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April 7 is World Health Day

Categories: child health, infectious disease, malaria, mosquito-borne disease, neglected tropical diseases (NTDs), parasitic diseases

    

April 7 marks World Health Day. This year World Health Day focuses on vector-borne diseases. More than half the world is at risk from vector-borne diseases. What exactly is a vector? A vector is a small organism, like a tick or mosquito, that transmits disease. Malaria, dengue, Chagas Disease and lymphatic filariasis are just four examples of vector-borne infectious diseases.   

Come learn about some of these vector-borne diseases and the work that CDC does to prevent, treat, and control these diseases around the world.    

Malaria

By Laurence Slutsker, MD, MPH    

(This blog originally posted January 28, 2013.)    

Twenty-five years ago, I went to western Kenya as a Centers for Disease Control and Prevention (CDC) Epidemic Intelligence Service (EIS) officer to study an outbreak of severe anemia. No one was sure of the cause. Was it parvovirus, or exposure to an environmental toxin, perhaps? In the hospital there were five or six sick children to a bed, and they were so anemic that their blood looked more like a pinkish fluid than the rich red to which we are accustomed. As it turned out, there was no exotic cause. I was seeing the ravages of drug-resistant malaria at a time when chloroquine, the routinely used antimalarial drug, was failing globally.   

That kind of grim hospital scene is much rarer these days, thanks to the enormous investment in malaria programs in Africa over the past decade and the improvements these investments have made possible. Programs that provide proven interventions—artemisinin-based combination therapies (ACTs), insecticide-treated bed nets (ITNs), and indoor residual spraying (IRS)—have achieved a 49% reduction in malaria deaths in the African region and saved 3.3 million lives saved globally. While this is a reason to celebrate, we have much more to do.

Photo of child in Kenya with bednetsOur current tools are grounded in decades of basic, applied, and operational research. These are highly effective, powerful tools; however, the malaria parasites and their mosquito vectors change every day to evade the interventions we use to kill them. Increasing parasite resistance to drugs and increasing mosquito resistance to insecticides are sure bets. Our tools and strategies also need to adapt and evolve. Now is the time to invest in new drugs, insecticides, and approaches for the future. While developing brand new compounds takes many years, understanding how to use better our existing tools—novel combinations of vector control tools, or creative uses of drugs for prevention, for example—can help us continue to stay ahead of our elusive foes.
    

The Reality of Outbreak Investigations: Dengue in Angola

By Tyler Sharp and Ryan R. Hemme    

(This blog originally posted July 18, 2013.)     

    

Wanna know a secret? Here it is. Chances are, the same reason you’re reading this blog is why many folks at CDC do what they do: a fascination with infectious diseases and a desire to help others. Although the work of CDC employees is frequently glamorized in movies like Outbreak and Contagion, we face the same challenges as any other large, complex organization: communication, logistics, funding, and teamwork. These challenges become especially apparent when outbreaks occur, such as during CDC’s recent response to a dengue outbreak in Angola. Based on our experiences in Angola, this blog will dispel 5 myths about outbreak investigation that are often dramatized by Hollywood.    

Myth #1 Mystery Disease X   

Residents of Angola drying fish and cookingAlthough Hollywood likes to make it seem like every outbreak is a complete mystery, most of the time when a team goes into the field, preliminary diagnostic testing has already suggested the cause of the outbreak before a foot hits the ground. Nonetheless, whether the cause be viral, bacterial, parasitic, poison or toxin, a critical first step in every outbreak investigation is confirming the cause of the outbreak.   

It was no exception when we were sent to Angola to assist the Ministry of Health respond to a recently identified dengue outbreak in May of 2013.  Dengue is an acute febrile illness that can cause explosive outbreaks. Although most people that get dengue will only suffer fever, headache, body pain, and possibly minor bleeding from the nose or gums, a relatively small proportion of people will develop severe dengue, which can result in hemorrhage, shock, and even death. By the time we were contacted, there were already dozens of sick people that had tested positive with a dengue rapid diagnostic test. Specimens were sent to CDC and the outbreak was confirmed soon after.   

Myth # 2 Rushing into the field on a moment’s notice   

The special red phone in the CDC Director’s office rings, an ominous look draws over their face, and a team is on a plane that evening, right? Not quite. There is a lot of careful planning that has to go into an outbreak response that may last weeks or longer in a country you’ve probably never visited. You have a limited idea of what exactly you’ll be doing once you get there, so you don’t immediately know what equipment and supplies will be needed in the field. In addition, most countries require visas to get in, which can take days or weeks to receive, even in an emergency. Finally, you have to coordinate with the host country to define an appropriate response. What CDC recommends may not be possible for many reasons, from the response being too ambitious to required resources not being available to lack of political support. Therefore, it’s important to pitch the plan to the local officials before arriving in the field. They may not come right out and say it, but hints of trepidation may mean that the plan needs to be revised. For that and many other reasons, flexibility is one of the most important traits that a “disease detective” can have. Before departing for Angola, we proposed to the local health authorities what we believed would be the most informative and feasible response to the ongoing epidemic, and then we tweaked the plan based on the feedback we received from them.      

Tyler teaching a clinical training session on Dengue Fever in AngolaPriority #1 for the Angola dengue response was to raise awareness of the outbreak in the medical community. During dengue epidemics that occur in large, densely-populated cities like Luanda, the capital city of Angola, typically 5–10% of residents will become infected, so it’s not uncommon for hospital emergency rooms to become overrun with patients complaining of fever and body pain. Although there is no specific medication to cure dengue, early initiation of supportive therapy and close clinical monitoring can reduce the case-fatality rate for severe dengue from ~10% to <0.1%. Therefore, clinicians need to know that a dengue epidemic is occurring, the criteria they should use to determine which patients can go home and which need to be hospitalized, and how best to care for those that are hospitalized. The first week that we arrived, Tyler worked with the Ministry of Health to train >150 clinicians in two days, most of whom were sent home with training materials to train their colleagues.   

Ryan and members of the ministry of health conducting an investigationMeanwhile, Ryan worked with staff from the Ministry of Health’s entomology and vector control programs. The Ministry has an established mosquito control program that is operated by very capable staff; however, in Angola the main concern is malaria, which is caused by a different mosquito than the one that transmits dengue, and the two mosquitoes behave quite differently. There are >3,500 species and subspecies of mosquitoes, and each one has a unique biology. Some mosquitoes like the dengue vector Aedes aegypti prefer to lay eggs in water-filled containers, while others will readily lay their eggs in water on the ground. As an entomologist you have to know where to look for the mosquito you are interested in. After another lesson in the importance of being flexible following some snafus with getting our checked baggage, which contained all of our response supplies, Ryan was finally able to work with local staff to provide training and identify surveillance methods to attempt to control the mosquitoes causing the outbreak.   

Myth # 3 One of the “disease detectives” always gets infected   

Collection of medications to prevent infection while investigating the dengue outbreakDoes being in the field put you at greater risk for being infected with whatever bug is causing the outbreak?  Probably, but we’re sent into the field with a small pharmacy of pills, sprays and ointments to either prevent us from getting sick or to treat us when we do get sick. Moreover, depending on the cause of the outbreak and what we’ll be doing in the field, we may bring additional personal protective equipment with us to keep us from being infected. Despite being vigilant about wearing mosquito repellent, on our last day in Luanda Ryan got bit by ravenous mosquito. He swatted it dead, examined it to identify it as Aedes aegypti, gave me a worried look and said, “I’m done for.”  (Spoiler alert: Thankfully, neither of us ended up getting dengue during this response.)   

Myth # 4 CDC saves the day    

In the movies, CDC is usually portrayed as a public health SWAT team. They storm in, identify the source of the outbreak, institute harsh but necessary containment measures, and ultimately stop the outbreak. In reality, it rarely works that way. First, CDC is only ever involved in an outbreak response by formal invitation from the state or country in which the outbreak is occurring. Second, CDC never acts alone. In Angola, we worked on the outbreak response with local health officials, foreign governments, USAID, World Health Organization, and local non governmental organizations. CDC is a very competent agency, but we rely on collaboration with local and international partners for a successful response.   

Myth # 5 Outbreaks can rapidly spread worldwide   

Children infront of water at sunsetOK, this one is actually pretty accurate. The ease and frequency of international travel has increased the likelihood of cases from any given outbreak being imported into other cities, especially if the outbreak happens in a large, international city like Luanda. Around the end of our second week in the field, a report came online documenting dengue in travelers to Luanda that were diagnosed after returning to their home countries on four different continents.  Because of the oil industry, Luanda receives numerous international visitors each year, and some of them were bringing the unwanted souvenir of dengue back home with them. When physicians see a patient with a fever who has recently traveled to Africa, they are likely to suspect malaria, but not dengue. There were also three other dengue outbreaks in Africa in 2013, so the issue of clinical recognition of dengue was not likely to be limited to travelers returning from Angola. Because of this and the rapidly increasing case count, we decided to release an MMWR to notify clinicians in the U.S. and abroad of the need to be vigilant for dengue as a potential cause of fever in residents of and travelers returning from Angola. One of our important findings from the investigation was that genetic analysis of the virus revealed that it had been circulating in this region of Africa for the past 45 years. This meant that this was not a “new” outbreak of dengue, but rather that dengue was actually endemic in Angola and just hadn’t been recognized. These findings were in agreement with to a recent study suggesting that 64 million dengue virus infections occur each year in Africa.   

All in all, this investigation was an excellent example of the international team pulling together to get the job done quickly and correctly, and brought attention to a neglected tropical disease of significant public health importance. It was also a lesson to us that, unfortunately, reality isn’t always what Hollywood would have us believe.   

Chagas disease and the kissing bug

By Dr. Susan Montgomery, DVM, MPH    

(Adapted from a blog originally posted June 5, 2012.)    

Dr. Susan Montgomery, DVM, MPH

Dr. Susan Montgomery, DVM, MPH

The kissing bug, also known as a triatomine, can be infected by Trypanosoma cruzi, the parasite that causes Chagas disease. Chagas disease is found in many parts of Latin America, where an estimated 8 million people have this disease. It is not widespread in the United States, but CDC estimates at least 300,000 people in the United States are infected by Trypanosoma cruzi and have Chagas disease.    

Chagas can cause cardiac disease including stroke and arrhythmias, and gastrointestinal disease over time. It can take several years to decades for the infection to take its toll on the human heart and stomach.    

Most people with Chagas disease have no apparent symptoms, so people infected don’t know they have it. When people are diagnosed, with the exception of those who are already very sick, it can be treated with drugs CDC gives to health care providers.    

Often people find out they have it when donating blood, as blood banks use the FDA’s guidelines to test and notify donors. In addition to blood transfusions, the parasite is also transmitted through organ and tissue transplants. CDC has collaborated with transplant experts to publish recommendations for testing organ donors and monitoring organ recipients to prevent Chagas disease so that transplant centers can help protect their patients from the parasite.    

The parasite also can be transmitted from infected mothers to their babes. It’s important for health care providers to know about Chagas disease so that pregnant women who might be at risk for Chagas disease can be tested. Babies born to infected mothers can be monitored and treated if they are infected.    

Triatomine bug is an insect that carries the parasite Trypanosoma cruzi, which causes Chagas disease. It can also infect pets and livestock.

Triatomine bug is an insect that carries the parasite Trypanosoma cruzi, which causes Chagas disease. It can also infect pets and livestock.

Lymphatic filariasis: Spotlight on elimination in Haiti

By Valery E. Madsen Beau De Rochars, MD, MPH, Assistant Professor at University of Florida    

(Blog originally posted June 14, 2013.)    

Valery E. Madsen Beau De Rochars, MD, MPH

Lymphatic filariasis (LF), sometimes known as elephantiasis, is delivered by mosquitoes infected by young, blood-borne parasites. The worms lodge in a person’s lymph nodes, causing fluid to pool in their legs and testicles, forcing them to swell dramatically. LF affects over 120 million people in 73 countries throughout the tropics and sub-tropics of Asia, Africa, the Western Pacific, and parts of the Caribbean and South America.    

Humans are the only known host for the parasite in Haiti, which means it’s an ideal infectious disease to eliminate. Once we eliminate it from people, it can’t be brought back by animals carrying the parasite, which is the case for many infectious diseases.    

Dr. Madsen Beau de Rochars (second from right) in Haiti with collaborators Dr. Abdel Direny (far left) of IMA World Health LF program, Jean Marc Brissau (far right) of the Notre Dame LF program, and an associate (second from left)

LF wasn’t always in Haiti or the Americas; it was imported through slave trade. The costly disease is still endemic in four countries in the Americas; one shares an island with Haiti, the Dominican Republic, which will also benefit from Haiti’s efforts. LF has been gone from the United States since the 1930s but also remains in some areas of Brazil and in Guyana.    

Haiti has some of the worst rates of LF in the world. As much as 50 percent of schoolchildren in some parts of the country were infected before CDC started the elimination program 20 years ago. Haiti and its partners are implementing an innovative and manageable drug treatment program to stop the spread of this infectiousparasitic disease.    

An added benefit of the treatment, called mass drug administration, is that it kills other intestinal parasites that cause nutritional and growth deficiencies. As a result of this treatment, children will now perform better at school and experience less diarrhea and other health problems.    

Mass Drug Administration for lymphatic filariasis in Port au Prince, Haiti

The Haitian Ministry of Health has been working with CDC and other important partners to deliver this community-wide treatment since 2000: we’ve trained hundreds of public health workers, not just to administer the drugs, but to monitor the program and verify results so we know when to stop treatment.    

The treatment program is also a public health best buy. It costs only about 50 cents a dose. Although it can’t cure those with the disease, now future generations will live free from suffering the pain and ostracization.    

    


    

For more information about these vector-borne diseases, visit the following:    

CDC Supports the Ministry of Health in Guatemala in the Creation of a National Public Health Institute

Categories: health systems strengthening

 

Guatemala National Public Institute Director, Ministry of Health Guatemala, Mayari Centeno MD, MPH (left) and CDC - Central American Regional Office Director, Nelson Arboleda, MD, MPH (right) meet with CDC Director Tom Frieden, MD, MPH (center) in CDC-Atlanta, February 2014.

Guatemala National Public Institute Director, Ministry of Health Guatemala, Mayari Centeno MD, MPH (left) and CDC - Central American Regional Office Director, Nelson Arboleda, MD, MPH (right) meet with CDC Director Tom Frieden, MD, MPH (center) in CDC-Atlanta, February 2014.

Big things often start small. So do success stories.

Nelson Arboleda, MD MPH, Director - CDC Central American Regional Office

Nelson Arboleda, MD MPH, Director - CDC Central American Regional Office

For proof, simply look to CDC’s work – and history – in Central America. From a single field station established more than 40 years ago in El Salvador by CDC’s Division of Parasitic Diseases; CDC today has a broad and respected presence across Central America and other countries in the region.

As in other parts of the world, we are working closely with public health colleagues across the region to strengthen the capacity of Ministries of Health to prevent, detect, and control disease. We work collaboratively to strengthen countries’ abilities to respond to public health threats by providing technical expertise and evidence-based foundations for a wide array of public health programs.

The hub of the Department of Health and Human Services (DHHS) activities in the region are through CDC’s Central American Regional Office (CDC-CAR) based in Guatemala. Since opening in the 70s the over-arching mission has been to translate research into public health policy and practice, to impact and improve the quality of public health services.

More specifically, the Central American Regional Office focuses on strengthening the Ministry of Health’s public health capacity through seven resident (in-country) programs – with the objective of supporting the National Health Plans of the countries and the Regional Plan of the Council of Ministers of Health of Central America (COMISCA).

CDC-CAR programs in Central America tackle a range of priority health issues with an approach tailored to local and regional conditions. They include influenza, emerging infectious diseases, HIV/AIDS, zoonotic and parasitic diseases. Other efforts are designed to build capacity, to prepare and respond to emergencies and disasters, training field epidemiologists and strengthening laboratory systems.

Creation of the New Public Health Institute in Guatemala

Those efforts along with the close and collaborative relationship with Guatemalan health officials have yielded real results.

In late 2012, for example, Guatemala’s Minister of Health announced his interest to create a National Public Health Institute (NPHI) for the country.

For years CDC and the Pan-American Health Organization (PAHO/WHO) have been two of the most notable partners for the Ministry of Health. In 2013, The CDC-CAR Director (Dr. Nelson Arboleda), together with the PAHO/WHO representative for Guatemala (Dr. Guadalupe Verdejo), received a request from the Minister of Health to support the creation of the new NPHI.

This started the ball rolling almost immediately. CDC and PAHO began coordinating visits to other similar institutions in the region to identify lessons learned and potential approaches for NPHI development in Guatemala. In May 2013, NPHI Director (Dr. Mayari Centeno) visited The Gorgas Institute in Panama and in September of the same year, visited the recently established National Institute of Health in El Salvador. Both visits were very productive and provided a new perspective for the structure of the Guatemalan NPHI.

Continued Support to Guatemala

In February, Guatemala’s NPHI director, Dr. Mayari Centeno visited CDC offices in Atlanta. She met with CDC Director Dr. Tom Frieden; Dr. Tom Kenyon, Director of CDC’s Center for Global Health; Carmen Villar, CDC Chief of Staff and many other CDC experts and senior leaders.

The visit provided productive discussions and the opportunity to explore opportunities to collaborate further on public health priorities for Guatemala, the Region and the United States.

The NPHI will have five divisions which will focus on epidemiology, laboratory, research/ethics, health education and public health management. The majority of CDC supported projects fit strategically within the newly established Guatemalan NPHI.

Additionally, the support HHS/CDC is giving to the NPHI in Guatemala fits well with  the recently launched strategy on Global Health Security, one of the U.S. government’s highest public health priorities, that will refine – and strengthen – the ability to prevent, detect and respond to public health threats worldwide at the earliest possible opportunity.

CDC is committed to working with the Ministry of Health in Guatemala and throughout the region to continue to build public health capacity, to conduct non-communicable disease surveillance, to expand their Field Epidemiology Training programs (FETP), strengthen laboratory capacity, address the HIV/AIDS epidemic, consolidate their national research ethics committees and generate NPHI bulletins. CDC will also support Guatemala’s NPHI in becoming a member of the International Association of National Public Health Institutes – IANPHI – to connect it with similar institutions globally and develop a stronger overall public health system.

Addressing Childhood Tuberculosis: Shedding Light on a Hidden Epidemic

Categories: infectious disease, tuberculosis (TB)

 

Dr. Maloney consulting on a case in Taiwan

Dr. Maloney consulting on a case in Taiwan

Today is World TB Day, and while we have made great progress to control and cure TB, we must recognize that there is still more that needs to be done. TB remains an urgent public health problem in many parts of the world, often affecting the most vulnerable. In 2012, a total of 8.6 million people became ill with TB and 1.3 million died from the disease globally. TB is a leading cause of death among women worldwide, and has orphaned 10 million children in the past decade. In countries with a high burden of TB, it is also a leading cause of death among children, claiming the lives of more than 200 children each day.

That’s why today is important. World TB Day gives us another chance to renew our determination to work even harder to reach the ultimate goal – eliminating the disease.

The reasons aren’t difficult to find.

TB often affects an entire family; TB in a child represents recent and ongoing transmission of TB bacteria in the household or community. Once infected with TB bacteria, young children are at greater risk of progressing more quickly than adults to disease, and often suffer from severe forms of TB disease. At the same time, diagnosing TB disease among young children is more challenging because the most widely available laboratory tests perform poorly among children, detecting fewer than 30% of TB cases. 

TB among children has been called a “hidden epidemic.” 

The disease frequently goes undiagnosed and therefore underreported. The World Health Organization’s best estimates suggest at least 10% of TB cases worldwide are among children, but the number may be as high as 20%. 

Addressing this hidden epidemic has been the recent focus of a broad and growing coalition of U.S. government agencies, international and non-profit organizations, and private sector partners. In October 2013, the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), in collaboration with many other partners, launched the first action plan to address TB in children. 

The Roadmap for Childhood TB: Towards Zero Deaths outlines actions to accelerate progress against this deadly disease. These actions include the following.

  • Empower healthcare workers to “Think TB” through training and access to childhood TB screening tools.
  • Integrate TB screening into existing family, community, and health services.
  • For every adult TB case, look for exposed children through contact tracing.
  • Provide therapy to prevent TB among children at high-risk of developing disease.
  • Collect and report more accurate data about TB in children to enable improved approaches.
  • Invest in developing new clinical tools, including child-friendly diagnostics and medicines.

At CDC, we have been partnering with other U.S. government agencies, international organizations, and ministries of health to find the best ways to develop innovative approaches to diagnosing TB in children, while making the best use of available tools to reach children at-risk for TB.

CDC collaborates with communities and healthcare workers in Ethiopia, Kenya, South Africa, and Uganda to improve TB case-finding and patient outcomes.

A community-wide approach to TB prevention, case finding, and supportive care is essential to ensure all children with TB receive accurate, timely diagnosis and effective treatment and eliminate TB deaths among children.

Baby Hope and her mom, now happy and healthy outside their home in Kenya. (Photo courtesy of Kevin Cain, CDC)

Baby Hope and her mom, now happy and healthy outside their home in Kenya. (Photo courtesy of Kevin Cain, CDC)

Hope is the human face for why these efforts are important. Hope was an 8-month-old baby girl in Kenya who was very ill—she was losing weight and her mother, who was also ill, didn’t know what was wrong. Despite visits to healthcare providers, Hope’s condition was not improving.  She was so ill that her neighbors began raising money to allow the mother and child to take one last visit to their home village. 

Hope’s mother, determined to do everything she could, took baby Hope to a community health center, where she was quickly diagnosed with TB based on a simple clinical screening.

As part of a program developed by CDC and local partners, a community volunteer began visiting the family to ensure Hope was taking and tolerating all of her medications. The community volunteer also recognized that Hope’s mom had signs and symptoms of TB. After Hope’s mom was diagnosed with TB, she also started treatment while receiving daily support from the volunteer. Today, baby Hope has gained weight, and both she and her mother have been cured of TB and are healthy.

As we raise awareness of childhood TB and encourage community and child health services to integrate TB into their programs, we must also emphasize the importance of collecting better, routine data to help us understand this epidemic and how best to address it. 

TB is preventable. And it is treatable. Every child who dies from TB is one child too many. 

For more information on CDC’s role in national and global TB control, visit http://www.cdc.gov/tb. 

For CDC World TB Day resources, visit http://www.cdc.gov/TB/events/WorldTBDay/default.htm.

For more information about the WHO’s plan for addressing childhood TB, visit Childhood TB Roadmap: Toward Zero Deaths.

Haiti makes solid progress in reducing TB

Categories: infectious disease, tuberculosis (TB)

  

On World Tuberculosis Day, a personal account from the frontline, Haiti, which has the highest reported rates of TB in the western hemisphere. 

Macarthur Charles, MD, PhD, CDC’s TB Advisor in Haiti

Macarthur Charles, MD, PhD, CDC’s TB Advisor in Haiti

 

There is a certain poetic symmetry to my return to Haiti this year as tuberculosis (TB) advisor. It was exactly 10 years ago that I first set foot on Haitian soil as a doctor. The little boy who left the little town of Deschapelles in Haiti’s Artibonite Valley years ago, was back, and now able to give back to his people. 

There’s nowhere else I’d rather be right now and no other job I’d rather do. Sadly, expertise in TB is badly needed here in Haiti, which is very poor, has relatively high rates of HIV, a weak health infrastructure, and the highest reported TB prevalence rates in the western hemisphere – 300 cases per 100,000 people. The Dominican Republic, with which Haiti shares the Caribbean island of Hispaniola, has just half the number of cases. 

So the situation here is of obvious concern in global health security terms. As Dr. Frieden and others stressed at the mid-February launch of the Global Health Security Agenda, the frontline is wherever diseases break out. Disease knows no borders, and we live in an age of increased mobility. But more specifically, Haiti is known to be one of the top ten contributors of TB cases to the United States. To combat TB in the U.S., we have to fight it abroad, especially in countries like Haiti where multidrug-resistant (MDR) TB has emerged as a particular concern since the earthquake struck in 2010.

Dr. Charles and a patient at the field TB hospital in 2010

Dr. Charles and a patient at the field TB hospital in 2010

 

The quake damaged TB hospitals, displaced 1.5 million people and forced them to crowd into cramped quarters – a classic situation conducive to the transmission of an infectious disease. I was here in Port au Prince the whole of 2010. At the main (and, at the time, only functioning) field TB hospital in the Haitian capital, we were seeing twice as many TB patients as before the quake. We were seeing many more children with TB. Most of the new TB cases were HIV-negative. CDC helped reinforce surveillance in crowded camps in Port au Prince in the months after the earthquake.

Four years on, we’re making solid progress in the battle to reduce TB prevalence 25% by 2015. This is an important public health goal for the U.S. government, Haiti’s Ministry of Public Health and Population (MSPP), and other partners. CDC is contributing to this by working on better diagnostics, better treatment, and better surveillance – the holy trinity of TB diagnosis and treatment. We’re providing support to two TB hospitals badly damaged by the quake – SanaPaP, as it’s colloquially called, in Port au Prince and Sigueneau in Gressier in the Ouest department – . We’re also working with the National Laboratory and the National TB Program to implement a country-wide surveillance program.

On the last day of February, I attended the launch of a pilot scheme for MDR TB surveillance in the Ouest department, where a third of all cases are concentrated. As I stood there, I thought back to my childhood and the Albert Schweitzer Hospital in Deschapelles, where I got all my shots and which was one of the first hospitals in the world to run a hugely successful community care program for TB patients. 

If Haiti could do that back then, I thought, it can do even more today.

Saving Energy, Saving Lives: World Water Day 2014

Categories: infectious disease, water

 

Photo of a woman washing her clothes

Water is easy to take for granted until…you don’t have enough of it.

Ciara O’Reilly, PhD, Epidemiologist, CDC’s Waterborne Disease Prevention Branch

Ciara O’Reilly, PhD, Epidemiologist, CDC’s Waterborne Disease Prevention Branch

Jennifer Murphy, PhD, Microbiologist, CDC’s Waterborne Disease Prevention Branch

Jennifer Murphy, PhD, Microbiologist, CDC’s Waterborne Disease Prevention Branch

But the simple and indisputable fact is this: a sufficient supply of clean water is a necessity for life and an essential ingredient in the battle against disease.

That’s why as populations grow and demands for water increase the focus on how it’s used and conserved become more important than ever before. And it’s why CDC is working in various ways to find ways of ensuring clean water and using it wisely.

It’s the reason that this year, on World Water Day, March 22, the theme of Water and Energy is more than just a throw-away phrase.

March 10-16 Is World Salt Awareness Week

Categories: cardiovascular disease, noncommunicable diseases (NCDs)

 

This blog was originally posted on CNN.com on January 23, 2014.

 

Grocery store

Almost two years ago, Philadelphia launched its Healthy Chinese Take-out Initiative with the goal of reducing sodium content by 10% to 15%.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

The city’s Public Health Department worked with 206 restaurants, first evaluating their menus for sodium content and then helping them choose ingredients and develop recipes with less sodium. One way found to reduce sodium was for restaurants to cut the use of commercially prepared sauces and instead make their own.

After nine months, the initiative analyzed two popular dishes from 20 participating restaurants to see what changed. The result? A 20% reduction in sodium, more than the project’s goal.

It’s one thing to choose how much salt to add to your food when you eat. It’s another to live with decisions made by those who prepare your food before it makes it to the table.

Preventing Maternal Deaths in Africa

Categories: HIV/AIDS, women's/maternal health

 Healthy mothers and babies

Maternal health has improved in most regions of the world, with far fewer women dying during pregnancy and childbirth than 20 years ago. 

Isabella Danel, MD, MS, CDC Division of Reproductive Health

Isabella Danel, MD, MS, CDC Division of Reproductive Health

Progress in sub-Saharan Africa, however, has been much slower. HIV and complications of childbirth are the leading causes of death among reproductive age women around the world, but above all in this region. Being pregnant in sub-Saharan Africa is often a dangerous medical condition. In Zambia, women who have given birth are often greeted with a Bemba expression of relief and surprise: “Mwapusukeni.” Translated it means, “You have survived!”

That greeting is becoming more commonplace these days, which is another way of illustrating a basic truth: positive change can happen quickly when the right actions are taken to improve maternal health.

DPDx: 15 Years of Strengthening Laboratory Capacity for Parasitic Disease Diagnosis

Categories: health security, parasitic diseases

 

CDC’s DPDx helps labs around the world identify parasites like Taenia saginata. (Photo courtesy of David Snyder/CDC Foundation)

CDC’s DPDx helps labs around the world identify parasites like Taenia saginata. (Photo courtesy of David Snyder/CDC Foundation)

The inquiries and images come from almost every state in the United States, and often with a sense of urgency. Still others arrive from Argentina and Germany, Italy, Japan, China, New Zealand, India—and dozens more countries around the globe. Each time the question for CDC’s parasite identification laboratory, known as DPDx, is the same: What is it?

Alexandre J. da Silva, PhD, CDC DPDx

Alexandre J. da Silva, PhD, CDC DPDx

The diagnostic parasitology experts on CDC’s Division of Parasitic Diseases and Malaria’s DPDx team provide answers.

DPDx is the effective merger of technology, laboratory science, and CDC’s unparalleled expertise in parasite identification and the diseases they cause.

DPDx is a unique online educational resource that includes visual depictions of parasite lifecycles, a reference library of free images of parasites, and guidance on proper laboratory techniques for diagnostic parasitology. But it is much more than a Web site.

The primary role of DPDx is reference diagnosis, wherein CDC laboratory scientists confirm diagnoses or discover that the diagnosis is something altogether different from what was originally thought. In both cases, but especially in the latter cases, DPDx impacts treatment. For example, Babesia microti is one of the parasites that cause the tick-borne disease babesiosis; it can be misidentified as Plasmodium falciparum, which causes malaria. The two diseases require different treatments and on many occasions, the DPDx team has corrected a misdiagnosis, ensuring that the patient is appropriately treated.

Stopping rubella in its tracks: CDC works with countries to introduce rubella vaccine

Categories: immunization, infectious disease, rubella

 

Cambodian children show off their purple marked pinkies, showing that they are protected from measles and rubella, during an immunization campaign in 2013. (Photo courtesy of Sue Chu, CDC.)

Cambodian children show off their purple marked pinkies, showing that they are protected from measles and rubella, during an immunization campaign in 2013. (Photo courtesy of Sue Chu, CDC.)

 

Pop quiz: What vaccine-preventable disease, whose name means “little red”, can cause severe birth defects if pregnant women become infected? If you answered rubella, also known as German measles, you are right.

Gavin Grant, MD, CDC Global Immunization Division

Gavin Grant, MD, CDC Global Immunization Division

Susan Reef, MD, CDC Global Immunization Division

Susan Reef, MD, CDC Global Immunization Division

It’s okay if you didn’t know, since rubella is mostly a distant memory in the United States thanks to a comprehensive and effective immunization program that’s been in place for decades.

Sadly that’s not true everywhere.

Each year there are thousands of rubella cases around the world, a number that’s made all the more tragic when there is a safe, effective vaccine. And while the number of cases has fallen, the threat remains. Rubella is spread in the same way as the common cold, through sneezing and coughing. In children rubella is typically a mild disease that may include a rash, fever and sore throat. Adults can get rubella as well—usually they experience symptoms such as rash, headache, pink eye, joint pain and general discomfort. 

Strengthening Global Health Security Protects Americans

Categories: HIV/AIDS, flu, health security, infectious disease, malaria, parasitic diseases

 

This blog was originally posted on CNN.com on February 13, 2014.

 

The 5 Ways Diseases in Other Countries Can Kill You

The world is smaller and people are more mobile than at any time in history. This makes it easier than ever for what’s happening anywhere on the globe to harm Americans’ health. 
 
Here are five ways diseases in other countries pose a threat:

1) The flu could threaten millions. Even in a mild year for flu, in the United States alone, there are thousands of deaths, hundreds of thousands of hospitalizations, and billions of dollars in productivity losses.
 
In a pandemic, millions of people worldwide could be killed. H7N9 influenza, also known as bird flu, is spreading in China, though fortunately it has not mutated to become an infectious disease outbreak that could threaten the health of people around the world.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

2) Antibiotic resistance is on the rise. Antibiotic resistance just might be the most urgent health threat facing us now.

The nightmare strain of bacteria known as CRE, carbapenem-resistant Enterobacteriaceae, arose abroad and was introduced to one state in the United States. Now it’s in at least 44 states. It can resist all or almost all antibiotics, kills many of the people who get it in their blood, and spreads its resistance capabilities to other bacteria.

The World Health Organization estimates multidrug-resistant tuberculosis already has infected a half a. million people across the globe.

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