Mammalian-Transmissible H5N1 Virus: Containment Level and Case Fatality Ratio

The life sciences, and the field of microbiology in particular, are in the midst of an unprecedented debate regarding the risks posed by the publication of two studies that report the generation of mammalian-transmissible H5N1 virus in the laboratory. The controversy was precipitated when the National Science Advisory Board for Biosecurity (NSABB) advised the U.S. government that the best course of action was to seek a redaction of the manuscripts to delete important details that could be used for nefarious purposes (1, 2). In a recent issue, mBio published pro- and anti-NSABB decision commentaries (3–6) with the goal of informing the debate and the hope that airing these views would lead to the best decisions. At the time of this writing the issue remains unsettled, and a fierce debate is raging in government and academic circles on the best course of action. Even with the question of how to publish these studies unsettled, two other issues have quickly emerged: (i) the appropriate biosafety containment level (BSL) to be used for studies with mammalian-transmissible H5N1 viruses and (ii) the case fatality ratio of human H5N1 infections. The question of the appropriate level of containment is both a biosafety and a biosecurity issue. Although “biosafety ” and “biosecurity” are sometimes used interchangeably, it is important to recognize that they denote very different concerns (7). The existence of mammalian-transmissible H5N1 immediately brings about the question of whether the current biosafety level of containment is adequate. Currently, studies with mammaliantransmissible H5N1 are being done at BSL3 or higher (8). However, Canada has already moved to institute the highest level of biosafety containment for research work involving mammaliantransmissible H5N1 virus (see

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