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.

About NCEZID

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.

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Battling Biting Mosquitoes and Jumping Genes in 2016

NCEZID microbiologist Jane Basile shows how to use the new yellow fever test kit that in less than 4 hours yields results that are as accurate as the older 2-day test.

Last year, an expert from the CDC National Center for Emerging and Zoonotic Diseases (NCEZID) found himself in an unlikely position: guest starring on a popular Navajo language radio program to field questions about hantavirus infection. Hantavirus is caused by contact with mouse droppings and can sometimes be fatal.

This is just one example of how NCEZID has worked over the past year to confront a wide range of infectious disease concerns. From antibiotic resistance to Zika, last year’s threats required rapid and innovative responses, and CDC experts stepped up to the plate. Below are just a few of highlights from 2016.

Fighting the bite

In 2016, the mosquito was a major culprit. Zika virus became the first known mosquito-borne virus that can cause major birth defects, and we continue to learn about Zika virus every day. The Zika virus outbreaks in the Americas and other parts of the globe required a massive response, which is hands-down a top accomplishment for 2016. The consequences of Zika can be devastating, and stopping the epidemic has been anything but simple. It has involved expertise from many fields, including mosquito control, pregnancy and birth defects, laboratory, epidemiology, blood safety, communication, and the list goes on. NCEZID led that effort and, by the end of the year, more than 2,000 CDC staff members had been part of the Zika response.

Confronting an imminent threat

Imagine a post-antibiotic world where bacteria no longer respond to the drugs designed to kill them. It’s a real threat, and many consider it the most concerning challenge to our country’s health. CDC has made the fight against antibiotic resistance a priority, and our transformative investments nationwide can be seen using the interactive AR Investment Map. This work includes establishing a new lab network in 2016 with expanded lab capacity in all 50 states.

Tackling illnesses caused by food

What do packaged salads and raw flour have in common? In 2016, both made dozens of people sick. For the first time, NCEZID experts conclusively showed that these foods were linked to specific bacteria that caused outbreaks. Whole genome sequencing helped connect the dots by showing that flour was the cause of an E. coli outbreak that made 60 people in 24 states sick, a third of whom were hospitalized. Some reported eating raw dough or raw batter. Whole genome sequencing also helped determine that an outbreak of listeriosis, which resulted in at least one death and 30 hospitalizations in the United States and Canada, was caused by eating packaged salads. As a result, the company that produced the salads recalled all brands produced at a single US facility.

Responding to rare infections

The jumping gene. A fungus that can cause bloodstream infections. A rare bacteria found in water. These are brief descriptions of three new or rarely seen emerging infectious threats that caused heightened concern in 2016. We worked to identify and contain the mcr-1 – or “jumping” – gene, which can make bacteria resistant to an antibiotic that is a last resort for some infections. A report by our experts also detailed the first US cases of Candida auris, an emerging fungus that is resistant to drugs and can cause serious – and sometimes deadly – blood infections. And, after the first cases of the rare Elizabethkingia infection were reported in Wisconsin, our scientists assisted the Wisconsin and Michigan state health laboratories in investigating the outbreak that would sicken almost 60 people and cause 20 deaths.

Assisting the response to hantavirus in Navajo Nation

NCEZID’s Craig Manning (left) fields a question about hantavirus from KTNN-AM radio host Navajo Bob during the live call-in program.

When a young woman from Navajo Nation in western United States died from an uncommon respiratory infection in early 2016, CDC experts stepped in to help. The problem was hantavirus which is spread by deer mice and causes a serious, sometimes lethal, respiratory infection. NCEZID experts worked with Navajo leaders to share information about hantavirus and create messages on preventing infection, including messages broadcast on a popular Navajo language radio station.

For more on the top infectious threats of 2016 and how we confronted them, please see the NCEZID 2016 Accomplishments.

When Preparation Meets Opportunity: Cameroon Gets a Jump on Outbreak Response

 Buea-Regional-Hospital-at-the-foot-of-Mt-Cameroon

When Dr. Aristide Abah stepped off the plane that brought him from Atlanta back to his home in Cameroon, there was no time to waste. An outbreak of H5N1 flu threatened the country, and it was up to Dr. Abah to lead the response.

Fortunately, he was prepared.

Dr. Abah had just spent four months at CDC headquarters as part of CDC’s Public Health Emergency Management Fellowship, which invites public health experts from all over the world to learn how to organize an emergency response in their country.

A deadly threat

In Cameroon, H5N1 was raging in poultry, putting people at risk. The virus can spread to people who come into contact with infected birds, and the result can be devastating. An estimated 60% of people who get the disease, die.

A swarm of activity took place around Cameroon’s response: culling chickens, contact tracing, delivering Tamiflu to people who needed it, providing personal protective equipment (PPE) to workers, and more. The country faced challenges; with over 500 sets of PPE needed each day, animal health workers ran out and had to repurpose supplies that were never used for the 2014 Ebola outbreak.

If they were to stop the deadly virus from spreading to humans, the country needed to act fast and be efficient. For Dr. Abah – and for Cameroon’s public health emergency operations center – it was time to put some newfound knowledge to the test.

From fellowship to field

Dr. Abah leads Cameroon H5N1 response
Dr. Abah leads Cameroon’s H5N1 response

Dr. Abah returned home from his fellowship on a Sunday night. On Tuesday, he stepped in as Incident Manager for the response. On Wednesday, he walked around the room and put nameplates at every desk.

This simple action served two important purposes.

The first was to make sure everyone knew their designated roles. In an emergency, we use an organizational structure called an Incident Management System to assign specific roles and responsibilities to every person. This ensures that everyone knows exactly what they and others are doing.

Nameplates also meant that everyone had an assigned seat, so that people who worked on the same tasks sat near each other. When information has to travel fast, proximity is priceless.

After he organized the people, Dr. Abah organized their time. He set up a system that gave everyone an allotted number of minutes to speak at meetings. He even appointed a timekeeper to help stay on track. “As you may or may not know,” joked Kerre Avery, a CDC Emergency Management Specialist who works closely with Cameroon, “it’s the French custom to talk a lot.”

Dr. Abah also improved the way information traveled, both within the response and outside it.  He adopted the CDC template for daily update slides and situation reports in the EOC, and added a communications team to the incident management structure to help get critical messages out to the public.

For Dr. Abah, these were the opening steps of a wider plan to respond to the crisis. During his fellowship, he had learned the critical importance of planning and organization. “For me, the planning was key,” he said. “I now know that we can’t do anything without a plan.”

Knowledge can’t wait                                                                  

When Dr. Abah first learned of the H5N1 outbreak, he had not yet completed his fellowship, but he knew that the lessons he was learning would help his colleagues back home. He set up an internet-based platform so they could all see and benefit from the lessons. He also reached out with new ideas: “I wanted to speak to higher management,” he said. “I told them they had to have an Incident Manager [in the EOC].”

Cameroon was already getting better and better at responding to health threats. A year ago, it took the country eight weeks to activate their public health emergency operations center in response to a cholera outbreak. Several months later, when Lassa fever erupted, they had reduced their response time to a week. By the time H5N1 appeared in local poultry, it took the country less than 24 hours to activate the PHEOC.

Cameroon’s recent improvements – including their investment in sending Dr. Abah to the fellowship – are all part of a worldwide effort to better prevent, detect, and respond to public health emergencies. And their efforts in preparedness are paying off: during the latest outbreak, there were zero transmissions of H5N1 to humans.

Inspiring lessons

The lessons the Public Health Emergency Management Fellowship teaches are designed to be applied to virtually any crisis situation. Since the 2013 inaugural class, CDC has hosted 39 fellows from 25 countries, giving them important education they can take back and use in their home countries.

While in the U.S., Dr. Abah was particularly inspired by a visit to meet Dr. Nicole Lurie, the Assistant Secretary for Preparedness and Response in Washington, D.C. Her advice to him summarizes perhaps the most important lessons from the fellowship.

“I keep in my memories three words of advice from Dr. Lurie.” Dr. Abah recalls. “Never give up, stay connected, and get better.”

The Public Health Emergency Management Fellowship is implemented by CDC’s Division of Emergency Operations. The program helps countries meet the goals of the Global Health Security Agenda, including having an emergency operations center that can respond within two hours of a public health emergency.

Learn More

 Read our other National Preparedness Month blogs:

Rabies Scare Leads to Quick Public Health Action

Bats

By Jacquelyn Lickness

When a hospital in South Carolina spotted bats flying through its facility, officials sprang into action launching an investigation to prevent a possible rabies outbreak. Because bats are commonly infected with the virus, any contact with the flying mammals is taken very seriously. The hospital quickly involved state public health officials, who then reached out to CDC to help investigate any possible exposure to the rabies virus.

Team in the EOCRabies is a disease typically acquired through the bite of a rabid animal, and can be deadly if the exposure (e.g., bite) is not recognized early enough. Across the globe there are more than 55,000 human deaths from rabies each year. However, in the U.S. human cases are extremely rare, with approximately two human deaths annually. Most exposures to the rabies virus in the U.S. occur through contact with animals that are commonly infected with the virus, including bats, raccoons, skunks, and foxes.

Participation in the response effort

The response effort in South Carolina is ongoing and has involved collaboration among hospital staff, state public health officials, and CDC rabies experts and volunteers. Because hundreds of patients and hospital staff might have come in contact with bats, it was important to assess each individual’s risk of exposure.

In this event, it was critical to understand any interaction with a bat. It is possible that bat bites can go unnoticed if the person is sleeping or sedated, thus placing a person at risk for rabies. As a result, the investigation team asked about certain activities such as bat handling and touching, heavy sleeping or sedation, and other medical history that may indicate exposure.

Rabies expert and CDC Epidemic Intelligence Service (EIS) Officer Dr. Neil Vora orchestrated a response that included the administration of hundreds of phone-based surveys to hospital patients and staff. This large-scale investigation was managed through the CDC Emergency Operations Center. EIS officers, veterinary and medical students, and public health students from nearby Emory University eagerly offered their support for the data-gathering activities. The Student Outbreak and Response Team (SORT), a public health organization from Emory University that assists in outbreak responses, organized a contingency of nearly 20 students to assist the efforts. In the span of four days, a total of 55 volunteers made 817 calls.

EOC teamThe investigation wasn’t just limited to patient questionnaires. Other activities included the distribution of letters and flyers to patients and visitors to warn of bat exposure, mapping and creation of a timeline of bat sightings, and testing of bats for rabies. A quick response was made possible through collaboration between the hospital, South Carolina public health officials, a local pest control company, and all participants at CDC.

Determining the extent of exposure

In total, 53 bats have been sighted in the hospital, of which 12 were tested and have results available, all of which were negative. That said, other bats in the colony that have not been tested could still have had rabies. After the removal of the bats and other interventions to prevent their re-entry, the bat sightings have decreased. As a result of the collaborative effort among CDC, the state public health department, and the affected hospital during this response, partnerships were strengthened and new public health tools and practices were developed. Most importantly, all involved continue taking measures to understand best practices in rabies prevention and treatment to ensure the safety of the public’s health.

l’heure du spectacle: Film-based monkeypox outreach in the Democratic Republic of Congo

Teacher speaking with students in the Democratic Republic of CongoBy Benjamin Monroe

The glow of the dell projector was the only source of light for miles except the blanket of stars in the African sky.  In a life without lights, the chance to watch a movie can be a really big deal.  So it shouldn’t come as a surprise when an entire village shows up to an educational film screening.  What was amazing was the audience frozen in rapt attention, the simultaneous gasps and laughter from the audience as if on cue, and the hour-long discussion that occurred afterwards.   This was no ordinary PSA, but something meticulously developed by a group with vast working knowledge of conservation, health, and behavioral education.

Community leader talking to villagers before a screening of the educational monkeypox videoWe had come to the town on Bokungu in a remote area of the Congolese rainforest to investigate a recent epidemic of human monkeypox.  The often-neglected disease is a relative of smallpox, and can cause widespread rash over much of the body and be fatal in some severe cases.  The virus hides in an undiscovered animal reservoir and spills over to humans after contact with infected wildlife.  Once infected, it is possible for a patient to infect other close contacts like family members and playmates.  An important goal of this investigation was to educate the local population about ways to prevent monkeypox. 

One of the keys to producing useful and effective health videos is to make them relevant and relatable to the population you are trying to reach. Luckily, the International Conservation and Education Fund, a conversation organization working in the Congo basin, graciously agreed to lend us their monkeypox films and equipment to aid in this effort. InCEF takes great care to incorporate African film makers, regional subject matter experts, and local residents in all their films.  To an outsider, watching and InCEF film is like a 10-minute trip to one of the most remote regions of earth.  You hear the songs of village children, see a level of poverty that is almost unimaginable to those from developed countries, and begin to grasp the resiliency of a people largely overlooked by even their own government.  To the residents of these communities, there is an undeniable excitement of seeing people just like them living their lives and sharing their stories on screen. 

A particular vignette that resonated with these audiences was a tale of two boys who fell ill after they disobeyed their father and decided to eat a squirrel they had found dead in the forest.  Based on audience reaction, this situation was as common in this area as breaking mom’s vase on a Western TV sitcom. Thanks to these common storylines, and relatable characters, these films sparked animated discussions among the audiences and gave health educators a chance to impart valuable information on how to avoid contracting and spreading this deadly disease.

Children and other villagers look into a school showing monkeypox videoAll the effort involved in bringing these films to affected populations starts to pay off when InCEF educators can lead a community discussion.  People began to line up to share their thoughts with neighbors while the credits rolled.   Amplified by a megaphone in the local dialect, Lingala, several themes seemed to constantly reoccur as the audience took the floor.  What animals have monkeypox and how can you tell if it is sick?  That meat available in the market often comes from untrustworthy sources.  Are there methods of preparing these types of meat that prevent monkeypox?  Why are there no medications available to treat the disease?   

A great deal of tact is necessary to put misconceptions about this disease to rest and address the risks associated with wildlife consumption.   It’s easy to sit in an office somewhere with a full stomach and make the recommendation to not eat dead animals you find in the forest.  But when standing in front of chronically malnourished crowd the words can get stuck in your throat.  These communities are some of the most marginalized in the world.  Agriculture is difficult in a landscape covered in dense tree cover and flooded lowlands, there is minimal infrastructure to transport goods, and no social safety nets available if crops fail.  Subsistence is based almost entirely on what you collect from the forest.  The choice is often between letting your family eat the dead squirrel you found collecting wood, or not eat at all. This issue is complex to the heart, and is unlikely to be solved by campaigns developed worlds away.   There is no substitute for the ground-level effort groups like InCEF put into bringing information like this to forgotten places.    Over a seven-day period we were able to reach more than 2,300 people with the light from one small projector.  That could mean an untold number of future monkeypox cases prevented.