They Spread, and Their Potential Impact: 

-- The last two pandemic viruses were combinations of bird and human influenza viruses. Many persons believe that these new viruses emerged when an intermediate host, such as a pig, was infected by both human and bird influenza A viruses at the same time. 

Heinen, Swine influenza and public health implications:

-- "Around 1970, following the human 'Hong Kong' flu pandemic, the human H3N2 virus was transmitted to pigs. This human-like swine H3N2 virus continued to circulate, particularly in Europe and Asia, but only sporadically caused clinical signs. It has only started causing clinical disease since 1984, probably as a result of a reassortment with the avian-like swine H1N1 virus. 

Slide 40: Agricultural Security

January 16, 2002: Memorandum

•  Though significant progress has been made since the September 11 attacks, concerns remain regarding the deliberate introduction of a Foreign Animal Disease (FAD) in multiple locations and/or with multiple pathogens that could potentially overwhelm an emergency response system. 

Reference Notes:

Slide 41: Agricultural Security – Contingency Plans

•  In the context of this assessment, it is crucial that solid contingency plans are established that encompass the capacity to handle any threat against the U.S. food and agricultural system. 

•  If an outbreak is detected, the time required to diagnose FMD and initiate the appropriate measures will be crucial to determining the outbreak's ultimate effect. These measures would include a ban on all movements of susceptible animals that might have been exposed to other animals, contact tracing, prompt and rigid control of the movements of animals and animal products, vehicles, equipment and people in a surveillance area around any outbreak area. Successful eradication of the disease would require the commitment of government, livestock industries, farmer's organizations and the general public. Research has suggested that a one week delay could increase the proportion of infected premises from 18% to more than 90%. -- Ekboir: Potential Impact of Foot-and-Mouth Disease in California: The role and contribution of animal health surveillance and monitoring services.

Reference Notes:

Ekboir: 

•  The conditions under which alternative policies would be preferable should be evaluated in advance because once an outbreak has occurred, eradication strategies are largely irreversible.

•  Without strong support of producers and producers’ organizations, it is impossible to maintain proper surveil-lance and to conduct a successful eradication campaign.

Slide 42: Current Industry Concerns

•  Range of Threats for Risk Analysis
•  Communication Challenges
•  Need for Industry Alerts – Alternative Communication Strategies.
•  Guidelines for safeguarding products
•  Biosecurity guidelines
•  Security checks 
•  Recommendations for the industry, policy implications and impact/role of the industry in the event of a bioterrorist incident such as an FMD outbreak
•  Quarantines, import/export issues, potential impact for the biologics industry.

Reference Notes:

FEMA Directorate/Department of Homeland Security level discussion regarding the gaps outlined by the industry,  the message was that the industry must engage itself in risk analysis, strategic planning and development of contingency plans. 

The intergovernmental transition associated with the new Department of Homeland Security is challenging, but it is coming together. 

“If the system ignores the challenges at the producer level, then that problem reflects the size of the gap that exists for the grass roots level cooperation that is vital for effective surveillance, containment and control of a foreign animal disease outbreak.” 

Slide 43: Biosecurity Reference Library

•  News & Information 
       Combating Terrorism: Actions Needed to Improve Security at Plum Island Animal Disease Center: GAO Report, September 2003. 
       10.13.2003: Letter to Secretaries Veneman and Thompson: National Security - Interruption of biodefense research.
•  Guidelines 
       Biosecurity Fundamentals: Penn State University, College of Agricultural Sciences, Vet Extension. 
       Biosecurity Resources: Documents, Risk Assessment, Biosecurity Presentations, General Farm Biosecurity Links.
       Initiatives in Biosecurity: Prepared by the Homeland Agro-Security Task Force, Experiment Station Committee of the Board on Agricultural Assembly, National Association of State Universities and Land-Grant Colleges. 
       National Biosecurity Resource Center for Animal Health Emergencies: Purdue University Web-based National Biosecurity Resource Center for Animal Health Emergencies. 
•  Law 
       Legal Resource Center: Biodefense Reference Library
       Legal Resource Center: U.S. and International Security

Reference Notes:

Veneman/Thompson letter: Suspension of research involving select agents due to the inability to “promptly” conduct security checks.  Presented by the Association of American Medical Colleges, Association of American Universities, Council on Government Relations and National Association of State Universities and Land Grant Colleges.

Slide 44: 2003 AVBC Conference

•  Password protected secure site providing easy online access to materials/resources discussed in this presentation.

AVBC Conference Resource Site
www.pathobiologics.org/xxxxxxx
User name: XXXXXXX  Password: XXXXXXX

Reference Notes:

Company: Pathobiologics International

Stephen M. Apatow, Consultant: Analysis, strategic planning and development associated with risk management, infrastructure optimization, media and communication initiatives.