Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Chagas disease wikipedia , lookup
Bioterrorism wikipedia , lookup
Sexually transmitted infection wikipedia , lookup
Onchocerciasis wikipedia , lookup
Leptospirosis wikipedia , lookup
Schistosomiasis wikipedia , lookup
Marburg virus disease wikipedia , lookup
Middle East respiratory syndrome wikipedia , lookup
African trypanosomiasis wikipedia , lookup
Neglected tropical diseases wikipedia , lookup
Cysticercosis wikipedia , lookup
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.