The Perfect Storm Bill Palmer Aero Med Inc

The Perfect Storm Bill Palmer Aero. Med, Inc.

The Perfect Storm • Impact – 208 million dollars of damage (1991 $) – 12 Dead (6 on Andrea Gail, 1 Air National Guard) – Storm tide of 13’ above a storm surge of 5’ along with 30’ waves – Duxbury Beach, MA had gusts up to 85 MPH – Worst of the storm stayed off shore

The Microbial Perfect Storm • Convergence model – Due to special combinations and circumstances – Relatively common occurrence – Doesn’t dissipate, but may perpetuate or accelerate

H 5 N 1 Avian Influenza

Avian Influenza • Filtration 2007 in Chicago, presentation on avian influenza at request of Bob Burkhead because of the importance of this subject to the filtration industry

Avian Influenza • What is the deal with guys from Kentucky and their fascination chicken?

Bio-Insecurity • BSL-4 labs prior to 9/11 = 5 • BSL-4 labs post 9/11 = 15 • # of US scientists authorized to work with deadly pathogens = 15, 000 • # of agencies that fund, operate or work with BSL -3 or BSL-4 labs = 12 • Fed agencies charged with oversight of labs and risk assessment = 0

Bio-Insecurity Baxter: Product contained live bird flu virus By Helen Branswell, THE CANADIAN PRESS Last Updated: 27 th February 2009, 3: 26 pm The company that released contaminated flu virus material from a plant in Austria confirmed Friday that the experimental product contained live H 5 N 1 avian flu viruses. And an official of the World Health Organization’s European operation said the body is closely monitoring the investigation into the events that took place at Baxter International’s research facility in Orth-Donau, Austria. • “Was this just criminal negligence or it was an attempt to provoke a pandemic using vaccination against flu to spread the disease. . ” blog • Little if any coverage in US press

Global Richness Map of the Geographic Origins of EID Events (all pathogen-types) from 1940 to 2004 Jones et al. Nature 2008

USA TB Headlines April 2009 • S. D. inmate found to have tuberculosis • Inmate with TB may have been exposed to thousands • Northeast High School students test positive for tuberculosis • Lakewood Ranch High tuberculosis case • Bexar County inmates diagnosed with tuberculosis • Tuberculosis: Doctor-intraining may have exposed hundreds of children, infants to TB in 3 Chicago hospitals • Supervisors to discuss moving TB clinic • TB case reported at UC Berkeley • Airport workers given TB tests

Global TB News April 2009 • Drug-resistant TB may ‘spiral out of control, ' U. N. says • China Finds More Than 200 Deadly Tuberculosis Cases • Tuberculosis: The disease that keeps on giving • One-Third Of Tuberculosis (TB) Cases Go Undetected: WHO • Former Soviet countries face 'widespread epidemic' of drugresistant TB • Nurse at Osaka hospital contracted tuberculosis

1/3 of Global Population Infected with TB 8. 8 million TB Cases Annually >1/3 in Populous India and China < 1 000 to 9 999 10 000 to 99 999 100 000 to 999 1 000 or more No Estimate 22 high burden = 80% of total ≈ 700, 000 new cases HIV+ ≈ 424, 000 new cases MDR The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2002

Estimated HIV Prevalence in TB Cases, 2004 0 -4 5 - 19 20 - 49 50 or more No estimate HIV prevalence in TB cases, 15 -49 years (%)

Estimated Incidence* of MDR TB *Zignol et al. , JID 2006 More than 50 000 cases From 10 000 to 50 000 cases From 1 000 to 9 999 cases From 100 to 999 cases Less than 100 cases

Drug-resistant TB may ‘spiral out of control, ' U. N. says By TIM JOHNSON Mc. Clatchy Newspapers BEIJING -- The world is on the cusp of an explosion of drug-resistant tuberculosis cases that could deluge hospitals and leave physicians fighting a nearly untreatable malady with little help from modern drugs, global experts said Wednesday. "The situation is already alarming, and poised to grow much worse very quickly, " said Dr. Margaret Chan, the director-general of the World Health Organization.

The March of Resistance Drug susceptible TB 0000 SM, INH resistant TB MDR TB XDR TB 1947 1983 2004 1952 1992 2006 Paul Nunn, Global Task Force on XDR TB, Geneva, 2006

Drug Susceptible Multidrugresistance Extensive drug resistance Isoniazid Rifampicin Pyrazinamide Ethambutol Aminoglycosides Capreomycin Quinolones Thioamides Cycloserine PAS Resistance by definition Resistance possible or likely

The Last Straw • Bad Global Economy – Fewer jobs – Fewer insured – Less spending on healthcare – Poorer nutrition – Increase in crime – Less oversight of abuses – Less spending for global health issues

Panic vs. Complacency • 3 rd Option is a strategic response!

So, how do we divert the coming storm?

NAFA Response • CDC is calling for consistent guidelines – Efficiency of filters to use for healthcare applications – Proper guidance for when and where to apply filtration solutions – Guidance on filtration equipment – See facilities from a different viewpoint

What’s in your “sandbag”? ?