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The High Stakes in Fighting Ebola: Leave One Burning Ember and the Epidemic Could Re-Ignite

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


This blog was originally posted on the Huffington Post on August 7, 2014.


A banner encouraging people suffering from Ebola to go immediately to a health center for treatment is seen on a sidewalk in the city of Freetown, Sierra Leone, Thursday, Aug. 7, 2014. While the Ebola virus outbreak has now reached four countries, Liberia and Sierra Leone account for more than 60 percent of the deaths, according to the World Health Organization. The outbreak that emerged in March has claimed at least 932 lives. (AP Photo/Michael Duff)

(AP Photo/Michael Duff)

CDC and our partners are currently fighting the biggest and most complex outbreak of Ebola virus disease ever recorded.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

There are hundreds of cases in West Africa and now a new cluster of cases in Nigeria is very concerning. The spread of Ebola shows what happens if we don’t have meticulous infection control, contact tracing, and proper isolation of those with symptoms of the disease.

There are two things that are very important to understand about how Ebola spreads.

The evidence suggests that Ebola only spreads from sick people—not from people who have been exposed to the disease but haven’t yet become sick from it. The illness has an average 8-10 day incubation period, although in rare instances the incubation period may be as short as two days or as long as 21 days, which is why we recommend monitoring for 21 days after any potential exposure.

People are not contagious during that incubation period; they become contagious only when they start having symptoms.

Second, the evidence shows that Ebola outbreaks aren’t propagated by casual contact or through the air or in water.

Ebola is transmitted through direct contact with body fluids of an infected, symptomatic sick person, or exposure to objects such as needles that have been contaminated.

This is a disease that has been hard to stop in Africa, but if it were to show up here, we can stop in the United States.

Ebola virus disease spreads in Africa through inadequate infection control in hospitals as well as through traditional burial ceremonies that directly expose people to body fluids. We can avoid those problems here.

The standard, rigorous infection control procedures used in hospitals in the United States will prevent spread of Ebola.

The problem isn’t that Ebola is highly infectious—it’s not.

It’s that the stakes are so high.

So the key to contain the virus is to have meticulous, rigorous procedures in place to ensure adherence to scrupulous infection control.

Ebola in West AfricaIn the past decade, the United States has had five imported cases of hemorrhagic fevers—one of Marburg and four of Lassa, both viruses that are similar to Ebola. Each time, the American public health system identified the cases and through scrupulous infection control procedures prevented any one else from becoming ill.

The best way to protect Americans is to stop the outbreak in West Africa.

We know how to control Ebola. Previous outbreaks of Ebola virus disease have been contained by patient isolation, rigorous use of infection control measures in hospitals, intensive and thorough contact tracing in affected communities, and community education.

CDC, the World Health Organization, and our partners are committing to deliver a surge of resources and expertise to help end this outbreak. Far too many lives have been lost already. We have a difficult road ahead, which will take many months, but we must redouble our efforts to bring this terrible outbreak under control.

CDC is sending at least 50 public health staff to West Africa in the next few weeks. These staff members include epidemiologists, data managers, health educators, and other specialists who can assist with efforts to control the outbreak.

We have stopped every previous outbreak of Ebola in Africa, and CDC is ready to help the World Health Organization stop this one, too.

As part of the Global Health Security Agenda, a partnership of the U. S. government, WHO and other multilateral organizations and non-government actors, the President’s FY 2015 budget includes $45 million for CDC to accelerate progress in detection, prevention, and response and potentially reduce some of the direct and indirect costs of infectious diseases. Improving these capabilities for each nation improves health security for all nations.

It’s like fighting a forest fire.

Leave behind one burning ember and the epidemic could re-ignite.

That ember could be one case undetected, one contact not traced or health care worker not effectively protected, or burial ceremony conducted unsafely.

Our efforts will not only stop these outbreaks, but we are working to leave behind stronger laboratories, emergency operations centers, and trained public health staff who can prevent, detect, and stop future outbreaks of Ebola and other diseases before they spread.

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World Cup serving as real-world test for new disease detection technology

Categories: global disease detection, global health security, health systems strengthening, infectious disease


World Cup soccer ball


With the World Cup underway in all its frenzied glory, you can be forgiven for missing another major effort currently underway in Brazil that represents the first large scale, real-life, real-world test of important new technology.

And no, it’s not the goal-line technology that’s being used for the first time at soccer’s biggest competition.

This technology uses computer tablets, sophisticated software designed by CDC and public health experts from Brazil’s Ministry of Health (MOH) trained in the Field Epidemiological Training Program (FETP) to provide the most complete, detailed and timely information about disease threats and other public health concerns.

The Value of CDC’s Work in Thailand

Categories: global disease detection, global health security, health systems strengthening, HIV/AIDS, infectious disease, noncommunicable diseases (NCDs), refugee health, tuberculosis (TB), violence and injury


Thai monk


When I became country director in 2013 the relationships between Thailand’s public health officials and CDC were already strong and well established.

Mitch Wolfe, MD MPH, Director, CDC-Thailand

Mitch Wolfe, MD MPH, Director, CDC-Thailand

That wasn’t surprising. CDC’s collaboration with the Ministry of Public Health, after all, began 30 years ago and the partnership has been prospering  – and expanding – ever since. And there is a strong history between the two countries – this year Thailand and the US are celebrating 180 years of Friendship.

The reasons are well established too. And numerous.

Last summer, while visiting family, I was asked by a U.S. border guard, “Why is America working abroad for public health?” I was happy to get this question, as it was an opportunity to deepen understanding for why CDC works abroad – to protect Americans from health threats, to build important relationships with strategic partners, and to learn lessons that can be expanded to other parts of the world.

Kenya’s progress towards sustainable health

Categories: global disease detection, HIV/AIDS, tuberculosis (TB)


Dr. Tom KenyonRecent events in Nairobi have understandably focused the world on security challenges in Kenya. In that context it is important to recognize inspiring public health advances that represent innovative collaboration between CDC and our Kenyan partners to increase health security for Kenya and the global community. I made a two-day trip to visit our CDC-Kenya programs – a quick stop before commissioning the new CDC Global Disease Detection Center in Dhaka, Bangladesh. While I have previously worked as CDC Country Director in Ethiopia and had a general idea of what to expect, visiting Kenya reminded me that each of our CDC country offices has developed unique programs and solutions to address public health issues affecting local populations.

Uganda Makes Impressive Progress on Health

Categories: global disease detection, global health security, health systems strengthening, HIV/AIDS, mosquito-borne disease, women's/maternal health


This blog was originally posted in the Huffington Post on August 8, 2013.


CDC Director Dr. Tom Frieden peers into Python Cave.

CDC Director Dr. Tom Frieden peers into Python Cave.

Last month I was in Uganda. As I planned for this trip, I wasn’t sure what to expect. Uganda is the only country served by the president’s Emergency Plan for AIDS Relief (PEPFAR) with a rising HIV incidence; I anticipated that there might be problems.

CDC Director Dr. Tom Frieden

CDC Director Dr. Tom Frieden

What I saw instead was impressive progress.

Although Uganda will have challenges for many years as a result of increased HIV infections over the past decade, and has much more to do, I was struck by how much headway they’ve made in the past couple of years. The country has scaled up lifesaving anti-HIV treatment as well as voluntary medical male circumcisions, which sharply reduce the chance of becoming infected.

While in Uganda, I got to peer into a cave — the same cave where two tourists got Marburg virus in 2007. This deadly virus, similar to Ebola, was unknown in this location until identified by CDC staff.

This is Python Cave — and I was awed to see the python, which is at least 12 feet long and 24

Community Survey for Nodding Syndrome in Northern Uganda – CDC an Unfailing Hope

Categories: global disease detection

James Sejvar advises the healthcare workers on a completed NS questionnaire

James Sejvar advises the healthcare workers on a completed NS questionnaire

On a hot afternoon under the shade of a drought-ridden tree, fourteen year old Ojok Daniel (name changed) suddenly stopped eating. Ojok began staring into the distance and his head started to nod every 8-10 seconds. This episode lasted for about 5 minutes. Unfortunately, this is neither the first nor the last occurrence for Ojak. Described as Nodding Syndrome, a form of atypical seizures, Ojok is one among the many children in his village who are afflicted with this disease. Health officials have seen Nodding Syndrome in geographically defined regions of northern Uganda, South Sudan and Tanzania.  The descriptions of the syndrome include head nodding that gets worse over time and is sparked by exposure to cold weather and familiar food, with additional cognitive and neurological dysfunction over time.

Sudhir Bunga, MD, MBBS, Analyst for Global Disease Detection Operations Center

Sudhir Bunga, MD, MBBS, Analyst for Global Disease Detection Operations Center

The road from Kampala to Kitgum District is scenic, with the quietly streaming Nile River providing a light background noise along parts of the journey. However, very abruptly the drive became rough as our vehicle careened onto a dirt road, the only indication of its existence being tire tracks of an earlier vehicle. This served as our welcome to the epicenter of Nodding Syndrome in Uganda. Northern Uganda in February and March still manages to reach anywhere from 85 to 95 degrees Fahrenheit which, coupled with torrential rains and strong winds, made my two week trip anything but easy. The U.S. Government's Official Web PortalDepartment of Health and Human Services
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