GHSA Success Stories
Community members are often the first to hear of possible disease outbreaks, so engaging them in disease surveillance can decrease the time it takes to detect and respond to outbreaks. At three pilot sites in Burkina Faso, CDC and partners reinforced community event-based surveillance (EBS) detection and notification of outbreaks. EBS tools and operating procedures were developed and validated with field partners and Ministry of Health leaders. Three district health teams, 210 assistant nurses and chief nurses, and 935 community health workers were trained on the EBS tools. In addition, 92 primary healthcare facilities were equipped with tools and standard operating procedures. Within three months after the EBS training, 23 disease events were reported, compared to 14 events notified over the course of the previous year. Burkina Faso’s EBS system includes human health, animal health, and environmental health events, and is shared by WHO and Africa CDC technical working groups as a model from which countries can develop adaptable tools and directives.
Lassa fever is an animal-borne, or zoonotic, acute viral illness. It is endemic in parts of West Africa, including Sierra Leone, Liberia, Nigeria, and Guinea. When a case of Lassa fever that originated in Guinea was detected in Liberia in October 2018, the Guinean National Health Security Agency (ANSS) sprang into action within 24 hours, recognizing that the patient may have infected others before traveling out of the country. ANSS immediately coordinated response activities at the community, regional, and national levels, as well as mobilized partners to support government efforts to limit transmission. With CDC support, Community Health Volunteers were trained to conduct contact tracing to identify all possible contacts. Collectively, these efforts identified 28 contacts that were followed over a 21-day period. Cross-border coordination of community-based surveillance activities and POE health monitoring minimized the potential for the disease to spread. Guinea’s rapid response to a potential epidemic demonstrates that health security investments are smart investments, saving countless lives and stopping disease at its source.
Nipah virus has no cure, kills approximately 75% of the people it infects, and can be spread quickly by both animals and humans. This highlights the need for fast and accurate diagnosis of this fatal emerging zoonotic virus and potential threat to global health security. When Nipah Virus was suspected in India in 2018, accurate diagnosis was swift, as state and central government agencies responded to the outbreak quickly, containing its spread and limiting its severity. The Government of India used the technical expertise gained from training by CDC experts, including the use of next-generation sequencing (NGS) analysis, to swiftly and accurately diagnose the initial Nipah cases, allowing India to do the testing in-country instead of referring samples out for testing to CDC headquarters.
Antimicrobial resistance (AMR) is a growing threat to health security around the world. With support from CDC, Indonesia’s Eijkman Institute for Molecular Biology, in collaboration with the National AMR Committee, established AMR surveillance in four hospitals across the nation and incorporated two additional pathogens, S. pneumoniae and H.Influenzae, into the existing National AMR surveillance platform. Extensive training of hospital laboratory staff helped establish culturing and antimicrobial susceptibility testing capacity for the two WHO priority pathogens. Initial results after only four months of surveillance identified strains of S. pneumoniae with high levels of resistance to several classes of antibiotics. These highly resistant strains were all characterized as a single serotype, which is vaccine preventable. Indonesia has not yet introduced pneumococcal conjugate vaccine and the evidence generated through this new surveillance will be used to inform vaccine policies and National AMR guidelines. CDC and country partners will continue to strengthen this effort by expanding the surveillance system to other hospitals, conducting additional laboratory trainings, and helping the country make evidence-based decisions to combat antibiotic resistance.
Measles is a highly contagious disease that is still a real threat everywhere around the world. A 2018 measles outbreak in Mali threatened the lives of thousands of people throughout the nation, including healthcare providers who were overburdened and working under difficult conditions. Twenty-seven graduates of the CDC-supported Field Epidemiology Training Program (FETP), in coordination with Mali’s Ministry of Health, led the outbreak investigation and conducted contact tracing to stop the spread of the infection. This response, which was initiated within 24 hours of notification of the first case, limited the outbreak to 492 suspected cases and 154 laboratory-confirmed cases. Confirmed measles cases received immediate care, leading to quick recovery times and minimization of exposure to others. From working with the FETP graduates, health officials learned about risk factors for the disease, which informed response interventions, including immunization and sensitization campaigns to increase community awareness. In 2018, 23 new FETP graduates entered the workforce in Mali. More than 115 disease detectives have graduated from the program since the start of the Mali FETP in 2016.
On June 4, 2018, a measles outbreak was reported in two remote communities of Sierra Leone’s Koinadugu district near the Guinean border, striking fear that the outbreak could become a cross-border epidemic. Within 24 hours of beginning the outbreak investigation, four CDC-supported Sierra Leone FETP trainees conducted an active case search and identified new cases, instituted prevention and control measures, reviewed and harmonized the outbreak data, and prepared the outbreak report with the national response team. The district mounted a response within hours, which dramatically reduced the response time from an average of seven days. The outbreak was limited to 31 confirmed cases, the majority of whom were children under five years old. The rapid response and containment of this measles outbreak by Sierra Leone FETP confirms the need for a trained and skilled workforce that can immediately be deployed to stop outbreaks in their tracks and save lives. Since the start of the program in 2016, more than 100 disease detectives have graduated from the Sierra Leone FETP. In 2018 alone, Sierra Leone added 42 FETP graduates to its ranks.
In 2016, CDC launched the first regional acute fever surveillance network in Uganda. Six hospitals, already part of the President’s Malaria Initiative, were selected as sentinel sites across the country. Each hospital now has the capacity to perform, for the first time, blood culture and AMR testing for bloodborne enteric bacteria. From June 2016 to December 2018, more than 40,000 pediatric admissions were assessed, nearly 10,000 blood cultures were completed, and at least 18 pathogenic bacteria species were identified. The introduction of routine antimicrobial drug testing in Uganda has uncovered many resistant strains, which led to appropriately targeted treatment and enabled the Ministry of Health to supply hospitals with alternative antibiotics. Additionally, cases of leptospirosis, arboviruses, and a high prevalence of spotted fever rickettsioses were identified.