National Center for Emerging and Zoonotic Infectious Diseases

Office of the Director

Emerging and Zoonotic

Infectious Diseases Updates

HICPAC Meeting

July 16, 2015

Beth P. Bell, MD, MPH

Director

National Center for Emerging and Zoonotic Infectious Diseases

Centers for Disease Control and Prevention

NCEZID FY2015 Appropriations

� $405 million for Emerging and Zoonotic Infectious

Diseases in FY2015� $352.99 million budget authority

� $52 million Prevention and Public Heath Fund

� Supports activities focused on:� Foodborne / waterborne 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

FY2016 President’s Budget Request

Budget Highlights Include:

• $264 million increase for

antibiotic resistance

• $10 million increase for

laboratory capacity and

safety

• $14 million increase for

the National Healthcare

Safety Network

Signature Programs

EID Journal

National Healthcare Safety

NetworkThe Yellow Book

Laboratory Response

Network

PulseNet

Epidemiology and Laboratory

Capacity for Infectious Diseases

EIP

Emerging Infections

Program

Strengthening State and Local CapacityEpidemiology and Laboratory Capacity for Infectious

Diseases Cooperative Agreement (ELC)

• Supports 50 state health departments, 6

largest local health departments, and 8

territories or US affiliates

• Support >20 specific disease areas, e.g.,

influenza, foodborne disease, HAIs

• Provides cross-cutting support for infectious

disease epidemiology, laboratory and health

information systems

Responding to Outbreaks

In 2014, NCEZID received 37 requests from

states and other countries to assist

Blue Bell Ice Cream ~ Listeria

• 10 ill people in 4 states – 3 deaths

• Recall of ALL products

• Collaboration and data sharing

CRE ~ Duodenoscopes� Number of CRE outbreaks traced back to

duodenoscopes

� NCEZID helped state assess duodenoscope

cleaning and disinfection practices;

developed an interim protocol for facilities

that want to test their duodenoscopes for

contamination with bacteria

Botulism

� Many sickened, 1 death

� Linked to a church potluck

� CDC released anti-toxin from SNS

� NCEZID sent 3 staff members to assist in

investigation

CDC’s Ebola Response

� 373 days of EOC activation as of July 16, 2015

� 27,564 Reported cases* in Sierra Leone, Liberia, and Guinea. Over 11,000

reported deaths

� 3000+ CDC staff involved in the response in the past year

� 6,800 communications products & 360 scientific documents cleared

� 35,000+ responses to Ebola-related inquiries

� 1,105 responses to calls from U.S. doctors and health departments

about patients with possible Ebola. Most did not require testing.

� 150,000 US healthcare workers trained via webinars and calls

� Internet users have watched CDC PPE videos 445,849 times

* Suspected, probable, and confirmed cases as of July 4, 2015

• While the situation in West Africa has improved, there is more work to

be done• New Ebola cases in Sierra Leone and Guinea, many of which have

unexplained chains of transmission

• On June 29, routine surveillance detected a new confirmed case of Ebola

in Liberia—the first since March 20. The person died on June 28 and

postmortem testing confirmed Ebola. Four subsequent cases have been

confirmed.

• CDC is committed to continuing to help the affected countries get to

zero new cases of Ebola by working with local ministries of health and

international partners

National Momentum on AR

AR Threat Report

FY 15 Detect and Protect Initative

National Strategy & PCAST Report

FY 16 AR Solutions Initiative

National Action Plan

WH Antibiotic

Stewardship Summit

• Released March 27, 2015

• Outlines steps to implement the National Strategy and address policy recommendations of the PCAST report

• Significant outcomes expected by 2020

• Activities are consistent with investments in the FY 16 budget

• Companion TB Action Plan under development

National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB)

11

National Strategy for Combating Antibiotic-Resistant

Bacteria (CARB) Goals for the U.S. Government

1. Slow the Emergence of Resistant Bacteria and Prevent the

Spread of Resistant Infections

2. Strengthen National One-Health Surveillance Efforts to

Combat Resistance

3. Advance Development and Use of Rapid and Innovative

Diagnostic Tests for Identification and Characterization of

Resistant Bacteria

4. Accelerate Basic and Applied Research and Development for

New Antibiotics, Other Therapeutics, and Vaccines

5. Improve International Collaboration and Capacities for

Antibiotic Resistance Prevention, Surveillance, Control, and

Antibiotic Research and Development

1. Slow the Emergence of Resistant Bacteria and Prevent the

Spread of Resistant Infections

2. Strengthen National One-Health Surveillance Efforts to

Combat Resistance

3. Advance Development and Use of Rapid and Innovative

Diagnostic Tests for Identification and Characterization of

Resistant Bacteria

4. Accelerate Basic and Applied Research and Development for

New Antibiotics, Other Therapeutics, and Vaccines

5. Improve International Collaboration and Capacities for

Antibiotic Resistance Prevention, Surveillance, Control, and

Antibiotic Research and Development12

FY16 AR Solutions Initiative:

New Chapter $264 Million

Detect & Respond

• Regional Lab• EIP• NARMS

Protect

• State AR Prevention (Protect) Programs

• Stewardship

Innovate

• Microbiome• Prevention Epi-Centers

� Comprehensive Tracking

� Rapid Detection

� Faster Outbreak Response

� Insights for Research Innovation

� Better Patient Care

� Improved Prescribing

CDC’s proposed FY 16 AR activities will also be supported through the FY 16 proposed increase to CDC’s National Healthcare Safety Network (NHSN).

Chikungunya in the Western

HemisphereCountries and territories in the Americas where locally acquired chikungunya cases have been reported.

Cumulative CHIK in the Americas (July 2015)

• 44 countries or territories in the Caribbean,

Central America, South America, and North

America.

• 1,561,553 suspect/confirmed cases

• The outbreak will likely continue to spread

to new areas in the Americas.

Cases in the Continental United States (2014)

• 47 states reporting cases, and the District of

Columbia

• 2,760 travel-associated cases

• 17% from FL

• 29% from NY

• 11 locally-acquired cases (FL)

Advanced Molecular Detection and Response to Infectious Diseases

AMD combines

• Traditional epidemiology

• Genomic sequencing

• Bioinformatics

AMD projects

• Target specific pathogens and improve laboratory methods

• Span multiple CDC laboratories and many state and local

partner laboratories.

• Aim to develop innovations that will help CDC transform

public health and protect people from disease threats

Nationwide Listeriosis Surveillance Using WGS

• 1338 patient isolates and 1363 food and

environmental isolates sequenced as of Feb. 18,

2015

• Compared with PFGE, WGS• Detected clusters faster and sped investigations

• Excluded cases from PFGE clusters

• Included isolates with different PFGE patterns in same

cluster

• Identified clusters not detected by PFGE

• Strongly linked patient isolates with food and

environmental isolates

• Successful pilot demonstrates WGS can eventually

replace PFGE

• Emerging organisms

• Drug resistance

• Intentional creation

• Societal commitment

• New technologies

• Success leads to success

• Prevent wherever possible

• Detect rapidly

• Respond effectively

33 33 33Risks Opportunities Priorities

Supporting Global Health Security

© David Snyder/CDC Foundation

Global Health Security• CDC received $1.193 billion in FY2015 to build core public health

capacities around the world

– $597 million GHS appropriation

– $596 million in the Ebola Emerging Funding Request

• GHS focuses on 11 targets:

PREVENT DETECT RESPOND

Antimicrobial Resistance

Infection Control

National Laboratory

System

Emergency Operations

Center

Zoonotic Diseases Surveillance Link Public Health and

Law Enforcement

Biosafety & Biosecurity Information & Reporting Medical

Countermeasures

Immunization Workforce Development

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333

Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official

position of the Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention

National Center for Emerging and Zoonotic Infectious Diseases