Our Best Defense: Fighting Emerging Diseases
It's not often that an academic figure holds a place in pop culture, but Dr. C.J. Peters, professor of pathology and of microbiology and immunology, and biodefense director of the Center for Biodefense and Emerging Infectious Diseases at The University of Texas Medical Branch at Galveston, has turned that trick. In 1989, when he was head of the Disease Assessment Division at the U.S. Army Institute for Infectious Diseases at Fort Detrick, Maryland, Peters led a team that discovered and contained an Ebola outbreak among imported monkeys in a facility in the Washington, D.C. suburb of Reston, Virginia. Their success in preventing the deadly virus from escaping the lab was documented in Richard Preston's 1994 bestseller The Hot Zone. That book inspired the hit movie "Outbreak" (1995), which was so heavily fictionalized that Peters still can't figure out whether he's supposed to be the Rene Russo or the Dustin Hoffman character.
Peters considers the New Yorker article by Preston that led to the book to be "a superb piece about decision-making in the presence of uncertainty." He found the book itself to be "accurate but a little overdramatized in places." But he describes the movie as "total fantasy, completely inaccurate in almost every way, but fun — I suggest you get some pizza and rent it." In other words, it's mindless, sensational entertainment, so long as you don't take it too seriously. The actual work of Peters and his colleagues, on the other hand, is life-and-death serious; and rather than having a glorious climax, it brings a series of incremental gains.
The Texas native, who holds the John Sealy Distinguished University Chair in Tropical and Emerging Virology, came to UTMB in 2000, after eight years at the Center for Disease Control in Atlanta preceded by 15 at Fort Detrick. He was attracted to Galveston by the promise of a BSL-4 lab. The Robert E. Shope, M.D., Laboratory in the John Sealy Pavilion for Infectious Diseases, which includes 2000 square feet of BSL-4 space, was dedicated in November 2003 as the nation's first BSL-4 on a college campus. It's now dwarfed by the neighboring Galveston National Laboratory, dedicated in November 2008, with 12,000 square feet of BSL-4 facilities. The labs, and the elite group of scientists who work in them, put UTMB at the forefront of the American battle against bioterrorism — which, since the post-9/11 anthrax scare of 2001, has become the main thrust of research into emerging diseases.
The Aerosol Menace
"It's difficult today to sort out the differences between emerging diseases and biodefense," Peters says. "If a bioterrorist is going to do something, he has to have an agent to start with. I think in the future he'll be able to make some of his own, but for now and the immediate future that's just not possible. So for now, he gets them from nature. Bioterrorist threats are generally organisms that come from nature; they're actually disease-causing viruses that are emerging or about to emerge."
The way to turn such viruses into weapons is to "aerosolize" them — break them down into very fine, invisible particles that are carried on the air, and can thus be breathed deep into the lungs by hundreds of thousands of people at a time. (In nature, most of these viruses infect people one at a time via such means as mosquito or tick bites, handling of infected animals and, occasionally, person-to-person contact.) In their search for vaccines and cures, scientists in BSL-4 labs study these viruses by generating small amounts of them for experimentation, which means aerosols can also be inadvertently created in the process. To protect the scientist and to keep any aerosols from escaping the building, the "Level 4" standards of safety are critical. "If we're going to have a biodefense program, and if we're going to work with the emerging infectious agents that also happen to be aerosol-infectious," Peters stresses, "we must have these laboratories."
Peters' own research subjects include the Rift Valley fever virus and the SARS (severe acute respiratory syndrome) coronavirus. The former, which first surfaced in Kenya in 1931, re-emerges periodically, especially during heavy rainfall, in subSaharan Africa. While 98 percent of those who contract it suffer only a flu-like illness, the other two percent develop a hemorrhagic form that will kill half of them and blind many more. "And now it's moving out of its original area," Peters notes, detailing recent cases in Egypt and on the Arabian peninsula. The initial SARS epidemic started in Guangdong Province, China, in November 2002 and spread to 37 countries around the world within six weeks. "If it emerges once, it will emerge again, because the conditions that created it the first time will be duplicated again somewhere," Peters cautions. "It may take a year or it may take 20, but these diseases always come back — always." There is no vaccine to prevent, or drug to cure, either of them, making them particularly menacing if they're weaponized.
Best Offense is Good Defense
They're just the beginning. Peters can run down a whole list of other exotic-sounding viral diseases or viruses that are presently untreatable and potentially fatal. These include the Marburg and Ebola hemorrhagic fevers; eastern, western and Venezuelan equine encephalomyelitis; yellow fever and dengue fever; and the Hendra and Nipah viruses. As diseases, they are all threats mainly somewhere overseas — so far — but any of them could be weaponized and used against huge populations of people. Indeed, Russian and/or American scientists successfully aerosolized several of them before then-President Richard M. Nixon banned U.S. offensive biological weapons research in 1969. Since then, American research has been strictly defensive, though even that had little urgency until the first Gulf War in 1991, when the possibility of biological weapons being used against American troops first loomed. Today, the mandate for Peters and his fellow UTMB scientists is clear.
"The United States seeks more generic solutions; they want us to find drugs that can treat whole families of viruses, rather than a different drug for each virus," Peters says. "I don't know if we can treat whole families with one drug in every case — some individual viruses will probably require individual treatments — but I suspect we can for some of them." That's the kind of crucial work being done today in UTMB's BSL-4 labs; it's not much like a Hollywood movie, but there's a lot at stake.
What is a BSL-4 Lab?
Those who use them refer to BSL-4 labs as "hot labs." Facilities such as the two BSL-4 labs at UTMB primarily protect scientists working with the most deadly viruses from any aerosols of that virus that they may inadvertently create; these aerosols are too small to be a threat to anyone other than the scientist himself and sometimes a couple others in the lab. While working with aerosol-infectious viruses, the scientist must wear a white polypropylene "biosafety suit" (also called a "space suit"). Yellow hoses snap into the hoods of the suits to provide a continuous supply of air around the worker that blows pathogens away from him wherever he is in the lab. When the worker is finished in the lab, he must take an eight-minute chemical shower with his suit on, followed by a conventional shower, before he can change into street clothes and leave the building.
The floor above the lab is filled with air filters that process incoming and outgoing air through a series of high efficiency particulate air filters that catch even the tiniest microscopic particles, including any bacteria or viruses; just in case, a second set of HEPA filters is there to trap anything that somehow does slip through the first. (Such double and triple redundancies are built into all the lab's systems and equipment to provide back-ups.) Air filters also keep the lab itself under negative air pressure, so that if one of the double-doors is accidentally opened lab air cannot escape; instead, outside air rushes in and forces biohazards up through the HEPA filters. On the floor below the lab, liquid waste, feces and urine flow into tanks where they're heated to temperatures at which nothing can survive, after which they go into the sewage system; other waste, such as lab-animal carcasses and disposable lab equipment, is sterilized in giant steam-pressure cookers called autoclaves before being incinerated off-site.
The walls of the new GNL are reinforced concrete 10 inches thick, and a corridor runs around the entire lab to provide another buffer zone. Built on 700 concrete pilings anchored 120 feet into the ground, the GNL was the only building on the UTMB campus, and possibly in the whole city, that went undamaged when Hurricane Ike ripped through the island in mid-September 2008. The only sign of Ike at the GNL was a puddle in the lobby and some water blown under one door.