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Maximum Containment Infectious Disease Laboratories as an Integral Part of Emergency Preparedness and Emergency Response

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Defense Against Biological Attacks

Abstract

Maximum containment [biosafety level 4 (BSL-4)] laboratories offer unique opportunities for research on emerging infectious diseases. Though maximum containment laboratories contribute to some of the seminal research on viral haemorrhagic fevers, very little has been written about the roles of these laboratories in infectious disease outbreaks response and preparedness. Drawing on interviews and data coming from maximum containment laboratories, the authors elucidate the complex roles of maximum containment laboratories in infectious disease outbreaks, using the recent 2013–2016 Ebola virus disease epidemic to highlight these functions. The first three sections define terms, discuss the unique research produced at maximum containment laboratories, and consider the barriers to operating these facilities. The next section focuses on the role of maximum containment institutions in capacity-building and surveillance as a part of emergency preparedness prior to the outbreak of an epidemic. Subsequently, the authors examine the function of these laboratories in emergency response as sources of subject matter expertise and as contributors to on-the-ground mobile laboratory systems. The chapter concludes with recommendations for improved collaboration between maximum containment laboratories themselves as well as between the laboratories and resource-limited countries most affected by the studied pathogens.

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References

  1. Chosewood LC, Wilson DE, Centers for Disease Control and Prevention (U.S.), National Institutes of Health (U.S.). Biosafety in microbiological and biomedical laboratories. 5th ed. Washington, DC: U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institutes of Health; 2009. xxii, p. 415.

    Google Scholar 

  2. World Health Organization. Biorisk management: laboratory biosecurity guidance. 2006. Contract No.: WHO/CDS/EPR/2006.6. http://www.who.int/csr/resources/publications/biosafety/WHO_CDS_EPR_2006_6.pdf. Accessed 26 Sept 2017.

  3. National Research Council (US). Committee on scientific milestones for the development of a gene sequence-based classification system for the oversight of select agents and National Academies Press (US). Sequence-based classification of select agents: a brighter line. Washington, DC: National Academies Press; 2010. xv, p. 220.

    Google Scholar 

  4. Centers for Disease Control and Prevention. Bioterrorism agents/diseases. 2017. https://emergency.cdc.gov/agent/agentlist-category.asp. Accessed 17 Apr 2017.

  5. Nisii C, Castilletti C, Di Caro A, Capobianchi MR, Brown D, Lloyd G, et al. The European network of biosafety-Level-4 laboratories: enhancing European preparedness for new health threats. Clin Microbiol Infect. 2009;15(8):720–6. https://doi.org/10.1111/j.1469-0691.2009.02946.x

  6. Halfmann P, Kim JH, Ebihara H, Noda T, Neumann G, Feldmann H, et al. Generation of biologically contained Ebola viruses. Proc Natl Acad Sci USA. 2008;105(4):1129–33. https://doi.org/10.1073/pnas.0708057105

  7. Bressler D, Hawley R. Safety considerations in the biosafety level 4 maximum-containment laboratory. In: Wooley DP, Byers KB, editors. Biological safety: principles and practices. 5th ed. Washington, DC: ASM Press; 2017. p. 695–717. https://doi.org/10.1128/9781555819637.ch38

  8. Smith PL, Edwards S. Working at biosafety level 4—contain the operator or contain the bug? In: Richmond JY, editor. Anthology of biosafety V: BSL-4 laboratories. Mundelein: American Biological Safety Association ABSA; 2015. p. 209–12.

    Google Scholar 

  9. National Institute of Allergy and Infectious Diseases. The need for biosafety laboratories: more about biodefense. 2010. https://www.niaid.nih.gov/research/biosafety-laboratories-needed. Accessed 12 Aug 2017.

  10. World Health Organization. Programme to facilitate Variola virus research. 2018. http://www.who.int/csr/disease/smallpox/research/en/. Accessed 16 Apr 2018.

  11. Mylne AQ, Pigott DM, Longbottom J, Shearer F, Duda KA, Messina JP, et al. Mapping the zoonotic niche of Lassa fever in Africa. Trans R Soc Trop Med Hyg. 2015;109(8):483–92. https://doi.org/10.1093/trstmh/trv047

  12. Jones BA, Grace D, Kock R, Alonso S, Rushton J, Said MY, et al. Zoonosis emergence linked to agricultural intensification and environmental change. Proc Natl Acad Sci USA. 2013;110(21):8399–404.

    Article  CAS  Google Scholar 

  13. Falzaran D, Bente DA. Animal models for viral haemorrhagic fever. Clin Microbiol Infect. 2015. https://doi.org/10.1111/1469-0691.12630

  14. Pettitt J, Zeitlin L, Kim D, Working C, Johnson JC, Bohorov O, et al. Therapeutic intervention of Ebola virus infection in rhesus macaques with the MB-003 monoclonal antibody cocktail. Sci Transl Med. 2013;5(199):199ra113. https://doi.org/10.1126/scitranslmed.3006608

  15. Warren TK, Wells J, Panchal RG, Stuthman KS, Garza NL, Van Tongeren SA, et al. Protection against filovirus diseases by a novel broad-spectrum nucleoside analogue BCX4430. Nature. 2014;508(7496):402–5.

    Article  CAS  Google Scholar 

  16. World Health Organization. Background document potential Ebola therapies and vaccines. 2014. http://www.who.int/csr/disease/ebola/ebola-new-interventions-02-sep-2014.pdf. Accessed 3 Aug 2017.

  17. Qiu X, Wong G, Fernando L, Audet J, Bello A, Strong J, et al. mAbs and ad-vectored IFN-α therapy rescue Ebola-infected nonhuman primates when administered after the detection of viremia and symptoms. Sci Transl Med. 2013;5(207):207ra143. https://doi.org/10.1126/scitranslmed.3006605

  18. Broadhurst MJ, Brooks TJ, Pollock NR. Diagnosis of Ebola virus disease: past, present, and future. Clin Microbiol Rev. 2016;29(4):773–93. https://doi.org/10.1128/CMR.00003-16

  19. Raabe V, Koehler J. Laboratory diagnosis of Lassa fever. J Clin Microbiol. 2017;55(6):1629–37. https://doi.org/10.1128/JCM.00170-17

  20. World Health Organization. Guidance on regulations for the transport of infectious substances 2015–2016. WHO/HSE/GCR/2015.2. 2015. http://apps.who.int/iris/bitstream/handle/10665/149288/WHO_HSE_GCR_2015.2_eng.pdf;jsessionid=05E6CCB02D28D1A234527E76009F8EEA?sequence=1. Accessed 18 Apr 2018.

  21. Boston University. Appendix B: Import and export of infectious biological agents. Institutional Biosafety Committee Biosafety Manual; 2018.

    Google Scholar 

  22. Mungwira RG, Nyangulu W, Misiri J, Iphani S, Ng’ong’ola R, Chirambo CM, et al. Is it ethical to prevent secondary use of stored biological samples and data derived from consenting research participants? The case of Malawi. BMC Med Ethics. 2015;16(1):83. https://doi.org/10.1186/s12910-015-0077-x

  23. Mahomed S, Behrens K, Slabbert M, et al. Managing human tissue transfer across national boundaries – an approach from an institution in South Africa. Dev World Bioeth. 2016;16(1):29–35. https://doi.org/10.1111/dewb.12080

  24. Wellcome Trust. Ethics and governance framework for best practice in genomic research and biobanking in Africa. H3Africa Working Group on Ethics; 2018. https://h3africa.org/images/Ethics_folders/Oct2017/Final%20Framework%20for%20African%20genomics%20and%20biobanking_SC%20.pdf. Accessed 18 Apr 2018.

  25. Janosko K, Holbrook MR, Adams R, Barr J, Bollinger L, Newton JT, et al. Safety precautions and operating procedures in an (A)BSL-4 laboratory: 1. Biosafety level 4 suit laboratory suite entry and exit procedures. J Vis Exp. 2016;116. https://doi.org/10.3791/52317

  26. Kraus A, Mirazami A. Laboratory biosafety in containment laboratories. In: Weidmann M, Silmann N, Butaye P, editors. Working in biosafety level 3 and 4 laboratories: a practical introduction. New York: Wiley; 2013. p. 5–12 (Incorporated).

    Google Scholar 

  27. Shurtleff A, Garza N, Lackemeyer M, Carrion R Jr, Griffiths A, Patterson J, et al. The impact of regulations, safety considerations and physical limitations on research Progress at maximum biocontainment. Viruses. 2012;4(12):3932–51. https://doi.org/10.3390/v4123932

  28. Le Duc J. Requirements for and challenges associated with BSL-4 laboratories (plenary session). In: Biosecurity challenges of the global expansion of high-containment biological laboratories: summary of a workshop. Washington, DC: The National Academies Press; 2012. p. 81–8. https://doi.org/10.17226/13315

  29. Shen H. Ebola spurs creation of Japan’s first maximum-security biolab. Nature. 2015;524(7565):274–5. https://doi.org/10.1038/nature.2015.18179

  30. Allen E, Gans F. BU biolab gets approval for research on deadliest pathogens. The Boston Globe; 2016. https://www.bostonglobe.com/metro/2016/12/24/biolab-gets-cdc-green-light-for-level-research-but-still-needs-city-approval/xgYk6jljuTOyohcWRySTNI/story.html. Accessed 26 Sept 2017.

  31. Dickmann P, Keith K, Comer C, Abraham G, Gopal R, Marui E. Report of the International Conference on Risk Communication Strategies for BSL-4 laboratories, Tokyo, October 3–5, 2007. Biosecur Bioterror. 2009;7(2):227–33.

    Article  Google Scholar 

  32. Race MS. Evaluation of the public review process and risk communication at high-level biocontainment laboratories. Appl Biosaf. 2008;13(1):45–56.

    Article  Google Scholar 

  33. Federal Select Agent Program. Select agent regulations. 2017. https://www.selectagents.gov/regulations.html. Accessed 27 Sept 2017.

  34. Penzenstadler N. Report: CDC could do more to keep laboratories safe. USA Today; 2017. https://www.usatoday.com/story/news/2017/05/25/report-cdc-could-do-more-keep-laboratories-safe/102109390/. Accessed 27 Sept 2017.

  35. Government Accountability Office. High-containment biosafety laboratories; Preliminary observations on the oversight of the proliferation of BSL-3 and BSL-4 laboratories in the United States. (GAO Publication No. GAO-08-108T). 2007. http://www.gao.gov/new.items/d08108t.pdf

  36. U.S. Department of Health and Human Services. CDC generally met its inspection goals for the federal select agent program. However, opportunities exist to strengthen oversight. (Report no. OEI-04-15-00430). 2017. http://library.bryanhealthcollege.edu/c.php?g=3265&p=10833

  37. National Academy of Sciences and National Research Council. Biosecurity challenges of the global expansion of high-containment biological laboratories: summary of a workshop. Washington, DC: The National Academies Press; 2012. https://doi.org/10.17226/13315

  38. Ksiazek T. National Biocontainment Training Center. 2015. http://www.dtic.mil/dtic/tr/fulltext/u2/1002976.pdf. Accessed 27 Aug 2017.

  39. Le Duc J, Anderson K, Bloom M, Estep JE, Feldmann H, Geisbert JB, et al. Framework for leadership and training of biosafety level 4 laboratory workers. Emerg Infect Dis. 2008;14(11):1685–8. https://doi.org/10.3201/eid1411.080741

  40. American Association for the Advancement of Science. Biological safety training programs as a component of personnel reliability. 2009. https://absa.org/wp-content/uploads/2017/01/AAASBiosafetyTraining.pdf. Accessed 12 Aug 2017.

  41. World Health Organization. Emerging and dangerous pathogens laboratory network (EDPLN). 2015. http://www.who.int/csr/disease/OP_EDPLN_FINAL.pdf?ua=1. Accessed 3 Aug 2017.

  42. World Health Organization. New technology allows for rapid diagnosis of Ebola in the Democratic Republic of the Congo. 2017. http://www.who.int/emergencies/ebola-DRC-2017/articles/rapid-diagnosis/en/. Accessed 3 Aug 2017.

  43. Leroy E, Gonzalez JP. Filovirus research in Gabon and equatorial Africa: the experience of a research center in the heart of Africa. Viruses. 2012;4(9):1592–604. https://doi.org/10.3390/v4091592

  44. Rouquet P, Froment JM, Bermejo M, Kilbourn A, Karesh W, Reed P, et al. Wild animal mortality monitoring and human Ebola outbreaks, Gabon and republic of Congo, 2001–2003. Emerg Infect Dis. 2005;11(2):283–90. https://doi.org/10.3201/eid1102.040533

  45. World Health Organization. Factors that contributed to undetected spread of the Ebola virus and impeded rapid containment. One year into the Ebola epidemic. 2015. http://www.who.int/csr/disease/ebola/one-year-report/factors/en/. Accessed 20 Apr 2018.

  46. World Health Organization. Key messages from the WHO meeting on clinical aspects of Ebola virus disease. Advancing standards of clinical care. 2015. http://www.who.int/csr/disease/ebola/clinical-care-summary.pdf. Accessed 26 Sept 2017.

  47. Uyeki T, Mehta A, Davey R Jr, Liddell AM, Wolf T, Vetter P, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016;374(7):636–46. https://doi.org/10.1056/NEJMoa1504874

  48. Qiu X, Wong G, Audet J, Bello A, Fernando L, Alimonti JB, et al. Reversion of advanced Ebola virus disease in nonhuman primates with ZMapp. Nature. 2014;514(7520):47–53. https://doi.org/10.1038/nature13777

  49. Dodd LE, Proschan MA, Neuhaus J, Koopmeiners JS, Neaton J, Beigel JD, et al. Design of a randomized controlled trial for Ebola virus disease medical countermeasures: PREVAIL II, the Ebola MCM study. J Infect Dis. 2016;213(12):1906–13. https://doi.org/10.1093/infdis/jiw061

  50. U.S. Food and Drug Administration. Expanded access (compassionate use). 2017. https://www.fda.gov/NewsEvents/PublicHealthFocus/ExpandedAccessCompassionateUse/default.htm. Accessed 26 Sept 2017.

  51. Hantel A, Olopade C. Drug and vaccine access in the Ebola epidemic: advising caution in compassionate use. Ann Intern Med. 2015;162(2):141–2. https://doi.org/10.7326/M14-2002

  52. Rid A, Emanuel E. Ethical considerations of experimental interventions in the Ebola outbreak. Lancet. 2014;384:1896–9. https://doi.org/10.1016/S0140-6736(14)61315-5

  53. National Academies of Sciences, Engineering, and Medicine. Integrating clinical research into epidemic response: the Ebola experience. Washington, DC: The National Academies Press; 2017. Report No.: 9780309457767, 0309457769. https://doi.org/10.17226/24739

  54. Prevail II Writing Group, Multi-National PREVAIL II Study Team, Davey RT Jr, Dodd L, Proschan MA, Neaton J, et al. A randomized, controlled trial of ZMapp for Ebola virus infection. N Engl J Med. 2016;375(15):1448–56. https://doi.org/10.1056/NEJMoa1604330

  55. Henao-Restrepo AM, Camacho A, Longini IM, Watson CH, Edmunds WJ, Egger M, et al. Efficacy and effectiveness of an rVSV-vectored vaccine in preventing Ebola virus disease: final results from the Guinea ring vaccination, open-label, cluster-randomised trial (Ebola Ca Suffit!). Lancet. 2017;389(10068):505–18. https://doi.org/10.1016/S0140-6736(16)32621-6

  56. Huttner A, Agnandji ST, Combescure C, Fernandes JF, Bache EB, Kabwende L, et al. Determinants of antibody persistence across doses and continents after single-dose rVSV-ZEBOV vaccination for Ebola virus disease: an observational cohort study. Lancet Infect Dis. 2018. Epub. https://doi.org/10.1016/S1473-3099(18)30165-8

  57. Dungu B, Lubisi BA, Ikegami T. Rift Valley fever vaccines: current and future needs. Curr Opin Virol. 2018;29:8–15. https://doi.org/10.1016/j.coviro.2018.02.001

  58. Middleton D, Pallister J, Klein R, Feng YR, Haining J, Arkinstall R, et al. Hendra virus vaccine, a one health approach to protecting horse, human, and environmental health. Emerg Infect Dis. 2014;20(3):372–9. https://doi.org/10.3201/eid2003.131159

  59. Liberian Institute of Biomedical Research. Programs and capabilities of LIBR. 2017. http://libresearch.org/programs.html. Accessed 18 April 2018.

  60. Olinger G. Personal communication with Nahid Bhadelia. NIH/NIAID-IRF, MRI Global; 2017.

    Google Scholar 

  61. O’Dempsey T, Khan SH, Bausch DG, et al. Rethinking the discharge policy for Ebola convalescents in an accelerating epidemic. Am J Trop Med Hyg. 2015;92(2):238–9. https://doi.org/10.4269/ajtmh.14-0719

  62. Sealy T, Erickson B, Taboy C, Stroher U, Towner JS, Andrews SE, et al. Laboratory response to Ebola – West Africa and the United States. MMWR Morb Mortal Wkly Rep. 2016;65(3):44–9. https://doi.org/10.15585/mmwr.su6503a7

  63. Wölfel R, Stoecker K, Fleischmann E, Gramsamer B, Wagner M, Molkenthin P, et al. Mobile diagnostics in outbreak response, not only for Ebola: a blueprint for a modular and robust field laboratory. Euro Surveill. 2015;20(44):pii 30055. https://doi.org/10.2807/1560-7917.ES.2015.20.44.30055

  64. World Health Organization. Ebola situation report, September 16, 2015: Map of Mobile Laboratories. 2015. http://www.who.int/csr/disease/ebola/situation-reports/16-september-2015-map5.png?ua=1. Accessed 3 Aug 2017.

  65. Zhang Y, Gong Y, Wang C, Liu W, Wang Z, Xia Z, et al. Rapid deployment of a mobile biosafety level-3 laboratory in Sierra Leone during the 2014 Ebola virus epidemic. PLoS Negl Trop Dis. 2017;11(5):e0005622. https://doi.org/10.1371/journal.pntd.0005622

  66. Yen J. Personal communication with Sarah carpenter. National Emerging Infectious Diseases Laboratories; 2017.

    Google Scholar 

  67. University of Cambridge. Call of duty: fighting Ebola in Sierra Leone. 2017. http://www.cam.ac.uk/research/features/call-of-duty-fighting-ebola-in-sierra-leone. Accessed 13 Apr 2018.

  68. Federal Select Agent Program. Occupational health program. 2017. https://www.selectagents.gov/ohp-app2.html. Accessed 27 Sept 2017.

  69. Best M. Medical emergency planning for BSL-4 containment facilities. In: Richmond JY, editor. Anthology of biosafety V: BSL-4 Laboratories. Mundelein, IL: American Biological Safety Association ABSA; 2015. p. 98–295.

    Google Scholar 

  70. Courage K. Inside the 4 U.S. Biocontainment Hospitals that are stopping Ebola. Scientific American; 2014. https://www.scientificamerican.com/article/inside-the-4-u-s-biocontainment-hospitals-that-are-stopping-ebola-video/. Accessed 26 Sept 2017.

  71. Kreuels B, Wichmann D, Emmerich P, Schmidt-Chanasit J, de Heer G, Kluge S, et al. A case of severe Ebola virus infection complicated by gram-negative septicemia. N Engl J Med. 2014;371(25):2394–401. https://doi.org/10.1056/NEJMoa1411677

  72. Coalition for Epidemic Preparedness Innovations. Mission. 2017. http://cepi.net/mission. Accessed 26 Sept 2017.

  73. Yozwiak N, Happi C, Grant D, et al. Roots, not parachutes: research collaborations combat outbreaks. Cell. 2016;166(1):5–8. https://doi.org/10.1016/j.cell.2016.06.029

  74. Global Health Security Agenda. Global health security agenda. 2017. https://www.ghsagenda.org/. Accessed 27 Sept 2017.

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Carpenter, S., Bhadelia, N. (2019). Maximum Containment Infectious Disease Laboratories as an Integral Part of Emergency Preparedness and Emergency Response. In: Singh, S., Kuhn, J. (eds) Defense Against Biological Attacks. Springer, Cham. https://doi.org/10.1007/978-3-030-03053-7_7

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