Global Health Threats & Indiana :Global Health Threats & Indiana :2009 H1N1 Human Influenza as One Example2009 H1N1 Human Influenza as One Example

Lloyd J. Kolbe, PhDLloyd J. Kolbe, PhD

Associate Dean for Global & Community HealthAssociate Dean for Global & Community Health

Professor of Applied Health ScienceProfessor of Applied Health Science

April 30 , 2009April 30 , 2009

Simultaneous Global Health Threats in the 21Simultaneous Global Health Threats in the 21stst Century CenturyPopulations increasing, urbanizing, poor, famined, migratingPopulations increasing, urbanizing, poor, famined, migratingIncreasingly toxic environments, deforestation, undrinkable waterIncreasingly toxic environments, deforestation, undrinkable waterGlobal air pollution, warming, dimming, climate changes, storms, Global air pollution, warming, dimming, climate changes, storms, floods, droughts, wildfiresfloods, droughts, wildfiresAntimicrobial resistanceAntimicrobial resistanceRapid transportation available to masses of peopleRapid transportation available to masses of peopleEmerging and re-emerging diseases and global pandemicEmerging and re-emerging diseases and global pandemicssChronic diseases from environments and behavioral patternsChronic diseases from environments and behavioral patternsUnintentional and intentional physical and psychological injuries Unintentional and intentional physical and psychological injuries Conventional, biological, chemical & radiological terrorismConventional, biological, chemical & radiological terrorismWar undeclared, declared, intra-national, international, nuclearWar undeclared, declared, intra-national, international, nuclearNatural disasters (earthquakes, tsunamis, volcanoes)Natural disasters (earthquakes, tsunamis, volcanoes)Demographic extremes, aging and adolescent populationsDemographic extremes, aging and adolescent populationsRapid changes in culturesRapid changes in culturesStress, anxiety, depression, dementia, immune suppressionStress, anxiety, depression, dementia, immune suppressionPsychological/physiological pharmaceutical reliance/addiction Psychological/physiological pharmaceutical reliance/addiction Increasing health disparities, medically underserved populationIncreasing health disparities, medically underserved populationIncreasing economic globalization ,disparities, downturns, crises Increasing economic globalization ,disparities, downturns, crises

Simultaneous Global Health Threats in the 21Simultaneous Global Health Threats in the 21stst Century Century

Past history should teach us to expect the unexpectedPast history should teach us to expect the unexpectedProblems not only are additive, they are exponential (synergistic) Problems not only are additive, they are exponential (synergistic) We will experience more problems than those listed hereWe will experience more problems than those listed here

Global Examples of Emerging & Re-emerging Global Examples of Emerging & Re-emerging Infectious DiseasesInfectious Diseases

Source: Morens DM, Folkers GK, Fauci AS. The challenge of emerging and re-emerging infectious diseases. Nature. 2004;430(6996):242-249.Source: Morens DM, Folkers GK, Fauci AS. The challenge of emerging and re-emerging infectious diseases. Nature. 2004;430(6996):242-249.

West Nile Virus in the United States, 2006West Nile Virus in the United States, 2006

Lyme Disease in the United States, 2006Lyme Disease in the United States, 2006

Indiana Counties with Confirmed Human Lyme DiseaseIndiana Counties with Confirmed Human Lyme Disease

Percentage of Contaminated Chickens in US Retail Stores, Percentage of Contaminated Chickens in US Retail Stores, 2007 2007

Emerging, Re-Emerging, & Deliberately EmergingEmerging, Re-Emerging, & Deliberately EmergingInfectious DiseasesInfectious Diseases

ddrug-resistant infections (antimicrobial resistance)bovine spongiform encephalopathy (Mad cow disease) bovine spongiform encephalopathy (Mad cow disease) and variant Creutzfeldt-Jakob disease (vCJD)and variant Creutzfeldt-Jakob disease (vCJD)campylobacteriosiscampylobacteriosisChagas diseaseChagas diseasecholeracholeracryptococcosiscryptococcosiscryptosporidiosis (Crypto)cryptosporidiosis (Crypto)cyclosporiasiscyclosporiasiscysticercosiscysticercosisdengue feverdengue feverdiphtheriadiphtheriaEbola hemorrhagic feverEbola hemorrhagic feverEscherichia coliEscherichia coli infection infectiongroup B streptococcal infectiongroup B streptococcal infectionhantavirus pulmonary syndromehantavirus pulmonary syndromehepatitis Chepatitis Chendra virus infectionhendra virus infectionhistoplasmosishistoplasmosisHIV/AIDSHIV/AIDSinfluenzainfluenzaLassa feverLassa feverlegionnaires' disease (legionellosis) and Pontiac feverlegionnaires' disease (legionellosis) and Pontiac feverleptospirosisleptospirosisListeriosisListeriosisLyme disease

malariaMarburg hemorrhagic feverMarburg hemorrhagic fevermeaslesmeaslesmeningitismeningitismonkeypoxmonkeypoxMRSA (Methicillin Resistant MRSA (Methicillin Resistant Staphylococcus aureusStaphylococcus aureus))Nipah virus infectionNipah virus infectionnorovirus (formerly Norwalk virus) infectionnorovirus (formerly Norwalk virus) infectionpertussispertussisplagueplaguepolio (poliomyelitis)polio (poliomyelitis)rabiesrabiesRift Valley feverRift Valley feverrotavirus infectionrotavirus infectionsalmonellosissalmonellosisSARS (Severe acute respiratory syndrome)SARS (Severe acute respiratory syndrome)shigellosisshigellosissmallpoxsmallpoxsleeping Sickness (Trypanosomiasis)sleeping Sickness (Trypanosomiasis)tuberculosistuberculosistularemiatularemiavalley fever (coccidioidomycosis)valley fever (coccidioidomycosis)VISA/VRSA - Vancomycin-Intermediate/Resistant VISA/VRSA - Vancomycin-Intermediate/Resistant Staphylococcus aureusStaphylococcus aureusWest Nile virus infectionWest Nile virus infectionyellow feveryellow fever

A Brief Glimpse of the Global Obesity Pandemic, 2007A Brief Glimpse of the Global Obesity Pandemic, 2007

Global Prevalence of Obesity in Adult Males

% Obese

0-9.9%

10-14.9%

15-19.9%

20-24.9%

25-29.9%

≥30%

Self Reported data

North AmericaUSA 31%Mexico 19%Canada (self report) 17%Guyana 14%Bahamas 14%

South Central AmericaPanama 28%Paraguay 23%Argentina (urban) 20%Uruguay (self report) 17%Dominican Republic 16%

AfricaSouth Africa 10% Seychelles 9%Cameroon (urban) 5%Ghana 5% Tanzania (urban) 5%

South East Asia & Pacific RegionNauru 80%Tonga 47%Cook Island 41%French Polynesia 36% Samoa 33%

Eastern Mediterranean

Lebanon 36%Qatar 35%

Jordan 33%Kuwait 28%

Saudi Arabia 26%

European RegionCroatia 31%Cyprus 27%Czech Republic 25%Albania (urban) 23%England 23%

With examples of the top 5 Countries in each Region

With the limited data available, prevalence's are not age standardised. Self reported surveys may underestimate true prevalence. Sources and references are available from the IOTF. © International Obesity TaskForce, London –January 2007

WHO Human H1N1 Influenza Phase, April 30, 2009WHO Human H1N1 Influenza Phase, April 30, 2009

Confirmed A(H1N1) Global Distribution, April 30, 2009Confirmed A(H1N1) Global Distribution, April 30, 2009Austria Austria 1 1

CanadaCanada 19 19

GermanyGermany 3 3

Israel Israel 2 2

Mexico 97 (7 deaths)Mexico 97 (7 deaths)

NetherlandsNetherlands 1 1

New Zealand 3New Zealand 3

Spain Spain 13 13

Switzerland 1Switzerland 1

United Kingdom 8United Kingdom 8

United States 109 (1 death) TOTAL: 11/257United States 109 (1 death) TOTAL: 11/257

Confirmed A(H1N1) U.S. Distribution, April 30 2009Confirmed A(H1N1) U.S. Distribution, April 30 2009

Arizona 1Arizona 1

California 14California 14

Indiana 1Indiana 1

Kansas 2Kansas 2

Massachusetts 2Massachusetts 2

Michigan 1Michigan 1

Nevada 1Nevada 1

New York 50New York 50

Ohio 1Ohio 1

South Carolina 10South Carolina 10

Texas 26Texas 26

TOTAL: 11/109 cases, 1 deathTOTAL: 11/109 cases, 1 death

How to Protect Yourself and Others from H1N1 InfectionHow to Protect Yourself and Others from H1N1 Infection

Stay informed. See the CDC Website on H1N1Stay informed. See the CDC Website on H1N1

Cover your nose and mouth with a tissue when you cough or sneeze. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Throw the tissue in the trash after you use it.

Wash your hands often with soap and water, especially after you Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. cough or sneeze. Alcohol-based hand cleaners are also effective.

Avoid touching your eyes, nose or mouth. Germs spread this way. Avoid touching your eyes, nose or mouth. Germs spread this way.

Try to avoid close contact with sick people. Try to avoid close contact with sick people.

If you get sick with influenza, CDC recommends that you stay home If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from from work or school and limit contact with others to keep from infecting them.infecting them.

Follow public health advice regarding school closures, avoiding Follow public health advice regarding school closures, avoiding crowds, and other social distancing measures.crowds, and other social distancing measures.

Develop a family emergency plan as a precaution. This should Develop a family emergency plan as a precaution. This should include storing a supply of food, medicines, facemasks, alcohol-include storing a supply of food, medicines, facemasks, alcohol-based hand rubs and other essential supplies.based hand rubs and other essential supplies.

Global Health Threats & Indiana :Global Health Threats & Indiana :2009 H1N1 Human Influenza as One Example2009 H1N1 Human Influenza as One Example

Lloyd J. Kolbe, PhDLloyd J. Kolbe, PhD

Associate Dean for Global & Community HealthAssociate Dean for Global & Community Health

Professor of Applied Health ScienceProfessor of Applied Health Science

April 30 , 2009April 30 , 2009