Scott McPherson's Web Presence

Yesterday, I had the grand opportunity to be interviewed by "learning guru" Elliott Masie on the topic of pandemic influenza preparedness and the role that the chief learning officers and chief training officers of business, industry, academia and government will be asked/forced to play in preparing for, and mitigating the effects of, pandemic influenza.  Heckuva sentence, huh?

I am unfamiliar with the "training and learning universe," so I did exactly what Elliott did to come up with my name:  I Googled him.  He is an extremely well-respected and admired advocate of innovation and reinventing the entire learning and training experience.  He is also a facilitator and incubator of ideas.  His organization, the MASIE Center (www.masieweb.com) is a major supporter of the Malaria No More project, at http://www.malarianomore.org/.  His conference, currently under way in Orlando, has more than 2,100 attendees from 29 countries.

Masie also "vetted" me through the Central Intelligence Agency beforehand, which has caused me to start speaking in a friendly tone of voice to the little fire sprinkler I have in the ceiling of my office.  Anyway, with that kind of gravitas, I could not possibly resist his request for me to come down and have a personal discussion on influenza in front of twenty-one hundred of his closest friends!

We covered 1918, H5N1 and world history.  We covered my favorite line, WWID, or What Would Ike Do, regarding panflu planning.  But I asked a question of the audience.  I said, How many of you are currently involved in pandemic preparedness within your organization?

A fair number of hands shot up.  But then Elliott turned the question inside out and asked, How many of them were not involved?

A sea of arms and hands shot up.  Our look of surprise had to be evident on the two hi-def screens on either side of the stage.  We were both amazed that such a key pandemic resource as learning and training was being overlooked by upper management.  That, I feel, is symptomatic of where we are as a nation today with pandemic preparedness.  Few corporate leaders are seriously engaged in out-of-the-box thinking on this topic. For every Michael Dell, who I can personally assure you is engaged on this topic, there are ten thousand flu-clueless captains of industry.  For every Michael Leavitt, there are ten thousand flu-clueless agency heads, elected officials and political leaders nationwide.

CTOs and CLOs are a growing and influential lot.  And they were told, by Elliott and by me, that they need to become pandemic subject matter experts and agents for change within their own organizations.  Trainers and learning professionals need to quickly ramp up their knowledge of influenza, and of H5N1 in particular, I told the assembly.  Read John Barry's The Great Influenza.  Learn how to overcome supply chain failures.  Subscribe to Google alerts.  Go to flu blog sites and other important flu sites. Learn as much as they can about the disease themselves.  Don't rely upon the American mainstream media for when to prepare.  Be prepared to teach employees how to prepare -- and care for -- their families. And know when the whole thing is about to go Pop! 

So you captains of industry and government, pull up an empty chair for the learning and training officers.  They are your best hope at imparting the necessary knowledge and skills necesary to weather this coming storm.

As if in response to my diatribe regarding Riau, Indonesia doctors' reluctance to test for H5N1 and my comparison to American medical attitude (and I mean attitude in the 'TUDE sense), comes this superb AP article, given prominent treatment by MSNBC. 

It involves the personal crusade of a MRSA victim and the subsequent eye-opener, revealed last week, that MRSA kills more Americans than AIDS.  Here is the link: http://www.msnbc.msn.com/id/21456183/ and here is the story.

By the way, the photo of the brown recluse spider has nothing to do with the story, but everything to do with the subject.  A growing feeling in this country is that so-called "brown recluse spider bites" were, in fact, MRSA infections.  The brown recluse is a veritable pussycat of a spider and only bites under extreme stress, such as getting tangled in human hair, clothing, or having to read the words of Dr. Don Goldmann (below).

Few hospitals screen for 'superbug'

CHICAGO - Testing all new hospital patients for a dangerous staph "superbug" could help wipe out a germ that likely kills more Americans than AIDS, consumer advocates say and early evidence suggests.

Yet few U.S. hospitals do it, and many fight efforts to require it. Why?

Jeanine Thomas, who nearly died from the drug-resistant staph bug, says the reason is simple: "Doctors don't want to be told what to do."

The Chicago suburbanite's personal crusade led Illinois this year to become the first state to order testing of all high-risk hospital patients and isolation of those who carry the staph germ called MRSA.

Powerful doctor groups fought against it. The testing and isolation of patients would be too costly, they said. Many other germs plague hospitals that also require attention. Experts said a more proven approach would focus on better hand washing by hospital staff — a simple measure tough to enforce.

Yet, Thomas prevailed. Similar measures passed this year in Pennsylvania and New Jersey. And Thomas' national crusade to make hospitals test for MRSA and report their infection rates gained steam last week after a Virginia teenager's death from the germ and a government report estimated it causes dangerous infections that sicken more than 90,000 Americans each year and kill nearly 19,000.

Suddenly the little-known germ with the cumbersome name, methicillin-resistant Staphylococcus aureus, is getting lots of attention.

People in health care settings, like hospitals and nursing homes, are most at risk for MRSA infections. Doctors and nurses who treat staph-infected patients and then don't carefully wash up can spread the germ to other patients. Germ-contaminated medical devices used on people having dialysis or medical procedures also can spread staph. Older patients and blacks are most at risk, according to the recent report by government researchers.

MRSA, pronounced Muhr-suh, has been around for decades and in recent years has spread to schools, prisons and crowded public housing projects. Even healthy people can carry it on their skin. It may look like a pimple or spider bite that doesn't heal, but it can turn deadly if it enters the bloodstream or morphs into a flesh-eating wound.

Many opposed to testing
Yet, many infection control experts oppose required testing for it in hospitals.

Many note that MRSA is just one of dozens of risky germs that often infect people in hospitals — particularly those with weakened immune systems or open wounds.

But Lisa McGiffert doesn't buy it. The director of the Consumers Union's campaign to stop hospital infections calls that "an argument of distraction."

"Certainly there are other superbugs and they should be tackling those, too," said McGiffert. "To eradicate hospital-acquired infections is going to take a comprehensive effort" that should include testing hospital patients, she said.

About 1.7 million Americans each year develop infections from various germs while hospitalized and almost 100,000 of them die, according to the U.S. Centers for Disease Control and Prevention. (bold mine)

MRSA accounts for only about 10 percent of these infections. Other worrisome bugs include C-difficile (an intestinal infection), vancomycin-resistant Enterococcus (linked with intestinal, skin and blood infections), and drug-resistant Acinetobacter (which can cause pneumonia, skin and blood infections); none of them accounts for more than 10 percent of hospital infections.

MRSA infections have hogged attention, partly because they're on the rise. And, acknowledges the CDC's Dr. John Jernigan, "MRSA likely accounts for a disproportionate amount of illness and death" because of its strength and resistance to mainline antibiotics.

CDC recommendations for fighting drug-resistant bugs list MRSA testing as an option. However, the agency says it's unclear whether that works better than other measures. Those include judicious use of antibiotics, hand washing, and wearing gloves, gowns and other protective gear.

"We don't think (testing is) a silver bullet to that problem," Jernigan said.

The Joint Commission, an independent, nonprofit group that sets standards for the nation's hospitals, doesn't have specific rules on how to prevent MRSA.

The commission's Dr. Robert Wise said the organization wants to see evidence that MRSA testing and other measures work. He said the commission hopes to have an answer early next year and then will then decide whether to adopt new standards.

VA testing at all 155 hospitals
Perhaps the commission will review an experiment done in Pittsburgh. There, the Veterans Affairs hospital tried MRSA testing, and annual infection rates fell from about 60 to 18 cases, said Dr. Rajiv Jain.

The staph bug used to cause "occasional" deaths, but no patient has died since 2005 when testing of all patients began, said Jain, who is with the VA's MRSA prevention program.

In May, the VA began putting a $28 million testing system in place for all 155 hospitals. But it costs about $32,000 to treat one hospitalized MRSA patient, so "if you reduce infections by 50 percent, you more than recuperate the cost," Jain said. (bold also mine)

Denmark, Iceland, Norway, and the Netherlands have reduced their MRSA rates and all test high-risk patients. In the Netherlands, that means testing foreign patients.

Opponents of mandatory testing point out that these small countries all had low rates of the germ to begin with. Hospitals in larger, more diverse nations like Britain, for example, have long had problems with MRSA.

And testing may not make sense for hospitals that treat few high-risk patients or where other bugs are more prevalent, opponents say.

"The best approach is not to have state legislators dictating how hospitals go about fighting infections, said Dr. Don Goldmann, of the Institute of Healthcare Improvement, a nonprofit advocacy group.

At the University of Chicago Medical Center, doctors have been focusing on C-difficile bacteria, which can cause severe intestinal illness.

With Illinois' new law requiring MRSA testing, "We're having to shift gears and haven't been able to devote what we'd hoped on these other pressing problems," said Dr. Stephen Weber, the hospital epidemiologist.

At Chicago's Rush University Medical Center, lab supplies alone for the testing will likely cost about $80,000, said Stacy Pur, Rush's chief nurse epidemiologist for infection control.

"It's very labor-intensive and we would really much rather focus our efforts on infection control" measures proven to work, including better hand washing by hospital staff, she said.

But Thomas, the MRSA patient-turned-advocate, argues: "You're never going to control this with hand hygiene, because you're never going to get 100 percent compliance."

Thomas had never heard of MRSA until she slipped on ice seven years ago and broke her left ankle. That landed her in a Chicago hospital, where she believes she got the infection.

Two days after being sent home, she developed throbbing pain in her left leg. She went to the emergency room, where doctors removed her splint and found the ankle hugely swollen, black and draining pus. She was admitted and given antibiotics, but within a week the infection spread inside her body; her lungs, kidneys and other vital organs shut down.

Hospitalized for three weeks and bedridden for six months, she recovered but her ankle joint was destroyed. She formed a support group and began lobbying for the new law.

Now Thomas is working with advocates in several other states.

"We have a wave happening," she said.

And if Illinois hospitals don't comply, she may push to enact testing of all — not just high-risk — hospital patients.

Infections dropped 60 percent
That has been done since 2005 at three Chicago area hospitals in the Evanston Northwestern Healthcare system. There, the MRSA infection rate has dropped 60 percent, said the system's Dr. Lance Peterson.

And at the VA hospital in Pittsburgh, Jain reported an added bonus. The rates for other hospital-acquired infections also fell after MRSA testing began.

Why? The testing may have caused hospital workers to pay more attention to hand washing and other prevention efforts, he said.

Doctors and hospitals frequently miss the point, especially Dr. Don Goldmann, referenced in the story by his quote (repeated here) that "The best approach is not to have state legislators dictating how hospitals go about fighting infections."

Well, Dr. Goldmann, who else should do it?  Clearly the profession is incapable of doing it on its own, or it wouldn't have the bloody problem!  The medical profession routinely snatches defeat from the jaws of victory with attitudes such as the one exhibited by Dr. Goldmann.  One could only conclude from his remarks that defending his profession is more important to him than seeking the truth or protecting his patients or the public at large.  Sweeping the problem under the contaminated rug is more like it.  And while he says what he says, people get sick -- and die -- and families suffer and the trial bar gets richer.  And hospitals continue to do nothing, because there is little incentive for them to do anything.  Shame on Dr. Goldmann for his shortsightedness. 

Dr. Goldmann misses the other point, which is cost avoidance.  Just ONE avoided wrongful death suit, or avoided malpractice suit, more than defrays the cost of the testing.  In the immortal words of Stan Lee: "'Nuff Said!" 

Tensions between Riau and Jakarta, news media turn nasty

The recent flap over whether ten-year old Gozi Sultia Ningsih actually died of H5N1 avian influenza or "regular" fever rages on, and will not be resolved until the WHO weighs in with the final word. However, that has not stopped officials from demanding that surveillance be stepped up in the region.

And it has, with the disclosure that no fewer than eleven (11) children from Gozi's immediate neighborhood (photo) have been taken in for testing and observation. The eleven began displaying flu-like symptoms. It started with seven childrem. 

From China's Xinhua news service:

The number of suspected cases in Riau just this year now numbers 29, with either 5 or 6 confirmed cases, and 4 or 5 deaths.  The exact number of dead may never truly be known, since the local officials apparently are not that keen on taking samples.  This trait is not limited to Indonesia:  How many Western doctors -- shoot, how many American doctors are, be it due to arrogance or a lack of motivation, reluctant to take requisite samples because they are so stubborn in their belief they know the cause of the malaise?  Why are so many seasonal flu samples taken in this country not strain-specific (they just say "Untyped")?

Then the Riau testing number suddenly turned to eleven.  From Riau Today, with translation provided by alert multiflusite poster Dutchy :

7 children Siak Evidently Negative Bird Flu

on Wednesday, on October 24 2007

From results of the beginning inspection in RSUD Siak, seven children from the Merempan Hulu Village, Kabupaten Siak that was stated suspect bird flu, results of bird flu of the negative.

They it was warned only were affected by the common fever.

In accordance with protap (protocol,ed) the handling of bird flu, the seven children were from this Merempan Village reconciled by the beginning inspection in RSUD Siak.

’ Examination early, seven children the Merempan Hulu Village mentioned the bird flu negative. Afterwards four other children who also took part in being checked by us, results of the negative. (underline mine)

In accordance with clinical (examination,ed), both from results of the inspection x-rayed and laboratory , was not found by the existence of the sign that headed in the attack of the bird flu virus.

The sign was sick the fever that was found by only common fevers ,’’ said the RSUD Siak Head Dr R Toni to Riau Pos, on Tuesday (23/10) in Siak.

According to Dr Toni, originally from results of the survey that we received had seven villagers Merempan that it was suspected was attacked by bird flu.

The seven villagers Merempan that suspected was attacked by this bird flu in general was supervised by the age 10 years with the condition experienced the fever.

To strengthen this assumption, in accordance with protap (protocol,ed) the handling of bird flu, the seven children were at once reconciled to RSUD to be carried out examinaton early.

From seven that was examined, afterwards had four other patients who also went along dipriksa because of taking part in being suspected of being attacked by bird flu.

And from results of the beginning inspection, the eleven patients who were examined by all of them were not found by the existence of the sign of the bird flu attack. Both from the inspection x-rayed and from results of the laboratory cheque.

http://www.riautoday.com/new/index.php?option=com_content&task=view&id=2917&Itemid=1

OK, so the Riau authorities are apparently sick and tired of being branded as hillbilly quacks by the Jakarta regime, which is playing host to Pelestinian Authority President Mahmoud Abbas.  Remember that the PA and the Israeli government speak at least once daily on the avian influenza situation, so I am sure Abbas has H5N1 on the agenda for discussion.  Perhaps the "nonaligned" PA is seeking prepandemic vaccine???  I would not be the least bit surprised. Here is the story, also translated by Dutchy, who also credits History Lover for the help:

Tuesday, October 23, 2007

Jakarta (Suara Karya): Health Minister Siti Fadilah Supari said that the resident of County Siak, Riau Province, initials GZ (10), that died at Siak, Provinsi Riau, RSUD Arifin Achmad, Pekanbaru Riau, Sunday (21/10), was positively infected with bird flu.

"Iya, positive. Continuing with the account, she said that the suspect died displaying previously with lungs and idea that pretty much the same and a large possibility as bird flu," said Menkes (Minister) following a national ceremony greeting President of Palestine Mahmoud Abbas, in Istana Merdeka, Jakarta, Monday.

Even so, Menkes (Minister) pushed Riau district as new bird flu cluster, because GZ's aunt have not taken blood sample.

"Not must, because her aunt have not taken blood sample. If it is positive with family relations, it should be a cluster," she said.

With the last sacrifice, Menkes (Minister) said that the total number of postive bird flu patients in Indonesia has reached 110 people and 89 positive for bird flu have died.

Gz died in the world in RSUD Arifin Achmad, Pekanbaru, after having been attended for a few hours in the medical center in isolation space. Captain of Bird Flu Handling Team at RSUD Arifin Achmad, Dr. Azizman Saad said that a new sacrifice was reconciled to the medical center with references to bird flu illness after it was known/detailed that she suffered from bird flu disease.

While the team from Riau Province Health Agency along with Siak County Health Agency did field investigations in the location where the presumed bird flu patient lived as died in world at RSUD Arifin Achmad Saturday (20/10).

"An investigation was done to determine the risk factors of the death of the avian influenza suspect patient," said Riau Kasubdis Health Diskes, Burhanudin Agung, to Between in Pekanbaru, Monday.

Burhanudin continued, the investigation needed to be done despite the fact that the suspect patient have not assigned as a positive bird flu patient.  http://www.suarakarya-online.com/news.html?category_name=Sehat

Incredible candor and a downright pre-WHO Margaret Chan-ish change of tune regarding the situation in Riau.  And now both the local government and the Riau authorities are falling back on a tried-and-true strategy:  When all else fails, blame the media!  From multiflusite poster Commonground's translation of a Riauinfo.com article,  http://www.riauinfo.com/main/news.php?c=6&id=2800 :

And now, today, in Riau, things are getting really, really testy.  Again, from Commonground:

Burhanuddin and Azizman confess/promise/claim to be more and more confused when news that same garnish/embellish screen of television in form of raining text amounting to television private. "A Cause/sign/commotion raining test aforementioned I more and more receive telephone all kinds side that wish to find out truth including from WHO," sigh Burhanuddin.  http://www.riauterkini.com/sosial.php?arr=16273 

The disclosure that seven (now eleven) children in the immediate neighborhood were tested for flu burung was picked up quickly by the local newspapers and television -- so quickly, in fact, that even the WHO got on the phone to know what in Sam Hill was going on down there!  This, in a way, partially assuages the concerns of Crawford Kilian (CROFS, H5N1) who recently and correctly lamented that there are no journalistic boots on the ground in Riau.  Apparently, the local media are picking up the gauntlet -- much to the consternation of the people trying to get work done down there.

As usual, stay tuned.

Sports teams, schools, hospitals wrestle with global MRSA epidemic

MRSA has claimed yet another young life.  Seventeen year-old Ashton Bonds of Lynch Station, Virginia, died following a bout with the disease.  MRSA is the acronym for Methicillin-resistant Staphylococcus aureus, a particularly nasty bacteria that is showing up all over the nation.  In Mr. Bonds' case, MRSA had spread via his bloodstream, attacking his kidneys, liver, lungs and heart muscle.

MRSA apparently began its life in hospitals.  The probable cause grew from lax oversight of hospital infectious disease control protocols. 

From a Bloomberg news story of December 19, 2005:  http://www.bloomberg.com/apps/news?pid=10000103&sid=aQGnyaFWj2FA&refer=us :

Researchers are concerned especially about antibiotic resistant bacterial infections that arise in hospitals and spread to homes and crowded workplaces. The microbe, called methicillin-resistant staphylococcus aureus, or MRSA, is creating a health hazard in the U.S. dwarfing the threat posed by the H5N1 avian flu, said Steve Projan, vice president of protein technologies for Wyeth, the drugmaker that markets the Tygacil antibiotic.

``This is a hyper-virulent virulent bug,'' Projan said in a press conference at the Interscience Conference on Antimicrobial Therapy and Antibiotics on Friday. ``While we're very concerned about H5N1, we do have in front of us today this outbreak of community-acquired MRSA.''  (bold mine)

Increasingly, researchers are finding these drug-resistant infections outside the hospital, leading to concerns about widespread outbreaks of hard-to-treat microbes.

In some hospitals in San Francisco and Los Angeles, the new toxic strain is the leading cause of drug-resistant staph infections. More than half the MRSA's at the Harbor-UCLA Medical Center are the community-acquired strain, according to a study presented Dec. 17 by Cynthia Maree, an infectious disease specialist at the University of California, Los Angeles Geffen School of Medicine.

``That's more than twice the rate we had in 1999,'' she said in an interview at the conference. ``When patients make repeat trips to the hospital with the same strain, health workers will sometimes clean the patient's home,'' in an attempt to get rid of the source of infection, she said.

MRSA has become a major pain in the rear for school districts.  It has hit sports teams especially hard -- especially those sports with a great deal of abrasion on hard surfaces, where the bacteria can transfer from skin to skin.  As a result, athletic coaches and trainers are learning about MRSA in clinics and lectures at coaches conventions.  Today, for example, wrestling coaches in several states are required to disinfect all wrestling mats after practice and before and in some cases, even during wrestling matches.

But the disease is certainly not limited to high school athletics.  In 2003, the St. Louis Rams had to disinfect their playing surface and their practice fields, following the revelation that opposing teams were contracting MRSA after playing the Rams in their domed stadium.  In fact, the New England Journal of Medicine published a scientific paper on the outbreak, submitted by researchers from (among other entities) the National Center for Infectious Diseases and the Epidemic Intelligence Service, Division of Applied Public Health Training, Centers for Disease Control and Prevention.  The abstract is located at: http://content.nejm.org/cgi/content/abstract/352/5/468 . It says, in part:

We conducted a retrospective cohort study and nasal-swab survey of 84 St. Louis Rams football players and staff members. S. aureus recovered from wound, nasal, and environmental cultures was analyzed by means of pulsed-field gel electrophoresis (PFGE) and typing for resistance and toxin genes. MRSA from the team was compared with other community isolates and hospital isolates.

During the 2003 football season, eight MRSA infections occurred among 5 of the 58 Rams players (9 percent); all of the infections developed at turf-abrasion sites. MRSA infection was significantly associated with the lineman or linebacker position and a higher body-mass index. No MRSA was found in nasal or environmental samples; however, methicillin-susceptible S. aureus was recovered from whirlpools and taping gel and from 35 of the 84 nasal swabs from players and staff members (42 percent). MRSA from a competing football team and from other community clusters and sporadic cases had PFGE patterns that were indistinguishable from those of the Rams' MRSA; all carried the gene for Panton–Valentine leukocidin and the gene complex for staphylococcal-cassette-chromosome mec type IVa resistance (clone USA300-0114).  (bold mine)

From the Bloomberg story of 2005:

Episodes of drug-resistant infections have occurred in the past year on professional U.S. football teams, including the St. Louis Rams, Baltimore Ravens, and San Francisco 49ers, said Dan Jernigan, chief of CDC's epidemiology branch at the National Center for Infectious Diseases. Infections have been seen among newborns in nurseries, he said.

In an article in today's Washington Post, reporter Rob Stein gives some unbelievable new factoids.  http://www.washingtonpost.com/wp-dyn/content/article/2007/10/16/AR2007101601392.html?hpid=topnews

A dangerous germ that has been spreading around the country causes more life-threatening infections than public health authorities had thought and is killing more people in the United States each year than the AIDS virus, federal health officials reported yesterday.

The microbe, a strain of a once innocuous staph bacterium that has become invulnerable to first-line antibiotics, is responsible for more than 94,000 serious infections and nearly 19,000 deaths each year, the Centers for Disease Control and Prevention calculated.

MRSA is a strain of the ubiquitous bacterium that usually causes staph infections that are easily treated with common, or first-line, antibiotics in the penicillin family, such as methicillin and amoxicillin. Resistant strains of the organism, however, have been increasingly turning up in hospitals and in small outbreaks outside of heath-care settings, such as among athletes, prison inmates and children.

The CDC's Scott K. Fridkin discloses the results of a multi-state study of MRSA.  It yielded the following information:

In the new study, Fridkin and his colleagues analyzed data collected in California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon and Tennessee, identifying 5,287 cases of invasive MRSA infection and 988 deaths in 2005. The researchers calculated that MRSA was striking 31.8 out of every 100,000 Americans, which translates to 94,360 cases and 18,650 deaths nationwide. In comparison, complications from the AIDS virus killed about 12,500 Americans in 2005.

"This indicates these life-threatening MRSA infections are much more common than we had thought," Fridkin said.

In fact, the estimate makes MRSA much more common than flesh-eating strep infections, bacterial pneumonia and meningitis combined, Bancroft noted.

"These are some of the most dreaded invasive bacterial diseases out there," she said. "This is clearly a very big deal."

The infection is most common among African Americans and the elderly, but also commonly strikes very young children.

So there are more deaths from MRSA in the United States that there are from HIV/AIDS, a recognized pandemic.  And perhaps MRSA is a candidate for true pandemic status, based on this snippet, also from the Bloomberg article of 2005:

The Netherlands has taken a ``search and destroy'' approach to drug-resistant superbugs, said Vincent Jarlier, an infection control officer for the Assistance Publique hospital network in France. Dutch doctors and nurses who test positive for the superbugs must have six negative tests before they can return to work, he said. Hospitals are required to shut down wards where the superbugs are detected; one hospital shut down ten at one time.

But wait, there's more!  Vietnam has had its own MRSA epidemic. From the National Institute of Health, published just last month:  http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1950567

An Outbreak of Severe Infections with Community-Acquired MRSA Carrying the Panton-Valentine Leukocidin Following Vaccination

We carried out a field investigation after adverse events following immunization (AEFI) were reported. We reviewed the clinical data from all cases. S. aureus recovered from skin infections and from nasal and throat swabs were analyzed by pulse-field gel electrophoresis, multi locus sequence typing, PCR and microarray. In May 2006, nine children presented with AEFI, ranging from fatal toxic shock syndrome, necrotizing soft tissue infection, purulent abscesses, to fever with rash. All had received a vaccination injection in different health centres in one District of Ho Chi Minh City. Eight children had been vaccinated by the same health care worker (HCW). Deficiencies in vaccine quality, storage practices, or preparation and delivery were not found. Infection control practices were insufficient. CA-MRSA was cultured in four children and from nasal and throat swabs from the HCW. Strains from children and HCW were indistinguishable. All carried the Panton-Valentine leukocidine (PVL), the staphylococcal enterotoxin B gene, the gene complex for staphylococcal-cassette-chromosome mec type V, and were sequence type 59. Strain HCM3A is epidemiologically unrelated to a strain of ST59 prevalent in the USA, although they belong to the same lineage.

So while we all try to figure out what the heck H5N1 is doing, remember that the Devil you know -- MRSA -- is out there, multiplying, mutating and killing.  Sometimes we'd prefer the Devil you know over the Devil you don't know.

Thomas P.M. Barnett has written an excellent opinion piece for the Scripps-Howard News Service. Titled "In the future: health screening at airports," the piece clearly and plainly lays out the enormous difficulties nations and the aviation industry in general will face when the next pandemic arrives (via a scheduled passenger airline flight). The link is at: http://www.scrippsnews.com/node/27573

Barnett is no stranger to planning.  In fact, if you have not heard of him, let me condense his story.  Barnett was in the Pentagon in the late 1980s and started giving Powerpoint presentations regarding what he believed was the inevitable implosion of the Soviet Union.  He even went so far as to predict the American Navy, for example, would be called upon to help its Soviet counterparts. 

The assembled admirals and generals scoffed at this heresy.  More than once he was laughed out of the room.  But the ensigns, commanders and captains in the back rows -- the inheritors of the military after the current silver-hairs retired -- they listened with intense interest. 

And they believed.

When the Soviet Union did collapse, just as Barnett predicted and within the timeframes predicted, and the U.S. was asked to help its former enemies, those same youthful military leaders sought out the visionary Barnett.  "Where's that guy with the Powerpoint!" they would yell at their adjutants.  In response, Barnett's first book -- The Pentagon's New Map -- was a New York Times bestseller and the second-most popular book in the entire Pentagon, behind the Bible.  Barnett's follow-up work, A Blueprint for Action, also sold well and both books are in trade paperback today and available at fine bookstores across the United States.

He is also a buddy of mine, so I am happy to shill for him!  Barnett gives the most lucid explanation for the violence directed against the civilized world today via his "Core and Gap" message.  It is simple yet not simplistic.  It is simple genius and one only wishes someone at 1600 Pennsylvania Avenue would stand up and articulate it to the world.  He is frequently bookended in peoples' minds with fellow globalization maven Thomas Friedman.  To contrast: Friedman is the diplomat and Barnett is the enforcer (again, a reference to his desire to revamp the military into "The Leviathan" and "System Administrators" -- oh, just go buy the damn books!).  He is sometimes described as "Jack Ryan with a Powerpoint."  He is brilliant.

Barnett was heavily involved in the Pentagon's Y2K planning effort in the late 1990s, which is where I first heard of him.  As I was running Florida's statewide Y2K preparedness effort, I naturally took a deep interest in those in Washington who were also thinking way outside the box.

Anyway, I have taken some excerpts from his latest column, which I referenced way back in the beginning of this blog.  Here they are:

The White House recently released its new homeland security strategy and, unlike the initial 2002 version, this one focuses far more on natural disasters as opposed to terrorist strikes. That's a welcome change not simply because Hurricane Katrina was a humbling experience, but because globalization's growing connectivity means a naturally occurring pandemic is the most likely mega-disaster we'll face in the near term.

A bird flu-triggered pandemic could easily become the most deadly global outbreak since the 1918 Spanish Flu, which killed at least 20 million people worldwide. In the United States alone, over one-quarter of the population became sick, with approximately 600,000 people succumbing to the virus. Extrapolated to today's American population of 300 million, that yields a potential death count of 1.5 million to 2 million.

Flu strains enter the United States in the bodies of sick travelers, so the key here will be our efficient and effective screening of in-bound passengers at international airports. According to Oak Ridge National Laboratory scientists currently investigating pandemic response procedures for the Department of Homeland Security, for every flu carrier who --unwittingly or not-- eludes that envisioned net, as many as 10,000 Americans could suffer exposure within three weeks time.

Consider the sheer volume: over 25,000 passengers arrive through Los Angeles' international terminals on a daily basis. In August, when a software glitch struck U.S. Customs' computers there, 20,000 passengers were stranded for up to 18 hours.

Ideally, any systemic approach would include initial diagnostic screens conducted overseas at originating airports. Since virtually all international flights are lengthy, passive diagnostic screening at points of embarkation and debarkation would offer authorities the opportunity to compare and contrast readings over time. For example, additional measures would be warranted if a passenger's symptoms worsened during the flight or if those symptoms spread to other passengers.

In the summer of 2004 my wife and I got a preview of this sort of screening at Honk Kong's international airport during a localized outbreak of avian flu cases. As we walked through the terminal with our youngest child, just then adopted from China, I noticed a large computer screen along the wall where our ghostly images were being displayed in real time. It turned out that airport authorities were scanning our body temperatures passively as we passed through a chokepoint.

I walked over to the technicians and asked about the procedure, only to be told that if any of us had registered an above normal temperature, our entire family would have been required to spend at least 48 hours in Hong Kong -- at our own cost! -- before we could again attempt departure on an outbound flight. Fortunately for us, what turned out to be our infant daughter's impending ear infection didn't kick in fully until we were several hours into our cross-Pacific flight. Had we been again screened at our American port of entry, we would have been nabbed, preventing -- for all we knew at the time -- something far worse from unfolding. (bold mine)

Where do you draw the lines in all of this? I can't begin to say.

I just know it's important that our Department of Homeland Security think through all realistic scenarios and gear up for the real-world tests that inevitably lie ahead.

Thomas P.M. Barnett is a distinguished strategist at the Oak Ridge Center for Advanced Studies and senior managing director of Enterra Solutions LLC.

As fellow bloggers Crawford Kilian and Mike Coston have pointed out, it is refreshing to have someone actually use the correct numbers when predicting an influenza pandemic.  It is no surprise that Barnett would use the appropriate numbers when predicting the potential pandemic's impact on the U.S. population.

What is most important to all of us is this: Because of Barnett's extreme gravitas inside and outside of the Pentagon and the Washington media, government think tanks and policy wonks everywhere, his voice becomes a powerful force for pandemic preparedness.  I am hopeful that this is the first of many, many written and vocal forays into the world of pandemic preparedness.  His Website/blogsite, by the way, is www.thomaspmbarnett.com .