Section VIII – Agent Summary Statements

Section VIII:  Agent Summary Statements (Bacterial Agents, Fungal Agents, Parasitic Agents, Rickettsial Agents, Viral Agents, Arboviruses and Related Zoonotic Viruses, Toxin Agents, Prion Diseases)

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106 Comments

  1. KP's Gravatar KP
    May 21, 2016    

    Changes over the past couple of years with importing agents and regulation changes were not know to PIs until they tried to import them from other countries. If it would be helpful if the agents under the CDC import are noted under ther agent section.

  2. Julia Hilliard's Gravatar Julia Hilliard
    May 21, 2016    

    As I read a number of comments, it seems that there is a lack of knowldege about BSL4 diagnostic labs. Perhaps some information could be provided that there are BSL4 laboratories that provide diagnostic reference services.
    For the section on B virus, I have some suggestions and updating. Firstly, list B virus, Herpes B virus (and in italics, Macacine herpesvirus 1). To the first paragraph, it would be helpful to the readers to add that B virus reactivation has been documented to occur in indivdiuals who have survived acute infection. I can provide the reference materials for these cases if the steering members would find that helpful.

    In the section of occupational infections, it would be helpful to also note that zoonotic infections have been documented in the absence of known exposures. Zoonotic infection resulting in seroconversion both with and without acute disease have occurred in individuals who report exposures with seronegative macaques. Seronegative macaques do not validate that a macaque is B virus-free.

    In the section on Natural Modes of Infection:

    Up to 90% of wild caught macaques are B virus antibody positive (not 10% as listed). At the time of capture, 7-10% may be shedding virus. Shedding, an intermittent event, from mucosal membranes may occur in the absence of lesions, and is for variable lengths of time. B virus is not a blood-born virus. To date, all species of macaques are capable of being natural reservoirs for B virus as determined by the presence of specific antibodies.

    Under Special issues, within the first sentence, “….considered for significant exposures…..” the word significant should probably be dropped because the consensus opinion is that even minor exposures can result in zoonotic infection. Stratification of the severity of injury is no longer done by the majority of institutions.

    Select Agent. Currently B virus is not a Select Agent.

    Thanks for the format to make suggestions.

  3. K. Perry's Gravatar K. Perry
    May 20, 2016    

    Section VIII-E Viral Agents. The introductory paragraph should provide more background on the specified virus. The content that provides additional background information in the “Special Issues” section should be moved into introductory paragraph.

  4. William Nicholson's Gravatar William Nicholson
    May 13, 2016    

    Coxiella burnetii
    Coxiella burnetii had long been handled by rickettsiologists, but has since been removed from the bacterial order. It should not be lumped into the rickettsial agents, but addressed separately in the new BMBL.
    Coxiella burnetii is almost ubiquitous in the environment, and frequently detected in farms, etc. with no obvious ill effects on humans. But when in higher concentrations (exposure to birth fluids, laboratory propagation without proper safety measures, etc.) can cause large outbreaks. The BSL levels used in the BMBL 5th ed. should be continued in the new edition.

    Coxiella burnetii has long been listed as an important laboratory hazard due to a high number of cases reported in earlier time periods (Pike 1976). This situation was caused by inadequate facilities, broken equipment, or certain procedures that made aerosolization more likely. The section should be updated to reflect the situation today. A more recent study (Rusnak et al. 2004) showed that the inherent risks of working with Coxiella burnetii have been ameliorated by changes in policies and safety equipment. The introduction of routine vaccination has reduced infection by Coxiella burnetii to zero at an active military research facility. The access to the vaccine remains problematic for US workers because the IND vaccine produced by the Army is no longer available and the QVax vaccine produced in Australia is not licensed for the US. In order to be vaccinated, one must travel to Australia for the skin test and the vaccination, which is an expensive option.

    Coxiella burnetii has been proposed to be removed from the Select Agent list. Public comments have been completed, but a final decision has not yet been issued. Any updated BMBL should reflect the status of this agent at the time of publication.

    A number of Coxiella endosymbionts are known to inhabit many tick species. These are not known to be transmitted to a host upon feeding and no pathogenicity for humans or any other vertebrate is known. These organisms should not be treated as Coxiella burnetii-like (with the associated properties or hazards).
    Rusnak, J. M., M. G. Kortepeter, R. J. Hawley, A. O. Anderson, E. Boudreau, E. Eitzen. 2004. Risk of occupationally acquired illnesses from biological threat agents in unvaccinated laboratory workers. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science 2 (4): 281-293.
    Disclaimer: The views expressed are those of the author and not necessarily representative of the official position of the Centers for Disease Control and Prevention.

  5. William Nicholson's Gravatar William Nicholson
    May 13, 2016    

    Disclaimer: The views expressed are those of the author and do not necessarily represent the official position of the Centers for Disease Control.

    Overall
    Recommendations on the rickettsial agents have been out-of-date in the BMBL for several editions. The rickettsial agents were treated as an aggregate group with similar properties and hazards, when in reality, they are a very diverse group of organisms with a full spectrum of properties. They should be addressed separately or in smaller groups and not as a bacterial order as a whole. This aggregation of recommendations has been detrimental to the conduct of rickettsial research at many universities as the governing bodies at the institutions have interpreted the recommendations differently. BSL-3 is not required for all species of Rickettsia.

    Rickettsia rickettsii
    Rickettsia rickettsii is no longer included on the Select Agent list (removed effective Dec. 2014). The current BMBL biosafety levels for various activities are suitable. The use of ABSL-3 for all animal work may not be justified.
    Rickettsia prowazekii
    Rickettsia prowazekii has been proposed to be removed from the Select Agent list. Public comments have been completed, but a final decision has not yet been issued. Any updated BMBL should reflect the status of this agent at the time of publication. The current BMBL biosafety levels for various activities are suitable. The use of ABSL-3 for all animal work may not be justified.
    BSL-3 should be retained for propagative activities of Rickettsia prowazekii, Rickettsia rickettsii, Rickettsia typhi, and Orientia tsutsugamushi due to the potential for severe illness and laboratory aerosolization. However, the use of BSL-3 may not be justified for certain rickettsial pathogens that infect humans as there is limited or no documented evidence for laboratory risk with those species. BSL-2 is needed for many of the species, with BSL-3 restricted to any manipulation known to create aerosols.
    Rickettsia spp.
    A number of rickettsial species have been genetically delineated, but not formally designated with new species names. These designations (Candidatus species and other taxa) do not have formal recognized names. They are often detected in ticks or animals, but their pathogenicity to humans is not known. We suggest that these be handled at BSL-2 unless and until a higher safety category is justified.
    Ehrlichia spp.
    The genus Ehrlichia contains several species that infect humans: E. chaffeensis, E. ewingii, E. muris, E. ruminantium (African and Panola Mountain strains), and E. canis. I propose consideration of handling these agents at BSL-2 for all activities. Many of these agents are veterinary pathogens and have been handled safely at BSL-2 levels in clinics and animal hospitals for many years.
    Anaplasma spp.
    Anaplasma phagocytophilum is the primary cause of anaplasmosis in humans. The species Anaplasma platys has been shown to have infected humans in Venezuela. Anaplasma ovis has infected humans in Cyprus and Iran, while a new agent, designated “A. capra” has been found to infect humans in China. I propose consideration of handling these agents at BSL-2 for all activities. Many of these agents are veterinary pathogens and have been handled safely at BSL-2 levels in clinics and animal hospitals for many years.
    “Candidatus Neoehrlichia spp.”
    This candidate genus includes at least one species (“Candidatus Neoehrlichia mikurensis”) that infects humans. Because of the growing interest and detection of this agent globally, we propose that it be included in the BMBL. I propose consideration of handling these agents at BSL-2 for all activities.

  6. William Nicholson's Gravatar William Nicholson
    May 13, 2016    

    Please add Heartland virus to the list of arboviruses. I have listed the pertinent information for consideration.

    Name Acronym Taxo status (genus) Biosafety Basis Antigenic group HEPA filtration
    Heartland virus HRTV Phlebovirus 2 A7 Heartland/SFTS group No

    References:

    Savage, H.M., M. S. Godsey, Jr., N. A. Panella, K. L. Burkhalter, D. C. Ashley, R. R. Lash, B. Ramsay, T. Patterson, and W. L. Nicholson. 2016. Surveillance for Heartland virus (Bunyaviridae: Phlebovirus) in Missouri during 2013: First detection of virus in adults of Amblyomma americanum (Acari: Ixodidae). J. Med. Entomol. (online on March 30, 2016) [doi:10.1093/jme/tjw028]
    A. M. Bosco-Lauth, N. A. Panella, J. J. Root, T. Gidlewski, R. R. Lash, J. R. Harmon, K. L. Burkhalter, M. S. Godsey, H. M. Savage, W. L. Nicholson, N. Komar and A. C. Brault. 2015. Serological investigation of Heartland virus (Bunyaviridae: Phlebovirus) exposure in wild and domestic animals adjacent to human case sites in Missouri 2012-2013. Am. J. Trop. Med. Hyg. 92 (6): 1163-1167.
    Savage, H. M., M. S. Godsey, Jr., A. Lambert, N. A. Panella, K. L. Burkhalter, J. R. Harmon, R. R. Lash, D. C. Ashley, and W. L. Nicholson. 2013. First detection of Heartland virus (Bunyaviridae: Phlebovirus) in field collected arthropods. Am. J. Trop. Med. Hyg. 89 (3): 445-452.
    McMullen, L. K., S. M. Folk, A. R. Kelly, A. MacNeil, C. Goldsmith, M. Metcalfe, B. Batten, C. Albarino, S. Zaki, P. Rollin, W. L. Nicholson, and S. T. Nichol. 2012. A new phlebovirus associated with severe febrile illness in Missouri. New Engl. J. Med. 367 (9): 834-841. [supplemental appendix available on http://www.nejm.com]
    Matsuno, K., C. Weisend, M. Kajihara, C. Matysiak, B. N. Williamson, M. Simuunza, A. S. Mweene, A. Takada, R. B. Tesh, and H. Ebihara. 2015. Comprehensive molecular detection of tick-borne phleboviruses leads to the retrospective identification of taxonomically unassigned Bunyaviruses and the discovery of a novel member of the genus Phlebovirus. J. Virology 89: 594-604.

    Disclaimer: The views expressed are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

  7. Anonymous's Gravatar Anonymous
    May 12, 2016    

    The list of Select Agents and Toxin (BSAT) have been updated since the BMBL 5th was published, and the list is scheduled to be revised again this year. The Agent Summary Statements should be thoroughly scrubbed to ensure that they accurately reflect the current status of each agent with respect to all the select agent regulations: 42 CFR. Part 73, 7 CFR Part 331, and 9 CFR Part 121.

  8. Shoolah Escott's Gravatar Shoolah Escott
    May 12, 2016    

    Please add in to each agent the level that specimens should be handled at versus higher concentrations of organisms e.g., cultures. This will be extremely helpful for the clinical labs. For example, when they were trying to determine how to handle Ebola specimens many clinical labs thought they had to have BSL-4 labs. However, that is not the case to just process the specimens or do non-culture testing.

  9. Sonia Godoy-Tundidor, PhD's Gravatar Sonia Godoy-Tundidor, PhD
    May 11, 2016    

    * Risk groups are not included for any of the pathogens listed and I think that is more important than biosafety levels, since BSLs depend on a risk assessment.

    * Permits may be required for the transfer of most pathogens listed, as specified under the “Transfer of Agent” section of each of them. Could that section be listed just once as general information for each group of pathogens (bacteria, viruses, etc.)?
    * Page 213 and others: Please change “positive air-purifying respirator” to “powered air-purifying respirator”.

    * Table 4 (page 234) explains the symbols used on Table 6 (page 246). Can those two tables be brought closer or, at least, have a note on Table 6 directing you to page 234 for an explanation of symbols?

    * Please add the definition of epizootic (disease temporarily prevalent and widespread in an animal population; an outbreak) and enzootic (of, relating to, or denoting a disease that regularly affects animals in a particular district or at a particular season) on page 242 or 243 (EEE, VEE & WEE viruses).

    * Please add the meaning of the acronym OIE (World Organisation for Animal Health) on page 244.

    * Would it be possible to break Table 6 into smaller tables by family or genus besides alphabetical order?

    * Table 7: Please change “Latrogenic CJD” to “Iatrogenic CJD” (with “i” instead of “l”).

  10. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Bacterial Agents: Brucella species–“Cases have occurred in clinical laboratory settings from sniffing bacteriological cultures or working on open bench tops”.30,++,+++

    ++ Traxler RM, Lehman MW, Bosserman EA, et al. A Literature Review of Laboratory-Acquired Brucellosis. J Clin Microbiol. 2013;51(9):3055–3062.

    +++ Traxler RM, Guerra MA, Morrow MG, et al. Review of Brucellosis Cases from Laboratory Exposures in the United States in 2008 to 2011 and Improved Strategies for Disease Prevention. J Clin Microbiol. 2013;51(9):3132–3136.

  11. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Bacterial Agents: Brucella species–Laboratory Safety and Containment Recommendations: Include, bone marrow, lymph nodes, liver and spleen, as tissues that can be infected.

  12. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Bacterial Agents: Brucella species–Natural Modes of Infection: Include raw cheese made from contaminated milk

  13. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Bacterial Agents–Brucella species: Select Agent This section is likely to need updating prior to publication of the 6th edition of BMBL if new recommendations are accepted by the Federal Select Agent Program. Brucella abortus and B. suis may be removed from the list of select agents and B. melitensis may become a USDA-only regulated select agent.

  14. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Bacterial Agents–Brucella species: Twelve *Brucella species have been described using epidemiologic and biological characteristics, although at the genetic level all brucellae are closely related. B. melitensis (natural host: sheep/goats), B. suis (natural host: swine), B. abortus (natural host: cattle), B. canis (natural host: dogs), B. ceti (natural host: marine mammals) and B. inopinata (natural host: unknown)**, have caused illness in humans exposed to the organism including laboratory personnel.

    * Scholz HC, Revilla-Fernández S, Al Dahouk S, et al. Brucella vulpis sp. nov., isolated from mandibular lymph nodes of red foxes (Vulpes vulpes). Int J Syst Evol Microbiol. 2016;66:2090-2098.

  15. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII: Pox Viruses–Other considerations: The phone numbers provided needed to be updated. The latter phone number is no longer a CDC number.

  16. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII: Pox Viruses: Occupational Infections and Laboratory Safety and Containment Recommendations–Both of these sections should be updated to include information provided in the most recent ACIP recommendations for lab workers and poxviruses (published March 17, 2016 in MMWR).

  17. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII: Pox viruses-General: This section should be updated to include information on ORF viruses.

  18. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII: Bacillus anthracis: Special Issues: “permit from USDA/APHIS/VS”

    Is this SA form 2? It should specify that.

  19. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Bacillus anthracis : Special Issues: “Worker vaccination is recommended for … 3) performing confirmatory testing for B. anthracis, with purified cultures… Vaccination is not recommended for workers involved in routine processing of clinical specimens or environmental swabs in general diagnostic laboratories.”

    This seems contradictory. Says it is not needed in diagnostic labs. But is needed for confirmatory testing of cultures. So what about a Public Health Laboratory (PHL). There are very few PHL’s that have anthrax vaccinated staff. They should talk about mitigation strategies to the risks

  20. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Bacillus anthracis –Laboratory Safety and Containment Recommendations: “Workers who frequently centrifuge B. anthracis suspensions should use autoclavable aerosol-tight rotors. In addition, regular routine swabbing specimens for culture should be routinely obtained inside the rotor and rotor lid and, if contaminated, rotors should be autoclaved before re-use”

    This seems out of place here. Maybe they should have a section on decontamination of equipment and work surfaces. This is suggesting that you should do routine environmental monitoring for contamination. Should it only be for centrifuge? Or other equipment too?

  21. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Bacillus anthracis — Laboratory Safety and Containment Recommendations: “BSL-2 practices, containment equipment, and facilities are recommended for activities using clinical materials and diagnostic quantities of infectious cultures.”

    There is a major gap between what is recommended here and what the select agent program requires. According to this, we do not have to perform BA testing in our BSL3, but I think SA program will argue this.

  22. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A- Bacillus anthracis: Laboratory Safety and Containment Recommendations–“Efforts should be made to avoid production of aerosols by working with infectious organisms in a BSC. In addition, all centrifugation should be done using aerosol-tight rotors that are opened within the BSC after each run”

    This is best practice for working with any infectious agent. Are there any additional recommendations specific for anthrax? What about inactivation? Should all work be done in a hood? If this paragraph is specific for diagnostic work, it should say that.

  23. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A-Bacillus anthracis: “ It is believed that very few spores (10 or less) are required for cutaneous anthrax.” This statement should be updated reflecting data published from the 2001 Anthrax cases.

  24. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Recommendation would be helpful for clinical laboratories on how to work with diagnostic specimens that could contain either a BSL 2 or BSL 3 arbovirus. Recommendation needed for both arboviral testing and how to complete other diagnostic testing, if universal precautions are not sufficient.

  25. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Explore an alternative organization than an alphabetical list of 597 viruses. It’s difficult to navigate.

  26. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Suggest separating the hemorrhagic viruses from the arboviruses

  27. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Table 6: Recommend adding more information in regards to different handling practices for different types of work ie. Diagnostic vs research. For example Lassa Fever and Ebola, it is recommended that it is handled at a BSL 4. There are no BSL-4 facilities in a diagnostic setting anywhere. Even after a patient has tested positive, they still need clinical blood work completed for a proper standard of care. Guidance on how to work with a known positive specimen is desperately needed in clinical laboratories, many of which use open automated systems for blood analysis. If universal precautions are not sufficient, mitigation strategies should be suggested that could easily be done in a clinical laboratory with minimal resources.

  28. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Table 6: Review all viruses and justification for recommended biosafety level. Special attention should be given to viruses that may now have more literature available to recommend a different biosafety level, especially the “ID” justification, but also virus with a different recommendation that we may now know more about, this includes Chikungunya and Powassan, and any other virus that has been or is predicted to be of particular public health concern.

  29. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-F (EEE) pg 243: Reference should be provided to support the recommendation of EEE to be a BSL-3 agent for diagnostic purposes.

  30. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-F (EEE) pg 242: reference 25 may not be strong enough to support the statements in the first paragraph. The abstract of the article only addresses VEE, not EEE or WEE. References about occupationally acquired EEE or WEE should be added. A literature review of lab acquired infection through diagnostic work should be completed.

  31. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-F (West Nile) pg 241: Appreciate separation of diagnostic activities from viral culture when recommending BSL-2 vs BSL-3. This guidance is missing from other sections as well.

  32. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-F (West Nile) pg 241: Suggest updated literature search for Laboratory Acquired Infections of WNV

  33. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-F Viruses with BSL3 Containment pg 236: Update what subtypes of CETBE are select agents

  34. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-F (Arboviruses and Related Zoonotic Viruses) pg 233: “at the time of writing this edition” update summary statements with the current public health threats.

  35. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-D Rickettsial agents : Select Agent: Select Agent R. prowazekii and R. rickettsia-No longer Select Agents (out of date).

  36. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-D Rickettsial agents (Vaccine): Should include the Australian QVax vaccine

  37. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-D Rickettsial agents: Currently states “BSL-2 practices and facilities are recommended for nonpropagative laboratory procedures, including serological” –this statement should also include PCR testing.

  38. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-D Rickettsial agents: currently states “The placenta of infected sheep may contain as many as 109 and organisms per gram of tissue and milk may contain 105”

    These are meant to be 10^9 and 10^5.

  39. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-D Rickettsial agents (Natural Modes of Infection)–states “wild mammals are natural hosts for Q fever” Should clarify –‘C. burnettii, not Q fever’

  40. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-D Rickettsial agents (Occupational Infections)–Q fever is the second most commonly reported LAI: (this is historical data up to 1976. More recent surveys shows Shigellosis to be the most common lab-acquired infections. CID 2009, 49:142-147)

  41. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-D Rickettsial agents: Coxiella burnetii should be removed from under Rickettsial agents as they are far removed from rickettsiae

  42. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-E –Hantavirus: Laboratory Safety and Containment Recommendations: Include: Potentially infected research tissue samples should be handled in a BSL-3 facility using BSL-3 practices, containment equipment and procedures.

  43. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-E –Hantavirus: Laboratory Safety and Containment Recommendations: Recommend BSL3 Practices, not BSL2.

  44. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-E –Hantavirus: Laboratory Safety and Containment Recommendations–The use of a certified BSC is recommended for all handling of human body fluids when potential exists for splatter or aerosol

    Remove: when potential exists for splatter or aerosol.

  45. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-E –Hantavirus: Laboratory Safety and Containment Recommendations–Include: There is currently no vaccine or antiviral treatment for Hantavirus infections.

  46. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-E –Hantavirus: Laboratory Safety and Containment Recommendations–Include: However, exposure may also occur by fluid contact and needlestick.

  47. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-E –Hantavirus: Natural Modes of infection: Include: Rodents shed copious amounts of virus from their saliva, urine, feces for months. Cats may become infected through contact with rodents and become a reservoir

  48. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-E –Hantavirus: Natural Modes of infection–Include: 6 Hantavirus infection is most commonly acquired by inhalation of infectious aerosols and extremely short exposure time (5 minutes) has been shown to be infectious

  49. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-E-Hantavirus (Occupational Infections): Documented laboratory-acquired infections have occurred in individuals working with hantaviruses. Include mostly infected rates.

  50. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Bordetella pertussis (Special Issues-Vaccines): Vaccine info needs to be updated probably from The Pink Book. In addition, some statement should be made of the immunity induced by vaccination is not enduring.

  51. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Bordetella pertussis (Introduction): Consider mentioning heavy reliance on PCR for diagnosis

  52. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Legionella pneumophila (Introduction): Currently the document states there are 48 species. This information is out of date as there are more than 60 known species.

  53. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-D (Rickettsial Agents): Special Issues – Select Agent: C. burnetii has been proposed to be removed from the select agent list. This information is out of date.

  54. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-D (Rickettsial Agents): Special Issues (Vaccine)–Review vaccine status. This information is potentially out of date

  55. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-D (Rickettsial Agents): Laboratory Safety and Containment–Need to include BSL recommendation for molecular methods, such as PCR

  56. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Chlamydophila pneumonia (Laboratory Safety and Containment): Review statement about BSL-3 practices for activities with high potential for droplet or aerosol production and large quantities/concentrations. Most diagnostic lab experience would be with clinical specimens and handling at BSL2 (in a BSC) should be sufficient for C. pneumoniae. The current recommendations may not accurately reflect commonly accepted practices.

  57. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Chlamydophila pneumonia (Introduction): While C. pneumonia is a common cause of respiratory infection, it is not often diagnosed. This lack of diagnosis is missing from current statement

  58. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A: Chlamydophila pneumonia (Introduction): Change Chlamydia pneumoniae to Chlamydophila pneumoniae as the genus name has changed

  59. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    VIII-E-SARS Coronavirus (Laboratory Safety and Containment Recommendations, Paragraph 5): States, “SARS-CoV propagation in cell culture and the initial characterization of viral agents recovered in cultures of SARS specimens must be performed in a BSL-3 facility using BSL-3 practices and procedures. Risk assessment may dictate the additional use of respiratory protection.”

    I think SMEs should review this guidance, and consider recommending the use of respiratory protection for SARS propagation activities.

  60. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    VIII-E-SARS Coronavirus: Natural Modes of Infection–Recommend that any updated information on spread and natural reservoir of SARS be included.

  61. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII SARS-MERS/Emerging Highly-Pathogenic Coronaviruses: Consensus of the group on the conference call was that MERS and SARS should be grouped as “Novel Coronaviruses” or “Emerging Coronaviruses”. Since additional coronaviruses may emerge in the future, SARS and MERS safety recommendations could be applicable.

  62. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-E Influenza (Natural Modes of Infection): Currently states “Transmission may also occur through direct contact since influenza viruses may persist for hours on surfaces” This section should read “direct and indirect contact”? Direct for contact with sick patients and indirect for contact with fomites? The current phrasing is unclear.

  63. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-E Influenza: There are three types of influenza A (currently says “three serotypes”). Serotype may not be technically accurate.

  64. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A Tuberculosis: Under “Surveillance” add IGRAs as an alternative to the skin test.

  65. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A Tuberculosis: Under “Containment Recommendations”—–Suggest adding that medical laboratories that perform minimal manipulation of positive cultures that may contain MTBC perform a risk assessment to determine the appropriate level of biosafety required. For example, working in a BSL2 facility using BSL-3 practices vs working in a BSL-3 facility

  66. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A Tuberculosis : Under “Natural Mode of Infection change the wording to”—“M. tb is the [predominant] etiologic agent of tuberculosis…” Currently states “M. tb is the etiologic agent…” Other members of the MTBC cause tuberculosis.

  67. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A Tuberculosis: Add species to the MTB complex—M. pinnipedii, M. caprae, M. orygis, M. canettii, M. mungi

  68. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 11, 2016    

    Section VIII-A Tuberculosis : Under Mycobacterium tuberculosis complex surveillance, PPD skin testing is recommended. I would like to see IGRA added to this recommendation as an alternative for foreign-born individuals who have had BCG vaccine, and perhaps for others who are skin test positive but IGRA negative.

  69. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Burkholderia mallei and Burkholderia pseudomallei: Burkholderia pseudomallei: The agent specific summary should be updated to include additional risk factors such as alcohol abuse and kidney disease etc. in more recent publications.

  70. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Burkholderia mallei and Burkholderia pseudomallei: The agent specific summary needs to be updated to included more recent references to laboratory related exposures such as Peacock EID 2008 in the occupational infection section.

  71. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Yersinia pestis: Define “additional containment for personal protective equipment”. This statement is vague and needs further explanation.

  72. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Yersinia pestis: Be sure to include: The outcome of this particular infection is the formation of dark-colored buboes (inflamed lymph nodes). It is important to note that bubonic plague is not transmitted person-to-person. The incubation period for bubonic plague ranges from two to six days.

  73. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Yersinia pestis: Include: The outcome of this particular infection is the formation of dark-colored buboes (inflamed lymph nodes). It is important to note that bubonic plague is not transmitted person-to-person. The incubation period for bubonic plague ranges from two to six days.

  74. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Yersinia pestis: Include: the disease manifestation of Y pestis infection is either in form of bubonic plague or pneumonic plague. IN the case of bubonic plague infective fleabites….etc. restructure where the information goes and move this information to the “Natural Modes of Infection” section.

  75. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Yersinia pestis: Avoid using the term microaerophlic: Most sentinel and Laboratory Response Network laboratories would not culture this organism in special atmospheric conditions. Pestis is simply cultured aerobically.

  76. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Yersinia pestis: BSL-3 practices should be used when working with Y. pestis. Wearing an N-95 or other respirator and face shield or safety glasses. This is due to the hazard posed from pneumonic plague.

  77. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A: Brucella Species: Special Issues: Remove section on transfer unless specific importation/domestic transfer requirements related to Brucella species can be defined. The general guidance is of no value.

  78. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A: Brucella Species–Lab Safety and Containment Recommendations: Incorporate a section/description of the specific clinical/diagnostic tests/results that would serve as “triggers” for implementing “BSL-2 transmission precautions” until Brucella is ruled out, e.g., submitted as suspect Brucella case, culture is gram negative bacteria, biochemical test result, etc.

  79. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A: Brucella Species–Lab Safety and Containment Recommendations–The reference to “products of conception” only should be expanded to blood and body tissues or cultures suspected of containing pathogenic Brucella until Brucella can be ruled out.

  80. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A: Brucella Species: Lab Safety and Containment Recommendations–Replace the recommendation for using “BSL-3 practices” for handling products of conception with the term “Aerosol/droplet precautions” or something similar which specifically references practice #10 under BSL-3 special practices (i.e., the practice of no open handling or use of respiratory protection and containment devices where that cannot be achieved in the lab or for the particular operation). The term “BSL-3 practices” includes a number of other administrative requirements that may not be appropriate for that enhanced requirement. The term used for enhanced BSL-2 requirements should reflect the need for no open handling or use of droplet vs. respiratory protection depending upon the suspected agent and procedures involved.

  81. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A: Brucella Species: Lab Safety and Containment Recommendations: Describe current modes of transmission from both a clinical and research laboratory standpoint. Address known exposure risks as well as suspected exposure risks associated with new technologies in the lab (i.e., risk associated with automated equipment where research data doesn’t exist to demonstrated whether or not there is aerosol and/or droplet exposure).

  82. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    VIII-A Brucella Species: Replace 1940 and 1991 references with more recent examples from the literature that reflect today’s laboratory exposure risks.

  83. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A Brucella Species: Under “Laboratory Safety and Containment Recommendations” – Review more recent literature to determine if most lab-associated cases still occur in research facilities from large quantity growth or placental tissue. Update as needed to reflect the highest risk exposure source associated with today’s laboratories.

  84. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    VIII-Brucella Species: Consider addressing risk of RB51 vaccine or other vaccine strains if still handled by labs (e.g., for PT purposes).

  85. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A: Brucella Species–Under “Occupational Infections” – references should be updated to reference more recent examples of both research and clinical associated lab infections involving Brucella if they exist.

  86. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Neurotoxin Producing Clostridia Species pg 134: The vaccine section needs to be updated to remove the reference to available vaccinations. There is no currently available vaccine.

  87. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Neurotoxin Producing Clostridia Species pg 134: Select Agent Neurotoxin producing Clostridia species are select agents: Preformed BoNT in concentrations ≥0.5 mg are also regulated by the Federal Select Agent Program

  88. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Neurotoxin Producing Clostridia Species pg 134: This section reads “Additional primary containment and personnel precautions, such as those recommended for BSL-3, should be implemented for activities with a high potential for aerosol or droplet production, or for those requiring routine handling of larger quantities of the organism”

    It would be beneficial for laboratorians to specify as to what is considered “larger”

  89. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Neurotoxin Producing Clostridia Species pg 134: Although spore-forming, there is no known risk to spore exposure except for the potential for the presence of residual toxin associated with pure spore preparations: Unless the laboratory scientist is an “…adult[s] with a compromised gastrointestinal tract (GI), such as following GI surgery or long-term administration of antibiotics, may increase risk for intestinal infection and in situ production of toxin”

  90. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Neurotoxin Producing Clostridia Species pg 134: In Wound Botulism, exposure to toxin is caused by introduction of spores into puncture wounds and in situ production [of toxin] by the organism.

    Include the [of toxin] for clarification

  91. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Neurotoxin Producing Clostridia Species pg 134: This section states that “Symptoms and even death are possible by accidental injection of botulinum toxin”. It is of note that this statement is also true for other routes of exposure to preformed toxin. Only including injection may lead the reader to think that BoNT exposure via other routes is less risky.

  92. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Neurotoxin Producing Clostridia Species pg 134: “Botulism occurs when botulinum toxin is released into circulation following ingestion of preformed toxin” It should be noted that ingestion of preformed toxin is not the only cause of “naturally” occurring botulism. For example, wound, infant botulism, and adult colonization are caused by an infection not ingestion of preformed toxin.

  93. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Neurotoxin Producing Clostridia Species pg 134: There has been only one report of botulism associated with handling of the toxin in a laboratory setting. However, concerns about potential use of the toxin as an agent of bioterrorism or biological warfare have led to increased handling of the substance by investigators studying mechanism of action and/or developing countermeasures to poisoning. Therapeutic use of BoNT is likely the predominant driver of “increased handling of the substance”

  94. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Neurotoxin Producing Clostridia Species pg 134: There is a note naming species that cause botulism, a life-threatening illness. Include that C. argentinense is isolated from soil and not known to cause food borne illness,

  95. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Neurotoxin Producing Clostridia Species pg 134: Currently the introduction states “Clostridium botulinum, and rare strains of C. baratii and C. butyricum are anaerobic spore-forming species that cause botulism, a life-threatening illness.” This should be modified to include some isolates of C. argentinense (BoNT/G

  96. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-francisella tularensis (pg 138): in section regarding FT vaccines, it should be noted that vaccination for tularemia is not generally available in the United States, nor is it useful in the management of ill patients. A vaccine for tularemia was used in the past to protect laboratory workers, but it is not currently available.

  97. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Francisella tularensis (pg 138): Currently reads ” Direct contact of skin or mucous membranes with infectious materials, accidental parenteral inoculation”. This statement should be modified to include animal bites.

  98. ABSA Member's Gravatar ABSA Member
    May 10, 2016    

    Mycobacterium Tuberculosis Complex Agent Summary
    Special Issues

    There is a statement, “Annual or semiannual skin testing with purified protein derivative (PPD) of previously skin-test negative personal can be used as a surveillance procedure.”

    Comment: Volume 54, RR-18, “Guidelines for Preventing the Transmission
    of Mycobacterium tuberculosis in Health-Care Settings 2005”, was published by Morbidity and Mortality Monthly Reports (MMWR) on December 30, 2005. As per that updated document, the term turbculin skin testing (TST) has been adopted in place of the term “PPD”. In addition, the frequency of TB medical surveillance is to be determined through a risk assessment that considers the incidence of TB disease in the community in which the health care facility is based and the incidence of TB within the health care facility. Guidance on medical surveillance should reference these CDC recommendations. It would be helpful to include a statement that the QuantiFERON® assay has been approved by the Food and Drug Administration for use in TB medical surveillance. Knowledge of the availability of this assay may help investigators with medical surveillance issues and could greatly assist in post exposure medical evaluations should they be necessary.

    References

    Comment: This agent summary cites a reference for the statement, “Animal studies using guinea pigs or mice can be conducted at ABSL-2.” The reference noted does not discuss animal studies. The reference cited discusses how to set up a clinical laboratory for TB analysis. The reference should be deleted and the appropriate reference for animal studies inserted, once it can be confirmed. The reference that should be deleted for this statement is: 111. Richmond, et al. Biosafety in the Clinical Mycobacteriology Laboratory. Clin Lab Med 1996: 527-50.

    Francisella tularensis Agent Summary

    There should be a reference to the IND vaccine that is available, similar to the vaccine statement made for bacillus anthracis, since this agent has a very low infectious dose and caused many laboratory acquired infections.

  99. Association of Public Health Laboratories (Member Contribution)'s Gravatar Association of Public Health Laboratories (Member Contribution)
    May 10, 2016    

    Section VIII-A-Francisella tularensis (pg 138)

    Type A and Type B strains are highly infectious, requiring only 10-50 organisms to cause disease:

    Requiring only 5-10 organisms by the respiratory route and 10 to 6 – 10 to 8 organisms by ingestion

  100. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Francisella tularensis (pg 138) –currently reads: ” In Natural Modes of Infection adjust language to: Francisella tularensis can survive in animal carcasses and organs up to 133 days and water for up to 90 days. Ingestion of contaminated water, food, animal tissues or fluids, inhalation of infective aerosols and bite of arthropods (deerfly, mosquito) and tick are the primary transmission modes in nature. ”

    It would be beneficial to include the “Tick bites, handling or ingesting infectious animal tissues or fluids, ingestion of contaminated water or food and inhalation of infective aerosols are the primary transmission modes in nature.”

  101. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Francisella tularensis (pg 138) currently reads “The incubation period varies with the virulence of the strain, dose and route of introduction but ranges from 1-4 days with most cases exhibiting symptoms in 3-5 days”

    The incubation period has been modified to range from 1-14 days

  102. Association of Public Health Laboratories (Member Contributions)'s Gravatar Association of Public Health Laboratories (Member Contributions)
    May 10, 2016    

    Section VIII-A-Francisella tularensis (pg 138): Currently reads Type A and Type B strains are highly infectious, requiring only 10-50 organisms to cause disease. This statement should be modified to read ” Requiring only 5-10 organisms by the resipriatory route and 10^6-10^8 organisms by ingestion)

    This is to clarify that the exposure route is significant in determining infectious dose.

  103. Karen Byers's Gravatar Karen Byers
    April 21, 2016    

    The Agent Summary Statement for Retroviruses should be updated with the current statistics available in Notes from the Field: Occupationally Acquired HIV Infection Among Health Care Workers — United States, 1985–2013. Weekly January 9, 2015 / 63(53);1245-1246. Currently, the fact that 4 non-clinical technicians had confirmed cases is not available in the Agent Summary Statement, and it is an important part of the risk assessment for HIV researchers.

  104. Katherine Spindler's Gravatar Katherine Spindler
    April 18, 2016    

    SALS voted in November 2013 and again in summer of 2014 (by email, considering a circulated Risk Assessment) that work on Oropouche virus can be appropriately done at BSL2 rather than BSL3. This change should be reflected in the new BMBL (and in interim recommendations while we await publication of the new BMBL).

  105. Benjamin Fontes's Gravatar Benjamin Fontes
    April 18, 2016    

    Section VIII-F: Arboviruses and Related Zoonotic Viruses contains the listing of Arboviruses and their classification based on risk in Table 6. A column is included that signifies the recommendation for “HEPA Filtration on lab exhaust.” There are 33 or so RG2, RG3 and RG4 pathogens that have a YES designation in Table 6. Can the authors approach those who constructed this table to identify why HEPA Filtration of Exhaust Air was required for the two Risk Group 2 Pathogens (O’nyong-Nyong virus and Ibaraki virus)? This requirements runs counter to what the CDC/NIH BMBL requires for BSL2 facilities.

  106. Shamsul Arfin Qasmi's Gravatar Shamsul Arfin Qasmi
    April 15, 2016    

    Section VIII-F, Table 6. Alphabetical Listing of 597 Arboviruses and Hemorrhagic Fever Viruses page 246 to 265. it may be shifted to appendix as this information is lengthy and subject to change with federal regulations, import export requirements and taxonomic status.