1. Global Health Threats & Indiana : 2009 H1N1 Human Influenza as One Example Lloyd J. Kolbe, PhD Associate Dean for Global & Community Health Professor of Applied Health Science April 30, 2009

2. Simultaneous Global Health Threats in the 21 st Century Populations increasing, urbanizing, poor, famined, migrating Increasingly toxic environments, deforestation, undrinkable water Global air pollution, warming, dimming, climate changes, storms, floods, droughts, wildfires Antimicrobial resistance Rapid transportation available to masses of people Emerging and re-emerging diseases and global pandemics Chronic diseases from environments and behavioral patterns Unintentional and intentional physical and psychological injuries Conventional, biological, chemical & radiological terrorism War undeclared, declared, intra-national, international, nuclear Natural disasters (earthquakes, tsunamis, volcanoes) Demographic extremes, aging and adolescent populations Rapid changes in cultures Stress, anxiety, depression, dementia, immune suppression Psychological/physiological pharmaceutical reliance/addiction Increasing health disparities, medically underserved population Increasing economic globalization,disparities, downturns, crises

3. Simultaneous Global Health Threats in the 21 st Century Past history should teach us to expect the unexpected Problems not only are additive, they are exponential (synergistic) We will experience more problems than those listed here

4. Global Examples of Emerging & Re-emerging Infectious Diseases Source: Morens DM, Folkers GK, Fauci AS. The challenge of emerging and re-emerging infectious diseases. Nature. 2004;430(6996):242-249.

5. West Nile Virus in the United States, 2006

6. Lyme Disease in the United States, 2006

7. Indiana Counties with Confirmed Human Lyme Disease

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

9. Emerging, Re-Emerging, & Deliberately Emerging Infectious Diseases drug-resistant infections (antimicrobial resistance) rug-resistant infections (antimicrobial resistance)rug-resistant infections (antimicrobial resistance) bovine spongiform encephalopathy (Mad cow disease) and variant Creutzfeldt-Jakob disease (vCJD) bovine spongiform encephalopathy (Mad cow disease) and variant Creutzfeldt-Jakob disease (vCJD) campylobacteriosis Chagas disease Chagas disease cholera cryptococcosis cryptosporidiosis (Crypto) cryptosporidiosis (Crypto) cyclosporiasis cysticercosis dengue fever dengue fever diphtheria Ebola hemorrhagic fever Ebola hemorrhagic fever Escherichia coli infection Escherichia coli infection group B streptococcal infection group B streptococcal infection hantavirus pulmonary syndrome hantavirus pulmonary syndrome hepatitis C hepatitis C hendra virus infection hendra virus infection histoplasmosis HIV/AIDS influenza Lassa fever Lassa fever legionnaires' disease (legionellosis) and Pontiac fever legionnaires' disease (legionellosis) and Pontiac fever leptospirosis Listeriosis Lyme disease Lyme disease malaria Marburg hemorrhagic fever Marburg hemorrhagic fever measles meningitis monkeypox MRSA (Methicillin Resistant Staphylococcus aureus) MRSA (Methicillin Resistant Staphylococcus aureus) Nipah virus infection Nipah virus infection norovirus (formerly Norwalk virus) infection norovirus (formerly Norwalk virus) infection pertussis plague polio (poliomyelitis) polio (poliomyelitis) rabies Rift Valley fever Rift Valley fever rotavirus infection rotavirus infection salmonellosis SARS (Severe acute respiratory syndrome) SARS (Severe acute respiratory syndrome) shigellosis smallpox sleeping Sickness (Trypanosomiasis) sleeping Sickness (Trypanosomiasis) tuberculosis tularemia valley fever (coccidioidomycosis) valley fever (coccidioidomycosis) VISA/VRSA - Vancomycin-Intermediate/Resistant Staphylococcus aureus VISA/VRSA - Vancomycin-Intermediate/Resistant Staphylococcus aureus West Nile virus infection West Nile virus infection yellow fever yellow fever

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

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

12. Confirmed A(H1N1) Global Distribution, April 30, 2009 Austria 1 Canada 19 Germany 3 Israel 2 Mexico 97 (7 deaths) Netherlands 1 New Zealand 3 Spain 13 Switzerland 1 United Kingdom 8 United States 109 (1 death) TOTAL: 11/257

13. Confirmed A(H1N1) U.S. Distribution, April 30 2009 Arizona 1 California 14 Indiana 1 Kansas 2 Massachusetts 2 Michigan 1 Nevada 1 New York 50 Ohio 1 South Carolina 10 Texas 26 TOTAL: 11/109 cases, 1 death

14. How to Protect Yourself and Others from H1N1 Infection Stay informed. See the CDC Website on H1N1 Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective. Avoid touching your eyes, nose or mouth. Germs spread this way. Try to avoid close contact with sick people. If you get sick with influenza, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them. Follow public health advice regarding school closures, avoiding crowds, and other social distancing measures. Develop a family emergency plan as a precaution. This should include storing a supply of food, medicines, facemasks, alcohol- based hand rubs and other essential supplies.

15. Global Health Threats & Indiana : 2009 H1N1 Human Influenza as One Example Lloyd J. Kolbe, PhD Associate Dean for Global & Community Health Professor of Applied Health Science April 30, 2009