“ Flu”:Globalization, Global Transmission and Pandemic Risk Ann Marie Kimball MD, MPH, FACPM

What we know Influenza pandemics of seasonal flu cause 500,000 deaths worldwide, 36,000 in the US annually Emergent strains migrate globally, North to South and South to North Global vulnerability, risk to infections related to biosecurity of industrial agriculture in low resource settings not known Air transportation plays a central role in global transmission

Influenza pandemics of seasonal flu cause 500,000 deaths worldwide, 36,000 in the US annually

Emergent strains migrate globally, North to South and South to North

Global vulnerability, risk to infections related to biosecurity of industrial agriculture in low resource settings not known

Air transportation plays a central role in global transmission

Levels of Prevention: Levels of Microbial Traffic Mechanisms TRANSNATIONAL TRAFFIC WHATS MISSING FROM THIS PICTURE? Local Health Containment option PANDEMIC Tertiary : Geographically Dispersed Clusters Secondary : Local extension Primary : Point of Emergence Species jumping, Ecological pressure Trade, Travel Direct Contagion

H5N1 Infection of Agriculture Workers (recent studies) Result Viral Subtype Study Risk factors associated with seropositivity.1:80 (owning a farm, living on a swine farm, entering a swine barn>4x per week, over 50 years of age.) H1N1 Cross section 74 Wisc. Swine workers, 114 urban controls Odds ratio Farmer 35.5 Vet 17.8 Meat packer 6.5 H1N1 Cross section 111 Iowa swine workers 79 referents

“Take away” points Globalization of travel, trade and extended chains of food production represent a poorly quantified risk for influenza Influenza surveillance may be missing sentinel populations such as farmers, vets and animal workers. Global “defense” is uneven with poor and middle income countries under-resourced IHR implementation for core capacities should be accelerated.

Globalization of travel, trade and extended chains of food production represent a poorly quantified risk for influenza

Influenza surveillance may be missing sentinel populations such as farmers, vets and animal workers.

Global “defense” is uneven with poor and middle income countries under-resourced

IHR implementation for core capacities should be accelerated.

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