HHS FACT SHEET
December 2, 1998
Contacts: CDC Press Office (404) 639-3286

NIH Press Office (301) 496-5787

HHS INITIATIVES TO COMBAT EMERGING INFECTIOUS DISEASES

Overview: Emerging infectious diseases present one of the most significant health challenges facing the global public health community today. Infectious diseases -- those caused by microscopic organisms and spread from person to person -- are the leading cause of death worldwide. Efforts to control them in the United States have led to important achievements in public health. But infectious diseases not only continue to occur, they are growing in number, type and importance to the health of the population globally. Examples include the outbreak of avian flu in Hong Kong in 1997, as well as outbreaks of Ebola hemorrhagic fever, hantavirus pulmonary syndrome, drug-resistant infectious diseases, HIV/AIDS, and foodborne diseases. The direct costs of infectious diseases in the United States alone are estimated to be more than $30 billion a year.

Since 1993, HHS health agencies have worked to strengthen our nation's defense against emerging infectious diseases. The Centers for Disease Control and Prevention (CDC) has primary responsibility for disease surveillance and prevention in the U.S., and it has developed a comprehensive strategy to improve the nation's methods for combating the threats posed by new and reemerging infectious diseases.

As part of its comprehensive strategy, CDC is working with states and international organizations to improve early disease detection and outbreak containment. The National Institutes of Health (NIH) is supporting research on detecting and controlling emerging infectious diseases and on the biology and pathology of infectious agents. Other HHS agencies such as the Food and Drug Administration (FDA) work to assure that the American public is protected from infectious diseases potentially spread by the food supply and other sources.

In June 1996, President Clinton issued a Presidential Decision Directive on Emerging Infectious Diseases. The directive sets policy and provides for coordination across the federal government in improving domestic and international disease surveillance, prevention, and the response measures.

HHS funding to combat emerging infectious diseases includes $79 million in FY 1999. A complementary joint effort in CDC and FDA is an initiative to counter food borne diseases totals $68.5 million in HHS funding in FY 1999.

BACKGROUND

In the years following World War II, it was widely believed that humans were winning the war against infectious disease. Life-threatening bacterial diseases such as tuberculosis and typhoid fever could be treated by antibiotics, and childhood diseases such as polio and whooping cough could be conquered through vaccination. The incidence of infectious diseases had been reduced dramatically.

But in the 1950s, penicillin began to lose its power to cure infections cause by Staphylococcus aureus, a common bacterium that can cause serious illness. In 1957 and 1968, new strains of influenza emerged in China and spread rapidly around the globe, and in the 1970s there was a resurgence of sexually transmitted diseases. Also during the 1970s, several new diseases were identified, including Legionnaires' disease, Lyme disease, toxic shock syndrome, and Ebola hemorrhagic fever. During the 1980s, as state and local support for infectious disease surveillance declined, acquired immune deficiency syndrome (AIDS) appeared and tuberculosis reemerged, spreading quickly through U.S. cities.

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

By the early 1990s, health experts no longer believed that infectious diseases were receding in the U.S. or elsewhere. In 1994, CDC launched a national effort to revitalize the U.S. capacity to protect the public from infectious diseases. CDC released an updated plan in November 1998. The strategy includes:

• Working in partnership with states to strengthen surveillance in the U.S. and to establish a coordinated global surveillance network with international partners;
• Developing new diagnostic tests;
  
  
• Enhancing emergency response capability to investigate and respond to infectious disease outbreaks;
• Developing and implementing guidelines for the prevention of infectious diseases; Strengthening the public health system by ensuring adequate personnel facilities, equipment, and supplies at the Federal, state and local level;
• Developing treatment and prevention strategies for targeted populations (e.g. women and minorities);
• Providing necessary training to public health surveillance and laboratory personnel; and
• Targeting research and prevention efforts.

Already, CDC's comprehensive plan has produced results. CDC has identified quick and accurate methods for diagnosing Cyclospora, improved its mechanism for identifying and controlling Ebola outbreaks, improved global influenza surveillance, and implemented a rapid response and outreach system for E.coli outbreaks.

Key elements of CDC's strategy that have already been implemented include:

• Establishing physician-based Emerging Infections Sentinel Networks (EISNs) to detect outbreaks and monitor emerging infectious disease incidence. Sentinel networks link groups of participating individuals or organizations to a central data receiving and processing center, which allows these groups to share information on emerging infections. CDC started the first EISN in 1995 with 11 academically affiliated emergency departments. A second EISN composed of more than 500 infectious disease specialists practicing in 47 states, the District of Columbia, and Puerto Rico, was formed in collaboration with the Infectious Disease Society of America. The third EISN network was established in 1996 and is composed of more than 22 travel medicine clinics located in the U.S., Canada, Germany, Australia, New Zealand, and Nepal.
  
  
• Creating population-based Emerging Infections Programs (EIPs) to conduct surveillance for bacterial diseases, pneumonia, and foodborne diseases. Since 1995, EIPs have been established in 7 states: California, Connecticut, Minnesota, Oregon, Georgia, New York, and Maryland. The EIPs include and expand upon the everyday functions of health departments by including population- based surveillance to identify specific infectious diseases.
  
  
• Increasing outreach to health care professionals and the public on emerging infectious diseases and drug-resistance. In 1995, CDC began publishing a quarterly journal entitled Emerging Infectious Diseases. The peer-reviewed journal is made available in hard copy and on the Internet and has approximately 20,000 subscribers.

NATIONAL INSTITUTES OF HEALTH (NIH)

NIH is responsible for research and training aimed at the development of vaccines, therapies, and diagnostics for emerging and reemerging infections. In 1996, the National Institute of Allergy and Infectious Diseases (NIAID) at NIH developed "A Research Agenda for Emerging Infectious Diseases," which identified three goals. These include research on environmental factors that influence disease emergence and create resistance to antibiotics, development of vaccines and medications, and education and training, both nationally and internationally, to help control future emergence of infectious diseases.

To put these goals into practice, NIH institutes have undertaken numerous research activities.

• To expand fundamental research on emerging and reemerging diseases, NIAID issued a 3-year program announcement in 1996, which has distributed $6.8 million to 38 grantees for research in areas such as environmental/ecological influences, development of disease resistance, and finding improved detection and prediction methods. Additional research initiatives have been targeted toward specific emerging or reemerging diseases, including hepatitis C, Helicobacter pylori, aspergillosis, ehrlichiosis, streptococcal infections, emerging viral diseases, tuberculosis and malaria.
  
  
• In 1997 NIH convened a panel of outside experts on the emergence of drug resistance to Staphylococcus aureus, which led to development of a comprehensive plan to address this problem. Several components of this plan have been implemented, including the release of a request for proposals to establish a network linking researchers with doctors treating patients with these conditions.
  
  
• NIH continues to support clinical trials of new vaccines and drugs for infectious diseases. Examples include the evaluation of a single-dose oral cholera vaccine and the use of intravenous ribavirin therapy for treatment of hantavirus pulmonary syndrome. In addition, the agency is expanding its international network of collaborative research projects targeting infectious diseases as well as malaria and tuberculosis.
  
  
• The Pennsylvania State University Shiga-Toxin Producing Escherichia Coli (STEC) center, supported by NIH, is a reference center designed to facilitate research on the strain of E. coli that produces shiga-like toxins, which can cause severe diarrhea and hemolytic uremic syndrome. The STEC center provides a standard reference collection of well-characterized strains of E. coli and a central, online accessible database.

FOOD AND DRUG ADMINISTRATION (FDA)

The FDA has developed working groups to address antibiotic resistance as it relates to new drug approvals. One group, the Antibiotic Resistance Coordinating Committee, educates health care professionals on antibiotic resistance and the appropriate use of antibiotics. It also reviews consumer ads and television commercials intended to market antibiotics to the public.

Another working group convened a workshop with industry representatives in July 1998 to discuss potential development of treatments due to antibiotic-resistant organisms. The committee also discussed the definition of antibiotic resistance, clinical trial design, and methods to encourage prudent use of antibiotics.

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