The Public Health Response to Emerging and Pandemic Diseases

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1 Centers for Disease Control and Prevention The Public Health Response to Emerging and Pandemic Diseases Anne Schuchat, MD (RADM, USPHS) Acting Director, Centers for Disease Control & Prevention Acting Administrator, Agency for Toxic Substances & Disease Registry Consortium of Universities for Global Health Conference April 9, 2017

2 SARS Epidemic, ,098 probable cases, 774 deaths Super-spreading events helped seed global spread Early lack of transparency and extreme travel restrictions prompted updated IHR framework (2005) Control strategies: surveillance isolation of ill quarantine of exposed infection control social distancing health alert notices MMWR, March 28, 2003

3 MERS Has Been Largely Contained to Saudi Arabia but Remains a Global Risk MERS outbreak in Republic of S Korea MERS-CoV: Middle East Respiratory Syndrome Coronavirus

4 A Health Threat Anywhere Is a Health Threat Everywhere Disease can spread nearly anywhere within 24 hours Global aviation network SOURCE:

5 Safeguarding America from Health Threats CDC Emergency Public Health Responses World Trade Center Attacks, Anthrax Attacks West Nile Virus Columbia Space Shuttle Disaster, SARS, Monkey Pox; NE Blackout, Hurricane Isabel, Domestic Influenza, CA Wildfires, Ricin, Tularemia, Anthrax;, BSE (Mad Cow Disease) Avian Influenza, Influenza Vaccine Shortage, Guam Typhoon, Ricin Domestic Response, G8 Summit, Summer Olympics, Democratic National Convention, Hurricanes Charley, Frances, Ivan, & Jeanne, Tsunami Marburg Virus, Hurricanes Katrina, Rita, & Wilma Tropical Storm Ernesto, Mumps, E. Coli Spinach, Botulism Carrot Juice, RI Mycoplasma XDR/ MDR TB, Hurricane Dean Satellite Intercept, Salmonella and E. Coli Outbreaks, Hurricane Dolly, Tropical Storm Edouard, Hurricanes Gustav, Hanna, & Ike Salmonella Typhi-murium Outbreak, H1N1 Influenza NH Anthrax, Haiti Earthquake, Deepwater Horizon Oil Spill, Haiti Cholera Outbreak Japan Earthquake & Tsunami, Polio Eradication Response, Hurricane Irene Polio, Meningitis Outbreak, Hurricane Sandy H7N9, MERS- CoV, Polio Ebola, MERS- CoV, Polio Ebola, MERS- CoV, Polio, Chikungunya Ebola, Zika, N7N9, MERS- CoV, Polio

6 Scope and Size of Recent CDC Responses H1N1 activation More than 12 months 3,300 CDC staff CDC received $1.235B Estimated 61 million cases in the US >80 million Americans received pandemic H1N1 vaccine Ebola activation Close to two years >4,000 CDC staff >3,500 total deployments CDC received $1.77B More than 28,000 cases & 11,000 Ebola deaths Zika activation 14 months and counting 2,000 CDC staff (with expertise from virtually every CDC unit) >4,900 US pregnant women infected so far

7 April 23, st press conference (N=7 cases)

8 Novel H1N1 Influenza, 2009: Rapid Detection, Identification & Response Late Feb Early March First cases in Mexico April 15 Recognition of a Novel Influenza Swine-Origin Virus April 27 CDC posts 40 gene sequences on GenBank May 1 Diagnostic Kits Shipped to State Labs May 2 Diagnostic Kits Shipped to WHO Network May Vaccine Strain Shipped to Manufacturers

9 H1N1 vaccination begins

10 Overall Goals in Ebola Outbreak Response Stop human-to-human transmission Case identification Isolation/care Limitations ETU/CCC needs Contact tracing Infection control Safe burials Health communication Improve patient care Triage Experienced staff Strict use of personal protective equipment

11 Training Humanitarian Workers in Infection Control CDC Training in Anniston, Alabama for Infection Prevention and Control 600 HCWs trained Representing 42 NGOs 21 institutions, organizations, and USG agencies 276 USPHS Commissioned Corps HCWs trained before deployment to Monrovia Medical Unit Train-the-trainer courses expanded the reach to thousands

12 Crisis and Emergency Risk Communication Be first Be right Be credible Express empathy Promote action Show respect

13 Ebola Accomplishments Stopped transmission in all communities through epidemiology and lab support, contact tracing, health communication Established emergency operations centers in all affected countries Transmission controlled quickly in Nigeria, Mali, Senegal Rapid isolation and treatment strategy in Liberia cut duration of outbreaks in half and doubled survival High-throughput lab capacity in Sierra Leone, 421 days of continuous operation > 23,000 specimens Hundreds of thousands of health workers trained in infection control in the US and globally >8,000 vaccinations of health care workers in Ebola trial US lab capacity expanded, decreased turnaround time Exit screening in West Africa and entry screening and active monitoring program in the US Increased readiness of US healthcare facilities

14 Vaccine trials launched in the 3 affected countries

15 Ebola: What Might Have Been Ebola treatment ward Monrovia, Liberia, Sept. 2014

16 Lessons Learned From Ebola Speed is of the essence every minute counts Every country must be prepared to Find a threat when it emerges Stop it promptly Prevent it wherever possible The world must be ready to surge in when a country s capacities are overwhelmed We must move from non-accountability & no assistance to mutual accountability & partnership

17 Joint External Evaluations for Global Health Security Transparent, independent, and objective JEE complete GHSA external assessment JEE scheduled Expressed interest in JEE Data as of March, 2017

18 January 15, 2016 Photo: James Gathany

19 Zika: CDC s Most Complicated Emergency Response Laboratory testing development Global migration analysis Statistical modeling Grants management Clinical management Communications specialists Pregnancy and birth defects experts Sexually transmitted disease Entomologists

20 Zika: Prevention, Detection, Response Prevention Reduce risk to pregnant women Mosquito surveillance and control in at-risk and affected areas Minimize other forms of transmission (especially sexual) Detection Real-time information on infections, adverse health outcomes, mosquito populations and resistance Improve laboratory test availability and accuracy (RT-PCR; serology; PRNT) Response Robust response in any area at risk for local transmission Improve vector surveillance and control Care for pregnant women, affected infants, patients with Guillain-Barré syndrome

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22 What Can Be Learned From Ebola, Zika & Other Outbreaks for Future Emergency Responses? Rapid detection and response Global surge Infection control Vector control Pace needed for research Community mobilization

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24 For more information, contact CDC CDC-INFO ( ) TTY: