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2nd CDC Global Health quarter 2009

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

Coordinating Office for Global Health

2nd quarter 2009 CDC Global Health E-Brief

Ensuring Public Health in Insecure Areas

In This Issue

pg 2 CDC and Partners 

Work to End Polio in 

Conflict Areas

pg 3 Economic and Political 

Upheaval Can’t Deter 

CDC Commitment 

to Supporting Care 

and Treatment for 

Zimbabweans with 

HIV/AIDS

pg 4 CDC Expertise in 

Nutrition Surveys 

Helps Ensure Food Aid 

in Darfur, Sudan, Gets 

Where Most Needed

pg 5 Improving the Health of 

Iraqis Through Better 

Disease Surveillance and 

Electronic Reporting

pg 7 Newsbytes

Welcome to 2009’s second quarter 

Global Health E-Brief, designed to 

inform readers about key global health 

activities at the Centers for Disease 

Control and Prevention (CDC). Our 

second issue of the year highlights

how CDC strives to improve public

health in regions of turmoil. Civil unrest,

political instability, and economic

crises pose additional challenges to 

providing public health interventions

in already complex environments. 

Despite these difficult and sometimes

dangerous settings, CDC remains 

committed to helping improve the health

of those most in need worldwide.
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2nd CDC Global Health quarter 2009

CDC and Partners Work to End Polio in 

Conflict Areas

“It’s clear that many people here 

in Pakistan are making phenomenal efforts to eradicate polio. 

Just imagine in your own town if 

you were asked to knock on the 

door of every home and convince 

the parents to let you immunize 

all their children under age five 

for a disease that is now relatively 

uncommon. Now imagine doing 

it for over 20 million children 

spread over an area larger than 

France in 100 degree weather 

for the grand sum of 80 rupees 

($1.60)/day. These vaccinators are 

real heroes. —Taken from the notes of a 

”

CDC

employee deployed to Pakistan for three 

months to support polio eradication

Since 1988, when public health efforts 

to eradicate polio began, an estimated 

250,000 polio deaths have been prevented and 5 million young people are 

walking who would otherwise have been 

paralyzed by polio. The Global Polio 

Eradication Initiative (GPEI)—the largest 

public health initiative in history—is 

spearheaded by CDC, the World Health 

Organization (WHO), Rotary International, and UNICEF. Since 1992 CDC has 

deployed more than 50 epidemiologists, 

public health experts, and scientists to 

WHO and UNICEF in leadership roles 

in global, regional, and country polio 

eradication programs. CDC also provides 

a wide range of technical expertise 

and laboratory support for GPEI, and 

every year provides funds to purchase 

tens of millions of doses of oral polio 

vaccine for use in mass immunization 

campaigns. The US government is the 

largest single donor to GPEI, providing 

$1.4 billion, or roughly 23% of total 

donations, since 1988. 

Today, polio is endemic in only four 

countries in the world—Afghanistan, 

India, Nigeria, and Pakistan (compared 

with 125 countries in 1988)—and cases 

have dropped by more than 99%, from 

350,000 per year to 1,652 in 2008. In spite 

of this incredible public health 

accomplishment, challenges to eradicating

polio remain. One major barrier is 

ongoing civil strife 

in Afghanistan and 

Pakistan, which limits 

vaccinators’ access 

to children. It’s not 

the first time GPEI 

partners have faced 

such challenges. 

In 2000–2001, polio 

eradication efforts 

in the Democratic 

Republic of Congo 

(DRC), a country 

roughly the size of 

Western Europe, 

were hampered by low immunization 

coverage, poor surveillance, and political 

instability caused by warring factions 

in the eastern part of the country. 

The fighting jeopardized the safety 

of vaccinators, who were sometimes 

harmed or even killed during attempts 

to vaccinate children. Determined to 

continue the vaccination campaigns, 

the DRC government, WHO, and the 

U.S. government convened a meeting 

to discuss the multilateral nature of the 

eradication initiative and the neutral 

interest in immunizing children. As a 

result, safe passage for non-governmental organization-operated planes 

and for vaccinators was established. 

Ultimately, 4.2 million children younger 

than 5 years in insecure areas were 

reached. Not only were children vaccinated against a major disease, but the 

negotiations related 

to polio eradication 

helped open the 

door for additional 

emergency visits and 

technical assistance.

Similar events took 

place in another 

part of the world in 

the late 1980s. Opportunities for improving 

health in violent 

areas of El Salvador 

came as a result of 

negotiated ceasefires. 

In 1985 government and guerilla forces 

in the region suspended hostility for 

three “days of tranquility” to allow 

20,000 vaccinators, volunteers, and 

guerilla forces to immunize children 

against polio. An extraordinary media 

campaign mobilized popular support 

for the program. From 1985–1991, 

Since 1988, when 

public health efforts to 

eradicate polio began, 

an estimated 250,000 

polio deaths have 

been prevented and 5 

million young people 

are walking who would 

otherwise have been 

paralyzed by polio.

Community members

in Afghanistan help 

provide oral polio 

vaccine to a child.
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2nd CDC Global Health quarter 2009

multiple one-day truces were negotiated 

between opposing forces for polio 

immunization days in El Salvador. The 

campaign helped end polio transmission in the country in 1991. “Ceasefires 

for National Immunization Days” have 

also been conducted in Afghanistan, 

the Philippines, Sri Lanka, Sudan, and 

Tajikistan. Former UN Secretary-General 

Kofi Annan said in 2001, “In war zones 

around the world, guns have fallen silent 

to allow immunization days to take 

place—demonstrating that even in the 

most intractable of conflicts, warring 

parties can call a halt to destruction in 

the cause of life.” 

Today, the polio collaboration is 

conducting vaccination campaigns in 

insecure areas of Pakistan (North West 

Frontier Province/Federally Administered 

Tribal Areas and parts of Balochistan) 

and Afghanistan (in the south) and 

among highly mobile populations in 

both countries. This effort requires:

	 •Between large-scale nationwide

vaccination campaigns, delivering 

an extra dose of oral polio vaccine to 

people living in insecure areas;

	 • Regularly re-prioritizing districts 

based on the evolving security of the 

area and movement of people; and

	 • Involving all parties in the conflict in

efforts to allow safe passage of polio 

vaccinators.

“CDC is keenly aware of the challenges 

in achieving the goal of eradication 

—gaining access to all children; 

working in insecure areas; stopping 

outbreaks before virus transmission is 

re-established” says Dr. Steve Cochi, 

CDC expert on immunization who has 

worked on polio eradication for nearly 

20 years. “However, CDC, WHO, Rotary 

International, and UNICEF all remain 

committed to eradicating polio; success 

in more than 200 countries proves that 

a polio-free world is possible.” 

Economic and Political Upheaval Can’t 

Deter CDC Commitment to Supporting 

Care and Treatment for Zimbabweans 

with HIV/AIDS

fled the country to earn a living wage. 

Those that remained went on strike to 

protest the lack of protective equipment in a country where one in seven 

people is HIV-infected. 

The economic crisis was exacerbated by 

an intense political campaign leading

up to the March 2008 presidential 

election, which ended in a run-off. Any 

hope for change was crushed when 

the incumbent party campaigned with 

violence to ensure a win. To control the 

flow of information, any gathering of 

more than three people was banned. 

Overnight, Dr. Bwakura’s bustling clinic 

was labeled a political threat. Despite 

the health threats and empty bank 

accounts, Dr. Bwakura and his two staff 

kept the clinic running with support 

from CDC staff in Zimbabwe and at 

headquarters in Atlanta. So far this 

year, CDC has organized workshops 

to train workers in HIV treatment and 

management of tuberculosis (TB) coinfections and has conducted training 

for nurses—resulting in education for 

more than 2,000 health care providers.

Dr. Tapiwanashe Bwakura, a young doctor 

at Harare Central Hospital in Zimbabwe, 

was on assignment at CDC in Atlanta in 

2002 when he first visited an HIV/AIDS 

clinic. There he saw firsthand how HIV 

treatment could save patients’ lives and 

how treatment sites were operated. At 

the time, no treatment for HIV/AIDS was 

available in Zimbabwe. 

That early exposure bore fruit the next 

year. In 2003, soon after Dr. Bwakura’s 

visit to Atlanta, CDC and the University of 

Zimbabwe partnered to plan Zimbabwe’s 

first pilot HIV treatment sites. Nine 

months later, in a two-room clinic tucked 

in a corner of Harare Central, Dr. Bwakura 

and one nurse were administering the 

most advanced HIV treatment available 

to more than 250 patients. Over the next 

four years, with leveraged funding for drug 

orders, donated supplies, a larger space 

and another staff member, Dr. Bwakura 

showed the world that HIV treatment in 

Zimbabwe was not only possible, but 

practical on a national scale.

Zimbabwe was once the breadbasket of 

Africa, rich in natural resources and highquality education and health care. Over 

the past 20 years, however, the country 

has seen a drastic decline in affordable 

food, sanitation, and even basic health 

care. Throughout this decline, CDC 

provided assistance in improving HIV/

AIDS care and treatment in the country. 

Then the economic crisis of 2008 hit. 

Inflation soared to 230 million percent. 

Hundreds of skilled medical professionals

Individuals in Zimbabwe prepare sanitation 

packages (a bucket, water purification tablets, 

and soap) for distribution in response to the 

devastating and disruptive cholera epidemic.
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2nd CDC Global Health quarter 2009

“Training in Zimbabwe sometimes 

feels like treading water because of the 

constant emigration. Yet, it is essential 

that people affected and infected by HIV 

receive the best care possible. We work 

to keep providers up to date, whatever 

their background or their futures,” 

says Dr. Ruth Walkup, CDC’s Country 

Director in Zimbabwe.

Besides HIV, Zimbabwe has battled an 

epidemic of cholera—a potentially fatal 

bacterial infection that causes severe diarrhea and dehydration. According to the 

United Nations Office of the Coordination 

of Humanitarian Affairs, 94,443 suspected 

cases and 4,127 deaths were reported 

in the country from late August 2008 

through early April 2009. CDC supplied 

lab reagents to the National Laboratory 

in Harare to ensure that cholera drug 

resistance testing could take place. 

The funds and supplies have been 

invaluable, but, according to Walkup, 

CDC’s scientific expertise is the agency’s 

most valuable contribution. “CDC funding is welcome, but it is our specialized 

technical assistance that is unique.”

“Our staffs are specialists in their fields. Our 

ability to address local needs at all levels—

from the policies and systems that impact 

the delivery of services to the care that each 

individual patient receives—is helping to 

build sustainable programs, despite the 

challenges of working in Zimbabwe.” 

It’s hunger season in Darfur—the time 

of year before autumn harvests, when 

food supplies are running low and 

heavy rains contribute to malaria and 

diarrheal disease.

Even before the conflict in Darfur, Sudan, 

began in 2003, hunger and disease were 

major problems. But this year has Leisel 

Talley, a CDC epidemiologist who works 

in complex humanitarian emergency 

situations, especially worried about 

malnutrition in the region. As of January 

2009, the United Nations estimates that 

nearly 2.7 million people in Darfur are 

Internally Displaced Persons—all relying 

on international food aid. 

CDC works in about 40 countries around 

the world to improve the health of populations affected by complex humanitarian 

emergencies—war, famine, civil strife, 

disaster, genocide, drought and 

displacement. CDC has worked in the 

Darfur region to prevent hunger and 

monitor malnutrition for the past five years. 

Talley has conducted annual comprehensive nutrition surveys of Darfur’s children 

and their mothers since 2004. The 

surveys provide data on the extent of 

malnutrition in the area, information 

that is essential to plan for food aid 

and to coordinate humanitarian relief 

efforts. CDC conducts the surveys 

with the United Nations Children’s 

Fund (UNICEF), local nongovernmental organizations (NGOs), the World 

Food Programme, and the Sudanese 

government. 

Conducting the Darfur survey 

necessitates a marriage of science 

and logistics. Each year Talley and 

colleagues collect information about 

children in each of Darfur’s three 

states—90 locations and 800 children 

per year. Surveyors measure children’s 

height and weight, the circumference of 

their upper arms, and swelling of their 

feet (a sign of kwashiorkor, or extreme 

malnutrition). 

Getting surveyors to the sites is 

dangerous. Hijackers and bandits 

prey on the roads and many sites are 

only accessible by helicopter. “You’d 

be on the road to go, and you’d turn 

CDC Expertise in Nutrition Surveys 

Helps Ensure Food Aid in Darfur, 

Sudan, Gets Where Most Needed

“Our ability to address local 

needs at all levels—from the 

policies and systems that 

impact the delivery of 

services to the care that 

each individual patient 

receives—is helping to build 

sustainable programs, 

despite the challenges of 

working in Zimbabwe.”

Leisel Talley, 

CDC epidemiologist, 

interviews a mother 

and child in Darfur 

in 2004. 
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2nd CDC Global Health quarter 2009

around because you couldn’t go any 

further. Logistically, it’s not easy,”

 Talley said.

Working in one of 

the most troubled 

regions in the world 

is also mentally

challenging. In 

2007, Talley had a 

7-month-old son 

at home and found 

herself getting angry 

about the malnutrition she saw. 

“Sitting in a feeding center for the 

hundredth time in my career, I found 

myself getting angry that children 

were suffering and the situation hadn’t 

changed in the three years that I had 

been involved in Darfur.” 

In 2004, the surveyors found 21% of 

children were moderately to severely 

malnourished. In 2005 the presence of 

acute malnutrition decreased to 12%, 

below the 15% “emergency” threshold. 

Talley attributes that decrease to 

improved humanitarian access. But in 

2006 and 2007, acute malnutrition was 

back up to 16%. The Sudanese government has not yet released data for 2008.

Conducting the survey has become 

more difficult and expensive as security 

has deteriorated and nongovernmental 

organizations have left the region. This 

year, there are fears that the survey may 

not happen, but Talley is hopeful that 

the situation will improve. Among the 

important long-term outcomes of CDC’s 

work over the past five years is that UN 

agencies based in Darfur have improved 

nutritional data collection. This ensures 

that resources are used in the best way, 

for the most vulnerable populations.

CDC also has trained staff from the 

UN, UNICEF and NGOs based in Darfur 

to do the on-the-ground survey work 

and has been contacted about training 

surveyors in other conflict regions. 

Today, UNICEF is taking responsibility 

for more of the survey. 

“For me that’s been 

one of the big 

successes. We’re 

helping build 

capacity for these 

organizations in 

Sudan.” 

Besides the survey, 

CDC also conducts 

research on the 

best ways to prevent malnutrition. 

Talley is currently studying whether 

a fat-based nutrient spread—“super 

peanut butter”—given to children in 

internally displaced persons camps 

can prevent malnutrition. The spread 

can be used at home without further 

preparation (i.e. no cooking or additional water required), and it provides 

essential nutrients and protein needed 

for growth. 

According to Talley, three spoons three 

times a day, an extra 274 calories a day, 

could make a big difference.

Improving the 

Health of Iraqis 

through Better 

Disease 

Surveillance

and Electronic 

Reporting

A stable public health system is vital 

to building a healthy and resilient 

society. In countries like Iraq, decades 

of civil war have weakened the public 

health infrastructure, and power 

outages, malnutrition, and unsanitary 

conditions have created an ideal 

environment for infectious diseases 

to flourish. In its role in helping 

countries to strengthen their own 

public health systems to enable them 

to respond to their own public health 

needs, CDC is working in Iraq to 

build a strong foundation in disease 

surveillance and electronic reporting. 

“War and unrest always divide and, in 

doing so, take a toll on the public’s 

health” says Dr. Erica Dueger, who 

leads CDC’s efforts on international 

emerging infections in Cairo, Egypt. 

Recognizing the opportunity to 

protect the health of Iraqi citizens, 

Dueger and CDC colleagues at the 

Naval Medical Research Unit 3 

(NAMRU-3) in Egypt have partnered 

with the Iraq Ministries of Health and 

Agriculture and several governmental 

and non-governmental partners to 

improve public health in Iraq. 

In January, the partners launched a 

two-year project to improve Iraq’s 

ability to identify and respond to both 

human and animal health threats. Many 

infectious diseases that threaten people 

around the world, including H5N1 avian 

influenza and the new novel influenza A 

H1N1, originated in animals. 

The cornerstones of the project are 

public health training and disease 

surveillance. Over the next two years, 

Dueger and a team of CDC epidemiologists and laboratory staff will work 

closely with NAMRU-3 to provide a 

series of trainings for Iraqi health 

officials in the areas of epidemiology, 

medical entomology (the scientific 

study of insects that cause disease), 

laboratory practices, biosafety 

(safeguarding lab staff from exposure 

to infectious or toxic agents) and 

biosecurity (preventing unauthorized 

access, loss, theft, misuse, diversion, or 

intentional release of infectious agents 

or toxic materials), and public health 

information technology. 

Among the 

important long-term 

outcomes of CDC’s work 

over the past five years is 

that UN agencies based in 

Darfur have improved 

nutritional data collection.
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2nd CDC Global Health quarter 2009

In March 2009, a comprehensive, 

2-week workshop on epidemiology 

and laboratory science was pilottested in Cairo with 70 scientists 

from Egypt, Jordan, Djibouti, 

Afghanistan, Morocco, Libya and 

Sudan. All 50 of the participants 

who completed the workshop 

evaluation said they would recommend this workshop to their colleagues, and 47 of them said they 

would return to 

NAMRU-3 for a 

more advanced 

workshop. Their 

comments about 

the training 

were positive. 

“One of the best 

aspects was the 

opportunity to 

interact with 

public health 

people from 

other countries 

and to exchange ideas on surveillance programs and diseases 

encountered, etc... It was great 

to hear what projects were being 

undertaken in the region and 

what approaches they were taking 

to achieve their goals. From the 

epidemiology side, it was great to 

have more exposure to laboratory 

procedures and practices,” one 

participant noted in the evaluation.

Based on participants’ feedback 

during the pilot, the course has 

been modified and will be attended 

by 60 Iraqi epidemiologists and 

laboratory scientists this summer. 

For example, the modified course 

will include training in H1N1 flu, 

covering CDC’s response and the 

roles of other international 

organizations; it will have an 

increased focus on zoonotic 

disease; and 

it will include 

training in 

virology and 

entomology. The 

course will be 

taught by experts 

from across CDC, 

including those 

with expertise 

in field epidemiology, zoonotic 

diseases, and 

informatics. 

NAMRU-3 staff said they are 

pleased they will have the opportunity to collaborate with lecturers 

from CDC and have access to their 

expertise.

“It is heartening to know that 

through partnerships like these 

with Iraqi and other international 

organizations, we can bridge the 

divide caused by war to make a real 

(L to R) Dr. Rima Khabbaz, 

Dr. Erica Dueger, CDC, and 

Dr. Mohamed Abukela, 

Egyptian Ministry of Health 

and Population, mark the 

opening of the collaborative International Emerging 

Infections Program’s facility 

in Cairo, Egypt.

“It is heartening to know 

that through partnerships 

like these with Iraqi and other 

international organizations, 

we can bridge the divide 

caused by war to make a real 

impact on the health of the 

Iraqi people”

impact on the health of the Iraqi 

people,” Dueger said.

CDC is also working with partners 

in Iraq to develop an electronic 

disease-reporting system to rapidly

identify and prioritize infectious 

diseases into three categories: 

1) Those that pose the greatest 

risk of illness and death in 

people; 

2) Those that pose the greatest 

risk of transmission from 

animals to people; and 

3) Those that have the potential 

to prevent impact on muchneeded food production. 

The reporting system will also help 

lay the foundation for Iraq to comply with the revised International 

Health Regulations (IHR). These 

international health laws, which 

outline requirements for countries 

in order to help control the international spread of diseases, also now 

require WHO member countries 

to strengthen surveillance and 

response capacities. 
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2nd CDC Global Health quarter 2009

As WHO Raises the Alert 

level to Pandemic, CDC 

Continues its Critical Role in 

the Global Response to 

Influenza A (H1N1) 

As of June 22, 2009, according 

to the World Health Organization (WHO), 99 countries 

and territories have officially 

reported 52,160 laboratoryconfirmed cases of influenza 

A (H1N1) infection, including 

231 deaths; additionally, on 

June 11, WHO officially raised 

the pandemic alert level from 

Phase 5 to Phase 6; thereby 

declaring a pandemic. CDC 

is working very closely with 

public health officials around 

the world as part of the international response to the H1N1 

pandemic. As part of these 

efforts, CDC has supported 

staff deployments to Mexico 

and other countries for 

technical assistance, hosted 

liaisons from PAHO, the 

European Centre for Disease 

Prevention and Control, 

the Public Health Agency of 

Canada, and the China CDC; 

with this, we have facilitated 

coordination and collaboration 

with global partners, enhanced 

routine surveillance activities 

and laboratory testing activities to better detect unusual 

activities, and provided 

real-time RT-PCR protocols 

and kits for detection of H1N1 

free of charge to domestic and 

international public health 

institutions around the globe. 

CDC is also working to answer 

some critical research 

questions in the Southern 

Hemisphere, as they may 

uncover 

important 

clues to the 

future of 

the H1N1 

virus and 

its potential 

re-emergence 

during the 

influenza 

season in 

the US. 

The New 2010 Yellow Book 

has arrived

For decades, CDC’s Health Information for International Travel (the 

Yellow Book) has been the gold 

standard for travel medicine in 

the United States. Published 

every two years, health-care 

professionals and everyday 

travelers rely on it for the latest 

dependable advice about travel 

health issues, including vaccinations, essential trip planning 

and safety tips, travelers with 

specific needs, humanitarian 

work, and more! The 2010 edition is available in bookstores 

($29.95) and will be available 

for free this summer on CDC’s 

Travelers’ Health website. More 

information can be found at 

www.cdc.gov/yellowbook

Newsbytes

The Yellow Book is 

published every two years 

by CDC as a reference for 

those who advise international travelers about health 

risks. The Yellow Book is 

written primarily for health 

professionals, although 

others will find it useful.

Photo by 

Greg Sykes, ATCC

CDC produced 

diagnostic 

test kits (as 

pictured here) 

in response to

H1N1 Influenza. 
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2nd CDC Global Health quarter 2009

Stop Transmission of 

Polio Celebrates 10 Year 

Anniversary

Earlier this year CDC marked 

the Stop Transmission of 

Polio (STOP) program’s ten 

year anniversary by hosting a 

celebration at the CDC Global 

Health Odyssey museum 

in Atlanta, GA. Members 

of the current STOP team, 

representatives from Rotary 

International and the World 

Health Organization (WHO) 

(partners in polio eradication 

effort along with CDC, UNICEF 

and the Canadian Public 

Health Association) attended 

the celebration. During the 

past decade the program 

has sent more than 1,000 

volunteers to 60 countries 

around the world to support 

polio eradication; STOP has 

become largest global health 

training program ever at CDC. 

These volunteers provide a 

range of technical support, 

such as conducting field 

surveillance for polio, training 

local health care providers in 

surveillance, and planning and 

monitoring polio and measles 

vaccination campaigns. Dr. 

Stephen Blount, Director of 

CDC’s Coordinating Office for 

Global Health, says of STOP’s 

success, “More children today 

are leading healthy, active lives 

and hundreds of public health 

workers from around the world 

have learned—and lived—the 

lessons of hope and teamwork 

that predict the success soon 

of the eradication effort. In the 

years to come, I’m sure we will 

apply what we’ve learned from 

STOP to take on and complete 

the unfinished business of 

making routine immunizations 

a part of the life of every child.”

Celebrating World 

No Tobacco Day

In recognition of World No 

Tobacco Day, held on May 31, 

2009, the Morbidity and Mortality 

Weekly Report (MMWR), distributed 

on May 22nd, had a special focus 

on tobacco issues. CDC works in 

partnership with the World Health 

Organization (WHO) to address 

tobacco related health implications. This edition of the MMWR

includes an article on federal and 

state cigarette excise taxes, an 

article, submitted by the WHO, on 

the assessment of tobacco packaging and warning requirements 

worldwide, and an informational 

piece about World No Tobacco 

Day. To view this issue of the 

CDC Morbidity and Mortality Weekly 

Report, go to: http://www.cdc.gov/

mmwr/PDF/wk/mm5819.pdf

International Rabies 

Experts Address Global 

Canine Rabies Elimination 

Strategy

CDC staff participated at a 

conference in Turin, Italy, 

in April as members of the 

Partners for Rabies Prevention 

(PRP), an international group 

of rabies experts and stakeholders focused on global 

canine rabies elimination. 

The PRP is working to develop 

a strategy for eliminating 

canine rabies in countries 

where the disease is endemic 

in domestic dog populations 

and to provide guidance for 

rabies elimination projects. 

Recently, the Bill and Melinda 

Gates Foundation have added 

rabies to their list of neglected 

diseases, and are funding pilot 

projects in the Philippines, 

Tanzania, and South Africa to 

successfully control human 

and dog rabies within five 

years. Some of the key activities will include education and 

training to foster community 

awareness, improved access 

to human rabies biologicals 

(post-exposure prophylaxis), 

and mass dog vaccination 

campaigns. For more information:

http://www.rabiescontrol.

net/prp/Meetings.html 

A quilt made of t-shirts 

signed by representatives from 

countries participating in the 

Global Tobacco Surveillance 

System (GTSS) was displayed 

at the Global Tobacco 

Surveillance System conference

held in Atlanta in June.