Global & Disaster Medicine

Archive for the ‘Pandemic’ Category

A UC Davis-led program – PREDICT – discovers and detects viruses, many of which move between animals and people and can potentially trigger pandemics.

Global Health Institute



The next global infectious disease outbreak could harm the U.S. export economy and threaten U.S. jobs—even if the disease never reaches our shores.


Is the U.S. Export Economy at Risk from Global Infectious Outbreaks?

New CDC analysis examines potential threat to markets and jobs


Press Release

For Immediate Release
Tuesday, February 13, 2018
Contact:Media Relations
(404) 639-3286

In addition to tragic loss of life, the next global infectious disease outbreak could harm the U.S. export economy and threaten U.S. jobs—even if the disease never reaches our shores. Two Centers for Disease Control and Prevention (CDC) articles published in Health Security analyze the risks and show potential losses to the American export economy from an overseas outbreak.

The two articles underscore the importance of the President’s request this week for $59 million in support of the Global Health Security Agenda (GHSA) in Fiscal Year 2019.

“The President’s Budget request of $59 million for Fiscal Year 2019 for GHSA demonstrates the Administration’s commitment to global health security and provides an important bridge to the extension of the GHSA announced in October 2017 in Uganda,” said Anne Schuchat, M.D., acting Director of CDC. “This new funding continues the U.S. commitment to this multi-national effort and supplements U.S. Government multisector support for this initiative.”

America’s jobs at risk

The first of the two articles, Relevance of Global Health Security to the U.S. Export Economy, the potential disruption to the U.S. export economy if an infectious disease outbreak were to take hold in CDC’s 49 global health security priority countries.

Using 2015 U.S. Department of Commerce data, the article assesses the value of U.S. exports to the 49 countries and the number of jobs supported by those exports, finding that:

  • In 2015 the United States exported over $300 billion in material goods and services to the 49 global health security priority countries.1
  • These exports supported over 1.6 million American jobs across all 50 states, in sectors such as agriculture, manufacturing, and natural resource extraction.1

CDC’s global health security efforts stop outbreaks where they start to protect health worldwide, in turn protecting demand for U.S. exports and the jobs they support in America.

What could happen to the U.S. export economy if an epidemic hits Asia?

The second article, Impact of Hypothetical Infectious Disease Outbreak on U.S. Exports and Export-Based Jobs, examines what could happen to the U.S. economy if an epidemic were to strike a key region, such as Southeast Asia. The article demonstrates how an epidemic spanning nine countries in Asia could cost the U.S. over $40 billion in export revenues and put more than 1 million U.S. jobs at risk.2

Southeast Asia is at greater risk for an emerging infectious disease event due to zoonotic, drug-resistant, and vector-borne diseases. Exports to Asia support the largest number of U.S. export-related jobs, which is why a large-scale infectious disease outbreak in this region could significantly disrupt the U.S. export economy.

The article illustrates the potential impact on the U.S. economy of an outbreak in just one affected country, and then expands the hypothetical scenario to look at what might happen if the outbreak were to spread across the region. Economic models used in the scenario take into account a large number of variables, including the interconnections between sectors of an economy and the trade between countries.

“The results of this hypothetical scenario show that the U.S. economy is better protected when public health threats are quickly identified and contained,” said Rebecca Martin, Ph.D., director, CDC’s Center for Global Health.

These articles offer valuable findings for policymakers and partners to consider when prioritizing programs to improve prevention, detection, and response to outbreaks around the world, and thereby reduce the potential threat to global markets and U.S. jobs.


  1. Cassell C, Bambery Z, Kakoli R, et al. Relevance of global health security to the US export economy. Health Security. 2017;15(6):563-568.
  2. Bambery Z, Cassell C, Bunnell R, et al. Impact of a hypothetical infectious disease outbeak on US exports and export-based jobs. Health Security. 2018;16(1).


Impact of a Hypothetical Infectious Disease Outbreak on US Exports and Export-Based Jobs
Zoe Bambery, Cynthia H. Cassell, Rebecca E. Bunnell, Kakoli Roy, Zara Ahmed, Rebecca L. Payne, and Martin I. Meltzer

Health Security Volume 16, Number 1, 2018 Mary Ann Liebert, Inc. DOI: 10.1089/hs.2017.0052

We estimated the impact on the US export economy of an illustrative infectious disease outbreak scenario in Southeast Asia that has 3 stages starting in 1 country and, if uncontained, spreads to 9 countries. We used 2014-2016 West Africa Ebola epidemic–related World Bank estimates of 3.3% and 16.1% reductions in gross domestic product (GDP). We also used US Department of Commerce job data to calculate export-related jobs at risk to any outbreak-related disruption in US exports. Assuming a direct correlation between GDP reductions and reduced demand for US exports, we estimated that the illustrative outbreak would cost from $16 million to $27 million (1 country) to $10 million to $18 billion (9 countries) and place 1,500 to almost 1.4 million export-related US jobs at risk. Our analysis illustrates how global health security is enhanced, and the US economy is protected, when public health threats are rapidly detected and contained at their source.

1918 H1N1 & cytokine responses in ferrets: Could explain the severity of disease….

J Infect Dis

1918 H1N1 influenza virus replicates and induces pro-inflammatory cytokine responses in extra-respiratory tissues of ferrets.

The Journal of Infectious Diseases, jiy003,

Published: 10 January 2018

“….1918 H1N1 virus spread to, and induced cytokine responses in tissues outside the respiratory tract, which likely contributed to the severity of infection. Moreover, our data support the suggested link between 1918 H1N1 infection and CNS disease.….”



1918 pandemic’s first wave hit the poor & the second wave hit the rich


Mamelund, S.-E. (), 1918 pandemic morbidity: the first wave hits the poor, the second wave hits the rich. Influenza Other Respi Viruses. Accepted Author Manuscript. doi:10.1111/irv.12541


To study the associations between Influenza like illness (ILI) and socioeconomic status (SES), gender and wave during the 1918-19 influenza pandemic.


Availability of incidence data on the 1918-19 pandemic is scarce, in particular for waves other than the “fall wave” October-December 1918. Here, an overlooked survey from Bergen, Norway (n=10,633), is used to study differences in probabilities of ILI and ILI probability ratios by apartment size as a measure of SES and gender for three waves including the waves prior to and after the “fall wave”.


SES was negatively associated with ILI in the first wave, but positively associated in the second wave. At all SES levels, men had the highest ILI in the summer, while women had the highest ILI in the fall. There were no SES or gender differences in ILI in the winter of 1919.


For the first time it is documented a crossover in the role of socioeconomic status in 1918 pandemic morbidity. The poor came down with influenza first, while the rich with less exposure in the first wave had the highest morbidity in the second wave. The study suggest that socioeconomically disadvantaged should be prioritized if vaccines are of limited availability in a future pandemic.


Antimicrobial Resistance (AMR): Another type of pandemic? “We still face two trends that spell potential disaster: new classes of drugs are not being invented and resistance to existing drugs continues to spread inexorably.”

World Economic Forum

“…..The risks posed by AMR have continued to intensify in the five years since the 2013 report. Numerous welcome initiatives have been launched, but concrete successes in addressing the two drivers identified above remain elusive. We still face two trends that spell potential disaster: new classes of drugs are not being invented and resistance to existing drugs continues to spread inexorably. The stakes are incredibly high—if resistance overtakes all our available antibiotics, it would spell the “the end of modern medicine”.…..”

The Pharmaceutical Journal. 2017. “Chief Medical Officer Warns Antibiotic Resistance Could Signal ‘End of Modern Medicine’”. The Pharmaceutical Journal. 17 October 2017.

Selected AMR Rates 

Resistance of Staphylococcus aureus to Oxadcillin (MRSA), % Resistant (invasive isolates)

Resistance of Klebsiella pneumoniae to Cephalosporins (3rd gen), % Resistant (invasive isolates)

Source: Figure courtesy Center for Disease Dynamics, Economics and Policy. Used with permission via Creative Commons license.
Note: Countries in white indicate no data available.


New research shows that the flu virus can be airborne not just carried by droplets


Osterholm:  “Respiratory droplets are like boulders that fall quickly over a short distance, while aerosols are like the perfume that can be smelled from a store’s fragrance department three aisles away.”

Jing Yan, et al. and EMIT Consortium.  Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community PNAS 2018 ; published ahead of print January 18, 2018, doi:10.1073/pnas.1716561115

Research significance:  “…..We show that sneezing is rare and not important for—and that coughing is not required for—influenza virus aerosolization….”


Study some ferrets inoculated intranasally with 1918 H1N1 virus and see what happens…..

1918 Pandemic research article

1918 H1N1 influenza virus replicates and induces pro-inflammatory cytokine responses in extra-respiratory tissues of ferrets

Emmie de Wit
Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, United States of America
Emmie de Wit: 903 South 4th Street, Hamilton, MT 59840, USA; phone: +1-406-375-7490; fax: +1-406-375-9620;
“…..Evidence for active virus replication, as indicated by the detection of nucleoprotein by immunohistochemistry, was observed in the respiratory tract, peripheral and central nervous system, and liver. Pro-inflammatory cytokines were upregulated in respiratory tissues, olfactory bulb, spinal cord, liver, heart and pancreas…..”
Corresponding authors: Debby van Riel: P.O. Box 2040, Ee1716, 3000 CA Rotterdam, The Netherlands; phone +31 10 704 4069; fax: +31 10 704 4760;
The Journal of Infectious Diseases, jiy003,

Healthier world, safer America: A US government roadmap for international action to prevent the next pandemic.

“PATH is the leader in global health innovation. An international nonprofit organization, we save lives and improve health, especially among women and children. We accelerate innovation across five platforms—vaccines, drugs, diagnostics, devices, and system and service innovations—that harness our entrepreneurial insight, scientific and public health expertise, and passion for health equity. By mobilizing partners around the world, we take innovation to scale, working alongside countries primarily in Africa and Asia to tackle their greatest health needs. Together, we deliver measurable results that disrupt the cycle of poor health.”

Preventing the Next Pandemic

PATH. Healthier world, safer America: A US government roadmap for international action to prevent the next pandemic. Oct 24, 2017 [Full text]

“….The critical need for pandemic planning and preparedness and the price the world will pay for not preparing….”


“…..A pandemic puts the entire world at risk of a markedly increased occurrence of severe morbidity and mortality.
The collateral damage from a pandemic is twofold, First, the panic and fear surrounding these illnesses and deaths can cause global governance to be severely challenged and people’s behavior and activities unpredictable and counterproductive. It should never surprise us what we can do in the name of fear. And remember the entire world will be in the soup at the same time. The United States and other developed countries will not be sending public health first responders and medical supplies to developing countries in response to the pandemic. We will keep everything at home for our own needs.
Second, the simultaneous occurrence of the pandemic worldwide means that the supply chains for critical products like life-saving drugs and essential medical supplies will be quickly threatened. For example, with our current global just-in-time economy, most drugs and medical products that we need every day are made in China and India; there are no stockpiles of these items anywhere in the world. These drugs and products will quickly disappear or be in very short supply. Because of that, another wave of severe illnesses and deaths will occur among patients with other illnesses like cancer, heart disease, diabetes, and immunocompromised conditions and acute events like trauma. ….”

“….Our study indicates that the new H7N9 mutants are lethal to chickens and pose an increased threat to human health, and thus highlights the need to control and eradicate the H7N9 viruses to prevent a possible pandemic…..”

Cell Research

Alice Y Guh, Susan Hocevar Adkins, Qunna Li, Sandra N Bulens, Monica M Farley, Zirka Smith, Stacy M Holzbauer, Tory Whitten, Erin C Phipps, Emily B Hancock, Ghinwa Dumyati, Cathleen Concannon, Marion A Kainer, Brenda Rue, Carol Lyons, Danyel M Olson, Lucy Wilson, Rebecca Perlmutter, Lisa G Winston, Erin Parker, Wendy Bamberg, Zintars G Beldavs, Valerie Ocampo, Maria Karlsson, Dale N Gerding, L Clifford McDonald; Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study, Open Forum Infectious Diseases, Volume 4, Issue 4, 1 October 2017, ofx171,


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