Ed. Note: This concluding portion of the CBMTS VII executive summary is provided as a draft to the final CBMTS report. Presentation formats for each Sector were at the discretion of each Sector Chair or Chair's representative.
CBMTS VII, The Seventh Plenary in the Chemical and Biological Medical Treatment Symposium series
13 April - 18 April 2008, Spiez, Switzerland
Executive Summary: Part 2 Conclusion
Sectors 5 and 6
SECTOR 5: Detection/Decontamination/Special Interest
Chair: Walter Aue, SPIEZ LABORATORY, Switzerland
Co-Chair: Johnathan Kiel, AFRL/HEPC, Brooks City-Base, Texas, US
Presented by: Walter Aue
SECTOR 5 Sessions
Session 5: Special Interests
Chair: Timothy Henry
Co-Chair: Oliver Schirk
Session 11: Detection and Decontamination
Chair: Joseph Dudley
Co-Chair: Timothy Wood
Session 5: Special Interest
Presentations in this session discussed a broad range of special interest subjects, five of which focused on commercial products or processes.
Mr. Timothy Henry entitled his presentation "What Is Wrong With The Water". He discussed RSDL (reactive skin decontamination lotion) the product his company (E-Z-EM Inc) sells for topically neutralizing chemical warfare agents (CWA). Tim noted that the traditional use of water to dilute CWAs may actually worsen exposure to the agents, which are not water soluble, by spreading over larger portions of the body. When applied to exposed areas, his product neutralizes CWAs. It is as easy to use as sun block lotion and allows those exposed to CWAs to self medicate until further medical help is available. Users simply open the package containing the product, remove an impregnated sponge, and use it to apply the RSDL solution to exposed areas. Originally designed for the military, RSDL is now available to civilian agencies whose personnel (e.g., fire, police, emergency medical) will likely arrive first after a CWA release and may be exposed before protective measures are in place.
* Mr. Henry is the Vice President and General Manager of E-Z-EM, a healthcare company whose mission is to make the battlefield safer for war-fighters and civilian responders. He is based in the United States.
Mr. Oliver Schirk entitled his presentation "Measurement Of Biological Warfare Substances Using A Rapid Test System". He discussed the quick test system his company (Drager Safety) offers to rapidly detect bio-agents including anthrax, ricin, botulinum toxin, Yersinia Pestis, and Staphylococcal Enterotoxin B. The principle used is lateral flow with internal reference. For high concentrations of these agents, Mr Schirk's system provides results in three minutes. Lower concentrations may take ten minutes.
* Mr. Schirk is a specialist in portable detection systems for chemical and biological threats. He works for Drager Safety and is based in Germany.
Dr. Gerald Wannarka entitled his presentation, "The Auto-Injector As A Drug Delivery System". He discussed autoinjector technology for administering a broad range of premeasured pharmaceuticals for civilian and defense use. He described the various types, mechanisms, and power sources for the autoinjectors. He mentioned the technology was originally developed for the military to provide soldiers in the field a rapid means of self-medicating for exposure to chemical weapons. Now, however, the technology increasingly provides civilian medicine the means to deliver life-saving pharmaceuticals for anaphylactic shock and other applications including home administration of insulin.
* Dr Wannarka recently retired as the Senior Vice President and Chief Scientific Officer for Meridian Medical Technologies located in the United States.
Mr. Hannu Salmi entitled his presentation "Combined UV-Fluorescence And Background Aerosol Monitoring For Detection Of Intentional Release Of Airborne Biological Agents." He discussed the use of UV-florescence and "some electric property" to detect airborne biological agents that his company (Environics Oy) is developing into a product. He noted that the effectiveness of airborne detection using this technology depends on identifying and then compensating for the presence of natural background aerosols, which can confuse the detection of artificially spread bioaerosols. Mr. Salmi stated that an independent test laboratory verified that Environics' system produced excellent sensitivity to and selectivity for bioaerosols. A system that uses this technology could provide continuous monitoring and rapid detection of bio-aerosols. Following Mr. Salmi's presentation, Mr. Schirk and Mr. Salmi discussed the potential advantage of joining both of their technologies, Mr. Salmi's to produce an alarm for an unknown agent, Mr Schirk's for rapidly detecting the specific agent.
* Mr. Salmi is the managing director of Environics Oy, a provider of CBRN detection solutions. He is based in Finland.
Dr. Richard Karalus entitled his presentation "Disposable Integrated Micro-Fluidic Microarray Tests For Simple To Use, Low Cost Identification Of Infectious Agents". He discussed a system his company (CUBRC) has developed to diagnose bacterial and viral infections. The system employs patented three-dimensional gel element microarrays and injection-molded fluidics to integrate nucleic acid and antibody-based arrays into disposable test cartridges. The system allows surveillance and diagnosis of a wide range of infections including influenza A and B (including avian), human respiratory syncitial virus, adenovirus, SARS, Streptococcus, multidrug resistant Mycobacterium Tuberculosis, Yesinia Pestis, and Staphylococcus Pneumoniae. Dr. Karalus noted that healthcare professionals will be able to use his technology to rapidly and easily assess clinical samples for hundreds of genetic and protein based infections at low cost.
* Dr. Karalus is the director of Microbiology at CUBRC where he focuses on bio-defense programs. He is based in the United States.
Mr. Richard Nolan entitled his presentation "Logistics: Essential To Government, Often Overlooked". He discussed the problems with logistics planning and management by public health and agriculture officials in the US. He noted that the commercial sector and several US government agencies employ senior officials with extensive professional training to manage dedicated logistics agencies, divisions, and departments. By contrast, medical doctors in public health and veterinarians in agriculture -- neither with any training in logistics -- typically assume they should manage all aspects of their particular fields including logistics. That assumption has historically produced less than effective logistics support for human and animal disease outbreaks and could produce severe resource shortages during catastrophic outbreaks that terrorists might set intentionally. However, the implementation of the Strategic National Stockpile in the Department of Health and Human Services and the National Veterinary Stockpile in the US Department of Agriculture represent significant improvements since both employ logistics experts to plan logistics support before events and manage it during an event.
* Mr. Nolan is senior advisor to the Director of the United States National Veterinary Stockpile. He is based in the United States.
Session 11: Detection and Decontamination
The session was comprised of five papers, two papers on pathogen diagnostic assays and three papers on decontamination technologies and methodologies.
Walter Aue (Spiez Laboratory, Switzerland) presented results of experimental testing of 8 different firefighter foams (AFFF, protein, other, ...) and a decon foam with active chlorine (CASCAD) for the containment and mitigation of toxic vapor releases of DMMP and GB. The results showed that CASCAD is best suited for this use, since a 10cm layer of it covers and decontaminates GB. The other foams are also suitable for use against toxic vapor releases, but they vary greatly in their suitability and effectiveness in this special application.
Jonathan Kiel (Air Force Research Laboratory, USA) described the results of field tests on a new aptamer-linked immobilized sorbent assay (ALISA) for the detection of tularemia to evaluate the efficacy of this technology relative to that of available standard ELISA tests. The ALISA system will provide the basis for the development of new assays that do not require washing or multiple refrigerated reagents, and provide a more field hardy and flexible system than available standard ELISA format assays.
Timothy Wood (Protechnik Laboratories, South Africa) presented results of comparative studies of the effectiveness of COTS real-time PCR test kits for Roche Lightcycler against a novel SYBR-Green based kit for the detection of anthrax, using a Namibian anthrax isolate. The SYBR-Green kit provided detection sensitivity at acceptable levels, and is more user-friendly than some of the available COTS kits.
Pascale Ribordi (Stockholm Prehospital Center, Sweden) presented results of tests on the effectiveness of mobile decontamination units for emergency medical response to industrial chemical and CWA accidents which demonstrated serious flaws in the currently used equipment leading to significant agent vapor build-up in the units. This could lead to exposure of clean patients and unprotected emergency response personnel to chemical toxins.
Stef Steinstra (Active Technology Transfer Europe, Netherlands) described a new hydrogen peroxide based decontaminant spray technology which generates nanoparticulate mist particles (~ 1 micron) for disinfection of air as well as environmental surfaces in areas where disinfection and decontamination for recalcitrant pathogens may not be possible using more conventional methods. He summarized results of studies conducted in hospitals in the Netherlands which show that this technology is a very effective means for eliminating multi-antibiotic resistant Staphylococcus aureus from hospital environments, can be used against other pathogens (bacteria, virus spores), and should be a useful disinfection technology for decontaminating and detecting sites contaminated during bioterrorist attacks.
SECTOR 6: Emerging Threats: Dual Use, Biosafety and Biosecurity
Chair: Eric Stephen (Defence Research & Development Canada (DRDC)
Co-Chair: Dr. Martin Schütz, SPIEZ LABORATORY, Switzerland
Presented by:
SECTOR 6 Sessions
Session 9: The Emerging Threats: Dual Use, Biosafety and Biosecurity
Chair: Dr. Slavko Bolkan
Co-Chair: Dr. Peter Leitner
Session 13: Overview of the Initiatives for Proliferation Prevention
Chair: Dr. David Trudil
Co-Chair: Dr. Harry Deneer
The Emerging Threats: Dual Use, Biosafety and Biosecurity
Sector was delivered through two oral Sessions consisting of 8 papers. This is the second year for the Sector, inaugurated in 2007, and as with it predecessor, delivered a rich program that addressed a spectrum of issues from counter-proliferation to human factors in human CB vector identification to the responsibility of the scientific publishing community to best address the balance between the dissemination of scientific knowledge and public safety.
Session 9 began with a presentation that provided an example of how the Canadian journal editorial community is responding to the dual use issue. Dual-use research refers to research that has the potential to both generate valuable scientific knowledge and to intentionally or unintentionally pose a threat to public security. It was pointed out that Editors and Publishers of scientific journals are ultimately responsible for the final communication of research findings and as such, have certain responsibilities to authors, readers, and the general public. It is therefore recognized that Editors may at some point be faced with the question of how to handle manuscripts describing research that, while scientifically valid and valuable, may nevertheless carry a risk of being used for nefarious purposes. The presentation addressed two questions: firstly, should journal Editors and Publishers function as gate-keepers in the dissemination of information that may have dual-use potential; and secondly, if the answer to the preceding question is "yes", what level of involvement is appropriate and how is this best achieved in an operational sense?
These questions were recently deliberated by a group of Editors of Canadian scientific journals and as a result, a strategy was proposed by which manuscripts submitted for publication are first assessed for their dual-use potential, and then communicated in a manner that balances accountability to authors, scientific openness, and public safety. Operationally, this strategy includes:
- the development of an editorial policy statement which clearly articulates the position of the Journal with regard to the publication of sensitive information.
- the cultivation of a peer review system wherein reviewers are educated, using relevant case studies, as to what constitutes a "dual-use" risk before being asked to make such determinations for manuscripts which they themselves are asked to review.
- a description of the possible options available to Editors when faced with making a publication decision for a manuscript that may pose a dual-use risk. Rather than being limited to a "publish or not publish" option, choices include the addition of contextual information, the deletion of sensitive material, and/or the inclusion of an editorial commentary.
At this time, this strategy is being considered for adoption by the NRC Research Press in Canada, with the option of making it available to other Canadian journal publishers as well.
The second presentation of Session 9, addressed the promise and potential threats associated with exciting new developments in nanotechnology. The novelty of these materials lies in the unique physical and chemical properties at nanoscales. Nanotechnology is impacting all aspects our lives, through their use in a variety of processes that include electronics, chemical catalysis, manufacture of consumer products, sensors/detectors/monitors, protection and finally, delivery of pharmaceutical products such as vaccines and other drugs. The presentation noted that there was the potential for both positive and negative consequences through the increasing use of nanotechnology. The technology needs to be understood in terms of for example, toxicity and the potential for environmental impacts. The technology is expanding exponentially. The impacts of this technology need to be understood and explored to ensure that there are not inadvertent outcomes that can not be undone. Along with the potential for enormous benefit the potential threat needs to be acknowledged and the potential need for regulatory oversight was raised.
Our third speaker explored the role for risk assessment and pointed out that CBR threats do not present a uniform risk and that each threat and its associated risks have implications for those responding to a variety of threats. The results of a NBRC study were provided. The data generated would be used to inform policy makers in terms that were understandable to and in contextual framework that was understandable to policy decision makers. The "NRBC" risk can be refined into at least 11 separate risks. The most important in terms of potential impact are those which are least likely. Those risks which are more likely may employ unexpected agents or delivery mechanisms. Each risk carries its own implications for getting help to the people affected and for the health and security of aid workers. It is far from clear how, if an international response is required, this assistance can be provided without undue risk to those providing it. It was noted that the political and security implications for each risk are serious and complex. In relation to use of such weapons, our risk assessment can be refined as low (nuclear weapons, improvised nuclear devices; chemical warfare; highly infective and contagious anti-human biological agents with global implications; bacterial agents which are infective but whose effects can be treated and of which human-to-human transmission is controllable), medium (radiological device; non-contagious agents; infective and contagious agents against animals or plants; "new" chemical weapons) and finally high (limited or small-scale use of chemical weapons; riot control agents).
The fourth presentation of the Session provided insights into the area of biosafety and biosecurity. The presenter noted that adequate biosafety and biosecurity training is essential to work safely with hazardous biological agents, especially in light of the increasing numbers of higher containment facilities. The need for biosafety and biosecurity training is even more relevant with the increasing level 4 (BSL4) laboratory capacities and the higher number of scientists, technicians and biosafety professionals working in and maintaining BSL4 laboratories. To that end the Spiez Laboratory has dedicated one unit within the new BSL4 facility for education and training purposes. Besides the technical infrastructure for hands-on training on level 4, the laboratory is positioning itself to provide a unique capability to provide international education and training programmes on biosafety and bosecurity.
Rounding out the first Session in the Sector, we moved from Biosecurity on a local scale to an exploration of biosecurity on a global basis effected through disease surveillance was considered. Emerging zoonotic pathogens, in both the developed and developing world are becoming increasingly important public health threats and tied with their potential as bioweapons capable of significantly impacting world economies. There is a potential for the exploitation of some newly pathogens as biological weapons agents, and some of these pathogens have already been investigated for their potiential as biowaepons agents. With the exception of smallpox, all known bioweapon pathogens are zoonoses - diseases that infect animals as well as humans. The public health risks associated with bioweapons use of zoonotic pathogens includes not only human disease and mortality, but also potential "spill-over" effects from environmental contamination on wild and domestic animal populations, which if infected may serve as reservoirs and amplifying sources for subsequent "spill-back" secondary BW disease outbreaks among human populations.
The profound economic impacts of the rapid global spread of the SARS coronavirus in 2003, and the still-ongoing global spread and proliferation of the highly pathogenic A/H5N1 avian influenza virus, demonstrate the importance of increasing global capabilities for the surveillance and diagnosis of diseases transmitted between and among human beings, domesticated animals, and wildlife. Recent experiences with emerging zoonotic diseases in North America (West Nile Virus, monkeypox), Africa (Ebola and Marburg hemorrhagic fever viruses), and Asia (Nipah virus, H5N1 bird flu virus, SARS coronavirus), and a global resurgence of public health threats associated with natural infections by re-emerging bacterial pathogens such as anthrax and plague, demonstrate the need for the development new methods and technologies for the detection and treatment of emerging and re-emerging zoonotic disease pathogens, and the potential for local, regional and potentially global spread and proliferation of zoonotic biowepons pathogens following accidental or deliberate release from laboratory or storage facilities.
Greater attention needs to be placed on identifying the mechanisms by which emerging pathogens such as the H5N1 bird flu, Nipah virus, and SARS develop human-to human transmission capabilities, and whether these H2H transmission mechanisms can be targeted directly by treatment and prophylaxis regimens. There is a need for increasing the effectiveness of global zoonotic disease surveillance networks in order to counter the public health threats from emerging disease outbreaks, to identify outbreaks of diseases that could be the result of clandestine bioterrorist attacks, and to detect and trace potential escapes or accidental deployments of pathogens from clandestine BW laboratory facilities.
Session 13 began with an "Overview of the Initiatives for Proliferation Prevention", a program established by the US Congress in 1994 to enhance national security and enlist scientists in the pursuit of viable commercial projects. Scientists within FSU former weapons labs were teamed with US commercial entities to develop technologies for commercialization. As opposed to typical grant programs, the IPP projects paid FSU scientists after completion of a sub task or task. Monies were transferred into the individual's account, free of local taxes, once reviewed by both the US DOE lab and the commercial partner. The US partner also contributes to the project and therefore has commercial rights outside the FSU. Several projects were discussed with both issues and opportunities highlighted, including two new spin-off companies. The benefits include not only scientific exchange but an appreciation and understanding of the economic and regulatory issues inherent in both the FSU and Western environments. Although the current program is focused on the former FSU, there is a potential for the program to expand to include non-weapon scientists within the middle east and far east.
The second and final speaker of the Session brought in a human factors perspective in talking about humans as vectors for chemical or biological agent dissemination. When we think of dissemination of chemical or biological weapons, we often think in terms of mechanical dissemination. The human, as vector, can not be ruled out, and has been used effectively by suicide bombers. Technological solutions, that is, computer and sensor-based approaches to detect and warn, against covert activity although effective, are not universally available. Simpler, low tech, observer-based systems have been used effectively. These systems rely on behavioral observations, making the assumption that the vector will have been exposed to the chemical or biological agent to be delivered and will be symptomatic. Such vectors can have both tactical and strategic intent. Although mass casualty events are not easily creatable through such vectors damaging economic and psychological impacts can be significant. Using Polonium 210 as an example, the key variables were lethality and transmissibility. Masking techniques/symptom suppression are confounders that impact screeners ability to detect potential human vectors.
In summary, the emerging threat spectrum is varied and in flux. CBRN and security professionals everywhere need to be cognizant of and recognize emerging threat and note solutions that have worked or are being developed against weapons of mass destruction (WMD) whether formulated by terrorists, domestic or foreign.
Editor's Note: We very much appreciate the efforts of the Sector and Session Chairs and the 93 individual presenters for making this 15th CBMTS meeting the huge success that it was.
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