Last week in Flu And You - Part I, we talked about CDC's weekly data pointing to potential seasonal flu resistance this year to the commonly used anti-viral tamiflu, as well as preliminary reports of vaccine-to-circulating virus mismatching of the Influenza B component of this year's flu shot. Both of these situations are newsworthy (see here and here), and highlight the importance of lab surveillance of influenza and other infectious diseases.
It's not just a cable tv worry; infectious disease problems like the current 43 state salmonella outbreak will continue to occur, and timely lab confirmation and identification will continue to be needed to fight them.
Federal health officials on Saturday urged consumers to avoid eating cookies, cakes, ice cream and other foods that contain peanut butter until the authorities can learn more about a deadly outbreak of salmonella contamination.
Small scope problems occur all the time, both in humans and animals. Larger outbreaks – the analogy would be to category 5 hurricanes – don't happen as frequently, but can be devastating when they do.
The new President is aware. This is an excerpt from the prologue to Barack Obama's The Audacity of Hope (for more Obama statements on pandemics, follow the link):
"... I suggest how we might move beyond our divisions to effectively tackle concrete problems: the growing economic insecurity of many American families, the racial and religious tensions within the body politic, and the transnational threats - from terrorism to pandemic - that gather beyond our shores."
Here's a Voice of America article also spotlighting one of the potentially big problems, an influenza pandemic (a worldwide outbreak of a novel flu virus capable of infecting humans everywhere.)
The United States is concerned that the ongoing outbreaks of H5N1 avian influenza in birds, or bird flu, have the potential to turn into a human influenza pandemic. Whenever or wherever a pandemic begins, everyone around the world will be at risk.
To fuel a pandemic, a virus must be able to easily spread from person to person. And although currently the H5N1 virus does not spread easily from human to human, its mortality rate in humans is so high-over 60 percent-that we cannot take the chance that it will not do so in the future. Several influenza pandemics have occurred during the last century. The pandemic in 1918-1919 spread to every continent, and caused at least 40 million deaths world wide.
The effects of a pandemic can be lessened if preparations are made ahead of time. Working through the International Partnership on Avian and Pandemic Influenza, the U.S. Government and others in the international community have developed national and international programs to prevent, detect, and limit the spread of the avian flu virus.
Central to that effort is building infrastructure, including laboratory capacity and international rapid response mechanisms; a global surveillance and warning system; a coordinated plan of intervention; and of course, the development of vaccines. The U.S. has pledged $ 949 million in support of these efforts.
We are between pandemics, the last having occurred in 1968. Birds, however, are experiencing the equivalent, a panzootic infection of H5N1 (aka "bird flu", a misnomer because birds get all kinds of flu) with the latest outbreak in Nepal.
I bolded the part about laboratory capacity. What's that mean, exactly, for seasonal flu, for pandemics, and in general for infectious disease? These are some of the tools that public health people use to track disease, and this is where at least some of your tax dollars go. And for you long time readers, when we speak of infrastructure, this is part of the package.
To help clarify this, we asked Dr. Scott Layne of the UCLA School of Public Health to address some issues about lab infrastructure.
Daily Kos: Scott, you’re the Director of the Center for Rapid Influenza Surveillance and Research and High Speed, High Volume Laboratory Network for Infectious Diseases at the UCLA School of Public Health. Can you tell us what that is?
Let’s start with some perspective and rationale for our work. The world faces several enormous challenges (global warming, population overgrowth, food insecurity, monetary instability) and one of them is from infectious diseases. At present, infectious diseases kill 16 million people (mostly children) per year worldwide, and an unpredictable pandemic could dwarf these numbers. And the situation will only get more challenging as the world’s population increases to 9 billion over the next few decades.
Given this situation, we need new tools and transformative capabilities to deal with major infectious diseases threats. It starts with the ability (on a worldwide scale) to have near real-time information (situational awareness) on emergence, outbreaks and spread of infectious diseases, and to have accurate and useful ("actionable") information for public health decision making (warning, control and containment). Our efforts combine worldwide surveillance of infectious diseases (starting with influenza, mainly in animals so far) with high-throughput laboratory automation, testing and analysis capabilities. The goal is to collect samples fast and to test and analyze them fast for effective awareness in our ever increasing fast-paced and connected world.
Daily Kos: Who are your partners in making this happen?
Our work involves a close collaboration between UCLA and the Los Alamos National Laboratory in New Mexico. UCLA enables the public health part. Los Alamos enables the technology part. We are currently supported by congressionally-directed and CA Office of Homeland Security grants for high-throughput laboratory development, and a NIAID Center of Excellence contract for national and international surveillance work.
Daily Kos: When will you be up and running?
The high-throughput laboratory facility will be contained within the appropriate Biosafety Level 3-enhanced (BSL3e) space at UCLA. This containment space is scheduled for completed in May/June 2009. In parallel, several high-throughput laboratory systems (that perform all the various sample receiving, processing, testing and storing operations) have been designed and are being built. Some of these systems will be installed in May/June 2009. The remainder will be installed over the subsequent six to nine months. We will have core operations by mid 2009 and full operations by mid 2010. As we bring these capabilities on line, we will have the ability to perform increasingly penetrating testing, analysis and comparison of infectious disease samples.
Daily Kos: Does the lab service the entire country?
Yes, in fact, the laboratory is intended to have an even broader reach, as discussed below. We will have two modes of operation. The first is everyday surveillance (scientific research, monitoring) mode. The second is emergency surveillance (outbreak, pandemic) mode. At present, the laboratory surge capacity of our country is unknown but much to limited. We need to considerably strengthen its resilience, connectedness and capacity to handle outbreaks and pandemics.
Daily Kos: Last week I wrote about the twin issues of Influenza A H1N1 resistance and Influenza B vaccine mismatch. Will the lab you run help us to more quickly know what A sub-types and B families are circulating in CA and the rest of the country?
Yes, that is one of its important goals. Rapid, accurate and comprehensive information on circulating strains of influenza (in humans and animals) will support better decision making for vaccine selection and antiviral usage, and ongoing escape from these remedies. The primary concept is better information improves public health and health security decisions. Better information in fast-paced emergency (pandemic) situations is also essential — and for the first time we can build capabilities to save lives.
Daily Kos: Are there more rapid tests on the horizon for the community to use or is everything to be sent to UCLA?
The high-throughput laboratory at UCLA takes advantage of economy of scale, much like large clinical testing laboratories take advantage of economy of scale. However, we are also developing rapid tests (molecular-based dipsticks) that are inexpensive, disposable and intended for community use. Overall, we need a hybrid approach to near real-time surveillance of infectious diseases. We need distributed point-of-care testing for simple diagnosis and on-the-spot decision making. We need centralized high-powered testing for penetrating analysis and widespread (national, global) decision making. This hybrid strategy is the wave of the future.
Daily Kos: Will you have international reach? What do other countries do?
There are major two goals and measures of success for our work. The first is the high-throughput laboratory at UCLA performs as planned. The second is that our work serves as a (paradigm shifting) model and catalyst to build other like laboratories around the world. Humans tend to interact in "zones of cooperation" and so we need high-throughput laboratories situated in each of these zones — Asia, Eurasia, Middle East, Africa, Europe, South America, and North America. It is easy to imagine a global high-throughput laboratory network that focus on a number of serious infectious disease threats (influenza, HIV, tuberculosis, SARS-like emerging diseases) and that work together in a time of crisis, for example, during an influenza pandemic.
Daily Kos: What should we do in the meantime, given that the lab is not up and running?
Right now, we can do quite a bit. We can lead by example and invite the world to consider our new paradigm for global infectious diseases surveillance. The incoming (Obama) administration in Washington, DC appears to understand that more complete and rapid information enables better decision making and planning. I am therefore hopeful that our work will have renewed traction within our government (including HHS, DHS, DoD) as the high-throughput laboratory becomes operational in 2009. In addition, I am hopeful that other opportunities will arise in this new era. For example, the Internet-based surveillance at Google.org (Predict and Prevent) is very complimentary to our laboratory-based surveillance, and new interest at the Gates Foundation in influenza could help with development of our envisioned global network.
[More background on the UCLA high throughput lab can be found here. If you want to track whether people are searching the internet about flu in your state, go here. And if you want to see what CDC sees, go here. Any day you want to discuss flu, go here.]
More links!!
http://www.ph.ucla.edu/...
(White Paper)
http://www.universityofcalifornia.ed...
(UC Press Release)
http://pearl1.lanl.gov/...
(LANL Page)
http://commitments.clintonglobalinit...
(CGI)