Categories: Global Health, HIV/AIDS, maternal health, women's health
May 13th, 2013 4:52 pm ET -
Ambassador Eric Goosby, M.D., U.S. Global AIDS Coordinator
This is the 7th blog in a series of blogs from the Office of the Global AIDS Coordinator in recognition of the 10th anniversary of PEPFAR. Previous blogs in the series can be found on the PEPFAR blog site.
Ambassador Eric Goosby, M.D., U.S. Global AIDS Coordinator
“Children are our future, and their mothers are its guardians.”– Former United Nations Secretary-General Kofi Annan
Having just celebrated Mother’s Day, it is fitting to reflect on the significant strides the global community has made in improving and protecting the health of women around the world, particularly in countries with a high burden of HIV and AIDS.
One of the principal ways the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) improves the health and lives of mothers—and their children—is by helping to ensure the safety of blood transfusions. Lack of safe blood directly contributes to poor health outcomes, including high rates of maternal, infant, and under-five mortality. In many parts of sub-Saharan Africa, women and children are often at greatest risk of requiring blood transfusions. This is often due to post-partum hemorrhage and other complications of childbirth, childhood anemia associated with malaria, and trauma. In malaria endemic areas of sub-Saharan Africa, severe anemia in children due to malaria is estimated to account for at least half of all transfusions while obstetric complications are responsible for up to a quarter.
Through the U.S. Centers for Disease Control (CDC), PEPFAR works with Ministries of Health in foreign countries to develop and strengthen national blood transfusion services (NBTS), with a particular focus on countries with a high burden of HIV. Since 2004, PEPFAR has provided ongoing financial and technical support to more than 14 countries with NBTS programs, with the goal of ensuring an adequate supply of safe blood from voluntary non-remunerated donors through screening for transfusion-transmissible infections, such as HIV, syphilis, Hepatitis B, and Hepatitis C.
PEPFAR, through CDC, also supports infrastructure and laboratory development, technical assistance and training, universal testing of blood units for HIV with other transfusion-transmissible infections, development of safe injection policies, and expansion of safe disposal among healthcare workers and community members.
The results have been dramatic. In 10 out of 14 countries, the NBTS reported a significant decline in the percentage of collected blood units reactive for HIV between 2008 and 2010. For example, in Botswana the percentage of collected blood units reactive for HIV decreased from 7.5 percent in 2003 to 1.0 percent in 2010. In Zambia, PEPFAR has supported the shift from a fragmented hospital-based system to a regionalized system under the control of the country’s NBTS. The program has nearly tripled the number of donations from voluntary non-remunerated donors, who are at lower risk for HIV infection, and has eliminated collections from higher-risk family replacement donors. In 2012, the Zambia NBTS collected 108,000 units of blood – of which over 33,000 units were used to save the lives of new mothers or pregnant women. Zambia has also eliminated risky family replacement donations.
This robust platform has been leveraged to build a more sustainable and integrated response. By 2010, more than 80 percent of PEPFAR funds for blood safety had been shifted directly to each country, allowing country programs to more closely monitor and manage the transition of blood safety programs.
These programs are having a tangible impact on the communities they serve. In Rwanda, the NBTS instituted a cross-cutting incentive system to attract and retain voluntary blood donors with repeat donors qualifying for items such as insecticide-treated bed nets to combat malaria. And in Kenya, blood donations from volunteer donors nearly tripled in two years, from 43,000 units to 117,482 units; the NBTS now supplies 125 health care facilities with at least 80 percent of their blood needs, up from only 8 sites in 2004.
Despite these remarkable results, much more remains to be done. CDC and PEPFAR are committed to continued support of blood safety activities. Going forward, we will maintain our support in 14 countries and add 13 more countries through financial support to Ministries of Health and NTBS units, and the provision of technical assistance by CDC and other international experts in blood transfusion and the administration of blood services. Ensuring blood safety is a crucial component to maternal and child health, and critical to achieving an AIDS-free generation. We will not back down from this challenge; the stakes are too high—for mothers, children, and the millions of patients that PEPFAR helps to serve.
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Categories: Global Health, Refugee, UNICEF, WHO
May 13th, 2013 8:46 am ET -
Barbara Lopes Cardozo MD MPH, Medical Officer with the Emergency Response and Recovery Branch, Division of Global Health Protection (proposed)
Barbara Lopes Cardozo, MD MPH, Medical Officer with the Emergency Response and Recovery Branch, Division of Global Health Protection (proposed)
The Syrian refugee crisis has been two years in the making. It represents the culmination of the conflict between the Syrian government and its own people, a violent conflict that has greatly affected the civilian population and caused Syrians to flee in large numbers. Up to 1,000 people are now leaving the country each day; many are heading to Jordan but some have also fled to Turkey, Lebanon, and even Iraq. There is no end in sight as the conflict continues, and even if the regime were to fall, most people are pessimistic that violence would end immediately.
The Syrian refugee camp in Jordan is right along the border of the two countries. It is in the middle of the desert, a flat, featureless, dusty landscape that is hot in the summer and cold in the winter. I have seen many refugee camps throughout my career, and while this is certainly not the worst, it is not the best situation either. Many of the families in the camps are from Syria’s middle class, so they are not used to the rougher conditions and shared pit latrines. There have been sanitation problems as families, in attempts to avoid the communal toilets, have dug holes in their tents which end up flooding when it rains. Some are so unprepared for rough living that there have been reports of people creating open fires within their tents in efforts to keep warm. This is not a population familiar with this style of living, unlike African refugees, many of whom are used to moving from camp to camp.
Around 800,000 Syrians have now settled within Jordan. Jordan itself has been extremely hospitable, possibly due to its Bedouin heritage, a nomadic desert culture used to helping others. The country and its population have many connections with Syrians, so not everyone lives in the camps; many refugees instead choose to live with friends and relatives in neighboring towns and cities. The single refugee camp is still fairly crowded, and attitudes there, while not openly hostile, still render it unsafe for outsiders. The United Nations Children’ Fund (UNICEF) health officials fear that riots may erupt in the camp, and as a result we must remain in the van when traveling throughout the camp, children looking in the van as we pass.
For a week in late March of this year I helped facilitate a training organized by UNICEF in collaboration with the World Health Organization, the United Nations High Commissioner for Refugees, and local non-governmental organizations to discuss and plan for the public health needs of the refugee community. Subjects discussed ranged from a measles vaccination campaign, mortality surveillance, to shelter provision; we were also able to begin to address the psychological needs of the community. For refugees being driven out by a very violent situation, addressing the psychological wounds of war in the community as well as the (often neglected) mental health of aid workers is an important component of public health interventions. It is an area that is often overlooked in the haste to address more immediate health problems.
After the training in Jordan, I collaborated with the International Medical Corps (IMC) in order to establish an outcome evaluation to assess the effectiveness of their mental health intervention. Using a case management approach, the IMC team of experts, which includes psychologists, psychiatrists, nurses, and social workers, assess each new case individually in order to create a tailored treatment plan according to the needs of the patient. Because of the strength of evidence based interventions, and the lack of those that specifically address mental health, this outcome evaluation is especially important for demonstrating the effectiveness of the case management approach; an approach that we hope to continue using in this population. Remembering my work in Kosovo during the late 1990’s, where decades later there are still psychological issues and cycles of violence, the importance of addressing mental health early on cannot be stressed enough. By caring not only for a population’s physical health, but also for the psychological wounds caused by the violence, we can begin to take a more holistic approach with our public health interventions that allows for healing on multiple levels.
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Categories: Global Health, Immunization, polio
May 9th, 2013 9:32 am ET -
Nikki Grimsley, CHES, health communication specialist, CDC Emergency Risk Communication Branch
Nikki Grimsley, CHES, health communication specialist, CDC Emergency Risk Communication Branch
As part of World Immunization Week activities, April 20 – 26 2013, more than 75 members of Rotary International from Florida, Georgia, and North Carolina visited CDC’s Roybal Campus on Tuesday, April 23, 2013 to celebrate Polio Day.
I had the privilege of accompanying a group of Rotarians as they toured the CDC Museum, polio laboratory, and Emergency Operations Center. During the event, I spoke with Charlie Augello, a member of the Dunwoody Rotary Club, and his wife Anita, who settled in Atlanta after living all over the East Coast. Mr. Augello remarked, “It has been awakening to visit CDC and meet the talented and dedicated CDC staff who are contributing to global polio eradication efforts. I have a much better appreciation of the work that is being done at CDC and around the world.”
Local Rotarians remind us that we are “this close” to eradicating polio. Photo courtesy of Mark Fletcher/CDC.
Dr. Olen Kew, senior science advisor, in the Polio and Picornavirus Laboratory Branch, and Dr. Cara Burns, microbiologist, led tours of the polio laboratories. During the tours, Drs. Kew and Burns praised Rotary International’s invaluable contributions to help build the Global Polio Laboratory Network. Rotary International’s partnership provides resources to equip the laboratories and provides thousands of volunteers who work globally on polio eradication efforts. While in the laboratories, Dr. Kew, who described the Global Polio Laboratory Network as a “great big family of friends,” stopped to allow the Rotarians to observe genetic sequencing in action. Dr. Kew told the groups, “So much progress has been made through global cooperation, and exciting new technologies allow work that would have taken one microbiologist an entire career to complete is now accomplished in two weeks!”
Roy Wise, President, Rotary International Dunwoody Club, gave an inspiring address to CDC staff and local Rotarians. Photo courtesy of Mark Fletcher/CDC.
After the tours, CDC staff and Rotarians gathered to hear from CDC polio experts and Roy Wise, President of the Rotary International Dunwoody Club. Mr. Wise recognized the extraordinary partnership between Rotary International and CDC, highlighting the great work that Rotary International has galvanized by influencing local, national, and international leaders to support polio eradication efforts. I was inspired by his concluding remarks when he reminded everyone, “We are in the final two minutes of the fourth quarter. We will win this game.”
Dr. Robb Linkins, Chief of the Disease Eradication and Elimination Branch, also spoke at the event and recognized Rotary International’s tremendous contributions, support, and enthusiasm that both CDC and Rotary International share about the progress that has been made in recent years. He cited India’s accomplishment of being polio-free for more than two years and the work that led to achieving this milestone despite huge public health challenges.
Special Advisor to CDC’s Global Immunization Division, Dr. Stephen Cochi, commended Rotary International for their incredible generosity and support for global polio eradication, citing the service of many Rotarians on the front lines. He also noted that 165 people are currently deployed through the Stop Transmission of Polio (STOP) program to support polio eradication activities in 33 countries. Over the years, a number of Rotarians have participated in the STOP program.
CDC’s Alan Janssen speaking with an Atlanta Rotarian about the past, present, and future of the partnership between CDC and Rotary International. Photo courtesy of Mark Fletcher/CDC.
Dr. Cochi presented about the Polio Eradication Endgame Strategic Plan (2013-2018): the goal is to interrupt the transmission of poliovirus in the remaining three endemic countries in 2013 and to achieve global certification of polio eradication by 2018. The plan builds upon recent progress and addresses long-standing operational challenges including reaching hard-to-reach children; new risks, specifically those related to insecurity; and the need for affordable inactivated polio vaccines. The plan also looks beyond polio to adapt the program’s infrastructure to help deliver other vital health services to the world’s most vulnerable children.
Today, the promise of polio eradication is as close as it has ever been. In 2012, there were the fewest number of polio cases in the fewest number of countries ever. Worldwide in 2012, there were 223 polio cases in three endemic countries compared to 350,000 cases in 125 endemic countries in 1988. As depicted in the Rotarian campaign, we are indeed “this close” to eradicating polio. Because of the strong partnership between CDC and Rotary International and the other GPEI partners, polio eradication is within our reach. Yes, Mr. Wise, we will win this game.
Rotary International is one of the spearheading partners of the Global Polio Eradication Initiative and has contributed more than $1.2 billion and countless volunteer hours to protect more than two billion children from polio in 122 countries.
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Categories: Global Health, Immunization, World Immunization Week, measles
May 6th, 2013 9:51 am ET -
Linda Elsner, Writer/Editor, Global Immunization Division.
Linda Elsner, Writer/Editor, Global Immunization Division.
Acclaimed illustrator Sophie Blackall visited us at CDC on Monday, April 22, to share insights from her extraordinary collaboration with the Measles & Rubella Initiative. Her presentation at the World Immunization Week symposium, “Let Every Child Have a Name: the Road to a World Without Measles,” described her journey to the Democratic Republic of the Congo where she met and spoke with families and health workers affected by measles.
Alan Bethel, District Governor 2011-2012 District 18A Georgia Lions (Lions Clubs International), and his wife Carole, with Illustrator Sophie Blackall at CDC’s Measles/Rubella Day during World Immunization Week 2013. Photo courtesy of Mark Fletcher/CDC
Clearly touched by her experiences while traveling with a vaccination team in May 2012, Blackall described how she used her camera to record detailed images of the people and immunization activities in remote villages that later inspired her artwork.
“I was completely blown away by these volunteers,” she told the audience of CDC employees and more than 60 invited guests from Lions Club International Foundation and the American Red Cross; both organizations are some of our partners in the Measles & Rubella Initiative, which commissioned Blackall’s work. “It’s impossible not to want to save all of [the children]. I’m so in awe of the work you all do…. My role in this is to tell your story—and it’s an honor and a privilege to do it.”
Sophie Blackall, Illustrator, Measles & Rubella Initiative, presented her work done after joining vaccinators on a measles campaign in the Democratic Republic of Congo. Photo courtesy of Mark Fletcher/CDC
Our guests had an opportunity to tour the CDC Museum and visit the SHARE gift shop before the symposium, which also included remarks from Mr. Haynes Townsend, Past International Director, Lion’s Club International Foundation; Mr. Ruben L.C. Brown, a media specialist at the American Red Cross; our own Dr. Lisa Cairns, who provided a global update on the elimination of measles and rubella; and Mr. Harold Brooks, Senior Vice President for Global Programs, American Red Cross, who summed everything up by saying, “This initiative has magic to it.”
Following the presentations, we enjoyed an exhibition of Blackall’s delightful illustrations at a reception in the Tom Harkin Global Communications Center, with refreshments generously provided by the CDC Foundation.
What’s next for this talented artist? A visit to India to accompany UNICEF staff on vaccination campaigns is already on her agenda, and after that she hopes to start working on an interactive project designed to renew U.S. parents’ “sense of urgency” about and commitment to childhood immunization right here at home. We can hardly wait!
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Categories: Global Health, Malaria
April 25th, 2013 9:43 am ET -
Patrick Kachur, MD, MPH
Dr. Patrick Kachur, Chief, CDC Malaria Branch
Last month I took a few days of vacation and traveled to Basel, Switzerland. The sky was grey and a cold drizzle was steadily falling, melting the remaining layer of snow and ice that winter’s last storm had blasted onto the sides of trees and buildings. Many of the staff and students at the Swiss Tropical and Public Health Institute (Swiss TPH) had already begun traveling to warmer places. I had come to take part in a viva voce: the oral examination of a PhD candidate at the Institute. The candidate was M. Irene Masanja, a Tanzanian colleague with whom I had worked for some time. She presented her thesis: “Influence of health systems in malaria case management as part of malaria control in Tanzania,” to three examiners and a lecture room surprisingly packed with her fellow students and supporters (including her mother). She confidently answered all of our questions, including some from an examiner who attended by video link from the UK. Following that, the examiners met privately while Irene and the rest of the crowd waited anxiously outside the door. When they were permitted back into the room, the Department Chair asked her to swear an oath to maintain a high standard of scientific integrity in all her work, and conferred upon her the degree of Doctor of Philosophy, magna cum laude.
Drs. Joseph and Modesta Njau
Seeing Irene defend her work and being part of that morning was a terrific boost to my spirits. I met her in 2002 when I was based in Tanzania and she joined our research team at the Ifakara Health Institute. A single mother, Irene had already qualified as a dentist and got a master’s degree while working on our collaborative project. She coordinated studies to evaluate health worker attitudes and practices to new malaria treatments, and later, the expansion of diagnostic testing for malaria. Somewhat tentatively at first, she began to share her findings with district health officials and the national malaria control team. Eventually she became a well-respected advisor to the Ministry of Health, helping them to improve training, supervision, and supply chains for health workers. Her PhD papers represented over a decade of careful work and experienced observation. Just a week prior to her exam, Joseph Njau, one of her colleagues from those early days also successfully defended his own work, “Economic and socio-behavioral effectiveness of large-scale malaria control programs in three sub-Saharan African countries” at Emory University in Atlanta, Georgia. Both had pursued investigations that had concrete implications for complex health systems. Both have become the kind of scientists critically needed in many malaria-endemic countries, and will go on to make important contributions. Irene has already returned to a new project in Tanzania, and Joseph will complete a post-graduate fellowship to further hone his skills.
Professor Don deSavigny, Dr. Irene Masanja, Dr. Patrick Kachur
CDC is not a degree granting institution, so to help build capacity with our research partners, we rely on extensive partnerships with academic centers like Emory and Swiss TPH. As a result, students and fellowship trainees are involved in nearly every aspect of our work in the Malaria Branch. It’s hard to imagine how we could complete some of our projects without them. In addition, they help keep our investigators at the cutting edge of new or evolving scientific techniques and approaches. The academic partnerships also broaden the reach of our findings and recommendations. The broad range of students who work with us contribute greatly to CDC’s Congressional mandate to be a key implementer of strategic and applied science for malaria control. What better way to invest in the future while defeating malaria?
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Categories: Global Health, Immunization, World Immunization Week
April 22nd, 2013 8:46 am ET -
Rebecca Martin, PhD, Director of CDC Global Immunization Division
Rebecca Martin, PhD, Director, Global Immunization Division
Every 20 seconds, a child dies from a disease that could be prevented with a safe and effective vaccine. Millions more children survive but are left severely disabled. Vaccines have the power not only to save but also transform lives by protecting against disease—giving children a chance to grow up healthy, go to school, and improve their lives. Vaccination campaigns sometimes provide the only contact with health care services that children receive in their early years of life.
During World Immunization Week, beginning on 20 April, we at CDC and our partners around the globe aim to promote one of the world’s most powerful tools for health – the use of vaccines to protect, or “immunize”, people of all ages against disease.
Immunization Week initiatives began in the Region of the Americas in 2003. The Week was observed simultaneously in the World Health Organization’s (WHO) six regions for the first time in 2012, with the participation of more than 180 countries, territories and areas. The World Health Assembly endorsed World Immunization Week during its May 2012 meeting, alongside the Global Vaccine Action Plan.
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Categories: Global Health, Meningitis
April 15th, 2013 9:47 am ET -
Fabien Diomandé, MD, MSc and Ryan Novak, PhD
About the authors:
Fabien Diomandé, MD, MSc, medical epidemiologist, is stationed in Burkina Faso to work with the WHO Africa Bureau and local health authorities and Ryan Novak, PhD, epidemiologist, is based in Atlanta and supports meningitis activities in Africa.
Fabien Diomandé, MD, MSc, medical epidemiologist (CDC secondee) and Ryan Novak, PhD, epidemiologist/coordinator for Africa Meningitis Activities, walk railroad tracks in rural Burkina Faso in sub-Saharan Africa to reach a local vaccination site to deliver the new life-saving meningococcal A conjugate vaccine (MenAfriVac®) during the pilot safety evaluation conducted just prior to the full scale vaccination campaign.
In Africa, more than 90 percent of meningitis cases during epidemics are caused by Neisseria meningitidis serogroup A, which mostly attacks infants, children, and young adults. Without antibiotic treatment, up to 80 percent of infected individuals can die. The bacteria spread during the dry season from November through June. Meningitis is feared across Africa and contributes to poverty that impacts quality of life and has both short and long-term human and financial costs.
Epidemics of meningococcal A meningitis have swept across sub-Saharan Africa for a century putting the lives of approximately 450 million people at risk in the “meningitis belt,” a stretch of 26 countries from Gambia to Eritrea. As recently as 2009, more than 88,000 people were stricken by meningitis during one such epidemic. In this region of the world one in ten people who gets the disease will die, typically within a day or two of falling sick. Caring for someone sick from this disease can consume as much as a third of a family’s disposable income. Survivors are at risk of serious disabilities like hearing loss, developmental delays, seizures, paralysis, or infection requiring amputation of one’s limbs. This significant burden of disease has resulted in the people of sub-Saharan Africa eagerly anticipating a solution to the hundred year epidemic scourge.
In 2010 that solution came in the form of a new vaccine developed specifically for Africa, and the statistics started to change. Burkina Faso was the first country to conduct a nationwide mass vaccination campaign with this new vaccine. Over the course of ten days we witnessed hundreds of health workers armed with vaccines and supplies mobilize throughout Burkina Faso, and more than ten million women, men and children between the ages of 1 to 29 years turn up and endure long-lines to receive the lifesaving MenAfriVac® vaccine. Subsequent campaigns were soon conducted in the neighboring countries of Mali and Niger with similar success. At a cost of less than $1 per dose, this affordable vaccine is widely available, helping to save thousands of lives and improve health status across sub-Saharan Africa. Just two years after the MenAfriVac® campaigns were launched in Burkina Faso, seven additional countries have held vaccination campaigns. Last December, in a town in northern Nigeria, the 100 millionth person was vaccinated against meningitis A—to date there has been no evidence of vaccine failure. It has taken a little over a decade for the vision of a vaccine to prevent meningitis epidemics in Africa to become a reality.
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Categories: Global Health, diarrhea, water
April 8th, 2013 11:00 am ET -
Kathy Middleton, Associate Director of Extramural Programs for CDC-Haiti
At the small water point in Trianon, Haiti, you can see a crowd gather. Here, as at many such sites across the country, locals wait their turn to fill buckets for drinking, washing and cooking – proving the adage that no matter where you are in the world, water is life. So when a deadly outbreak of cholera struck the island in 2010, the need for clean, safe water became one of our paramount priorities.
In Haiti alone, almost 8,000 people have died as a result of cholera, an illness that is often transmitted through contaminated water. Providing safe drinking water is essential in reducing the risk of cholera and other waterborne diseases.
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Categories: Global Health, Malaria
April 1st, 2013 10:37 am ET -
Melody Miles, ASPH Fellow
This is the second in our ongoing “Fresh Voices From the Field” series, where we hear from ASPH Global Health Fellows working throughout the world. Global Health Fellows are recent Master of Public Health or Doctoral graduates placed in CDC global health offices in Atlanta and abroad. They work on a range of priority public health issues and bring a fresh perspective to CDC’s efforts in the field.
Melody Miles, President’s Malaria Initiative team at CDC
As a member of the President’s Malaria Initiative team at CDC, I support malaria efforts in Uganda, where 42% of children are infected with the malaria parasite. Since 2007, Uganda has operated one of the best malaria surveillance systems in the world, providing accurate, timely malaria data from 12 “sentinel” health facilities throughout the country. Despite high demands and limited staffing, these sites perform a laboratory test on every patient suspected of having malaria and ensure all malaria deaths are reported.
To better understand the dramatic burden of the disease on the community, I recently crossed Uganda’s Nile River and made the long, tumultuous drive to a hospital in the northern part of the country. I knew malaria-related mortality was high in this area, but what I found when I arrived brought tears to my eyes.
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Categories: Global Health, Tuberculosis (TB), World TB
March 24th, 2013 9:00 am ET -
Kenneth G. Castro, MD, Director of CDC Division of Tuberculosis Elimination
Kenneth G. Castro, MD, Director, Division of Tuberculosis Elimination
World TB Day is observed annually on March 24. On this date in 1882, German physician Robert Koch announced his discovery of the cause of tuberculosis (TB). At the time, TB caused one in seven deaths around the world, but could not be fought effectively because no one knew its source. Dr. Koch discovered that TB is caused by the bacillus Mycobacterium tuberculosis. Koch’s process set the stage for modern scientific procedures, and guides basic TB diagnosis today.
The World TB Day annual observance reminds us of Koch’s scientific breakthrough and provides an opportunity to raise awareness about the ongoing challenges, promising solutions and need to support TB-control efforts worldwide.
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Categories: Global Health, Immunization
April 23rd, 2012 4:25 pm ET -
Dr. Kevin De Cock
Dr. Kevin De Cock is Director of the CDC Center for Global Health (CGH).
Many voices join in the inspirational stories of global health. Today we begin sharing these stories through a new blog we call “Our Global Voices.” Check in often to hear and share in global health stories from around the world. We invite you to join the conversation on important global health topics. In this blog you’ll interact with CDC’s global health leaders and staff working to improve health and save lives around the world.
We kick off our blog today with the first ever World Immunization Week, observed April 21-28, 2012. Immunization prevents between 2 and 3 million deaths every year worldwide. World Immunization Week is a global event sponsored by the World Health Organization to underscore the importance of immunization in saving lives and to encourage parents to vaccinate their children.
Let me share three reasons why immunization is so important to protecting children and for improving health for all of us.
Immunization works
If ever the term “breakthrough” applies to public health, it applies to immunization. Through this approach we have witnessed extraordinary progress against a host of infectious diseases that caused incalculable suffering and loss throughout most of human history. Today safe and effective vaccinations spare the lives of countless children, and at the same time protect parents and families. Diseases like diphtheria, pertussis, measles, rubella, and polio once swept through communities. Now, most people in developed countries never encounter anyone who’s had any one of these diseases because immunization works so well at preventing or even eradicating them. Some vaccines, like those against human papilloma virus and hepatitis B virus, for example, prevent later complications such as cancer of the liver and cervix, respectively.
Child receiving measles vaccine. Photo credit: C. McNab/Measles Initiative
Immunization is possible
CDC, the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) are helping countries assure that no fewer than nine out of ten children in every country receive the three-dose diphtheria-tetanus-pertussis (DTP3) vaccine by their first birthday. By 2009 coverage reached 82 percent. In January 2012, India marked its first anniversary without a single case of polio. Successful polio elimination in the world’s second largest country demonstrates, again, that immunization works and immunization is possible.
Immunization is right
The public health tradition upholds the ideal of social justice. We can attribute the virtual elimination of severe illness and death from childhood diseases in the world’s affluent countries to safe, effective vaccines. Immunization works; its safety and affordability make immunization possible everywhere. But just as measles progress has shown to be fragile in Europe when immunization uptake declines, so it is across much of Africa where weak programs lead to renewed outbreaks and deaths. Measles can then affect unvaccinated individuals and communities in the US. Our commitment to social justice obliges us to recognize that regardless of where they live, children and adults need not suffer from diseases we can and should prevent. That is the promise and moral obligation of immunization.
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Categories: Global Health, Immunization, World Immunization Week, vaccine
April 24th, 2012 7:24 pm ET -
Sara Test, MPH
CDC-Kenya, Nairobi, Kenya
Recently I had the opportunity to speak with Tabu Collins, a Medical Epidemiologist for the Kenyan Ministry of Public Health and Sanitation (MOPHS). Tabu told me about his journey to becoming an epidemiologist and the public health challenges and successes in Kenya. Every day he sees the power of vaccines, not only to save but also to transform lives, giving children in Kenya an opportunity to grow up healthy, go to school, and live long productive lives.
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Categories: Global Health, Immunization, World Immunization Week, measles, vaccine
April 27th, 2012 9:08 pm ET -
Jeffrey McFarland, MD
In celebration of world immunization week, one cannot ignore the great strides China has made to protect over one-fifth of the world’s population from vaccine preventable diseases. The Chinese government has worked closely with CDC, WHO, UNICEF and other partners as it has addressed this challenge head on with new policies, supplemental immunization activities and successes reaching those most in need of care. These steps protect not only China’s population from disease, but also protect the U.S. and the rest of the world from the global spread of infectious, vaccine-preventable health threats.
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Categories: Global Health, Malaria
May 9th, 2012 5:17 pm ET -
Mary Hamel, MD, MPH
Tens of thousands of children’s lives have been saved in Africa, largely thanks to the rapid scale-up of four safe, effective malaria interventions―made possible by dramatically increased funding starting in the early 2000s.
Still, too many children are dying―about one every minute―and the fight against malaria is far from over. Worldwide an estimated 655,000 people died of malaria in 2010. Most of them were young children in Africa.
The global malaria community no longer articulates “control” as the goal. The goals are now elimination in individual countries and eventually global eradication.
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Categories: Chagas, Global Health, Parasites
June 5th, 2012 2:18 pm ET -
By Dr. Susan Montgomery, DVM, MPH
Dr. Susan Montgomery, DVM, MPH
From its labs in Atlanta and around the world, Centers for Disease Control and Prevention scientists have been dissecting insects and the parasites they leave in humans for more than 65 years. The kissing bug, also known as a triatomine, can be infected by Trypanosoma cruzi, the parasite that causes Chagas disease. It is not widespread in the United States, but 300,000 people 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.
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Categories: Child Survival, Child Survival Summit, Global Health, HIV/AIDS
June 14th, 2012 9:05 am ET -
Kevin De Cock, MD, FRCP (UK), DTM&H
Dr. Kevin De Cock, Director of Center for Global Health
Improvements in child health are a major focus of the health-related Millennium Development Goals (MDGs). Targets set for 2015 are rapidly approaching, and, much remains to be done to achieve reductions in child mortality. This week’s Child Survival Call to Action in Washington, DC (June 14-15) will address progress achieved and challenges ahead (www.apromiserenewed.org). International NGOs, representatives of US Government global health programs, and ministers of health from around the world will gather to discuss strategies to advance child survival goals.
CDC’s global health programs have contributed significantly to accomplishments related to child survival. The breadth and depth of CDC’s expertise in child health stems from both its domestic and global work. With CDC offices in over 40 countries, our strong partnerships with ministries of health are critical to achieve goals associated with child health.
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Categories: Global Health, HIV/AIDS
July 23rd, 2012 10:02 pm ET -
John Blandford
By any measure, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) – in which CDC plays a key role – has proven to be a great success. Since its launch in 2003, PEPFAR has provided life-saving antiretroviral drug treatment for nearly 4 million people worldwide and last year alone provided care and support for nearly 13 million people and helped more than 200,000 infants to be born HIV-free. Still, millions more people are infected with the HIV virus ever year, many of them children.
The bottom line? We need to work harder and smarter to take advantage of the new science for preventing HIV infections – all the more essential in the context of current global financial challenges. I am in Washington, DC this week at the International AIDS Society Conference to discuss how public health economics can contribute to achieving the goal of an AIDS-free generation.
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Categories: Global Health, HIV/AIDS
July 26th, 2012 12:01 pm ET -
Jane Mwangi, CDC Kenya
This week, as scientists and public health partners meet at the International AIDS Society (AIDS 2012) meeting in Washington, D.C., one of the key challenges for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is to continue to increase the numbers of individuals on antiretroviral therapy (ART) while making sure that those who are currently on ART get quality care.
Increasing access to improved clinical management in resource-limited settings and identifying persons on ART whose treatment is beginning to fail is a key area where CDC, one of the key U.S. agencies implementing PEPFAR, brings its public health research and evaluation expertise to the table. Through research supported by PEPFAR, CDC in partnership with the Kenya Medical Research Institute (KEMRI) and the Kenya Ministry of Health and Sanitation will present at AIDS 2012 the results of three studies on viral load (VL) testing and illustrate how treatment access and outcomes can be improved.
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Categories: Global Health, Immunization, Kenya, polio
October 23rd, 2012 4:46 pm ET -
Victoria Gammino
The CDC “Nomads Project” was piloted in northern Nigeria in 2011 and brought to scale in 2012 through funding from USAID. The concept is now being piloted by CDC-Kenya in collaboration with CDC’s Global Immunization Division. In addition to bilateral government and NGO partners in Kenya and Nigeria, CDC collaborates with colleagues from WHO, UNICEF, and FAO as part of CDC’s effort to eradicate polio.
Health care systems are designed to meet the needs of the population in the communities where they exist, generally addressing the most urgent health needs, and providing services in a culturally familiar context. But what if that “community” is a mobile one? Many of the things we take for granted — continuity of care or even familiarity with the language and customs among health care providers — can vary from region to region.
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Categories: Children in Adversity, Global Health
December 19th, 2012 9:00 am ET -
Dr. Tom Frieden
CDC welcomes the implementation of the U.S. Government Action Plan on Children in Adversity. At the heart of the Action Plan is the dedication to reducing violence against children, along with its vast, common, destructive and preventable consequences, including HIV, chronic diseases, and mental health problems. CDC is committed to working alongside other USG agencies and an array of global partners to help assure that children not only survive, but also thrive, growing up in strong families, with safe, stable and nurturing relationships. CDC’s work with Together for Girls, funded through the President’s Emergency Plan for AIDS Relief, is just one example of such partnerships.
CDC’s uniquely valuable contribution to the Action Plan consists in linking nationally representative survey data on the magnitude and impact of violence against children to effective, sustainable, and scalable 
programs that reduce violence and its consequences. The need for these Violence Against Children Surveys, which have been conducted in Swaziland, Kenya, Tanzania, Zimbabwe, and Haiti, is strong and growing. The data from these surveys increase countries’ abilities to create and evaluate violence prevention efforts and to help victims and their families.
CDC will continue to support the objectives of the Action plan through partnerships that help nations around the world invest effectively in the futures of their children.
Thomas R. Frieden, MD, MPH
Director, Centers for Disease Control and Prevention
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Categories: Global Health, Health Systems Strengthening
December 27th, 2012 4:20 pm ET -
Elizabeth H Howze, ScD, CHES
Season’s Greetings! As we come to the close of 2012 and embrace 2013, I wanted to reach out and let you know that CDC has reached an important milestone in training global health leaders. We’re celebrating the 20th Anniversary of the Sustainable Management Development Program (SMDP) — a program that CDC developed in 1992 to assist ministries of health in low- and middle-resource countries strengthen their health management systems.
To kick-off the 20th Anniversary celebration, we hosted a webinar on December 11th and invited all of our graduates from the Global Health Leadership Forum (Forum) and the Management for Improved Public Health (MIPH) to join the webinar and share their experiences. I was so pleased to see that graduates from all over the world participated in the webinar and shared powerful stories about how the Forum and the MIPH program have been of value in helping them make sound decisions as they progressed in their careers.
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Categories: Global Health, Malaria, Parasites
January 28th, 2013 12:48 pm ET -
Laurence Slutsker, MD, MPH
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 33% reduction in malaria deaths in the African region and 1.1 million lives saved globally. We have much more to do, but this is a reason to celebrate. As we celebrate, however, we must realize that we are also in the midst of a very fragile situation for three major reasons.
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Categories: Global Health, HIV/AIDS, polio
February 1st, 2013 12:00 pm ET -
Tom Frieden, Director of CDC
For more than 30 years, the US CDC has worked with China on public health issues that have benefited people of all nations. Together our nations proved the benefits of folic acid which saved children around the world from birth defects. We are exploring novel approaches to HIV prevention, testing and treatment. We are researching risk factors for cardiovascular disease – one of the world’s leading causes of death. Along with other nations, China and the US are working together on influenza surveillance to better protect the world.
This week, I had an opportunity to discuss these achievements with my colleague Dr. Wang Yu, Director of the Chinese Center for Disease Control and Prevention (China CDC). The US CDC and China CDC Directors meet annually to decide our mutual priorities, explore ways to share what we’ve learned with other nations and expand upon our collaborative successes. This was the tenth anniversary of the US-China CDC Directors meeting that allowed for reflection on a few key 10-year benchmarks.
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Categories: Global Health, HIV/AIDS
February 11th, 2013 9:44 am ET -
Deborah Birx, MD
Director of Division of Global HIV/AIDS (DGHA)
Debbi Birx, MD
As we usher in the New Year, I am struck by the incredible gains made – especially in the last 12-24 months – in the fight against HIV/AIDS and the key role the United States has played. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), under the leadership of the Office of the Global AIDS Coordinator (OGAC), has helped pave the way to historic progress. The U.S. Global AIDS Coordinator, Ambassador Eric Goosby, has strategically guided the implementation of PEPFAR by leveraging scientific advances, innovation, and the strengths of each PEPFAR implementing agency to ensure the greatest health impact.
Photo: David Snyder/CDC Foundation
Unprecedented results
This impact was confirmed in the UNAIDS 2012 global report. New HIV infection rates have fallen by 50% or more in 25 countries with an additional 14 countries having achieved incidence declines ranging from 25% to 49%. Half of all reductions in new HIV infections are among children, reflecting strong progress towards the elimination of mother-to-child transmission.
These unprecedented results also show increasing momentum over recent years as evidence-based, high-impact prevention interventions have been scaled-up. Importantly, the report also demonstrated that in a very small number of countries, stalling the expansion of HIV services can reverse hard won gains.
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Categories: Global Health, Immunization
February 24th, 2013 10:51 pm ET -
Scott Dowell, MD, MPH, RADM, USPHS
Scott Dowell, MD, MPH, RADM, USPHS
Ten years ago this month, I was living in Bangkok, Thailand when the world was stunned by the spread of sudden acute respiratory syndrome (SARS). At that time, I was helping to establish the first International Emerging Infections Program with a small group of CDC and Thai colleagues. We saw first-hand the effects of SARS on our patients and our friends, the fear it created in the general public, and the cost to economies throughout Asia. Since then, we have experienced the H5N1 bird flu virus spread, the novel H1N1 influenza pandemic, and numerous other global disease outbreaks.
Global health security aims to protect Americans and others around the world from emerging infectious disease outbreaks – whether natural, intentional, or accidental. Through strategic investments in basic public health systems including effective and adequate laboratories, information systems, trained personnel, and effective response strategies, effective control of epidemics is possible. We have seen it happen.
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Categories: Global Health, HIV/AIDS
February 17th, 2013 9:04 pm ET -
Edward Vallejo, ASPH/CDC Global Strategic Information Fellow
This is the first in our “Fresh Voices From the Field” series, where we hear from ASPH Global Health Fellows working throughout the world. Global Health Fellows are recent Master of Public Health or Doctoral graduates placed in CDC global health offices in Atlanta and abroad. They work on a range of priority public health issues and bring a fresh perspective to CDC’s efforts in the field.
Edward Vallejo earned his Master of Public Health degree in Quantitative Methods: Epidemiology at the University of Medicine and Dentistry of New Jersey while working as a microbiologist at the UMDNJ Center for Emerging Pathogens. He has conducted biomedical research with the Russian Federal Space Agency in Moscow, Russia and volunteered as a relief worker in Haiti and the Philippines. He is from Cranford, New Jersey.
Edward Vallejo, ASPH/CDC Global Strategic Information Fellow
Does having access to clean water, stable electricity, and freedom from the fear of contracting an infectious disease make your list of major health and safety concerns? If you live in the developed world, the answer is most likely no, but for the last four months, I have been working in the West African country of Nigeria, where those issues and an ever-changing security situation are a regular part of my daily life. As a member of CDC Nigeria’s Strategic Information Team, my focus has been on HIV/AIDS, the global pandemic that is a leading cause of death for the 170 million people living in Africa’s most populous country.
Less than a month after arriving, I helped to coordinate a large-scale HIV/AIDS service and data quality assessment that involved 40 public health physicians, epidemiologists, strategic information and database specialists traveling to 18 medical facilities across the country. These personnel from CDC Nigeria, CDC Atlanta, the University of California at San Francisco, Nigeria’s Federal Ministry of Health and the Nigerian Field Epidemiology and Laboratory Training Program developed a detailed picture of the current state of services and data in those facilities. As a result, established and future programs will benefit from our recommendations, especially in preventing mother to child transmission of HIV/AIDS, an area in which Nigeria carries a substantial burden.
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Categories: Global Health
March 4th, 2013 11:12 am ET -
Guest blogger: Thais dos Santos, PAHO/WHO Office for Barbados and Eastern Caribbean Countries
Thais dos Santos, Advisor, Health Surveillance and Disease Prevention, PAHO/WHO Office for Barbados and Eastern Caribbean Countries
Barbados and the Eastern Caribbean States received nearly 1.5 million tourists in 2012 alone according to the Caribbean Tourism 
Organization. Considering their total population of just under one million, this means that there were more people passing through than people actually living in this region. This is a region with a lot of mobility, both of people looking to enjoy the beautiful sites as well as transit between the islands. In this context of movement of people and goods, the current International Health Regulations (IHR) become a cornerstone in providing an effective framework for collaboration among international partners in containing public health risks and in minimizing their impact on travel and trade.
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Categories: Global Health, HIV/AIDS, PEPFAR
March 11th, 2013 9:21 am ET -
Thato Farirai, CDC-South Africa’s Counseling and Testing Lead
Thato Farirai, CDC-South Africa’s Counseling and Testing Lead
We at the CDC-South Africa office are proud to be associated with the recent release of South Africa’s first national guidelines on counseling and testing children for HIV. Developed by the Human Sciences Research Council (HSRC) of South Africa with support from CDC-South Africa and the Bill and Melinda Gates Foundation, this toolkit fills a very important gap in the response to the HIV epidemic.
A forgotten group
With more than 5.6 million infected people, South Africa remains the country with the largest HIV epidemic in the world. Although South Africa has successfully managed to reduce its mother-to-child HIV transmission rate to less than 3% nationally, children younger than 15 years are still a neglected group. According to the South African National Department of Health, an estimated 32,940 children younger than 15 years are living with HIV and AIDS but are not on treatment.
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Categories: Child Survival, Global Health, diarrhea, water
March 18th, 2013 11:31 am ET -
Michael Beach, PhD, Associate Director for Healthy Water, National Center for Emerging and Zoonotic Infectious Diseases
Michael Beach, PhD, Associate Director for Healthy Water, NCEZID
What if we lost 32 school buses full of children today? That’s 2,195 children—the number who die daily of diarrhea around the world. That’s more than die from AIDS, malaria, and measles combined.
As World Water Day approaches on March 22, we should consider water’s role in those deaths—and what we can do to prevent them. About 88% of diarrhea-associated deaths are attributable to unsafe water, inadequate sanitation, and insufficient hygiene. Yet most diarrheal deaths are preventable using simple, low-cost interventions.
Diarrhea: common illness, global killer
Diarrheal diseases account for 1 in 9 child deaths worldwide, making diarrhea the second leading cause of death among children under the age of 5. For children with HIV, diarrhea is even more deadly; the death rate for these children is 11 times higher than the rate for children without HIV.
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