CDC (United States Centers for Disease Control and Prevention)

█ BRIAN HOYLE

CDC is an acronym for Centers for Disease Control and Prevention. The center, which is headquartered in Atlanta, Georgia, is one of the predominant public health institutions in the United States and in the world. The CDC serves United States national security by monitoring the incidence of infectious disease in the U.S. (and around the world), and through the development and implementation of disease control procedures. As part of this mandate, the CDC is one of the few facilities in North America that houses a biological laboratory capable of handling very infectious and lethally-dangerous microorganisms such as the Ebola virus and Bacillus anthracis, the bacterium that causes anthrax.

The CDC is the pre-eminent institution in the United States dedicated to the prevention of disease, and is a global leader in public health. In addition to the Atlanta headquarters, the CDC has facilities in San Juan, Puerto Rico, and in eight other locations in the continental United States. The U.S. locations are Anchorage (Alaska), Cincinnati (Ohio), Fort Collins (Colorado), Morgantown (West Virginia), Pittsburgh (Pennsylvania), Research Triangle Park (North Carolina), Spokane (Washington), and Washington D.C.

Approximately 8,500 people work at the CDC in 170 occupations pertaining to public health research, administration, monitoring, and education. CDC personnel are also seconded to other international health agencies such as the World Health Organization and to state and local health agencies in response to disease outbreaks.

The CDC is organized into 11 national centers that are concerned with health care and disease prevention. The national centers study:

• Birth Defects and Developmental Disabilities,
• Chronic Disease Prevention and Health Promotion,
• Environmental Health (that includes the Office of Genomics and Disease Prevention),
• Health Statistics
• HIV (Human Immunodeficiency Virus), STD (Sexually Transmitted Disease), and TB (Tuberculosis) Prevention,
• Infectious Diseases,
• Injury Prevention and Control,
• Immunization Program,
• Occupational Safety and Health,
• Epidemiology Program, and,
• Public Health Practice Program.

At the beginning of 2003, the CDC enters its 57th year of existence. The institution was established on July 1, 1946 in Atlanta. At that time the acronym CDC stood for Communicable Disease Center. The CDC replaced another center known as the Malaria Control in War Areas. The former institution had been established as part of the Public Health Service to rid the southern United States of malaria during the years of World War II. As well, the center had assumed the responsibility for keeping the region free of murine typus fever. The establishment of the Communicable Disease Center continued these functions while expanding to include all diseases that could be transmitted from person to person.

The institute's founding director was Dr. Joseph M. Mountin. In its early days, the center was small and research and surveillance programs were still geared towards insect-transmitted diseases such as malaria. After an aggressive campaign of expansion by Mountin, however, which was intended to entrench CDC's position and value to the country, the center became the national agency for epidemiology (the study of the origin and spread of diseases).

The Korean War in the 1950s solidified the center's value as an epidemiological resource. The Epidemiological Intelligence Service (EIS) was created during that time, with the mandate to protect U.S. citizens from diseases that originated in other regions of the world. The EIS remains an important part of today's CDC, especially because of the recognition, in the 1950s, that biological warfare was an emerging threat to national security.

Two other events in the 1950s besides the Korean conflict increased the national importance of the CDC, and served to ensure that the funding of the center continued. First, a national campaign to inoculate children with the recently approved Salk polio vaccine led to a spate of poliomyelitis cases. A Polio Surveillance Unit was established at CDC. The unit quickly determined that a contaminated batch of the vaccine has been the problem. Their findings allowed the contaminated units of vaccine to be withdrawn from use, and the inoculation program continued with confidence. In retrospect, the continuation of the vaccination campaign has been invaluable, since it was pivotal in the eradication of polio, and since it instilled the confidence in vaccines in general that helped ensure the

success of other vaccination campaigns. These outcomes also solidified the CDC's reputation as a disease-monitoring center of excellence. The other event was a large influenza outbreak in the U.S. Once again, a surveillance campaign on the type of virus that was involved and its pattern of spread helped future efforts to develop effective vaccines and inoculation programs.

During the 1950s and 1960s, the CDC grew through the assumption of responsibility for programs that had been previously handled by other government departments and agencies. Examples include the centers of venereal disease, tuberculosis, and immunization.

Beginning in the 1960s, CDC assumed an increasingly important role in the public awareness of infectious diseases. One important example occurred in 1961 when the institution took over the publication of the Mortality and Morbidity Weekly Report (MMWR). The MMWR publishes information on the number of deaths and cases of infectious disease from every state in the country each week. The availability of such detailed information has allowed the progression of some emerging diseases such as AIDS to be charted.

By the late 1960s, the CDC had become much more than a center for the study and action against communicable diseases. These activities had moved CDC far beyond its original mandate as a communicable disease center. In recognition of the center's changed role, its name was changed in 1970 to the Center for Disease Control. Further expansion led to a slight name change in 1981, to the Centers for Disease Control. Finally, as further expansion took the CDC into disease prevention, in 1992 the organization became the Centers for Disease Control and Prevention. Even so, for the sake of continuity the acronym CDC has been retained.

These and other efforts have contributed to national security through the preservation of public health. In more recent times, accomplishments of significance have included participation in the development of a smallpox vaccine and inoculation program, and the identification of the agents of several diseases including Legionnaire's disease, toxic shock syndrome, hantavirus pulmonary syndrome, and Acquired Immunodeficiency Syndrome.

In 1978, biosafety level 4 containment laboratory was opened in the CDC Atlanta headquarters. Then as now, this is one of only a handful of level 4 labs in North America. Other similar facilities are present in San Antonio, Texas, at the U.S. Army Medical Research Institute of Infectious Disease (USAMRIID) in Fort Detrick, Maryland, and in Winnipeg, Manitoba, Canada. It is only at these facilities that highly infectious and lethal viruses and bacteria can be safely studied and treatments devised. At CDC, for example, the Special Pathogens Branch studies the Ebola, Marburg, and Hantaviruses.

In the present day, CDC provides a great deal of information concerning naturally occurring infectious diseases and, particularly since in the aftermath of the September 11, 2001 terrorist attacks on the U.S., information on bioterrorist threats such as anthrax. The research and disease surveillance expertise at CDC is being harnessed, along with other national laboratories and intelligence gathering organizations, to strengthen the United States from bioterrorist attacks.

█ FURTHER READING:

PERIODICALS:

Epidemiology Program Office, CDC. "CDC's 50th Anniversary: History of CDC." Morbidity and Mortality Weekly Report no. 45 (1996): 525–30.

ELECTRONIC:

Centers for Disease Control and Prevention. "About CDC." November 2, 2002. <http://www.cdc.gov/aboutcdc.htm> (28 December 2002).

Centers for Disease Control and Prevention. "CDC Timeline." <http://www.cdc.gov/od/oc/media/timeprnt.htm> (28 December 2002).

SEE ALSO

Biocontainment Laboratories
NNSA (United States National Nuclear Security Administration)
Public Health Service (PHS), United States

CENTERS FOR DISEASE CONTROL AND PREVENTION

The Centers for Disease Control and Prevention (CDC) is a federal agency, under the United States Department of Health and Human Services (USDHHS), whose vision is to promote healthy people in a healthy world through prevention. CDC's mission is to promote health and quality of life by preventing and controlling disease, injury, and disability. The agency addresses a broad range of preventable health problems, from infectious disease to chronic diseases and risk factors to negative environmental effects on health. Most of CDC's seven thousand employees live and work in Atlanta, Georgia, the agency headquarters. CDC employees are also stationed in state and local health departments in all fifty states and in about twenty countries worldwide. CDC has facilities in Alaska, California, Colorado, the District of Columbia, Florida, Illinois, Maryland, North Carolina, Ohio, Pennsylvania, Puerto Rico, Washington, and West Virginia.

CDC has three primary functions: to actively protect the health and safety of the nation; to provide credible information so that the general public, health care providers, and leaders in government can make well-informed health decisions; and to promote better health in all stages of life through strong partnerships.

CDC has always demonstrated a strong commitment to protecting health and safety. In 1942, malaria in the southeast United States was more common, so it made sense to establish the Office of Malaria Control in War Areas in Atlanta. Dr. Joseph Mountin, a leader of the Public Health Service, wanted to create a national organization to keep more than six hundred bases and essential war-industrial establishments in the southern United States malaria-free. At the end of World War II, Mountin created the Communicable Disease Center from these initial malaria-control efforts. The agency's purpose was to gather physicians, entomologists, and engineers in the battle against a wide range of infectious health risks.

Over the past fifty-three years, CDC's name has changed along with the evolution of its focus. The agency has maintained its commitment to the prevention and control of infectious disease, while building its efforts to address the leading health threats of the nation, including environmental hazards like lead poisoning, chronic diseases like cancer and heart disease, occupational illnesses, and injuries at home, on the road, and on the playground. CDC has worked to reduce the spread of AIDS (acquired immunodeficiency syndrome) since its recognition in 1981. CDC has instituted important changes in treating and controlling the spread of this disease, including ensuring that the nation's blood supply is safe and reducing the risk of HIV (human immunodeficiency virus) transmission in health care settings.

Along with actively protecting health and safety, CDC provides credible health information to various decision makers, including individuals making personal health decisions and policy leaders making decisions affecting larger populations. Working with state and local partners, CDC collects and analyzes data to monitor health threats, detect disease outbreaks, and identify risk factors and causes of diseases and injuries. CDC also conducts research to identify what works in disease and injury control and prevention.

CDC's National Health and Nutrition Examination Survey (NHANES), for example, is the nation's most comprehensive study of the health and nutritional status of Americans. Each year, approximately five thousand randomly selected residents in twelve to fifteen counties across the country have the opportunity to participate in the survey. NHANES is a unique resource for health information in the United States. Without it, decision makers would not have adequate data on health conditions and issues, such as obesity, environmental (secondhand) tobacco smoke, and lead poisoning.

CDC also provides information to the public via comprehensive public health communication programs on such issues as diabetes, skin and colorectal cancer, HIV, and hepatitis C. International travelers turn to CDC to obtain timely updates on disease outbreaks in foreign countries and a list of suggested immunization. The agency also publishes guidelines, such as its Community Prevention Guidelines, to identify evidence-based practices for disease control and prevention.

CDC's third function is to promote better health in all stages of life through strong partnerships. The agency has forged relationships with other federal, state, and local health agencies, not for-profit organizations, and members of private industry who have an interest in reducing the burdens of disease, injury, and disability. CDC's strongest traditional partnerships have been with state and local health departments. Through the National Breast and Cervical Cancer Early Detection Program, for example, CDC is providing funds and technical assistance to fifty states, five U.S. territories, the District of Columbia, and fifteen American Indian/Alaska Native organizations. This program exemplifies how the combination of public health expertise in screening and detection, quality assurance, professional and public education, and coalition building can address critical gaps in health care needs. The program delivers critical breast and cervical cancer screening services to underserved women, including older women, women with low incomes, and women of racial and ethnic minority groups.

CDC has evolved from an agency focused on fighting infectious diseases to one that addresses a variety of health issues on both national and international fronts. In the future, it may need to address additional health issues—such as responding to bioterrorism, using genetic information to improve health, reducing violence in society, and closing the gap in health disparities among racial and ethnic groups.

Jeffrey P. Koplan

(see also: Communicable Disease Control; Noncommunicable Disease Control )

Bibliography

Etheridge, E. W. (1992). Sentinel for Health: A History of the Centers for Disease Control. Berkeley, CA: University of California Press.

Centers for Disease Control and Prevention (CDC)

The Centers for Disease Control and Prevention (CDC) is a federal agency primarily focused on protecting public health and safety. The CDC was founded in 1946 and is organized under the U.S. Department of Health and Human Services. The agency's headquarters are located in Atlanta, Georgia. Various programs of the CDC are directed toward disease prevention, controlling the spread of disease, promotion of good health practices, and public education to improve health. More recently, preparedness for health threats and bioterrorism have become key activities of the CDC. Forensic scientists are involved in almost all departments of the DCD, from identifying the cause of death during a disease outbreak, to supplying data and testimony at legal proceedings about injury trends and environmental or other health hazards.

The annual budget for operations within the CDC is just under $8 billion, including approximately $5 billion for primary CDC activities, and an additional $3 billion for the Agency for Toxic Substances and Disease Registry (ATSDR), childhood vaccines , and terrorism programs. Two broad areas of spending are in health promotion and prevention of disease, and in preparedness for health threats and terrorism.

The CDC employs more than 8,500 people within the United States, approximately 65% of whom are located in the Atlanta area with less than 20% at the primary headquarters. More than 100 employees of the CDC are stationed overseas in 45 different countries at any given time.

There are seven different National Centers within the CDC including:

• The National Crenter on Birth Defects and Developmental Disabilities provides national leadership for preventing birth defects and developmental disabilities and for improving the health and wellness of people with disabilities.
• The National Center for Chronic Disease Prevention and Health Promotion works toward prevention of premature death and disability from chronic diseases and promotion of healthy lifestyles.
• The National Center for Environmental Health focuses in the prevention and control of disease and death resulting from environmental agents.
• The National Center for Health Statistics is a key national resource that provides statistical information to guide actions and policies to improve health.
• The National Center for HIV, STD, and TB Prevention engages in prevention and control of human immunodeficiency virus infection, sexually transmitted diseases, and tuberculosis.
• The National Center for Infectious Diseases is primarily concerned with the prevention of illness, disability, and death caused by infectious agents (bacteria, viruses, and other organisms) in the United States and around the world.
• The National Center for Injury Prevention and Control works to prevent death and disability from injuries that are not work-related, including both acts of violence and unintentional causes.

The CDC also operates a National Immunization Program (NIP), providing leadership for planning, organizing, and implementation of immunization activities across the country. Primary activities within the NIP include consultations, training, statistical support, promotion, education, health monitoring, and technical services to assist health departments with immunization related services.

The Epidemiology Program Office at the CDC operates to strengthen the public health system through health monitoring, and provides national and international support for such public health efforts through scientific communications, consultation in epidemiology and statistics, and by training experts in disease surveillance, epidemiology, applied public health, and prevention effectiveness.

The Public Health Practice Program Office at the CDC attends primarily to four elements of public health practice: the public health workforce, organizational effectiveness, the scientific capacity of public health laboratories, and the systems that manage public health information and knowledge.

The National Institute for Occupational Safety and Health (NIOSH) is an institute within the CDC that serves as the primary government-sponsored agency responsible for conducting research and making recommendations for the prevention of work-related injuries and illnesses. Occupational injuries number in the millions each year in the United States, and thousands of deaths due to occupational injuries occur each year, with an annual cost of $40 billion. Additionally, work-related diseases result in nearly 50,000 deaths each year. NIOSH, and its sister organization in the Labor Department, the Occupational Safety and Health Administration (OSHA), were created by the U.S. Congress in 1970. While OSHA plays a more regulatory role in monitoring and enforcing safety standards, NIOSH provides research, training, education, and information directed toward the improvement of occupational safety and identification of potential hazards.

The Agency for Toxic Substances and Disease Registry (ATSDR) is an adjunct CDC agency focused on critical health assessment work related to toxic waste sites, and improving the health consequences of related exposures. ATSDR serves the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and disease related to toxic substances.

The CDC has identified a number of challenges and future programs will be developed to meet these challenges. This includes enhancing the extent to which science is applied to improving health, prevention of violence and unintentional injury, health and safety needs of a changing workforce, utilization of new technologies to provide credible health information, protection against the threats of bioterrorism and newly emerging infectious diseases, elimination of racial and ethnic health disparities, fostering safe and healthy environments, and promoting good health globally.

see also Bioterrorism; Epidemiology; Toxicology.

Centers for Disease Control

The Centers for Disease Control and Prevention (CDC) is one of the primary public health institutions in the world. CDC is headquartered in Atlanta, Georgia, with facilities at 9 other sites in the United States. The centers are the focus of the United States government efforts to develop and implement prevention and control strategies for diseases, including those of microbiological origin.

The CDC is home to 11 national centers that address various aspects of health care and disease prevention. Examples of the centers include the National Center for Chronic Disease Prevention and Health promotion, National Center for Infectious Diseases, National Immunization Program, and the National Center for HIV , STD, and TB Prevention.

CDC was originally the acronym for The Communicable Disease Center. This center was a redesignation of an existing facility known as the Malaria Control in War Areas. The malaria control effort had been mandated to eradicatemalaria from the southern United States during World War II. The Communicable Disease Center began operations in Atlanta on July 1, 1946, under the direction of Dr. Joseph M. Mountin.

Initially, the center was very small and was staffed mainly by engineers and entomologists (scientists who study insects). But under Mountin's direction, an expansion program was begun with the intent of making the center the predominant United States center of epidemiology . By 1950 the center had opened a disease surveillance unit that remains a cornerstone of CDC's operations today. Indeed, during the Korean War, the Epidemiological Intelligence Service was created, to protect the United States from the immigration of disease causing microorganisms .

Two events in the 1950s brought the CDC to national prominence and assured the ongoing funding of the center. The first event was the outbreak of poliomyelitis in children who had received an inoculation with the recently approved Salk polio vaccine . A Polio Surveillance Unit that was established at CDC confirmed the cause of the cases to be due to a contaminated batch of the vaccine. With CDC's help, the problem was solved and the national polio vaccination program recommenced. The other event was a massive outbreak of influenzae. Data collected by CDC helped pave the way for the development of influenza vaccines and inoculation programs.

In the 1950s and 1960s, CDC became the center for venereal disease, tuberculosis , and immunization programs. The centers also played a pivotal role in the eradication of smallpox , through the development of a vaccine and an inoculation instrument. Other accomplishments include the identification of Legionnaire's disease and toxic shock syndrome in the 1970s and 1980s, hantavirus pulmonary syndrome in 1993, and, beginning in 1981, a lead role in the research and treatment of Acquired Immunodeficiency Syndrome.

In 1961, CDC took over the task of publishing Morbidity and Mortality Weekly Report. Then as now, the MMWR is a definitive weekly synopsis of data on deaths and selected diseases from every state in the United States. A noteworthy publication in MMWR was the first report in a 1981 issue of the disease that would come to be known as Acquired Immunodeficiency Syndrome.

Another advance took place in 1978, with the opening of a containment facility that could be used to study the most lethal viruses known to exist (e.g., Ebola). Only a few such facilities exist in the world. Without such high containment facilities, hemorrhagic viruses could not be studied, and development of vaccines would be impossible.

Ultimately, CDC moved far beyond its original mandate as a communicable disease center. To reflect this change, the name of the organization was changed in 1970 to the Center for Disease Control. In 1981, the name was again changed to the Centers for Disease Control. The subsequent initiation of programs designed to target chronic diseases, breast and cervical cancers and lifestyle issues (e.g., smoking) extended CDC's mandate beyond disease control. Thus, in 1992, the organization became the Centers for Disease Control and Prevention (the acronym CDC was retained).

Today, CDC is a world renowned center of excellence for public health research, disease detection, and dissemination of information on a variety of diseases and health issues.

See also AIDS, recent advances in research and treatment; Bacteria and bacterial infection; History of public health; Public health, current issues

Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention (CDC) is the Atlanta, Georgia-based agency of the Public Health Service that has led efforts to prevent diseases such as malaria , polio, smallpox, tuberculosis, and acquired immunodeficiency syndrome (AIDS ). As the nation's prevention agency, the CDC's responsibilities have expanded, and it now addresses contemporary threats to health such as injury, environmental and occupational hazards, behavioral risks, and chronic diseases.

Divisions within the CDC use surveillance, epidemiologic and laboratory studies, and community interventions to investigate and prevent public health threats.

The Center for Chronic Disease Prevention and Health Promotion designs programs to reduce death and disability from chronic diseases—cardiovascular, kidney, liver and lung diseases, and cancer and diabetes.

The Center for Environmental Health and Injury Control assists public health officials at the scene of natural or artificial disasters such as volcano eruptions, forest fires, hazardous chemical spills , and nuclear accidents. Scientists study the effects of chemicals and pesticides, reactor accidents, and health threats from radon , among others. The National Institute for Occupational Safety and Health helps identify chemical and physical hazards that lead to occupational diseases.

Preventing and controlling infectious diseases has been a goal of the CDC since its inception in 1946. The Center for Infectious Diseases investigates outbreaks of infectious disease locally and internationally. The Center for Prevention Services provides financial and technical assistance to control and prevent diseases. Disease detectives in the Epidemiology Program Office investigate outbreaks around the world.

Prevention of tobacco use is a critical health issue for CDC because cigarette smoking is the leading preventable cause of death in this country. The Office on Smoking and Health conducts research on the effects of smoking, develops health promotion and education campaigns, and helps health departments with smoking education programs.

CDC researchers have improved technology for lead poisoning screening, particularly in children. CDC evidence on environmental lead pollution was a key in gasoline lead content reduction requirements. The CDC also coordinated and directed health studies of Love Canal , New York, residents in the 1980s. The director of the CDC administers the Agency for Toxic Substances and Disease Registry , the public health agency created to protect the public from exposure to toxic substances in the environment . In 1990, CDC became responsible for energy-related epidemiologic research for the U.S. Department of Energy nuclear facilities. This includes studies of people who have been exposed to radiation from materials emitted to the air and water from plant operations.

The CDC today carries out an ever-widening agenda with studies on adolescent health, dental disease prevention, the epidemiology of violence, and categorizing and tracking birth abnormalities and infant mortality .

[Linda Rehkopf ]

RESOURCES

ORGANIZATIONS

Centers for Disease Control and Prevention, Public Inquiries/MASO, Mailstop F07, 1600 Clifton Road, Atlanta, GA USA 30333 Toll Free: (800) 311-3435, , http://www.cdc.gov