1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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

10. 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.

11. 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

12. 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

13. Supporting Global Health Security3 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

14. Questions? Centers for Disease Control and Prevention
National Center for Emerging and Zoonotic Infectious Diseases