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Protecting Our Nation's Health in an Era of Globalization: CDC's Global Infectious Disease Strategy
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Priority Area 1: International Outbreak Assistance
Isolation ward in Gulu, Uganda, October 2001.

Outbreak of Ebola hemorrhagic fever, Uganda, 2000. The isolation ward of Gulu Municipal Hospital, Gulu, Uganda, during an outbreak of Ebola hemorrhagic fever in October 2000. There is no known drug treatment or vaccine for this disease, which is transmitted person-to-person through contact with infected bodily fluids and has a case-fatality ratio of 50–90%.

At the invitation of the Ugandan Ministry of Health, CDC sent several teams of scientists to Gulu to participate in a multinational WHO-coordinated response team. The response team helped bring the epidemic under control by providing assistance and consultation to help rapidly identify cases, provide safe care, and interrupt the spread of the virus.

Photographer: Daniel Bausch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC

When a new, highly dangerous, or reemerging disease is detected anywhere on the globe—whether in a developing or industrialized country, in a close ally or a “nation of concern”—U.S. citizens, as well as foreign governments, often rely on CDC to provide outbreak assistance and public health information. CDC is unusual among public health institutions in its comprehensive capacity to identify a wide range of infectious bacteria, viruses, fungi, parasites, and rickettsia.

  Box 11
  An Outbreak of Leptopirosis Affecting Athletes from 26 Countries Reported by the GeoSentinel Disease Surveillance System

In past years, however, maintaining this capacity has not always been a priority. Attempts have been made to cut costs by reducing support for laboratory expertise on diseases that are currently uncommon in the United States, including zoonotic diseases like plague and leptospirosis. However, CDC’s repeated experience with outbreaks of diseases once thought to be archaic or obscure—including a 1994 outbreak of plague in India, a 1995 outbreak of a virulent pulmonary form of leptospirosis in Nicaragua, and a 2000 outbreak of leptospirosis in Malaysian Borneo among athletes at an international competition (Box 11)—has underscored the value of having a comprehensive, integrated ability to identify and investigate most human diseases and to recognize new threats. However, gaps remain in CDC’s repertoire of diagnostic tools in such areas as diseases caused by prions (e.g., new variant Creutzfeldt-Jakob disease, the human consequence of infection with bovine spongiform encephalopathy, or “mad cow disease”), and some areas require upgrading to remain effective (e.g., leptospirosis, yellow fever, diphtheria, anthrax, and helminthic diseases).

CDC frequently collaborates on international outbreak investigations conducted in partnership with host nations. CDC participation occurs on an ad hoc basis, in response to requests for assistance from foreign governments or WHO. There is no formal structure for this activity, nor are there designated resources. An underlying principle of the global strategy is the recognition that international outbreak assistance is an integral function of CDC. Supporting this function will require augmenting, updating, and strengthening CDC’s diagnostic facilities, including laboratories that participate in the WHO Collaborating Centre network, as well as capacity for epidemiologic investigation overseas, including field logistics and data management.


Box 12

  Follow-up Activities in the Aftermath of the 1994 Plague Outbreak in India

Outbreak follow-up. In the future, as part of the global strategy, CDC will routinely offer to assist host-country ministries of health and WHO in assessing the public health situation in the aftermath of a major outbreak. If requested, CDC will send a dedicated prevention team to revisit the outbreak site and suggest additional strategies to improve disease surveillance and outbreak response. The team will share clinical and epidemiologic outbreak data with health authorities and work to strengthen local laboratories. The team may also sponsor local workshops or conferences to consider lessons learned from the outbreak, review local hospital resources, and discuss long-term surveillance efforts. These follow-up efforts will help maintain mutually beneficial relationships and research partnerships between CDC, WHO, and local health authorities (Box 12 and Priority Area 2).

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Booklet Contents
item Contributors
item Table of Contents
item Preface
item Executive Summary
item Introduction
item International Cooperation To Combat Infectious Diseases
item U.S. Investment in Global Public Health
item Protecting the health of U.S. citizens at home and abroad
item Furthering U.S. humanitarian efforts
item Providing economic and diplomatic benefits
item Enhancing security
item CDC's Role in Promoting Global Public Health
item An evolving mission
item Vision for the Future
item Partnerships and Implementation
item Priorities and Objectives
1. International Outbreak Assistance
item Objectives
2. A Global Approach to Disease Surveillance
item Objectives
3. Applied Research on Diseases of Global Importance
item Objectives
4. Application of Proven Public Health Tools
item Objectives
5. Global Initiatives for Disease Control
item Objectives
6. Public Health Training and Capacity Building
item Objectives
item List of Boxes
item Acronyms
item Appendix A
item Appendix B
item Appendix C
item Appendix D
item Appendix E
item Acknowledgments
item References

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Date published: 2002

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