Emerging and Zoonotic Infectious Diseases May 14, 2015 Beth P. Bell, MD, MPH Director National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases Office of the Director

NCEZID: Protecting People from Infectious Disease Foodborne illnesses Infections that spread in hospitals and other healthcare settings Infections that are resistant to antibiotics Deadly diseases like anthrax and Ebola Diseases caused by having contact with animals Diseases spread by mosquitoes, ticks, and fleas Illnesses that affect immigrants, migrants, refugees, and travelers

National Healthcare Safety Network Signature Programs Laboratory Response Network The Yellow Book PulseNet National Healthcare Safety Network Epidemiology and Laboratory Capacity for Infectious Diseases EID Journal

Responding to Outbreaks Around the Globe NCEZID has supported the response in several ways >300 NCEZID personnel deployed to West Africa Hundreds of staff working in EOC Others worked with US Customs & Border protection to conduct screening at 5 US airports Preparing US healthcare facilities to safely manage a person with Ebola

Responding to Outbreaks in the US Outbreak of E Responding to Outbreaks in the US Outbreak of E. coli O157 infections in Washington State, 2015 15 lab-confirmed cases (no deaths) among ~1,000 children who attended Milk Makers Festival in Whatcom County April 21-23 CDC sent Epi Aid team to investigate Objectives: identify risk factors, prevent additional transmission, prevent similar outbreaks in the future In 2014, NCEZID received 37 requests from states and other countries to assist in the investigation of outbreaks

Collaborating with States: Botulism outbreak in Ohio, 2015 April 19 church potluck meal attended by ~77 people 22 confirmed cases, including 1 death and 9 suspected cases Likely source of outbreak: potato salad from home-canned potatoes CDC provided antitoxin; worked closely with Fairfield County Health Department and Ohio Department of Health, which provided outstanding leadership in triage of patients and managing response

Strengthening State and Local Capacity Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement (ELC) $97.2M awarded in 2014 Supports 50 state health departments, 6 largest local health departments, and 8 territories or US affiliates Works with CDC partner infectious disease programs to support >20 specific disease areas, e.g., influenza, foodborne disease, HAI Through PPHF, ELC also provides cross-cutting and flexible support for infectious disease epidemiology, laboratory and health information systems Local health departments are often the country’s first line of defense when disease outbreaks emerge. Annually, CDC allocates funding to help these “first responders” fight infectious disease outbreaks more quickly and develop better interventions to protect the public’s health. The funding is awarded through two platforms: ELC and EIP. In 2014, -CDC awarded over $97 in ELC funds to 50 state health departments, 6 large local health departments, and 8 territories or US affiliates. The ELC operates a nationwide cooperative agreement supporting all 50 states, the six largest local health departments, and U.S. territories and affiliates. ELC focuses investments on building essential epidemiology and laboratory capabilities in all grantees while also providing targeted resources for issues of regional concern.

Emerging Infections Program (EIP) 10 state health departments and university partners Gold standard surveillance translated into policy and public health practice Disease burden estimates, tracking trends, evaluation of the impact of vaccination programs and other public health interventions, capacity to rapidly implement special projects. Emerging Infections Program 10 state health departments and university partners Gold standard surveillance translated into policy and public health practice

Preventing and Controlling Vector-borne Diseases Significant cause of severe illness and death High cost due to health care, lost income and vector control Vector-borne diseases are on the rise – increasing in incidence, distribution, and severity No vaccines to prevent or drugs to treat most viral vector-borne threats Domestic outbreak threats are driven by globalization, changing ecology, and emerging pathogens: Lyme disease West Nile disease Chikungunya Japanese encephalitis Dengue Reported cases of many tick-borne diseases continue to rise. While in part this may be due to improved surveillance, its clear the range of Lyme disease is increasing, perhaps due to climactic changes. Places at greatest risk for CHIK are those that already dengue-endemic. There is no feral host for CHIK in the US (like birds for WNV) that would spread the disease without detection via human illness. 3

Preparing for Chikungunya New mosquito-borne disease in Western Hemisphere CDC has prepared for outbreaks since 2009 Improve diagnostic capacity Assess gaps in state/local capabilities to detect and respond to outbreaks Develop and disseminate guidelines, information and education materials for all audiences Aid state/local health department investigations Chikungunya New mosquito-borne disease in Western Hemisphere CDC has worked since 2009 on preparing for introduction of chikungunya virus in the Americas No vaccine or specific treatment. Best protection--avoiding mosquito bites. Local transmission possible in all states with Aedes vector mosquitoes.

Protecting Against Importation of Infectious Diseases Quarantine Stations at 20 U.S. Ports of Entry Detect and respond to communicable diseases related to travel and imported pathogens Travelers’ Health Safeguard the health of U.S. residents traveling abroad Immigrant, refugee, and migrant health Provide guidelines for screening/treating refugees and immigrants to U.S.; track diseases in these populations Quarantine Stations at 20 US Ports of Entry The United States has over 300 airports, seaports, and land border crossings with over 350 million international travelers arriving in the U.S. every year. CDC has 20 Quarantine Stations located at international airports and land borders covering 85% of all arriving international travelers Typically staffed by 2–6 officers, including a medical officer, depending on the size of the airport. Help protect our nation’s health by preventing the introduction and spread of dangerous diseases in the U.S Works closely with partners at U.S. ports of entry (primarily international airports) to recognize signs of infectious disease in travelers. Our partners notify CDC’s quarantine stations to respond as needed. CDC also works closely with the airline, cruise ship, and cargo ship industries to ensure that suspected cases of communicable diseases are reported to CDC Quarantine Stations, and that appropriate measures are taken to prevent the spread of disease. Travelers’ Health Safeguard the health of U.S. residents traveling abroad Yellow Book, Travelers’ Health website, and travel health-related apps Immigrant, refugee, and migrant health Provide guidelines for screening/treating refugees and immigrants to U.S. Track diseases in these populations

Championing Innovation: Advanced Molecular Detection AMD combines Traditional epidemiology Genomic sequencing Bioinformatics AMD in Action Listeria in Blue Bell products Bourbon virus discovery Listeria in caramel apples Advanced Molecular Detection (AMD) uses traditional epidemiology, whole genome sequencing, and bioinformatics to rapidly identify and stop some of today’s most challenging public health threats, including Ebola, antibiotic-resistant infections, MERS (Middle East Respiratory Syndrome), and a deadly new respiratory virus affecting children (EV-D68).   Recent examples of AMD in Action Listeria in Blue Bell products Bourbon virus discovery Listeria in caramel apples

Supporting Global Health Security 3 3 3 © David Snyder/CDC Foundation Risks Opportunities Priorities Ability of each country to find and stop threats mention global response capacity, eg strengthening GOARN Emerging organisms Drug resistance Intentional creation Societal commitment New technologies Success leads to success Prevent wherever possible Detect rapidly Respond effectively

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