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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

Coordinating Office for Global Health

3rd quarter 2009 CDC Global Health E-Brief

Global Health Research Helps Save Lives 

Welcome to 2009’s third quarter Global 

Health E-Brief, designed to inform readers 

about key global health activities at the 

Centers for Disease Control and Prevention (CDC). This issue highlights CDC’s 

global health research. Looking for 

ways to ensure efforts maximize health 

and economic impact, CDC conducts 

research to evaluate, compare, and 

improve health programs and policies 

at every stage — from initial planning 

and design through implementation 

under often-challenging field conditions 

in country. Research, particularly operations or applied research that takes science from “laboratory to field” is one of 

CDC’s core contributions to the field of 

global health. 

Residents of the Field Epidemiology Training Program in Thailand dissect bat samples during a 

leptospirosis outbreak investigation. Operations research helps CDC understand the root cause of 

an outbreak and prevent additional illness.

pg 2 Asking the Right Questions 

Leads to Effective TB 

Treatment in People With HIV

pg 3 CDC Research Looks at How 

to Make Rotavirus Vaccines 

More Effective in Developing 

Countries

pg 4 Not Just Blowing Smoke: 

Simple, Low-Cost Changes 

Reduce Respiratory Disease 

in Kenyan Children

pg 5 CDC Costing Study Helps 

Ensure Sustainability of Global 

HIV Care and Treatment 

Programs

pg 6 With Findings from CDC 

Research, Africans Use Rapid 

Diagnostic Tests to Effectively 

Treat Malaria

pg 7 Improved Routine 

Immunization Means More 

Children Protected from 

Disease in Assam, India

pg 8 Newsbytes

In This Issue

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3rd CDC Global Health quarter 2009

Asking the Right Questions Leads to Effective TB Treatment 

in People With HIV

CDC researchers have found that asking 

about the right combination of symptoms can be an effective tool to screen 

people with HIV for tuberculosis (TB). 

This relatively simple intervention is 

easily done in even the 

poorest, most resourcelimited settings. 

Hospital wards in 

Cambodia were once 

overwhelmed with 

people dying of AIDS. 

Today, with support 

from the President’s 

Emergency Plan for 

AIDS Relief (PEPFAR), 

Cambodian hospitals 

are seeing far fewer 

patients in such dire 

condition. Cambodians 

with HIV have better 

access to treatment and 

not only live longer, but 

are able to support their families. 

Unfortunately, misdiagnosis of TB, a common disease for people with HIV, threatens many of the gains made by PEPFAR. 

TB is the most common cause of death for 

people with HIV. With early diagnosis and 

treatment, many of the deaths associated 

with TB could be prevented.

The World Health Organization (WHO) 

recommends that individuals with HIV 

be screened for TB when they are first 

diagnosed with HIV and periodically 

thereafter. Diagnosing TB in people 

with HIV can be difficult because they 

are more likely than persons who do not 

have HIV to have extra-pulmonary TB and 

to lack “classic” TB symptoms, such as 

chronic cough. In addition, the two most 

common tests for TB 

(chest x-ray and examination of sputum under 

a microscope) often fail 

to detect TB in people 

with HIV. One common 

approach, never studied 

for effectiveness, was 

to conduct further 

tests only if the person 

reports coughing for 2-3 

weeks. 

CDC, with financial 

support from the U.S. 

Agency for International 

Development (USAID) 

and PEPFAR, conducted 

a study to determine 

how best to screen for TB among people 

with HIV, even in the poorest, most 

resource-limited areas of the world. Working with local doctors and nurses, and 

the Ministries of Health in each country, 

CDC researchers enrolled 2,000 people 

with HIV in Cambodia, Vietnam, and 

Thailand. For each individual, scientists 

performed specialized TB tests—not 

usually available in countries with limited 

resources—to confirm the diagnosis of 

TB with as much certainty as possible. 

With this information, researchers then 

tested whether less resource-intensive 

methods, such as asking questions about 

specific symptoms, would be effective in 

diagnosing TB.

The results showed that 75% of TB diagnoses were missed if people were asked 

only about whether they had a cough for 

at least 2 weeks. If health care workers 

asked about three specific symptoms 

(cough, fever, and night sweats), however, 

the percentage of TB diagnoses missed 

dropped to less than 10%.

Persons who reported having none of the 

three symptoms did not need additional 

tests and could be started safely on HIV 

treatment and TB prevention medication. 

Persons who reported one or more 

symptoms received additional tests. 

“We have known for a long time that TB 

screening is important in people with 

HIV, but we have not previously known 

how to do it. Now we have identified an 

Part of the study team at Sereysophon 

Referral Hospital in Banteay Meanchey 

Province, Cambodia, along with CDC staff. 

This site was the first to enroll patients 

in Cambodia. The success of the study in 

achieving its goals is attributed to the hard 

work of staff at this and other hospitals that 

participated.

Photo by 

Kevin Cain, CDC

“We have known for 

a long time that TB 

screening is important 

in people with HIV, but 

we have not previously 

known how to do it. 

Now we have identified an approach to 

accurately screen for 

this deadly disease 

even in very resourcelimited settings.”
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3rd CDC Global Health quarter 2009

approach to accurately screen for this 

deadly disease even in very resourcelimited settings. This will not only have a 

dramatic impact on the life of individual 

patients, but also affect families and the 

population of small villages overall,” said 

Dr. Kevin Cain, a CDC expert on tuberculosis. “It was a heartwarming experience 

to be able to improve the diagnosis of 

these patients and give them a chance to 

recover from TB.”

These promising results have encouraged health officials in Cambodia, 

Vietnam, and Thailand to revise their 

national guidelines for TB screening and 

diagnosis in people with HIV. The revised 

national guidelines will end the use of 

chronic cough alone for TB screening, 

which misses too many patients with 

TB to be useful, and will replace it with 

screening based on multiple symptoms, 

such as those identified in this study. 

CDC is also working with the World 

Health Organization to incorporate these 

findings and other research into a new 

global policy on how people with HIV are 

screened for TB. 

CDC Research 

Looks at How to 

Make Rotavirus 

Vaccines More 

Effective in 

Developing 

Countries

“We in the developed countries often take 

vaccines and vaccination for granted, 

but children in many resource-poor, 

developing countries are still dying of 

vaccine-preventable diseases. That is the 

hardest and most important lesson I have 

learned.” 

—Dr. Baoming Jiang

(WHO), Program for Appropriate Technology in Health (PATH), United Nations 

Children’s Fund (UNICEF), the Bill and 

Melinda Gates Foundation, and the 

Global Alliance for Vaccines and Immunizations, Jiang and vaccine manufacturers 

in China, India, and Vietnam are working 

to better understand the reasons for the 

reduced effectiveness and how to modify 

the vaccines so that they are effective.

CDC is also collaborating with partners 

to develop a needle-less micro-patch to 

deliver rotavirus vaccine. This technology 

may make it easier to vaccinate large 

populations during immunization campaigns. All of these efforts are essential 

for progress in developing improved 

vaccines that protect 

children against local 

strains of rotavirus, 

and are less expensive 

and therefore more 

available to those who 

need them most. 

Jiang has been involved 

in the development of 

rotavirus vaccines for 

children in developed 

and developing 

countries for more than 

17 years. For Jiang, 

vaccine research is “a 

noble profession that saves hundreds of 

thousands of lives each year.” His contributions to vaccine development were 

recently recognized in the journal Nature 

Reviews Drug Discovery (www.nature.com/

nrd/journal/v7/n5/full/nrd2587.html). 

Thanks to the efforts of CDC research 

microbiologist Baoming Jiang and colleagues, the day is coming when developing countries will have vaccines effective 

against indigenous strains of rotavirus.

Rotavirus is the leading cause of severe 

diarrheal disease in children worldwide 

and causes the deaths of nearly 1,400 

children each day in developing countries. 

The severe dehydration caused by 

rotavirus is easily treated in the United 

States and other developed countries, but 

an effective vaccine is the key to saving 

lives in the developing world. 

Two oral rotavirus vaccines available 

since 2006 have been shown to be 

effective in developed 

countries in the 

Americas, Europe, 

and Australia, but 

they have been less 

effective in preventing 

hospitalizations and 

deaths from rotavirus 

disease in developing 

countries. Possible 

reasons include the 

presence of other 

enteric infections and 

persistent levels of 

malnutrition. Furthermore, many developing countries don’t have the technology 

and resources needed to make and use 

the oral vaccines.

Supported by an array of partners, 

including the World Health Organization 

CDC’s Dr Baoming Jiang 

(sitting) conducts an 

in-country consultation 

in Vietnam with 

representatives of PolyVac, 

a vaccine manufacturer in 

Hanoi, Vietnam. 

Photo by:

Baoming Jiang, CDC

“We in the developed countries often take vaccines and 

vaccination for granted, but 

children in many resourcepoor, developing countries 

are still dying of vaccinepreventable diseases. That is 

the hardest and most important lesson I have learned.”

— Dr. Baoming Jiang
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3rd CDC Global Health quarter 2009

CDC has joined a cadre of partners to 

reduce the risk of respiratory infections 

and pneumonia in children in rural 

western Kenya. Village by village, CDC, 

the World Health Organization (WHO) 

and Kenyan partners are showing how 

the use of a simple and relatively lowcost intervention clean-burning cook 

stoves – can help prevent pneumonia 

and improve health and economies in 

sub-Saharan Africa.

Few know that pneumonia kills approximately 2 million children under 

the age of five years, worldwide each 

year. Resource-poor countries are 

particularly hard hit—for every child 

who dies of pneumonia in a developed 

country, more than 2,000 children die of 

pneumonia in developing countries. 

WHO reports that indoor smoke from 

solid fuels is 10th on a list of 26 risk 

factors contributing to the global 

burden of all disease. Indoor smoke 

released from fuels used to cook and 

boil drinking water is the main risk 

factor for one-third of pneumonia 

infections. The problem is particularly 

evident in sub-Saharan Africa where 

1 in 3 young children are reported to 

have pneumonia each year and up to a 

third of pneumonia deaths are attributed to indoor smoke released from 

fuels used during cooking. 

In the villages of rural western Kenya, 

traditional open fire pits are used in 

homes for cooking and 

heating. As is tradition, 

women often keep their 

young children nearby 

while cooking, and family members sometimes 

sleep in cooking rooms 

which may not vented 

to the outdoors. As a 

result, all breathe in 

particulate matter—

carbon monoxide, 

greenhouse gases, 

and other pollutants. 

A 2007 survey CDC 

conducted in Kenya’s Nyanza Province 

found a heavy burden associated with 

respiratory diseases. Parents reported 

that nearly a quarter (22%) of children 

younger than age 3 had experienced 

an acute respiratory infection in the 

previous 24 hours. 

To address the problem, CDC partnered 

with WHO, the Kenya Ministry of 

Health, the Safe Water and AIDS Project 

(a Kenyan non-governmental organization), and GTZ (a private international 

enterprise that works with the German 

government to improve people’s living 

conditions on a sustainable basis) to 

encourage the use of locally crafted 

low-cost, clean-burning stoves (Jiko 

Kisasa stoves) in 10 Kenyan villages. 

Unlike the traditional fire pits, the 

clean-burning stoves contain the fire 

and help to prevent 

release of particulate 

matter into the air. 

CDC scientists collected data in the project’s 

10 villages to learn 

more about health and 

spending priorities and 

how social networks 

can spread the word 

about new technologies 

in resource-limited settings. Researchers used 

Google Maps to plot 

where stoves are bought and installed. 

Particulate monitors in homes track 

changes in the air quality after installation and use of the stoves. Researchers 

interviewed members of more than 

1,000 households in 59 villages. Pneumonia was reported as the second most 

commonly reported health problem 

among children, and cooking fuel was 

the sixth most common expenditure of 

households. 

Kenyans in homes using the stoves 

reported fewer respiratory illnesses. 

The project has had economic benefits 

as well. Project organizers have helped 

financially vulnerable women use their 

social networks to promote and sell 

the stoves—creating a new source of 

income for these women. Stoves cost 

about US$3-4 and require less fuel than 

open fire pits, enabling families to use 

their limited income for other needs, 

including healthcare and education. 

Rates of acute

respiratory infections 

in children are high in 

Kenya. Mothers typically 

have their babies and 

young children with 

them while cooking and 

many also sleep in the 

cooking room.

Not Just Blowing Smoke: Simple, LowCost Changes Reduce Respiratory 

Disease in Kenyan Children

Photo by:

Bobbie Person, CDC

One villager praised her 

new stove: “I no longer 

have concern about my 

children’s health while 

cooking with the new Jiko 

stove. It produces less 

smoke so my children will 

not be sick, and it cannot 

burn my children.” 
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3rd CDC Global Health quarter 2009

One villager praised her new stove: “I no 

longer have concern about my children’s 

health while cooking with the new Jiko 

stove. It produces less smoke so my 

children will not be sick, and it cannot 

burn my children.”

The project continues to scale up with a 

goal to reach families in 50 more villages 

in rural western Kenya within the year. 

Monitoring of respiratory disease in this 

region will continue, along with collection and evaluation of data on presence 

of particulate matter in households with 

properly installed cooking stoves. This information will inform the effectiveness of 

the program and help to prioritize future 

sites. CDC and the other implementing 

partners are also collecting information 

about consumer use and satisfaction 

with the clean-burning stoves and testing 

social marketing approaches in different 

villages to ensure that lessons learned 

and best practices are incorporated as 

the project expands. 

CDC Costing 

Study Helps Ensure 

Sustainability of 

Global HIV Care 

and Treatment 

Programs

Over the past five years, more than 

2.1 million men, women, and children 

around the world have received lifesaving treatment for HIV with support 

from the U.S. President’s Emergency Plan 

for AIDS Relief (PEPFAR) program. Every 

month, PEPFAR helps provide access to 

HIV treatment for 60,000 new people who 

would otherwise have few or no options 

for addressing their HIV disease. One of 

the most important treatment options in 

the battle against HIV/AIDS has been the 

use of antiretroviral therapy (ART)—the 

use of at least three antiretroviral (ARV) 

drugs to stop the progression of disease. 

As a key implementing agency in PEPFAR, 

CDC leads the coordination of PEPFAR’s 

applied (or operations) and effectiveness 

research, which measures the outcomes 

and impact of PEPFAR interventions to 

inform future program design and to 

ensure efficient use of resources. 

Today, CDC is leading an advanced 

economic evaluation of HIV treatment 

throughout PEPFAR countries. This type of 

evaluation will help countries and donors 

plan and use resources effectively to 

continue to improve and maintain these 

HIV treatment programs over many years. 

In 2006, when new HIV treatment 

programs were being scaled-up 

across Africa, CDC developed the 

first multi-country ART costing study 

for PEPFAR, which assessed ART 

program costs in more than 45 health 

facilities in Nigeria, Ethiopia, Uganda, 

Botswana, and Vietnam. Findings 

from the study provided a breakdown 

of the major costs associated with 

new ART programs and the average 

annual per-patient treatment cost 

across multiple agencies, partners, and 

facilities. This effort allowed Ministries 

of Health and PEPFAR country teams to 

project treatment costs under different 

funding and care scenarios, leading to 

more strategic decisions that help to 

ensure long-term sustainability of the 

treatment programs in these countries. 

PEPFAR is now expanding this effort to 

conduct a PEPFAR-wide ART costing 

initiative, which includes:

•	 reviewing each PEPFAR country team’s 

understanding of the economic and 

clinical aspects of its ART program; 

•	 sharing sophisticated methods for 

determining the comprehensive costs 

of the treatment programs; and 

•	 helping country teams to use costing 

information and modeling to determine 

the capacity of the PEPFAR program 

and countries to maintain ART for 

individuals who are currently receiving 

treatment, and to enroll new patients. 

This baby is receiving ART; evaluating the cost effectiveness of ART 

programs in Africa and elsewhere in the world will help make the 

programs stronger saving future generations like this baby. 

Photo by:

Susy Mercado, CDC

Now more than ever, 

country programs need 

robust data on treatment 

costs—and ultimately care 

and prevention program 

costs—to continue treatment scale-up and maintain 

balanced programs. 
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3rd CDC Global Health quarter 2009

“Because of the recent global economic 

downturn, understanding the cost of 

ART is critical”, says Dr. John Blandford, 

a senior CDC health economist and 

principal investigator of the study. 

“Ministries of Health are facing severe 

budget constraints and donor resources 

have flattened. Now more than ever, 

country programs need robust data on 

treatment costs—and ultimately care 

and prevention program costs—to 

continue treatment scale-up and 

maintain balanced programs.” 

The advanced economic analysis takes 

into account some of the issues faced 

by treatment programs as they mature, 

including decreasing costs for existing 

antiretroviral drugs, introduction of 

newer, better therapies into the market 

at a higher price, and the need to move 

people over time to more expensive 

second-line regimens as resistance to 

first-line drugs develops. 

Once final data are available, countries 

can estimate their total treatment costs 

and major cost drivers of ART under 

different scale-up scenarios, such as 

meeting the goal of universal access 

to ART. In so doing, countries can 

anticipate future resource needs and 

leverage additional donor support, such 

as from the Global Fund to Fight HIV/

AIDS, TB, and Malaria. Furthermore, the 

cost projection information will help 

shape PEPFAR Partnership Frameworks, 

the 5-year strategic frameworks for 

cooperation between U.S. and host 

partner governments focused on 

securing long-term sustainability of HIV/

AIDS programs.

In 2009, CDC is supporting 124 countryspecific program evaluations and six 

multi-country public health evaluations, the latter which will answer key 

program-wide questions on preventing 

mother-to-child transmission of HIV, 

tuberculosis, health systems strengthening, and HIV counseling and testing. 

With Findings from 

CDC Research, 

Africans Use Rapid 

Diagnostic Tests 

to Effectively Treat 

Malaria

CDC research is helping to find the best 

ways to use new rapid diagnostic tests 

in Africa to help save lives and scarce 

resources.

Rapid, accurate diagnosis of malaria 

historically has been difficult. Until 

recently, the only way to diagnose the 

disease was for a skilled laboratory 

worker to use a microscope to look for 

malaria parasites in a blood sample. 

Unfortunately, many facilities had 

neither the microscope nor adequately 

skilled staff. So a mother who brought 

her ill child to a clinic in sub-Saharan 

Africa with symptoms of fever and 

headache often was simply given 

antimalarial medication. There were two 

problems with that approach: the child 

might not have malaria and wouldn’t 

improve, and overuse of antimalarial drugs can lead to drug resistance, 

causing the currently useful drugs to 

become ineffective. 

Availability of rapid diagnostic tests 

(RDTs) has allowed health workers to 

determine in as little as 15 minutes 

whether a patient has malaria. As a 

result, workers can treat children and 

adults with effective antimalarial drugs 

or look further for the cause of illness. 

Ultimately, the result is fewer complications and deaths.

Many malaria-endemic countries have 

started to use RDTs, and CDC has 

collaborated with local research institutions in Kenya and Tanzania to learn 

more about how best to use these tests 

in routine patient care. Although rapid, 

the tests are not necessarily simple to 

perform, require storage at the right 

temperature and humidity, and produce 

results that are not always accepted by 

health workers, largely because older 

guidelines from WHO called for treatment without diagnosis, a lack of 

experience in using RDTs, and changing 

national malaria treatment guidelines. 

Health worker in 

Tanzania performing 

a rapid diagnostic 

test for malaria.

Photo by:

S. Patrick Kachur, CDC

Availability of rapid diagnostic 

tests (RDTs) has allowed health 

workers to determine in as 

little as 15 minutes whether a 

patient has malaria. 
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3rd CDC Global Health quarter 2009

Recent studies showed that after the new 

tests were introduced, health workers 

needed training to use the tests appropriately. A CDC study in rural Tanzania found 

that, despite training and supervision, 

some health workers did not perform 

the tests correctly or use the results to 

influence treatment decisions. Another 

study in Kenya showed that use of RDTs 

did not improve treatment of malaria 

cases. Instead of increasing the number 

of people tested at a clinic, fewer people 

with malaria symptoms were tested. Both 

studies signaled the need to understand 

more about why health workers were not 

using RDTs and how best to encourage 

their appropriate use. 

Recent research conducted in 2008 by 

CDC scientists in Tanzania has found that 

health workers at outlying health facilities 

successfully use RDTs to improve care 

when they receive appropriate supervision 

and RDT quality control procedures 

are followed. As a result, the Tanzanian 

National Malaria Control Program will take 

steps to improve supervision and quality 

control of malaria RDTs nationwide.

With the proper supports in place in 

health facilities, public health officials 

are encouraged that the use of RDTs will 

improve diagnosis of malaria and effective 

treatment for individuals – another step 

forward in the battle against malaria.

Dr. Larry Slutsker, who leads CDC’s malaria 

program, is pleased with the progress in 

effective use of the rapid tests.

“We need to have accurate malaria 

diagnosis—for better case management 

of sick people and to track our progress in 

controlling this disease. RDTs will play an 

important role in these efforts.” Malaria 

causes approximately 500 million infections and more than one million deaths 

annually; most deaths occur in young 

children. Although about one-half of the 

world’s population is at risk for malaria, 

90% of the cases and deaths occur in 

sub-Saharan Africa. 

A recent CDC-led intervention to improve 

routine immunization coverage in 

the state of Assam, India, resulted in 

vaccination of 12,000 children to prevent 

infectious diseases–a 29% increase in 

coverage in one district.

Assam is famous for its tea estates and 

rich in natural resources and culture, yet 

still lacks basic infrastructure to effectively deliver healthcare, including routine 

immunizations for children. Immunizations are critical to reducing morbidity 

and mortality caused by diseases such as 

measles, polio and tetanus.

The major barriers to routine immunization are common throughout India: 

lack of trained health care workers and 

supervisors, shortages of vaccine, and 

power outages that render vaccines 

ineffective when refrigeration fails. For 

these reasons, each year an estimated 

9.7 million Indian children are only partially vaccinated by the age of one year, 

and remain vulnerable to disability and 

death from serious infectious diseases.

To improve routine immunization coverage, 

CDC partnered with United Nations Children’s Fund (UNICEF) and the government 

of Assam to implement and evaluate the 

effectiveness of the Reaching Every District 

(RED) intervention. The project trained 

program staff from eight districts in Assam 

in the essential elements of a successful 

immunization campaign:

•	 Supportive supervision

•	 Outreach vaccination sessions 

•	 Strong links with communities

•	 Planning and management of resources

•	 Monitoring for action

CDC Public Health Advisor Tove Ryman presents at a RED training 

in Assam, India.

Photo by:

Tove Ryman, CDC

Improved Routine Immunization Means 

More Children Protected from Disease 

in Assam, India
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3rd CDC Global Health quarter 2009

Newsbytes

Two of the eight districts were selected as 

focus districts, and each was supported 

by a full-time UNICEF consultant. CDC 

public health advisor Tove Ryman helped 

establish the project and visited each 

focus district to launch the intervention. 

During the year-long intervention CDC 

conducted quarterly site visits. 

One year after implementation, the 

results are exciting and promising. The 

number of fully vaccinated children 

increased in every district that received 

the RED intervention. In Barpeta, one 

of the focus districts, the percentage 

of children vaccinated increased by 

29 percent among children ages 12-23 

months. Barpeta also had improvements 

in program record-keeping and recording, 

calculating and interpreting information, 

frequency of supervision, and increased 

numbers of outreach sessions and links 

with communities. 

One immunization worker in the district 

described the impact of the intervention 

this way: “Now we can calculate our 

coverage and also find dropouts. And 

we communicate better with people 

than before.”

Ryman noted that “For the first time, we 

established a baseline so that we can 

most effectively measure the impact 

of the RED strategy.” She adds, “It was 

really rewarding to see the quality of 

the program enhanced as a result of the 

intervention.”

The lessons learned in Assam are now 

being put into practice by CDC and 

partners in the populous Indian states 

of Jharkhand and Bihar. One finding 

was that many of the staff delivering 

immunization services had not received 

any job-related training. Trainers now 

conduct skill-building exercises at a 

very basic level. CDC and UNICEF also 

learned that training was more effective 

when broken into modules taught over 

time, rather than in one long session. 

Now, trainees practice new skills and 

then review them with trainers. 

“For the first time, we 

established a baseline so 

that we can most effectively 

measure the impact of the 

RED strategy.”

WHO: Elimination of River 

Blindness Possible in Africa

Results of a World Health Organization 

study published in the open-access 

journal PLoS Neglected Tropical Diseases 

presents the first evidence that treatment 

with ivermectin may help the world 

eliminate onchocerciasis (river blindness).

Mass ivermectin treatment has been 

widely accepted as a proven strategy to 

control the disease and, in Latin America, 

ivermectin twice-annual treatments have 

interrupted transmission in a number of 

areas. Until now, however, there has been 

no evidence in Africa that ivermectin could 

interrupt transmission of the parasite and 

eliminate the disease in endemic areas. 

The WHO study showed that after 15-17 

years of annual treatments, only a few 

infections remained in humans. Because 

transmission levels were below the threshold required for elimination, treatment 

was stopped in test areas; follow-up evaluations after 1.5 to 2 years found no further 

infections or transmission. The authors 

report that the findings are evidence, in 

principle, that onchocerciasis elimination 

is feasible in Africa. Further studies are 

necessary to determine whether transmission recurs and under what circumstances.

To view the news release visit WHO: 

www.who.int/mediacentre/news/

releases/2009/river_blindness_

20090721/en/index.html

To view the study visit PLoS Neglected 

Tropical Diseases:

www.plosntds.org/article/

info%3Adoi%2F10.1371%2F

journal.pntd.0000497

CDC Assigns Epidemiologist 

to WHO China for Assistance 

to Eradicate Hepatitis B Virus

With support from the ZeShan Foundation, a family foundation concerned with 

the prevention and treatment of HIV/

AIDS and Hepatitis B, CDC has assigned 

Dr. Yvan Hutin to the World Health 

Organization (WHO) China Office. Hutin 

will work with China and other countries 

in WHO’s Western Pacific Regional Office 

to reduce early childhood hepatitis B 

virus (HBV) infections from more than 8% 

to less than 2% by 2012. HBV deaths in 

the region, primarily from cirrhosis and 

liver cancer caused by chronic infection 

acquired at birth, account for more 

than 50% of the world’s HBV deaths.

CDC Supports Preventing 

Violence against Children 

Study in Tanzania, Zanzibar 

Violence against children is an urgent public 

health issue in Tanzania. Reports indicate that 

31% of girls and 25% of boys in Tanzania have 

experienced at least one incidence of sexual 

violence before the age of 18
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3rd CDC Global Health quarter 2009

At the request of the United Nations 

Children’s Fund (UNICEF), CDC is 

providing technical assistance to conduct 

a national survey on violence against 

children in Tanzania and Zanzibar. Data 

from the survey will be used to identify the 

national prevalence of violence against 

children in Tanzania and Zanzibar; risk 

and protective factors for victimization; 

and health outcomes of such violence. 

Findings from the survey will be used to 

inform policy and program development 

on the prevention of violence against 

children. The CDC team will begin 

interviewer training and data collection 

in the two countries in October 2009.

For more information, visit Global 

Violence Prevention at:

www.cdc.gov/ViolencePrevention/

globalviolence/index.html

November 2, 2009, is 

World Pneumonia Day

Major health and humanitarian relief 

organizations are joining forces to coordinate education outreach, walks, runs and 

policy summits in New York, Washington 

DC, Kenya, Nigeria, India and Bangladesh 

on November 2nd to increase awareness 

that preventing pneumonia saves lives.

For more information, visit: 

www.WorldPneumoniaDay.org

Learn more about pneumonia in a special 

Notice to Readers in the November 2nd, 

2009 issue of the Morbidity and Mortality 

Weekly Report (MMWR) at:

www.cdc.gov/mmwr

Burma Ministry of Health 

Launches the DOTS PLUS 

Program for Management 

of Multidrug-Resistant 

Tuberculosis 

The Ministry of Health of Burma recently 

launched the DOTS PLUS for MultidrugResistant Tuberculosis Management 

Program. DOTS PLUS is the internationally recommended strategy for treating 

drug-resistant tuberculosis that builds 

upon the standard program for treating 

drug-sensitive tuberculosis—DOTS 

(Directly observed therapy, short-course). 

The launch was made possible by the collaboration and support of multiple private 

and public partners and donors, including 

the World Health Organization (WHO), 

United States Agency for International 

Development (USAID), United Nations 

Children’s Fund (UNICEF), and others. 

CDC employees who helped advance the 

collaboration included Dr. John MacArthur, 

on detail to USAID’s Regional Development Mission in Asia, who oversaw 

USAID’s participation in this collaboration, 

and Dr. Jay Varma, who provided technical 

assistance to USAID and the U.S. Embassy 

in Burma on assessment and implementation. The first patients enrolled in the 

program began receiving treatment in July.

For more information visit WHO TB:

www.who.int/tb/dots/en

CDC Helps Advance Public 

Health Management and 

Leadership in Ghana 

CDC provided technical assistance to help 

launch the Centre for Leadership and 

Management at the University of Ghana 

School of Public Health. CDC collaborated 

with University of Ghana School of Public 

Health to develop a detailed curriculum, 

lesson plan, course schedule, and instruction for the Centre’s four-week course 

entitled “Improving Management of Public 

Health Interventions.” Twenty-two public 

health professionals from Ghana, Kenya, 

Tanzania and Uganda attended the course 

held at the University of Ghana School 

of Public Health June 22-July 17. Faculty 

members included representatives from 

the World Health Organization (WHO), 

African Field Epidemiology Network 

(AFENET), Field Epidemiology and 

Laboratory Training Program (FELTP), the 

Ghana Health Service, the Ghana School 

of Public Health and CDC. The Ghana 

Health Service has now adopted the 

program for senior leadership training.

For every 1 child that dies of pneumonia in an 

industrialized country, more than 2000 children 

die of pneumonia in developing countries. 

World Pneumonia Day on November 2nd will 

bring worldwide awareness of this disease so 

that it may be eradicated one day.

Dr. John MacArthur (USAID, on detail from US 

CDC), and Dr. Hans Kluge, Medical OfficerTB, (WHO/Burma) see the first patient receive 

TB medications as part of the DOTS PLUS 

program.

Managers of health districts and hospitals in 

Ghana, Kenya, Tanzania and Uganda participate in the Project Management workshop, 

facilitated by CDC Training Specialist Denise 

Traicoff.