Have you ever wondered how the Centers for Disease Control and Prevention knows which bacteria are ‘emerging’ or ‘trending,’ what outbreaks are occurring insidiously in the community, what specific strains need to be included in future vaccines, and whether the vaccines are working as intended? The answer, at least for invasive bacterial diseases, is their Active Bacterial Core surveillance program. Even an infectious diseases physician like me heard about this program only a couple years ago, I am somewhat ashamed to admit. Valuable programs like this one must not be kept a secret and therefore, this blogpost.
ABCs is part of the Emerging Infections Program that was established following an Institute of Medicine report in 1992, which emphasized that infectious diseases are not a ‘solved problem’ in the United States and that there are dynamic and modern factors that cause ID to emerge and re-emerge. Even in 2018, infectious diseases are not a ‘solved problem’ and programs such as ABCs need continued investments and support. Funding for public health programs is constantly under threat, and every time there is government shutdown, these programs can’t run. I welcome you to read a nice article in The New York Times on poor investments in public health from a couple days ago.
At the foundation of ABCs is a strong partnership between federal, state and local public health institutions, academic medical centers and microbiology laboratories. In order to detect, investigate, control and prevent emerging infections, scientists and epidemiologists with expertise in medicine, public health, laboratory and data science collaborate and publish data that helps inform public policy. Ten states participate in this program- California, Oregon, New Mexico, Colorado, Georgia, Tennessee, Minnesota, Maryland, New York, and Connecticut. The program is designed to identify everyone with a positive microbiology lab test for select invasive bacterial diseases in these ten states. These diseases include pneumococcal disease, Legionnaires’ disease, streptococcal infection, Haemophilus influenzae disease, pertussis, and meningococcal disease. The list of pathogens tracked is changed periodically based on disease occurrence and emerging priorities.
ABCs data have been used for multiple disease trend analyses. For example, this system of tracking helped detect a large reduction in invasive pneumococcal disease among children younger than five years. The program also recognized an increase in invasive pneumococcal disease caused by bacterial serotypes that were not present in the 7-valent vaccine, PCV7. This finding contributed to an accelerated approval of the 13-valent pneumococcal vaccine, PCV13. The program has deep expertise in using whole genome sequencing to recognize outbreaks occurring in the community, and generate efforts to control these outbreaks. The program is also taking steps to incorporate advanced molecular detection methods and culture independent diagnostic tests in its work. The program has recently developed a publicly available data visualization tool named Bact-Facts to improve data sharing and communicate the program findings to the community – this tool will be available to the public in the coming weeks to months.
If you look at the picture at the top closely, the tree represents the Emerging Infections Program, with the IOM report, CDC plan and the active surveillance processes as the roots; CDC programs, state health departments, academic institutions, surveillance and applied research as the trunk; ABCs as one of the largest branches (the other branches are programs that conduct surveillance for foodborne illnesses and outbreaks, healthcare-associated infections occurring in the community, influenza, tick borne illnesses, etc.); and the fruit in the basket as the prevention guidelines, vaccine recommendations and vaccine formulations. Please support public health!
Suggested Additional Reading:
Gayle Langley, MD, and others. Emerging Infectious Diseases. Volume 21, No. 9 Available at: https://wwwnc.cdc.gov/eid/article/21/9/14-1333_article Accessed May 30, 2018
Ruth Lynnfield, MD and William Schaffner, MD. Emerging Infectious Diseases. Volume 21, No. 9 Available at: https://wwwnc.cdc.gov/eid/article/21/9/15-0564_article Accessed May 30, 2018
Picture courtesy: Melissa Arvay, MD. Adapted from article by Robert W. Pinner and others. Emerging Infectious Diseases. Volume 21, No. 9 Available at: https://wwwnc.cdc.gov/eid/article/21/9/15-0619_article Accessed May 30, 2018