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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.

 

DSC_0523

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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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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What it’s REALLY like fighting Ebola in Liberia

Categories: Ebola, global health security, infectious disease

 

This blog was originally posted on the ONE.org on September 11, 2014.

 

A Médecins Sans Frontières/Doctors Without Borders (MSF) staff member ties the face mask of Dr. Jordan Tappero, CDC, before Dr. Tappero enters the Ebola treatment unit (ETU), ELWA 3. MSF operates the ELWA 3 ETU, which opened on August 17.

A Médecins Sans Frontières/Doctors Without Borders (MSF) staff member ties the face mask of Dr. Jordan Tappero, CDC, before Dr. Tappero enters the Ebola treatment unit (ETU), ELWA 3. MSF operates the ELWA 3 ETU, which opened on August 17.

Jordan W. Tappero, MD, MPH

Jordan W. Tappero, MD, MPH

During my time in Liberia, I have tried not to provide much detail to my family about the day-to-day work we are doing.

I don’t want to cause alarm or propagate fear; conditions in Monrovia can at times be deeply troubling.

I have spent the past month working to help control the Ebola outbreak in Liberia as part of the United States Government’s Disaster Assistance Response Team, or DART.

Our work here has been nonstop and it doesn’t appear that the end of the epidemic will be anytime soon. There are days when there is palpable tension in the air, especially when a new community experiences Ebola virus transmission for the first time, or experiences a second or third wave of disease.

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.

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.

Polio Eradication, Microplanning and GIS

Categories: child health, immunization, polio

A Bugagi child travels by camel near Lake Chad in Borno State, Nigeria. Photo courtesy of Thomas Moran/WHO.

A Bugagi child travels by camel near Lake Chad in Borno State, Nigeria. Photo courtesy of Thomas Moran/WHO.

Victoria Gammino, PhD, MPH, Epidemiologist, CDC Global Immunization Division

Victoria Gammino, PhD, MPH, Epidemiologist, CDC Global Immunization Division

Geospatial data have been used in public health since John Snow mapped cholera cases around the Broad Street water pump during the London cholera epidemic of 1854.  And, while global positioning system technologies (GPS) are so ubiquitous in the United States that virtually all new smartphones, tablets and cars have this technology embedded, in many areas of the world, health care workers in the field are often without the most basic two-dimensional paper maps.

So what do maps and map literacy have to do with polio?  Polio is a crippling and potentially fatal infectious disease. There is no cure, but there are safe and effective vaccines. Therefore, the strategy to eradicate polio is based on preventing infection by immunizing every child to stop transmission of the virus that causes polio, and ultimately make the world polio free.   The four pillars of polio eradication all rely on “microplans”— detailed logistical blueprints that guide the planning and implementation of vaccination campaigns, routine immunization outreach, and surveillance for polio cases by providing critical data on the size and location of the target population in a given geographic area.  These target population numbers determine the amount of vaccine required, the number of health care workers and supervisors to deliver the vaccine, and the cost of transportation to get the vaccine and health care workers where they need to go.

CDC Staffers Take No Refuge From Helping Refugees Around the World

Categories: infectious disease, refugee health

A child plays with a kite in a tent camp after the earthquake, Port-au-Prince, Haiti, 2010.

A child plays with a kite in a tent camp after the earthquake, Port-au-Prince, Haiti, 2010.

For anybody wondering why CDC has a branch dedicated to helping refugees or why the United Nations has formally recognized World Refugee Day every year since it was created in 2001, the answer can be found in a single, stark statistic: In 2013, a person became a new refugee or internally displaced person every 4.1 seconds.

Michelle Dynes, PhD, MPH, MSN, CNM, RN, EIS Officer/Epidemiologist, CDC Emergency Response and Recovery Branch

Michelle Dynes, PhD, MPH, MSN, CNM, RN, EIS Officer/Epidemiologist, CDC Emergency Response and Recovery Branch

Cyrus Shahpar, MD, MBA, MPH, Medical Epidemiologist, CDC Emergency Response and Recovery Branch

Cyrus Shahpar, MD, MBA, MPH, Medical Epidemiologist, CDC Emergency Response and Recovery Branch

That translates to “a population of concern” of nearly 40 million refugees or internally displaced people worldwide every year, according to the United Nations.

It also translates to a lot of illnesses and suffering. And that’s the reason Cyrus Shahpar, Michelle Dynes and approximately 50 other staff in CDC’s Emergency Response and Recovery Branch (Division of Global Health Protection) have their bags packed and are constantly ready to deploy to the field.

Communication Matters in Global Health Deployments

Categories: global health security, infectious disease

During the simulation exercise, ECN trainees deployed to the site of a mock disaster in Avully, Switzerland.

During the simulation exercise, ECN trainees deployed to the site of a mock disaster in Avully, Switzerland.

Communication matters.

Gaya Gamhewage, MD, Coordinator, WHO Communication Capacity Building Team; Founder, WHO Emergency Communication Network

Gaya Gamhewage, MD, Coordinator, WHO Communication Capacity Building Team; Founder, WHO Emergency Communication Network

That’s not a new idea. Many of us have learned this the hard way. This concept is being applied in a new, more comprehensive way for a key purpose—to help the World Health Organization (WHO) communicate more effectively, with more clarity and purpose during humanitarian and public health emergencies.

The idea is to better integrate communications specialists from WHO, CDC, ministries of health and a wide array of other humanitarian and global health organizations into a cohesive, specially trained team that can be dispatched on short notice when public health or humanitarian emergencies occur.

The logic is based on the idea that communications is part and parcel of emergency health response. Communicating in a crisis not only provides the public and policy maker clear and critical information, it also can help the technical side of the response. It connects those affected with those willing to help and can make sure that resources are aligned to the most important needs.

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