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Gary Evans writes Hospital Infection Control & Prevention (HIC), Hospital Employee Health (HEH) and contributes to IRB Advisor (IRB). As senior writer at AHC, Evans has written numerous articles on infectious disease threats to both patients and health care workers, including pandemic influenza, MERS and Ebola. He has been honored for excellence in analytical reporting five times by the National Press Club in Washington, DC.
Reeling from a series of stunning breaches in laboratory safety, the Centers for Disease Control and Prevention is doing a comprehensive review of its lab procedures, forming a laboratory advisory committee of top national scientists, and appointing a single point person to assess lab activities and report directly to CDC director Tom Frieden, MD, MPH.
The recent incidents involved three deadly agents, any of which could be used as a bioterrorism weapon if it fell into the wrong hands: anthrax, H5N1 avian influenza, and – astoundingly – smallpox. The latter is our focus for today because smallpox is in a league of its own when it comes to human pathogens.
Smallpox was the scourge of the planet in a reign of thousands of years and millions of deaths, killing monarchs and peasants alike in horrific, disfiguring fashion. With the development of vaccine, the variola virus was finally declared eradicated in the wild in 1980 in what remains one of the greatest public health achievements of all time. Epidemiologists used a “surveillance and containment” strategy of identifying cases and vaccinating the population around them. Though the U.S. has stockpiles of smallpox vaccine in case of emergency, immunization is no longer routinely done and the vast majority of the people on the planet are susceptible to a rapidly transmitted disease that will kill at least a third of those infected and badly scar many others. A single case of smallpox anywhere in the world would be a public health emergency.
The officially acknowledged stocks of live smallpox virus – the so-called “demon in the freezer” -- are stored at the CDC in Atlanta and the Russian State Research Center of Virology and Biotechnology in Koltosovo. The World Health Organization has recommended for years that these stocks be destroyed, but the two rival nations continue to hold them in a manner reminiscent of Cold War weapons. Now, however, it turns out that there was a third cache of smallpox, long forgotten in a lab storage area at the National Institutes of Health in Bethesda, MD. After the recent discovery of six vials of smallpox -- dated February 10, 1954 – the NIH alerted the CDC and transported them to Atlanta. CDC scientists worked through the night and found that at least two of the vials contained live smallpox. The investigation is ongoing, so the other vials may also contain viable smallpox.
“There was no risk to workers or to the public, but this event also should never have happened,” says Frieden. “My understanding is that NIH will scour their entire campus to see if there are any other stray materials that shouldn't be present, and CDC, which has a regulatory function in this area, will monitor their progress and completion in doing this. … The problem was not in the creation of the materials but in the inventory control which allowed them to remain unsecured for decades. They should have been destroyed decades ago, and once we complete the work here, we will destroy them.”
Though this monumental oversight occurred at the NIH, all smallpox is supposed to be at the CDC, which has seen its global reputation as the gold standard in public health considerably diminished by all three of the laboratory events.
“Together, these events I’m sure have many people asking and questioning government labs,” Frieden says. “They may be wondering whether we're doing what we need to do to keep our workers and our communities safe. And I think it's fair to raise those questions. I’m disappointed by what happened, and frankly, I’m angry about it.”