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Working Towards an Achievable Goal: A World without CRS

Categories: immunization, infectious disease, rubella

Rubella is generally a mild illness but when pregnant women become infected, there is a 90% chance of the fetus having congenital rubella syndrome (CRS). The baby can be born with multiple birth defects -- if he or she survives at all. Rubella vaccination prevents mothers from giving birth to babies with CRS and prevents life-long disability. 100,000 babies are born with CRS around the world each year.

Susan Reef, MD, Rubella Team Lead, Global Immunization Division

Susan Reef, MD, Rubella Team Lead, Global Immunization Division

When I started focusing on rubella in 1994, it was mainly recognized as a significant public health problem in high-income countries. When the public health community realized that rubella and congenital rubella syndrome (CRS) were actually significant public health issues in the entire region of the Americas, things took a turn and an elimination goal was set for 2010. In the pre-vaccine era, some 20,000 infants were born each year in the Americas region with CRS and one or more of its devastating birth defects. I look at our success in achieving the elimination goal —which occurred in 2009, a year before the target date—in terms of the lives it impacted: 20,000 of them, born free of CRS disabilities each year since then.

The Americas Region is rubella’s great success story. But unfortunately, that success isn’t always seen elsewhere; less than 55% of children live in countries with access to the rubella vaccine. In my decades of experience as a medical professional, I have seen my share of disease and the horrific impact it can have. But seeing infants with CRS has to be one of the most heartbreaking. Multiple defects, heart issues, cataracts, deafness all carry a significantly larger burden for families in low-income countries. They are often without extra resources, or access to services or facilities to help care for children born with CRS. Tiny babies starting their lives with a host of health issues that would challenge a full grown adult. Some infants even abandoned by their families because the costs and lifetime of dedication needed to care for them were too much to bear.

Between 1996 and 2014, the number of countries offering the rubella vaccine increased from 79 to 141 (73% of all countries). However, there are still 53 countries that have not yet introduced the vaccine. Most of these remaining countries are in the African and Eastern Mediterranean regions, but also in a few densely populated countries like India and Indonesia with substantial numbers of babies born with CRS each year. In an age where we have a safe and effective vaccine, 100,000 CRS babies are still born every year.

The fact that we can protect children everywhere from rubella and CRS motivates me to eliminate these viruses from the earth. Fortunately, the global health community is working hard to make this goal a reality. Over the last two years, there have been 10 countries that have introduced rubella vaccine and several more countries will be introducing rubella vaccine in 2015. It is so important to reach people with rubella vaccine when they are young, both male and female, to ensure rubella is eliminated in all regions where it is endemic. That is why conducting wide-age range vaccination campaigns are essential when introducing rubella vaccines into national immunization systems – we can protect more than one generation at a time: children and their future children.

Progress is slow and steady, but is gaining momentum thanks to the advocacy and activities of the Measles & Rubella Initiative. It is a global partnership committed to ensuring no child dies from measles or rubella, or is born with congenital rubella syndrome. As a founding member, CDC provides scientific and financial support to partners and countries to protect against rubella and CRS. Our efforts have been strengthened with significant assistance since 2013 through Gavi, the Vaccine Alliance. Since 2013, Gavi supports catch up campaigns for measles-rubella for countries self-financing the introduction of the measles-rubella vaccine in their routine immunization programmes. This means that by 2020, more than 600 million children in 49 countries between 9 months and 14 years are expected to be immunized against measles and rubella.

Even with this excellent progress, there are too many infants being born with CRS simply because of lack of access to the vaccine. As a global community, we need to prioritize getting life-saving vaccines to children in even the hardest-to-reach places. We call them “vaccine-preventable” because immunization truly does prevent these devastating diseases from spreading. By working to ensure that safe, effective vaccines reach every remaining corner of the world, we will give babies around the world a chance to live healthier lives, free from the scourge of CRS.



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.


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.


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



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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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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