The American Society for Microbiology (ASM), the largest single life science Society with over 39,000 members, wishes to submit a statement in support of increased funding in the FY 2015 budget for the Centers for Disease Control and Prevention (CDC). As the Nation’s health protection Agency, the CDC’s programs are critical to preventing disease and injury. The CDC conducts scientific investigations, develops public health guidelines and provides information and expertise in response to threats against public health in the United States and worldwide.
The ASM urges Congress to approve the requested budget of $445.3 million for the National Center for Emerging and Zoonotic Infectious Diseases (EZID), an overall increase of $54.9 million over FY 2104. The EZID budget includes an increase of $31 million for Core Infectious Diseases. A funding level of $30 million is included for Advanced Molecular Detection (AMD), year 2 of the 5 year initiative to enhance CDC’s microbiology and bioinformatics capabilities to detect and respond to infectious disease outbreaks. The AMD initiative will improve pathogen identification and detection; adapt new diagnostics to meet evolving public health needs; help states meet future reference testing needs in a coordinated manner; implement enhanced, sustainable and integrated laboratory information systems; and develop prediction modeling and early recognition tools. Advances in biotechnology and computing must be part of CDC efforts against the threat of infectious diseases. Because of the need for better molecular sequencing tools and bioinformatics, last year CDC proposed the AMD initiative, integrating cutting edge laboratory and computer tools to enhance infectious disease prevention and control. A 2013 pilot study tracking a Listeria outbreak demonstrated that AMD technologies and methods could detect outbreaks sooner, halting disease faster. The study used whole genome sequencing with diagnostic testing for the first time to help clarify which patients’ illnesses were related to a listeriosis outbreak linked to contaminated cheese. Listeria ranks third as a cause of death from foodborne pathogens in the United States and sickens about 1,600 people each year.
The EZID budget includes a $10 million increase for CDC’s Food Safety program. This increase is essential to enhance national surveillance outbreak detection and response and food safety prevention efforts. It will help modernize PulseNet and apply advanced DNA technology and expand sites for FoodCORE to improve outbreak detection and response. It will improve foodborne disease tracking, detection and response through the Integrated Food Safety Center of Excellence. Food safety is one of CDC’s foremost strategic goals and heavily reliant upon state of the art surveillance. Last year, the CDC published first ever estimates of which food types were causing foodborne illnesses in the United States. These attribution estimates guide regulators, industry and consumers toward more precise and effective measures to prevent food contamination. In June, a new CDC report identified the key demographic groups most affected by Listeria bacteria infections. During 2009–2011, twelve Listeria outbreaks sickened people in 38 states. CDC partnerships with other public health agencies clearly extend the CDC’s ability to prevent disease. For example, data from the Foodborne Diseases Active Surveillance Network (FoodNet) are the source for CDC’s most recent annual food safety report, which showed that 2012 rates of infection for two foodborne pathogens (Campylobacter and Vibrio) had increased significantly when compared to 2006–2008, while rates of most others have not changed during the same period. FoodNet involves CDC, ten state health departments, the Department of Agriculture and the Food and Drug Administration.
The ASM strongly supports the FY 2015 EZID budget request of $30 million for the Antibiotic Resistance (AR) Strategy, which will speed up outbreak detection through regional labs, support development of new antibiotics and diagnostics and improve infection prevention and antibiotic prescribing. With a $30 million annual funding for 5 years, the AR initiative could achieve reductions in many infections, including C. difficile, carbapenem resistant Enterobacteriaceae (CRE), Multidrug Resistant (MDR) Pseudomosas, Invasive Methicillin-resistant Staphylococcus aureus (MRSA) and MDR Salmonella.
CDC efforts have intensified against microbial pathogens that have evolved resistance against known drug therapies. In September, a landmark CDC report warned that antimicrobial resistant infections infect more than two million people in the United States every year, causing at least 23,000 deaths. CDC ranked AR threats into three categories: urgent, serious and concerning. Infections classified as urgent include CRE, drug resistant gonorrhea and Clostridium difficile, a diarrheal infection that causes about 250,000 US hospitalizations and at least 14,000 deaths annually. Last year, CDC data showed more patients at hospitals and long term care facilities are being diagnosed with CRE infections; other AR reports are equally alarming.
In November, CDC joined with the American Academy of Pediatrics to slow AR expansion with new guidelines, “Principles of Judicious Antibiotic Prescribing for Bacterial Upper Respiratory Tract Infections in Pediatrics.” Every year, up to 10 million children in the United States risk side effects from antibiotic prescriptions unlikely to help their respiratory symptoms. Many of these infections are caused by viruses not treatable by antibiotics. Antibiotic use is the single most important factor in antibiotic resistance, with up to 50 percent of prescriptions unnecessary or prescribed inappropriately. Studies estimate that AR adds $20 billion in excess direct health costs, with additional costs to Society for lost productivity as high as $35 billion a year.
CDC guidelines that include science based prevention protocols can be very effective, for example, the ongoing battle against healthcare acquired infections (HAIs). About 1 in every 20 hospitalized patients develops an infection caused by receiving medical care. Many of these are drug resistant (e.g., three quarters of Staphylococcus aureus infections in hospital ICUs are methicillin resistant MRSA). CDC aggressively promotes use of prevention protocols in all facilities in the United States. In 2013, CDC found that bloodstream infections in patients with central IV lines had decreased by over 40 percent and surgical site infections by 20 percent since 2008 and that following CDC protocols could cut dialysis related bloodstream infections in half. Another CDC coauthored report last fall concluded that there were an estimated 30,800 fewer invasive MRSA infections in 2011 compared with 2005. More than 12,000 healthcare facilities now track HAI infections using CDC’s National Healthcare Safety Network (NHSN).
Surveillance and Response
CDC depends upon extensive surveillance networks and unique rapid response mobilization. Sustaining these CDC capabilities is critical to detect health threats, halt outbreaks and prevent illness and injury. Familiar threats like hepatitis and HIV/AIDS continue to affect lives. Public health institutions also are repeatedly challenged by emerging infectious diseases (EIDs), unexpected and often dangerous. CDC regularly confronts new threats, including the following EIDs in the past year:
- CDC scientists traced the newly discovered Heartland virus that infected two men from Missouri to lone star ticks in the region, adding another tick borne disease to those the CDC monitors.
- NCEZID helped identify a novel poxvirus (the same genus as smallpox) afflicting shepherds in the Republic of Georgia and is developing new diagnostic tests.
- International travel advisories released by CDC address threats posed by the new coronavirus MERS-CoV, first reported by Saudi Arabia in 2012. CDC is working with health departments, hospitals and other partners to prepare for possible cases in the United States.
- CDC is monitoring new reports of the mosquito borne chikungunya virus among residents of St. Martin in the Caribbean, the first time the disease has been detected among non-travelers in the Western Hemisphere.
In 2013, CDC updated new surveillance results on several infectious diseases with serious healthcare and economic consequences in the United States:
- Each year there are about 19 to 21 million cases of norovirus illness, about 570 to 800 people die, and many thousands more are hospitalized or visit emergency rooms and outpatient clinics. Another CDC study found that the contagious stomach virus is now the leading cause of acute gastroenteritis among children less than 5 years of age who seek medical care. It caused nearly one million U.S. pediatric visits in 2009–2010.
- About 300,000 people are diagnosed with Lyme disease each year in the United States, making it the most commonly reported tick borne illness. The early estimate is based on findings from three ongoing CDC studies. It suggests that the total number is roughly 10 times higher than the number reported to CDC by healthcare providers.
- Valley Fever, a fungal respiratory infection, dramatically increased in several southwestern states, from 2,265 in 1998 to more than 22,000 in 2011. CDC is investigating whether the increase is related to changes in weather, rising populations or changes in the way the disease is detected and reported to the states or CDC.
Each year, CDC gives financial support to all 50 state health departments, six local departments, and eight territories or affiliates. Since 2010,CDC has provided funds to 57 state, local and territorial health departments to increase the use of electronic lab reporting (ELR). About 10,400 labs send reportable data to health agencies but many do not report electronically.
With globalization of our food supply and frequent travel to and from the United States, health security threats can come from anywhere. CDC’s Center for Global Health and Office of Infectious Diseases oversee Agency efforts to prevent, detect and respond to outbreaks in other countries. There are more than 1,600 CDC employees located in over 60 countries. At present, only 1 in 5 countries can rapidly detect, respond to or prevent global health threats caused by emerging infections. Improvements overseas, such as strengthening surveillance and lab systems or training investigators, make both the United States and the rest of the world more secure against infectious disease.
In January, CDC reported results from pilot projects in Uganda and Vietnam to improve disease detection and response capabilities. Work in Uganda modernized diagnostic testing, developed real time information systems for faster outbreak response and improved emergency operations procedures. It focused on three priority diseases, drug resistant tuberculosis, cholera and viral hemorrhagic fever caused by Ebola virus. The Vietnam project trained Vietnamese health officials in advanced PCR techniques to detect H7N9 influenza, enterovirus 71 and respiratory viruses.
The ASM strongly urges Congress to increase CDC’s budget in FY 2015 to the highest level possible and approve funding increases for infectious diseases.