Project Firstline Reaches Frontline Healthcare Workforce with Infection Control Training

The COVID-19 pandemic has highlighted long-standing gaps in infection control knowledge and understanding among the frontline healthcare workforce. Since the onset of the pandemic, healthcare-associated infections and antibiotic-resistant infections have increased, reversing national progress made before 2020.

Infectious disease threats like Ebola, COVID-19, and antibiotic resistance will continue to emerge. It’s more important than ever that we equip our nation’s healthcare workforce with the infection control knowledge they need to protect themselves, their patients, and their communities.

One year ago, this month, CDC launched Project Firstline. Project Firstline provides engaging, innovative, and effective infection control education and training for U.S. frontline healthcare workers.

Meeting the Needs of the Diverse Healthcare Workforce

Project Firstline’s innovative content is designed for all healthcare workers, regardless of their previous training or educational background. The program’s training and educational materials provide critical infection control information in a format that best meets healthcare workers’ needs.

During its first year, Project Firstline and its partners hosted more than 300 educational events on infection control and developed more than 130 educational products. The products are accessible on a variety of digital platforms, including Facebook, Twitter, and CDC and partner websites. Products currently available on the CDC Project Firstline site include:

Maximizing Impact through Partnerships

Project Firstline brings together academic, public health, and healthcare partners plus 64 state, local, and territorial health departments to provide infection control educational resources to healthcare workers nationwide.

Our partners have used a diverse range of products and activities to reach healthcare workers with tailored infection control information during the COVID-19 pandemic. Some of these activities include Twitter chats, podcasts, videos,  and virtual training events simulcast and translated into multiple languages.

Additionally, Project Firstline launched the Community College Collaborative in partnership with the American Hospital Association and the League of Innovation in the Community College. The program is integrating enhanced infection control content into the health programs of community college classrooms. The program was piloted this summer with faculty cohorts from 16 participating colleges across a range of community college settings. Faculty came together to tailor the infection control curriculum for each professional area, with a plan to phase it into their coursework. Professional areas included:

  • emergency medical services
  • respiratory care
  • nursing
  • practical nursing and nursing assistants
  • medical assisting

This effort will help ensure that the future healthcare workforce starts their careers with key infection control knowledge to protect themselves and their patients.

The Future of Project Firstline

Project Firstline aims to become the go-to resource for infection control among healthcare workers. It will focus on building a strong culture of infection control within all healthcare facilities.

Using insights learned during its first year, the program will create a new suite of readily available and easy-to-consume education materials. The new materials will be designed to help strengthen infection prevention and control capacities beyond the COVID-19 pandemic.


Thanks in advance for your questions and comments on this Public Health Matters post. Please note that CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor.

Have a question for CDC? CDC-INFO ( offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.

Healthcare Workers “Pop Up” to Help Vaccinate in IL Communities

This student-authored post is published by CPR in partnership with Medill News Service and the Northwestern University Medill School of Journalism, Media, Integrated Marketing Communications. The views and opinions expressed in this article are the author’s own and do not necessarily reflect the views, policies, or positions of CPR or CDC.

The sound of live music and the smell of fried food filled the air on a warm July evening in Moline, Illinois’ Hispanic Floreciente neighborhood. Peggy Newkirk, 73, a retired nurse practitioner, stands behind a folding table in the shade with other volunteers.

Most people crowd to Mercado on Fifth—a weekly open-air cultural fest and market—in the summer to shop, eat, and dance. But Newkirk and her fellow volunteers were there with other plans—to distribute COVID-19 vaccines. “We make it as convenient as possible so that if somebody is even considering it, you’re right there before they have a chance to change their mind,” Newkirk said.

“Pop Ups” Put Shots in Arms

The Rock Island County Health Department has held pop-up vaccine clinics at Mercado on Fifth and at community gathering places in other minority neighborhoods across Rock Island and Moline. The health department also held clinics at the Islamic Center of Quad Cities in Moline and the Second Baptist Church in Rock Island.

About 42% of the population of Rock Island County was fully vaccinated as of August 31, according to the Illinois Department of Public Health.(1) About 52% of people in the U.S. are fully vaccinated.(2)

Nationally, vaccination rates are lower on average among people from racial and ethnic minority groups, according to CDC.(3) The goal of the pop-up vaccine clinics in Rock Island County is to reach disproportionately affected communities and remove barriers to vaccination access.

The clinics were run by health department staff and Rock Island County Medical Reserve Corps volunteers. Most volunteers are retired healthcare workers like Newkirk. They’re trained to fill the gap of first responder and medical staff shortages in emergencies.

“We’re just trying to reach anyone and everyone we can,” said Kate Meyer, manager of emergency planning and response for the health department. “And we couldn’t have done all of our response without the Medical Reserve Corps.”

“Like Giving People Hope.”

Deborah Freiburg, 70, is another Medical Reserve Corps member. She retired in Rock Island after 40 years as a nurse at the Children’s National Medical Center in Washington, D.C. “Going from working such a heavy job and just all of a sudden retiring, you can’t just sit at home,” she said.

When Freiburg’s planned trip to the Galapagos fell through due to the COVID-19 pandemic, she called the health department and offered to help, first as a contract tracer, then later at the vaccine clinics.

Things were hectic at first. Freiburg remembers standing for six hours at a time in an ice-covered parking lot outside the Tax Slayer Center, the site of Rock Island County’s first mass vaccination clinics. Her job was to monitor vaccine recipients for adverse reactions.

People poured into the clinics. They came by car, bus, and on foot. The health department partnered with public transit company that serves Rock Island and Moline, to provide free bus rides to vaccine appointments. Once dropped off at a clinic parking lot, volunteers would pick up people with mobility issues in golf carts. Peggy Newkirk remembers a family of three generations that came together to get their vaccines.

One man told Freiburg he had waited in his car overnight for his shot. “It was the most exciting thing,” Freiburg said. “Because, you know, it was like giving hope to people. No matter how cold it was outside, or how long you were on your feet, everybody was just excited to be part of this part of history.”

Volunteers and staff were giving out 800 or more vaccine doses each day earlier this year, but the numbers have dropped. Still, regular clinics are set to continue indefinitely.

Hurdles of Hearts and Minds

Many factors influence vaccine decision-making, including cultural, social, and political factors; individual and group factors; and vaccine-specific factors.(3) Newkirk said some of her family members won’t get the shot, despite her best efforts to build COVID-19 vaccine confidence.

Newkirk is undeterred. Confidence in the vaccines leads to more people getting vaccinated, which leads to fewer COVID-19 illnesses, hospitalizations, and deaths. “Everybody wants to get society back to normal and the best way to do that is to get the people who aren’t vaccinated, vaccinated,” she said.





Thanks in advance for your questions and comments on this Public Health Matters post. Please note that CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor.

Have a question for CDC? CDC-INFO ( offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.

Create Co(i)mmunity. Get Vaccinated.

August is National Immunization Awareness Month, an annual observance highlighting the importance of vaccination for people of all ages.

Life has been anything but routine lately. A sometimes overlooked result of the COVID-19 pandemic is that many people have missed routine medical checkups, routine screenings, and recommended vaccinations.

Recommended vaccines

Vaccines aren’t just for children. Adults need them to avoid getting and spreading certain serious diseases that can result in missed work, medical bills, and problems taking care of others, as well as serious illness, or even death.(1)

Vaccines for adults are recommended based on different factors like a person’s age, health, lifestyle, jobs, and travel. All adults need:

  • Flu vaccine. An annual flu vaccine is recommended for everyone but is especially important for adults with certain chronic health conditions, pregnant people, and those who are 65 years and older.
  • Tdap vaccine: If they have never gotten one before, a Tdap vaccine helps protect against pertussis (whooping cough). Pregnant people should get a Tdap vaccine during each pregnancy, preferably at 27 through 36 weeks.
  • Td vaccine:(tetanus, diphtheria) or Tdap shot every 10 years.(1)
  • Pneumococcal polysaccharide vaccine (PPSV23): If they are 65 years and older or 19–64 years old and have certain health conditions or smoke cigarettes. In addition, adults 65 years and older may discuss and decide, with their clinician, to receive a pneumococcal conjugate vaccine (PCV13). Pneumococcal vaccines help protect against serious illnesses like meningitis, bloodstream infections, and pneumonia.
  • Shingles vaccine: Two doses of shingles vaccine for everyone 50 years of age and older. Your risk of shingles and complications increases as you age. Shingles vaccine provides strong protection from shingles and long-term nerve pain.
  • HPV vaccine: HPV vaccination is also recommended through age 26, if they did not get vaccinated when they were younger. For adults aged 27 years and older, talk with your doctor about HPV vaccine.
  • COVID-19 vaccine: CDC recommends vaccination for all adults and children of certain ages.(2)

Take this quiz to find out what other vaccines may be recommended for you. Then talk with your doctor to make sure you get the vaccines that are right for you. Some adults with specific health conditions should not get certain vaccines or should wait to get them.(1)

Staying up to date on vaccinations helps protect you and others in your family and community. Every year, tens of thousands of Americans get sick and some die from diseases that could be prevented by vaccines.(3)

Vaccine records

Today, people move, travel, and change healthcare providers often. This can make it hard to keep an accurate vaccination record. If you don’t have copies of your vaccination records, ask for help from:

  • Your current or previous doctor or medical provider
  • Your parents or caregivers
  • Your high school or college health services group
  • Previous employers (including the military) that may have required vaccinations
  • Your state health department to see if they can direct you to their immunization registry

It’s a good idea to try and keep track of your own vaccinations. Ask your doctor, pharmacist, or vaccination provider for a vaccination record form or download one. Take it with you to health visits. Ask your vaccination provider to sign and date the form for each vaccine you receive.(4)

After getting a COVID-19 vaccine, you should get a small, white card with information about which vaccine you received, when you received it, and where you received it. This card is a vaccination record.(5). As such, it is important that you take steps to check and protect it:

  1. Check your card to make sure everything is correct.
  2. Take a picture of the front and back of the card with your cellphone or a camera.
  3. Use plastic envelopes for vaccine cards. Lamination is not recommended in case future shots are recommended. A photocopy can be laminated.
  4. Store your card in a secure, fireproof, and water-resistant bin or safe.

Vaccination records are examples of important paperwork that you need to collect and protect. Keeping a record and storing it in a safe place can save you time and unnecessary hassle later.

Important paperwork

The term “important paperwork” applies to any documents and personal data that you might need in an emergency or disaster.

What to collect

How to protect

Once you’ve collected your important paperwork, take steps to proofread and protect it. Store paperwork someplace that is a) easily accessible and b) safe from theft, fire, flood, and other emergencies.

Some ways to keep your important paperwork safe and secure include:

  • Scanning or saving to your computer important paperwork and personal items, like family photos. Creating digital duplicates of originals makes it easier to share the information, helps preserve the original, and serves as a backup in case the original is destroyed
  • Storing external drives and hardcopies of important papers in a fireproof and water-resistant file organizer, container, or storage bag with a trusted friend or relative or in a safety deposit box
  • Telling family members, friends, or trusted neighbors where you keep your important paperwork

Learn more ways to prepare your health for emergencies.




Thanks in advance for your questions and comments on this Public Health Matters post. Please note that the CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor.

Have a question for CDC? CDC-INFO ( offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.


Other Diseases Did Not Rest During COVID-19

Protecting Health in 2020. NCEZID Progress Report.

The COVID-19 response is the largest and longest in CDC history. But the virus that causes COVID-19 wasn’t the only infectious disease that CDC responded to last year. Diseases like those caused by the Marburg virus and antibiotic-resistant bacteria didn’t go away because of the pandemic.

The National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) deployed 1,736 staff who devoted 1.35 million hours to the COVID-19 response in 2020. At the same time, the center worked to protect people in other important areas. NCEZID details its activities in the Protecting Health in 2020 NCEZID Progress Report.

The COVID-19 response

The magnitude of CDC’s COVID-19 response was reflected in last year’s raw data. People viewed CDC’s COVID-19 webpages over 2.3 billion times. They used the Coronavirus Self-Checker over 40 million times.

About 1,500 staff, including members of NCEZID, deployed nearly 3,000 times to about 250 cities in the United States and other countries. NCEZID also set records in the amount of funding it awarded. It gave $11 billion to 64 public health departments to help fight the spread of COVID-19.

An NCEZID lab ran 6,417 pathology tests to study COVID-19’s damage on a cellular level. The Advanced Molecular Detection (AMD) program built a national network of more than 600 scientists to track COVID-19’s spread using genetic data while keeping track of new variants.

Over the course of years, NCEZID successfully encouraged 90 percent of U.S. health departments to switch to electronic laboratory reporting. This has paid off during the pandemic response by enabling health departments to send more COVID-19 testing and other data more quickly to CDC.

Other threats

Scientists think that the virus that causes COVID-19 likely circulated in bats before making its way to humans. NCEZID scientists monitor bats for emerging disease threats. Last year, they found an especially deadly strain of Marburg virus circulating in fruit bats in Sierra Leone. Marburg virus disease causes hemorrhaging and other Ebola-like symptoms but is often deadlier than Ebola.

Melioidosis, a life-threatening bacterial disease, infected a few people in the United States last year. Catching it in the country is unusual. Infected people usually get the disease on trips abroad. NCEZID researchers found evidence that melioidosis could be an emerging threat in the U.S.

Other researchers used genetic sequencing data to explore why gastric cancer caused by bacteria afflict Alaskan Native people more than other people.

Years of public health and healthcare measures have reduced infections with antibiotic-resistant germs, but they are still a threat. CDC is spearheading an action plan in communities where infections are on the rise.

The threat of Ebola typifies NCEZID’s dual mission of preparing for and responding to disease threats. Last year, two outbreaks were declared over. Now, two new outbreaks threaten two African countries. Experience gained in last year’s responses will help prepare this year’s Ebola responses.


NCEZID is one of the national centers, institutes, and offices that together make up CDC. NCEZID protects people from domestic and global health threats, including:

  • Foodborne and waterborne illnesses
  • Infections that spread in hospitals
  • Infections that are resistant to antibiotics
  • Deadly diseases like Ebola and anthrax
  • Illnesses that affect immigrants, migrants, refugees, and travelers
  • Diseases caused by contact with animals
  • Diseases spread by mosquitoes, ticks, and fleas

NCEZID has led efforts to prepare for and respond to infectious disease outbreaks. Its staff includes subject matter experts in bacterial, viral, and fungal pathogens and infectious diseases of unknown origin.


Thanks in advance for your questions and comments on this Public Health Matters post. Please note that the CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor.

Have a question for CDC? CDC-INFO ( offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.

Threats Unseen: Beware of Norovirus During an Emergency

Woman clutches her stomach as if feeling nauseous

Natural disasters are unpredictable. Often, we don’t know when or where they will happen or if we will have to leave our homes because of them. Evacuations for hurricanes and wildfires can force people into emergency shelters, where close quarters, shared spaces, and high-touch surfaces can make it easy for norovirus to spread.Graphic that defines norovirus. Text also in body of article.

Norovirus outbreaks occurred in most evacuation shelters in Butte and Glenn counties, Calif., during the Camp Fire in November 2018. Public-health officials identified 292 people ill with acute gastroenteritis caused by norovirus.(1)

A norovirus outbreak among evacuees from Hurricane Katrina in 2005 was also reported in CDC’s Morbidity and Mortality Weekly Report. That outbreak might have affected approximately 1,000 evacuees and relief workers.(2)

What is Norovirus?

Norovirus is a very contagious virus that causes vomiting and diarrhea. Most “stomach bugs” are likely norovirus infections because it’s a relatively common virus. Anyone can catch norovirus from direct contact with an infected person, touching a contaminated surface, or eating contaminated food. It only takes a very small amount of virus particles to make
you sick. The number of particles that could fit on the head of a pin is enough to infect more than 1,000 people.

A person infected with norovirus usually starts to feel ill 12 to 48 hours after they’ve been exposed. The most common symptoms of norovirus infection are diarrhea, vomiting, nausea, and stomach pain. But it can cause fever, headache, and body aches, too.

Be Prepared

Follow the guidance of local officials when going to an emergency shelter during the COVID-19 pandemic. They will tell you when and where to take shelter and what to bring with you.

Act now to prepare “go kits” for family members. Include everyday personal items you cannot do without and other personal protective supplies, such as hand sanitizer with at least 60% alcohol, bar or liquid soap, disinfectant wipes and spray, and at least two masks per person age 2 or older in your household.

If your Emergency Action Plan is to go to a shelter in an evacuation, your kit might also include plenty of nonperishable food, mess kits (e.g., reusable cups, plates, bowls utensils). Also, pack paper towels and disposable plastic gloves to clean up after a sick family member. If you are cleaning up after someone vomits or has diarrhea, use a bleach-based cleaner to prevent the spread of norovirus.

Wash Your Hands

Clean hands are essential to health, whether in an emergency or day-to-day life. Handwashing can keep you healthy and prevent the spread of respiratory and diarrheal infections, like norovirus, from one person to the next. Unseen woman washing her hands with soap in a sink.

Wash your hands thoroughly with soap and water especially after using the toilet or changing diapers; always before eating, preparing, or handling food; and before giving yourself or someone else medicine. Here’s how:

  • Wet your hands with clean, running water (warm or cold) and apply soap.
  • Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
  • Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  • Rinse your hands well under the water.
  • Dry your hands using a clean towel or air dry them.

You can use alcohol-based hand sanitizers in addition to hand washing. But you should not use hand sanitizer as a substitute for washing your hands with soap and water. Hand sanitizers aren’t as effective at removing norovirus particles as washing hands with soap and water.

If you start to feel sick, continue to wash your hands often with soap and water and try to avoid direct contact with others. You should not prepare food for others or provide health care while you are sick, and for at least 2 days after symptoms stop.

Learn More

CDC and state and local health departments help to raise awareness among healthcare providers and the public about norovirus and how to prevent it. Learn more about how they work to prevent and stop norovirus outbreaks.

For more suggestions on how to prepare your health for emergencies, visit




Thanks in advance for your questions and comments on this Public Health Matters post. Please note that the CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor.

Have a question for CDC? CDC-INFO ( offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.

AFM is Serious: Know the Symptoms. Act Fast.

Acute flaccid myelitis (AFM)

Acute flaccid myelitis (AFM) is a serious neurologic condition that causes limb weakness and paralysis. While uncommon, AFM affects mostly children, and can have devastating, long-term effects for patients and their families.

There have been three AFM outbreaks in the United States—in 2014, 2016, and 2018. If this biennial pattern continues, another outbreak might occur in 2020.

What AFM Might Look Like

Little boy doing physical therapy
Braden, who was diagnosed with AFM in 2016, doing his physical therapy. Braden needed a breathing tube for 3 years and was initially paralyzed from the neck down. Now Braden can walk short distances, and his breathing tube has been removed. Braden’s mom Rachel is a co-founder of the Acute Flaccid Myelitis Association.

Imagine your 5-year-old son, who is usually very excited to get up and get going in the morning, complains that his neck hurts, and he can’t move his left arm. You think nothing of it. Maybe he just slept wrong and his arm “fell asleep” and it will go away shortly.

You fix his favorite cereal and call him to come eat, but he doesn’t. It’s been almost half an hour since he woke up. Any other morning, he’d be running around, talking about this and that, and demanding his breakfast. You check on him again. He is still lying in bed and still complaining about his neck and arm.

You check his temperature, which seems fine. What could this be? You don’t think he’s making it up, especially since he was excited about an art project happening today.

You call the doctor’s office and get the nurse on the line. She asks you a series of questions, and you remember that his older sister was sick last week with a mild fever, but your son only had some sniffles. Your pediatrician wants to see your son right away, and after examining his reflexes and strength, he tells you to bring your son immediately to the nearest children’s hospital’s emergency department (ED). The pediatrician suspects your son may have a serious neurologic condition. Scared and worried, you rush to the ED.

AFM is a Medical Emergency

AFM can progress quickly to respiratory failure. Patients who develop AFM symptoms need immediate medical care. That’s why it’s very important that parents call their child’s pediatrician right away or go to the ED, and that clinicians recognize the symptoms of AFM early and hospitalize patients for further evaluation and monitoring.

When to Suspect AFM

You should suspect AFM when a person has sudden onset of arm or leg weakness. Also, did the person have a recent respiratory illness or fever? If so, this should heighten your suspicion for AFM.

Also, look for other signs and symptoms such as:

  • Loss of muscle tone and reflexes in the affected extremities.
  • Difficulty moving the eyes or drooping eye lids.
  • Facial droop or weakness.
  • Difficulty with swallowing or slurred speech.
  • Pain in arms or legs.
  • Pain in neck or back.

AFM & the COVID-19 Pandemic

How to Spot Symptoms of AFM in Your Child
View Printable Poster: How to Spot Symptoms of AFM in Your Child.

COVID-19 is likely on everyone’s minds and causing concern, uncertainty, and challenges for communities across the country.

It is not known how the COVID-19 pandemic and social distancing may affect AFM this year, or the health care system’s ability to promptly recognize and respond to it. However, even in communities with high COVID-19 activity:

  • Parents should act and get medical attention immediately if their child develops sudden arm or leg weakness. It may be AFM, which is serious and requires urgent care. It is very likely that the assessment of your child will require hospitalization if clinicians think your child might have AFM.
  • Clinicians should not “wait and see.” They should refer patients suspected to have AFM to the ED immediately. They should reference CDC resources on AFM symptoms, provide optimal medical management, collect specimens, and report cases to health departments. Clinicians can also contact an AFM expert for a clinical consult through the AFM Physician Consult and Support Portal.

Clinicians may consider reassuring parents about going to the ED during the COVID-19 pandemic for serious health problems. Clinicians can let parents know that hospitals are taking precautions to prevent exposures to COVID-19, such as providing separate entrances and rooms for those with respiratory symptoms, requiring hospital staff to wear appropriate protective equipment like face coverings and shields for all encounters with patients, and increasing access to hand sanitizer and disinfecting surfaces frequently.

AFM remains a public health priority for CDC. CDC is committed to investigating AFM, working with partners, supporting affected families, and responding to outbreaks. Clinicians are encouraged to review CDC’s AFM website, stay alert for AFM in late summer through fall, and promptly evaluate and hospitalize AFM patients.

Resources for Parents:

Resources for Health Care Professionals:

If you have questions, you may send them to

Thanks in advance for your questions and comments on this Public Health Matters post. Please note that the CDC does not give personal medical advice. If you are concerned you have a disease or condition, talk to your doctor.

Have a question for CDC? CDC-INFO ( offers live agents by phone and email to help you find the latest, reliable, and science-based health information on more than 750 health topics.

3 Reasons Why Handwashing Should Matter to You

Unseen woman washing her hands with soap in a sink.

Most of us are familiar with the parental-like voice in the back of our minds that helps guide our decision-making—asking us questions like, “Have you called your grandmother lately?” For many that voice serves as a gentle, yet constant reminder to wash our hands.

Handwashing with soap and water is one of the most important steps you can take to avoid getting sick and spreading germs to loved ones. Many diseases are spread by not cleaning your hands properly after touching contaminated objects or surfaces. And although not all germs are bad, illness can occur when harmful germs enter our bodies through the eyes, nose, and mouth. That’s why it is critical to wash hands at key times, such as after a flood or during a flu pandemic, when germs can be passed from person to person and make others sick.

Washing hands with soap and water is the best way to reduce the number of germs on them, however during a disaster clean, running water may not be available. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs.

Here are three key reasons why you should always care about handwashing:Your hands carry germs you can't see. Wash your hands.

  1. Handwashing can keep children healthy and in school. Handwashing education can reduce the number of young children who get sick and help prevent school absenteeism.
  2. Handwashing can help prevent illness. Getting a yearly flu vaccine is the most important action you can take to protect yourself from flu. Besides getting a flu vaccine, CDC recommends everyday preventive actions including frequent handwashing with soap and water.
  3. Handwashing is easy! Effective handwashing is a practical skill that you can easily learn, teach to others, and practice every day to prepare for an emergency. It takes around 20 seconds, and can be done in five simple steps:
    1. Wet your hands with clean, running water, turn off the tap, and apply soap
    2. Lather your hands by rubbing them together with the soap
    3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice
    4. Rinse your hands well under clean, running water
    5. Dry your hands using a clean towel or air-dry them

Promote Handwashing in Your Community

Global Handwashing Day is celebrated annually on October 15 to promote handwashing with soap as an easy and affordable way to prevent disease in communities around the world. This year’s theme, “Clean Hands—A Recipe for Health,” calls attention to the importance of handwashing at key times, such as before eating or feeding others, and before, during, and after preparing food.

Learn how you can get involved and promote handwashing at home, your child’s school or daycare, and your local community:

Personal Protective Actions You Can Take in a Flu Pandemic

Young woman under the covers in bed blowing her nose.

Every fall and winter the United States experiences epidemics of seasonal influenza (flu). Sometimes a flu pandemic occurs due to a new flu virus that spreads and causes illnesses around the world. We cannot predict when a flu pandemic will occur, but over the past 100 years, we have documented four flu pandemics resulting in close to 1 million deaths in the United States alone. 1Get a flu vaccine! The most important way to prevent the flu in everyone 6 months and older is to get a yearly flu vaccine.

When a flu pandemic happens, it can take up to 6 months before a vaccine against a new flu virus is available. Antiviral drugs can help manage the symptoms of the flu, shorten the time you are sick by 1 or 2 days, and prevent serious flu complications, like pneumonia. But, there may be a limited supply of these medications during a pandemic so nonpharmaceutical interventions (or NPIs) may be the only prevention tools available during the early stages of a pandemic.

There are things you can do, apart from getting vaccinated and taking medications, to help slow the spread of a flu pandemic. NPIs, also known as “community mitigation measures,” are important because they will be the first line of defense in the absence of a pandemic vaccine. NPIs may be more effective when used early and in a layered approach (i.e., using more than one measure at a time). During the 1918 pandemic, cities that put NPIs in place quickly reported fewer deaths.2,3 NPIs may be used in different settings, including homes, schools, workplaces, and places where people gather (e.g., parks, theaters, and sports arenas).

Personal protective measures to prevent flu at all times

Photo of someone washing their hands in a sink.CDC recommends using some NPIs to prevent seasonal flu and other respiratory infections. To help prevent the flu, you should always:

  • Stay home when sick and away from others as much as possible,
  • Stay away from people who are sick as much as possible,
  • Cover your coughs and sneezes with a tissue,
  • Wash your hands often with soap and water,
  • Avoid touching your eyes, nose, or mouth, and
  • Regularly clean surfaces and objects that you use a lot.

Personal protective measures to prevent flu during a pandemic

Many of these NPIs would still be recommended during a pandemic, but some would be reserved for use during a flu pandemic. Depending on the severity of a pandemic, CDC might recommend:

  • Stay home if exposed to a sick household member,
  • Use a face mask when sick and out in crowded community settings, and
  • Implement community measures to reduce exposure to pandemic flu (coordinating school closures, limiting face-to-face contact in workplaces, and postponing or canceling mass gatherings).

CDC is preparing for a flu pandemic

There is always a threat that a flu pandemic will arise, so CDC is taking steps to prepare. In 2017, CDC issued updated community mitigation guidelines to help state and local public health departments and their community partners make plans before the next pandemic happens. Visit to access the updated guidelines; plain-language planning guides for the general public and community settings; and additional NPI communication, education, and training materials. You can find more information about seasonal and pandemic flu at and at


1 Past Pandemics:

2 Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci U S A. 2007; 104:7582-7.

3 Markel H, Lipman HB, Navarro JA, et al. Nonpharmaceutical interventions implemented by US cities during the 1918–1919 influenza pandemic. JAMA. 2007; 298:644-54.

The 1918 Flu Pandemic: Why It Matters 100 Years Later

Group photo of Red Cross nurses in Boston wearing personal protective equipment.

100 years ago, an influenza (flu) pandemic swept the globe, infecting an estimated one-third of the world’s population and killing at least 50 million people. The pandemic’s death tollAmerican soldiers returning home on the Agamemnon, Hoboken, New Jersey was greater than the total number of military and civilian deaths from World War I, which was happening simultaneously.  At the time, scientists had not yet discovered flu viruses, but we know today that the 1918 pandemic was caused by an influenza A (H1N1) virus. The pandemic is commonly believed to have occurred in three waves. Unusual flu-like activity was first identified in U.S. military personnel during the spring of 1918. Flu spread rapidly in military barracks where men shared close quarters. The second wave occurred during the fall of 1918 and was the most severe. A third wave of illness occurred during the winter and spring of 1919.

Here are 5 things you should know about the 1918 pandemic and why it matters 100 years later.

1. The 1918 Flu Virus Spread Quickly

500 million people were estimated to have been infected by the 1918 H1N1 flu virus. At least 50 million people were killed around the world including an estimated 675,000 Americans. In fact, the 1918 pandemic actually caused the average life expectancy in the United States to drop by about 12 years for both men and women.Flu patients in Iowa

In 1918, many people got very sick, very quickly. In March of that year, outbreaks of flu-like illness were first detected in the United States. More than 100 soldiers at Camp Funston in Fort Riley Kansas became ill with flu. Within a week, the number of flu cases quintupled. There were reports of some people dying within 24 hours or less. 1918 flu illness often progressed to organ failure and pneumonia, with pneumonia the cause of death for most of those who died.  Young adults were hit hard. The average age of those who died during the pandemic was 28 years old.

2. No Prevention and No Treatment for the 1918 Pandemic Virus

In 1918, as scientists had not yet discovered flu viruses, there were no laboratory tests to detect, or characterize these viruses. There were no vaccines to help prevent flu infection, noPolicemen patrol the streets in masks in Seattle to ensure public safety. antiviral drugs to treat flu illness, and no antibiotics to treat secondary bacterial infections that can be associated with flu infections. Available tools to control the spread of flu were largely limited to non-pharmaceutical interventions (NPI’s) such as isolation, quarantine, good personal hygiene, use of disinfectants, and limits on public gatherings, which were used in many cities. The science behind these was very young, and applied inconsistently. City residents were advised to avoid crowds, and instructed to pay particular attention to personal hygiene. In some cities, dance halls were closed. Some streetcar conductors were ordered to keep the windows of their cars open in all but rainy weather. Some municipalities moved court cases outside. Many physicians and nurses were instructed to wear gauze masks when with flu patients.

3. Illness Overburdened the Health Care System

An estimated 195,000 Americans died during October alone. In the fall of 1918, the United States experienced a severe shortage of professional nurses during the flu pandemic because large numbers of them were deployed to military camps in the United States and abroad.A black-and-white advertisement for the Chicago School of Nursing. This shortage was made worse by the failure to use trained African American nurses. The Chicago chapter of the American Red Cross issued an urgent call for volunteers to help nurse the ill. Philadelphia was hit hard by the pandemic with more than 500 corpses awaiting burial, some for more than a week. Many parts of the U.S. had been drained of physicians and nurses due to calls for military service, so there was a shortage of medical personnel to meet the civilian demand for health care during the 1918 flu pandemic. In Massachusetts, for example, Governor McCall asked every able-bodied person across the state with medical training to offer their aid in fighting the outbreak.

As the numbers of sick rose, the Red Cross put out desperate calls for trained nurses as well as untrained volunteers to help at emergency centers. In October of 1918, Congress approved a $1 million budget for the U. S. Public Health Service to recruit 1,000 medical doctors and more than 700 registered nurses.

At one point in Chicago, physicians were reporting a staggering number of new cases, reaching as high as 1,200 people each day. This in turn intensified the shortage of doctors and nurses.  Additionally, hospitals in some areas were so overloaded with flu patients that schools, private homes and other buildings had to be converted into makeshift hospitals, some of which were staffed by medical students.

4. Major Advancements in Flu Prevention and Treatment since 1918

The science of influenza has come a long way in 100 years!A man dress in personal protective equipment in a laboratory. Developments since the 1918 pandemic include vaccines to help prevent flu, antiviral drugs to treat flu illness, antibiotics to treat secondary bacterial infections such as pneumonia, and a global influenza surveillance system with 114 World Health Organization member states that constantly monitors flu activity. There also is a much better understanding of non-pharmaceutical interventions–such as social distancing, respiratory and cough etiquette and hand hygiene–and how these measures help slow the spread of flu.

There is still much work to do to improve U.S. and global readiness for the next flu pandemic. More effective vaccines and antiviral drugs are needed in addition to better surveillance of influenza viruses in birds and pigs. CDC also is working to minimize the impact of future flu pandemics by supporting research that can enhance the use of community mitigation measures (i.e., temporarily closing schools, modifying, postponing, or canceling large public events, and creating physical distance between people in settings where they commonly come in contact with one another). These non-pharmaceutical interventions continue to be an integral component of efforts to control the spread of flu, and in the absence of flu vaccine, would be the first line of defense in a pandemic.

5. Risk of a Flu Pandemic is Ever-Present, but CDC is on the Frontlines Preparing to Protect Americans

Four pandemics have occurred in the past century: 1918, 1957, 1968, and 2009. The 1918 pandemic was the worst of them. But the threat of a future flu pandemic remains. A pandemic flu virus could emerge anywhere and spread globally.A crowd of people with the Washington Monument in the distance.

CDC works tirelessly to protect Americans and the global community from the threat of a future flu pandemic. CDC works with domestic and global public health and animal health partners to monitor human and animal influenza viruses. This helps CDC know what viruses are spreading, where they are spreading, and what kind of illnesses they are causing. CDC also develops and distributes tests and materials to support influenza testing at state, local, territorial, and international laboratories so they can detect and characterize influenza viruses.  In addition, CDC assists global and domestic experts in selecting candidate viruses to include in each year’s seasonal flu vaccine and guides prioritization of pandemic vaccine development. CDC routinely develops vaccine viruses used by manufacturers to make flu vaccines. CDC also supports state and local governments in preparing for the next flu pandemic, including planning and leading pandemic exercises across all levels of government. An effective response will diminish the potential for a repeat of the widespread devastation of the 1918 pandemic.

Visit CDC’s 1918 commemoration website for more information on the 1918 pandemic and CDC’s pandemic flu preparedness work.

Responding to Emerging and Zoonotic Infectious Disease Threats in 2017

Montage of photos. From left: a photo of different raw foods, including salmon, fruits and vegetables. A photo of a boy taking an oral vaccine. A photo of bacteria growing in petri dish.

Photo of Rima F. Khabbaz, MD, Director, National Center for Emerging and Zoonotic Infectious Diseases
Rima F. Khabbaz, MD, Director, National Center for Emerging and Zoonotic Infectious Diseases

The fungal superbug Candida auris causes serious and often fatal infections. It can strike people in the places where they seek care—hospitals and other healthcare facilities. In early 2016, we knew about outbreaks of C. auris infections on multiple continents, but we were not sure whether C. auris was in the United States. Fast forward to 2017: C. auris is a priority for public health workers in the United States, and CDC, along with state and local health departments, has tracked more than 200 cases of C. auris infection in the country. Our experts have worked with healthcare facilities across the nation to implement infection control measures and stop transmission.

The progress to track and prevent C. auris is just one example of the important work experts from CDC’s National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) tackled in 2017. Some of the other highlights from the NCEZID 2017 Accomplishments report are described below.

A tremendous year for public health

Summarizing last year’s major efforts was a difficult task. The numbers alone depict a tremendous year for public health. Here are just a few examples.  CDC sequenced nearly 45,000 DNA samples by using Advanced Molecular Detection (AMD) technologies. The agency identified more than 1,100 illnesses that were associated with backyard flocks—the highest number ever recorded by CDC in a single year. And the Antibiotic Resistance Lab Network performed more than 12,000 tests to contain the spread of resistant infections, just to name a few accomplishments.

Tracking new and evolving threatsCDC’s National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) focuses on emerging diseases and diseases spread between animals and people. Our experts work around the clock to identify, track, control and prevent some of the deadliest diseases on the planet. This work includes tracking diseases across the globe and at home, developing innovations, investigating disease outbreaks in extreme conditions, and helping experts prepare for infectious disease threats.

Every day we are learning more about antibiotic resistance, which continues to be among the biggest health concerns in our country. In 2017, CDC took several important steps to combat antibiotic resistance, including rolling out a containment strategy to slow the spread of drug-resistant diseases in healthcare facilities—starting with a single case—and supporting 25 innovators through a CDC pilot project to develop solutions to antibiotic resistance crises.

Understanding the impact

We are also learning more about Zika virus. Zika was often in the headlines in 2016 and 2017, and the mosquito-borne virus continues to be a threat, especially for pregnant women and their fetuses. Last year, CDC experts shed light on a lesser-known effect of Zika virus infection: a link with Guillain-Barré syndrome (GBS), an uncommon illness of the nervous system. In 2017, CDC and partners conducted the first case-control study in the Americas that showed evidence linking Zika virus infection and GBS. This was just one of many vector-borne diseases CDC tackled in 2017.

Responding to new outbreaks

As we continued to work on lingering threats like antibiotic resistance and Zika, CDC also responded to new outbreaks in 2017, both at home and abroad. In the United States, we saw a range of illnesses connected to food products—from Salmonella infections linked to papayas to an Escherichia coli outbreak from soy nut butter. For the first time, scientists linked an outbreak of Seoul virus infections to pet rats in the United States, and AMD lab techniques proved critical in tracing this and other outbreaks. CDC scientists traveled across the globe in 2017 to investigate a myriad of outbreaks, including an outbreak of anthrax infections in animals in Namibia that posed a threat to human health. Experts helped respond to yellow fever outbreaks in countries including Brazil, and we continue that work today as the yellow fever outbreak in Brazil has expanded over the past two years and could affect US travelers.

Like CDC’s response to yellow fever outbreaks, much of last year’s work continues in 2018. We are closely tracking emerging infections like C. auris, continuing to study the effects of unusual diseases like Zika, and investigating and containing outbreaks of infections caused by a wide range of microbes such as Salmonella bacteria, monkeypox virus, and hemorrhagic fever viruses.

Want to learn more? Read the full NCEZID 2017 Accomplishments report, and follow NCEZID on Twitter @CDC_NCEZID.