Oct 30, 2012 (CIDRAP News) – An annual report released yesterday by the US Centers for Disease Control and Prevention (CDC) profiles a wide range of CDC influenza-related projects around the world, from flu surveillance in Indonesia to vaccine effectiveness studies in El Salvador and epidemiology training in Ghana.
The 268-page report describes the CDC's collaborations with the World Health Organization (WHO), outlines projects it supports in about 40 countries, and describes specific studies undertaken in many of those countries. It also lists international training conferences it has sponsored and describes the CDC program for sharing diagnostic test kits and reagents.
The report, covering 2011, is the third annual account of the agency's global flu activities, which have expanded greatly in the past decade.
The CDC's international flu efforts began with the first human infections with the H5N1 avian flu virus in Hong Kong in 1997, when the agency helped investigate the outbreak, the report explains. But the major spur to the programs came with the re-emergence of H5N1 and human H5N1 cases in China, Vietnam, and Thailand in 2003 and 2004. Those events pointed up yawning gaps in flu surveillance, laboratory and epidemiologic capacity, and collaboration between animal and human health authorities.
In 2004 the CDC, with the Department of Health and Human Services, "developed a multi-faceted approach to support global capacity for seasonal influenza and pandemic preparedness," the report says. The agency enhanced its support for the WHO's Global Influenza Program and provided support to high-risk countries for flu surveillance and response.
The report says those efforts bore fruit during the H1N1 flu pandemic in 2009, when many countries that had received CDC help were able to show the progress they had made in flu surveillance and response in the previous few years.
"Over the past six years the [international] program has undergone remarkable growth and has expanded to provide support to over 40 countries, all WHO regional offices and WHO headquarters," the report states. More than 20 permanent staff members have been stationed abroad to help local authorities and the WHO and assist CDC Global Disease Detection sites and Department of Defense international program sites.
Collaborations with the WHO
The report details a long list of flu projects on which it has joined forces with the WHO. Some examples include:
- Estimating flu deaths during seasonal epidemic and pandemics
- Creating a tool for community-level risk assessment forH5N1 infection, along with other international agencies
- Reviewing measures of severity during a pandemic and the concept of pandemic phases
- Assessing the effectiveness of school closures
- Providing governments with guidance and support for pandemic preparedness
- Conducting safety inspections at vaccine manufacturing plants
A 44-page chunk of the report is devoted to research projects the CDC is supporting in various countries.
One of these was a hospital study of the effectiveness of the trivalent seasonal flu vaccine used in El Salvador in 2010 in children 6 through 23 months old and adults over 60. The researchers found that the vaccine was 54% effective overall, but the study was hindered by a small sample.
Another study focused on the effectiveness of the pandemic H1N1 vaccine in Bangladesh. The report says the vaccine seemed effective, but "low circulation of pH1N1 hampered our ability to differentiate the proportion of pH1N1 infections among vaccine recipients and those unvaccinated."
Still another study, launched in September 2011, is to be a 5-year examination of the burden and epidemiology of flu and other respiratory diseases, along with flu vaccine effectiveness, in the Southern Hemisphere. It involves public health labs and universities in New Zealand and St. Jude Children's Research Hospital in Memphis. The project is called SHIVERS, for Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance Study.
The report also outlines a number of other research projects in Egypt, Bangladesh, Ghana, Central America, India, Kenya, Madagascar, Peru, Senegal, South Africa, Thailand, and Vietnam.
Another part of the report profiles activities in individual countries. A section on Indonesia, for example, says the CDC supports influenza-like illness surveillance in 24 healthcare centers in 24 provinces and surveillance for severe acute respiratory infections in 10 hospitals nationwide.
The report also cites the East Jakarta Project, launched in August 2011, which provides a model for harmonizing epidemiologic and virologic surveillance and increasing flu surveillance. It "rapidly provided information about the epidemiology, clinical presentation, and virus subtypes circulating in an urban area in one province of Indonesia."
Sharing diagnostic kits, reagents
The document also describes the CDC program for providing flu diagnostic kits and related materials to labs around the world.
Since the 2009 pandemic, it says, the agency has provided pandemic H1N1 virus diagnostic kits, reagents, reference viruses, and other materials to more than 187 labs in 128 countries. The Influenza Reagent Resource, as the program is called, also has provided material to 161 public health labs in 50 US states and territories.
Also counted among the CDC's international flu activities are monitoring and evaluation tools, the report notes. The agency provides tools to help countries assess their pandemic preparedness and response capabilities and their flu surveillance system and tools to help labs evaluate their flu diagnostic capabilities.
The report says the agency conducted four flu-related training conferences in Africa in 2011. The meetings were held in Ghana, Kenya, and South Africa and covered topics including surveillance and epidemiology, detection and diagnosis, research writing, and lab management.
Home page for 2011 annual report of the CDC Influenza Division's International Program