Anthrax: tracing and containing the threat

You might think it highly unlikely that live samples of anthrax could mistakenly find their way to 19 US states and, at the time of writing, four foreign countries - but that’s exactly what happened. So, how was this possible and what processes are in place to contain and control deadly bacteria?


Anthrax

Earlier this year it was revealed that the US military's Dugway Proving Ground laboratory in Utah had shipped live samples of anthrax - a disease caused by the bacterium Bacillus anthracis - to laboratories and foreign countries.

The scope of the problem has grown daily, with new cases appearing and statements from US officials regularly finding their way to newspaper and website front pages across the globe.

The Centers for Disease Control and Prevention (CDC) quickly announced a review and the US Department of Defense (DoD) launched what it calls a "comprehensive review of its laboratory procedures", which will work closely with the CDC.

US Undersecretary of Defense for Acquisition, Technology and Logistics Frank Kendall will lead the DoD investigation, looking at the root causes of the failure to deactivate the anthrax, the procedures in place for biohazard safety, adherence to these procedures and necessary solutions to any problems that are identified.

Tracing the chain

At the end of May it was reported the anthrax from the laboratory, which should have been deactivated or destroyed, had mistakenly been sent to as many as nine labs and the US military Osan Air Base in South Korea.

The BBC reported that 22 people at the base were receiving treatment for possible exposure, including "appropriate medical precautionary measures to include examinations, antibiotics and in some instances, vaccinations".

Spores can get into the body through inhalation, from eating or drinking contaminated products, or via a cut or scrape in the skin. If exposed, the body can suffer from haemorrhaging, swelling, falling blood pressure and possibly death.



Bioweapons such as Anthrax, Botulism and Variola have been studied as weapons, engineered and in some cases even deployed.


Pentagon spokesperson Colonel Steve Warren said at the time that "out of an abundance of caution, [the DoD] has stopped the shipment of this material from its labs".

However, if officials thought this was the end of it, they were very wrong. On 30 May it emerged that a portion of a batch of bacteria dating from 2008 had been sent to Australia, and just two days later USA Today reported that Canada had joined the list of destinations.

At this time it was stressed that the public was not in any danger, although on 4 June up to 31 military and civilian lab workers were being treated with antibiotics.

Referring to the rapidly developing situation, Deputy Defense Secretary Bob Work said: "We expect this may rise because the scope of the investigation is going on."

Work was proven right when the UK become the latest country linked with lapse. In 2007 shipments of the deadly spore were sent to a private company in the UK, although the UK Health and Safety Executive (HSE) confirmed the samples had been destroyed many years ago.

"If anyone would have been exposed in 2007, symptoms would have presented shortly after. No such reports of ill health were apparent in the workforce," a HSE spokesperson was quoted as saying by the Telegraph.

Understandably, the revelations have provoked criticism. Several members of the US Congress said in a statement, quoted on NBC News, that they were "deeply concerned" about the "issue of inactivation protocols and procedures for studying dangerous pathogens in our federal research laboratories", and urged those in a position to do so to prevent lapses before someone is seriously harmed.

Biosafety: controlling Anthrax

Dr Amesh A. Adalja, a senior associate at the UPMC Center for Health Security, says that, even without a risk to human health, the news highlights that biosafety lapses occur even at the most sophisticated labs, creating the potential for injury.

"Events like this occur when biosafety procedures, which are usually in place and effective, are not followed to the letter or when a procedure is malfunctioning and there is no redundant check on the process to ensure it was effective.

"These lapses may unfortunately cause the public to believe that this vital research is too dangerous."

"Such [biosafety] procedures may involve irradiating materials, treating materials with formaldehyde-like compounds as well as proper storage and shipping protocols."

Anthrax samples are meant to be irradiated to kill live spores before they are shipped to other labs for research. Research that will focus on improving the vaccine, improving treatment, and understanding how the bacteria might behave when released.

A federal investigation report obtained by USA Today in June claims that the Dugway Proving Ground's Life Science Test Facility failed to implement the correct procedures.

It states that there were three violations of federal regulations for working with potential bioterror agents, adding that Dugway's procedures "did not account for the variable amounts of spores treated in the gamma cell irradiator", and were "not validated using standardised control spore samples at varying concentrations, volumes, and levels of irradiation."

The report's author, the CDC's Division of Select Agents and Toxins, claims the information has been shared with the US military.

However, USA Today has also reported that Dugway faced potential sanctions for its failure to kill specimens of anthrax as far back as 2007, although the method used was different to irradiation

According to the publication, an experimental chemical method was ineffective, leading to the transfer of anthrax bacteria to another facility. It goes on to claim that staff at Dugway ignored results of their own tests to confirm the deactivation of bacteria, and proceeded to ship the sample.



The UK Government's newly released Biological Non-Proliferation Programme supports research into 'dual-use' pathogens.


This chimes with what Adalja says: "Ultimately, human error will have played a role because all the biosafety procedures were put in place by a human. However there may have been mechanical issues with the irradiation procedure and those will also need to be assessed."

Vital research put at risk

As highlighted earlier, anthrax, in a controlled environment, is used to improve our understanding of the bacteria and develop vaccines and treatment for exposure.

Events where the safety of research is put into question only serve to undermine this process, and are worrying developments for Adalja.

"Fourteen years after the anthrax attack on America (where letters containing anthrax spores were sent, killing five people), many in the general public have forgotten about the real risk of another attack with anthrax and how vital the research done on
anthrax is to fortifying the world's defences against another attack.

"These lapses may unfortunately cause the public to believe that this vital research is too dangerous."

Coming after another similar lapse in 2014, when the CDC sent live anthrax bacteria that caused the closure of flu and anthrax laboratories in Atlanta, there are certainly question marks surrounding safety and accountability.

"Abilities to diagnose and survey for novel infectious diseases are still inadequate and with contagious diseases, spread may occur prior to recognition."

In 2013 a Government Accountability Office report noted "a continued lack of national standards for the design, construction, commissioning, and operation of high-containment laboratories".

However, with a CDC spokesperson telling the Guardian that 181 organisations are registered as working with anthrax, the key for the ongoing reviews, says Adalja, is to identify how and why the lapse occurred, and "ensure that the risk of future mishaps like this are minimised".

While there is no suggestion that any of the samples have caused a wide-scale threat and the risk to public health has been relatively low, Adalja believes there is much room for improvement in how we respond to infectious disease threats.

"There has been significant improvement in the ability to respond to infectious disease threats - natural or intentional - since 2001, however there is still much room for improvement," Adalja adds.

"Abilities to diagnose and survey for novel infectious diseases are still inadequate and with contagious diseases, spread may occur prior to recognition. As we are seeing with the Ebola outbreak in West Africa, which took three months to identify, if early recognition is not achieved, control measures become much more difficult."

It is the now the responsibility of the US military to ensure that, following the review, a similarly embarrassing episode of ineptitude does not happen again.