From an outbreak of mysterious lung-injury deaths to America’s near loss of measles elimination status, the beginning of the end of the U.S. HIV epidemic to the Ebola outbreak in the Democratic Republic of the Congo (DRC), CDC worked around the clock – and around the globe – to protect Americans from domestic and global health threats in 2019.
Here’s a closer look at some of the biggest health issues that CDC tackled this year.
Part 1 of this two-part series focuses on the response to outbreaks and threats. Part 2, which will be published Friday, deals with disease control and elimination, and domestic preparedness and global health security.
Responding to outbreaks and threats
Lung Injuries linked to E-Cigarette use, Vaping, (EVALI)
Image courtesy of CDC
CDC continues investigating the outbreak of lung injury associated with the use of e-cigarette, or vaping, products, together with state and local health departments and federal partners, such as the U.S. Food and Drug Administration (FDA).
As of December 10, CDC reported 52 deaths and 2,409 cases of hospitalized EVALI by all 50 states, Washington D.C, Puerto Rico, and the U.S. Virgin Islands.
In a breakthrough, CDC laboratories detected vitamin E acetate in the lungs of EVALI patients – direct evidence suggesting that this sticky substance is present in many EVALI cases. Investigation into other possible causes continues.
In September, CDC activated its Emergency Operations Center (EOC) to enhance the inter-agency response to the EVALI outbreak.
EOC activation allowed the agency to increase its coordinated operational support for the response to meet the outbreak’s evolving challenges. CDC is providing assistance in epidemiology, disease surveillance, pathologic consultation, clinical guidance development, and communication.
Opioids
Drug overdoses continue to be a major problem across America. There were over 70,000 U.S. drug overdose deaths in 2017, the most recent year for which final data are available.
Over two-thirds involved opioids, including heroin and synthetic opioids (such as illicitly manufactured fentanyl and fentanyl analogs). There have also been recent increases in overdose deaths involving cocaine (largely due to contamination with opioids) and methamphetamines and other psychostimulants with misuse potential (both with and without opioids).
The prescribing and dispensing of the overdose-reversing drug naloxone is a critical part of the public health response to the opioid overdose epidemic. Naloxone saves lives – but only if it’s readily available when an overdose occurs.
Despite a huge increase in overall prescribing of naloxone, far too little is being dispensed, including in many rural areas of the country where the need is greatest. Moreover, too few doctors are prescribing naloxone to high-risk patients as recommended by CDC’s Guideline for Prescribing Opioids for Chronic Pain.
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As the drug overdose crisis evolves and becomes more complex, CDC is providing $301 million in new Overdose Data to Action funds to states and jurisdictions to align surveillance data with more targeted prevention efforts better.
The funds, which will support the work of 47 states, Washington, D.C., Puerto Rico, Northern Mariana Islands, and 16 counties and cities, are part of the Department of Health and Human Services Five Point Strategy to Combat the Opioid Crisis.
Antibiotic (AR) and Antimicrobial Resistance (AMR)
Antibiotic-resistant (AMR) bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the United States each year, according to a November 13 CDC report. These are sometimes referred to as antimicrobial-resistant germs.
On average, every 11 seconds someone in the United States gets an antibiotic-resistant (AR) infection – and every 15 minutes, someone dies. When Clostridioides difficile, a bacterium that is not typically resistant but can cause severe diarrhea resulting in death and is associated with antibiotic use, is added to these, the U.S. toll of all the threats exceeds 3 million infections and 48,000 deaths annually.
There were nearly twice as many annual deaths from AR infections as CDC originally reported in 2013.
The update comes from previously unavailable data sources. Since then, prevention efforts have reduced deaths from AR infections by 18 percent overall and by nearly 30 percent in hospitals. Without continued vigilance, this progress may be challenged by the increasing burden of some infections.
This year, CDC highlighted the success of the yearlong AMR Challenge, an ambitious global initiative to combat the growing threat of AR. Launched in 2018, CDC obtained nearly 350 commitments from 33 countries, pharmaceutical and health insurance companies, food animal producers and purchasers, and medical professionals and healthcare systems to take specific actions to combat antibiotic resistance.
Foodborne Outbreaks
Throughout 2019, CDC investigated and resolved more than 75 outbreaks related to food or animal contact.
Notable Salmonella outbreaks were linked to ground beef, raw turkey, pre-cut melons, and papayas. E. coli outbreaks were linked to flour, ground bison, and romaine lettuce.
Additionally, there was the largest ever outbreak of Salmonella infections linked to backyard chickens, and an outbreak of drug-resistant Salmonella infections linked to pig-ear dog treats.
During any multistate foodborne disease outbreak, CDC serves as lead coordinator working in close coordination with public health partners to detect the outbreak, define its size and extent, and to identify the source. Public health officials investigate outbreaks to control them, so more people do not get sick in the outbreak, and to learn how to prevent similar outbreaks from happening in the future.
Pregnancy-Related Deaths
A recent Morbidity and Mortality Weekly Report (MMWR) documented persistent racial and ethnic disparities in pregnancy-related deaths.
American Indian, Alaska Native, and black women were two to three times as likely to die from a pregnancy-related cause as were white women.
According to a 2019 CDC Vital Signs report, 3 in 5 pregnancy-related deaths could have been prevented. Overall, heart disease and stroke cause more than 1 in 3 pregnancy-related deaths—other leading causes include infections and severe bleeding. The leading causes of death differ by time period throughout pregnancy and after delivery.
Ensuring quality care for mothers throughout pregnancy and the postpartum period can reduce preventable maternal deaths.
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