CDC At A Glance

CDC and Agency for Toxic Substances and Disease Registry (ATSDR) are two of the 13 major operating components of the

Department of Health and Human Services. Since its inception in 1946, when CDC was charged with controlling malaria in the United States, the Agency has emerged as and remains today the most reputable source of public health information in the world.

As the scope and breadth of CDC activities have grown, so has the workforce. Today, CDC and ATSDR have more than 8,000 full-time, permanent staff; 118 part-time staff; and approximately 5,000 contract employees. The majority of employees work out of the Atlanta headquarters, but the Agency also has a major presence in diverse geographical areas such as Cincinnati, Ohio; Morgantown, West Virginia; Hyattsville, Maryland; Pittsburgh, Pennsylvania; Puerto Rico; Washington, DC; Spokane, Washington; Durham, North Carolina; and, Fort Collins, Colorado; and in 46 countries around the world.

• Women make up 58% of CDC′s workforce
• Staff are from a variety of backgrounds and locations throughout the country and across the globe, with 33% of a minority race/national origin
• Disabled employees constitute 6% of our workforce
• More than 80% holds a bachelors degree or higher

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Surveillance

CDC′s National Health Interview Survey turned 50 this year. Since 1957, the Survey has monitored trends in illness and disability. The numbers are used to track national health objectives. The public health research community also uses these data to help see a more detailed picture of myriad health problems, to identify access barriers to health protection and disease prevention tools, and to evaluate Federal health programs. Highlights from the 2006 survey include

• 61% of adults 18 years of age and over were in excellent or very good health, 27% were in good health, and 12% were in fair or poor health.
• 21% of adults 18 years of age and over were current cigarette smokers, 21% were former smokers, and 59% had never smoked at least 100 cigarettes in their lifetime.
• 62% of adults 18 years of age and over never engaged in any periods of vigorous leisure-time physical activity lasting 10 minutes or more per week; 24% engaged in such activity three or more times per week.
• 57% of men were current regular drinkers compared with 39% of women.
• 36% of adults 18 years of age and over had ever been tested for HIV.
• 8% of adults 18 years of age and over had ever been told by a doctor or other health professional that they had diabetes.

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Preparedness

• The number of users for the Epidemic Information Exchange, a secure CDC-based communications system that helps track disease outbreaks, has increased from 890 people in 2001 to 4,885 people in 2007.
• All 50 states now have plans to receive, store, and distribute the Strategic National Stockpile, and CDC reviews these plans regularly to identify gaps in planning.
• CDC deployed more than 170 staff to 31 states to support health department investigations of urgent health problems, such as an unexplained cluster of patients with neurologic disease, a meningitis outbreak, and hurricane-related health threats.
• All 50 states have at least one public health laboratory that can perform rapid tests for anthrax and other bioterrorism agents, and 47 public health laboratories can test for a variety of chemical agents.

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Communicartion

• One millionth inquiry received to CDC INFO, with over 1,200 daily inquires.
• 94,489 subscribers received CDC.gov email updates.
• CDC deployed more than 170 staff to 31 states to support health department investigations of urgent health problems, such as an unexplained cluster of patients with neurologic disease, a meningitis outbreak, and hurricane-related health threats.
• All 50 states have at least one public health laboratory that can perform rapid tests for anthrax and other bioterrorism agents, and 47 public health laboratories can test for a variety of chemical agents.

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Fiscal Year 2007 Budget

In an era of limited fiscal resources and many competing priorities, CDC is committed to leveraging resources to achieve maximum health results and reduce health disparities. Prioritizing the agency′s activities within the four overarching Health Protection Goals ensures that we are focused on optimizing health impact in every laboratory on our campus, in every program we fund, in all our health protection research, and in every outbreak we contain.

Our focus on strategic excellence and innovation is illustrated by the incredible progress we have made in 2007 on “Health Impact Planning” for CDC. CDC now has available a robust Web-based tool that pulls together much of the agency′s strategy information, including alignment to the Health Protection Goals, budget, and procurement information at the project level. We are also taking on some tough policy issues, including looking at the future of our role in immunizations and exploring how we can better leverage external spending to create societal change around some of our best science (e.g., health associated with tobacco). We have started work on founding a new virtual “Policy Academy” to help mentor and support CDC′s commitment to health policy analysis. We are especially excited about the work we have done in the past year to achieve organizational excellence, as showcased by the following:

• Received the highest rating on Improved Financial Performance as part of the President′s Management Agenda
• Implemented the Vaccine Management Business Improvement Project that will lead to more efficient distribution of vaccine directly to providers and clinics
• Enhanced financial reporting system to speed up our reporting capability and provide us with tools to better determine fiscal needs for the next year
• Created a business services improvement office to increase the effectiveness of business activities at CDC
• Targeted communication and media activities to successfully raise awareness about such health concerns as chronic fatigue syndrome, multidrug resistant Staphylococcus, foodborne illnesses, and multidrug resistant tuberculosis

In the coming fiscal year, CDC will continue to lead in promoting health among young people and adults, across all life stages, and in schools and communities around the country. With sustained focus and continued investment, we will continue to be prepared for the next public health emergency, we will begin to roll back the impact of a sedentary lifestyle and stop the spread of HIV/AIDS, and we will work with partners at home and abroad to ensure a healthy national and international community.

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State of CDC In Briefs

Cardiovascular Health in Women

Well-Integrated Screening and Evaluation for Women across the Nation (WISEWOMAN) provides screening and lifestyle interventions to low-income, underinsured, or uninsured women in an effort to reduce risks for heart disease and other chronic diseases. From its inception, WISEWOMAN has provided more than 100,000 lifestyle interventions, reaching the CDC goal of having healthier people in every stage of life. For women who entered the program from 2000–2005, cholesterol levels dropped after one year from 211 to 206 milligrams per deciliter, and their estimated risk of heart attack in the next five years decreased. In the past four years, WISEWOMAN has identified more than 3,000 cases of previously undiagnosed hypertension, 3,600 cases of undiagnosed cholesterol, and more than 500 cases of undiagnosed diabetes.

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Coal-Mining Safety

CDC has collaborated with manufacturers, labor, and industry, developed a new personal dust monitor (PDM) for assessing coal miners′ exposure to coal dust in underground coal mines. The PDM provides real-time exposure data during a work shift so that mine operators can reduce overexposures that might lead to the development of coal workers′ pneumoconiosis or “black lung.” This debilitating lung disease caused 14,000 deaths between 1991 and 2000. CDC and its partners received the prestigious R&D (Research and Development) 100 Award for development of the “Coal Dust Explosibility Meter—Model 100.” This is the first device created to immediately determine if coal dust concentrations in active areas of underground coal mines have been sufficiently mixed with rock dust to prevent risk of explosion.

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President′s Malaria Initiative

The global toll of malaria is high: an estimated one million people die each year, most of them young children in Africa. The economic costs alone for malaria-related illness and mortality are estimated to cost Africa′s economy $12 billion per year. Since President Bush announced the $1.2-billion President′s Malaria Initiative (PMI) in 2005, CDC has been at the forefront of efforts to cut malaria deaths in half in targeted African countries. CDC worked closely with USAID not only to design the initiative, but to conceive and implement evaluation of PMI′s impact in achieving its goal. To date, PMI has provided life-saving interventions to more than six million people, and estimate that approximately 11 million people were reached with life-saving interventions by the end of 2007. An additional eight countries also will be added to initiative in FY2008.

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Measles Initiative

Measles deaths have fallen by 60% worldwide, from an estimated 873,000 deaths in 1999 to 345,000 in 2005—a major public health success. This decline exceeds the United Nation′s goal to halve measles deaths by 2005. In Africa alone, deaths from measles have declined by 75% since the initiative started. This unprecedented decline is attributed to the collaborative work of the Measles Initiative with the American Red Cross, CDC, the United Nations Foundation, UNICEF, and the World Health Organization. CDC′s technical assistance supports the implementation of this high-quality measles campaign to strengthen field and laboratory surveillance for measles virus detection and for efforts to strengthen national routine immunization systems in priority countries. Since 2001, the agency has contributed more than $50 million to the UN Foundation for the purchase of bundled measles vaccine (more than 280 million doses). This contribution has generated additional funds of more than $16 million to reduce measles mortality and morbidity in priority countries supported by the partnership.

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A Health Mystery in Panama

In October 2006, after dozens of Panamanians suddenly fell ill from unexplained renal failure, the country′s minister of health turned to CDC. Twelve of 21 patients had already died when a team of CDC epidemiologists, medical toxicologists, and infectious diseases specialists landed in Panama. They quickly distributed supplies and equipment to gather medical data and diagnostic samples from patients—and sent them back using CDC′s leased airplane.With assistance from the FDA and international partners, the CDC team identified the source of the mysterious illness in just nine days—cough syrup contaminated by diethylene glycol, which is commonly found in brake fluid and antifreeze. This rapid response allowed Panamanian health authorities to quickly withdraw the contaminated medications from clinics, and begin a national public health prevention and risk communication program. Although more than a hundred people were sickened by the poison, the rapid response saved many lives.

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Links Between Birth Defects and Depression Treatment

For the last decade, CDC has been working on the largest study ever undertaken in the United States on the causes of birth defects. Researchers have gathered information from more than 25,000 participants and are using this information to look at key questions on potential causes. Recently, scientists have examined the use of certain antidepressants— selective serotonin-reuptake inhibitors most commonly known as SSRIs—during pregnancy and have found that they do not significantly increase the risk for most birth defects. As well, the study found no significant increase in the risks for the majority of birth defects assessed when all SSRIs were studied together. This finding includes the risk for congenital heart defects, which were associated with SSRI use in previous studies. Researchers, did, however, find associations between SSRI use and three specific birth defects: a defect of the brain, one type of abnormal skull development, and a gastrointestinal abnormality.

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Vehicle Crash Response Study

The decision of whether a victim of a vehicle crash requires care at a trauma center is a matter of life or death. Recent CDC-supported research showed that care at a Level-1 trauma center lowers the risk of death by 25% for severely injured patients compared with treatment received at a hospital without trauma care services. CDC and the CDC Foundation recently partnered with On Star and the GM Foundation to develop procedures to help emergency responders quickly make treatment decisions. Through this partnership, OnStar and the GM Foundation also awarded the CDC Foundation a $250,000 grant that enables CDC to develop protocols that allow the emergency medical community to reduce injury or death through faster identification, diagnosis, and treatment of patients.

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Road Safety

Native Americans are killed in motor vehicle crashes at about twice the rate of all Americans. To address this disparity, CDC began funding four tribes in the fall of 2004 to design, implement, and evaluate evidenced-based strategies to reduce alcohol-impaired driving and increase seat belt use. This effort is paying off with life-saving results:
Ho-Chunk Indian Nation in Wisconsin—A partnership with local county police departments and the airing of a media campaign resulted in an 18% increase in driver safety belt use and a 64% increase in passenger safety belt use from 2005 to 2006.
San Carlos Apache Reservation in Arizona—In 2004, the driving under the influence (DUI) sobriety checkpoints on reservation roads program began, publicizing the checkpoints through TV, radio, local newspaper ads, and local community events. Since 2004, total DUI arrests have increased 33%, and motor vehicle crashes have decreased 27%.
Tohono O′odham Indian Nation in Arizona—The passage of a primary safety belt law and strengthening of the impaired driving law resulted in overall seatbelt use increase of 47% between 2005 and 2006.

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Quit Now!

In In 2007, CDC worked with the National Cancer Institute, North American Quitline Consortium, and all 50 states and five U.S. territories to establish the National Network of Quitlines, which provides smokers in the United States easy access to support and information to help them quit. Research shows that telephone counseling can significantly increase long-term quit rates compared with the effectiveness of self-help materials alone. By calling 1-800-QUIT-NOW, smokers can receive the resources they need to stop smoking. As of October 2007, more than 927,000 calls had been made to 1-800-QUIT-NOW. A Web site, www.smokefree.gov, provides complementary information and cessation support as well.

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E.coli and Food Safety

The nationwide spinach scare of 2006 still resonates across the country as government regulators and vegetables growers hash out proposed guidelines that will alter the way fresh greens are handled in this country. This multistage Escherichia coli (E. coli) outbreak linked to fresh spinach grown in California′s Salinas Valley was the largest ever for leafy green products. By the time it was over, 200 persons in 26 states were infected with the outbreak strain of E. coli O157:H7, and three confirmed deaths were associated with the outbreak. Multiple federal agencies, including CDC, identified the food production area as the source of the E. coli contamination. The produce industry responded quickly to the recall in an effort to rebuild consumer confidence and minimize the risk of future outbreaks. The U.S. Department of Agriculture led the push to add new safeguards for how leafy greens are handled and processed.

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World Rabies Day

There were special reasons to celebrate this year′s work to control rabies. Not only was the United States declared free of canine rabies, but it also witnessed the first successful treatment of human rabies. Since she contracted rabies two years ago, Jeanna Giese, has fought this disease; today, she is cured and set to attend college. Her successful recovery has energized CDC efforts to better understand rabies as a disease process that can be treated. CDC is working with infectious disease physicians around the world on new strategies for future research and on the treatment of rabies. Jeanne Giese′s recovery from rabies is proof that the potential for finding a treatment for this historically fatal disease is within reach

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Vaccine Protection Campaign

In FY07, CDC launched a campaign to encourage parents to vaccinate their preteens against serious, sometimes life-threatening diseases. The CDC′s Preteen Vaccine campaign is designed to inform parents, caregivers, family physicians and pediatricians about CDC′s new vaccination recommendations for 11- and 12-year-olds. The three preteen vaccines are MCV4, which protects against meningitis and its complications; Tdap, a booster against tetanus, diphtheria, and pertussis or “whooping cough”; and Gardasil®, a newly approved human papillomavirus (HPV) vaccine for females that protects against the types of HPV which most commonly cause cervical cancer. CDC recommends the use of HPV for girls and women to help prevent cervical cancers and other diseases caused by certain types of genital HPV. Gardasil® protects against four HPV types, which together cause 70% of cervical cancers and 90% of genital warts. Information on CDC′s Web site features easy-to-understand, downloadable educational materials in English and Spanish. See www.cdc.gov/vaccines/preteen.

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REACH (Racial and Ethnic Approaches to Community Health)

Recent evaluations of REACH have shown that this program supports CDC′s goal of having healthier people in every stage of life by eliminating health disparities in key areas, while making significant reductions in others, including:

• The proportion of African Americans getting screened for cholesterol was below the national average for all population groups in 2002, and now exceeds the national level. Among Hispanics, a large 2002 gap has diminished, and is now nearing the national average.
• More American Indians in REACH communities who have high blood pressure are now taking medications to control their conditions.
• A sizeable 2002 gap between the number of Asian American men who smoke and the national average was eliminated in 2005.

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REACHing African Americans in Los Angeles

In Los Angeles County, African Americans have higher rates of death from coronary heart disease, stroke and diabetes than any other racial or ethnic group in the United States. Further inhibiting healthy habits, South Los Angeles residents have little or no access to resources such as healthy food options and safe places for exercise compared with residents of similar cities.

To address these inequalities and promote healthy communities, Community Health Councils (CHC) of Los Angeles brought together a cross-section of groups and key stakeholders to form the African Americans Building a Legacy of Health coalition. Through a grant from CDC′s Racial and Ethnic Approaches to Community Health (REACH) program, the coalition is improving food and physical activity options in South Los Angeles through community development, awareness, and advocacy. These efforts recently resulted in the Los Angeles County Board of Supervisors adopting a policy to improve the quality of food offered in county-sponsored programs. The coalition also has helped develop wellness programs and policies in nearly 50 local workplaces.

“The wellness program created enough buzz around the office—people interested in walking more, drinking more water, avoiding processed foods—that a second eight-week set of classes was set up for people who missed the opportunity the first time around,” says Emile Gardner, assistant general manager of First Transit in Los Angeles. “The program is a great way to improve health and quality of life, and it pays dividends to participants and the community as a whole.”

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Project DIRECT

Project DIRECT is a community participatory diabetes intervention project designed to test a comprehensive approach (health promotion, outreach and diabetes care) to diabetes prevention and care. The intervention was conducted among a predominantly African-American community of North Carolina. Preliminary results show that sedentary behavior was reduced over the 7-year period in the intervention community compared to the control community. As well, although the total diabetes prevalence increased in both communities, the rate of increase was 40% less in the intervention community.

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Health Protection Challenges

In FY07 CDC established the Federal Collaboration on Health Disparities Research as part of its ongoing strategies to eliminate health disparities. The collaboration brings together 15 federal agencies and focuses on translating and disseminating those research strategies and results. CDC also is initiating entrepreneurial research to meet health protection challenges by creating innovation teams charged with identifying and rewarding innovation; convening leader-to-leader meetings with retail health partners; developing grand rounds for health proprotection goals; and examining best practices in innovation in public and private sectors.

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Data-driven Interventions and Reduction of Global Tobacco Use

In 2007, the Bloomberg Family Foundation contributed $125 million to launch the Bloomberg Global Initiative to Reduce Tobacco Use. A significant portion of these resources is being used to better understand adult tobacco use by building on the successful youth tobacco surveys and to optimize the reach and results of the ongoing Global Tobacco Surveillance System. CDC played an instrumental role in designing the new standard Global Adult Tobacco Survey instrument to measure adult tobacco use and testing it in India and the Philippines. CDC also developed training materials for staff and provided technical assistance to the Ministries of Health and other partners in focus countries. The new survey will be implemented next in 15 low- and middle-income countries that are home to more than half of the world′s smokers—Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Pakistan, Philippines, Poland, the Russian Federation, Thailand, Turkey, Ukraine, and Vietnam—and bear the highest burden of tobacco use.

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CDC′s Laboratory Response Network (LRN)

For the detection of biological threat agents, CDC has increased the number of LRN reference laboratories to 163. This number includes public health, military, environmental, water, food, and veterinary labs. These labs are now located in all 50 states and several installations abroad. Of the 54 domestic labs that are affiliated with grantees of the Public Health Emergency Preparedness cooperative agreement, 100% can confirm the agents that cause anthrax, tularemia, and plague. For the entire network, more than 90% can test for melioidosis, ricin, SEB, orthopoxviruses, or influenza A/H5. In addition, 62 public health laboratories can either detect chemical agents in human specimens, ship samples, or both. CDC has trained more than 8,800 clinical laboratorians to play a role in detecting, diagnosing, and reporting public health emergencies.

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Preparedness for Vulnerable Populations

“Chronic Disease and Vulnerable Populations in Times of Natural Disasters” is an action guide developed recently for U.S. public health practitioners—especially at local and state levels. It offers practical, easy-to-use advice that is specific to chronic disease, reproductive health, and other vulnerable/at-risk population needs for disaster planning and response. The guide covers basic principles of disaster planning and response and addresses the need for plan development before a disaster occurs, the immediate impact and postimpact phases of disaster response, and the long-term follow-up and evaluation of the response.

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NHANES Collaborative Genomics Project

Since 2002, CDC and NIH′s National Cancer Institute (NCI) have been measuring population variation in selected genes by using stored DNA samples collected during the third National Health and Nutrition Examination Survey (NHANES). NHANES is a nationally representative, weighted sample survey, with over sampling of youth, elderly, non-Hispanic blacks, and Mexican Americans to improve representation of these groups, and encompasses a large segment of the U.S. population. In FY2007, NCI and CDC laboratories completed the genotyping of 90 variants in 50 genes. CDC staff are conducting a statistical analysis for each of the approximately 35 genotype-phenotype correlation studies. One finding from the study shows that family history of diabetes has a significant, independent, and graded association with the prevalence of diabetes in the U.S. population. People with a family history of diabetes were 2.3 to 5.5 times more likely to have diabetes.

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Genomics and Education

Since 2003, CDC has supported genomics programs in four state health departments (Michigan, Minnesota, Oregon, and Utah) to integrate genomics knowledge (e.g., genetic risk factors) and tools (e.g., family history assessments) into chronic disease prevention programs and core public health functions. The Minnesota health department has now collaborated with the University of Minnesota′s School of Public Health to organize three new courses and a roundtable session on public health genomics as part of the 6th annual Summer Public Health Institute. This collaboration builds genomics capacity by educating the workforce on the importance and application of genomics principles in research, practice, and policy development.

The Power of New Media

An award-winning Web design. National broadcasts to CDC-Info queries. Innovative ideas for using new media. Across the spectrum, CDC is taking to the airwaves through tools that are anything but conventional. Over the last year, CDC launched a Whyville influenza vaccination campaign where the citizens of this tween′s virtual community were encouraged to get vaccinated against Whyville′s own virtual “Why-Flu.” And the virtual community Second Life was not left behind. There were new updates to CDC′s Second Life site, providing this 6-million-plus cyber community with the opportunity to download CDC materials, visit CDC Web sites, listen to podcasts, and learn about the latest health concerns and disease outbreaks.

Health e-Cards were also launched as a product line in February 2007. In the first 24 hours, almost 3,000 e-cards were sent for Valentine′s Day with messages for loved ones on ways to stay healthy or get healthier in the coming year. From blogging and surfing, to chat rooms and emergency notification systems, a new information age is upon us. For CDC, this new media is making health information more personal, more participatory, and more powerful. Find out more from the video on the CD-ROM in this report or by visiting www.cdc.gov/Features/VirtualTour

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