CDC (Centers for Disease Control and Prevention)

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CDC (Centers for Disease Control and Prevention)

Introduction

The Centers for Disease Control and Prevention (CDC) is part of the federal government's U.S. Department of Health and Human Services. Its headquarters are in Atlanta, Georgia. By maintaining viable relationships with state health departments and other related organizations, the CDC researches all aspects of diseases, along with developing and applying disease prevention and control, environmental health, and health education activities for all citizens of the United States. CDC also participates in international infectious disease research and response.

CDC has about 15,000 employees and 6,000 contractors in various positions, including biologists, behavioral and social scientists, physicians, veterinarians, microbiologists, statisticians, chemists, economists, engineers, epidemiologists, statisticians, and various other scientists and support personnel. CDC's headquarters coordinates its operations across the United States and Puerto Rico, including regional offices in Alaska, Colorado, Ohio, Maryland, North Carolina, Pennsylvania, Washington State, Washington D.C., and West Virginia. Other CDC employees are located in about 45 countries around the world.

History and Scientific Foundations

The CDC was established on July 1, 1946, in Atlanta, Georgia, under its original name: the Communicable Disease Center (CDC). At that time, it had fewer than 400 employees. Its founder was U.S. public health official Joseph Walter Mountin (1891–1952).

The organization was established out of the U.S. military agency called the Office of Malaria Control in War Areas, which was active during World War II (1939–1945). By taking over the military office, the CDC gained access to over six hundred military bases and related establishments in order to combat mosquitoes carrying malaria, which was still prevalent in the southern states. Besides malaria, the fledgling organization also worked with typhus and other infectious diseases.

The agency hired engineers, entomologists (scientists that study insects), and physicians to research and develop ways to combat infectious health problems. These professionals of the Communicable Disease Center, a part of the U.S. Public Health Service, fought mosquito-carrying malaria with the use of the insecticide DDT that is now restricted in the United States and many other countries of the world. In those years, the organization sprayed millions of homes for malaria.

By 1947, Mountin was promoting his organization as an effective organization to pursue additional public health issues such as birth defects, chronic diseases, communicable diseases, health statistics, injuries, occupational health, and toxic chemicals. The organization expanded its operations when fifteen acres of Emory University land in Atlanta, Georgia, was donated by Robert Woodruff, chairman of the board of the Coca-Cola Company. The campus included two Biosafety Level 4 laboratories and other scientific facilities. Branches were established in Morgantown, West Virginia; Cincinnati, Ohio; Fort Collins, Colorado; and locations overseas.

Over the next sixty years, the organization expanded its expertise in the control and prevention of diseases. In 1970, its name was changed to the Center for Disease Control in order to include all of its work with communicable diseases such as AIDS (acquired immunodeficiency syndrome); chronic diseases such as cancer and heart disease; emerging diseases; birth defects such as those caused by lead poisoning; occupational illnesses and disabilities; injury control; workplace hazards; blood supply; environmental health threats; and bioterrorism.

In 1980, with expansion of the organizational structure, its name was changed to the Centers for Disease Control. Twelve years later, in 1992, its current name was adopted: the Centers for Disease Control and Prevention. The U.S. Congress requested that the organization maintain the initials CDC when its new, longer name was adopted.

Applications and Research

The hierarchy of the CDC begins with the Office of the Director and the National Institute for Occupational Safety and health. The Office of the Director manages and coordinates the activities of the CDC by providing overall direction to its scientific and medical programs and by providing leadership and assessment of administrative management activities. The National Institute for Occupational Safety and Health, which joined the CDC in 1973, ensures safety and health for all people in the workplace.

Six coordinating centers concentrate on specific areas of concern. Three of its coordinating centers are the: (1) Coordinating Center for Environmental Health and Injury Prevention (National Center for Environmental Health and National Center for Injury Prevention and Control); (2) Coordinating Center for Health Information Service (National Center for Health Marketing, National Center for Health Statistics, and National Center for Public Health Informatics); and (3) Coordinating Center for Health Promotion (National Center on Birth Defects and Developmental Disabilities, National Center for Chronic Disease Prevention and Health Promotion, and Office of Genomics and Disease Prevention).

Further, its other three coordinating centers are the: (4) Coordinating Center for Infectious Diseases (National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, National Center for Immunization and Respiratory Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, National Center for Preparedness, Detection, and Control of Infectious Diseases); (5) Coordinating Office for Global Health; and (6) Coordinating Office for Terrorism Preparedness and Emergency Response.

CDC began a reorganization of its Coordinating Center for Infectious Diseases (CCID) on March 13, 2007. Various research centers were reorganized—or created anew—to better combat emerging and endemic global health threats.

CDC's reorganization also acknowledges the impact of globalization on infectious disease. Travel, migration, and trade have increased incidence of some infectious diseases. Disease outbreaks frequently cross state and national borders, requiring increased communication and coordinated response among various public health agencies and governments. Increased education of health care providers is necessary to help recognize, report, and respond to infectious diseases in regions where various diseases are rare or had been eliminated. The Coordinating Center for Infectious Diseases works with other CDC branches (such as the Coordinating Office for Global Health) and international health agencies such as the World Health Organization (WHO) to research infectious diseases worldwide.

Under the umbrella of the Coordinating Center for Infectious Diseases, the National Center for Preparedness, Detection, and Control of Infectious Diseases works with researchers, public health organizations, and government agencies to track, study, and respond to infectious disease. Part of its mission is to develop United States policy on infectious disease including travel advisories and restrictions, quarantine and isolation laws, and epidemic preparedness requirements.

The National Center for Zoonotic, Vector-Borne, and Entric Diseases (NCZVED) will assist international efforts to prevent and treat diseases caused by animal and insect vectors as well as food and waterborne diseases. The center will play a key role in international efforts to combat neglected tropical diseases such as malaria and emerging threats in the United States such as rodentborne hantavirus.

In responseto the increasing global incidence of HIV/AIDS and reemerging tuberculosis (TB), CDC's National Center for HIV/AIDS, Viral, Hepatitis, STD and TB Prevention (NCHHSTP) will focus on research, prevention, and intervention initatives tocombat TB and sexually transmitted diseases (STDs), including HIV/AIDS. Research at the new center will assist treatment and education programs, as well as aid vaccine development.

The Coordinating Office for Terrorism Preparedness and Emergency Response works with federal, state, and local officials in the United States to develop emergency preparedness and response plans. While CDC efforts focus on response to bioterrorism events, it also advises officials on possible health concerns following a conventional terrorist event of natural disaster.

CDC also publishes several journals intended to relay information throughout the international public health community. Emerging Infectious Diseases is published by CDC's Coordinating Center for Infectious Diseases and compiles articles and announcements on infectious diseases worldwide. Morbidity and Mortality Weekly Report, commonly known as the MMWR, collects and publishes reports from state public health agencies. Both publications foster communication and share upto-date information among various health organizations.

The CDC has the main Biosafety Level 4 laboratories in the United States in its Special Pathogens Branch. A Biosafety Level 4 laboratory is one of a select few laboratories whose scientists and technicians are allowed to work with dangerous and unusual agents that have the highest potential for individual health risks and life-threatening diseases.

WORDS TO KNOW

EPIDEMIOLOGY: Epidemiology is the study of various factors that influence the occurrence, distribution, prevention, and control of disease, injury, and other health-related events in a defined human population. By the application of various analytical techniques including mathematical analysis of the data, the probable cause of an infectious outbreak can be pinpointed.

NEGLECTED TROPICAL DISEASES: Many tropical diseases are considered to be neglected because despite their prevalence in less-developed areas, new vaccines and treatments are not being developed for them. Malaria was once considered to be a neglected tropical disease, but recently a great deal of research and money have been devoted to its treatment and cure.

VECTOR: Any agent, living or otherwise, that carries and transmits parasites and diseases. Also, an organism or chemical used to transport a gene into a new host cell.

VECTOR-BORNE DISEASE: A vector-borne disease is one in which the pathogenic microorganism is transmitted from an infected individual to another individual by an arthropod or other agent, sometimes with other animals serving as intermediary hosts. The transmission depends upon the attributes and requirements of at least three different living organisms: the pathologic agent, either a virus, protozoa, bacteria, or helminth (worm); the vector, which are commonly arthropods such as ticks or mosquitoes; and the human host.

The Centers for Disease Control and Prevention is also the only repository of smallpox in the United States. Smallpox is a highly contagious disease that is acquired only by humans. It is caused by two virus variants: Variola major and Variola minor.

The CDC also provides health information to various sectors of the U.S. economy. Working with state and local organizations, the organization collects and analyzes data to detect disease outbreaks and health threats, researches effective measures for disease and injury control and prevention, and identifies risk factors and causes of diseases and injuries. Along with actively protecting health and safety, the CDC provides information to individuals making personal health decisions and organizations making professional decisions affecting larger populations of people.

In general, CDC conducts research both in the field and in the laboratory. Several CDC centers maintain field response teams to aid in the identification and surveillance of infectious diseases. International health agencies may request CDC assistance in identifying or studying disease outbreaks.

CDC participates in several international efforts to identify, research, and respond to infectious disease. For example, CDC's international outreach includes participation in the Integrated Disease Surveillance and Response (IDSR) program. IDSR seeks to strengthen local public health surveillance of and response to infectious disease outbreaks. The program goals also include increasing communication between various health agencies, sharing accurate and timely information about outbreaks, and collecting samples and utilizing laboratory research to assist further disease surveillance.

Impacts and Issues

The CDC has made dramatic impacts into the health of U.S. citizens throughout its existence. Two important CDC accomplishments have been identifying the causes of toxic shock syndrome (TSS, a rare disease in which Staphylococcus aureus bacteria infect human skin, oral cavities, and vagina) and Legionnaires’ disease (a serious type of pneumonia caused by the bacterium Legionella pneumophila that was first recognized in July 1976 at an American Legion convention in Philadelphia, Pennsylvania).

Today, the CDC is working to find solutions for many global health threats, from malaria to HIV/AIDS. CDC is committed to education and outreach efforts promoting food and water safety, sanitation, nutrition, wellness, and personal hygiene as means of fighting infectious disease.

CDC's broad international experience and close relations with other public health agencies also aids the fight against infectious diseases within the United States. In 1993, a mysterious illness appeared in the Four Corners region of the southwestern United States (the area at the borders of the states of Arizona, Colorado, New Mexico, and Utah). The CDC quickly identified the illness as a new form of hantavirus. Government laboratories once associated with the Department of Defense collected information on hantaviruses, especially Korean hemorrhagic fever with renal syndrome (HFRS), after outbreaks among troops during the Korean War (1950– 1953). CDC researchers were able to compare the emerging outbreak in the Four Corners area with previous studies on hantaviruses in Asia, thus quickly diagnosing hantavirus pulmonary syndrome (HPS), a new health threat never-before recognized in the Western Hemisphere. HPS remains an emerging health threat. The hantavirus is routinely found in rodent populations, the vector (transmitter) of the disease, in the U.S. southwest, occasionally sickening humans. CDC continues to research HPS and disseminate information on identification and prevention to local health officials.

CDC is currently participating in WHO's Global Alliance for Vaccines and Immunization (GAVI) initiatives to identify the sources of disease in underdeveloped and developing nations, as well as increase development of and access to vaccines and therapeutic medications. CDC's commitment to GAVI includes assisting the disease identification, control, elimination, and eradication efforts through field and laboratory research. CDC is also participating in GAVI research programs on microbial resistance, antibiotic usage, and pandemic influenza preparedness planning.

BIBLIOGRAPHY

Books

Dowell, Scott F. Protecting the Nation's Health in an Era of Globalization: CDC's Global Infectious Disease Strategy. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control, 2002.

Web Sites

U.S. Centers for Disease Control and Prevention (CDC). “Home Website of the CDC.” May 4, 2007 <http://www.cdc.gov/> (accessed May 4, 2007).

William Arthur Atkins

Infectious Diseases: In Context