Organic material that the bacterial die-off we now have studies showing that he Coli o157 for example in cow manure Will Survive over a hundred and twenty days in the field applied to product and if that gets out of the product and obviously have a problem so I would just say that right now is that short of you know, really being able to either cook the product or or making sure that doesn't happen. Organic material that the bacterial die-off we now have studies showing that he Coli o157 for example in cow manure Will Survive over a hundred and twenty days in the field applied to product and if that gets onto the product and obviously have a problem so I would just say that right now is that short of you know, really being able to either cook the product or or making sure that doesn't have that manure doesn't have contact with the product. You do Post magician Risk Jack hear your question for Doctor what's wrong place? When is how which type of home filtration would protect a vulnerable person such as a immunosuppressed person from crypto if it happened to get Municipal Water Supply and secondly in a public waiting pool. What type of filtration would Ultra? Pilot light exposure or ozone treatment like they use in aquariums. What what type of filtration would work both in the home for drinking water and also in a public waiting for Philippi? This was the problem out at the zoo. Right? Right. This was the outbreak that we just recently had the associate with a fountain kind of waiting area at the Minnesota Zoo and Jack thanks for for this because it really does I think serve to good questions in terms of public education cryptosporidium is a parasite that is extremely resistant to the normal kinds of disinfection that we think of like the flooring in our water supply. And in fact, if you want to store cryptosporidium so that we can use it for future research efforts. We actually stored in that old terrible yellow acid fluid magnesium chromate that you used to using your Chemistry laboratory some years ago to store glass pipettes in you know, that the new stuff actually lives best in that kind of a product that kills everything else so that that's where we actually store our sis for future research. Chlorine has little to no effect on cryptosporidium in any short time. If you expose for days and days and days it can begin to kill it. So the question you really ask Jack was about the ozone and so forth the techniques that we typically used to disinfect are not really adequate. So the next thing we the next kind of War we try to put between us in the bag is actually filtration, which means if we can't kill will try to get it out of there and that's really the question you asked regarding the water supply. The only filters that are effective against us in the water supply or those it get down to we call certain poor sizes mean in the size of what can pass through the filter in you need something on the order of less than 1 Micron so I can't sit here and tell you exactly which home filter to use but you need something with a pore size lesson 1 Micron and they should be able to tell you another problem with that is if you have a water system that has any kind of of material and it from sloughing off of pipes or whatever from time to time that gets plugged up pretty quickly at one point. We are at 1 micron. Kaiser smaller, so you have to change the filter often, but that is really the only solution to have in terms of swimming pools. We don't really have a method right now to effectively kill cryptosporidium in either a wading pool or swimming pool. Again. It's the circulation in filtering it through certain filters and the only really good effective filter that we have is one called diatomaceous earth, which is basically diatoms. It's a white powder material very fine powder material of which of Minnesota and fortunately about 5% of the swimming pools have diatomaceous earth filters and even then if someone were to accidentally defecate into the pool the average swimming pool in Minnesota probably has between a 5 and 12-hour recirculation time. So for all the water to circulate through one time alone to take this out at 5 to 12 hours and that's why we've been concerned at this could happen more often to give you an idea how infectious cryptosporidium is and it makes the Milwaukee outbreak. We're over 450,000 residents got sick kind of Some kind of perspective is if one child accidentally defecates into the pool or in the waiting area that is enough to contaminate a hundred million gallons of water. So that's on one swallow you get sick that gives you a sense of this and so what happened in the swimming pool is there you couldn't find a much better mixing pot because if that does happen you think of it like I can't see it. It's probably not till the water's clear but this mix is very well is kids are moving around in the water and its really tell it filters through one time that you've effectively taken it out. We're seeing more and more waterborne outbreaks with cryptosporidium throughout the country often associated with wading pools water slides. The big water parks in this is clearly a concern to us and we're working with the industry to see what we can do to improve on filtration and the time that it takes to filtrate water so that in fact we can never be certain we get rid of the parasites going to say is this something that's kind of a new bug that is attacking us or is it always been around and we just finally figured out It is in a little bit more about how it operates and get better reporting systems at that people actually get sick from it. I think it's a combination when I say a combination. We know that we've had outbreaks in municipalities around the country with cryptosporidium. Even before I recognize is cryptosporidium dating 20 or 30 years ago, but we've seen more recent outbreaks. You don't miss a Milwaukee outbreak, you know, when you have a 450000 people in the way you pick it up is because you run out of toilet paper and anti-diarrheal medications in your grocery stores and pharmacies before people even have a chance to get to the doctor, you know, you got a problem. So I thinking that since we are seeing more but clearly was also some recognition I have to tell you that the outbreak at the Minnesota Zoo, you know, the health department got a fair amount of credit from the community for this when we appreciate that and we like to think they were on top of it. But I think the real credit goes to a group of mothers in Apple Valley who had taken their children to the zoo and for a birthday party and the kids all got sick and they recognize the only thing that they had in common or had all been at the zoo. With the same time and contact us and said, you know, we think the zoo is a problem issue here. We don't know what our kids have they've been to several Physicians. None of them have been diagnosed with anything that we at least can say is the same thing and it was only two that contact of the health department and we got involved in the stool samples and found it was cryptosporidium in and did the additional investigation. So I think that the fact that people are now more aware in Minnesota that they can call there someplace to call if you have these kind of problems I think does mean that we hear about these at these mothers hadn't called us, you know, this could have clearly gone unnoticed for some time. You're a question for Michael Strahan Place. Hello. I just would like to say you open with one of my questions concerning staff a Vancomycin resistance in Japan As I understood you this did not evolve a genetic transfer from Aunt arakaki which was speculated on a while back. I think is it possible that might also occur here by the transfer method rather than the evolution within the bacterium, but secondly the thing I'd like you to do Gus and I talked to one of your epidemiologist concerning scabies b a c c j s and consumers reported mentioned a couple of months ago the inadequacies of the FDA or USDA requirements and a couple of things have appeared in the light pressed maybe Holcomb maybe for real the connection between using bone meal for all the rows lovers in England that the incidence of CJ a cadaver pituitary growth hormone the incidence of CJ s and the case is now appearing clinically representing differently than in the past I want and also I just put a bottle of chondroitin sulfate back on the Shelf when it said it was made from bovine connective tissue and it just in parting might I say I fully approve of your dekoni and efforts to financially support their staff at the blue-collar retiree was never had more than fifteen bucks an hour. I think it's obscene the scientists and Physicians are paid a fraction of ballplayers and rockstars. I'm all for you, sir. I hope you understood most of his question guess which was this bacteria that has the resistance for Vancomycin the last line drug. We have against staph aureus and this is where that genetic material resided. We were convinced that into a caucus was going to transmit this on to staff a while but it didn't happen. In fact is I said staph aureus did it on its own and your questions could this show up elsewhere at this point? I think that we're going to see in the United States most likely staph aureus developing Vancomycin as a resistance as a result of its own inherent ability just like we saw in Japan because now we recognize that it was easier for to do that the next to pick it up in the inner caucus that's really scares us because it it means that it's not just our ability to skip these two bacteria separated or two really defeated on the inner caucus front what you're talkin. Turn the second question was that a creutzfeldt-jakob disease or the verium price felt yakup in. This was the mad cow that occurred in Great Britain, and now there's several cases reported in internal of Europe two cases in the last several weeks has been reported now in Switzerland and what we are all concerned about is can in fact that was called a prion and I mean to give you a sense of how how complicated this is a prion is not like I like a virus even which is much bigger, even though viruses are nonliving things. They have to infect cells. This is just a little piece of genetic material that gets inserted into things when consumed is so heat stable at that's why cooking doesn't even kill it and what this prion that causes the condition known as Christ Jakob disease in humans, which is a very low level in many cases probably genetically related condition did in Great Britain was get caused when cattle developed this Disease in the meat was eaten by the individuals over there and it's residing in the in the connective tissue area in the neurologic tissue or I should say the neurologic tuition at the connective tissue and that one that was consumed basically. Yeah, these people picked it up. I think the relationship is very tight. Now between the issue of creutzfeldt-jakob disease variant creutzfeldt-jakob at least and eating this meat product over there. We have no evidence in this country that we either seen the disease in animals. Kick the ball Vine which would then transfer to humans or that even if we did we have any humans that would get sick from it. We have no evidence of any increased occurrence here of creutzfeldt-jakob disease or this particular kind and I just one point I want to make is epidemiologically what makes this complicated and Great Britain is it's not the people had a lot of meat contact. It's not the people who a lot of contact the animals that have developed this some of them were not quite vegetarians, but almost into one of the things we're looking at also is what is the relationship between the host other unique host factors meaning? Some people are susceptible to this and that's where we're at today. But I think at this point you have many more things to worry about in this country than then that here and steps are being taken to clearly make sure that there is no neurologic tissue in any of our meat products that we get today back to bed to staphylococcus business and hospitals. Are we on the verge of getting to the point where many many many people are going to get what I'm onto incurable diseases while they're in the hospital. Well, we we have some now in the sense that if you look at this vancomycin-resistant enterococci, you know, we've had outbreaks occur in this country of people who very successfully get through there a transplant will be a liver transplant whatever but they pick it up in the Intensive Care area this bacteria ended up dying from that as opposed to anything related to their transplant that has been a real problem. I think that what we're all looking towards in the future is an increasing number of diseases where the options we have for treatment are either so limited or do not exist at all that we will start losing patience and we know the hospitals while they do mini mini good things for us and thank God we have them for years have been also a source of infection because of what we call nosocomial infections were people actually get the disease trantor the bacteria transmitted in there from hand-washing or any number of things that don't occur adequately and so yeah, I think that the hospitals are going to have to deal with this when we have been working with the Medical Care Community here in men. Soda and try to come up with the standards, and I might had nausea Steven hospital, but nursing homes any of that kind of a care facility. We've been very involved in doing an investigation on an outpatient setting where we do more more invasive procedures outpatient and in some of those in since we've had transmission of antibiotic-resistant bacteria infections in the outpatient setting, but so it's not going to be limited to the hospital wonderful wonderful State epidemiologist, Michael osterholm is our guest today with the lots of good news to 276 thousand is our Twin City area number if you'd like to join your conversation if you have a question to 276 thousand outside the Twin Cities one. 800-242-2828 Helen your question, please I have a concern about a cat in the household. It was recalled recently diagnosed with the human equivalency of AIDS. Now there's a small child in the household, which is just beginning to crawl. I have two concerns. First of all, is there a possibility of mutation of this virus and secondly what illnesses that requires because of its weakened immune system could be transferred to this child through hands mouth true or do any people matter that might be on the paws of the cat what precaution should be taken and thank you for calling actually that's a relatively common question in a good one in the sense that the other cat ownership is at an all-time high in this country. And there is a condition. I'm sure you're referring to feline leukemia virus infection that the cat has developed that causes a a kind of picture not that totally dissimilar from that of of HIV AIDS in human. I'm very happy to What is good news? There is no relationship between that disease in human infection and you don't have to worry about that. That is a very species specific situation and is in turn. I don't think there's really any one condition. I think you need to be concerned about with the cat beyond what we normally give her advice. For example today were very concerned about an increase in the occurrence of toxoplasmosis in women particularly pregnant women wear their we think this is one of the leading causes of death due to foodborne disease in this country where women are taken care of cat litter not realizing the old days of pregnant women not handling cat litter because if you get infected with that Toxoplasma parasite during your pregnancy, it will have very deleterious effects on your unborn child. I either killing the child or causing severe mental retardation brain infection, and that's a very major problem. So we first of all I would tell anyone who has a cat noise be careful of cat litter particularly if your Woman if you get infected, you're not a pregnant woman. It's not really that much of a life-threatening infection. Unless you're even though compromised yourself. But if you're pregnant, that's a key problem the secondary that we'd be more concerned with cats about is a thing called Cat Scratch Fever which is a newly discovered bacteria and it actually is a result of a type of bacteria are bacteria like agent that's in the saliva and on the pause pic of young kittens and when they bite or they scratch you you may get a slight infection at the wound site, but you can go on and develop more systemic disease and clinicians. I think they're much more aware of this today and we have some test for it and requires antibiotics treatment kind of causes a flu like symptoms with actual site to become an inflamed and can cause more systemic symptoms in that since always say is if a child gets scratched or bitten by a cat that you just clean it out with normal, you know, hydrogen peroxide alcohol that type of thing and it shouldn't be a major problem, but that's the other conditions. Beyond those two I'd say I really wouldn't be concerned other than the good hygiene issues of cat feces in general are there comprable problems with dogs the dogs are not a carrier situation for either one of these and so we don't see that with dogs dogs have other issues a course in terms of of the stool continue some of the common bacterial foodborne kind of pathogens possibility of actually dogs are much less of a problem. That way we're dogs become another problem really is not that they transmit the disease, but there has been some indication that I have in close contact with dogs and dogs in the house have been an increased risk factor for things like Lyme disease where they bring a text with them that didn't come in the house and then if they're not attached to the dogs, they may find you and be attached to you and there's been some evidence that there may be increased risk for Lyme disease in humans have close contact with dogs Margaret your question for a Michael osterholm place. Parent who has Grave concerns regarding immunizations particularly a certain kinds of vaccinations for their child because I want difficult option and the second question I have has to do with since you were talking about the swimming pools. What if you know what the Department of Health guidelines are footballs in swimming pools and how often but they have to use their to kill fungus and bacteria and so forth. When you say you have concerns about specific vaccinations, could you kind of give me more information at which ones are of concern to you? Take care and diphtheria. In fact you were recorded in one of the books that I that I You didn't quite finish reading regarding I think you would written and I can't remember what it was which one it was about right now, but it was the serious side effects and it was a quote from you from 1988. And I was in the JM JM a right. Actually. What I did is I did an investigation along with our team at the State Health Department back in the late eighties with you early hermopolis influenza type B vaccines the back tree that used to cause severe meningitis in kids. One of the worst aspects of my job. If not the absolute worst aspect of my job is watching very serious life-threatening in far too often fatal cases of disease in children that you never get used to that and if there is anyone good news peace again, I can also tell talk about today as it used to be there used to be over 300 cases of amethyst in twinsy type B meningitis every year in the state in young children and about 10% of the children to Die Another 10 to 15% would be like Severe neurologic sequelae which is obviously a lifelong kind of situation and with the Advent of the hermopolis vaccine the initial one in the 1980s. What am I study actually showed was is that the vaccine didn't work well and that it didn't actually prevent disease and there may be an even a slight risk that you are at higher risk of the disease initially That vaccine is very quickly replaced with a much better vaccine. And as a result of that we have virtually eliminated that disease today. I mean that is public health at its very best rather than treating 300 kids are vaccinated make sure they don't get it and we now have fewer than three to five cases a year of this disease in the state, which is just a remarkable change from just a few years ago. So I hope there's no misinterpretation that we think the him off was vaccines a very very good one today. It's very very safe. You issue around four tosses is one where they're clearly are some were some issues with pertussis vaccine. How's that again? No longer exist. I think today in terms of real side effects. And when what happened was is pertussis is a bacteria that causes an in children in particular severe again lights running kind of infection. If you don't die, you're so very very sick. You may be in the hospital for for extended periods of time. And in this kind of infection also, you can have some very serious long-term side effects the bacteria that causes this did not lend itself well to the formation of the vaccine and so it we did in the kind of the old days meaning just a little a couple years ago. We used to more or less just trapped is bacteria up kill it and make sure it was dead and then give you that and hope that you responded to all the different pieces and it's kind of like a car imagine that difficult car was the size of a microbe, you know, there's a motor there's a there's wheels or tires or steering wheel their seats. There's Trunks and we kind of gave you all of it. Well today what we've been able to do is figure it out. That day if that same car unit was the size of a micro we needed to protect you against turn wheels and front right tire is all we've actually separated out parts of the bacteria. And now only inject against those pieces in the process of doing that. We've actually made the vaccine much much much safer. And when I say safe and Raven poem about life-threatening problems because I think that those were clearly overstated with pertussis and that the kinds of seizures and so forth that we saw of pertussis. We're often situations that could be related just a pertussis. It's the fact that kids have a lot of other conditions around the same time. That you were concerned that there truly were some neurological issues that came up today. We have virtually eliminated those with what's now called acellular pertussis vaccine datp. It's a cellular reproduction. So I would just say that for the purposes of of immunizations that I would not be reluctant to get the new vaccine and would suggest you that that if you look at the World literature some of the old things in four tosses. That's a whole new ballgame today. I would just remind people that each year in this state. We have 63 65,000 new children that we have to keep vaccinated and keep working on that. We can't just really make an effort and then stopped for a while. And if we don't we all see it. We see the measles outbreaks. We see the problems with pertussis. We see the problems with the with diphtheria and so forth. And so we're really concerned that we think ization still represents one of the very best if not the best aspects of Public Health and would strongly encourage that parents do that and working with your position today. There really are very very few contraindications for vaccinations and from a safety perspective quick one more question on vaccinations were coming up soon to the flu season. Begin our is that a good idea? Are those are those safe? Flu shots right when you ask are they safe, you know, everyone always goes back to what happened with swine flu in 1976 and caused the condition known as Gian Beret syndrome kind of was often also referred to as French polio there clearly wasn't interaction between some individuals who got the flu vaccine and the swine in in in Gian Beret syndrome. We've not had any evidence since that time that there's been any problem with that. We know that flu is one of the primary killer is particularly of a middle-aged older adults in this country during the winter months in a may not be the flu directly and maybe a second secondary bacterial infection occurs as a result of the flu. Also we've documented here in Minnesota and the first group to do that in the country and now others have clearly found the influenza also predispose you to toxic shock syndrome, which is kind of interesting issue because it gets a to bug hit and what happens is is it with influenza you develop Dish in your throat where you throw it just feels really sore and what's happening is your throat is basically having the outer mucosal area destroyed. If not, really very severely damaged by the influenza virus and in the staphylococcus bacteria, which causes toxic shock syndrome a certain strain of it sets up residence there in your throat. And so you have the flu for the first couple of days and a four or five you develop toxic shock syndrome. And the first time we discovered this was it when several children died from it who died from toxic shock, so I was going to their flu infection. So we really do believe the influenza vaccine is a very good thing. We strongly encourage it. Dr. Kristin Nicols here at the VA Hospital Minneapolis has been one of the real Pioneers nationally looking at what is it also do for younger adults and teenagers and in that sense and not in terms of bad disease outcome because most of us won't die from the flu. But what does it do to lost time from work and how many days are you off and she's been able to show that routine flu vaccine? Influenza vaccine for the general population could have a real impact on just the amount of lost time we have and how many days you just feel crummy. So I just kind of sunrise in a personal Way I Know Myself and all of my friends get their influenza shot every year and strongly encourage it because even if I don't think I'm going to be in a life-threatening disease situation. I just do not spend four days late on the couch wishing I could die because I feel so bad and I think that that's a very important consideration Our Guest today is Minnesota state epidemiologist Michael osterholm. If you've got a question or comment give us a call to 276 thousand in the Twin Cities outside the Twin Cities one 800-242-2828 bill your next glad plays. Hello. Do you do more infectious diseases thrive in the warm tropical climates rather than in The Frigid or colder climates water seems to be safer in the colder climates had wooden on the equator that in Thank you very much. Sure. Actually, that's a great observation and although Charles Darwin never dealt with the issue of microbes in diversity of the species. He did note it for everything on higher orders other than microbes that the greatest genetic diversity that we see in the world is in the tropics for everything else flowers Birds plants animals fish. You name it? Well, believe it or not. We think that the same is true for many of the issues around infectious agent. And that's where many of the Exotic viruses are coming out of today that kind of the tropical rainforest where there are so many different niches for these things to reside the other thing. That's that plays into that is the fact that up until 15 or 20 years ago. We didn't really have ways of penetrating the rainforest. And for the first time we as a human kind of coming in contact with these because now today, you know, we practical go everywhere in the world and with some regularity and so we're seeing these diseases coming out and when we are very can. Learned recently you may have heard about reports now about monkeypox and it in Africa, which is very concerning. This was a condition that was seen primarily in monkeys very similar to smallpox. We now recognize that what happened there was it this has been residing in the monkey population there and that it was humans were relatively protected against it because we were all vaccinated against smallpox the red had it and it had recovered and therefore there was enough antibody against smallpox it covered against monkeypox has now been 25 to 30 years since we've been vaccinated against smallpox or that there's been any natural smallpox out there and we have a whole new world population is susceptible to this and now we're starting to see monkeypox transmission the Tropics of Africa among humans, which we have never seen before and so I think that you're right and terms of the diversity and that that is a real concern is we now have this global economy that means Global Travel gold Global Food and and Global movement of Different products show even something like smallpox, which clearly was so one of the great success stories as I understand it in the in the world of immunizations public health and so on even there, it was a partial Victory. Well, I'm sure anyone who's listening to this program who knows me well as probably laughing right now because I don't think you want to get me started on this issue. If if you think that Doom and Gloom is part of our business, this is an area that just frankly frightens the hell out of me. I'm convinced that we've Not Seen the Last of smallpox. I'm very afraid that this agent will be Altima use in the very near future and from a bioterrorist extant point we have evidence in the world that there are roll groups that have smallpox virus right now that it doesn't reside just in the US of Russia into Laboratories, where debate has been raging on for the last 10 years weather destroy the virus or not and should Happen should smallpox be used in just ironically this week's issue of the journal American Medical Association is entirely devoted to bioterrorism and the fact that you're hearing about bombs being used as ways of terrorizing populations, but infectious agents are not far behind and in many cases, they are much more terrorist acts in the bomb itself because there a bomb to keep going off and on off and off after the initials hit and if that would happen to smallpox, we would basically be in very very very serious trouble in this country for the whole world for that matter. We virtually have no smallpox vaccine. We have a world population is highly susceptible. This is an agent that transmits very readily through the respiratory tract. So just being in contact in a room with someone for a very limited time. Would transmit a dry rattly people are highly infectious in about 30% of people die from it. So it's it's not an easy one. So I'd like to tell you the smallpox is dead and gone until I can be assured. The last virus strain of smallpox has been destroyed. I think we have got to keep a vigilance up and I would put smallpox almost in the category of nuclear war and I can see what other infectious agent I'd say that about but this is one that has all the earmarks people don't understand that there's a book out by the population was thinner which is a book by a professor at University of Tennessee in which he describes how in 1551 the first Spanish set foot on the North American continent there about 750,000 to make an Indian in Florida in Georgia, very well-documented studies and so forth in 10 years at number was down to $30,000 and it was all small box. That's what happens when it gets into a new version population were virtually that now we are virgin population, even those of us were vaccinated 30 to 40 years ago have really little to no residual protection left. Why should we start vaccinating people again? Well, I think we have a hard time right now. People to believe that this is a problem and I can just tell you from my national International work. There are scientists who believe this is a real problem and we just haven't gotten policymakers to make this the kind of strategic and priority issue on a world diplomatic front. I think anyone who even threatens to use smallpox oughta be handled as if they were using a nuclear bomb and if I went to my doctor today and said, yeah, I want a smallpox shot just in case this should happen. There is no smallpox in the country smallpox vaccine in the country with the exception of one Depot that's under the auspices right now the Department of Defense in the Center for Disease Control and prevention, which is currently the vaccine being used for military purposes that has been in the past or that in certain Research Laboratories is still being used where you might have exposure to this kind of virus if you were working with it in the laboratory. Otherwise, it doesn't exist. It hasn't been produced for virtually 15 or 20 years and as a result the stocks we have now. Are weaning in their ability to really do mount a good protective kind of effect. And also just the numbers are way down. So if we needed vaccine, it would probably take us well over a year. If not more before we could get it up get new production going make sure that it's the right kind of potency and get into the people in the meantime. Smallpox would really break out. We would be in deep trouble bills on the line with a question for Michael osterholm. Go ahead place with all the Doom and Gloom there with the current budget requirements in the cutbacks. What is our national ability to handle a massive outbreak of of a common agent has ear infections or even a rare bug with class for labs up and running and all those things. The question you're asking is really what's what's National preparedness and I think it's really better than it was for 5 years ago in that. We've added some resources at the national level. But at the same time, I think that it's fair to say that that even with the kinds of resources we get here in where one of the now seven emerging infectious disease sites in the United States and we're talkin, you know, literally 400 $500,000 a year kind of support. It's it's not a lot when you think about all the laboratory issues and all the other things you need to do you multiply that by 7 that's not a big investment and infectious diseases out here in the field at the national level in the Laboratories there. I think that things are better at the cdc's and they were but they're still far far behind of what we need to do to really stay in front of it. We virtually have no surveillance system in this country for antibiotic resistance the things we talked about earlier, you know, we are basically Trying to run our ability to detect this and respond to it much like trying to run your air O'Hare Air Traffic Control Towers tin cans and string so that you know, we are very limited in those areas. One of the things in public health is have the ability to do that was a problem is identified. We throw down everything else in temporarily divert ourselves to that and so in the past we've been pretty effective at stopping the brush fire before it got too far some notable exceptions, of course rates IV AIDS and things like that. We're where we didn't because it was so far Advanced before we even got into it. So I think that if the right age and came along and I thought were the right set of agents and I think antibiotic-resistant agents are one of those set I think that if I mention the smallpox thing if that were to go that would clearly that would that would stretch everything not just Public Health that would be all government infrastructure. We were timer quarantine whole cities which I mean law enforcement. Everybody would be involved with this one. And so that I think that we do have a real problem that way I don't want to make it sound like it's just Doom and Gloom and I Those of us who work in this area sleep at night. So it's not as if we don't sleep but I think at the same time we do see the potentials and you know, we can't forget that aids was not a disease just really 17 years ago in the minds of anybody and look what it's done. Speaking of AIDS we've gotten some encouraging information of light indicating that the death rate has gone down fairly substantially. Have we gotten a handle on that problem? Well, I guess this is more of the good news bad news. I think that the good news is clearly. We've had a remarkable impact on the current clinical status of people with HIV infection and I think you had Frank RAM on Heroes and then he was very articulate in talking about all the benefits that we've seen in all the other places people literally having a whole second chance at life. We have a public health perspectives of two very serious concerns right now about HIV AIDS number one is that we have more people live in Minnesota today with HIV infection we've ever had in history because what's happening is we see people now becoming more complacent about HIV prevention is not as big an issue because it's they now think of it almost like a chronic disease where they can you know, basically if I do It's a lot and I'll take some drugs and I'll I'll still live forever and as a result of that people keep getting infected yet. They're not dying and the other end which is the things I want to avoid of course, but so this thing is just keeping those balls can getting bigger and bigger and bigger in terms of the number of people with HIV infection. And so one of the things we've got to do is prevention primary prevention still key and why because this isn't I believe going to be a long-term chronic disease already. We're beginning to see the first evidence of resistance develop in the HIV virus to these drugs, you know, I'd for dr. Ram talked about the triple drug therapy approach and you know, the different combinations and self-worth and they're not easy to take me see people who take him for a while and then get off of them because of some of the side effects and this virus in the way it replicates and the rapidity with which it replicates really does set itself up perfect resistant. I hope that we're not talkin in 5 years from now about major problems with drug. Resistance develop into the antivirals for HIV AIDS and people who had lived literally symptom-free lives for years with HIV infection now suddenly crashing as a result of the fact that there strains have now developed primary resistant and the drugs are no longer effective and I'm not alone in that. There are a lot of people in the HIV aids Community who have serious concerns about that and feel that we may have bought some time right now, but that if we rest on our Laurels, it will be very very short-lived and that we could literally see this back ordering of all the cases of HIV infection quickly going on to AIDS in 5 or 10 years and actually have a second wave of the epidemic which would actually exceed that that we saw in the early 80s. Just one little bit of good news after another Elite. We're just about out of time. I've got to get a quick comment from you on a couple of things. First of all, there was a very confusing story hero of the week or two ago about a hepatitis C epidemic lurking out there. Is it was that something we might be stirred up about no actually the epidemic of real problem with hepatitis. He's already over with it was an outbreak that occurred Associated primarily with IV drug use some sexual transmission in the late 80s that's dropped dramatically. The real issue that has gotten a lot of tension lately was it there were a group of individuals that received an immune globulin product, which was an intervenience product meaning it went right into the vein. It didn't get like a shot and it was only one kind of intervenience product that didn't have sufficient treatment to kill hepatitis C in it and the people who got that problem call a product called gammagard did develop hepatitis C General Me and Bobby on the kind of getting your bottom is route for travel and so forth to say than the other immune globulins are safe. We have no evidence. Transmission there and give anything a new on the you had said that you were going to quit at the end of this month. And if the legislature didn't pass a bill raising the pay of state employees so that the other people you work with and get a pay raise after what 10 years or something with no pay raise any new developments on that front still waiting to hear what their legislators going to do on that. We're hopeful since that time I've received a number of calls and letters from A lot of other senior State people who are not the political appointees or not the Commissioners, but they're the technical people in all the Departments and I think that there's a potential for a mass resignation in another couple of weeks. If that doesn't pass of some of the most important technical people in the state of Minnesota in terms of keeping our highways running are our streets safe economic situation in place, and I think it would be very difficult if this doesn't pass because I think the implication be far-reaching and given away one last thing. Hey if this is my last interview on the station, which I've been doing for years, I just want to say to you that there is no better interviewing radio than you and there isn't really better interview in the news media than you and I really appreciate that. You you amaze me at how you were able to grasp the issues you grasp and how well you do them and it's been a real privilege to to sit across the table from you over the years. I guess her I'll send the check right after the show our guests day Minnesota state epidemiologist Michael osterholm that does it for our mid-day program today Gary I could hear thanks for tuning in. Do a little mid-year tax planning on South London this weekend with Ed slott author of your tax questions.