Download The US Centers for Disease Control and Prevention (CDC) and

Acta Tropica 87 (2003) 161 /163
www.elsevier.com/locate/actatropica
The US Centers for Disease Control and Prevention (CDC)
and research and control of cysticercosis
Peter M. Schantz *, Victor C.W. Tsang
Division of Parasitic Diseases, National Center For Infectious Diseases, Centers For Disease Control and Prevention, Atlanta, GA, USA
Abstract
It is generally recognized that it is not possible to adequately protect the health of any nation without addressing
infectious disease problems that occur elsewhere in the world. In 2002, the US Centers For Disease Control and
Prevention (CDC) developed a revised strategy for consolidating, enhancing, and improving the effectiveness of CDC’s
efforts to prevent and control infectious diseases on a global scale. Taenia solium is one example of an imported
infection disease, which impacts on the health of the US population but requires international coordinated efforts to
prevent or limit transmission. This report outlines CDC’s refocused global infectious disease strategy and how CDC
collaborates in international efforts to eliminate taeniasis/cysticercosis.
# 2003 Elsevier Science B.V. All rights reserved.
Keywords: Cysticercosis; Taeniasis; International disease control; International collaboration
1. Introduction
CDC has long engaged in efforts to prevent and
control infectious diseases outside the United
States because it is understood that it is not
possible to adequately protect the health of our
nation without addressing infectious disease problems that occur elsewhere in the world. In
Centers for Disease Control and Prevention
(2002), the US published a document entitled,
‘Protecting the Nation’s Health in an Era of
Globalization: CDC’s Global Infectious Disease
Strategy.’ The refocused strategy recognizes the
accelerating pace of globalization, and the atten-
* Corresponding author. Tel.: /1-770-488-7767.
E-mail address: [email protected] (P.M. Schantz).
dant risks of rapid and widespread disease transmission and provides a blueprint for consolidating,
enhancing, and improving the effectiveness of
CDC’s efforts to prevent and control infectious
diseases on a global scale.
There are six priority areas (Table 1).
1.1. International outbreak assistance
An underlying principle of the global infectious
disease strategy is that international outbreak
assistance is an integral function of and a priority
for CDC. Outbreaks offer unique opportunities to
learn more about the dynamics of disease transmission, the effectiveness of prevention and treatment strategies, and the risk factors for severe or
fatal disease, and the knowledge gained in one
investigation, can be more generally applied in
0001-706X/03/$ - see front matter # 2003 Elsevier Science B.V. All rights reserved.
doi:10.1016/S0001-706X(03)00039-1
162
P.M. Schantz, V.C.W. Tsang / Acta Tropica 87 (2003) 161 /163
Table 1
US investment in global public health: priorities and objectives
International outbreak assistance
Global approach to disease surveillance
Applied research on diseases of global importance
Application of proven public health tools
Global initiatives for disease control
Public health training and capacity building
many other areas. Targeted resources and enhanced capacity for laboratory and epidemiologic
investigations, and the ability to routinely offer
support for follow-up activities including surveillance and the development, implementation and
evaluation of long-term prevention measures are
needed to take full advantage of the opportunities
that international outbreak investigations provide.
1.2. Global approach to disease surveillance
The second priority area is a global approach to
disease surveillance. Accurate information about
emerging infectious diseases needs to travel at least
as rapidly as the diseases themselves, and in this
age of jet travel and 24/7 media coverage, public
health authorities need modern rapid laboratory
diagnostics and electronic connectivity and communication networks to stay one step ahead of the
epidemic wave.
1.3. Applied research on diseases of global
importance
Several years ago, one could have argued that
understanding the complex ecology of the West
Nile virus was not something that would have been
particularly high priority for CDC, since this virus
did not affect US citizens to any great degree. Of
course, subsequent events have changed that
perception. The introduction of West Nile virus
in New York and it is subsequent spread throughout most of the United States have highlighted the
importance of doing research on diseases of global
importance and not just on those diseases that
occur in the United States.
1.4. Application of proven public health tools
Furthering the application of proven public
health tools is the fourth priority. An example of
a proven public health tool is the insecticideimpregnated bed net. These nets have been shown
to reduce morbidity and mortality from malaria in
multiple field trials. Yet, despite this knowledge,
less than 10% of people at risk use bed nets. Other
underutilized proven public health tools include
auto-disable syringes, point-of-use chlorination
and safe storage of drinking water, routine immunization with hepatitis B vaccine, and singledose nevirapine to prevent perinatal HIV transmission. These tools are underutilized for a variety
of reasons, but common problems include a lack
of knowledge among public health authorities and
the target populations, and a lack of access
because of logistic or economic challenges. Beyond
the basic applied research, there is a need for
implementation research that will translate the
science into meaningful differences in infectious
disease morbidity and mortality on a global scale
and in a timely manner.
1.5. Global initiatives for disease control
The fifth priority is participation in global
initiatives for disease control. CDC has participated actively in these initiatives, which are often
led by WHO or other partners. The recently
created Global AIDS Program is one of the
biggest international programs with which CDC
is involved. TB has now become largely an
imported disease in the United States, highlighting
the importance of prevention and control efforts
outside our borders, and we are committed to
working with WHO, USAID, the World Bank,
and other partners in the fight to Roll Back
Malaria. Smallpox, polio, and dracunculiasis are
diseases which have been eradicated or are well on
their way to being eradicated worldwide through
partnerships that have included CDC. Taenia
solium cysticercosis has also been identified as a
potentially eradicable disease and future committed efforts by national bodies deserve our
strong support as well.
P.M. Schantz, V.C.W. Tsang / Acta Tropica 87 (2003) 161 /163
1.6. Public health training and capacity building
The final priority, public health training and
capacity building, is another area in which CDC
has been involved internationally for a very long
time, but at a smaller scale, in terms of financial
resources, than in some of the other areas. There
are, however, some very significant successes, such
as the Field Epidemiology Training Programs and
the International Emerging Infectious Diseases
Laboratory Fellowships, and this is an area where
we believe that additional investments could yield
some very important benefits.
2. CDC and international collaborations on Taenia
solium cysticercosis research and control
T. solium infections in humans have long been
recognized in the United States as an imported
disease with potential for local transmission. The
incidence of imported cases of NCC has increased
markedly in recent years because of improvements
in performance and availability of specific diagnostic techniques and continued immigration of
infected persons from regions where the tapeworm
is endemic/enzootic. A recent survey in 11 states
showed that in states with large Hispanic populations such as California and Texas, neurocysticercosis was the cause of up to 10% of the undefined
seizure cases admitted to hospital emergency
departments. CDC responded to this situation by
developing improved diagnostic techniques, monitoring the emerging epidemic of imported and
introduced cysticercosis in the US and collaborating with investigators in many countries to characterize the epidemiological characteristics and
health impact of the disease in countries where
163
the infection is endemic (reviewed in Tsang et al.,
1989; Schantz et al., 1998).
The Division of Parasitic Diseases, NCID, CDC
is committed to expanded support and collaboration in research and control activities and the
possibilities for collaboration have been enhanced
and formalized through designation of the Division of Parasitic Diseases (NCID, CDC) as WHO/
CDC Collaborating Center for Cysticercosis and
Taeniasis. The mission and objectives of the
Collaborating Center are coincident with several
of the priority areas of the new CDC Global
Infectious Disease Strategy. Specifically, expanded
activities on diagnosis, surveillance, application of
public health tools and disease control are areas
emphasized in the CDC emerging infections goals
in which CDC collaboration might be of assistance
to workers in endemic countries. Development of
collaborative activities is facilitated in cases when
national health services identify T. solium as a
public health priority and solicits international
collaboration.
References
Centers for Diseases Control and Prevention, 2002. Protecting
the Nations Health in an Era of Globalization: CDC’s
Global Infectious Disease Strategy. US Department of
Health and Humans Services, Atlanta, GA.
Schantz, P.M., Wilkins, P.P., Tsang, V.C.W., 1998. Immigrants, imaging and immunoblots: the emergence of neurocysticercosis as a significant public health problem. In:
Scheld, W.M., Craig, W.A., Hughes, J.M. (Eds.), Emerging
Infections. ASM Press, Washington, DC, pp. 213 /242.
Tsang, V.C.W., Boyer, A.E., Brand, J.A., 1989. An enzymelinked immunotransfer blot assay and glycoprotein antigens
for diagnosing human cysticercosis (Taenia solium ). J.
Infect. Dis. 159, 50 /59.