Need for #Aeromedical #Evacuation High-Level #Containment #Transport #Guidelines (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 5—May 2019 / Research Letter

Need for Aeromedical Evacuation High-Level Containment Transport Guidelines

Shawn G. Gibbs, Jocelyn J. Herstein  , Aurora B. Le, Elizabeth L. Beam, Theodore J. Cieslak, James V. Lawler, Joshua L. Santarpia, Terry L. Stentz, Kelli R. Kopocis-Herstein, Chandran Achutan, Gary W. Carter, and John J. Lowe

Author affiliations: Indiana University School of Public Health, Bloomington, Indiana, USA (S.G. Gibbs, A.B. Le); University of Nebraska Medical Center College of Public Health, Omaha, Nebraska, USA (J.J. Herstein, T.J. Cieslak, C. Achutan, J.J. Lowe); University of Nebraska Medical Center College of Nursing, Omaha (E.L. Beam); University of Nebraska Medical Center College of Medicine, Omaha (J.V. Lawler, J.L. Santarpia); National Strategic Research Institute, Omaha (J.V. Lawler, J.L. Santarpia, G.W. Carter); University of Nebraska–Lincoln Charles W. Durham School of Architectural Engineering and Construction, Lincoln, Nebraska, USA (T.L. Stentz, K.R. Kopocis-Herstein)



Circumstances exist that call for the aeromedical evacuation high-level containment transport (AE-HLCT) of patients with highly hazardous communicable diseases. A small number of organizations maintain AE-HLCT capabilities, and little is publicly available regarding the practices. The time is ripe for the development of standards and consensus guidelines involving AE-HLCT.

Keywords: Biological Hazards; Biocontainment; Infectious Diseases; Emerging Diseases.



#REDCap for #Biocontainment #Worker Symptom #Monitoring (Health Secur., asbtract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Health Secur. 2019 Feb 6. doi: 10.1089/hs.2018.0086. [Epub ahead of print]

REDCap for Biocontainment Worker Symptom Monitoring.

O’Keefe AL1, Buss BF2,3, Koirala S4,5, Gleason MX6, Mudgapalli A7, Schwedhelm S8.

Author information: 1 Anne L. O’Keefe, MD, is Senior Epidemiologist, Douglas County Health Department, Omaha, Nebraska. 2 Bryan F. Buss, DVM, is a Career Epidemiology Field Officer, the Nebraska Department of Health and Human Services, Lincoln, Nebraska. 3 Bryan F. Buss, DVM, the Center for Preparedness and Response, Division of State and Local Readiness, Centers for Disease Control and Prevention (CDC), Lincoln, NE. 4 Samir Koirala, MBBS, is a CDC Temporary Epidemiology Field Assignee, the Nebraska Department of Health and Human Services, Lincoln, Nebraska. 5 Samir Koirala, MBBS, the Center for Preparedness and Response, Division of State and Local Readiness, Centers for Disease Control and Prevention (CDC), Lincoln, NE. 6 Michael X. Gleason, PhD, is a Programmer/Analyst, the Research IT Office, University of Nebraska Medical Center, Omaha. 7 Ashok Mudgapalli, PhD, is Director, the Research IT Office, University of Nebraska Medical Center, Omaha. 8 Shelly Schwedhelm, MSN, is Executive Director, Emergency Management & Biopreparedness, Nebraska Medicine, Omaha.



The Ebola epidemic of 2014 demonstrated that outbreaks of high-consequence infectious diseases, even in remote parts of the world, can affect communities anywhere in the developed world and that every healthcare facility must be prepared to identify, isolate, and provide care for infected patients. The Nebraska Biocontainment Unit (NBU), located at Nebraska Medicine in Omaha, Nebraska, cared for 3 American citizens exposed in West Africa and confirmed with Ebola virus disease (EVD). Symptom monitoring of healthcare workers caring for these patients was implemented, which included twice daily contact to document the absence or presence of signs of fever or illness. This article describes the symptom monitoring experience of the NBU and local and state public health agencies. Based on lessons learned from that experience, we sought a more efficient solution to meet the needs of both the healthcare facility and public health authorities. REDCap, an open-source application used commonly by academic health centers, was used to develop an inexpensive symptom monitoring application that could reduce the burden of managing these activities, thus freeing up valuable time. Our pilot activities demonstrated that this novel use of REDCap holds promise for minimizing costs and resource demands associated with symptom monitoring while offering a more user-friendly experience for people being monitored and the officials managing the response.

KEYWORDS: Biocontainment; Epidemic management/response; Hospital preparedness; Infectious diseases

PMID: 30724610 DOI: 10.1089/hs.2018.0086

Keywords: Infectious Diseases; Emerging Diseases; Biocontainment; HCWs.


Evaluating Promising #Investigational #Medical #Countermeasures: #Recommendations in the Absence of #Guidelines (Health Secur., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Health Secur. 2019 Feb 6. doi: 10.1089/hs.2018.0092. [Epub ahead of print]

Evaluating Promising Investigational Medical Countermeasures: Recommendations in the Absence of Guidelines.

Bhadelia N1, Sauer L2, Cieslak TJ3, Davey RT4, McLellan S5, Uyeki TM6, Kortepeter MG7; National Ebola Training and Education Center’s Special Pathogens Research Network (SPRN)’s Medical Countermeasures Working Group.

Collaborators (12): Akers M, Dierberg K, Eiras D, Evans J, Figueroa E, Kraft C, Kratochvil C, Martins K, Measer G, Mehta A, Hu-Primmer J, Risi G.

Author information: 1 Nahid Bhadelia, MD, MA, is Medical Director, Special Pathogens Unit, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA. 2 Lauren Sauer, MS, is Assistant Professor, Director of Research, Johns Hopkins Biocontainment Unit, Department of Emergency Medicine, Johns Hopkins Medicine, Baltimore, MD. 3 Theodore J. Cieslak, MD, MPH, is Associate Professor, Department of Epidemiology, University of Nebraska College of Public Health, Omaha, NE. 4 Richard T. Davey, MD, is Deputy Clinical Director, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD. 5 Susan McLellan, MD, MPH, is Medical Director, Biocontainment Treatment Unit, Division of Infectious Diseases, University of Texas Medical Branch at Galveston, TX. 6 Timothy M. Uyeki, MD, MPH, MPP, is Chief Medical Officer, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. 7 Mark G. Kortepeter, MD, MPH, is Professor, Department of Epidemiology, University of Nebraska College of Public Health, Omaha, NE.



Emerging and re-emerging infectious diseases pose growing global public health threats. However, research on and development of medical countermeasures (MCMs) for such pathogens is limited by the sporadic and unpredictable nature of outbreaks, lack of financial incentive for pharmaceutical companies to develop interventions for many of the diseases, lack of clinical research capacity in areas where these diseases are endemic, and the ethical dilemmas related to conducting scientific research in humanitarian emergencies. Hence, clinicians providing care for patients with emerging diseases are often faced with making clinical decisions about the safety and effectiveness of experimental MCMs, based on limited or no human safety, preclinical, or even earlier product research or historical data, for compassionate use. Such decisions can have immense impact on current and subsequent patients, the public health response, and success of future clinical trials. We highlight these dilemmas and underscore the need to proactively set up procedures that allow early and ethical deployment of MCMs as part of clinical trials. When clinical trials remain difficult to deploy, we present several suggestions of how compassionate use of off-label and unlicensed MCMs can be made more informed and ethical. We highlight several collaborations seeking to address these gaps in data and procedures to inform future clinical and public health decision making.

KEYWORDS: Drug development; Ebola; Emerging infectious diseases; Ethics; Medical countermeasures; Outbreaks

PMID: 30724616 DOI: 10.1089/hs.2018.0092

Keywords: Infectious Diseases; Emerging Diseases; Antivirals; Vaccines.


High #ambient #temperature dampens adaptive immune #responses to #influenza A virus #infection (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

High ambient temperature dampens adaptive immune responses to influenza A virus infection

Miyu Moriyama and Takeshi Ichinohe

PNAS published ahead of print February 4, 2019 / DOI:

Edited by Ruslan Medzhitov, Yale University School of Medicine, New Haven, CT, and approved December 26, 2018 (received for review August 31, 2018)



Although half of the world’s population could face severe food crisis as a result of global warming by the end of this century, the effects of environmental temperature and host nutritional status in host defense to viral infection in vivo are less clear. Here, we demonstrated that exposure of mice to the high ambient temperature of 36 °C reduced their food intake and impaired adaptive immune responses to influenza virus infection. In addition, we found that administration of glucose or dietary short-chain fatty acids restored influenza virus-specific adaptive immune responses in high heat-exposed mice. Our results imply possible public health problems and concerns that outside temperature and host nutritional status may be critical determinants of viral pathogenesis or vaccine efficacy.



Although climate change may expand the geographical distribution of several vector-borne diseases, the effects of environmental temperature in host defense to viral infection in vivo are unknown. Here, we demonstrate that exposure of mice to the high ambient temperature of 36 °C impaired adaptive immune responses against infection with viral pathogens, influenza, Zika, and severe fever with thrombocytopenia syndrome phlebovirus. Following influenza virus infection, the high heat-exposed mice failed to stimulate inflammasome-dependent cytokine secretion and respiratory dendritic cell migration to lymph nodes. Although commensal microbiota composition remained intact, the high heat-exposed mice decreased their food intake and increased autophagy in lung tissue. Induction of autophagy in room temperature-exposed mice severely impaired virus-specific CD8 T cells and antibody responses following respiratory influenza virus infection. In addition, we found that administration of glucose or dietary short-chain fatty acids restored influenza virus-specific adaptive immune responses in high heat-exposed mice. These findings uncover an unexpected mechanism by which ambient temperature and nutritional status control virus-specific adaptive immune responses.

global warming – vector-borne diseases – immunity to viral infection – autophagy – inflammasomes



1 To whom correspondence should be addressed. Email:

Author contributions: M.M. and T.I. designed research; M.M. and T.I. performed research; M.M. and T.I. analyzed data; and T.I. wrote the paper.

The authors declare no conflict of interest.

This article is a PNAS Direct Submission.

This article contains supporting information online at

Published under the PNAS license.

Keywords: Influenza A; Climate Change; Global Warming.


#Viral #Infections of the #CNS in #Africa (Brain Res Bull., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Brain Res Bull. 2019 Jan 15. pii: S0361-9230(18)30341-1. doi: 10.1016/j.brainresbull.2018.12.019. [Epub ahead of print]

Viral Infections of the Central Nervous System in Africa.

Kakooza-Mwesige A1, Tshala-Katumbay D2, Juliano SL3.

Author information: 1 Department of Paediatrics & Child Health, Makerere University College of Health Sciences and Mulago Hospital, Kampala, Uganda; Astrid Lindgren Children’s Hospital, Neuropediatric Research Unit, Karolinska Institutet, Sweden. Electronic address: 2 Department of Neurology and School of Public Health, Oregon Health & Science University, Portland, OR, USA; Department of Neurology, University of Kinshasa, Democratic Republic of the Congo; Institut National de Recherches Biomedicales, University of Kinshasa, Democratic Republic of the Congo. Electronic address: 3 Neuroscience, USUHS, Bethesda, MD, 20814, USA. Electronic address:



Viral infections are a major cause of human central nervous system infection, and may be associated with significant mortality, and long-term sequelae. In Africa, the lack of effective therapies, limited diagnostic and human resource facilities are especially in dire need. Most viruses that affect the central nervous system are opportunistic or accidental pathogens. Some of these viruses were initially considered harmless, however they have now evolved to penetrate the nervous system efficiently and exploit neuronal cell biology thus resulting in severe illness. A number of potentially lethal neurotropic viruses have been discovered in Africa and over the course of time shown their ability to spread wider afield involving other continents leaving a devastating impact in their trail. In this review we discuss key viruses involved in central nervous system disease and of major public health concern with respect to Africa. These arise from the families of Flaviviridae, Filoviridae, Retroviridae, Bunyaviridae, Rhabdoviridae and Herpesviridae. In terms of the number of cases affected by these viruses, HIV (Retroviridae) tops the list for morbidity, mortality and long term disability, while the Rift Valley Fever virus (Bunyaviridae) is at the bottom of the list. The most deadly are the Ebola and Marburg viruses (Filoviridae). This review describes their epidemiology and key neurological manifestations as regards the central nervous system such as meningoencephalitis and Guillain-Barré syndrome. The potential pathogenic mechanisms adopted by these viruses are debated and research perspectives suggested.

Copyright © 2019. Published by Elsevier Inc.

KEYWORDS: CNS viral infections; Ebola; HIV; Herpes; Rabies; Zika

PMID: 30658129 DOI: 10.1016/j.brainresbull.2018.12.019

Keywords: Emerging Diseases; Neurology; Flavivirus; Filovirus; Rhabdovirus; Herpesvirus; HIV/AIDS; Bunyavirus; Retrovirus.


Using #physical #contact heterogeneity and frequency to characterize #dynamics of #human #exposure to nonhuman #primate bodily #fluids in central #Africa (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]


Using physical contact heterogeneity and frequency to characterize dynamics of human exposure to nonhuman primate bodily fluids in central Africa

Victor Narat, Mamadou Kampo, Thibaut Heyer, Stephanie Rupp, Philippe Ambata, Richard Njouom, Tamara Giles-Vernick

Published: December 27, 2018 / DOI:



Emerging infectious diseases of zoonotic origin constitute a recurrent threat to global health. Nonhuman primates (NHPs) occupy an important place in zoonotic spillovers (pathogenic transmissions from animals to humans), serving as reservoirs or amplifiers of multiple neglected tropical diseases, including viral hemorrhagic fevers and arboviruses, parasites and bacteria, as well as retroviruses (simian foamy virus, PTLV) that are pathogenic in human beings. Hunting and butchering studies in Africa characterize at-risk human social groups, but overlook critical factors of contact heterogeneity and frequency, NHP species differences, and meat processing practices. In southeastern Cameroon, a region with a history of zoonotic emergence and high risk of future spillovers, we conducted a novel mixed-method field study of human physical exposure to multiple NHP species, incorporating participant-based and ecological methodologies, and qualitative interviews (n = 25). We find frequent physical contact across adult human populations, greater physical contact with monkeys than apes, especially for meat handling practices, and positive correlation of human exposure with NHP species abundance and proximity to human settlement. These fine-grained results encourage reconsideration of the likely dynamics of human-NHP contact in past and future NTD emergence events. Multidisciplinary social science and ecological approaches should be mobilized to generate more effective human and animal surveillance and risk communications around neglected tropical diseases. At a moment when the WHO has included “Disease X”, a presumably zoonotic pathogen with pandemic potential, on its list of blueprint priority diseases as, new field-based tools for investigating zoonotic disease emergence, both known and unknown, are of critical importance.


Author summary

Animal diseases that infect humans are a major threat to human health. Nonhuman primates’ genetic relatedness to human beings makes them an important source of disease spillovers into human populations. The central African rainforest has witnessed many infectious spillovers from primates, including multiple neglected tropical diseases. Previous studies have focused on hunting and butchering of primates as risky practices that expose central Africans to their diseases. These studies have not investigated how different kinds and frequencies of contact or the abundance of different monkey and great ape species affect these risks. We examined these factors in southeastern Cameroon, conducting a social sciences study of human physical contacts with nine different primate species. We found that Cameroonian adults had frequent physical contact with primates, and more with monkeys than apes, especially through handling meat for butchering, marketing, and preparation. People also had more contact with more abundant primate species living closer to villages. National and international authorities should support improved surveillance of humans and abundant monkey species, as well as popular messages to promote safe meat handling practices. Multidisciplinary social science and ecological approaches should be used to improve surveillance and communications with forest populations about neglected tropical diseases.


Citation: Narat V, Kampo M, Heyer T, Rupp S, Ambata P, Njouom R, et al. (2018) Using physical contact heterogeneity and frequency to characterize dynamics of human exposure to nonhuman primate bodily fluids in central Africa. PLoS Negl Trop Dis 12(12): e0006976.

Editor: Benjamin Althouse, Institute for Disease Modeling, UNITED STATES

Received: July 29, 2018; Accepted: November 5, 2018; Published: December 27, 2018

Copyright: © 2018 Narat et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Quantitative data are contained in the manuscript. Qualitative data, because they contain identifying information, cannot be shared publicly because this would violate our ethical approvals.

Funding: The Agence Nationale de la Recherche (France; funded the study ANR-14-CE31-004, including postdoctoral salary and field missions. TGV received this funding. The Canadian Institute for Advanced Research( provided additional funding for field investigation. TGV received this funding. The Institut Pasteur Infection and Epidemiology Department ( provided supplemental funding for VN’s salary. VN received this funding. The Institut Pasteur International Direction ( provided supplemental funding for RN’s participation in the study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Emerging Diseases; Infectious Diseases; Wildlife; Cameroon.


#Epidemic #preparedness: why is there a need to accelerate the #development of #diagnostics? (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Epidemic preparedness: why is there a need to accelerate the development of diagnostics?

Prof Rosanna W Peeling, PhD, Maurine Murtagh, PhD, Piero L Olliaro, MD

Published: December 11, 2018 / DOI:



Global epidemics of infectious diseases are increasing in frequency and severity. Diagnostics are needed for rapid identification of the cause of the epidemic to facilitate effective control and prevention. Lessons learned from the recent Ebola virus and Zika virus epidemics are that delay in developing the right diagnostic for the right population at the right time has been a costly barrier to disease control and prevention. We believe that it is possible to accelerate and optimise diagnostic development through a five-pronged strategy: by doing a global landscape analysis of diagnostic availability worldwide; through strategic partnerships for accelerating test development, in particular with vaccine companies to identify novel diagnostic targets; by creating and sharing repositories of data, reagents, and well characterised specimens for advancing the development process; by involving key public and private stakeholders, including appropriate regulatory bodies and policy makers, to ensure rapid access for researchers to diagnostics; and last, by fostering an enabling environment for research and access to diagnostics in the countries that need them. The need is great, but not insurmountable and innovative and faster development pathways are urgently required to address current shortfalls.

Keywords: Emerging Diseases; Infectious Diseases; Pandemic preparedness; Diagnostic tests.