Publications

Singapore is poised to be a critical partner to the US in minimizing biosecurity challenges in Southeast Asia. As a nation, it is vulnerable to both emerging infectious disease and potential terrorism in the region. In addition to its geographical importance within the Asia-Pacific region, Singapore is a rising powerhouse in biotechnology, having invested $13.2B in biotech R&D from 2011-2015. As a result, it has become an attractive site for international biotechnology companies like Novartis, as well as world-class research universities. It is home to government and academic expertise capable of identifying and responding to biosecurity challenges. Its expertise is, in many ways, complementary to that of the US in these realms. 

The importance of health security in the United States has been highlighted by recent emergencies such as the H1N1 influenza pandemic, Superstorm Sandy, and the Boston Marathon bombing. The nation’s health security remains a high priority today, with federal, state, territorial, tribal, and local governments, as well as nongovernment organizations and the private sector, engaging in activities that prevent, protect, mitigate, respond to, and recover from health threats. 

In May of this year, the 67th World Health Assembly will again debate the question of when the remaining specimens of smallpox virus should be destroyed. . . . Inordinate amounts of time, effort, and resources have been spent in endeavoring to reach consensus on this one component of a smallpox threat strategy: whether to destroy or not destroy smallpox virus strains now being retained in the 2 World Health Organization (WHO) Collaborating Laboratories (in the United States and Russia). In both, the virus is being held under secure conditions. This year, a WHO-appointed group of international scientists concurred that there is no justification for retaining live smallpox virus. In any case, as others have pointed out, advances in genomic biology would now permit strains of virus to be replicated should someone wish to do so. Logic dictates an early date for destruction of the last laboratory strains.

We report the generation of five mouse strains with the tamoxifen-inducible Cre (Cre-ERT2; CE) gene cassette knocked into the endogenous loci of Pax3, Myod1, Myog, Myf6, and Myl1, collectively as a resource for the skeletal muscle research community. We characterized these CE strains using the Cre reporter mice, R26RLacZ, during embryogenesis and show that they direct tightly controlled tamoxifen-inducible reporter expression within the expected cell lineage determined by each myogenic gene. We also examined a few selected adult skeletal muscle groups for tamoxifen-inducible reporter expression. None of these new CE alleles direct reporter expression in the cardiac muscle. All these alleles follow the same knock-in strategy by replacing the first exon of each gene with the CE cassette, rendering them null alleles of the endogenous gene. Advantages and disadvantages of this design are discussed. Although we describe potential immediate use of these strains, their utility likely extends beyond foreseeable questions in skeletal muscle biology. genesis 52:759–770, 2014. © 2014 Wiley Periodicals, Inc.

Global biosecurity engagement programs designed to prevent misuse of biological agents and pathogens internationally have increased dramatically under the National Strategy for Countering Biological Threats (NSCBT), which outlined the commitment of the United States Government towards advancing health security.1 But it is difficult to measure the effectiveness of these programs in improving biosecurity given that there have been relatively few attempts to misuse the life sciences. Current metrics that focus on outputs (what was done) as opposed to outcomes (the impact of what was done) have not been helpful in determining how these efforts might be improved in the future. With these metrics in mind, the goals of the programs have traditionally been more quantitative in nature – for example, increasing the number of agents secured and number of scientists engaged. Broadening the scope of biosecurity engagement metrics can help align program goals with a more qualitative approach that prioritizes the international partner’s global health security. Such an approach will be more efficient and successful in improving global and U.S. national biosecurity.

Personal health records (PHRs), in contrast to electronic health records (EHRs) or electronic medical records (EMRs), are health records in which data are accessible to patients and not just providers. In recent years, many systems have enabled PHRs to be available in a mobile format. Mobile PHRs (mPHRs) allow patients to access health information via the Internet or telecommunication devices, such as mobile phones, personal digital assistants, and tablet computers. mPHRs have the potential to help patients and providers identify medical conditions and prescriptions from numerous locations, which may minimize medical errors and identify improvements to health behaviors during emergencies, when patients present to a new provider, or EHRs are not accessible. Despite their benefits, numerous challenges inhibit the adoption and further development of mPHRs, including integration into overall health technology infrastructure and legal and security concerns. This paper identifies the benefits of mPHRs during emergencies and the remaining challenges impeding full adoption and use, and provides recommendations to federal agencies to enhance support and use of mPHRs.

The CDC has announced the first confirmed US case of MERS. 

According to press reports [1] the patient is a healthcare worker who traveled by air from Saudi Arabia and then by bus to Indiana by way of London and Chicago while asymptomatic on April 24. Respiratory symptoms started on April 27, and the patient was seen in an emergency department on April 28. Testing for MERS was initiated because of the travel history. The patient is isolated and is in stable condition and not on mechanical ventilation at this time. No other details are available at this time.

Twenty-two months after its discovery and despite extensive investigation and research, the source and origin of the Middle East Respiratory (MERS) coronavirus remain unknown.¹ . . . Improved collaboration between clinicians, scientists, and public health authorities will be necessary to understand the epidemiology and define the sources and modes of transmission.

The Medical Reserve Corps (MRC) was established in the Office of the Surgeon General in response to the spontaneous but disorganized outpouring of medical volunteers following the terrorist attacks of 2001. The mission of the federal MRC office is to provide organizational structure and guidance to the nearly 1,000 locally organized and funded MRC units that have grown up across the country and the more than 200,000 volunteer health professionals that staff these units. Despite the large size of this program and its numerous activations over the past decade, including in the Boston Marathon bombing and Hurricane Sandy, relatively little is known about the MRC, including the make-up of the units, the ways units have been used, and the challenges faced by MRC units and their volunteers. Here we report the results of a mixed-methods investigation of MRC unit organization, activities, and challenges.

Pandemic influenza or other crises causing mass respiratory failure could easily overwhelm current North American critical care capacity. This threat has generated large-scale federal, state, and local efforts to prepare for a public health disaster. Few, however, have systematically engaged the public regarding what values are most important in guiding decisions about how to allocate scarce healthcare resources during such crises.

The American public's use of social media and mobile technologies has consistently grown in recent years. According to a May 2013 Pew study, 91% of American adults own cell phones, a 9% increase since May 2010. Of those cell phone owners, 81% communicate via text message and 60% access the Internet via phone. The rising use of cell phones and social media by the American public on a day-to-day basis has led to a corresponding rise in communication through these technologies to share and find information during emergencies. Subsequently, recent events such as Hurricane Sandy demonstrate their potential benefits for communicating preparedness messages. According to a 2012 American Red Cross survey, mobile applications and social media are now tied as the fourth most popular ways to get information during an emergency, following only by television, radio, and other online news. Local health departments' (LHDs') ability to more quickly communicate preparedness information to their communities could minimize adverse effects of disasters.

On February 13, 2014, a new Global Health Security (GHS) agenda was launched by more than 20 countries, in collaboration with the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (OIE). This new effort aims to drive and coordinate action among these partners, as well as the international NGO community and the private sector, in a more dedicated effort to prevent epidemics, detect biological threats early, and respond rapidly. There is hope and expectation that many more countries will join the agenda in the year ahead. All countries are invited.

Anthrax is a very serious bioterrorism threat. B. anthracis was developed by several countries as part of their biological weapons (BW) programs, and autonomous groups have also demonstrated the intent to use the bacterium in acts of terrorism.

Tuberculosis (TB) remains a global public health problem with significant morbidity and mortality. In 2011, there were an estimated 8.7 million new cases of TB, and 1.4 million people died from TB. Individuals with latent TB infection (LTBI) represent an important source of new cases of active TB. Approximately 5%–10% of those infected will develop active disease, and most will be capable of infecting others. Accurate diagnosis and effective treatment of LTBI represent an important opportunity to prevent the morbidity and mortality associated with TB.

The UPMC Center for Health Security and the National Association of County and City Health Officials (NACCHO) produced this report to catalyze improvements in local health departments' ability to use social media and mobile technologies to improve preparedness efforts. We conducted 65 interviews with LHD staff across the country and analyzed existing data and studies on the use of social media and mobile technologies for disaster management. This report outlines organizational factors that enable or impede LHDs' ability to use social media and mobile health platforms, as identified through interviews with LHD staff, and puts forth a series of recommendations for local health practitioners and state and federal policymakers to support use of these platforms at the local level.

Over the past decade, community engagement has become a central tenet of US federal doctrine on public health emergency preparedness. Little is known, however, about how the vision of a ready, aware, and involved populace has translated into local practice, or which conditions thus far have advanced community involvement in what is typically considered the province of government authorities and emergency professionals. In 2011-12, to help close that knowledge gap, investigators carried out semistructured qualitative interviews with practitioners (N = 25) from 7 local health departments about which conditions have advanced or inhibited community engagement in public health emergency preparedness. Among the organizational factors identified as enabling local health departments’ involvement of community residents and groups in emergency preparedness were a supportive agency leadership and culture, sufficient staffing and programmatic funding, interested and willing partners, and external triggers such as federal grants and disaster experiences that spotlighted the importance of community relationships to effective response. Facing budget and staff cuts, local health departments feel increasingly constrained in efforts to build trusted and lasting preparedness ties with community partners. At the same time, some progress in preparedness partnerships may be possible in the context of agency leadership, culture, and climate that affirms the value of collaboration with the community.

Since 2001, the United States government has spent substantial resources on preparing the nation against a bioterrorist attack. Earlier articles in this series have analyzed civilian biodefense funding by the federal government for fiscal years (FY) 2001 through proposed funding for FY2013. This article updates those figures with budgeted amounts for FY2014, specifically analyzing the budgets and allocations for biodefense at the Departments of Health and Human Services, Defense, Homeland Security, Agriculture, Commerce, Veterans Affairs, and State; the Environmental Protection Agency; and the National Science Foundation. This article also includes an updated assessment of the proportion of biodefense funding provided for programs that address multiple scientific, public health, healthcare, national security, and international security issues in addition to biodefense. The FY2014 federal budget for civilian biodefense totals $6.69 billion. Of that total, $5.86 billion (88%) is budgeted for programs that have both biodefense and nonbiodefense goals and applications, and $835 million (12%) is budgeted for programs that have objectives solely related to biodefense.

It's that time of year to think about New Year's resolutions--the kind that could increase our chances that the coming year will be better than 2013 and years prior. In that spirit, we suggest some resolutions for 2014 to better protect people from the consequences of (increasingly common) disasters, epidemics, and other threats to health security.

During past influenza seasons, the principal quandary individuals faced was whether or not to get a flu vaccination. However, this flu season we have the additional decision of choosing among several different vaccine options. The fact that these options exist is a testament to the investments made to improve flu vaccine in the face of looming pandemics.

To better respond to influenza pandemics, vaccines have been sought that offer broader protection, can be delivered in novel ways, have greater immunogenicity, are antigen sparing (that is, contain less of the active ingredient), do not require eggs for manufacture, and harness recombinant technology. This year, for the first time, each of these advances is represented in one or more of the vaccine options.

The Rad Resilient City Checklist is a local planning tool that can help save tens of thousands of lives following a nuclear detonation. If prevention of nuclear terrorism fails, then reducing exposure to radioactive fallout is the intervention that can save the most lives following a nuclear detonation. Yet, most Americans are not familiar with correct safety measures against fallout, and many believe that nothing can be done to reduce the suffering and death inflicted by a nuclear attack. Moreover, cities have no checklist on how to prepare the emergency management infrastructure and the larger population for this hazard, despite hundreds of pages of useful guidance from the federal government and radiation professional organizations. The Rad Resilient City Checklist reverses this situation by converting the latest federal guidance and technical reports into clear, actionable steps for communities to take to protect their residents from exposure to radioactive fallout. The checklist reflects the shared judgment of the Nuclear Resilience Expert Advisory Group, a national panel led by the Center for Biosecurity and comprised of government decision makers, scientific experts, emergency responders, and leaders from business, volunteer, and community sectors.