The Infectious Disease Threat and Laboratory Biosafety - Sandia ...

The Infectious Disease Threat andLaboratory BiosafetySNL Biosecurity TeamNational Workshop on BiosecurityKuala Lumpur, Malaysia31 May 20052005- p/1SAND No. 2005-3346CSandia is a multiprogram laboratory operated by Sandia Corporation, a Lockheed Martin Company,for the United States Department of Energy’s National Nuclear Security Administrationunder contract DE-AC04-94AL85000.

The Infectious Disease Threat• Recent outbreaks of emerging infectious diseaseawakened the international community to threats topublic and agricultural health• Most threat mitigation strategies have focused onoutbreak management• Measures must also be developed to preventoutbreaks of highly infectious disease• Laboratory biosafety is one aspect of the solution• Ensures the safety and well being of workers in thelaboratory• Safeguards public and agricultural health bypreventing the accidental release of harmfulbiological agentsToday, the infectious disease threat is a globalproblem that requires global solutions2005- p/2

Severe Acute Respiratory Syndrome(SARS)• In 2003, SARS infected over 8,000 peopleand killed almost 800• The disease ravaged economies in thePacific Rim and Canada and struck fearacross the globe• Laboratory acquired SARS outbreaksoccurred in Singapore, Taiwan, andmainland China• Singapore—September 2003• Taiwan (China)—December 2003• Beijing and Anhui (China)—March 20042005- p/3

Laboratory-Acquired Case of SARSSingapore, September 2003• Patient: 27-year-old male graduate student• Place of infection: BSL-3 laboratory, Environmental HealthInstitute• Onset of illness: August 26, 2003• Hospitalization: September 3, 2003• Confirmed day: September 8, 20032005- p/4

Summary of the WHO Investigation, Singapore• The graduate student acquired the infection in the BSL-3laboratory in the Environmental Health Institute where heworked• Inappropriate laboratory procedures and a crosscontaminationof West Nile virus samples with SARS-CoV inthe laboratory led to the infection• No evidence could be found of any other source of infection• Isolated event: no evidence of secondary transmission2005- p/5

Laboratory-Acquired Case of SARSTaiwan (China), December 2003• Patient: 44-year-old male laboratory scientist• Place of infection: BSL-4 laboratory, Institute ofPreventative Medicine (IPM), National Defense MedicalCenter (NDMC)• Onset of illness: December 11, 2003• Hospitalization: December 16, 2003• Confirmed day: December 17, 20032005- p/6

Summary of WHO Investigation, Taiwan (China)• Scientist was working on SARS-CoV in a BSL-4 facility atthe IPM-NDMC• He found a spillage of material in the transportationchamber and disinfected it with 70% ethanol and cleaned itmanually• The environment specimens collected from the handle of analcohol spray bottle from the transportation chamber andthe switch panel of the cabinet yielded positive results forSARS-CoV• Isolated event: no evidence of secondary transmission2005- p/7

Laboratory-Acquired SARS Outbreakin China, March-April 2004• Occurred in Beijing and Anhui Province,linked to the National Institute of Virology,China CDC• The source of the outbreak was failed orincomplete inactivation of SARS-CoV(cold inactivation)• Involved two verified chains of SARS-CoV transmission• Three generations, resulting in 9 cases• Serological analysis on the laboratory staff revealed threemore seroconverted cases and one of them is most likely tohave been infected early in February 20042005- p/8

Laboratory-Acquired SARS Outbreakin China, March-April 2004•A (female research student) 25 MarchChina CDC2ndB (A's mother)deathC (nurse attending A)3rdD(C's mother)E(C's aunt)F(C's father)G (retired doctor sharing hospital room with C)H(G's daughter-in-law)• I (male laboratory researcher) 17 AprilSARS IgG (+)J (female laboratory worker in BSL-3 laboratory)K (female laboratory worker developed pneumonia)L (male laboratory worker, A's supervisor)2005- p/9

Common Problems• Bad practice in laboratory management• Poor supervision of less experienced professionals• A lack of accountability for occupational health and safety• A lack of biosafety policy• A lack of biosafety procedures and staff training inbiosafety practice• A lack of internal and external quality assurance2005- p/10

Highly Pathogenic Avian Influenza• Millions of poultry culled in response tooutbreaks in South East Asia• Over 50 humans dead since late 2003,elevated mortality rates• Experts fear that if human-to-humantransmission becomes more efficient, apandemic looms• Push to construct clinical anddiagnostic laboratories for H5N1throughout Southeast Asia• Imperative to establish sound biosafetypractices• To prevent accidental release of thevirus• To minimize workers becoming infected,providing opportunities for virusadaptation to humansAvian influenza virus2005- p/11

Nipah• 1999 Outbreak in Malaysia killed 105people and thousands of pigs• Over 900,000 pigs culled• FAO estimates total cost close to$450 million• Concern that the Nipah virus couldmutate to a more deadly form• Potential to devastate agriculturalindustries worldwideNipah virus in pig lung2005- p/12

Polio• The debilitating childhood diseasecontinues to plague developing countries• Currently being tackled by WHO’s GlobalPolio Eradication Initiative• Vaccination remains the only effectiveeradication method• Recent re-emergence of polio inIndonesia, Yemen• Imperative to prevent re-establishment incountries where the disease has beeneradicated• Laboratory Biosafety practices contributeto this goal2005- p/13

Laboratory Biosafety• Provides a means to reduce outbreaks ofhighly infectious diseases• WHO biosafety:• “Laboratory biosafety” describescontainment principles, technologies,and practices implemented to preventunintentional exposure to pathogens andtoxins, or their accidental release• Achieving biosafety• Important to develop national biosafetypolicies• Critical to develop a culture of biosafetyLaboratory Biosafety Manual,3 rd Edition2005- p/14

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Conclusions• Infectious diseases pose significant threats to public andagricultural health• Research on harmful biological agents is crucial to mitigatethe threat• However, release and theft of biological agents must beavoided• Imperative to protect public and agricultural health, andsafeguard laboratory workers• Managing risks in the laboratory is dependent on bothbiosafety and biosecurity• Helps reduce the threat of infectious disease2005- p/16