The CDC is the lead federal agency to prevent disease, injury, and disability and it must be adequately resourced for known and new public health threats. CDC partners with state and local health departments and global organizations and CDC medical personnel, scientists and other public health professionals respond to public health events 24/7 wherever needed. CDC experts react quickly to events here and abroad, ranging from foodborne illness outbreaks or previously unknown infectious pathogens, to the health crises following earthquakes or typhoons.
The ASM is very concerned that budgetary cuts are seriously eroding CDC’s capabilities in key areas like surveillance, laboratory diagnosis, and control and prevention strategies. The budget constraints now in effect will prove deleterious to our Nation’s public health system. Sequestration mandated cuts will certainly weaken or even eliminate important CDC activities. CDC officials have already announced probable decreases in grant award amounts and in numbers of new awards. Sequestration is expected to cut CDC support to states by more than $200 million, which will unquestionably affect responses to disease outbreaks and other urgent public health problems.
Recent outbreak investigations point to the CDC’s unique and multifaceted capabilities that are at risk under budget shortages. Last year, CDC personnel tracked the fungal meningitis linked to contaminated steroid injections, with over 700 cases and almost 50 deaths across 20 states. CDC’s epidemiologists and laboratories investigated hantavirus infection among visitors to Yosemite National Park, bacterial infections in pediatric oncology patients in Colorado, the unprecedented outbreak of West Nile encephalitis in the Dallas/Fort Worth area. CDC also supported international efforts against infectious diseases, investigating cholera in Sierra Leone, anthrax in the Republic of Georgia, Marburg hemorrhagic fever in Uganda, and other outbreaks elsewhere. CDC funding is critical to building and maintaining the expertise necessary to sustain CDC’s rapid responses to public health threats in the US and worldwide.
As the Nation’s public health agency, CDC continually faces challenges like microbial agents of infectious disease and other illnesses. One in six Americans gets sick each year from eating contaminated food; more than 1,000 foodborne outbreaks are reported to CDC officials annually. The CDC estimates that, each year in the United States, there are nearly 20 million new sexually transmitted diseases (STD) infections incurring lifetime medical costs of $15.6 billion. Despite progress in treating HIV infection, significant challenges remain (e.g., in 2010, an estimated 12,200 new infections in people in the US aged 13-24; in 2011, 2.5 million people newly infected worldwide). Nearly 900,000 children in other countries still die each year from vaccine preventable diseases like rotavirus, hepatitis B, pneumococcal pneumonia, and meningitis. The U.S. has also witnessed a recent upsurge in vaccine-preventable diseases, with over 42,000 cases of pertussis (whooping cough) reported in 2012 alone and declared epidemics in several states. Globalization has meant fewer barriers to the spread of infectious diseases, making CDC’s multi-talented programs even more essential. Human migration contributes considerably to the spread of disease: Each year, about 214 million people move across national borders, three quarter billion within their own countries, and nearly 3 billion travel by plane.
CDC Funding Provides Rapid Response, Surveillance
CDC has more than 15,000 employees and has personnel deployed to over 50 countries, trained to protect through health promotion, prevention of disease and disability, and preparedness. Such widespread, diverse expertise gives CDC its agility to detect and define an expansive array of threats and to respond quickly. The 2012-2017 strategic plan of CDC’s National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) underscores the complexities involved―one overall strategy, intended to “strengthen public health fundamentals,” directs CDC personnel to “advance and increase effectiveness of infectious disease laboratory science, surveillance, epidemiology, information technology, communications, and strategic partnerships.” The CDC budget directly support extensive surveillance, science based epidemiology, and other tools effective in combating disease.
CDC investigations vary from behind the scenes lab support for localized incidents to frontline responses in highly visible outbreaks. An example is CDC’s current collaboration with the World Health Organization (WHO) to better understand a previously unknown respiratory virus, related to the SARS virus that emerged in China in 2002 and rapidly infected 8,000 worldwide. The new coronavirus, thus far called NCoV for novel coronavirus, causes severe lower respiratory disease. As of March 7, there were only 14 confirmed cases reported to WHO, with eight deaths, all among patients with ties to the Middle East, and thus far no cases have been identified in the United States. But CDC and other health organizations that have already faced fast moving outbreaks like SARS are concerned by similar evidence of human-to-human transmission and spread of the virus to other countries, especially given the conflicts and volatility currently engulfing the Middle East. CDC laboratories also are conducting tests on patient specimens to isolate the new virus, as public health officials prepare to engage yet another communicable disease.
CDC regularly applies its scientific expertise and laboratory capabilities to investigate outbreaks both large and limited in scope, including these recent examples:
- CDC investigated more than 300 cases of swine-origin variant influenza virus that occurred last summer and fall across 9 midwestern and mid-Atlantic states. Most cases were in children who attended or exhibited swine at agricultural fairs, and a number of hospitalizations and one death occurred. This virus has acquired genetic material from the 2009 pandemic H1N1 virus, raising concerns about its pandemic potential. CDC and states have been working with 4-H clubs, USDA, and state agriculture agencies to address this emerging public health concern and reduce the risk for the upcoming fair season.
- CDC is collaborating with the US Department of Agriculture's Animal and Plant Health Inspection Service and state health departments to follow an outbreak of human Salmonella typhimurium infections linked to contact with pet hedgehogs. The outbreak strain had been rare, with only one to two cases reported via PulseNet (the national network for foodborne disease surveillance) annually since 2002. Since 2011, an increasing number of cases have been detected, with 14 in 2011, 18 in 2012, and two thus far in 2013.
- In August, CDC investigators and the FDA linked a multi-state outbreak of salmonellosis to contaminated cantaloupes from an individual farm, using pulsed field gel electrophoresis analysis of patient samples. There are over 2,700 serotypes of foodborne Salmonella bacteria, and advanced diagnostic tests used by CDC are essential in accurately pinpointing sources.
- In January, CDC summarized its foodborne surveillance for 2009-2010: 1,527 foodborne disease outbreaks reported, involving 29,444 cases of illness. Among the 790 events with a single confirmed pathogen, 42 percent were caused by norovirus, 30 percent by Salmonella.
CDC must also address the alarming rise of drug resistant pathogens, including Carbapenem Resistant Enterobacteriaceae (CRE). Multiple CDC networks, with input from state health departments, have detected increased cases over the past decade, warning of a potential “nightmare” scenario. CDC officials just released strongly worded reports on the pathogen’s “triple threat”: (1) resistant to all, or nearly all, available antibiotics; (2) causes a high mortality rate (40-50 percent); and (3) can transfer antibiotic resistance to certain other bacteria, even those normally benign. This is yet another example of the continuing threat of health care associated infections (HAIs).
Surveillance networks hosted by CDC collect data on a long list of diseases, using powerful computing and two way communication with thousands of public health partners. These help guide CDC strategy, providing another weapon against both emerging threats, like chikungunya virus or multidrug resistant tuberculosis, and longtime problems like foodborne illnesses. Last year, for instance, CDC surveillance identified a resurgence of WNV infections: By mid-December, there had been nearly 5,390 US cases reported from 48 states, the highest number since 2003. Since 1999, when WNV was first identified in the United States, CDC has tabulated more than 30,000 cases. With transfusion associated cases first reported in 2002, CDC and its partners implemented WNV screening of the US blood supply in 2003, preventing an estimated 3,000 to 9,000 transfusion related infections.
CDC Funding Protects, Promotes Public Health
Using surveillance data, public education, and tools like vaccines, CDC strives to prevent illness and injury, being proactive well beyond reacting to disease outbreaks. To illustrate, although CRE is still limited in the United States, it is typically acquired within healthcare settings. This has prompted CDC to develop a CRE action plan, part of its ongoing education campaigns to both minimize drug resistance among pathogens and prevent costly healthcare associated infections (HAIs). In its latest progress report (February 2013), CDC listed successes against some types of HAIs using stringent infection control measures; for example, a 41 percent reduction in central line associated bloodstream infections since 2008. These CDC efforts embody the obvious: that prevention quite literally is more cost effective than finding a cure.
There are few public health measures as historically effective as immunization against communicable diseases. Both in the United States and elsewhere, CDC has been a major contributor, of personnel, vaccines, expert support systems, to national and global immunization campaigns like those against smallpox and polio. As of 2010, 85 percent of children aged 12-23 months were immunized against measles worldwide. Over the previous decade, measles deaths had been cut by 74 percent. In this country, CDC vigorously promotes vaccination against childhood infectious diseases, influenza, hepatitis, and more. It also evaluates new candidate vaccines through collaborations with medical schools and other federal agencies. Yet last year’s outbreak of whooping cough, a vaccine preventable disease, is a reminder that US vaccination coverage is incomplete and that CDC education efforts must continue.
The ASM strongly urges that Congress increase the CDC budget in FY 2013 and FY 2014 and fund the CDC at the highest possible level.