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Our Global Voices Posts

Safe Water Saves Lives- How We Can Combat Cholera

Posted on by Andrea Martinsen

CDC public health engineer Andrea Martinsen works on the Global WASH team within the Division of Global Health Protection (DGHP), where she responds to international disasters, disease outbreaks, and humanitarian crises that threatened the supply and provision of safe drinking water.


In September 2018, an outbreak of cholera was declared when 25 patients were first admitted to the Beatrice Road Infectious Disease Hospital in Harare, Zimbawbe. Cholera is a highly infectious disease, which can be spread through food or by drinking water contaminated with feces from an infected person. Like many other waterborne diseases, cholera is best prevented by properly treating and chlorinating water, adopting healthy hygiene behaviors such as handwashing, and safely disposing of fecal matter.

I, along with two other colleagues from DGHP, traveled to Harare to address the major water challenges contributing to this outbreak as one component of the CDC cholera response team. The City of Harare’s municipal water system faced many challenges, including aging infrastructure, insufficient water supply, and inconsistent free residual chlorine (FRC) levels.  Most importantly, free residual chlorine levels were too low, meaning the water wasn’t chlorinated to the recommended levels and not safe to drink.

First, CDC, along with the City of Harare Environmental Health Department and UNICEF, began a municipal tap surveillance system to document water quality. As a part of the system, several water taps around the city were sampled to document water availability, free residual chlorine levels, pH, and turbidity, or the amount of dirt or other small particles in the water. Booster chlorination was priotized in highly-affected areas as a result.

Second, with funding provided by DGHP’s inter-agency agreement with the U.S. Office of Foreign Disaster Assistance, we conducted an evaluation of in-line chlorinators at hand pumps. As a result of the insufficient quanity of water from the municipal water system, many people in Harare were using other water sources, such as boreholes with hand pumps. These wells are not regulated and may contain water contaminated with cholera or other pathogens, if not drilled correctly.  The installation of in-line chlorinators provides chlorination at the point of collection of water, ensuring it is treated and safe to drink. It also protects from secondary contamination within the household. However, when we set out to evaluate the chlorinators in June of 2019, only 33% of water points sampled had detectable free residual chlorine levels. Additionally, only 14% of these points with detectable FRC had levels greater than 0.5 mg/L, the level recommended by the World Health Organization during a cholera outbreak. This means the majority of Harare’s citizens were drinking unsafe water. Increasing the amount of water points with detectable and safe levels of FRC was critical to controlling the outbreak.

To improve chlorination of drinking water during a cholera outbreak, monitoring at all levels, whether it is the municipal water system or at the point of water collection at hand pumps, is critical to ensure that we meet WHO recommended levels and guarantee safety of all people.

Through strengthening capacity and responding to waterborne disease outbreaks, we at CDC work in partnership to ensure everyone has access to clean and safe water. Whether you call it mvura, amanzi, or agua—water is essential to a safe and healthy life.

Posted on by Andrea MartinsenLeave a comment

Ending the HIV/AIDS Epidemic: Community by Community

Prevention of Mother To Child Transmission Turns Around A Widow’s Life

The Centers for Disease Control and Prevention (CDC), a lead agency in the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), works every day with partners to accelerate HIV epidemic control efforts. Communities play a vital role in controlling and ultimately ending the epidemic. A key part of CDC’s efforts in Tanzania includes working with Read More >

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CDC Responders talk about their experiences in Rwanda

Travelers get their temperature checked while crossing the DRC border into Rwanda.

Serving in Rwanda as an Assistant Ebola Coordinator CDC epidemiologist Shayne Gallaway served as Assistant Ebola Coordinator during multiple deployments to Rwanda for the 2018 Eastern DRC Ebola Response. Gallaway and team provided technical assistance to the Ministry of Health to prevent, detect, and respond to viral hemorrhagic fevers, including Ebola. He is a Lieutenant Read More >

Posted on by Shayne Gallaway / Dr. Kristie E. N. Clarke / Dr. Samira Sami / Todd Lucas, MD, MPHLeave a commentTags , ,

World Day of Remembrance for Road Traffic Victims

World Day Remembrance for Road traffic victims

  The World Day of Remembrance for Road Traffic Victims takes place every third Sunday in November. It serves as a way to: Remember the millions of people killed and injured in road traffic crashes, and recognize their families, friends, and communities; Pay tribute to the dedicated emergency responders, police, and medical professionals who deal with Read More >

Posted on by Erin K. Sauber-Schatz, PhD, MPHLeave a commentTags , ,

We can finish the job of Polio Eradication but, it will not be easy.

afghanistan polio vaccination immunization campaign

This year, 2019, has been a challenging one for polio eradication.  Though we have made incredible gains in recent years, the polio program has faced two critical challenges. First, an increase in wild poliovirus (WPV) cases in Pakistan and Afghanistan, the only two countries with detected WPV cases since 2016. And second, a large increase Read More >

Posted on by Dr. John Vertefeuille Branch Chief, Polio Eradication Branch, Global Immunization Division, Center for Global Heath, Centers for Disease Control and PreventionLeave a commentTags , , ,

The Face of Dengue

Colorful bed nets

By mid-July 2019, more than 28,000 cases of dengue had been reported in Honduras with a total of 178 deaths. This outbreak is the biggest recorded in recent history. The total number of deaths in a seven-month period, marks this outbreak as having the highest death rate than any other in Honduras. It had been Read More >

Posted on by Beatriz LopezLeave a commentTags , ,

Strengthening the Heart of a Community in Thailand

Sampaow discusses her blood pressure reading with Monsasiporn and describes challenges she has been facing with self-monitoring. Photo credit: Henry Vandi

Henry Vandi is a CDC Foundation field employee in the Division of Global Health Protection in CDC’s Center for Global Health As we approached a house surrounded by lush, tropical vegetation, a petite but muscular woman with a warm smile greeted us on the porch. “Hello! I’ve been waiting for you!” Sampaow said cheerfully, wrapping Read More >

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A life-long career dedicated to protecting people against mosquito borne diseases

Dr. Bill Brogdon (center) along with USN CAPT (retired) David Hoel and National Malaria Control Program staff at PMI Entomology Training in Uganda, 2015

Many people don’t choose a career path until after college, or even after a few years of working in a particular field. But then, many are not like my former colleague, Dr. William (Bill) Brogdon. Bill first entered the doors of the Centers for Disease Control and Prevention as a 17-year-old high school student and Read More >

Posted on by Audrey Lenhart, Research EntomologistLeave a commentTags , , , ,

Controlling hepatitis B in Sierra Leone

Lisa Breakwell

The leading cause of liver cancer worldwide is hepatitis B virus (HBV). Sierra Leone is thought to have a high percentage, at least 8%, of the population actively infected with HBV. Some studies report that in Sierra Leone, 6% to 11% of pregnant women have active HBV infection, which they can transmit to their babies Read More >

Posted on by Lucy Breakwell, GIDLeave a commentTags ,

Three Responders talk about their experiences in Uganda

Protecting Uganda’s Border Vance Brown, Ebola Coordinator and Deputy Director for the Division of Global Health Protection Program in Uganda. Vance and team provide technical support to the Government of Uganda to prevent, detect and respond to especially dangerous pathogens, including Ebola. “It was 8:00 p.m. on a Friday when I got the call. CDC Read More >

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