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Tom Frieden: What I’m Thankful For

Categories: Ebola


This blog was originally posted on on November 20, 2014


CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

This Thanksgiving Day, 170 CDC disease detectives, public health experts, and communication specialists will not be home celebrating with loved ones. They’ll be in West Africa, working to contain the Ebola epidemic.

Some of them are deep in remote areas, far from the home comforts we take for granted. Some are traveling on dangerous roads, by helicopter, and in dugout canoes to help stop outbreaks of Ebola. They do many critical things such as trace contacts so they can be isolated, and treated if necessary, to improve their survival and prevent spread of the epidemic. Others swelter in personal protective equipment to prepare blood samples for Ebola testing in mobile labs. Still others stay up late into the night poring over epidemiologic data to see where teams will need to be sent the next day.

Our workers on the front lines are supported by hundreds of equally hard-working staff back in Atlanta who keep CDC’s Emergency Operations Center running 24/7. They’ve been working at full speed for more than four months, and will keep going until the job is done. Thousands of other equally dedicated CDC workers continue to protect Americans from other health threats, ranging from influenza to drug-resistant infections and more. And there are teams to jump in at a moment’s notice in the event there is another case of Ebola here in the United States.

None of these extraordinarily dedicated women and men are strangers to work on holidays, weekends, or after-hours. They aren’t doing it to get rich or famous. And they won’t get thank-you letters from the millions of Americans and others around the world who won’t get sick or injured because of their work. Public health successes are usually invisible – the “dog that doesn’t bark in the night.”

Please join me in recognizing them on this day of Thanksgiving. Epidemiologists, lab scientists, public health specialists, world experts in every aspect of public health, and so many more – we all owe them thanks for the work they do at home and abroad to keep us safe and healthy.


Implications of Latrines on Women’s and Girls’ Safety

Categories: Emergency Response and Recovery, toilet, water, women's/maternal health

Michelle Hynes and Michelle Dynes are epidemiologists in CDC’s Emergency Response and Recovery Branch.

Michelle Hynes and Michelle Dynes are epidemiologists in CDC’s Emergency Response and Recovery Branch.

Michelle Hynes and Michelle Dynes are epidemiologists in CDC’s Emergency Response and Recovery Branch. They took a moment out of their hectic schedules to talk about their work related to World Toilet Day. Dr. Hynes and Dr. Dynes have been involved in public health activities linking the safety of women and girls to the locations and privacy of latrines in humanitarian settings.

Michelle Dynes, EIS Officer/Epidemiologist, PhD, MPH, MSN, CNM, RN

Michelle Dynes, EIS Officer/Epidemiologist, PhD, MPH, MSN, CNM, RN

During CDC’s response following the Haiti earthquake, my team worked with the International Rescue Committee and the USAID Office of Foreign Disaster assistance to address the needs of women and girls in internally displaced persons’ camps in Port au Prince. Our team evaluated the use of handheld solar lights by women and girls. We wanted to better understand women and girls’ sense of safety in the camps and to know if the solar lights were acceptable, useful, and durable.

We found that one of the primary reasons women and girls left their shelters at night was to use latrines. In focus group discussions, women identified the latrines and the paths leading to the latrines as areas where they felt the least safe. Women and girls spokes about men hanging around the latrines and nearby paths. They described lack of proper lighting in the area. They also described latrines without privacy or doors to close the latrines, with men positioning themselves so they could see inside the facilities.

After the baseline surveys, the team distributed handheld solar lights to each household and followed up every other month to explore their impact. It turned out that the lights were extremely beloved, even precious. Women reported using them at least once a day, if not more often. They used them for going to latrine, to navigate dark pathways, and kids used them for homework at night.

The intervention was successful. We know these lights had high durability and were used often. Women and girls maintained the ability to use the lights when they needed them. We think, because the lights were introduced into the household in the context of safety for women and girls, that men and boys in the family respected their rights to use the devices.

The handheld solar light project is important for women and girls. Having access to lighting is critical. Think about how many times a day you turn a light on. Here in the U.S., you expect to be able to see in the parking lot or to turn on a light when you walk into the house after dark. Giving women and girls in displacement camps access to lighting also gives them control. This is a huge change for women and girls who feel like they have little control in their lives. As an intervention, it is easy to do.

Michelle Hynes, Epidemiologist, sexual and reproductive health lead for CDC’s Emergency Response and Recovery Branch

Michelle Hynes, Epidemiologist, sexual and reproductive health lead for CDC’s Emergency Response and Recovery Branch

The project that my colleague, Michelle Dynes, described is a great example of the ways in which violence against women and girls can be prevented or reduced in humanitarian settings. The location and lighting of public latrines is only one of the safety issues in displacement camps. As part of an inter-agency task team led by UNICEF and UNFPA, I have been working on the revision of guidelines for the integration of gender based violence (GBV) interventions in humanitarian settings. Many different sectors work in humanitarian settings, such as the Water, Sanitation and Hygiene Sector. These sectors aren’t necessarily aware of actions they can take to increase the safety of women and girls or other at-risk groups, or feel confident in their ability to do so. Woman and girls who must walk into isolated areas to bathe, go to the bathroom, or get water are vulnerable to rape and other violent acts. The guidelines provide suggested actions the sector can take to reduce these risks. For example, those who are at risk can be included in the planning process for the location of the latrines and aspects of the construction such as lighting and privacy. Similar guidance will be given for all sectors working in humanitarian settings. By providing specific ways in which each sector can include GBV prevention and response activities into their normal tasks, the humanitarian field as a whole will have increased capacity to respond to and prevent this type of violence. We expect the revision of the GBV Guidelines to be completed by the end of 2014 with the official launch in 2015.




Take charge of your health this World Diabetes Day

Categories: diabetes, noncommunicable diseases (NCDs)

world diabetes day
Diabetes is a chronic condition that continues to be a burden throughout the world. As we observe World Diabetes Day, let’s define some terms and talk about who is at risk. How does diabetes affect you or someone close to you?

Ann Albright, PhD, RD, Director, CDC Division of Diabetes Translation

Ann Albright, PhD, RD, Director, CDC Division of Diabetes Translation

Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn’t make enough insulin or can’t use its own insulin as well as it should. This causes glucose to build up in your blood.

A person with prediabetes has a blood sugar level higher than normal, but not high enough yet for a diagnosis of diabetes. He or she is at higher risk for developing type 2 diabetes and other serious health problems, including heart disease and stroke.

You are at increased risk for developing prediabetes and type 2 diabetes if you:

  • Are 45 years of age or older.
  • Are overweight.
  • Have a parent with diabetes.
  • Have a sister or brother with diabetes.
  • Have a family background that is African-American, Hispanic/Latino, American-Indian, Asian-American, or Pacific-Islander.
  • Had diabetes while pregnant (gestational diabetes), or gave birth to a baby weighing 9 pounds or more.
  • Are physically active less than three times a week.

What can you do to prevent or delay type 2 diabetes? We know of three things that together help prevent or delay this: healthy eating, physical activity, and weight management.

Healthy eating and physical activity are great concepts, but they can seem like lofty challenges on hectic days. To prevent or delay type 2 diabetes, as well as care for yourself if you have diabetes, eating well and increasing physical activity are an important part of a routine to ward off a host of problems. And with a bit of planning and careful scheduling, healthy eating and moving more can be both achievable and fun.

You already know that healthy eating is important and the right thing to do, both for yourself and for your family. The latest diabetes numbers tell the story: 382 million are living with diabetes worldwide. In addition, 86 million Americans have prediabetes, and 9 out of 10 of them don’t know they have it. If you pay attention to your body’s cues, you know how much better you feel with a consistent approach to good nutrition. Cooking with your family can be a great way to spend time together, encouraging one another while sharing food preparation and even trying new things to eat. This can work with adults as well as children!

Healthy meals don’t have to mean more shopping trips or additional preparation time. There are many free resources with updated healthy recipes, even for those who want 30-minute or less meals, low sodium items, vegan dishes, etc. It’s easy to spark your imagination and find something new and healthy to cook. In fact, this year the American Diabetes Association’s November diabetes month theme is “Get Cooking to Stop Diabetes.” Small changes can make a big difference.

For increasing physical activity, we’re not talking about adding hours of daily physical activity. Limiting calorie intake, as well as moving more, is essential to losing weight. We know this: research shows that modest weight loss and regular physical activity can help prevent or delay type 2 diabetes by up to 58% in people with prediabetes. Modest weight loss means 5% to 7% of body weight, which is 10 to 14 pounds for a 200-pound person. Getting at least 150 minutes each week of physical activity, such as brisk walking, is important. May not be able to start at 150 minutes each week, but start with a few a few minutes each day and increase the time so you can reach this goal.

Some people like to work out first thing in the morning, which can be great if you have children and schedule after-school activities. Or, you can walk, ride a bike, jog or even go to the gym directly after work (do not go home, avoid the couch). Others like to use lunchtime to work out in a fitness center or take a brisk walk outside. Use the stairs, or have a walking meeting. If you can find just ten minutes here and there throughout the day, that’s good, too.

If you have prediabetes and want additional help making these changes, consider finding a local program of the CDC-led National Diabetes Prevention Program. This is currently offered in the United States and U.S. territories. Lifestyle coaches work with participants to identify helpful tools and techniques as well as emotions and situations that can sabotage their success, and the group process encourages participants to share strategies for dealing with challenges.

Here are more resources for delicious meals and tips for physical activity:

On this day to ponder the effects of diabetes throughout the world, take time to eat right and move more.

Preparedness Workshops Help At-Risk Countries Prepare for Ebola

Categories: Ebola, global health security, infectious disease

Real time contact tracing system used in Nigeria to track Ebola response (September 9, 2014)

Real time contact tracing system used in Nigeria to track Ebola response (September 9, 2014)


Frederick J. Angulo, DVM, PhD

Frederick J. Angulo, DVM, PhD

A recent news story in Bloomberg Businessweek proclaims “How to Avert an Ebola Nightmare: Lessons from Nigeria’s Victory.” The article outlines the remarkable achievement of Nigeria’s Ministry of Health with partners, including CDC, to contain the spread of Ebola in that country. Now declared Ebola-free by the World Health Organization (WHO), Nigeria stands as a case study for other nations who are at high-risk for transmission of Ebola from neighboring countries.

A team of Nigerian scientists shared those lessons with public health officials from Ghana and Gambia at a workshop held October 7-9, 2014, in Accra, Ghana, “Strengthening Detection and Response Capacity to Significant Public Health Events, including Ebola.” Led by Dr. Akin Oyenakinde, Chief Consultant Epidemiologist at the Nigeria Centre for Disease Control, the Nigerian team described the critical role of communication, their emergency operations center, financial resources, political will, and contact tracing to the effective control of Ebola. He highlighted the role of the Field Epidemiology and Laboratory Training Program, an initiative in partnership with CDC, in preparing Nigeria for response to Ebola. Notably 100 or the 150 contact tracers who monitored potential Ebola cases were trained through the Nigeria FELTP program.

 Dr. Fred Angulo, CDC Lead Unaffected Countries Team and Dr. Lisa Kramer, USAID East Africa Regional Emerging Pandemic Threats Advisor,  prepare for the next session of the Ebola preparedness workshop in Accra, Ghana, October 7-9, 2014.

Dr. Fred Angulo, CDC Lead Unaffected Countries Team and Dr. Lisa Kramer, USAID East Africa Regional Emerging Pandemic Threats Advisor, prepare for the next session of the Ebola preparedness workshop in Accra, Ghana, October 7-9, 2014.

Participants in the workshop peppered Dr. Oyenakinde and his team with questions about case management, infection control, and contact tracing. Their response was evidence that countries who have successfully met the challenge of public health emergencies have high credibilty for nations who are preparing for potential cases of Ebola.

The workshop in Ghana shared best practices, such as those applied in Nigeria, and led participants through hypothetical, but likely scenarios in which Ebola was introduced into their countries. Participants were asked to respond to those scenarios by identifying resources and strategies for early detection, infection control, contact tracing, and emergency operations systems. At the end of the workshop, the process was designed to help Ghana and Gambia create concrete plans. The workshop was sponsored by the USAID, in partnership with CDC, Public Health England, and the U.S. Defense Threat Reduction Agency.

The workshop in Ghana was the second of three planned regional Ebola preparedness workshops. The first was held in Cote d‘Ivoire, and the third is designed in Cameroon for West Africa French-speaking countries, November 4-6. The workshops are one part of a multi-prong strategy that CDC is supporting to prepare countries that are at high risk for introduction of Ebola, but have not yet reported cases or faced widespread disease.

See CDC Supplements Ebola Assistance to Liberia, Sierra Leone, and Guinea by Preparing Neighboring Countries to Rapidly Detect and Contain Ebola



October 29 is World Stroke Day!

Categories: Uncategorized

Mary G. George, MD,  Deputy Associate Director for Science and Senior Medical Officer, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Mary G. George, MD, Deputy Associate Director for Science and Senior Medical Officer, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

On October 29, 2014, for World Stroke Day, the World Stroke Organization will launch a new campaign around women and stroke. Every year 3.2 million women die of strokes globally, including more than 75,000 women in the United States, and thousands of other women are suffer long-term disabilities resulting from stroke.  The “I Am Woman” campaign emphasizes that women are more at risk of having a stroke and, in many cases, are the primary caregiver to a family member who suffers a stroke. The global campaign raises awareness about the special challenges of stroke in women and how women can reduce their risk and protect their health.

Created in 2006, World Stroke Day promotes the stroke warning signs and the importance of taking immediate action if you think you or someone you know might be having a stroke. Every two seconds, someone in the world suffers a stroke, according to the World Health Organization. Of every 10 deaths from stroke, 6 occur in women, largely because the risk of stroke increases with age and women have longer life expectancy than men.

A stroke—sometimes called a brain attack—occurs when the blood supply to the brain is blocked or when a blood vessel in the brain ruptures, causing brain tissue to die. A stroke often starts as a sudden feeling of numbness or weakness on one side of the body. Other warning signs of stroke arewoman-holding-head

  • Sudden confusion, trouble speaking, or understanding.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, loss of balance, or loss of coordination.

Anyone can have a stroke at any age. You can’t control some stroke risk factors, like heredity, age, gender, and ethnicity. Some medical conditions—including high blood pressure, high cholesterol, heart disease, diabetes, overweight or obesity, and having had a previous stroke—can also raise your stroke risk.

CDC encourages everyone to know the signs and symptoms of stroke and to call 9-1-1 right away if they think they or someone else might be having a stroke. Getting fast treatment is important to prevent death and disability from stroke. People may be able to prevent stroke or reduce their risk through healthy lifestyle changes. In addition, medication can reduce stroke risk for some people.

Here are six steps anyone can take to reduce the risk and the danger of stroke:

1. Know your family history and personal risk factors, such as high blood pressure, diabetes, atrial fibrillation, and high blood cholesterol. Knowing one’s family history can help you start prevention early in life.

2. Be physically active and exercise regularly.

3. Maintain a healthy diet high in fruits and vegetables, and low in salt to stay healthy and keep blood pressure low.

4. Limit alcohol consumption.

5. Avoid cigarette smoke. If you smoke, seek help to stop now.

6. Learn to recognize the warning signs of a stroke.

CDC supports several public health efforts that address stroke, including the WISEWOMAN program, the Paul Coverdell National Acute Stroke Program (PCNASP), and the Million Hearts® initiative. WISEWOMAN also helps women with little or no health insurance reduce their risk for heart disease, stroke, and other chronic diseases. The PCNASP funds 11 states to improve the quality of care and transition of care from first contact with emergency medical services through in-hospital care and transition to next care provider. Million Hearts®, which is co-led by CDC and the Centers for Medicare & Medicaid Services, aims to prevent 1 million heart attacks and strokes by 2017.

Learn more about World Stroke Day and the “I Am Woman” campaign.

Learn more about how CDC addresses stroke prevention and care.

CDC Division for Heart Disease and Stroke Prevention

The mission of CDC’s Division for Heart Disease and Stroke Prevention is to provide public health leadership to improve cardiovascular health for all, reduce the burden, and eliminate disparities associated with heart disease and stroke.

Paul Coverdell National Acute Stroke Program

The Paul Coverdell National Acute Stroke Registry Program is a cooperative agreement competitively awarded to 11 states to improve quality of care and transition of care from first contact with emergency medical services through in-hospital care and transition to next care provider.

Million Hearts®

Million Hearts® is a national initiative to prevent 1 million heart attacks and strokes by 2017. Million Hearts® brings together communities, health systems, nonprofit organizations, federal agencies, and private-sector partners from across the country to fight heart disease and stroke.


The Well-Integrated Screening and Evaluation for WOMen Across the Nation (WISEWOMAN) program focuses on reducing cardiovascular disease (CVD) risk factors among at-risk women. CVD, which includes heart disease and stroke, is the leading cause of death for women in the United States.

Sodium Reduction in Communities Program

The Sodium Reduction in Communities Program (SRCP) works with communities to increase access to and availability of lower sodium foods.

The State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health (State Public Health Actions)

The State Public Health Actions Program works to improve health for all Americans through coordinated chronic disease prevention programs. The program funds statewide initiatives to prevent, manage, and reduce the risk factors associated with chronic diseases—including childhood and adult obesity, diabetes, heart disease, and stroke.

Get to know a STOPper

Categories: immunization, polio


In honor of World Polio Day, the polio communications team sat down with the lead of the CDC Global Immunization Division’s STOP team Yinka Kerr for a little Q & A.

Yinka Kerr, MSPH, STOP Team Lead, Global Immunization Division

Yinka Kerr, MSPH, STOP Team Lead, Global Immunization Division

Q: Yinka, how did you become involved in the global initiative to end polio?

Yinka: I started in polio in 1997 when I did a 6-month rotation as part of my Public Health Prevention Service training program. My supervisors were Bob Keegan and Denise Johnson, who were amazing mentors. I had a taste of what it would be like working in a global health position through being part of an immunization program review in China and writing a financial report in Zimbabwe for the Africa Region of the World Health Organization.

I was on the second Stop Transmission of Polio (STOP) team in 1999, where I was stationed in Nepal for 3 months. When I finished my training with the Public Health Prevention Service in 2000, CDC’s polio program was the first place that I came to look for a job and I have been with the Global Immunization Division ever since.STOP 2 Training Nepal Yinka for blog

Q: What parts of your experience as a STOP volunteer in Nepal remain the most memorable?

Yinka: I worked with Dr. Choudhury, the national surveillance officer, responsible for tracking polio throughout the eastern region. We were based in Biratnagar and would travel up to where the roads ended to talk to health care volunteers, community workers, private doctors and hospital staff about checking for cases of paralysis to test for polio. I remember thinking that this was an amazing program that brings all people together to work towards one goal—ridding the world of polio. It did not matter that I could not speak their language; just bringing the message that we were all working towards this common goal was unforgettable.

One time we went to check on a paralyzed child that the hospital told us had returned to the village. We headed off to the village in the pouring rain. We crossed through a large creek and arrived in the village where the child was, only to be told that the child had gone across the border to seek health care. We turned around and started home only to get stuck in the rising creek coming back across the river. Luckily, I had some cookies and water that I always kept in the car for food emergencies. We sent a villager who was passing by us on a bicycle back to the village to get a tractor and some villagers who helped to get us out of the mud. Thanks to all, we made it home later that night. These have been and will be the trials and tribulations of everyone who is working to find that last case of polio.Stuck in the mud for blog

Q: What is your favorite part of leading CDC’s STOP Team?

Yinka: I like the depth and breadth of activities that I do as STOP team lead in order to recruit, train, and deploy the STOP teams. The passion the STOP staff and CDC colleagues instill in people during the training is amazing. Our teams are deployed with expertise in their minds and passion in their hearts. Being a part of it is truly an honor.

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CDC Director: Why I don’t support a travel ban to combat Ebola outbreak

Categories: Ebola, global disease detection, global health security, infectious disease


This blog was originally posted on Fox News on October 9, 2014.



CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

The first case of Ebola diagnosed in the United States has caused some to call on the United States to ban travel for anyone from the countries in West Africa facing the worst of the Ebola epidemic.

That response is understandable. It’s only human to want to protect ourselves and our families. We want to defend ourselves, so isn’t the fastest, easiest solution to put up a wall around the problem?

But, as has been said, for every complex problem, there’s a solution that’s quick, simple, and wrong.

A travel ban is not the right answer. It’s simply not feasible to build a wall – virtual or real – around a community, city, or country. A travel ban would essentially quarantine the more than 22 million people that make up the combined populations of Liberia, Sierra Leone, and Guinea.

We don't want to isolate parts of the world, or people who aren't sick, because that's going to drive patients with Ebola underground, making it infinitely more difficult to address the outbreak.When a wildfire breaks out we don’t fence it off. We go in to extinguish it before one of the random sparks sets off another outbreak somewhere else.

We don’t want to isolate parts of the world, or people who aren’t sick, because that’s going to drive patients with Ebola underground, making it infinitely more difficult to address the outbreak.

It could even cause these countries to stop working with the international community as they refuse to report cases because they fear the consequences of a border closing.

Stopping planes from flying from West Africa would severely limit the ability of Americans to return to the United States or of people with dual citizenship to get home, wherever that may be.

In addition to not stopping the spread of Ebola, isolating countries will make it harder to respond to Ebola, creating an even greater humanitarian and health care emergency.

Importantly, isolating countries won’t keep Ebola contained and away from American shores. Paradoxically, it will increase the risk that Ebola will spread in those countries and to other countries, and that we will have more patients who develop Ebola in the U.S.

People will move between countries, even when governments restrict travel and trade. And that kind of travel becomes almost impossible to track.

Isolating communities also increases people’s distrust of government, making them less likely to cooperate to help stop the spread of Ebola.

Isolating communities and regions within countries will also backfire. Restricting travel or trade to and from a community makes the disease spread more rapidly in the isolated area, eventually putting the rest of the country at even greater risk.

To provide relief to West Africa, borders must remain open and commercial flights must continue.

There is no more effective way to protect the United States against additional Ebola cases than to address this outbreak at the source in West Africa. That’s what our international response—including the stepped-up measures the president announced last month—will do.

What works most effectively for quelling disease outbreaks like Ebola is not quarantining huge populations.

What works is focusing on and isolating the sick and those in direct contact with them as they are at highest risk of infection. This strategy worked with SARS and it worked during the H1N1 flu pandemic. Casting too wide a net, such as invoking travel bans, would only provide an illusion of security and would lead to prejudice and stigma around those in West Africa.

Americans can be reassured we are taking measures to protect citizens here.

Today, all outbound passengers from Guinea, Liberia, and Sierra Leone are screened for Ebola symptoms before they board an airplane.

Staff from CDC and the Department of Homeland Security’s Customers & Border Protection will begin new layers of entry screening, first at John F. Kennedy International Airport in New York this Saturday, and in the following week at four additional airports — Dulles International Airport outside of Washington, D.C.; Newark Liberty International Airport; Chicago’s O’Hare International Airport; and Hartsfield-Jackson Atlanta International Airport.

Combined, these U.S. airports receive almost 95 percent of the American-bound travelers from the Ebola-affected countries.

Travelers from those countries will be escorted to an area of the airport set aside for screening. There they will be observed for signs of illness, asked a series of health and exposure questions, and given information on Ebola and information on monitoring themselves for symptoms for 21 days. Their temperature will be checked, and if there’s any concern about their health, they’ll be referred to the local public health authority for further evaluation or monitoring.

Controlling Ebola at its source – in West Africa – is how we will win this battle. When countries are isolated, we cannot get medical supplies and personnel efficiently to where they’re needed – making it impossible to fight the virus in West Africa.

As the WHO’s Gregory Hartl said recently, “Travel restrictions don’t stop a virus. If airlines stop flying to West Africa, we can’t get the people that we need to combat this outbreak, and we can’t get the food and the fuel and other supplies that people there need to survive.”

We know how to stop Ebola: by isolating and treating patients, tracing and monitoring their contacts, and breaking the chains of transmission.

Until Ebola is controlled in West Africa, we cannot get the risk to zero here in the United States.

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Two Initiatives Worth Their Salt: Reducing Sodium Intake in Philadelphia and Shandong, China

Categories: cardiovascular disease, noncommunicable diseases (NCDs)

September 29 is World Heart Day.

September 29 is World Heart Day.

Background information

Barbara Bowman, Ph.D., Director, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC

Barbara Bowman, Ph.D., Director, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC

CDC’s 2013 Vital Signs publication reported that more than 200,000 deaths among Americans younger than age 75 are preventable. These deaths from heart disease and stroke, both primary contributors to cardiovascular disease (CVD), could be prevented through better lifestyle practices and better care. Heart disease and stroke are two of our nation’s leading causes of death, responsible for nearly 1 in 3 deaths in the US each year. Globally, hypertension accounts for almost one-half of heart attacks and strokes. In China alone, CVD caused an estimated 3.5 million deaths in 2008.

Excess sodium intake is a key risk factor for hypertension, and reducing sodium intake is a global and domestic public health priority. A 2007 study found that reducing average population sodium intake by 15% in 23 low- and middle-income countries (bearing 80% of the chronic disease burden) could prevent 8.5 million deaths over 10 years, at a cost of only $0.05 / person / year (see footnote #1). In China and in the US, average sodium consumption is in excess of recommendations (see footnote #2). Primary sources of sodium vary depending on the country: the primary sources of sodium in the US are packaged and restaurants foods, while in China it is salt added during cooking. Thus, efforts to reduce sodium consumption in each country focus on their respective primary contributors to sodium intake.

Shandong Province is the third most populous province in China with 96 million residents. Rates of hypertension and salt intake in adults are higher than the national average; Shandong Province is also one of the largest salt producers in China. To reduce the burden of hypertension, in 2011China’s National Health and Family Planning Commission (formerly the Ministry of Health) and Shandong provincial government, with technical assistance provided by US CDC, launched the first comprehensive salt reduction project in China: the Shandong Province & Ministry of Health Action on Salt and Hypertension (SMASH). The goal of SMASH is to: 1) reduce daily salt intake from 12.5 grams/day to 10 grams/day by 2015; and 2) improve hypertension control within the province.

In order to reduce salt intake, food labeling, reformulating local cuisine, distribution of scaled spoons for measurement of salt use in cooking, and food industry product reformulation are being broadly adopted. The initiative works with restaurants to develop sodium standards for Shandong cuisine, including, developing and conducting chef training and contests to provide lower salt menu items and recipes track salt usage, and disseminate educational resources. Restaurants that follow the lower salt requirement are designated a “Distinguished Restaurant”.

Philadelphia, also interested in reducing salt intake as part of its Get Healthy Philly initiative, launched the Philadelphia Healthy Chinese Take-out Initiative in 2012, a joint effort of the Philadelphia Chinese Restaurant Association, the Center for Asian Health of Temple University, the Asian Community Health Coalition and the Department of Health (DOH), to improve access to healthier food options. In an effort to control and prevent high blood pressure, the initiative aims to reduce the sodium content in Chinese take-out dishes by 10-15%. BetweenJuly, 2012 and April, 2013, 206 restaurants of more than 400 agreed to participate in the initiative. Philadelphia Healthy Chinese Take-out Initiative provided a series of free cooking trainings for owners and chefs on low salt cooking techniques. These included enhancing flavor with herbs and spices, using lower sodium ingredients such as reduced sodium soy sauce, modifying recipes to use ½ the amount of prepared sauce in dishes, and limiting distribution of soy sauce packets to customers. Marketing materials for owners and consumers to promote awareness of the initiative were also developed and distributed. DOH staff collected and analyzed samples of two popular dishes from 20 restaurants to assess changes in sodium content since the program began: preliminary results show an average of a 10% reduction in sodium content over the past two years.

After learning about US sodium reduction efforts via CDC’s Salt e-Update, SMASH officials have been working with Philadelphia Healthy Chinese Take-out Initiative to share information on their respective sodium reduction initiatives. Shandong shared CDC sodium fact sheets translated to Chinese with Philly, which assisted Philly in communicating with participating restaurant operators who only speak Chinese. Philly has provided Shandong with program insights and experience on monitoring and evaluation as well as program scope. Continued discussions will allow both communities to better communicate and share enhanced recipes, cooking techniques, and chef training materials with restaurants to reduce sodium in their menus. Expanded dialogue will also allow both projects to share lessons learned and fine tune efforts around training restaurants to reduce sodium, conducting public education campaigns focused on sodium reduction, and collecting baseline survey data to help inform targeted strategies for sodium reduction.

While the US continues to make progress in achieving our national CVD goals for sodium intake, there remains great opportunity to achieve more. Active engagement with global partners not only provides the unique opportunity to share our expertise and knowledge but to also leverage existing global efforts to enhance our knowledge and improve domestic approaches. SMASH and Philly’s Healthy Chinese Take-out Initiative share similar goals and approaches and are leveraging resources and experiences to enhance their respective programs.

To learn more:

  • CDC Division for Heart Disease and Stroke Prevention
    The mission of the Division for Heart Disease and Stroke Prevention (DHDSP) is to provide public health leadership to improve cardiovascular health for all, reduce the burden, and eliminate disparities associated with heart disease and stroke.
  • Sodium
    Most of the sodium we consume is in the form of salt, and the vast majority of sodium we consume is in processed and restaurant foods. Too much sodium can increase your blood pressure and your risk for a heart attack and stroke. Heart disease and stroke is the leading cause of death in the US.
  • Sodium Reduction Toolkit: A Global Opportunity to Reduce Population-Level Sodium Intake
    The toolkit is designed to provide international and national government agencies and public health organizations with a brief overview, tools, and information for developing and implementing sodium reduction programs, policies, and initiatives aimed at lowering sodium intake. The toolkit offers seven self-guided modules, each about 30 minutes to complete. (Chinese modules are currently hosted on a Chinese site through US CDC China office.)
  • High Blood Pressure
    High blood pressure is a common and dangerous condition. Having high blood pressure means the pressure of the blood in your blood vessels is higher than it should be. But you can take steps to control your blood pressure and lower your risk of heart disease and stroke.
  • The Shandong Province and Ministry of Health Action on Salt and Hypertension (SMASH)
  • Healthy Chinese Takeout Initiative

Ebola Requires the World’s United Action

Categories: Ebola, global health security


This blog is cross-posted on the White House website.


White House

The nations of the world, along with key international organizations, gather at the White House today to advance a Global Health Security Agenda that will help keep the world safe from infectious disease threats.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

This meeting is a critical opportunity to increase international commitment and, more importantly, action to stop the Ebola epidemic in West Africa and the infectious disease threats to come.

Ebola is a critical issue for the world community. There’s a real risk to the stability and security of societies, as governments are increasingly challenged to not only control Ebola but to provide basic health services and other government functions. The stability of these countries and their economies, as well as those of their neighbors and of others, is at increasing risk.

Ebola is the most recent tragic example of why it is imperative to work together to make the world safer from infectious disease outbreaks. Ebola is precisely the kind of health threat the Global Health Security Agenda could have prevented. We and our partner countries have agreed to work together so that effective prevention, detection, and response mechanisms are present in every country around the world.

There are three key actions we must take:

  1. Prevent avoidable catastrophes and epidemics. We can only do this if we track health threats and work strategically to prevent emergence and spread.
  2. Detect threats early. This requires real-time disease tracking and effective systems to identify clusters of illness and to do the laboratory tests, including collecting outbreak specimens and safely and securely transporting them for accurate laboratory testing.
  3. Respond rapidly and effectively. Each country needs trained disease detectives. These individuals can work most effectively in interconnected emergency operations centers connected with response capacity ready to spring into action.

CDC has many years of experience assisting countries throughout the world with public health emergency detection and response capacity. Recent demonstration projects in Uganda and Vietnam created emergency operations centers, national laboratory systems, and real-time information systems, and are a proof of principle that global health security systems can be rapidly implemented and used immediately to find and stop health threats.

Dr. Tom Frieden, Director of the U.S. Centers for Disease Control and Prevention, prepares to don googles before entering the Ebola treatment unit (ETU), ELWA 3. Médecins Sans Frontières/Doctors Without Borders operates the ELWA 3 ETU, which opened on August 17.

Dr. Tom Frieden, Director of the U.S. Centers for Disease Control and Prevention, prepares to don goggles before entering the Ebola treatment unit (ETU), ELWA 3.

Last year, I visited urban and rural areas in Uganda to review the progress of this pilot project and I was deeply impressed; this project is one of the highest impact initiatives CDC has undertaken in my time as director. Progress improving disease detection and response in these countries shows that such models can work on a global scale.

One critical need is to train disease detectives around the world so that they can close gaps in surveillance and detect disease outbreaks as early as possible. CDC’s Epidemic Intelligence Service program is a global model for this type of training.

Since the 1980s, we’ve helped 40 other countries develop their own similar training. Trainees and graduates of these programs find and stop hundreds of outbreaks a year, usually without CDC’s direct involvement, which is exactly the result that we will see the more we invest in smart and effective programs like this one. In fact, graduates of these programs from Cameroon, Democratic Republic of Congo, Kenya, Morocco, South Africa, and Tanzania have been working on the ground to help stop the current Ebola outbreak.

It is increasingly clear that the health of other nations has a direct impact on health in the United States—infectious diseases do not recognize borders, and a disease outbreak is just a plane trip away.

Strengthening global health security will protect Americans, and protect people from around the world.

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What is Rabies?

Categories: rabies

3 dogs

Healthy Animals, Healthy People

















Ryan M. Wallace, US Centers for Disease Control and Prevention

Ryan M. Wallace, US Centers for Disease Control and Prevention

Most people in the United States know rabies as a rare and terrifying disease, ending in almost certain death. However, it’s not usually something they think about, except when the reminder card arrives from their veterinarian that their pet needs its rabies vaccine booster. Even then, they probably are not considering how important that shot is to not only keep their pet safe, but also as a barrier from exposure to rabid wildlife. In addition, that single shot is a critical tool in an international battle to prevent the tens of thousands of human deaths from this disease every year.

I occasionally hear stories from friends and family members who worry about rabies. I once talked to a woman who didn’t give rabies a second thought until she was deployed to Senegal as part of the Peace Corps. Her biggest fear was getting bitten by a stray dog and contracting a disease she might not be able to recover from.

Or consider the young professional who told me a story about traveling abroad and getting bitten by a stray dog on a beach. He panicked and didn’t know if that bite was his death sentence. Thanks to decades of public health interventions, canine rabies has been eliminated in the United States. However, what most people do not realize is that approximately three quarters of the world’s population currently lives in a country where rabies is an ever-present threat.

As the Veterinary Medical Officer for the CDC Rabies team, I’ve seen the toll rabies has taken on families around the world. In Taiwan, I had the difficult task of assessing a young puppy that was attacked by a wild ferret badger during a rabies outbreak. While there were no visible wounds, we could not rule out that the puppy had been exposed to rabies. The unfortunate recommendation was to either euthanize the puppy or quarantine it for six months. The family was poor, subsiding on a small farming plot; the cost for quarantine was seemingly out of reach. Yet the family scraped together the funds and paid for the quarantine. Unfortunately, four weeks later the puppy developed signs of rabies and was euthanized. The compassion this family showed for their puppy was amazing, but in the absence of qualified rabies control officials, the consequences could have been dire if the dog had remained at home.

CDC Veterinary Epidemiologist, Ryan Wallace, trains veterinarians at a spay/neuter clinic in Ethiopia. In many parts of the world standard veterinary services, an integral component of rabies control, are not present. CDC is collaborating with the Ethiopian government, Gondar University, and Ohio State University to help improve veterinary infrastructure to keep animals healthier, and prevent rabies.

CDC Veterinary Epidemiologist, Ryan Wallace, trains veterinarians at a spay/neuter clinic in Ethiopia. In many parts of the world standard veterinary services, an integral component of rabies control, are not present. CDC is collaborating with the Ethiopian government, Gondar University, and Ohio State University to help improve veterinary infrastructure to keep animals healthier, and prevent rabies.
Photo by Ally Sterman, OC Hubert Fellow, Ohio State University School of Veterinary Medicine

Earlier this year I was in Haiti helping the local government train veterinary staff on humane euthanasia of suspected rabid animals. During the training, a veterinarian received a call from a young man who was bitten by his dog. Like many dogs in Haiti, this family pet was allowed to roam freely around the community. Three months prior to the call, the pet came home with a bite wound to his back leg. The family thought nothing of it; dog fights are common, especially among young male dogs in the neighborhood. It was now three months later and the dog was in a full rage. When the young man opened his door on this particular morning his dog lunged at him, leaving two deep bite wounds in his hand. The family was trapped inside their house for several hours until we arrived to safely euthanize the animal. Even though this animal was obviously ill, and had bitten two people, the family was still distraught by the thought of losing their beloved pet.

In Ethiopia, while assisting with a rabies vaccination clinic for dogs, we saw that people had walked for hours to get their dogs vaccinated. In particular, two boys waited more than six hours to have their dogs protected from this deadly disease. In all of the places I have traveled, I have witnessed the same truth: the human-animal bond is deep and universal, but dog-transmitted rabies is a far too familiar story for those of us who work in this field.

So what is rabies? To people in the United States, it may be something that is rarely considered. To most of the world, it is likely something they have intimately experienced. In the public health world, rabies is defined as a neglected tropical disease (NTD). Why is this? How does it happen? Some NTDs don’t cause enough deaths to be a priority to many. Some NTDs are found only in poor parts of the world, where other public health issues take priority. Some NTDs, for various reasons, do not attract international attention. Those of us working on preventing NTDs often spend more time advocating for elimination of the disease than we do actually fighting it.

What is often frustrating for those of us who are passionate about preventing NTDs like rabies is that, unlike many NTDs, rabies is vaccine-preventable. In fact, there are over 20 different approved rabies vaccines for more than six animal species (and people too!). In addition to those vaccines, there are also step-by-step recommendations developed by world experts that have been proven, when followed, to successfully eliminate canine rabies. Yet despite the existence of effective vaccines and proven successful interventions, more than 55,000 people die each year from an easily preventable disease. 95% of these deaths can be attributed to a bite from a rabid dog. All of these deaths at the jaws of rabid dogs, even though in most parts of the world it costs less than one U.S. dollar to protect a dog against rabies.

World Rabies Day was created in 2007 as a way to raise awareness for this NTD. As a veterinarian working in the public health field, I cannot imagine a more rewarding NTD to fight against and advocate for prevention. I am fortunate enough to have the opportunity to travel the world, not only to save human lives, but also to advocate for healthier, happier animals. In my travels, I am reminded of how important and loved animals are to the families with whom they share homes.

So this Word Rabies Day please take a moment to thank all of the hard-working people who spend every day to prevent you and your pets from catching this fatal disease. Thank your veterinarian for keeping your pets healthy. Thank your local animal control officer, who just tussled with that rabid fox in your backyard. Thank that doctor who reminded you to get those rabies shots before your vacation to any one of the 150 rabies-endemic countries. Hug your dogs if they are vaccinated, and get them vaccinated if they are not! (Then hug them.)

Finally, in honor of World Rabies Day, I’d like to highlight some of the many great stories about how the rabies work of CDC and our collaborators impacts the lives of families around the world:


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