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CDC collaborations succeed at protecting against infectious disease threats
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Two projects testing health security in Uganda and Vietnam have made rapid progress at protecting these countries, as well as the United States and the rest of the world, against infectious disease threats, according to the CDC.
According to CDC Director Thomas Frieden, MD, MPH, there have been three important trends recently that put the world at greater risk for infectious disease spread: new and re-emerging pathogens such as influenza A(H7N9) and plague; drug-resistant organisms such as drug-resistant tuberculosis and carbapenem-resistant Enterobacteriaceae; and intentionally created bioweapons.
Thomas Frieden
“Mass gatherings like the Winter Olympics and the Lunar New Year bring millions of people together across long distances and are other examples of why it is so important to stop outbreaks before they occur and spread,” Frieden said during a media briefing. “We are all connected by the food we eat, the air we breathe and the water we drink. Therefore, a threat to health anywhere is a threat to health everywhere.”
In MMWR this week, the CDC reported on models of health security that were implemented in Uganda and Vietnam with collaboration between the CDC and the ministries of health of those countries. The purpose of the models included several core items: modernize diagnostic testing for high-risk pathogens; develop real-time information systems to track outbreaks faster; and improve emergency operations procedures to respond to urgent situations faster and more effectively.
In Uganda, three priority pathogens were chosen because of their likelihood to contribute to public health emergencies: multidrug-resistant (and extensively drug-resistant) Mycobacterium TB, Vibrio cholera and Ebola virus. The project resulted in an outbreak response system that utilized text messages to report suspected illnesses and enhancing an existing specimen transport system supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR). Other accomplishments include strengthening laboratory management, establishing an emergency operations center and evaluating the enhancements during an outbreak exercise.
In Vietnam, there was a similar project, in which the country established an emergency operations center, improved the nationwide laboratory system and created an emergency response information systems platform with real-time reporting capability.
Frieden said these projects were in response to the 2005 WHO International Health Regulations requiring all countries to identify, report, stop and prevent infectious disease spread by 2012. Only one in five countries self-reported that it has met that level of preparedness.
“These reports outline very encouraging progress in Uganda and Vietnam in making those countries, and therefore neighboring countries and the rest of the world, safer from infectious disease threats,” Frieden said. “Keeping the world safe from infectious disease threats is achieved by preventing, detecting and responding to outbreaks as thoroughly and effectively as possible. What we need to do in the coming years is to build on these experiences so that countries have more stable, productive and vibrant societies that are protected from infectious disease threats.”
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Perspective
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Stephen S. Morse, MD
The International Health Regulations (IHR 2005) were a major change and WHO decided it should be used as a platform for surveillance for infectious diseases: both ones that we already knew and had been especially concerned about and, perhaps more worrisome, new ones that we don’t. The purpose is to get as early warning as possible so we can act appropriately. We have never successfully predicted an emerging infection or pandemic before it came into the human population. The IHR of 2005 tasked every country with strengthening its surveillance capabilities and thinking more broadly in terms of diseases that might be of international concern. This is necessary because we’re living in a highly globalized world where these emerging infections result from a variety of changes, such as land use, agriculture, urbanization, extractive industries such as timber harvesting or mining and movement of people and goods. When people get a local disease of a species they had not been in contact with before, and then they move to the city, other people can be exposed. A prime example of this is SARS, which started in south China, where it had been smoldering for a while, then spread to Hong Kong. And of course, Hong Kong is a major hub, which allowed SARS to spread throughout almost the entire world. So the whole world really is interdependent and I think it’s essential to understand that you're no stronger than the weakest links. This is a global situation in which a country may be limited in its resources but may nevertheless be highly susceptible to the introduction of an infectious disease or to the dissemination of it. We’re all in this together. Every country has a stake in this, but not every country has equal resources. It was a very good thing that CDC made an effort to demonstrate some ways that this could be done. These demonstrations were very specific and successful.
The CDC also mentions other efforts. USAID, our foreign aid agency, has risen to the occasion in this respect. For example, the PREDICT project was designed to be able to find out what’s in the zoonotic reservoir, the animals, often mammals, that carry most of future infections that are going to come into the human population. Most of these already exist they just haven’t had the chance to “experience” humans. Those that can infect people have much better chances now with population movement and globalization. The idea of the PREDICT program is to find out more about what’s out there and try to get a better understanding of what the future threats are. Every expert group in the area has called for the need for more global surveillance and early warning. Having said that, early warning is only as good as what you do with that information. If you don’t act on it, which unfortunately happened with HIV over and over in many countries, it becomes a political issue that requires political will. That’s a part we sometimes, as scientists, forget about. Nevertheless everyone has called for early surveillance for years and we actually may have better tools for it now. We have better molecular diagnostics for identifying microbes we weren’t able to identify before because they were unknown. We also now have communication mechanisms that make it possible to communicate this information even in remote places.
The other situations, however are very much still the same. The political limitations, resource limitations, and increased globalizations give some advantage to the microbes. We’ve come a long way and I think these CDC demonstrations are a very good way of beginning to encourage people to think about how they might handle what seems to be an almost impossible task.
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