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2014: A pivotal year for the HIV response in Malawi

Categories: HIV/AIDS, Malawi

How we refined and refocused programs using a data-driven approach

Beth A. Tippett Barr, DrPH Chief of Health Services, CDC Malawi

Beth A. Tippett Barr, DrPH Chief of Health Services, CDC Malawi

The appointment of Dr. Deborah Birx as the new Global AIDS Coordinator in May 2014 heralded an enormous change in the PEPFAR world:  Within the span of a few weeks, the focus changed from the newly-cemented PEPFAR vocabulary around ‘sustainability’ and ‘country ownership’ to language more targeted at maximizing resources for ‘epidemic control’.  As Dr. Birx said at the PEPFAR Annual meeting in Durban in June 2014, “We cannot sustain an uncontrolled epidemic”.  Although there has been enormous success in globally scaling up access to HIV testing and counseling (HTC) and anti-retroviral therapy (ART), the point Dr. Birx has continually reiterated in her six months in office, is that we need to find those places and populations in which the epidemic is least-controlled and respond accordingly.

To successfully do this, data is required:  Data on locating those who have never been tested and those at highest risk of acquiring HIV, and data that identifies which programs work best at reducing new infections and caring for those already infected.  The wide variation in new and existing HIV infections between urban and rural, male and female, and between age groups has long been established;  however, the use of this and other data to maximize the entire spectrum of our HIV prevention, care and treatment interventions in a coordinated effort to control the epidemic, has not been maximized.  With this challenge ringing in our ears, and a mandate from the Office of the U.S. Global AIDS Coordinator (OGAC) to revise our 2014 annual plan (COP), CDC and the other US Government (USG) agencies utilizing PEPFAR funding in Malawi, sat down to plan how to better work with the Ministry of Health and gain control over the HIV epidemic. As a result of these meetings, the following has been endorsed or adopted.

Malawi has recently endorsed the UNAIDS ‘90-90-90’ goals for 2030, which include:

  • 90% of People Living with HIV (PLHIV) are tested and know their status
  • 90% of known PLHIV are initiated on Anti-retroviral Therapy (ART)
  • 90% of ART patients are retained in care at one year

To reach these ambitious goals we will actively pursue progress by matching the appropriate amount of funding with similar outputs of effort, targeted to the right places and the right populations.  The first 90% is the gateway to the subsequent 90’s for the 2030 goals; if we don’t find those already living with HIV, we won’t be able to start them on treatment or keep them in care.  To find 90% of people living with HIV (PLHIV), we have to know where to look, and although our national survey data isn’t current, there is enough available information to rethink our overall strategy.  Of immediate importance is ensuring we get the highest ‘yield’ for HIV Testing and Counseling (HTC); the highest likelihood of identifying an HIV-positive individual with every test used.  This is a recent departure from the last few years in which HTC had become a way to identify those who were negative and provide counseling on staying HIV-negative.  Fortunately, thinking has now come full circle, and the role of HIV testing is rapidly regaining its priority as the most important gateway to treatment, survival and epidemic control.  This has had the immediate effect of highlighting the importance of testing in health facilities, particularly in settings where HIV prevalence may be higher than the national average, including STI clinics, TB clinics and in-patient wards.

HIV prevention in the new millennium

The emphasis on reaching the 90-90-90 targets mandates that the targeted behaviors for change be HIV testing, accepting treatment, taking one’s medication, and keeping appointments.  Should these behavior change and treatment agendas truly align to support each other, the 90’s can be achieved in Malawi.  If this happened, then 73% of the approximately one million PLHIV would lower the amount of HIV in their blood so they essentially do not transmit the virus, reducing new infections nationally to 0.2 per 100 individuals per year.  This is a staggering 78,000 adult infections and 75,000 pediatric infections prevented in the next five years, a massive impact on HIV prevention in Malawi, the likes of which has never been seen before.


Reviewing our data from a new perspective

Districts in Malawi are made up of anywhere from 100,000 to 1,000,000 people, and HIV prevalence in antenatal (prenatal) clinics within a district can vary from 0.2% to 33%.  When reviewing variation in HIV prevalence in the Demographic and Health Survey (DHS) 2010 at the cluster level, it rapidly became clear that the epidemic needs a targeted response at the lowest possible geographic unit, certainly well below the typical approach of district level.  All health facilities in Malawi are assigned ‘catchment areas’, an uneven radius around each facility which provides an approximation for the population each health center is responsible for serving.  Because the entire population of the country can also be divided into these catchment areas, and because HIV service delivery data is available at the facility level and provides a proxy measure for community coverage, the use of facility and catchment areas to define our refocused response was the most appropriate choice for geographic refining of our programs.


Refining site-level focus

While funding cannot provide support to every ART site in Malawi, our data shows intensive HIV program support isn’t needed in every facility.  This has enabled us to rethink how every dollar invested in HIV can produce maximum impact.  Several measures for the prioritization of health facilities were considered, and after discussing the pros and cons of each measure with the Ministry of Health Department of HIV and AIDS, we utilized a combination of measures to identify those health facility catchment areas which altogether would provide 90% population coverage based on three priority criteria:

  1. Number of current ART patients of treatment
  2. Expected number of HIV-positive pregnancies registering at the ANC clinic
  3. Number of PLHIV in the health facility catchment area

The last measure was important, as it gives us an estimated program need outside of documented facility services.  In each of the measures, we sorted the health facilities in the country in order of size from largest to smallest, and identified which sites would enable us to reach 90% of the population.  We then displayed the results visually, via Venn diagram, to show the overlap between the criteria and the health centers.  venn_diagramMalawi_HIV

We found that we could reach 90% of the HIV-positive population by prioritizing support to 50% of the health facilities in the country. The majority of health centers which were to become ‘priority sites’ met two or more criteria, but 99 sites met only one of the three criteria, which emphasizes the importance of knowing priorities when targeting programs for impact.



We now have at hand all of the tools we need to fight the HIV epidemic – and win.  We have the program science, the ARVs, trained staff in the health centers, the experience at national, district and site levels, and organizations to support the program in every district in Malawi.  And now, we have the data.  We’ve mapped out the country’s population, reduced the programs at every site to numbers, and we have a logical approach to moving forward.  We have the ability to now intensively target our response within each facility, addressing challenges systematically, and monitoring results.  The data is complex and the road ahead still difficult, but for the first time in more than three decades, a clear end to the HIV epidemic is in sight.



A Life Dedicated to Public Health Service

Categories: HIV/AIDS, infectious disease

Ellen Wan, Division of Healthcare Quality Promotion

Ellen Wan, Division of Healthcare Quality Promotion

In January 2010, Diane Caves was on a 3-week assignment from CDC to improve HIV/AIDS programs in Haiti when the massive 7.0 earthquake struck, killing her and 230,000 others on the island. She was 31 years old and the only CDC employee to die in the tragedy. Diane’s reasons for going to Haiti were typical of her deep commitment to helping others. Her sharp intellect, optimism, adventurous spirit, and infectious smile touched all who met her. I count myself lucky to have been her colleague and friend, and her spirit continues to influence my approach to life and work.


Diane Caves and friend in Haiti before the earthquake. Ellen Wan (Division of Healthcare Quality Promotion) and Diane Caves were colleagues in the Office of Public Health Preparedness and Response.

Diane Caves and friend in Haiti before the earthquake. Ellen Wan (Division of Healthcare Quality Promotion) and Diane Caves were colleagues in the Office of Public Health Preparedness and Response.

Diane left an enduring legacy of public health service for CDC and the community at large. Shortly after her passing, CDC established an award in Diane’s honor to recognize early career CDC employees who inspire others in the public health community through collaboration, resourcefulness, and perseverance. Rice University, Diane’s alma mater, supports undergraduate scholarships in her memory, and Georgia State University’s School of Public Health, where Diane was completing her second master’s degree, established an award to recognize students who best exemplify her selflessness and dedication to public health.

Today, I know Diane would be right there working alongside the many CDC staff who risk their personal safety and well-being to create healthier and safer communities throughout the world, from the ongoing CDC Ebola response in West Africa to public health efforts closer to home. Through their own dedication to public health service, CDC staff honor Diane’s memory and continue her legacy every day.

Fulfilling the Decade of Vaccines Vision

Categories: Ebola, HIV/AIDS, immunization, infectious disease, malaria

Dr Rebecca MartinAs 2014 draws to a close, one theme that has been continuously present is the importance of a strong public health infrastructure in a country to effectively protect against vaccine-preventable diseases (VPDs).  Universal access to immunization is the Decade of Vaccines vision, and in order to achieve this, more efforts are needed to build upon the existing infrastructure developed for immunization programmes and other health interventions, such as for HIV prevention and treatment and malaria control and elimination.  With the importation of Ebola virus disease into Nigeria, we saw the country use its Emergency Operations Centre built to support polio eradication to quickly respond to the outbreak supporting case investigation, contact tracing, and bringing government together with national and international partners to stop the outbreak.  The infrastructure built in Uganda to collect samples from individuals at the community level for HIV testing and get them to a laboratory for testing in minimal time, can be used to quickly identify cases of epidemic-prone VPDs.  We should continue to build upon and use the experiences to save more lives and achieve global goals that have been delayed.  The coming year, 2015, marks the halfway point of the Decade of Vaccines—let us use this moment to accelerate efforts by ensuring the public health infrastructure is there to reach every individual with lifesaving vaccines.


A Day in Liberia — John Logan Town

Categories: Ebola

On the trip back from John Logan Town, we were stopped for nearly two hours while a new bridge was built.  I was observing the construction since this was really a once in a lifetime opportunity.

On the trip back from John Logan Town, we were stopped for nearly two hours while a new bridge was built. I was observing the construction since this was really a once in a lifetime opportunity.

Justin Williams, Health Communications Specialist, Division of Global Health Protection

Justin Williams, Health Communications Specialist, Division of Global Health Protection

I am not a morning person. In a typical week, it takes a long shower and a cup or two of coffee before I hit my stride. This was not the case for me on October 30th. I sprung out of bed at 5:00am and was ready to start the day’s mission. We were heading to John Logan Town in Grand Bassa County, Liberia to investigate if there was active transmission of Ebola. John Logan Town, which is not directly accessible by road, is home to 20,000 people. It is locally called the “City in the Jungle”.

I was in Liberia as part of the health promotion team to help interrupt transmission of Ebola through community engagement and education. My role was to provide training on social mobilization to volunteers in John Logan Town.

Dr. Meghan Weinberg, EIS Officer, introducing the CDC team to the residents of John Logan Town, Grand Bassa County, Liberia.  Dr. Pearce also provided a training on infection prevention and control during the visit.

Dr. Meghan Weinberg, EIS Officer, introducing the CDC team to the residents of John Logan Town, Grand Bassa County, Liberia. Dr. Pearce also provided a training on infection prevention and control during the visit.

We got on the road by 5:30 am and met with our colleagues from the Liberian Ministry of Health, the World Health Organization (WHO), the UN Children’s Fund (UNICEF), Concern Worldwide, Global Communities and Ehealth Africa. We were a multi-disciplinary team organized to handle the key areas of the Ebola response including case identification, contact tracing, infection prevention and control, safe burial, and of course education.

It was critical to have all elements of the team in place for the visit to John Logan Town because they had recently had a number of unexplained deaths in the community and had at least one laboratory confirmed case of Ebola in the prior weeks.

The journey to John Logan Town was an arduous one. Although the roads were wide, there were many sections of deep mud which often trapped at least one of our seven vehicles. In true team spirit, our caravan would not progress until all vehicles were freed from the mud. We crossed several handmade bridges of boards and fallen trees. We even had to ford a river to reach our final destination.

One of the vehicles in the caravan from Concern Worldwide stuck in the mud in route to John Logan Town.

One of the vehicles in the caravan from Concern Worldwide stuck in the mud in route to John Logan Town.

In John Logan Town, we did not find evidence of active Ebola cases, but we found a community thirsty for information on Ebola and how to protect themselves and their loved ones. During the 2 hour social mobilization training, we taught a group of 15 men and women, both Christian and Muslim, how to prepare their community for Ebola.

At least an additional 20 people stood and observed the training and hopefully learned more about Ebola in the process.

We discussed the signs and symptoms, ways to prevent spread of Ebola such as notifying town leadership of any sick persons, and what as social mobilizers they should accomplish by raising awareness and further educating the community.

Although there are many aspects of the response, one of the best ways to beat Ebola is to arm people with information about how they can prevent family members and health care workers from exposing themselves to Ebola. As I settled into the SUV for the rugged ride back to the hotel, I pictured the many hopeful faces who we had helped that day. And I realized that the next morning’s shower and coffee would never quite measure up to this day’s wake up call.


World AIDS Day 2014: Closer to an AIDS-Free Generation

Categories: HIV/AIDS

Shannon Hader, MD, MPH

Shannon Hader, MD, MPHDirector, CDC’s Division of Global HIV/AIDS

On December 1, people throughout the world observe World AIDS Day to raise awareness of the global impact of HIV/AIDS, to honor those affected by it, and—ever so importantly—to recommit to achieving more in the upcoming year. An estimated 35 million people are living with HIV/AIDS worldwide. The theme for World AIDS Day 2014 – “Focus, Partner, Achieve: An AIDS-Free Generation” – reflects the drive to focus on interventions proven to work and to partner with a broad range of stakeholders to achievecontrol of the HIV epidemic and, ultimately, an AIDS-free generation.

CDC plays a key role in fighting the epidemic. We provide scientific and technical support to more than 60 countries through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the largest commitment by any nation to combat a single disease. Daily, our teams are working to support Ministries of Health, community organizations, and other stakeholders to strengthen their systems to detect, manage, and respond to the epidemic; to deliver quality HIV services; and to be ready to shift as the epidemic shifts so as to ensure continued progress.


CDC activities are grounded in science and critical to saving lives and preventing new HIV infections. Core efforts include preventing mother-to-child HIV transmission, antiretroviral treatment, and voluntary medical male circumcision. We are also helping countries build and enhance the resources they need to achieve and sustain epidemic control, including accurate, reliable laboratories and a trained healthcare workforce. Innovative programs developed and led by CDC scientists are now being used by countries to collect more detailed data that allow them to target HIV treatment services to where they are needed most and to reduce the cost of delivering services. Besides reaching more people in need, these data-driven activities support greater accountability for the use of U.S. government funds.

No single entity can do it alone. We work closely with key partners such as the Global Fund to Fight AIDS, Tuberculosis and Malaria — to which the United States is the largest contributor—to ensure maximum impact for our investments.

Together, we are making great progress: AIDS-related deaths fell by 35% since the peak in 2005 to 1.5 million, and new HIV infections decreased 38% since 2001 to 2.1 million. But millions more around the globe are waiting for access to lifesaving antiretroviral drugs, including 40 percent of eligible adults and 75 percent of eligible children. We must continue to work to reach those affected by this devastating disease, including children, adolescent girls, and other neglected and hard-to-reach groups.

The United States has made an unwavering commitment to work with partner governments and other stakeholders to turn the tide on HIV/AIDS. Working together, I know we can achieve this.


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.

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