CDC's Global Rapid Response Team Is a First Responder to Health Threats Worldwide

When a health emergency erupts somewhere in the world, the Centers for Disease Control and Prevention (CDC) quickly sends its new Global Rapid Response Team (Global RRT). Roughly 50 on-call staff members are ready to deploy wherever needed anytime at short notice to support and enhance the CDC’s emergency response capacity.

Since the Global RRT mobilized about a year ago, it has been supporting emergency public health efforts with rapid assessment, surveillance, risk communication, field logistics, coordination, epidemiology, lab support, as well as longer-term capacity building, staffing and management, health promotion and partnership building.

Several members of the Global RRT, in the Division of Global Health Protection (DGHP), summarized their recent projects and what they've learned so far in a special session, Global Rapid Response Team — An Agency-Wide Approach to Supporting CDC’s Response to Global Outbreaks and Humanitarian Emergencies, presented on May 5, 2016 at the 65th Annual Epidemic Intelligence Service (EIS) Conference in Atlanta, Georgia.

Carlos Navarro Colorado, MD, MSc, PhD, gave an overview of the program.

RRTs strengthen the CDC's emergency response to global health threats, supporting CDC experts and country offices, ministries of health and public health organizations worldwide at short notice. RRTs can also provide long-term emergency response and train in-country RRTs to work on the problem as well, he said.

"RRTs help us quickly mobilize staff, supplies, and funding in emergency settings. This will enhance relationships with our partners in global health emergencies by forming the bridges we need in order to do this work before the emergencies happen," Dr. Colorado said.

Ashley Greiner, MD, MPH, talked about her group's experiences during the cholera outbreak in Tanzania that began last year and what they've learned from it.

The Global RRT's mission includes deploying trained and equipped multidisciplinary teams with appropriate staff to assess current issues, make recommendations and effectively respond with measurable actions, Dr. Greiner began.

Within 72 hours of the Tanzania Ministry of Health's request for assistance, she and her colleagues organized to work with the ministry, the CDC, the World Health Organization (WHO), Médecins Sans Frontières (MSF), the United Nations Children's Emergency Fund (UNICEF) and other agencies. The CDC provided cholera subject matter experts, lab and epidemiologic expertise and support for an emergency operations center (EOC).

"Cholera outbreaks require a multifaceted control strategy involving surveillance, laboratory, case management, social mobilization, water, sanitation and hygiene, as well as a strong coordination mechanism to oversee this approach," Dr. Greiner told the audience. "Such a strategy requires a collaborative effort with a diversity of expertise."

Her RRT evaluated cholera treatment centers for infection control, distributed pamphlets and posters and tackled misconceptions about cholera transmission, including a bracelet believed to protect the wearer from cholera.

But the staff were deployed without being briefed about region-specific data, key contacts on the ground and possible duplication of efforts. They lacked concrete objectives and necessary tools and resources, including antibiotics and guidelines; and poorly matched skill sets and lack of training led to confusion.

The RRT is learning from those experiences and developing protocols and situation-specific training for Ministry of Health and RRT staff. While the outbreak in Tanzania continues, the RRT is expanding beyond Tanzania to assist with cholera outbreaks in neighboring countries.

Tasha Stehling-Ariza, PhD, MPH, an epidemiologist in Panama collaborating with UNICEF during the Zika Outbreak in Latin America and the Caribbean, told the audience that Brazil reported its first lab-confirmed case of Zika virus infection in May 2015. By the end of January, 26 countries and territories had reported lab-confirmed Zika virus cases, and Brazil estimated that it had between a 0.5 and 1.5 million cases. In January, UNICEF asked the CDC for help.

"Working closely with other organizations such as UNICEF not only helps them; it also allows us to build on their strengths for more effective response and to better accomplish our mission," Dr. Stehling-Ariza said in her talk.

The CDC is very good at developing clear materials with the key messages, she said, and UNICEF promotes the rights and well-being of children in the community. UNICEF performs vector control, encourages people to wear long sleeves and use insect repellant, and the agency cares for and supports infants and families affected by Zika. UNICEF estimates that it reaches 200 million people in the region; by partnering with UNICEF, the CDC can reach more people.

Dr. Stehling-Ariza oversaw messaging, guidance and collaboration, and she was responsible for preparedness, behavior change, communication, vector management, information systems, technical support and helping coordinate the CDC, UNICEF and other partners. Collaborators created a simple document explaining in plain local language what local workers without a medical background needed to know.

The CDC developed Zika prevention kits — containing a bed net, standing water treatment tablets, insect repellant, permethrin spray and condoms — that are being distributed to pregnant women in the US territories; and the CDC, UNICEF and other partners are planning similar kits for other countries.

About 40 countries and territories in the Americas have reported Zika transmission so far and the number is growing. Challenges include a limited understanding of the Zika virus and its complications and keeping up with the rapidly evolving science.

"We should continue the joint projects and activities with UNICEF," Dr. Stehling-Ariza advised.

To illustrate the breadth of RRT's work, Cyrus Shahpar, MD, MBA, MPH, contrasted the cholera and Zika deployments.)

Tanzania's response to cholera was national in scope, involving the Ministry of health, multiple CDC assets on the ground, the Tanzania country office, the Ministry of health, and international non-governmental organizations (NGOs). By contrast, the Zika response in Panama had a more regional focus and partnered with UNICEF, the CDC and other agencies, he explained.

Both efforts involved workforce development, emergency operation center work, linking public health and law enforcement in multi-sectoral rapid response, medical countermeasures and personnel deployment, creating standards and procedures and sharing information.

Since the Global RRT began about one year ago, it has worked on polio, Ebola, cholera, wildfires, yellow fever and Zika.

The over 300 team members are devoted to global rapid response, Dr. Shahpar said. They routinely work on emergencies and are ready to quickly deploy wherever needed, including 50 or more on call at any given time. Members have international and emergency experience and critically needed foreign language skills.

Dr. Shahpar invited EIS officers and others to join the Global RRT. "To EIS officers who are graduating, we want you to join us. If you're finishing your first year, you're automatically a part of the Global RRT," he noted.

Applicants have come from the CDC, UNICEF, WHO and other agencies, and recruiters welcome candidates with various qualifications, "so we have a diversity of skill sets," he added.

"The Global RRT needs more than researchers and epidemiologists." Dr. Shahpar said. "We need emergency coordinators, team leads, task force leads, country directors and others to fulfill the breadth of public health work. We will have another recruitment in the fall and we hope that you will consider joining the Global Rapid Response Team."

Lorraine L. Janeczko, MPH, is a medical science writer who creates news, continuing medical education and feature content in a wide range of specialties for clinicians, researchers and other readers. She has completed a Master of Public Health degree through the Department of Epidemiology of the Johns Hopkins Bloomberg School of Public Health and a Dana Postdoctoral Fellowship in Preventive Public Health Ophthalmology from the Wilmer Eye Institute, the Johns Hopkins University School of Medicine and the Bloomberg School.

SOURCE: EIS 2016 Conference Program, p 104: Global Rapid Response Team — An Agency-Wide Approach to Supporting CDC’s Response to Global Outbreaks and Humanitarian Emergencies

Presentations:

Carlos Navarro Colorado, MD, MSc, PhD, medical epidemiologist, Global Rapid Response Team, Enhancing CDC’s Response to Global Outbreaks and Humanitarian Emergencies: An Overview of the Global Rapid Response Team

Ashley Greiner, MD, MPH, emergency public health epidemiologist, Global Rapid Response Team, Building Local Capacity for Emergency Response: The Role of the Global Rapid Response Team during the Cholera Outbreak in Tanzania

Tasha Stehling-Ariza, PhD, MPH, emergency public health epidemiologist, Global Rapid Response Team, Supporting Regional Capacity for Emergency Response: The Role of the Global Rapid Response Team during the Zika Outbreak in the Latin America and Caribbean Region

Cyrus Shahpar, MD, MBA, MPH, medical officer and deputy team lead, Global Rapid Response Team, Working with the Global Rapid Response Team