Global Disease Detection (GDD) Program:
2004-2018 History and Accomplishments

Background

For over a decade, the Global Disease Detection (GDD) Program built global health security capacity to respond to infectious disease threats and protect American lives by helping countries meet their commitments to the International Health Regulations (2005).

The GDD Program was created by the U.S. Congress in 2004 in response to the severe acute respiratory syndrome (SARS) pandemic and was designed to gather resources so countries could prepare for potential infectious disease threats1,2. The program harnessed CDC expertise to work with partners including ministries of health, nongovernmental organizations, the private sector, and other U.S. government agencies. Specific activities included developing surveillance and laboratory capacities for key diseases to improve health outcomes, limiting disease spread, and building collaborative workforce development programs such as the Field Epidemiology Training Program.

History and Approach

The ten international GDD Regional Centers (RCs) were established between 2004 and 2013 in Thailand, Kenya, Guatemala, Egypt, China, Kazakhstan, Bangladesh, India, South Africa, and Georgia.

The GDD Program engaged with ministries of health and other implementing partners to improve the local capacity in technical areas such as epidemiology, emergency management and response, laboratory biosafety and biosecurity, quality management systems, and level-appropriate diagnostic methodologies. Widely recognized as public health experts, GDD Program staff regularly worked with regional partners to provide fast and reliable support to contain and stop outbreaks before they spread.

The GDD Program supported country capacity building needs, while providing detailed technical assistance for outbreak investigations. The GDD Program successfully mobilized CDC subject matter experts around the agency to support outbreak response activities and worked collaboratively on public health research studies to improve understanding of the causes and burden of disease. These international centers were resources for neighboring countries and worked to improve public health regionally through scientific evidence-based capacity building activities and partnerships with countries.

GDD Regional Centers and Countries receiving Technical Assistance* (2016-2018)

GDD Regional Centers (10): Bangladesh China Egypt Georgia Guatemala India Kazakhstan Kenya South Africa Thailand Countries that received technical assistance (98): 2006-2018 (108) Afghanistan Angola Argentina Armenia Australia Azerbaijan Bahrain Belize Benin Bhutan Brunei Burkina Faso Burma Burundi Cambodia Cameroon Chile Colombia Comoros Costa Rica Cote d'Ivoire Democratic Republic of Congo Djibouti Dominican Republic East Timor El Salvador Ethiopia Finland Ghana Guinea Honduras Hong Kong Indonesia Iraq Islamic Republic of Iran Jordon Kurdistan Kuwait Kyrgyzstan Lao PDR Lebanon Lesotho Liberia Libya Madagascar Malawi Malaysia Maldives Mali Mauritius Mongolia Morocco Mozambique Myanmar Namibia Nepal Nicaragua Niger Nigeria North Korea Oman Pakistan Palestine Panama Peru Philippines Qatar Republic of Congo Rwanda Saudi Arabia Senegal Seychelles Sierra Leone Singapore Somalia South Sudan Sri Lanka Sudan Swaziland Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania Togo Tunisia Turkmenistan Uganda Ukraine United Arab Emirates United Kingdom United States Uzbekistan Venezuela Vietnam Yemen Zambia Zimbabwe

*CDC’s GDD Regional Centers worked in partnership with ministries of health and other organizations

Activities

High level containment PPE donning and doffing exercise during laboratory biosafety and biosecurity training in Dhaka, Bangladesh (2016).
Bangladesh

High level containment PPE donning and doffing exercise during laboratory biosafety and biosecurity training in Dhaka, Bangladesh (2016).

2016 vaccination in a Post-Exposure Prophylaxis (PEP) clinic for rabies exposure, Beijing. Photo: Dr. Jeanette Rainey, DGHP China
China

2016 vaccination in a Post-Exposure Prophylaxis (PEP) clinic for rabies exposure, Beijing.
Photo: Dr. Jeanette Rainey, DGHP China

CDC Egypt Program Director Dr. Mark Wooster presents a Damanhur Study Certificate of Appreciation to Egypt Ministry of Health and Population (2019).
Egypt

CDC Egypt Program Director Dr. Mark Wooster presents a Damanhur Study Certificate of Appreciation to the Ministry of Health and Population (2019).

Disease detectives investigate a case of novel Orthopox virus in Georgia during early 2009. Photo: CDC
Georgia

Disease detectives investigate a case of novel Orthopox virus in Georgia during early 2009.
Photo: CDC

The GDD Regional Center for Central America, CDC’s Division of Vectorborne Diseases, and Universidad del Valle de Guatemala worked closely to collect bat-related pathogen specimens (2012).
Guatemala

The GDD Regional Center for Central America, CDC’s Division of Vectorborne Diseases, and Universidad del Valle de Guatemala worked closely to collect bat-related pathogen specimens (2012).

Dr. James J. Sejvar (CDC) examines an Acute Encephalitis Syndrome (AES) patient three weeks after hospital discharge (2013). Photo: Satish Kumar
India

Dr. James J. Sejvar (CDC) examines an Acute Encephalitis Syndrome (AES) patient three weeks after hospital discharge (2013). Photo: Satish Kumar

As part of a 2019 cooperative rickettsial disease surveillance in Pavlodar Oblast, Kazakhstan, staff receive training in tick collection and laboratory testing.
Kazakhstan

As part of a 2019 cooperative rickettsial disease surveillance in Pavlodar Oblast, Kazakhstan, staff receive training in tick collection and laboratory testing.

Site visit to collect data from a Health and Demographic Surveillance System household (2016).
Kenya

Site visit to collect data from a Health and Demographic Surveillance System household (2016).

University of Pretoria and South African National Institute of Communicable Diseases scientists conduct field work to trap and sample bats, testing for novel and pathogenic viruses.
South Africa

University of Pretoria and South African National Institute of Communicable Diseases scientists conduct field work to trap and sample bats, testing for novel and pathogenic viruses.

DGHP Thailand biosafety officer demonstrates biosafety cabinet air flow patterns for laboratory technicians and veterinarians at the Thai National Institute of Animal Health in Bangkok, Thailand (2017).
Thailand

DGHP Thailand biosafety officer demonstrates biosafety cabinet air flow patterns for laboratory technicians and veterinarians at the Thai National Institute of Animal Health in Bangkok, Thailand (2017).

Outbreak Response

Between 2006 and 2018 the GDD Regional Centers (RCs) responded to 2,377 outbreaks and events in 62 countries for diseases and illnesses which included gastrointestinal, respiratory, vaccine-preventable, hemorrhagic, neurological, and zoonotic diseases. Technical assistance provided during these outbreaks and events included boots-on-the-ground field response, the introduction of laboratory diagnostic tests, and emergency response assistance to other public health emergencies, such as natural disasters. Sixty-two percent of requests for assistance to GDD RCs were acknowledged and responded to within 24 hours. An additional 19% of responses occurred within 25 to 48 hours. GDD RCs also worked to improve laboratory capacity during outbreaks to quickly identify and respond to pathogens of public health significance in countries and within the region. Sixty-seven percent of outbreaks received laboratory support and 83% of outbreaks that received laboratory support found the cause of the outbreak.

Developing the Capacity to Prevent, Detect, and Respond to Emerging Threats

The GDD Program, working in partnership with ministries of health, agriculture, and other key national and regional partners, helped build a global health workforce to improve the quality of epidemiology and laboratory sciences, thus improving country capacity to prevent, detect, and respond to new threats. From 2006 to 2018, GDD Regional Center staff and partners held nearly 4,000 training sessions and trained more than 131,500 health care and public health professionals in a range of topics including, but not limited to:

  • Epidemiology, Surveillance, and Laboratory
  • Emergency Management
  • Health and Risk Communication

Strengthening Public Health Laboratory Systems

The GDD Program helped countries develop robust public health laboratory networks focusing on building capacity around specimen collection and management, quality management systems, and biosafety and biosecurity. Technical assistance was provided to laboratories at the national, regional, and district levels, and support was provided to local universities and both public and private hospitals.

Strains and Pathogens New to the World Identified Between 2007 and 2014
Novel strains and pathogens new to the world in which GDD Regional Centers contributed to detection and identification

Year

GDD Center

Pathogen Name

Year

2007

GDD Center

Thailand

Pathogen Name

Bartonella tamiae

Year

2010

GDD Center

Egypt

Pathogen Name

Novel Vibrio cholera genotype

Year

2010

GDD Center

Egypt

Pathogen Name

Novel Crimean Congo hemorrhagic fever

Year

2010

GDD Center

Kenya

Pathogen Name

Bartonella novel species from bat flies

Year

2011

GDD Center

Kenya

Pathogen Name

Rickettsia asemboensis (candidate species)

Year

2011

GDD Center

Thailand

Pathogen Name

Bartonella vinsonii subsp. vinsonii

Year

2011

GDD Center

Guatemala

Pathogen Name

Influenza virus A/Hi&N10

Year

2011

GDD Center

Guatemala

Pathogen Name

Bartonella desmodus (candidate species)

Year

2013

GDD Center

Georgia

Pathogen Name

Novel Zoonotic orthopoxvirus (Akhmeta virus)

Year

2014

GDD Center

China

Pathogen Name

Clostridium difficile (novel hypertoxigenic strain)

Year

2014

GDD Center

Kenya

Pathogen Name

Novel rhabdovirus (Fikirini rhabdovirus)

The GDD Program strengthened laboratory capacities, mostly through technical assistance for

  • Implementing quality management system to support accreditation and certification
  • Developing laboratory diagnostic testing capacity
  • Conducting laboratory facility assessments and advising on laboratory design

Building the Evidence Base for Global Health Security

Over the last decade, the GDD Program committed to documenting advances in scientific knowledge and the impact that program and partners were having on global public health. In collaboration with subject matter experts from CDC and around the world, 1,065 articles were published in the scientific and peer-reviewed literature on topics such as respiratory illness, public health capacity strengthening, and antimicrobial resistance.

During 2017-2018 alone, the GDD Program published 179 peer-reviewed articles covering anthrax, avian influenza, brucellosis, gastrointestinal diseases, MERS-CoV, multi-drug resistance, nipah virus, rabies, Rift Valley fever, scrub typhus, tuberculosis, and vaccine preventable diseases. Several publications covered international multi-site network studies such as the Pneumonia Etiology Research for Child Health (PERCH) study, Global Enteric Multicenter Study (GEMS), and the WHO Global Foodborne Infections Network.

Not only did the GDD Program support the advancement of scientific knowledge through journal publications, but it also worked with ministries of health to develop policy and guideline documents. During 2017 and 2018, the GDD Regional Center staff helped create 132 products including laboratory methods documentation, protocols ensuring standard processes in disease, curriculum development for rapid response team trainings, and guideline development for national laboratory strategic plans. The most common products were

  • Position papers/editorials: 22%
  • Guideline development/revision: 21%
  • Standard operating procedures: 18%
  • Protocols: 13%
  • Policy documents: 8%
  • Training modules: 4%
Providing the Foundation for Global Health Security Work

The GDD Program is part of a long and significant history at CDC of protecting public health globally. Global health is constantly changing, and the work started by GDD is not finished. As part of global health security, CDC will continue to work with countries to develop the capacities and systems that are sensitive enough to signal a new health threat, specific enough to pinpoint problems and focus resources, and flexible and connected enough to protect the world’s economic and social wellbeing. Lessons learned through the lens of the GDD Program offer CDC and countries a way forward as we continue to work to keep our nation and our world safe, healthy, and secure.