Experts Explore CDC’s “Winnable Battles” in Infectious Disease with Contagion

Seeking to improve the nation’s health and safety as swiftly and broadly as possible, the Centers for Disease Control and Prevention (CDC) has been targeting several high-burden issues—deemed “Winnable Battles”—in which it could make the greatest impact.

Evidence-based interventions have enabled strides in public health priorities that the agency highlights in its recently released “CDC Winnable Battles Final Report.” Of the six “battles,” three pertain to infectious diseases: food safety, healthcare-associated infections, and HIV.

“There has been substantial progress in many of the infectious disease-related goals,” said Amesh Adalja, MD, a spokesman for the Infectious Diseases Society of America (IDSA), who offered an outside opinion on the report for Contagion. But more progress is needed to prevent catheter-associated urinary tract infections—one area in which CDC did not meet its goals.

The reasons behind these results are sometimes tough to explain. “Infectious diseases don’t have simple causal mechanisms,” said Dr. Adalja, an infectious disease specialist at the University of Pittsburgh Medical Center. “There are multiple factors that play into what the incidence and prevalence may be.”

Food Safety

In the realm of food safety, infections due to Escherichia coli (E. coli) O157 dropped 44% from 1998 to 2015, but there is still room for improvement in decreasing infections due to E. coli, Salmonella, and other food-borne germs. Each year, 1 in 6 Americans becomes ill from consumption of contaminated foods or beverages, and the associated medical and industry costs surpass $15.5 billion.

“Food-borne illness is a common, costly, and preventable public health problem,” said Michael Beach, PhD, deputy director of CDC’s Division of Foodborne, Waterborne and Environmental Diseases. “Making food safety a ‘Winnable Battle’ has helped the team advance more proactive and comprehensive efforts.”

A mere 10% reduction in food-borne infections would spare about 5 million Americans from sickness each year. Salmonella infections lead to more hospitalizations and deaths than any other bacteria detected in food, amounting to approximately $365 million in direct annual medical costs.

CDC’s adoption of whole genome sequencing for Listeria outbreaks has resulted in a 50% decline in the median number of these illnesses per outbreak. In fiscal year 2015, outbreak investigations recognized caramel apples and ice cream as two food sources of this severe infection. Until then, neither of these culprits had been perceived as major contributors to Listeria. Industries are implementing more rigorous control measures in response to these findings.

“We are now starting to use the lessons learned from the Listeria work to bring these cutting-edge technologies to bear on combatting additional food-borne germs like Salmonella,” Dr. Beach said.

Novel germs still appear on the horizon and outsmart researchers. “There are always new and emerging bacteria, toxins and antibiotic resistance that can be a challenge to food safety,” he added. “Food production and distribution is more widespread than ever before, which means contaminated food can be sent all over the country.”

To help curb the spread of food-borne infections, Dr. Beach would recommend that healthcare providers quickly obtain samples from sick people and forward to laboratories for advanced testing. They also should notify the local or state health department rapidly of suspected outbreaks.

Meanwhile, it would be wise to inform patients and caretakers of those who are older than 65 years, children younger than age 5, people with compromised immune systems and pregnant women that they are at a higher risk for food-borne illnesses, Dr. Beach said.

Healthcare-Associated Infections

CDC’s extensive record of tracking healthcare-associated infections has included formulating and promoting evidence-based guidance for prevention and control. Despite these measures, many infections were not being thwarted.

“We needed to develop a new normal in which healthcare-associated infections are considered unacceptable and rare events,” the “Winnable Battles” report noted. Making an impact would require dedication from traditional and new public health and healthcare stakeholders at federal, state, local and health systems, as well as providers and patients. Embracing more transparency and accountability became paramount.

CDC’s emerging infections program now entails tracking progress via population-based surveillance. “It accounts not only for what’s going on within the walls of healthcare facilities, but also outside the walls as well as in the broader community,” said Arjun Srinivasan, MD, associate director for CDC’s Healthcare-Associated Infection Prevention Programs.

Driving implementation of best practices is part of the agency’s multi-pronged strategy to combat healthcare-associated infections. The task involves educating providers about proper disinfection of medical devices, such as intravenous lines and catheters. “The biggest difficulty that we encounter is some of the complexity of healthcare delivery,” Dr. Srinivasan said.

A field of social science called “human factors engineering” could form the basis of team collaboration to prevent infections. In such a framework, providers would benefit from consulting with infection control personnel in hospitals where they see patients. They could inquire, “What are the best practices? What should I be following?” he explained.

HIV

The percentage of people living with HIV who know their status is steadily rising toward the 90% target due to CDC’s expansion of testing efforts, particularly focusing on communities with a high burden of infection among African Americans and Hispanics.

Treatment can help people with HIV lead longer, healthier lives while greatly reducing the possibility of transmitting the virus. Due to increased screening, an estimated 87% of about 1.2 million Americans living with HIV have been diagnosed and are aware of their infection. However, less than half of those with a diagnosed infection have their virus under control.

CDC’s recommendations on emerging testing technologies, such as antigen/antibody combination tests, are prompting earlier diagnosis and immediate linkage to care. Acknowledging the benefits of early treatment, CDC modified its linkage-to-care goal from within three months to within one month of diagnosis.

The agency and its state partners are relying more on usage of surveillance data to identify HIV-infected persons not in HIV care as part of efforts to achieve higher viral suppression rates.

“We’ve gained considerable ground in regards to declines in new diagnoses among African-American women, people who inject drugs, and heterosexuals,” said Jonathan Mermin, MD, MPH, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “And the increases once seen among gay and bisexual men have leveled off.”

About 40,000 Americans are still diagnosed with HIV every year. “We cannot claim victory until the war is won,” Dr. Mermin said.

Susan Kreimer, MS, is a medical journalist who has written articles about infectious diseases and many other health topics. For two decades, her coverage has informed consumers, physicians, nurses and health system executives. Raised in the Chicago area, she holds a master’s degree in journalism from Columbia University and lives in New York City.