Global Health Security Initiative Research Articles

From ISET to InDRE. V. Institute of Epidemiological Diagnosis and Reference. Global strategic position, 2012-2019.

This document describes the changes at the Institute of Epidemiological Diagnosis and Reference (InDRE) from 2012 to 2019, the administrative and equipment modifications, the new headquarters and the National System of Epidemiological Surveillance legal modifications. The process of relocation is mentioned, especially the careful transfer of the biological material protected by the Institute, and the new way of studying epidemic outbreaks, endemic diseases and the negative network is analyzed. At the international level, the promotion of links with global networks of the Pan American Health Organization, the World Health Organization (WHO) and other international organizations is described. The assignation to InDRE of four WHO collaborating centres is also mentioned. The Global Health Security Initiative Laboratory Network acknowledged InDRE's leadership, which co-chaired the working group during the study period.

Assessment and impact of a biosecurity course in raising the awareness of students at the Jinnah post graduate Medical Center, Pakistan

IntroductionPakistan Biological Safety Association (PBSA) is a not for profit, nongovernmental, professional organization established in 2008 and is striving to promote and implement Bio risk management in Pakistan. PBSA accelerated its program for strategic training of the national life scientists from 2013 and is still working on that mandate with the help of Fogarty International Center (FIC) & National Institute of Health USA and other international organizations working on this Global Health Security Initiative and subsequently Agenda (GHSA) Aims & ObjectivesThis biosafety training program was developed for capacity building of M.Phil. and PhD graduates the future laboratory users of Basic Medical Sciences Institute (BMSI), Jinnah Post Graduate Medical Center which is the largest tertiary care hospital in Karachi, Pakistan involved in Research &Development (R&D) in medical sciences. Materials & MethodsThis Pre post study was carried at Basic Medical Sciences Institute (JPMC), during the period of October 2018 to January 2019. A total of 48 (16 PhD. 32 M.Phil.) Grads students participated in the following study. The training program is administered through, custom made 4-month course having 16 contact hours also 4 hours of practical training. Training was evaluated using written assessment. The pre and post-training test was conducted after each session. Each test comprised of 15 multiple choice questions (MCQs) pre and post session making it 30 MCQs in total for each session. A final assessment consisting 30 MCQs conducted at the end of course. ResultsThere was vast difference observed in the post assessment results as compared to the pre assessment results. At the end of the course final assessment was carried out which gave an overall impression of vast change (83.3%) in awareness regarding bio risk management among the graduate students, which reflected the efficacy of this training. To ensure the validity of results and the intention to improvise the quality of course in future, feedback regarding the course and trainer was obtain through Likert scale. Reliability of Likert scale carried through Cronbach’s alpha, showed all variables with a maximum score of 0.9, indicating high reliability of the generated feedback evaluation. ConclusionThis study highlighted that through concerted efforts of professional organizations, proper awareness of public and concerned personals, regarding Biosafety & Biosecurity can certainly reduce the chances of errors and will ensure potential safety and security to the laboratory workers, community and environment, potentially exposed to these pathogens & toxins which are regarded as biohazards.

BIODOSIMETRY AND BIODOSIMETRY NETWORKS FOR MANAGING RADIATION EMERGENCY.

Biological dosimetry enables individual dose reconstruction in the case of unclear or inconsistent radiation exposure situations, especially when a direct measurement of ionizing radiation is not or is no longer possible. To be prepared for large-scale radiological incidents, networking between well-trained laboratories has been identified as a useful approach for provision of the fast and trustworthy dose assessments needed in such circumstances. To this end, various biodosimetry laboratories worldwide have joined forces and set up regional and/or nationwide networks either on a formal or informal basis. Many of these laboratories are also a part of global networks such as those organized by World Health Organization, International Atomic Energy Agency or Global Health Security Initiative. In the present report, biodosimetry networks from different parts of the world are presented, and the partners, activities and cooperation actions are detailed. Moreover, guidance for situational application of tools used for individual dosimetry is given.

GHSI EMERGENCY RADIONUCLIDE BIOASSAY LABORATORY NETWORK: SUMMARY OF A RECENT EXERCISE.

The Global Health Security Initiative (GHSI) established a laboratory network within the GHSI community to develop their collective surge capacity for radionuclide bioassay in response to a radiological or nuclear emergency. A recent exercise was conducted to test the participating laboratories for their capabilities in screening and in vitro assay of biological samples, performing internal dose assessment and providing advice on medical intervention, if necessary, using a urine sample spiked with a single radionuclide, 241Am. The laboratories were required to submit their reports according to the exercise schedule and using pre-formatted templates. Generally, the participating laboratories were found to be capable with respect to rapidly screening samples for radionuclide contamination, measuring the radionuclide in the samples, assessing the intake and radiation dose, and providing advice on medical intervention. However, gaps in bioassay measurement and dose assessment have been identified. The network may take steps to ensure that procedures and practices within this network be harmonised and a follow-up exercise be organised on a larger scale, with potential participation of laboratories from the networks coordinated by the International Atomic Energy Agency and the World Health Organization.

GHSI EMERGENCY RADIONUCLIDE BIOASSAY LABORATORY NETWORK - SUMMARY OF THE SECOND EXERCISE.

The Global Health Security Initiative (GHSI) established a laboratory network within the GHSI community to develop collective surge capacity for radionuclide bioassay in response to a radiological or nuclear emergency as a means of enhancing response capability, health outcomes and community resilience. GHSI partners conducted an exercise in collaboration with the WHO Radiation Emergency Medical Preparedness and Assistance Network and the IAEA Response and Assistance Network, to test the participating laboratories (18) for their capabilities in in vitro assay of biological samples, using a urine sample spiked with multiple high-risk radionuclides (90Sr, 106Ru, 137Cs, and 239Pu). Laboratories were required to submit their reports within 72 h following receipt of the sample, using a pre-formatted template, on the procedures, methods and techniques used to identify and quantify the radionuclides in the sample, as well as the bioassay results with a 95% confidence interval. All of the participating laboratories identified and measured all or some of the radionuclides in the sample. However, gaps were identified in both the procedures used to assay multiple radionuclides in one sample, as well as in the methods or techniques used to assay specific radionuclides in urine. Two-third of the participating laboratories had difficulties in determining all the radionuclides in the sample. Results from this exercise indicate that challenges remain with respect to ensuring that results are delivered in a timely, consistent and reliable manner to support medical interventions. Laboratories within the networks are encouraged to work together to develop and maintain collective capabilities and capacity for emergency bioassay, which is an important component of radiation emergency response.

Mass Casualty Decontamination in a Chemical or Radiological/Nuclear Incident with External Contamination: Guiding Principles and Research Needs.

Hazardous chemical, radiological, and nuclear materials threaten public health in scenarios of accidental or intentional release which can lead to external contamination of people. Without intervention, the contamination could cause severe adverse health effects, through systemic absorption by the contaminated casualties as well as spread of contamination to other people, medical equipment, and facilities. Timely decontamination can prevent or interrupt absorption into the body and minimize opportunities for spread of the contamination, thereby mitigating the health impact of the incident. Although the specific physicochemical characteristics of the hazardous material(s) will determine the nature of an incident and its risks, some decontamination and medical challenges and recommended response strategies are common among chemical and radioactive material incidents. Furthermore, the identity of the hazardous material released may not be known early in an incident. Therefore, it may be beneficial to compare the evidence and harmonize approaches between chemical and radioactive contamination incidents. Experts from the Global Health Security Initiative’s Chemical and Radiological/Nuclear Working Groups present here a succinct summary of guiding principles for planning and response based on current best practices, as well as research needs, to address the challenges of managing contaminated casualties in a chemical or radiological/nuclear incident.

Interfacing a biosurveillance portal and an international network of institutional analysts to detect biological threats.

The Early Alerting and Reporting (EAR) project, launched in 2008, is aimed at improving global early alerting and risk assessment and evaluating the feasibility and opportunity of integrating the analysis of biological, chemical, radionuclear (CBRN), and pandemic influenza threats. At a time when no international collaborations existed in the field of event-based surveillance, EAR's innovative approach involved both epidemic intelligence experts and internet-based biosurveillance system providers in the framework of an international collaboration called the Global Health Security Initiative, which involved the ministries of health of the G7 countries and Mexico, the World Health Organization, and the European Commission. The EAR project pooled data from 7 major internet-based biosurveillance systems onto a common portal that was progressively optimized for biological threat detection under the guidance of epidemic intelligence experts from public health institutions in Canada, the European Centre for Disease Prevention and Control, France, Germany, Italy, Japan, the United Kingdom, and the United States. The group became the first end users of the EAR portal, constituting a network of analysts working with a common standard operating procedure and risk assessment tools on a rotation basis to constantly screen and assess public information on the web for events that could suggest an intentional release of biological agents. Following the first 2-year pilot phase, the EAR project was tested in its capacity to monitor biological threats, proving that its working model was feasible and demonstrating the high commitment of the countries and international institutions involved. During the testing period, analysts using the EAR platform did not miss intentional events of a biological nature and did not issue false alarms. Through the findings of this initial assessment, this article provides insights into how the field of epidemic intelligence can advance through an international network and, more specifically, how it was further developed in the EAR project.

A screening tool to prioritize public health risk associated with accidental or deliberate release of chemicals into the atmosphere

The Chemical Events Working Group of the Global Health Security Initiative has developed a flexible screening tool for chemicals that present a risk when accidentally or deliberately released into the atmosphere. The tool is generic, semi-quantitative, independent of site, situation and scenario, encompasses all chemical hazards (toxicity, flammability and reactivity), and can be easily and quickly implemented by non-subject matter experts using freely available, authoritative information. Public health practitioners and planners can use the screening tool to assist them in directing their activities in each of the five stages of the disaster management cycle.

Public–private partnerships in trust-based public health social networking: Connecting organizations for regional disease surveillance (CORDS)

We describe a new trust-based global health security initiative known as CORDS: Connecting Organizations for Regional Disease Surveillance. Initiated and managed by the Nuclear Threat Initiative with support of The Rockefeller Foundation, Fondation Merieux and the Skoll Global Threats Fund. CORDS is a non-governmental platform to transform dialogue among public health, veterinary and wildlife professionals from multi-country infectious disease surveillance networks. It also links with the World Health Organization, World Organization for Animal Health and other global partners in managing cross-border emerging infectious disease threats and building disease surveillance capacity. The public–private partnerships of CORDS create a global social fabric and continuity of disease experts based upon trust.

Landscape of international event-based biosurveillance.

Event-based biosurveillance is a scientific discipline in which diverse sources of data, many of which are available from the Internet, are characterized prospectively to provide information on infectious disease events. Biosurveillance complements traditional public health surveillance to provide both early warning of infectious disease events and situational awareness. The Global Health Security Action Group of the Global Health Security Initiative is developing a biosurveillance capability that integrates and leverages component systems from member nations. This work discusses these biosurveillance systems and identifies needed future studies.

Policies in place throughout the world: action by the European Union

Policies in place throughout the world: action by the European Union

Public–private partnerships in trust-based public health social networking: Connecting organizations for regional disease surveillance (CORDS)

We describe a new trust-based global health security initiative known as CORDS: Connecting Organizations for Regional Disease Surveillance. Initiated and managed by the Nuclear Threat Initiative with support of The Rockefeller Foundation, Fondation Mérieux and the Skoll Global Threats Fund. CORDS is a non-governmental platform to transform dialogue among public health, veterinary and wildlife professionals from multi-country infectious disease surveillance networks. It also links with the World Health Organization, World Organization for Animal Health and other global partners in managing cross-border emerging infectious disease threats and building disease surveillance capacity. The public–private partnerships of CORDS create a global social fabric and continuity of disease experts based upon trust.