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Thesedeclinesreflectthesuccessofwidespread  implementationofPHSrecommendationsforroutine @@  counselingandvoluntaryHIVtestingofpregnant   womenanduseofzidovudine(AZT,alsocalled   ZDV)byinfectedwomenduringpregnancyand PP  deliveryandfortreatmentoftheinfantafterbirth#fXX"fA)t#f XfX.#fXXf Z#fA)"XfX   # ^,"fA)U#A)", ^Revisedperinatalcounselingandtestingguidelines   werereleasedinNovember2001.# ^,"A)#fA)", ^ ` `  #fXX"fA)#fA)"XfXCDCfocusesitsperinatalpreventioneffortsinthe   statesandcitiesthataccountforthemostcasesof p p  perinatalHIVtransmission.Activitiesinclude:1)   educatingprovidersabouttheimportanceofoffering   counselingandtestingtoallpregnantwomen;2)  providingoutreachtoincreaseprenatalcarefor 00 high-riskwomen;3)providingpublicinformation  campaignswithinformationaboutperinatalHIV  testingandtransmission;and4)examiningthe @@ feasibilityoftestingatdeliveryforwomenwhohave  hadnoprenatalcare.   PP 0 X # ^,"fA)##XGX, ^# XX Z[\]_E<<CLevel 1Level 2Level 3Level 4Level 5(.3$ !USUS.,  (.3$ !USUS.,  ($$   1  Level 1Level 2Level 3Level 4Level 5````)!dxdx dbbbb9Hairline!dxdx)Hairline d^\ed I&mage <=8C HKKKK)!dxdx( $ Figure  1  ,  AZArial   dgggg)!dxdxjjjj)!dxdxP Pdllll)!dxdx dnnnn)!dxdx djj)! dxdxqqqq)!dxdx&0 d dssss)!dxdx&P d duuuu)!dxdx&p d Pdwwww)!dxdx&p Pd dyzyz)!dxdx3+0 d d d3+0 d d d  @ @   ["USUS.,  _XXXXA)"XX TargetingInterventionstoMarginalizedPopulations   U.S.prisonsandjailshold2millionpersonsandrelease  approximately12millioninmatesintothecommunity hh annually.Thesefacilitieshousepersonswhoare  disproportionatelyaffectedbyhighratesofinfectious  diseasessuchasHIV/AIDS.TheconfirmedAIDScase xx rateamongprisonerswasfivetimestheU.S.ratein (( 1997.Approximately80%ofprisonershaveahistoryof  substanceabuse.Mostfacilitieslackcomprehensive  dischargeplanningtolinkreleaseeswith 88  community-basedprovidersforhealthcare,substance   abusetreatment,andotherservices.   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U% % % " ! T% % RL"Arial% FMSGRBP'% (   % V0,,,,FMSGREPFMSGRBPV0jjjjFMSGREPFMSGRBPV0FMSGREPFMSGRBPV0%C%CC%%FMSGREPFMSGRBPV0Q nQ n nQQ FMSGREPFMSGRBPV0||||FMSGREPFMSGRBPV0FMSGREPFMSGRBPV0EEEEFMSGREPFMSGRBPV0>>>>FMSGREPFMSGRBP V0*4G*4G4G**4FMSGREPFMSGRBP V0UisUisisUUiFMSGREPFMSGRBP V0}}}}FMSGREPFMSGRBP V0FMSGREPFMSGRBP V0FMSGREPFMSGRBPV0!!!FMSGREPFMSGRBPV0/L/LL//FMSGREP% % % " !  U% % % " !  :&% (   % % 666n6n565666Q6Q66S6666J6Ju6u666#6#N6Nz6z666(6(S6S&% ( S% 6SL6ZL6ZL6ZLW6ZWL*6Z*L6ZL6ZL6ZLs6ZsLF6ZFL6Z% % % " ! 6% % % " ! U% % % " ! U&% ( % '% RLTimes New RomanZLZLWZ*L*ZLZLZLZsLsZFLFZLZ---'% FMSGRBP  6%FMSGREPFMSGRBP-%6 FMSGREPFMSGRBP 64FMSGREPFMSGRBP46_FMSGREPFMSGRBP_6FMSGREPFMSGRBP6FMSGREPFMSGRBP6FMSGREPFMSGRBP6 FMSGREPFMSGRBP  69|FMSGREPFMSGRBP :9|6dxFMSGREPFMSGRBP dx6xFMSGREPFMSGRBP x6xFMSGREPFMSGRBP x6xFMSGREPFMSGRBP x6xFMSGREPFMSGRBPx6=FMSGREP% % % " ! U% % % " ! :% % % " ! 7% % % " ! :% % % " ! :% % % " ! :% % % " ! ;  % % TTAALP0- T`mAAmLT0.5  TTazAAaLP1 T`m(AAAm(LT1.5  TTAALP2 T`mAAmLT2.5  TT}AA}LP3 T`mD]AAmDLT3.5  TT $AA LP4' % % % " ! :% % % V &WMFC8 " ! ; % % Td AALT1983 Td  AALT1985 TdGv AAGLT1987 Td AALT1989 Td$ AALT1991 TdL{ AALLT1993 Td AALT1995 Td) AALT1997 % % % " ! :% % % " ! . % % Td &AA LTYear % % % " ! :% % % " ! )kD % RL"Arial% T0@jCAA0@ L`# of cases   RL"Arial% ( RL"Arial% TL9jCAAL9 L`(millions) % ( % % % " ! :% % % " ! ; % % TTdoAAdLP0 TXd{AAdLP10 TXdx{AAdxLP20 TXdJ{cAAdJLP30 TXd{6AAdLP40 TXd{AAdLP50 TXd{AAdLP60 TXd{AAdLP70 TXdf{AAdfLP80 TXd9{RAAd9LP90 T`d $AAd LT100 % % % " ! :% % % " ! C % RL"Arial--- U- "-   %%  44__% T?BAA? L`% Coverage  % ( % % % " ! :&% ( '% ( % % +uj5% % % " ! uk5% % % " ! uk5&% ( % (   % % +|,    % Tl-4AA-LXCases2   % % % " ! uk5% % % " ! uk5&% (  %% % 6% %% T|-b4AA-L\Coverage  % % % " ! uk5% % % " ! :% ( % % % " :! " ! "  : ''Times New Roman-' M:-' M:  "-,-$SS:5ku "--SS "---'  M:---'  M6---'  MU---'  MT--"Arial-- -$,,,$jjj$$%CC%%$Q n nQQ $|||$$EEE$>>>$*4G4G**4$UisisUUi$}}}$$$!!$/LL//---'  MU---'  M: "---nn55QQSJJuu##NNzz((SS "-S-SLZLZLZWLWZ*L*ZLZLZLZsLsZFLFZLZ---'  M6---'  MU---'  MU "---Times New Roman?-  % 4_ |9xdxxxx=---'  MU---'  M:---'  M7---'  M:---'  M:---'  M:---'  M; -- 2 0 2 m0.5  2 a1 2 (m1.5  2 2 2 m2.5  2 }3 2 Dm3.5  2 4 ---'  M:---'  M;-- 2 1983 2 1985 2 G1987 2 1989 2 1991 2 L1993 2 1995 2 1997 ---'  M:---'  M.-- 2 Year ---'  M:---'  MDk)-"Arial- 2 @0 # of cases   "Arial-  "Arial- 2 9L (millions) -  ---'  M:---'  M;-- 2 d0 2 d10 2 xd20 2 Jd30 2 d40 2 d50 2 d60 2 d70 2 fd80 2 9d90 2 d100 ---'  M:---'  MC-"Arial- 2 ? % Coverage  - ---'  M: "- -- -6ku---'  M5ku---'  M5ku "- - ---| .- 2 -Cases .---'  M5ku---'  M5ku "-%--%.%- 2 -Coverage .---'  M5ku---'  M:---- ' ' ' - "-'&&L% "--% P  --&&\ %e "--% ` ` --&&L  "--%P  --&--'-- - `@"Arial- .g2 \g@Reported number of measles cases and routine measles vaccinationtYbb>5Yb,bbbY>,b5,YYY,YY,YYYYY,Ybb,>bb5,bY,YYY,YY-WYYY-bY5,bb. .?2 %coverage among children aged 1 year, YcWY>YbY,Ybbb,Yb,,b>Yb,YbYb,Y-WYY>,,. .2 by yearcW.WYY>. . 2 D --53. .2  worldwide, 1983b>+`+bY,,YYYY. . 2 y-4. . 2 1998YYYY.--"System-&TNPP &WPWin 6.0/OLE 1.0 Prefix Information MarkerWPDraw30.Drawingࡱ> 1  !"#$%&'()*+,-./03456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^Root Entry`.@pg@Ole WPG20XYCompObjtreporting  +    `.@pCorel Presentations 9 Drawing Embed SourceWPDraw30.Drawing9qinfectionting 0 druguse,increaseYd @1 proportiondiagnosedbefore e 2 progressiontoAIDS. $%!3 $FY03: 77%  %4 FY02: 77%  P6 FY01: 76%  E!8 WPCWY.."51398! !.X n, &. &&#TNPP 2OMi & TNPP &&TNPP   . &4.  - "- .C M ;&" WMFC 8X0 &Rc: EMF8Y XF(MSGRCIhi !" !" !% " !:% " !: &% ',% V0SSSuk5&% (  % 6S6S66% % % " ! :% % % " ! 6% % % " ! U% % % " ! T% % RL"Arial% FMSGRBP'% (   % V0,,,,FMSGREPFMSGRBPV0jjjjFMSGREPFMSGRBPV0FMSGREPFMSGRBPV0%C%CC%%FMSGREPFMSGRBPV0Q nQ n nQQ FMSGREPFMSGRBPV0||||FMSGREPFMSGRBPV0FMSGREPFMSGRBPV0EEEEFMSGREPFMSGRBPV0>>>>FMSGREPFMSGRBP V0*4G*4G4G**4FMSGREPFMSGRBP V0UisUisisUUiFMSGREPFMSGRBP V0}}}}FMSGREPFMSGRBP V0FMSGREPFMSGRBP V0FMSGREPFMSGRBPV0!!!FMSGREPFMSGRBPV0/L/LL//FMSGREP% % % " !  U% % % " !  :&% (   % % 666n6n565666Q6Q66S6666J6Ju6u666#6#N6Nz6z666(6(S6S&% ( S% 6SL6ZL6ZL6ZLW6ZWL*6Z*L6ZL6ZL6ZLs6ZsLF6ZFL6Z% % % " ! 6% % % " ! U% % % " ! U&% ( % '% RLTimes New RomanZLZLWZ*L*ZLZLZLZsLsZFLFZLZ---'% FMSGRBP  6%FMSGREPFMSGRBP-%6 FMSGREPFMSGRBP 64FMSGREPFMSGRBP46_FMSGREPFMSGRBP_6FMSGREPFMSGRBP6FMSGREPFMSGRBP6FMSGREPFMSGRBP6 FMSGREPFMSGRBP  69|FMSGREPFMSGRBP :9|6dxFMSGREPFMSGRBP dx6xFMSGREPFMSGRBP x6xFMSGREPFMSGRBP x6xFMSGREPFMSGRBP x6xFMSGREPFMSGRBPx6=FMSGREP% % % " ! U% % % " ! :% % % " ! 7% % % " ! :% % % " ! :% % % " ! :% % % " ! ;  % % TTAALP0- T`mAAmLT0.5  TTazAAaLP1 T`m(AAAm(LT1.5  TTAALP2 T`mAAmLT2.5  TT}AA}LP3 T`mD]AAmDLT3.5  TT $AA LP4' % % % " ! :% % % V &WMFC8 " ! ; % % Td AALT1983 Td  AALT1985 TdGv AAGLT1987 Td AALT1989 Td$ AALT1991 TdL{ AALLT1993 Td AALT1995 Td) AALT1997 % % % " ! :% % % " ! . % % Td &AA LTYear % % % " ! :% % % " ! )kD % RL"Arial% T0@jCAA0@ L`# of cases   RL"Arial% ( RL"Arial% TL9jCAAL9 L`(millions) % ( % % % " ! :% % % " ! ; % % TTdoAAdLP0 TXd{AAdLP10 TXdx{AAdxLP20 TXdJ{cAAdJLP30 TXd{6AAdLP40 TXd{AAdLP50 TXd{AAdLP60 TXd{AAdLP70 TXdf{AAdfLP80 TXd9{RAAd9LP90 T`d $AAd LT100 % % % " ! :% % % " ! C % RL"Arial--- U- "-   %%  44__% T?BAA? L`% Coverage  % ( % % % " ! :&% ( '% ( % % +uj5% % % " ! uk5% % % " ! uk5&% ( % (   % % +|,    % Tl-4AA-LXCases2   % % % " ! uk5% % % " ! uk5&% (  %% % 6% %% T|-b4AA-L\Coverage  % % % " ! uk5% % % " ! :% ( % % % " :! " ! "  : ''Times New Roman-' M:-' M:  "-,-$SS:5ku "--SS "---'  M:---'  M6---'  MU---'  MT--"Arial-- -$,,,$jjj$$%CC%%$Q n nQQ $|||$$EEE$>>>$*4G4G**4$UisisUUi$}}}$$$!!$/LL//---'  MU---'  M: "---nn55QQSJJuu##NNzz((SS "-S-SLZLZLZWLWZ*L*ZLZLZLZsLsZFLFZLZ---'  M6---'  MU---'  MU "---Times New Roman?-  % 4_ |9xdxxxx=---'  MU---'  M:---'  M7---'  M:---'  M:---'  M:---'  M; -- 2 0 2 m0.5  2 a1 2 (m1.5  2 2 2 m2.5  2 }3 2 Dm3.5  2 4 ---'  M:---'  M;-- 2 1983 2 1985 2 G1987 2 1989 2 1991 2 L1993 2 1995 2 1997 ---'  M:---'  M.-- 2 Year ---'  M:---'  MDk)-"Arial- 2 @0 # of cases   "Arial-  "Arial- 2 9L (millions) -  ---'  M:---'  M;-- 2 d0 2 d10 2 xd20 2 Jd30 2 d40 2 d50 2 d60 2 d70 2 fd80 2 9d90 2 d100 ---'  M:---'  MC-"Arial- 2 ? % Coverage  - ---'  M: "- -- -6ku---'  M5ku---'  M5ku "- - ---| .- 2 -Cases .---'  M5ku---'  M5ku "-%--%.%- 2 -Coverage .---'  M5ku---'  M:---- ' ' ' - "-'&&L% "--% P  --&&\ %e "--% ` ` --&&L  "--%P  --&--'-- - `@"Arial- .g2 \g@Reported number of measles cases and routine measles vaccinationtYbb>5Yb,bbbY>,b5,YYY,YY,YYYYY,Ybb,>bb5,bY,YYY,YY-WYYY-bY5,bb. .?2 %coverage among children aged 1 year, YcWY>YbY,Ybbb,Yb,,b>Yb,YbYb,Y-WYY>,,. .2 by yearcW.WYY>. . 2 D --53. .2  worldwide, 1983b>+`+bY,,YYYY. . 2 y-4. . 2 1998YYYY.--"System-&TNPP &BOlePartOlePres0002YWPGExtents 8c.CY ,   .C8c     ?. . &. &&#TNPP 2OMi & TNPP &&TNPP   . &4.  - "- .C M ;&" WMFC 8X0 &Rc: EMF8Y XF(MSGRCIhi !" !" !% " !:% " !: &% ',% V0SSSuk5&% (  % 6S6S66% % % " ! :% % % " ! 6% % % " ! U% % % " ! T% % RL"Arial% FMSGRBP'% (   % V0,,,,FMSGREPFMSGRBPV0jjjjFMSGREPFMSGRBPV0FMSGREPFMSGRBPV0%C%CC%%FMSGREPFMSGRBPV0Q nQ n nQQ FMSGREPFMSGRBPV0||||FMSGREPFMSGRBPV0FMSGREPFMSGRBPV0EEEEFMSGREPFMSGRBPV0>>>>FMSGREPFMSGRBP V0*4G*4G4G**4FMSGREPFMSGRBP V0UisUisisUUiFMSGREPFMSGRBP V0}}}}FMSGREPFMSGRBP V0FMSGREPFMSGRBP V0FMSGREPFMSGRBPV0!!!FMSGREPFMSGRBPV0/L/LL//FMSGREP% % % " !  U% % % " !  :&% (   % % 666n6n565666Q6Q66S6666J6Ju6u666#6#N6Nz6z666(6(S6S&% ( S% 6SL6ZL6ZL6ZLW6ZWL*6Z*L6ZL6ZL6ZLs6ZsLF6ZFL6Z% % % " ! 6% % % " ! U% % % " ! U&% ( % '% RLTimes New RomanZLZLWZ*L*ZLZLZLZsLsZFLFZLZ---'% FMSGRBP  6%FMSGREPFMSGRBP-%6 FMSGREPFMSGRBP 64FMSGREPFMSGRBP46_FMSGREPFMSGRBP_6FMSGREPFMSGRBP6FMSGREPFMSGRBP6FMSGREPFMSGRBP6 FMSGREPFMSGRBP  69|FMSGREPFMSGRBP :9|6dxFMSGREPFMSGRBP dx6xFMSGREPFMSGRBP x6xFMSGREPFMSGRBP x6xFMSGREPFMSGRBP x6xFMSGREPFMSGRBPx6=FMSGREP% % % " ! U% % % " ! :% % % " ! 7% % % " ! :% % % " ! :% % % " ! :% % % " ! ;  % % TTAALP0- T`mAAmLT0.5  TTazAAaLP1 T`m(AAAm(LT1.5  TTAALP2 T`mAAmLT2.5  TT}AA}LP3 T`mD]AAmDLT3.5  TT $AA LP4' % % % " ! :% % % V &WMFC8 " ! ; % % Td AALT1983 Td  AALT1985 TdGv AAGLT1987 Td AALT1989 Td$ AALT1991 TdL{ AALLT1993 Td AALT1995 Td) AALT1997 % % % " ! :% % % " ! . % % Td &AA LTYear % % % " ! :% % % " ! )kD % RL"Arial% T0@jCAA0@ L`# of cases   RL"Arial% ( RL"Arial% TL9jCAAL9 L`(millions) % ( % % % " ! :% % % " ! ; % % TTdoAAdLP0 TXd{AAdLP10 TXdx{AAdxLP20 TXdJ{cAAdJLP30 TXd{6AAdLP40 TXd{AAdLP50 TXd{AAdLP60 TXd{AAdLP70 TXdf{AAdfLP80 TXd9{RAAd9LP90 T`d $AAd LT100 % % % " ! :% % % " ! C % RL"Arial--- U- "-   %%  44__% T?BAA? L`% Coverage  % ( % % % " ! :&% ( '% ( % % +uj5% % % " ! uk5% % % " ! uk5&% ( % (   % % +|,    % Tl-4AA-LXCases2   % % % " ! uk5% % % " ! uk5&% (  %% % 6% %% T|-b4AA-L\Coverage  % % % " ! uk5% % % " ! :% ( % % % " :! " ! "  : ''Times New Roman-' M:-' M:  "-,-$SS:5ku "--SS "---'  M:---'  M6---'  MU---'  MT--"Arial-- -$,,,$jjj$$%CC%%$Q n nQQ $|||$$EEE$>>>$*4G4G**4$UisisUUi$}}}$$$!!$/LL//---'  MU---'  M: "---nn55QQSJJuu##NNzz((SS "-S-SLZLZLZWLWZ*L*ZLZLZLZsLsZFLFZLZ---'  M6---'  MU---'  MU "---Times New Roman?-  % 4_ |9xdxxxx=---'  MU---'  M:---'  M7---'  M:---'  M:---'  M:---'  M; -- 2 0 2 m0.5  2 a1 2 (m1.5  2 2 2 m2.5  2 }3 2 Dm3.5  2 4 ---'  M:---'  M;-- 2 1983 2 1985 2 G1987 2 1989 2 1991 2 L1993 2 1995 2 1997 ---'  M:---'  M.-- 2 Year ---'  M:---'  MDk)-"Arial- 2 @0 # of cases   "Arial-  "Arial- 2 9L (millions) -  ---'  M:---'  M;-- 2 d0 2 d10 2 xd20 2 Jd30 2 d40 2 d50 2 d60 2 d70 2 fd80 2 9d90 2 d100 ---'  M:---'  MC-"Arial- 2 ? % Coverage  - ---'  M: "- -- -6ku---'  M5ku---'  M5ku "- - ---| .- 2 -Cases .---'  M5ku---'  M5ku "-%--%.%- 2 -Coverage .---'  M5ku---'  M:---- ' ' ' - "-'&&L% "--% P  --&&\ %e "--% ` ` --&&L  "--%P  --&--'-- - `@"Arial- .g2 \g@Reported number of measles cases and routine measles vaccinationtYbb>5Yb,bbbY>,b5,YYY,YY,YYYYY,Ybb,>bb5,bY,YYY,YY-WYYY-bY5,bb. .?2 %coverage among children aged 1 year, YcWY>YbY,Ybbb,Yb,,b>Yb,YbYb,Y-WYY>,,. .2 by yearcW.WYY>. . 2 D --53. .2  worldwide, 1983b>+`+bY,,YYYY. . 2 y-4. . 2 1998YYYY.--"System-&TNPP &     METAFILEPICT8cҼY8c.C ,   .C8c     ?. . &. &&#TNPP 2OMi & TNPP &&TNPP   . &4.  - "- .C M ;&" WMFC 8X0 &Rc: EMF8Y XF(MSGRCIhi !" !" !% " !:% " !: &% ',% V0SSSuk5&% (  % 6S6S66% % % " ! :% % % " ! 6% % % " ! U% % % " ! T% % RL"Arial% FMSGRBP'% (   % V0,,,,FMSGREPFMSGRBPV0jjjjFMSGREPFMSGRBPV0FMSGREPFMSGRBPV0%C%CC%%FMSGREPFMSGRBPV0Q nQ n nQQ FMSGREPFMSGRBPV0||||FMSGREPFMSGRBPV0FMSGREPFMSGRBPV0EEEEFMSGREPFMSGRBPV0>>>>FMSGREPFMSGRBP V0*4G*4G4G**4FMSGREPFMSGRBP V0UisUisisUUiFMSGREPFMSGRBP V0}}}}FMSGREPFMSGRBP V0FMSGREPFMSGRBP V0FMSGREPFMSGRBPV0!!!FMSGREPFMSGRBPV0/L/LL//FMSGREP% % % " !  U% % % " !  :&% (   % % 666n6n565666Q6Q66S6666J6Ju6u666#6#N6Nz6z666(6(S6S&% ( S% 6SL6ZL6ZL6ZLW6ZWL*6Z*L6ZL6ZL6ZLs6ZsLF6ZFL6Z% % % " ! 6% % % " ! U% % % " ! U&% ( % '% RLTimes New RomanZLZLWZ*L*ZLZLZLZsLsZFLFZLZ---'% FMSGRBP  6%FMSGREPFMSGRBP-%6 FMSGREPFMSGRBP 64FMSGREPFMSGRBP46_FMSGREPFMSGRBP_6FMSGREPFMSGRBP6FMSGREPFMSGRBP6FMSGREPFMSGRBP6 FMSGREPFMSGRBP  69|FMSGREPFMSGRBP :9|6dxFMSGREPFMSGRBP dx6xFMSGREPFMSGRBP x6xFMSGREPFMSGRBP x6xFMSGREPFMSGRBP x6xFMSGREPFMSGRBPx6=FMSGREP% % % " ! U% % % " ! :% % % " ! 7% % % " ! :% % % " ! :% % % " ! :% % % " ! ;  % % TTAALP0- T`mAAmLT0.5  TTazAAaLP1 T`m(AAAm(LT1.5  TTAALP2 T`mAAmLT2.5  TT}AA}LP3 T`mD]AAmDLT3.5  TT $AA LP4' % % % " ! :% % % V &WMFC8 " ! ; % % Td AALT1983 Td  AALT1985 TdGv AAGLT1987 Td AALT1989 Td$ AALT1991 TdL{ AALLT1993 Td AALT1995 Td) AALT1997 % % % " ! :% % % " ! . % % Td &AA LTYear % % % " ! :% % % " ! )kD % RL"Arial% T0@jCAA0@ L`# of cases   RL"Arial% ( RL"Arial% TL9jCAAL9 L`(millions) % ( % % % " ! :% % % " ! ; % % TTdoAAdLP0 TXd{AAdLP10 TXdx{AAdxLP20 TXdJ{cAAdJLP30 TXd{6AAdLP40 TXd{AAdLP50 TXd{AAdLP60 TXd{AAdLP70 TXdf{AAdfLP80 TXd9{RAAd9LP90 T`d $AAd LT100 % % % " ! :% % % " ! C % RL"Arial--- U- "-   %%  44__% T?BAA? L`% Coverage  % ( % % % " ! :&% ( '% ( % % +uj5% % % " ! uk5% % % " ! uk5&% ( % (   % % +|,    % Tl-4AA-LXCases2   % % % " ! uk5% % % " ! uk5&% (  %% % 6% %% T|-b4AA-L\Coverage  % % % " ! uk5% % % " ! :% ( % % % " :! " ! "  : ''Times New Roman-' M:-' M:  "-,-$SS:5ku "--SS "---'  M:---'  M6---'  MU---'  MT--"Arial-- -$,,,$jjj$$%CC%%$Q n nQQ $|||$$EEE$>>>$*4G4G**4$UisisUUi$}}}$$$!!$/LL//---'  MU---'  M: "---nn55QQSJJuu##NNzz((SS "-S-SLZLZLZWLWZ*L*ZLZLZLZsLsZFLFZLZ---'  M6---'  MU---'  MU "---Times New Roman?-  % 4_ |9xdxxxx=---'  MU---'  M:---'  M7---'  M:---'  M:---'  M:---'  M; -- 2 0 2 m0.5  2 a1 2 (m1.5  2 2 2 m2.5  2 }3 2 Dm3.5  2 4 ---'  M:---'  M;-- 2 1983 2 1985 2 G1987 2 1989 2 1991 2 L1993 2 1995 2 1997 ---'  M:---'  M.-- 2 Year ---'  M:---'  MDk)-"Arial- 2 @0 # of cases   "Arial-  "Arial- 2 9L (millions) -  ---'  M:---'  M;-- 2 d0 2 d10 2 xd20 2 Jd30 2 d40 2 d50 2 d60 2 d70 2 fd80 2 9d90 2 d100 ---'  M:---'  MC-"Arial- 2 ? % Coverage  - ---'  M: "- -- -6ku---'  M5ku---'  M5ku "- - ---| .- 2 -Cases .---'  M5ku---'  M5ku "-%--%.%- 2 -Coverage .---'  M5ku---'  M:---- ' ' ' - "-'&&L% "--% P  --&&\ %e "--% ` ` --&&L  "--%P  --&--'-- - `@"Arial- .g2 \g@Reported number of measles cases and routine measles vaccinationtYbb>5Yb,bbbY>,b5,YYY,YY,YYYYY,Ybb,>bb5,bY,YYY,YY-WYYY-bY5,bb. .?2 %coverage among children aged 1 year, YcWY>YbY,Ybbb,Yb,,b>Yb,YbYb,Y-WYY>,,. .2 by yearcW.WYY>. . 2 D --53. .2  worldwide, 1983b>+`+bY,,YYYY. . 2 y-4. . 2 1998YYYY.--"System-&TNPP &     WPCk+k+!k+tƚk+/d V: &[c &&#TNPP 2OMi & TNPP &&TNPP  [ T  - "-Q\[- "- - `@"Verdana- .K2 '-Vaccination Coverage and Reported Number of zk^^7rkI7nr7tnhjPkpj7krp7}jpnPIjp7rpjP7nD77. .K2 !-Vaccination Coverage and Reported Number of zk^^7rkI7nr7tnhjPkpj7krp7}jpnPIjp7rpjP7nD77. .H2 uC+Measles Cases, Region of the Americas, 1980jk_7j_7tk_j_:7}jp7nr7nD7Irj7|jP7^k_:7rrrr. .H2 o=+Measles Cases, Region of the Americas, 1980jk_7j_7tk_j_:7}jp7nr7nD7Irj7|jP7^k_:7rrrr. . 2 u-M. . 2 o-M. . 2 ul2000rrrr. . 2 of2000rrrr.@"Verdana- . 2 C2*J. . 2 ?.*J.&?9 .  --T !  e &" WMFC! 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Objective1.3ImprovethedietandlevelofphysicalactivityofAmericans. PP Objective1.4Reducealcoholabuseandpreventunderagedrinking.   Objective1.5Reducetheabuseandillicituseofdrugs. ``  Objective1.6Reduceunsafesexualbehaviors.   Objective1.7Reducetheincidenceandimpactofinfectiousdiseases. pp  Objective1.8Reducetheimpactofenvironmentalfactorsonhumanhealth.    #^d\\^}=@#^}=\\^dGoal4:0  Improvethequalityofhealthcareandhumanservices.  Objective4.1Enhancetheappropriateuseofeffectivehealthservices.  Objective4.2Increaseconsumerandpatientuseofhealthcarequality    Ѐinformation.   Objective4.3Improveconsumerandpatientprotection. , ,  Objective4.4Developknowledgethatimprovesthequalityandeffectivenessof   Ѐhumanservicespractice.#^d\\^}=5#^}=\\^d < <   Goal5:0  Improvethenationspublichealthsystems. L L  Objective5.1Improvethecapacityofthepublichealthsystemtoidentifyand   Ѐrespondtothreatstothehealthofthenationspopulation. ` `  Objective5.2Improvethesafetyoffood,drugs,medicaldevices,andbiological   Ѐproducts. pp  Goal6:0  Strengthenthenationshealthscienceresearchenterpriseand  enhanceitsproductivity.    Objective6.1Advancethescientificunderstandingofnormalandabnormal  Ѐbiologicalfunctionsandbehaviors.     Objective6.2Improveourunderstandingofhowtoprevent,diagnose,andtreat ! Ѐdiseaseanddisability. 00" Objective6.3Enhanceourunderstandingofhowtoimprovethequality, # Ѐeffectiveness,utilization,financing,andcosteffectivenessofhealth @@$ Ѐservices. % Objective6.4Accelerateprivatesectordevelopmentofnewdrugs,biologic PP& Ѐtherapies,andmedicaltechnology. ' Objective6.5Strengthenanddiversifythebaseofwellqualifiedhealth ``( Ѐresearchers. ) Objective6.6Improvethecommunicationandapplicationofhealthresearch pp* Ѐresults. + Objective6.7Strengthenmechanismsforensuringtheprotection#XX\^}=_# XXԀ#XX #^}=\XXofhuman , Ѐsubjectsinresearchandtheintegrityoftheresearchprocess.#XX\^}=##XGXXX#,  AZArial 2/+J 0_level9    L23  ..  2( 4 <DL2  2GJ 0_levsl1  X /%4 4 <DL/23  Ԁ  2( 4 <DL2   ["USUS.,  _   @X  @  @  @`  @ XXXX @ IIA.2Bioterrorism#XGXXXވ# 2DJ 0_levsl2   ," <DL,23  Ԁ  2( 4 <DL2  ,rAZArial 2AJ 0_levsl3   ) <DL)23  Ԁ  2( 4 <DL2  2>J 0_levsl4  ` &<<DL&23  Ԁ  2( 4 <DL2  2;J 0_levsl5   #DL#23  Ԁ  2( 4 <DL2   ( ["USUS.,  _ XX ^   PerformanceGoal:0  Continueeffortstoprotectthehealthandsafetyoffirstrespondersduring  biologicalandchemicalterrorismevents. 28J 0_levsl6    DL 23  Ԁ  2( 4 <DL2  25J 0_levsl7  h DDL23  Ԁ  2( 4 <DL2  22J 0_levsl8   L23  Ԁ  2( 4 <DL2  2/J 0_levsl9    L23  Ԁ  2( 4 <DL2  2GJ 0_levnl1  X /%4 4 <DL/23   2( 4 <DL2  2DJ 0_levnl2   ," <DL,23   2( 4 <DL2  2AJ 0_levnl3   ) <DL)23   2( 4 <DL2  ӄrAZ"Arial Regular  w      ($USUS.,    2    _ e `M'XX '`MԀSource:U.S.BureauoftheCensus,65+intheUnitedStates,SpecialStudies,SeriesP23190,U.S.GovernmentPrintingOffice,  Washington,DC,1996#`M' ##XGX'`Mz#,  AZArial %2A`Arial2>J 0_levnl4  ` &<<DL&23   2( 4 <DL2  2;J 0_levnl5   #DL#23   2( 4 <DL2  8TABLE R|TABLE DTABLE GKTABLE ETABLE J|TABLE BLTABLE H9GHIJKLMxzE[_cgkoswCheck MarkCheck Mark33333333TABLE IKTABLE Kp9GHIJKLMhZCEIMQUY]aAutoList8""""""""i)1)a)TABLE FHTABLE P9GHIJKLMhQCEIMQUY]aAutoList7========i)1)a)4(.(3($ !USUS.,      0  ````5 Shadow!dZdZ(#$  0  TABLE CTABLE L   TABLE S28J 0_levnl6    DL 23   2( 4 <DL2  25J 0_levnl7  h DDL23   2( 4 <DL2  22J 0_levnl8   L23   2( 4 <DL2  2/J 0_levnl9    L23   2( 4 <DL2  <6X9`(Courier New ["USUS.,  _   NXXlNIIA.3Immunization#Nlk##XGXNL# ,rAZArial  X ["USUS.,  _ XXo^      VaccinesareHighlyCostEffective   ~  #  o^\#o^   #oXX o^=#o^ XoXForevery$1spent:  ЀDTaPsaves$27.00  MMRsaves$13.50 HH Varicellasaves$5.40#oXX o^E##XGXXoX#  ,  AZArial TABLE AHTABLE BSTABLE HرTABLE BTABLE CVTABLE ITABLE Q TABLE R0;TABLE CKTABLE Q  lTABLE CO !USUS.,  _NXXN*}hv̀      ICentersforDiseaseControlandPrevention x  (CDC)#I#  FinalFY2003GPRAAnnualPerformancePlan ( RevisedFinalFY2002GPRAAnnualPerformancePlan , FY2001GPRAAnnualPerformanceReport  0  February2002  8  -() }h } }  vY_>.*lx x `Extt v (#(#   (#(#   ^ FY2003FinalPerformancePlan  FY2002RevisedFinalPerformancePlan l FY2001PerformanceReport# ^#^  4   # ^#^  @"""TableofContents  ^    #^   e# Introduction  L    PartI.0  CDCContextforPerformanceMeasurement  $  $ $  <(83"93"  0  932I-  A  3  0`  $ $  Vision,Mission,andLongTermGoals0` $` $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page593݌\  $ $ Ќ  0  IB0`  $ $Organization,Programs,Operations,Strategies,andResources0 ` $` $0x  $  $0 x $x $Page8l  $ $ 0  IC0`  $ $PartnershipsandCoordination0` $` $0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page11,  $ $ 0  ID0`  $ $  HighPriorityInitiativesintheFY2003Plan0p` $` $0p $p $0  $ $0x  $  $0 x $x $Page12  $ $  PartII.CDCPerformanceReport  l 0  IIA0`  $ $StrengtheningNationalSecurity:ProtectingAmericansfromInfectiousDiseases` $` $ 0  0`  $ $IIA.10 ` $` $InfectiousDiseasesControl0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page13$t $ $ 0  0`  $ $IIA.20 ` $` $_Bioterrorism_0h $ $0h $h $0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page254 $ $ 0  0`  $ $IIA.30 ` $` $Immunization0h $ $0h $h $0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page36 $ $ 0  0`  $ $IIA.40 ` $` $HIV/AIDS0h $ $0h $h $0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page50d $ $ 0  0`  $ $IIA.50 ` $` $SexuallyTransmittedDiseases0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page64$t $ $ 0  0`  $ $IIA.60 ` $` $Tuberculosis0h $ $0h $h $0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page734 $ $ 0  IIB0`  $ $ImprovingWellbeingandProductivity:ProtectingAmericansfromChronicDiseasesand d PromotingHealthyBehaviors$t` $` $ 0  0`  $ $IIB.10 ` $` $ChronicDiseasePreventionandHealthPromotion0  $ $0x  $  $0 x $x $Page79  $ $ 0  0`  $ $IIB.20 ` $` $PreventiveHealthandHealthServicesBlockGrant0  $ $0x  $  $0 x $x $Page99d! $ $ 0  IIC0`  $ $CreatingaResponsiveNationalPublicHealthSystem4#` $` $ 0  0`  $ $IIC.10 ` $` $PublicHealthImprovement0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page103d!% $ $ 0  0`  $ $IIC.20 ` $` $HealthStatistics0 $ $0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page124$"t& $ $ 0  0`  $ $IIC.30 ` $` $EpidemicServicesandResponse0p $ $0p $p $0  $ $0x  $  $0 x $x $Page133"4' $ $ 0  0`  $ $IIC.40 ` $` $BirthDefects/DisabilitiesandHealth0p $ $0p $p $0  $ $0x  $  $0 x $x $Page141#( $ $ 0  0`  $ $IIC.50 ` $` $InjuryPreventionandControl0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page147d$) $ $ 0  0`  $ $IIC.60 ` $` $OccupationalSafetyandHealth0p $ $0p $p $0  $ $0x  $  $0 x $x $Page166$%t * $ $ 0  0`  $ $IIC.70 ` $` $EnvironmentalHealth0 $ $0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page184%4!+ $ $ 0  IID0`  $ $MaintainingResponsibleStewardshipofPublicResourcesd'"-` $` $ 0  0`  $ $IID.10 ` $` $BuildingsandFacilities0 $ $0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page194(4$/ $ $ 0  0`  $ $IID.20 ` $` $OfficeoftheDirector0 $ $0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page198)$0 $ $    ` IID.30 ProgramSupport0 $ $0 $ $0p $ $0p $p $0  $ $0x  $  $0 x $x $Page215d*%1 $ $  Appendices  +4'3    ` AppendixA0  ApproachtoPerformanceMeasurement,'4 $ $    ` AppendixB0  DataVerificationandValidationl-(5 $ $    ` AppendixC0  KeyImprovementsintheCDCFY2003PerformancePlan,.|)6 $ $    ` AppendixD0  PerformanceMeasurementLinkages.<*7 $ $    ` AppendixE0  ChangeChartforGoalsandMeasures/*8 $ $ v 8GXXdd8   Qe^  ^  A_@ d@%AXX ^Introduction#^ XXޜ"#  V L"@z޾t޾@{1111!["@/^ XXX ^-"/Q"^  ^SaferHealthierPeopleisanationalandglobalidealmaderealbytheinformedactionsofthededicated ^  professionalsoftheCentersforDiseaseControlandPrevention(CDC).SaferHealthierPeopleisthe "  organizingprincipleoftheleadfederalagencythatisresponsibleforpromotinghealthandqualityoflifeby   preventingandcontrollingdisease,injury,anddisability.CDC,whichwasfoundedin1946,hasremainedat C  theforefrontofdomesticandglobalpublichealtheffortsformorethan5decades.  f  CDCisoftenrecognizedforitsworldclassresearchandhighprofile,lifesavinginvestigations.However,it   isCDCsactionorientedapproachofapplyingtheresultsofscientificinquirytomakingthecitizensofthe C  UnitedStates!andtheworld!saferandhealthierthatsetsitapartfromotheragencies.Sinceits f  inception,thescopeofCDCsmandatehasexpandedfrominfectiousdiseasepreventionandcontrolto & includetopreventionandcontrolofchronicdiseases,injuries,workplacehazards,disabilities,and  environmentalhealththreats.TheimpactofCDCsprogramsandactivitiescanbemeasuredbyits C performanceinthreeprincipalfocusareas: f /^ XXX ^#/ '9GHIJKLM(x8< ProtectingthehealthandsafetyofAmericans   +^ XXX ^+Infectiousdiseases,suchashumanimmunodeficiencyvirus(HIV)infection,tuberculosis(TB),and G _foodborne_Ԁinfections,candestroylives,straincommunityresources,anddestabilizenations.Inourfast j pacedsociety,newdiseaseshavethepotentialtospreadacrosstheworldinafewhoursordays,making * earlydetectionandactionmoreimportantthanever.CDCplaysacriticalroleincontrollingthesediseases,  withdiseasedetectivesreadyandabletotravelatamomentsnoticetoinvestigateacutethreatstohealth G athomeorabroad. j  ButdiseaseoutbreaksareonlyoneaspectofCDCsprotectiverole.Byprovidingstateandlocalhealth " departmentswithfunds,training,andothertypesoftechnicalassistance,CDCworkstoprotectthepublic G# frominfectiousandchronicdiseases,injuries,disabilities,andworkplaceandenvironmentalhazards. j$ Protectinghealthandsafetyalsorequiresthejudicioususeofthemostethicalandhighqualityscientific *% researchtechniquesthatallowCDCscientiststounderstandthecausesofdisease,injury,anddisabilityand & toimplementactionsthatpreventthem.CDCspecializesindetectinganddefininghealthproblemsthrough G' publichealthsurveillance,determiningtheircauses,developingandtestingstrategiesforaddressingthe j( problem,andimplementingprogramsthatpreventorreducethreatstohealthandsafety. *)  Providingcredibleinformationtoenhancehealthdecisions  G+ CDCrecognizesthatthebest,mostuptodatehealthinformationismeaninglessunlessitismeaningfuland  n, accessibletothepersonsitismeanttoserve.Byworkingwithpublichealthandgrassrootspartners,and  . - byleveragingthetechnologyoftheInternetandthetoolsofthecommunicationsmedia,CDCensuresthat ! . thebesthealthandsafetyinformationisaccessibletothecitizens,communities,healthcareproviders,and K"!/ policymakerswhoneedit.  #n"0 #^  ^*# Promotinghealththroughstrongpartnerships  $#2 Theeverydayworldprovidesaseriesofobstaclestocontinuedgoodhealth:emerginginfectiousdiseases O%$3 andthethreatof_bioterrorism_;pollutionintheairwebreatheandwaterwedrink;unsafeconditionsinour &r%4 workplaces;personalhabitsthatdamageourhealth;intentionalandunintentionalinjuries;andlimited &2&5 accesstohealthservices,especiallyfordisadvantagedpopulations.CDCworkscollaborativelywithglobal, '&6 national,state,andlocalorganizationstopromotehealthandprotectpeoplefromdisease,injury,and O('7 disability.CDCalonecannotprotectthehealthoftheAmericanpeople.However,bycollaboratingwith )r(8 others!fromstateandlocalhealthdepartmentstoprivatecorporations,fromcountysponsoredclinicsto )2)9 managedcareorganizations,frommediaoutletstothegeneralpublic!CDCcanleverageitsvisionofa *): betterworldofSaferHealthierPeople. O+*;  ,r+< *    ^  ^CDChasabroadmandatetopromotehealthandqualityoflifebypreventingandcontrollingdisease, e injury,anddisability.ThepeopleofCDCcontributesignificantlytoAmericansabilityleadlonger,more % productive,healthierlives.Asillustratedinthisreport,CDCsuniqueapproachtohealthimprovement  achievesresultsandcostsavings.SaferHealthierPeopleisadesirableandachievablegoalmade @ possiblebyCDC.  i #^  ^9#^  ^A_@ d@eA++ W811%%dXXd8@ \ &% ^PartI. @@   CDCContextforPerformanceMeasurement#^ %&<#  1 @ޝv@B1111!;@/^ XXX ^;/ (ڽ8x'9GHIJKLM"93"  &% ^93/>2ڽI-  A  3  0    Vision,MissionandLongtermGoals#^ %&_>#    p     93/>~>݌' $ $ Ќ  +^ XXX ^+TheCentersforDiseaseControlandPrevention(CDC)isrecognizedastheleadfederalagencyfor b protectingthehealthandsafetyoftheAmericanpeopleathomeandabroad,providingcredibleinformation  " toenhancehealthdecisions,andpromotinghealththroughstrongpartnerships.Workingwithpartners G  acrossthecountryandtheworld,CDChasbeenaleaderinmonitoringhealth,detectingandinvestigating   heathproblems,conductingresearchtoenhanceprevention,developingandadvocatingsoundpublic  b  healthpolicies,promotinghealthybehaviors,fosteringsafeandhealthyenvironments,andproviding  "  leadershipandtraining.Thenationhashowenteredthe21stcentury,butthefundamentalchallengefacing G   CDCisthesameasitwasinitsearlydaysmorethanfivedecadesago!toimprovethequalityofpeoples   livesbyprotectingthemfromdisease,injury,anddisability. b  /^ XXX ^?/ *9GHIJKLM(لx8 CDCsvision&% ^:0 ` #^ %&D# Healthypeopleinahealthyworld!throughprevention.G ` $` $ CDCsvisionconveysanideaofwhattheworldwouldbeifCDCspartnerships,information,andprotection '  activitieswerefullyrealized.Theagencyiscommittedtohelpingcreateasafephysicalandsocial   environmentwherehealthisbothprotectedandpromotednationallyandinternationally.CDCbelievesthat B preventionbasedonsoundscientificknowledgeisthefoundationforachievingthisvision. g Duringthepasthalfcentury,CDChasconstantlyevolvedandinnovatedtofacenewhealthchallenges.Itis ' thisconstantrenewalthatenablestheagencytocontinueprovidingqualityserviceandreliableinformation  totheAmericanpublic. B  CDCsmission: Promotehealthandqualityoflifebypreventingandcontrollingdisease,injury,and ' disability.    CDC'smissionstatementconveyshowtheagencyapproachesitsresponsibilitiesasthenationsprevention { agency.AccomplishingthismissionispredicatedonCDCsabilitytobuildonthefollowingagency ; strengths:  0  Preventionstrategiesbasedonsoundscientificknowledge{ $ $ 0  Leadershipandtechnologiccapabilitiesofstateandlocalhealthorganizationsandtheintegrationof ;  thosecapabilitieswithprivatehealthorganizations! $ $ 0  TrainedpublichealthworkersandleadersV" $ $ 0  Abilitytoserveadiversepopulationwithadiverseworkforce^  ^{# $ $  CDCslongtermgoals #^  ^nL#^  ^:   h     % CDChasadoptedkeypartsofthe_DHHS_Ԁstrategicplan,whichwascompletedinOctober2000,tomovethe !^& agencyforwardintothe21stcentury.The_DHHS_Ԁstrategicplanhassixbroadgoalsthataresupportedby "' multipleobjectives.CDCsprogramsprimarilyaddress_DHHS_ԀGoals1,4,5,and6,andtheircorresponding C#( objectives. #^  ^L# ^  ^_DHHS_strategicgoalssetthestageforactionsthat,onadailybasis,improvethequalityof $) peopleslivesthroughouttheworld.Whenitcomestoaction,CDCfocusesitsexpertiseandother $^ * resourcesinthreeprincipalareas: %!+ ProtectingthehealthandsafetyofAmericans!CDCaddresses_DHHS_ԀGoals1and6throughactions '"- generatedfromsciencebasedprograms.Seriousthreatstothenationshealthcomefrommanysources: 'b#. diseases,organisms,injuries,behaviors,emergingrisks.Meetingthesecomplexhealthproblemsheadon ("$/ requiresCDCtobebothnimbleandflexible!thatis,toadaptresourcesandbalanceprioritiesasneeded, G)$0 tousediversetactics,andtoforgeeffectivepartnerships. *%1    `     h      p        `     h      p  G,'4 +    Dramaticgainsinlifeexpectancyhaveresultedlargelyfromimprovementsinsanitationandtheprevention e ofdiseasesthroughvaccines.Acenturyago,pneumoniaandTBwerethetwoleadingcausesofdeathin % theUnitedStates.Then,inthe1940s,acriticalfocusofthenationshealthprioritieswasthecontrolof  malariaamongmilitarypersonnelduringWorldWarII.Fromtheseprogramscamethegenesisofthe @ CentersforDiseaseControlandPrevention,andsincethattimeCDChasbeenattheforefrontof#^  ^\O#^  ^the e nation'seffortstoimprovethe#^  ^V#Ԁ^  ^healthandwellbeingofAmericans.#^  ^wW# %  <(8x*9GHIJKLM  +^ XXX ^+iY5%!`|9%E `E EttB /i  $ $Aswemoveintoanewcentury,manyof  @ CDC'sresourcesarededicatedtosolving e  complex,crosscuttinghealthproblems %   thatrequireabroadarrayofskills,    abilities,andexperience.Forexample,  @  sincethe1960sand1970s,community e  basedprogramshavehelpedtoproduce %  morerecentreductionsintobaccouse,   increasesinbloodpressurecontrol, @  healthierdiets,increaseduseofseat e  belts,andeffectiveinjurycontrol.These %  improvementsandothershave   contributedinturntodeclinesindeaths @ fromstrokeandheartdiseaseand e declinesinoveralldeathratesfor % children.Yet,despitethesesuccesses,  heartdiseaseandcancerhaveremained @ theleadingcausesofdeaththroughthe e latterpartofthe20thcentury. % Today,CDCandpartnersconfront @ challenging,complexissuesthat e reinforce,reshape,andexpandthe % traditionalrolesofpublichealth.  Respondingtothosechallengesinvolves @ suchactivitiesas: e  /^ XXX ^X/ '9GHIJKLM(x8<"93"  93w_23  0    Investigatingdiseaseoutbreaks " intheUnitedStatesandaround @# theworld;93w__݌e$ $ Ќ   )9GHIJKLM(Ʉxx'9GHIJKLM"93"  93 a2Ʉ3  0    Probingtherealmsofviruses, % % bacteria,andparasitesto  & uncoverwaystocontrolboth !@' emergingandreemerging e"( pathogens;93 aMa݌%#) $ Ќ  +^ XXX ^+0  Protectingthefoodandwater #* suppliesfrombothinadvertent $@ + anddeliberatecontamination;e%!, $   $ $0  Curbingthetollofdeathanddisabilityfrompreventableinjuries;%&!- $ $ 0  StemmingtheepidemicofobesityintheUnitedStates;&". $ $ 0  Convincingthepublicthatalteringcertainbehaviorswillyieldlongtermhealthdividends;'@#/ $ $ 0  EducatingyouthabouttherisksofHIV,unintendedpregnancy,tobaccouse,physicalinactivity,and e($0 poornutrition;%)$1 $ $ 0  Translatingbiomedicalresearchfindingsintopracticeincommunities;and)%2 $ $ 0  EliminatingdisparitiesinthehealthofallAmericans.*@&3 $ $ _#^  ^b#^  ^   `     h _   %,'5 +    Protectinghealthandsafetyhasitsbasisinscience.CDCstaffusetheappliedtechniquesofepidemiology, e laboratory,behavioral,andsocialsciencesastheprimarytoolstounderstandthecausesofpoorhealth, % identifypopulationsatrisk,anddevelopinterventionsfordiseasecontrolandprevention.Asresearch  providesmoreinformationabouttherelationshipsamongthephysical,mental,andsocialdimensionsof @ wellbeing,abroaderapproachtopublichealthhasbecomeimportantinthequestforanswerstoprevent e andsolvehealthproblems.CDCiscommittedtoexpandingitsresearchagendatohelpbridgethegap % betweenresearchandprotectinghealthandsafety.  #^  ^f#^  ^/^ XXX ^j/  Providingcredibleinformationtoenhancehealthdecisions  !+^ XXX ^+CDCaddresses_DHHS_ԀGoal4byproviding e  credible,timelyhealthinformationtohelppolicymakers,providers,andconsumersmakeinformed )   decisionsaboutpersonalandpublichealth.Thegeneralpublicandhealthpractitionersatalllevelsrequire    uptodate,credibleinformationabouthealthandsafetytomakerationaldecisions.Tohelpsupportthis  D  crucialdecisionmaking,CDCcontinuestoincreaseandapplyitspreeminentexpertiseinthedisciplinesof i   publichealthsurveillance,epidemiology,statisticalanalysis,laboratoryinvestigationandanalysis,health )  communicationsandsocialmarketing,behavioralriskreduction,technologytransfer,andprevention   research.CDCappliesthesciencethatunderpinsthosedisciplinestodevelopanddisseminatecredible D  andpracticalhealthinformationtomeetthediverseneedsofitsprimaryclients,thepeopleoftheUnited i  States.Suchinformationaffectshealthandwellbeingacrossallstagesoflifewhenthebestpossible )  healthdecisionsmustbemadebyconsumers,providers,andpolicymakers.   CDCmakesthiscrucialhealthinformationavailablethroughmanychannels,includingbooks,periodicals, i andmonographs;Internet_websites_;healthandsafetyguidelines;reportsfrominvestigationsand ) emergencyresponses;publichealthmonitoringandstatistics;traveladvisories;andanswerstopublic  inquiries. D Inadditiontoservingthepublic,CDCdelivershealthinformationthatenablesproviderstomakecritical ) decisions.Forexample,thepracticingmedicalanddentalcommunitiesandthenation'shealthcare  providersaretargetaudiencesfornumerousofficialCDCrecommendationsonthediagnosisandtreatment D ofdisease,immunizationschedules,infectioncontrol,andclinicalpreventionpractices.CDCalsooffers i technicalassistanceandtrainingtohealthprofessionals. ) CDCispositionedinvanguardeffortstoinformpeopleaboutthebenefitsofhavingchildrenwearbicycle D helmets,teachingyoungwomenaboutpreventingbirthdefectsbytakingfolicacid,quittingsmoking,eating i  sensiblyandexercisingregularly,reducinghealthhazardsduringfoodpreparationinthehome,makingsure )! childrenandadultsarevaccinated,andalertingthepublictoenvironmentalhazards.CDCrecognizesthat " manyotherpublichealthmessageseitherneedtobeheardforthefirsttimeorshouldbereinforced#^  ^k#^  ^. D# #^  ^iw#^  ^  Promotinghealththroughstrongpartnerships!CDCaddresses_DHHS_ԀGoal5throughstrongworking ) % relationshipswithkeypublichealthpartners.CDChasalonghistoryofdevelopingandsustainingvital  & partnershipswithvariouspublicandprivateentitiesthatimproveservicetotheAmericanpeople.CDCs !H' partnersinconductingeffectivepreventionandcontrolactivitiesinclude: m"( 0  Publichealthassociations#* $ $ 0  Stateandlocalpublichealthagencies$H + $ $ 0  Other_DHHS_Ԁagenciesandagenciesinotherfederaldepartmentsm%!, $ $ 0  Practicinghealthprofessionals,includingphysicians,dentists,nurses,andveterinarians-&!- $ $ 0  Publicsafetyandsecurityofficials&". $ $ 0  Schoolsanduniversities'H#/ $ $ 0  Communitiesoffaithm($0 $ $ 0  Community,professional,andphilanthropicorganizations-)$1 $ $ 0  Nonprofitandvoluntaryorganizations     p   )%2 $ $ _   ` _  -,'5 0  Business,labor,andindustrye $ $ 0  CDCFoundationandotherfoundations% $ $ 0  Internationalhealthorganizations $ $ 0  Stateandlocaldepartmentsofeducation@ $ $ CDC'spartnersimplementmostoftheagency'sextramuralprograms.Theseprogramsaretailoredto % reflectlocalandcommunityneeds.Inaddition,partnersstrengthenCDCbyservingasconsultantstoCDC  programstaff,byparticipatinginCDCadvisorycommittees,andbyattendingCDCsponsoredseminarsand  @ conferences.ThewiderangingperspectivesthatCDCspartnersbringtocommoninterestsandgoals e  generatenewopportunitiesforcollaborations,helpshapekeystrategies,andprovideanothermeansfor %   stayingfocusedontheneedsoftheAmericanpublic.Sustainingthesepartnershipsinvolvescoordination    andcommunication.#^  ^w#^  ^  @  #^  ^?#^  ^#^  ^# ^  ^&% ^IB0  Organization,Programs,Operations,Strategies,andResources#^ %&##^  ^݂#^  ^   $ $  OrganizationandPrograms    CDC'smajorprogramcomponentsrespondindividuallyintheirareasofexpertiseandalsopooltheir M  resourcesandexpertiseoncrosscuttingissuesandspecifichealththreats.Theagencyiscomprisedof11    majorprogramcomponentsand11staffoffices. h \LHz \)p.@X@E))}I#^  ^#^  ^ ( /^ XXX ^$/e"93"  932Ʉ3  0    NationalCenterforBirthDefectsandDevelopmentalDisabilities(_NCBDDD_)preventsseriousand &" costlycausesofmorbidityandmortalityininfantsandchildrensuchasautism,fetalalcohol 'X# syndrome,and_spina_Ԁbifida.93Æ݌}($ $ $ Ќ  "93"  932Ʉ3  0    +^ XXX ^+NationalCenterforChronicDiseasePreventionandHealthPromotion(_NCCDPHP_)prevents =)$ prematuredeathanddisabilityfromchronicdiseasesandpromoteshealthypersonalbehaviors.93݌*% $ $ Ќ  /^ XXX ^/"93"  932Ʉ3  0    NationalCenterforEnvironmentalHealth(_NCEH_)providesnationalleadershipinpreventingand *\& controllingdisease,disability,anddeathresultingfromtheinteractionsbetweenpeopleandtheir + ' environment.^  ^93݌E,' $ $ Ќ  #^  ^##"93"  932Ʉ3  0    +^ XXX ^+NationalCenterforInfectiousDiseases(_NCID_)preventsillness,disability,anddeathcausedby e infectiousdiseasesintheUnitedStatesandaroundtheworld.93Ռ݌) $ $ Ќ  /^ XXX ^/"93"  932Ʉ3  0    +^ XXX ^+NationalCenterforHIV,STD,andTBPrevention(_NCHSTP_)providesnationalleadershipin  preventingandcontrollinghumanimmunodeficiencyvirusinfection,sexuallytransmitteddiseases, H andtuberculosis.93݌m $ $ Ќ  /^ XXX ^/"93"  932Ʉ3  0    +^ XXX ^+NationalImmunizationProgram(NIP)preventsdisease,disability,anddeathfromvaccine - preventablediseasesinchildrenandadults.93݌ $ $ Ќ  /^ XXX ^//"93"  93l2Ʉ3  0    +^ XXX ^+NationalCenterforInjuryPreventionandControl(_NCIPC_)preventsdeathanddisabilityfromnon  L occupationalinjuries,includingthosethatareunintentionalandthosethatresultfromviolence.93l݌u  $ $ Ќ  /^ XXX ^ߒ/"93"  93z2Ʉ3  0    +^ XXX ^+NationalInstituteforOccupationalSafetyandHealth(_NIOSH_)ensuressafetyandhealthforall 5   peopleintheworkplacethroughresearchandprevention.93z݌   $ $ Ќ  /^ XXX ^/"93 "  93]2Ʉ3  0    ^  ^NationalCenterforHealthStatistics(_NCHS_)providesstatisticalinformationthatguideactionsand  T  policiestoimprovethehealthoftheAmericanpeople.93]݌}   $ $ Ќ  /^ XXX ^Ж/"93 "  9372Ʉ3  0    ^  ^EpidemiologyProgramOffice(_EPO_Ԁ)strengthensthepublichealthsystembycoordinatingpublic =  healthsurveillance,providingsupportinscientificcommunications,statistics,andepidemiology,and   providingtraininginsurveillance,epidemiology,andpreventioneffectiveness.937d݌\  $ $ Ќ  /^ XXX ^/"93 "  932Ʉ3  0    +^ XXX ^+PublicHealthPracticeProgramOffice(_PHPPO_)strengthenscommunitypracticeofpublichealthby   creatinganeffectiveworkforce,buildinginformationnetworks,conductingpracticeresearch,and E  ensuringlaboratoryquality.#^  ^#^  ^93Ӛ݌  $ $ Ќ  /^ XXX ^/C+^ XXX ^+DCspresenceisglobal,withemployeesassignedtopostsin20countriesand46ofthe50states.CDC   headquartersislocatedinAtlanta,Georgia,with15fieldstationslocatedthroughoutthenationandinPuerto E Rico.#^  ^(#^  ^  #^  ^#^  ^ PersonnelResourcesandStrategies    OneofCDCsgreatestresourcesisitsmorethan8,500employees,whoprovidequalityservicetothe M Americanpeopleandexpertiseinpublichealthsurveillance,epidemiology,statisticalanalysis,laboratory   investigationandanalysis,healthcommunicationsandsocialmarketing,behavioralriskreduction, h technologytransfer,andpreventionresearch. ( Onadailybasis,CDCstaffareinvolvedininformationdependentactivitiesthatworksynergisticallytohelp   CDCaccomplishitsmission.SeveralkeyactivitiesillustratehowCDCaccomplishesitsmission.Tomonitor h healthproblems,CDCstaffexaminehealthpatternsquantitativelyintermsofwheredisease,injury,and ,  disabilityoccur,amongwhatpopulationgroups,andwhethertrendsarechangingovertime.Thisactivity U! requiresCDCtodrawuponahostofhealthdatabasesfromavarietyofsourcesandtousetheprinciplesof " publichealthsurveillanceandhealthstatistics.Completenessandtimelinessofmonitoringactivitieshelp p# CDCstaffdetectandinvestigateoutbreaksorunexpectedhealthpatterns.Detectingandinvestigating 0$ outbreaksallowthecausesoftheseoccurrencestobeuncoveredandcontrolmeasurestobeimplemented. Y % Theseactivitiesoftenrequiretheuseofhighlyanalyticalepidemiology,_biostatistics_,andlaboratory !& techniquesthathelptransformsimpledataintousefulinformation. !t' Todevelopandadvocatesoundpublichealthpolicies,CDCstafffrequentlyconductresearchthatspans Y#) biomedical,behavioral,andhealthservicesdisciplinesandmakesuseofepidemiology,_biostatistics_,and $* laboratorytechniques.Thegoalofpublichealthresearchistounveilsoundpreventionstrategies.Insimple $x + terms,thesestrategiesforimprovinghealthinapopulationrelyonhealthcommunicationsandsocial %.*lxQ `EQmtte} v $ $$ $e $e $ $ $$ $$ $$ $ $ $$ $$ $$ $ $ $$ $$ $$ $ e $e $$ $$ $ TotalProgramFunding(Dollarsinthousands)  %  FY2003: 0  $344,5700  $ $0 $ $(Estimate) $ $  FY2002: 0  $354,0770  $ $0 $ $(CurrentEstimate) P $ $  FY2001: 0  $326,3720  $ $0 $ $(Actual)}  $ $    OaMandate   x  ^  ^CDCischargedwithplanning,directing,andcoordinatinganationalprogramtoimprovetheidentification,  @  investigation,diagnosis,prevention,andcontrolofinfectiousdiseasesintheUnitedStatesandthroughout   theworld. M   HealthandEconomicBurden  H Onceexpectedtobeeliminatedasapublichealthproblem,infectiousdiseasesremainaleadingcauseof  deathworldwide.Earlierpredictionsoftheeliminationofinfectiousdiseasesdidnottakeintoaccount ] changesindemographics,humanbehavior,andtheabilityofmicrobestoadapt,evolve,anddevelop  resistancetodrugs.Morethan35newlyemergingdiseaseswereidentifiedbetween1973and2000,and P newinfectiousthreatswillcontinuetobeidentified.OutbreaksofinfectiousdiseasesendangerU.S.citizens  athomeandabroad,threatenU.S.forcesoverseas,andcontributetosocialandpoliticalinstability ] throughouttheworld.Outbreakscaninterferewiththeglobalmarketplaceandaffecttourism,trade,and  foreigninvestment.Thenationalcostsofcontrollingoutbreakscanalsobeconsiderable!forexample, P whenlargenumbersofdiseasecarryingfoodanimalsmustbeslaughtered,asoccurredrecentlyinthe   UnitedKingdom. ]! Infectiousdiseasescanlurkanywhere!inundercookedhamburgers,onunwashedhands,orcarriedby P# blood,water,ticks,ormosquitoes.Some,likethepathogensthatcauseinfluenzaorsyphilis,arefamiliar $ foesthathavepreyedonhumansforcenturies.Others,likeWestNilevirus,arerelativelyneworemerging ]% threats.Someoldthreats,liketuberculosis,haveadaptedtothedrugsdeployedagainstthem,makingthem & dangerousinnewways.Theseattributesmakeinfectiousdiseasesaconstantthreat.Theemergenceofa P' newstrainofinfluenzasomewhereintheworldcouldhaveasevereeffectontheUnitedStates,causingan ( estimated89,000to207,000deaths,314,000to734,000hospitalizations,anddirectandindirectcostsof$71 ]) billiontoasmuchas$167billion.Antimicrobialresistanceinsixbacteriacommonlyfoundinhospitalsadds * approximately$661millionperyearinhospitalcharges.Hospitalacquiredinfectionskillanestimated P+ 88,000Americansannuallyandcostmorethan$4.5billion.Theestimatedburdenofillnessfrom_foodborne_ , infectionsisupto5,000deathsand76millionillnessesannually,withassociatedcostsreachingseveral ] - billiondollarsannually. ! . Evenchronicdiseasesarebeinglinkedtoinfectiousagents.Todate,morethan30microbesarerecognized ""0 toinitiateordefinetheprogressionoflongtermillnessanddisability.Approximately40%ofchronicliver ]#"1 disease!thetenthleadingcauseofdeathamongU.S.adults!iscausedbyhepatitisCvirus(_HCV_).The $#2 medicalandworklosscostsof_HCV_Ԅrelatedliverdiseaseareestimatedtoexceed$600millionannually. $P$3 Evidencesupportsorsuggestsmanyotherinfectiouschronicdiseaseassociations,andscientistsknowthat %%4 newassociationsarelikelytoemergeatarapidpace. ]&%5 #^  ^O# Strategies,Activities,andResources  'P'7 In1994,recognizingtheseriousandgrowingthreatofinfectiousdiseases,CDCandpartnerslaunchedthe ((8 firstphaseofanationwideprogramtorevitalizeU.S.capacitytoprotectthepublicfrominfectiousdisease e)(9 threats.Thesecondphaseofthiseffortbeganin1998andcontinuestobuilddomesticandglobalcapacity %*): forrecognizingandrespondingtoinfectiousdiseasesthroughpartnershipswithfederal,state,andlocal *X*; agencies,universities,privateindustry,foreigngovernments,WHO,andnongovernmentalagencies.CDCs ++< effortsfocusonfourstrategies: e,+= Ї R9GHIJKLMD(Axx )9GHIJKLM"93"  932A3  0    Surveillanceandresponse!todetect,investigate,andmonitoremergingpathogens,thediseases e theycause,andthefactorsinfluencingtheiremergence;93݌% $ $ Ќ  "93"  9312A3  0    Appliedresearch!tointegratelaboratoryscienceandepidemiologytooptimizepublichealth  practice;931^݌@ $ $ Ќ  "93"  93e2A3  0    Infrastructureandtraining!tostrengthenpublichealthinfrastructuretosupportsurveillanceand e researchandtoimplementpreventionandcontrolprograms;and93e݌% $ $ Ќ  "93"  932A3  0    Preventionandcontrol!toensurepromptimplementationofpreventionstrategiesandenhance  communicationofpublichealthinformationaboutemerginginfectiousdiseases.93݌ @ $ $ Ќ  Withinthisframeworkkeyprioritieshaveemerged:strengtheningstateandlocalinfectiousdiseasecontrol %   capacity;developingstrategiestoaddressinfectiousdiseasesthatcontributetohighmortality,morbidity,and    healthcarecosts,suchashepatitisC,influenza,and_foodborne_Ԁillnesses;findingsolutionstotheproblems  @  posedbyantimicrobialresistance;reducingtheburdenofillnessfrominfectiousdiseasesamonghospitalized e  patientsandhealthcareworkers^  ^;andprovidinginformationlearnedthroughresearchoninfectiousdiseases %  toconsumers,providers,andpolicymakers.    Linksto_DHHS_ԀStrategicPlan  e  Infectiousdiseaseperformancemeasuresrelateto_DHHS_ԀGoal1,Objective1.7:Reducetheincidenceand -  impactofinfectiousdiseases;Goal5,Objective5.1:Improvethecapacityofthepublichealthsystemto   identifyandrespondtothreatstothehealthofthenationspopulation;andGoal6:Strengthenthenations P healthscienceresearchenterpriseandenhanceitsproductivity. y  Partnerships   Toaccomplishitsmissionofprotectingthepublicfrominfectiousdiseasethreats,CDCcollaborateswitha ` numberofagenciesandorganizations.Examplesofpartnersandsomeselectedactivitiesinclude:_CSTE_   (assiststateswithpandemicinfluenzaplanningactivities);_APHL_Ԁ(enhancestatelaboratorycapacityby E providinglongtermlaboratorytraining);NationalInstitutesofHealth(NIH);FoodandDrugAdministration  (FDA)(foodsafetyprograms),USDA(foodsafetyprograms),DepartmentofInterior(U.S.FishandWildlife), ` DepartmentofJustice(U.S.ImmigrationsandNaturalizationService),DepartmentofState,andDepartment   ofTreasury(U.S.Customs).Toaccomplish_HCV_Ԁpreventionobjectives,CDCcollaborateswiththeNational E AssociationofStateAIDSDirectors(_NASAD_),NationalMinorityAIDSCouncil(_NMAC_),AmericanSocial  HealthAssociation(_ASHA_),PacificIslandsHealthOfficersAssociation(_PIHOA_),AmericanLiverFoundation ` (ALF),HepatitisFoundationInternational(_HFI_),andIndianHealthService(_IHS_).     PresentationofPerformance  " Diseasebasedoutcomemeasuresarenotapplicabletoemerginginfectiousdiseases,manyofwhichare h# neworpreviouslyunrecognized.Uncertaintyaboutwhatdiseaseswillemergeorreemergeprecludesthe ($ developmentofbaselinesorperformancemeasuresofdiseaseincidence.Evenwhenbaselinesdoexist,it M % isoftendifficulttolinkdeclinesinincidencedirectlytopreventionandcontrolefforts.Forexample,1998  !& datafrom_FoodNet_Ԁ(anactivesurveillancenetworkfor_foodborne_Ԁdiseases)showadeclineinseveralofthe !h' majorbacterialandparasiticcausesof_foodborne_Ԁillness.Althoughthesedeclinesmayreflectthe "(( implementationofdiseasepreventionefforts(e.g.,changesinmeatprocessing;restrictionsonfoodimports), M#) theymayalsoreflectannualfluctuationsintheincidenceof_foodborne_Ԁillnessesandtemporalvariationsin  $* diagnosticpractices. $h + #^  ^#Anotherdifficultyinusingdiseasebasedoutcomemeasuresisthatimproveddiseasetrackingandbetter M&!- reportingsystemsmayresultintherecognitionofmoreoutbreaksandcases.Thisdoesnotmeanthatmore  '". casesofthediseaseareoccurring.Rather,itmeansthatoureyes,ears,andothertoolsarebetterableto 'h#/ findthem.Thus,ratherthanfocusingondiseasebasedoutcomes,manyoftheinfectiousdisease (($0 performancemeasuresassessCDCsongoingeffortstostrengthennationalpublichealthcapacityfor M)$1 diseasesurveillanceandresponsethroughtrainingprograms(the_EID_ԀLaboratoryFellowship),new  *%2 laboratorydiagnostics(_PulseNet_),andfundingofstateandlocalhealthdepartmentsforinfrastructure *h&3 improvements(hepatitisCcoordinators). +('4  M,'5 CDCsInfectiousDiseasesControlPerformancePlanincludesthreenewgoalswhichhighlightpriority e infectiousdiseasethreats,patientandhealthcareworkersafety,andourongoingeffortstoprovidesound % scientifichealthinformationuponwhichthepublicandhealthcareproviderscanmakeinformeddecisions.   &% ^ProtectingHealthandPromotingPartnerships  e  IIA.1aStateandLocalCapacity#^ %&I#    ProtectingAmericansfrominfectiousdiseasesbeginswithwellstaffedandwellequippedstateandlocal  P healthdepartments.CDCishelpingtorebuildtheinfectiousdiseasecontrolcomponentofthestateand u   localpublichealthinfrastructurebybuildingandmaintainingnationalepidemiologicandlaboratorycapacity. 5   Buildingnationalcapacitywillimprovetheabilitytorecognize,respondto,andmonitornewandresurgent    infectiousdiseases!thekeytopreventionandcontrol.Successdependsonensuringthatnationalpublic  P  healthcapacityexiststoquicklyrecognizeandrespondtotheappearanceofnewandreemergingthreats u  andtopreventandcontrolexistinginfectiousdiseaseproblems. 5  Anotherprogramthatiscontributingtoidentifiedgapsinournationsinfectiousdiseaseinfrastructureisthe P  EmergingInfectiousDisease(_EID_)laboratoryfellowship.Thistrainingprogramininfectiousdisease u  laboratorymethodsandpracticeisdesignedtoattractandpreparelaboratoryscientistsforcareersinpublic 5  health.Recruitingandretainingtrainedhealthprofessionalsiskeytorebuildingthenationspublichealth  infrastructure. P  PerformanceSummary  5 ^  ^InFY2001,57sites!50state,6local,and1territorialhealthdepartment!werefundedfortheEpidemiology  andLaboratoryCapacity(_ELC_)program.Becauseofoutbreaks,suchasWestNilevirus,andthethreatof X otheremerginginfectiousdiseases,expandingthiscapacitybuildingprogramtoalleligiblestateandlocal } healthdepartmentsbecameakeypriorityinFY2001;thus,weexceededtheproposedtargetbyfoursites. = WiththeexceptionofsometerritorialhealthdepartmentswhichwillbetargetedforfundinginFY2002,this  goalhasbeenmetandthismeasurewillbediscontinuedafterFY2002.The_ELC_ԀprogramassistsStateand X eligiblelocalpublichealthagenciestostrengthenthepublichealthinfrastructuretoaddressinfectious } diseasethreats.Resourcesareusedtoimprovesurveillance,developnewandimproveddiagnosticand = _subtyping_Ԁmethods,implementelectronicdiseasereportingsystems,transferstateofthearttechnologies  intopublichealthlaboratories,andtrain_epidemiologists_Ԁandlaboratoryworkers.ThroughFY2000,_ELC_ X  fundinghasbeenusedtohire160FullTimeEquivalents(_FTEs_)infundedsites(total43),including60 }! _epidemiologists_Ԁand46microbiologists.Eventhougheachgrantawardismodestinsize(average =" $311,000),the_ELC_Ԁprogramhasmadeadramaticimpact. # Theinfrastructuredevelopedthoughthe_ELC_ԀprogramwascrucialintheresponsetotheoutbreakofWest } % NilevirusintheNewYorkmetropolitanarea.Inaddition,throughtechnologytransfer,manystatesnowhave =!& stateoftheartmolecularlaboratorydiagnostictools,includingpulsedfieldgelelectrophoresis(_PFGE_)and !' polymerasechainreaction(PCR)technology.Thesetoolshavebeenusedtoidentify,investigate,and "X( rapidlyimplementcontrolmeasuresinhundredsofoutbreaks.Examplesin1999include,E.coliO157:H7at }#) anupstateNewYorkcountyfairlinkedtocontaminatedwater;multistateoutbreaksofSalmonella A$* associatedwithalfalfasprouts;andmultistateoutbreaksofListeriaassociatedwithhotdogs. % + #^  ^#^  ^ThroughFY2000,73scientistscompletedtheEmergingInfectiousDisease(_EID_)laboratoryfellowship. &$"- Successfulrecruitingofhighlyqualifiedapplicantsresultedinalargerthanexpectedclass.Ofthefellows I'". whohavecompletedtraining,48%areworkinginlaboratoriesinstatehealthdepartmentsoratCDCand  (#/ 34%returnedtoschool(primarilyinM.D.orPh.D.programs).Theothersacceptedemploymentwithnon (d$0 profit,healthrelatedorganizationsandprivateindustryoracceptedotherfellowships.#^  ^## )$%1      m       m     u  ,$(5  GoalbyGoalPresentationofPerformance e   A_@ d@APerformanceGoal:0 m Strengthenepidemiologicandlaboratorycapacitytorecognize,respondto,  andmonitorinfectiousdiseases. m $m $ @M@z1111!&@*`ddd Xdd Xdd Xe $e $,I dd , dd ,X dd ,Ddd +  &zz & PerformanceMeasures /C / Targets /C / ActualPerformance /C / Ref.  C   8#!    8Establishupto65state _   basedpreventionprograms    throughEpidemiologyand  z  LaboratoryCapacity(_ELC_)  :  forInfectiousDiseases _  cooperativeagreements. $  $ FY02: 57sites _   FY01 :53sites '   FY00: 43sites    FY99: 33sites  R       FY02: 57  _  FY01: Exceeded/57 '   FY00: Achieved    FY99: Achieved  R  FY98: 30(baseline)     Page _  164    9GHIJKLM(zxxR9GHIJKLMD"93"  93-2z33  0 #   93-.݌ * :#### *Ќ  *Increasethenumberof_EID_Ԁ s  microbiologyfellowstrained 3  foremploymentinpublic   healthlaboratories. $N ! $ FY03: 160fellows  s " FY02: 125fellows ; #  FY01: 100fellows  $  FY00: 󀀀70fellows f %  FY99: 󀀀40fellows .&   ['  FY03: 9/2003  s ( FY02: 9/2002  ; ) FY01: Achieved  *  FY00 :Exceeded/73 f +  FY99: Achieved .,  FY97: 13(baseline)  [-  9GHIJKLM(zxx9GHIJKLMPage s . 164 3 / "93"  93<22z33  0 #   93<2i2݌ 0#### Ќ   s2   ^  ^&% ^IIA.1bPriorityDiseaseProblems#^ %&03# #^  ^3# n4 Periodically,theresultsofpublichealthsurveillanceandappliedresearchcallfornewactionstoprotect s6 Americansfrominfectiousdiseases.ThisiswhyCDChasundertakeneffortstodevelopnationalstrategies 37 toaddressprioritydiseaseareas. 8 HepatitisC,chronicliverdisease,andviralhepatitis:ACDCgoalistolowertheincidenceofacutehepatitis s: CintheUnitedStatesandtoreducetheburdenofliverdiseasefromchronic_HCV_Ԁinfection.Tothisend, 3; CDCis:1)educatinghealthcareandpubichealthprofessionalstoimproveidentificationofpersonsatriskfor < _HCV_Ԁinfectionandensureappropriatecounseling,diagnosis,management,andtreatment;2)educatingthe N= publicandpersonsatriskaboutriskfactorsandtheneedfortestingandevaluation;3)promotingclinicaland s> publichealthactivitiesaimedatidentifying,counseling,andtestingpersonsatriskandevaluatingor 3? referringpersonsfoundtobeinfected;4)developingoutreachandcommunitybasedprogramstoaddress @ practicesthatputpeopleatriskandidentifypersonswhoneedtesting;5)strengtheningsurveillanceto NA monitordiseasetrendsandevaluatetheeffectivenessofpreventionactivities;and6)conducting s B epidemiologicresearchtoguidepreventionefforts. 3!C Influenza:^  ^ԀCDCplaysakeyroleinthepreventionandcontrolofinfluenza.Improvedpreparednessis "NE essentialtominimizetheimpactonAmericansofalongoverdueinfluenzapandemic.Tofulfillthisrole, s#F CDC:1)conductsworldwidemonitoringofinfluenzavirusestocollectdatatocontributetoannualNorthern 3$G andSouthernhemispherevaccinedecisions;2)isbuildingcapacitydomesticallyandinternationallyto $ H improvetheearlydetectionsystemsfornewinfluenzaviruses;3)isworkingcloselywithStatestoimprove %N!I theinfrastructurefordeliveryofinfluenzavaccines;4)conductsresearchstudiesoninfluenzavirusestoform s&"J thebuildingblocksforbettervaccinesandvaccinestoviruseswithpandemicpotential;5)participatesonan 3'"K interagencyworkgrouptodevelopaninfluenzapandemicpreparednessplanfortheUnitedStates.#^  ^":# '#L      m  s,(R _Foodborne_Ԁillnesses:CDChasaprominentroleinmaintainingthesafetyofthenationsfoodsupply.CDC e ischallengedto:1)buildastrongnationwidepublichealthnetworkfor_foodborne_Ԁdiseasesurveillanceand % response;2)designandimplementpreventionstrategies;3)support,educate,andtrainthepublichealth  workforce;and4)providescientificallysoundhealthinformationtothepublic.Theseeffortsareessentialfor @ foodsafetyregulatoryagenciesthatneedandrelyonCDCsepidemiologicdata,laboratoryscience, e environmentalhealthcapability,publichealthexpertise,andlinkstostateandlocalhealthandeducation % departments.   PerformanceSummary %     HepatitisC,chronicliverdisease,andviralhepatitis^  ^:   H  HepatitisCCoordinators 󀄀 CDCwasabletoexceedtheexpectednumberof_HCV_Ԁcoordinatorsfundedas u   Stateandlocalhealthdepartmentsquicklyrecognizedtheimportanceofcoordinatorswhoserveasthe =   linkingpin,coordinatinghepatitisCactivitiesamonghealthdepartmentprograms(e.g.,STD,Immunization,   andEpidemiology/Surveillance),andstateagencies(e.g.,MentalHealth,SubstanceAbuse,and X  Corrections).Theyarealsocloselyinvolvedwithmediacampaigns,providereducation,andthe }  developmentofeducationalmaterials. =  ViralHepatitisIntegrationProjects(_VHIP_)󀄀Astargeted,15_VHIPs_Ԁwerefundedthisyear.Theintegrationof X theseservicesintoexistingpreventionsystems(STDclinics,HIVcounselingandtestingsites,corrections } facilities,anddrugtreatmentprograms)isfundamentaltoprovidingoptimalprevention/interventionservices = toclientswithmultipleriskfactors.Thisapproachisalsofiscallymorerealisticandcosteffectiveasopposed  todevelopingnewvenuesinwhichtoprovideservices.Itmaximizesuseoffederaltaxdollarsand X accessibilitytoservicesbyatriskgroups. u  } SentinelSurveillanceforAcuteDisease  FundingwascontinuedinFY2001foraprogramofintensive  surveillanceforacuteviralhepatitisinsixsentinelcountiestomonitortheincidenceandepidemiologyofall ` typesofviralhepatitis.Thissystemprovidestheonlydataonincidenceandriskfactorsfornewlyacquired   hepatitisC.Thesedatahavebeencrucialindemonstratingthesignificantdeclineintransfusionassociated E hepatitisCandtheimportantroleofinjectingdruguseandpossiblysexualexposuresintransmission.The  participatingsiteshavealsodevelopedimprovedmethodsforsurveillancewhichhaveservedasmodelsfor ` othercountyandStatehealthdepartments.Thedatacollectedthroughthesentinelcountiesareessentialfor    monitoringtheimpactofpreventionandcontrolactivitiesforhepatitisCaswellasfordevelopingnew E! strategiesforpersonswhoremainatincreasedriskandcontinuetoserveasfocifordiseasetransmission. " Influenza󀄀CDChasimprovedpreparednessforbothepidemicsandapossiblepandemicofinfluenzaby  $ increasingthenumberofdomesticandglobalsitesthatmonitorinfluenza.In2000,weexceededourtarget E % fordomesticandinternationalsitesthroughdiligentrecruitmentforU.S.SentinelPhysiciansandconsistent !& followupbyCDCstaff.Thesedomesticandinternationalsitesprovidesurveillancedatathatarecriticalto !`' influenzavaccinedecisions.In9ofthelast10years,influenzavaccineswerewellmatchedtothe " ( circulatinginfluenzaviruses. E#) MaintainingandimprovingtheU.S.SentinelPhysiciansurveillancesystemisaprioritybecauseitisthe $` + primaryU.S.systemformeasuringinfluenzamorbidityandisasourceofspecimensnecessaryfor % !, monitoringcirculatingvirusesintheU.S..Datacollectedaboutcirculatinginfluenzavirusesareusedtoform E&!- thebasisofannualvaccinedecisions.TheU.S.SentinelPhysiciansurveillancesystemwillbetheprimary '". systemformeasuringtheimpactofaninfluenzapandemiconmorbidityintheU.S.#^  ^aB# '`#/ _Foodborne_Ԁillnesses  ^  ^CDChasimprovedfoodsafetythroughcollaborationswithfederal,state,andlocal E)$1 governmentsandotherpublicandprivatesectorpartners.CDCledthedevelopmentandimplementationof  *%2 _FoodNet_,anetworkof9sentinelsitesusedtodetermine_foodborne_Ԁdiseasetrenddatafortargetingof *h&3 resourcesandimprovingpreventionmethods.CDCanditsstatepartnersalsodesignedandimplemented +('4 the_PulseNet_ԀDNAfingerprintingnetworkinpublichealthlaboratories.Thisnetworkprovidesearlydetection M,'5 of_foodborne_Ԁdiseaseoutbreakswithinandbetweenstates.TheseprogramsandotherCDCeffortshave:1) e strengthenedandexpandedtheearlywarningsystemfor_foodborne_Ԁillness;2)improvedandexpanded % pathogendetectionmethods;3)improvedtechniquestoavoid,reduce,andeliminatepathogens;and4)  improvedoutbreakcontainment.IncollaborationwithFDAandUSDA,CDC:1)designedtrainingand @ educationalmaterialsforpublichealthandhealthcareprofessionals;2)collaboratedwithgovernment, e industry,andconsumerpartnerstoconductabroadbasedfoodsafetyeducationcampaign(Fight_BAC!TM_); % and3)launchedanationalpartnershipforschoolfocused_foodborne_Ԁillnessprevention.InFY2001,we  metourtargetwithsevencommonpathogens,twoparasites,andonesyndrome(Hemolytic_Uremic_  @ Syndrome)#^  ^R#^  ^Ԁunderactivesurveillance.   u  e  Thenumberofoutbreaksdetectedandinvestigatedhasbeenachievedasexpected,ashasdeterminingthe    causativefoodinoutbreaks.AfterFY2001,wewillnolongercontinuetotrackprogressoneitherofthese  @  twoperformancemeasuresbecauseoftheextremevariabilityinnumberandthedependenceonlocalhealth e  departmentpreferenceforCDCparticipation. %  CDCanditsstatepartnersalsodesignedandimplementedthe_PulseNet_ԀDNAfingerprintingnetworkinpublic @  healthlaboratories.Thisnetworkprovidesearlydetectionof_foodborne_Ԁdiseaseoutbreakswithinand e  betweenstates.CDChasprioritizedtheexpansionof_PulseNet_Ԁbecauseoftheincreaseddemandfrom %  participatingsites.AsofFY2001,thetargetsforeachofthepathogenshavebeenachievedasexpected.   InFY2000,using_FoodNet_Ԁandothersources,CDCupdatedestimatesoftheburdenof_foodborne_Ԁdiseasein e theUnitedStates.Newestimatesindicatethat76millioncasesof_foodborne_Ԁillnessesresultin325,000 % hospitalizationsand5,000deathseachyear._FoodNet_ԀdatafromFY1999showingdecliningratesof  _Campylobacter_(26%),Shigella(44%),E.coli(22%),andSalmonella_enteriditis_(48%)ledtonewinteragency @ effortsinresearchandsurveillancetodocumenttheeffectivenessoffoodsafetymeasures.FY2000data i hasshownacontinueddecliningtrendalbeitnotasremarkable. )       m    GoalbyGoalPresentationofPerformance #^  ^Y# y  A_@ d@APerformanceGoal:ProtectAmericansfrompriorityinfectiousdiseases.  2 @\v@+1111!b@HepatitisC,ChronicLiverDisease,andViralHepatitis   *`ddI dd I dd X dd X Ddd D`e $e $,dd , dd ,B dd ,[dd +  &k"k & PerformanceMeasures /j# / Targets /j$ / ActualPerformance /j% / Ref. (j&  (*` dd@ dd S dd dd B tdd [`e $e $,dd , dd ,B dd ,[dd +  &b&b &Providesupporttoupto65 + ' healthdepartmentsfor  ( coordinatorstoinitiate !F) hepatitispreventionand k"* controlactivities. $+#+ $ FY03: 50healthdepartments  + , FY02: 50healthdepartments  -  FY01: 25healthdepartments !V.  FY00: 󀀀9healthdepartments "/    $1  FY03: 9/2003  + 2 FY02: 9/2002  3  FY01: Exceeded/34 !V4  FY00: Exceeded/15 "5  FY99: 0 K#6   $7 Page + 8 164  9 ! ! 9GHIJKLM(zxx9GHIJKLM"93"  9j2z33   k"; 0 @!   93j+k݌  +#< Ќ  Providesupportto20health g%!= departmentstoassessthe '&!> effectivenessofintegration &"? of_HCV_Ԁcounseling,testing, 'B#@ andreferralprograms. $g($A $ FY01: 15healthdepartments g%!B  FY00: 15healthdepartments /&!C   *R&I  FY01: 15 g%!J  FY00: 12 /&!K  FY99: 0(baseline) &"L   +'R Page g%!S 164 '&!T Ѐ! ! 9GHIJKLM(zxx9GHIJKLM"93"  9n2z33   'B#V 0 @!   93no݌  g($W Oa e   ь  PerformanceMeasures /d / Targets /d / ActualPerformance /d / Ref. /d /Establishsentinel % surveillancesystemsfor  chronic_HCV_Ԁin10statesto @ monitortrendsinincidence, e riskfactorsforinfection,and %   outcomesofdisease. $   $ FY03: 6states  %  FY02: 6states    FY01 :5states P   FY00 :3states }  FY99: 1pilottest E     h  FY03: 9/2003  % FY02: 9/2002   FY01: Exceeded/6 P  FY00: Exceeded/5 }  FY99: Exceeded/2 E   FY98: 0(baseline)      p ! ! 9GHIJKLM(zxx9GHIJKLMPage % 164  "93"  9u2z33   e 0 @!   ݀93uHu݌ %   Ќ      Influenza   *!`#dd dd t dd  dd B sdd [` e $e $,dd , dd ,B dd ,[dd +  &   & PerformanceMeasures /i ! / Targets /i " / ActualPerformance /i # / Ref.  i $   1'%1 %   1*$`%dd@ dd S dd dd B tdd [!`#e $e $,dd , dd ,B dd ,[dd +  &! %!  &Monitorinfluenzavirusesin  & domesticandglobalsites(1 E ' site/250,000population  ( domesticallyandincreasing `) numbersinternationally)to  * enhanceearlydetectionof E+ viruseswithpandemic , potentialandimprove `- vaccinedecisionmaking. $ . $ FY03: 900sites   / FY02: 600sites M 0  FY01: 514sites  1  FY00: 510sites x2   e4  FY03: 9/2003   5 FY02: 9/2002 M 6  FY01: 550  7  FY00: Exceeded/514 x8  FY99: 410 @9  FY96: 󀀀0  m: Page  ; 164 E < "93"  9_}2z33   `> 0 @!   ݀93_}}݌  ? Ќ  ^  ^_Foodborne_ԀIllnesses 5@ *&`(dd@ dd S dd dd B tdd [$`%e $e $,dd , dd ,B dd ,[dd +  &PBP & PerformanceMeasures /C / Targets /D / ActualPerformance /E / Ref.  F Kx  1'%|G   1*-`4dd@ dd S dd dd B tdd [&`(e $e $,dd , dd ,B dd ,[dd +  &lGl &Detectandinvestigatelarge 5H orunusualoutbreaksof I diarrhealand/or_foodborne_ PJ illness. $uK $ FY01: 26outbreaks 5L  FY00: 26outbreaks M  FY99: 23outbreaks `N   (O  FY01: Achieved 5P  FY00: Achieved Q  FY99: Achieved `R  FY98: 15  (S Ѐ! ! 9GHIJKLM(zxx9GHIJKLM  #^  ^%~#Page 5T 164 U "93"  93}2z33  0 @   ݀^  ^93}݌ )uW  )Ќ  Increasetheproportionof X outbreakinvestigationsin  DY whichthecausative i!Z organism/toxinisidentified. $)"[ $ FY03: 58%  \ FY02: 57%  L]  FY01 :55% y!^  FY00: 50% A"_  FY99: 45%  #`   $, b  FY03: 12/2004  c FY02: 12/2003   Ld FY01: 12/2002 y!e  FY00: 12/2001 A"f  FY99: Exceeded/48%  #g  FY98: 40%  #lh #^  ^#Page i 164  Dj ! ! 9GHIJKLM(zxx9GHIJKLM"93"  92z33   i!k 0 @!   ݀^  ^93#݌  )"l Ќ  Increasetheproportionof %!m _foodborne_Ԁoutbreaksin &@"n whichthecausativefoodis e'#o identified. $%(#p $ FY01 :55% %!q  FY00: >50% &H"r  FY99: 󀀀50%  u'#s  FY01: 02/2002 %!t  FY00: Exceeded/55% &H"u  FY99: Exceeded/65% u'#v  FY98: 45%  =(#w #^  ^#Page %!x 164^  ^ &@"y "93"  9N2z33   e'#z 0 @!   93N{݌  %(#{ Ќ  %_cY PerformanceMeasures /d / Targets /d / ActualPerformance /d / Ref.  d   8#!,  8Expandtoupto60the  numberofpublichealth @ laboratoriesusing_PulseNet_ e tobuild_subtyping_Ԁcapacity %   andexchange_foodborne_    illnessdataforearly  @  identificationofand e   responsetooutbreaks %   (numberofagentsmay   increaseasnewpathogens  @  areidentified).#^  ^# e   $ $E.coli0157:H7:   FY03: 45labs  D FY02: 45labs q   FY01: 45labs 9   FY00: 40labs    FY99: 29labs  d Salmonella_Typhimurium_:    FY03: 45labs   x  FY02: 45labs @ !  FY01: 45labs m "  FY00: 40labs 5 #  FY99: 󀀀7labs  $ Listeria_monocytogenes_: M'  FY03: 30labs (  FY02: 30labs t)  FY01: 30labs <*  FY00: 20labs i+  FY99: 󀀀7labs 1, Shigella_sonnei_: /  FY03: 15labs  E0 FY02: 15labs   1 E.coli0157:H7:  2 FY03: 9/2003  D3 FY02: 9/2002  q 4 FY01: Achieved 9 5  FY00: Achieved  6  FY99: Achieved  d7  FY97: 0(baseline)  ,8 Salmonella_Typhimurium_:  :  FY03: 9/2003   | ; FY02: 9/2002 D <  FY01: Achieved q =  FY00: Achieved 9 >  FY99: Achieved  ?  FY97: 0(baseline) d @ Listeria_monocytogenes_: UB  FY03: 9/2003  C FY02: 9/2002 |D  FY01: Achieved DE  FY00: Achieved q F  FY99: Achieved 9G  FY97: 0(baseline) H Shigella_sonnei_: (J  FY03: 9/2003  QK FY02: 9/2002 L  FY01: Achieved |M  FY00: 7 DN  FY97: 0  q O Page P _164_ @Q Ѐ! ! 9GHIJKLM(zxx9GHIJKLM"93"  92z33   % S 0 @!   93݌   T Ќ  Enhance_FoodNet_Ԁby hU increasingthenumberof (V pathogensandsyndromes M W underactivesurveillance. $ !X $ FY03: 11  hY FY02: 11 0Z  FY01: 11 ] [  FY00: 10 %!\  FY99: 󀀀8 !]   u#_  FY03: 9/2003  h` FY02: 9/2002  0a FY01: Achieved ] b  FY00: Achieved %!c  FY99: 8 !d  FY97: 7  "Pe Page hf _164_ (g Ѐ! ! 9GHIJKLM(zxx9GHIJKLM"93"  9 2z33    !i 0 @!   93 :݌ !hj  Ќ  _ &% ^II_A.1c0  Antimicrobial_Resistance#^ %&# _%% k $ $ Americansareincreasinglyatthemercyofmicrobesthatareresistanttoantimicrobialagents.IntheUnited &`"m Statesandaroundtheworld,manyhumaninfectionsarebecomingresistanttotheantimicrobialdrugsused ' #n totreatthem.InsomeareasoftheUnitedStates,morethan30%ofinfectionswith_pneumococci_,themost E(#o commoncauseofbacterialpneumoniaandmeningitis,arenolongersusceptibletopenicillin.Nearly30%of )$p thebacteriathatmostfrequentlycauseinfectionsacquiredinhospitalintensivecareunitsareresistanttothe )`%q preferredantibiotic.DrugresistantStaphylococcusaureus,formerlyseenalmostexclusivelyinhospitals,is * &r nowbeingreportedinthecommunity. I+&s   ,'t %_c % %  Aninteragencytaskforce,cochairedbyCDC,FDA,andNIH,recentlyreleasedAPublicHealthActionPlan e toCombatAntimicrobialResistance,whichcallsfor1)anationalantimicrobialresistancesurveillanceplan; ) 2)promotionofappropriateuseofantimicrobialdrugsandpreventionoftransmissionofinfections;(3)  researchintoantimicrobialresistanceandmechanismsoftransmission;and(4)newproductdevelopmentto H prevent,diagnose,andtreatinfections. m ^  ^ PerformanceSummary   #^  ^#^  ^Thisyear,theantibioticusenumbersfor_otitis_Ԁmediahavebeenrevisedtoreflectcorrectedbaseline  P prescribinglevels.Measuringthenumberofcoursesofantibioticsforearinfectionsforchildrenunderthe u  ageof5yearsisusedasanindicatoroftwothings:1)physicianprescribingpracticesfor_otitis_Ԁmedia;and2) 5   overallincidenceof_otitis_Ԁmedia.Basedontherevisednumbers,CDChasexceededtheoveralltargetof    reducingthenumberofcoursesofantibioticsto57antibioticcoursesper100childrenandwilldropthis  P  measureafterthisyear.Reductionsinantibioticprescriptionsfor_otitis_Ԁmediamayreflectanincreased u   awarenessofthepublichealthproblemofantimicrobialresistance,theeffectivenessofanationalefforts 5  includingtheCDCseducationcampaignstargetedtophysiciansandthepubliconjudicioususeof   antibiotics,oradecreaseintheincidenceof_otitis_Ԁmedia. P  AnothermeasurethatCDCachievedsoonerthanexpectedistheestablishmentofanantimalarialdrug 5  resistancesurveillancesysteminAfrica.Usinganexistingregionalsurveillancesystemasabasisforthe   newsystemfacilitateditsimplementationandallcountrieswereagreeabletoimplementingthenewsystem. P #^  ^# GoalbyGoalPresentationofPerformance  5 A_@ d@XA PerformanceGoal:0 m Reducethespreadofantimicrobialresistance .m $m $ @jv@1111!@*7`8dd@ dd S dd dd B tdd [-`4e $e $, dd ,G dd ,dd ,dd +  & & PerformanceMeasure /K / Target /K / ActualPerformance /K / Ref. /K /Providesupporttohealth B departmentsandhospitalsfor g surveillance,prevention,and ' controlofantimicrobial   resistance. $B! $ FY01: 14sites B"  FY00: 14sites o #   %  FY01: Achieved B&  FY00: Achieved o '  FY99: 0  7( Page B) 164 g* '  )'+  )Diminishtherapidriseinthe , proportionof_enterococci_Ԁresistant V- to_vancomycin_Ԁ(_VRE_Ԁrate)among {. pathogensassociatedwith ;/ _nosocomial_ԀinfectionsinICU 0 patients. $ V1 $Increaseinresistantstrains:  2 FY03: 26.0%  V3 FY02: 26.0% 4  FY01: 27.2%  K5  FY00: 25.2%  6  FY99: 40.0%  v7   !>8  FY03: 3/2004  ^: FY02: 3/2003  &; FY01: 3/2002  S< FY00: 25.0%  =  FY99 :40.9%;5year  ~> historicalmean,47%.  !F? Page VA 164 {B ! ! 9GHIJKLM(zxx9GHIJKLM"93"  92z33   D 0 @-!   93@݌   VE Ќ  Establishasurveillancesystemto "F collectdataonantimalarialdrug #ZG resistanceinAfricancountries. $$ H $ FY01: 54countries "I  FY00: 25countries  #bJ   O% L  FY01: 54  "M FY00: Exceeded/54 #bN  FY99: Nosystem $* O   &!Q Page "R 164 #ZS L  )$ T  )Reducethenumberofcoursesof k'#U antibioticsforearinfectionsfor +(#V children<5yearsto57courses ($W per100children. $)F%X $ FY01: 󀀀54courses k'#Y  FY00: 106courses  3(#Z  FY01: 9/2002 k'#[  FY00: 54 3(#\  FY97: 108  ($] Page k'#^ 164 +(#_   ($` Reducethenumberofcoursesof *&a antibioticsprescribedforasole +Z'b diagnosisofthecommoncoldto ,(c 1,268coursesper100,000 ?-(d population. $-)e $ FY03: 2,017courses  *&f FY02: 2,144courses +b'g  FY01: 2,281courses ,*(h  FY00: 2,408courses W-(i   .z*k  FY03: 4/2004  *&l FY02: 4/2003 +b'm  FY01: 4/2002 ,*(n  FY00: 1,496 W-(o  FY97: 2,535(baseline)  .)p Page *&q  164 +Z'r   &% ^IIA.1dMedicalErrorsandHealthcareassociatedInfections#^ %&#  e  ^  ^Assuringthesafetyofpatientsreceivinghealthcareisapublichealthpriority.TheInstituteofMedicine  (_IOM_)hasestimatedthatmedicalerrorsandpreventableadverseeventscontributetothedeathsof44,000 ` to98,000patientsandadd$29billiontothecostofdirecthealthcareexpendituresintheU.S.annually.The   _IOM_Ԁhascalledfora50%reductioninmedicalerrorsandadverseeventswithin5yearsandthatanational E systemformonitoringandreportingtheseeventswillbecriticaltoachievingthisgoal.Inaddition,the_IOM_   proposesthatthewideradoptionofnewinformationtechnologycanmoreeffectivelyhelphealthcare  ` facilitiesimprovesystemsofcareandensureadherencetobestpracticesforpromotingpatientsafety.   CDCsstrategyforrespondingtothe_IOM_Ԁrecommendationswillbuildonitscorecapacitiesinmeasuringand E   monitoringinfectionsandotheradversehealthevents.Significantenhancementsinthemeasurementand    interventioncapacitytopreventmedicalerrorsandotheradversehealtheventsareneededbothatthe  `  individualfacilitylevelandwithinlocal,stateandnationalpublichealthagencies.Ourstrategyistobuildthis   capacitybyupdating,enhancing,expandingandextendingexistingpatientsafetycapacitiesthatare E  embeddedininfectioncontrolprograms.Thecoreofthisstrategyistoconvertthecurrentmeasurement   system,theNational_Nosocomial_ԀInfectionsSurveillance(_NNIS_)system,intotheHealthcareSafetyNetwork, `  anationalprogramwhichwillnotonlymeasure,butcanprovideinteractivecapacitytointervenethrough   healthcommunicationscampaignsandtargetedinterventionprograms.#^  ^# E   PerformanceSummary  ` ^  ^Throughhealthcommunicationscampaignsandotheractivepreventionefforts,thetargetofreductionof ( centrallineassociatedbloodstreaminfectionshasbeenexceeded.Furtherprogressisanticipatedbasedon M additionalplans#^  ^#  ^Ԁfor#^   #^  ^programsforeducationalandbehavioralinterventions.#^  ^#   ^  ^A_@ d@0A PerformanceGoal:ProtectAmericansfromdeathandseriousharmcausedbymedicalerrorsand a preventablecomplicationsofhealthcare  ) @4\޾@"1111!@e*:`=dd dd G dd G dd dd 7`8 $ $, dd ,G dd ,dd ,dd +  /"" / PerformanceMeasures A,! A Targets A,! A ActualPerformance A,! A Ref.   ݻ  #^  ^#^  ^ A,!N  AFunddemonstrationprogramsto   developandevaluatenew b! strategiestomeasureand "" preventhealthcareassociated G# infections 6,!$ 6 FY03: 2programs %  'O( ' FY03: 9/2003 )  FY02: 10/2002 j*  FY01: 0(baseline) 2+  '- '#^  ^#Page . 164^  ^ b/ ! ! 9GHIJKLM(zxx9GHIJKLM"93"  9-2z33   "0 0 @-!   93-Z݌̌  "2  "*@`Add dd G dd G dd dd :`= $ $, dd ,H dd ,dd ,dd +    /2 /Reducetherateofcentralline s3 associatedbloodstreaminfections 3 4 inadultICUpatientsto3.80,as  5 measuredthroughthe_NNIS_ !N6 system. 6,!s"7 6 FY03: 3.80 s8  FY02: 3.80 ; 9  FY01: 3.86 !:  FY00: 4.4 !f;  FY99: 5.2 ".<  '[#= ' FY03: 4/2004 s>  FY02: 4/2003 ; ?  FY01: 4/2002 !@  FY00: Exceeded/3.92 !fA  FY99: Exceeded/4.4 ".B  FY98: 5.3 '[#C '#^  ^W#Page sD 164^  ^ 3 E #^  ^#'^  ^"!NG " &% ^IIA.1fPublicandProviderEducation#^ %&q# %r!I  #^  ^%#CDCcontinuestoserveasasourceofscientificinformationonemerginginfectiousdiseases.Workingwith w'#K partnersinstateandlocalhealthdepartments,academicinstitutions,andotherorganizations,CDCconducts 7(#L researchanddemonstrationprojectstoidentifyandunderstandemergingdiseasesandtodevelopand ($M evaluatepreventionandcontrolstrategies.Diseasepreventioninformationandpreventionguidelinesare )R%N disseminatedtohealthprofessionalsandthepublicinavarietyofformats,usingtheinternet,CDROM,and w*&O variousjournalsandpublications. 7+&P __ r  .*U  PerformanceSummary  e Asuccessfulexampleofhowpreventionguidelineshavebeenusedisdemonstratedthroughthereductionin - theincidenceofperinatalgroupBstreptococcaldisease,themostcommoncauseofsevereinfectionsin  newborns.Providersandobstetricdepartmentshavequicklyadoptedrecommendedpreventionstrategies, H resultinginadeclineindiseasethatismorerapidthanexpected.CDCworkedwiththeAmericanCollegeof m ObstetriciansandGynecologists(_ACOG_)andtheAmericanAcademyofPediatrics(_AAP_)todevelop - guidelinesandinformationforpractitionersonthebestmethodsforpreventinggroupBstreptococcaldisease.  Surveyshaveshownthatthepreventionrecommendationshavebeenwidelyadopted.CDCsActive  H BacterialCoreSurveillance(ABCs)istrackinggroupBstreptococcaldiseaseinninestatesinareaswitha m  totalpopulationof28.3millionpersons.AccordingtoABCsdata,neonatalgroupBstreptococcalinfections -   havedeclined70%since1995,theyearbeforethepreventionrecommendationswerepublished.Toimprove    preventionefforts,CDCstaffareworkingwithABCspersonneltoassessmissedopportunitiesforprevention  H  andwillbemeetingwithrepresentativesfrom_ACOG_Ԁand_AAP_Ԁtoreviewthe1996preventionguidelines. m   PreliminarydataforFY2000showariseindiseaseincidence(0.6per1,000birthsupfrom0.4),whichCDC -  willbelookingintointhecomingyear.   Anothersourceofimportantinformationonemergingdiseasescomesfromproviderbasedsurveillance m  networkscalledtheEmergingInfectionsNetwork(_EIN_).Thesenetworks,establishedwithemergency -  departments,travelmedicineclinics,infectiousdiseasephysicians,alongtheU.S./Mexicoborder,andintwo   internationalsites(theAmazonBasinandsouthernconeregion),areabletodetectandmonitoremerging H diseasesinspecializedsettings.The_EIN_Ԁisintendedtofunctionprimarilyasan"earlywarningsystem"for m CDCandotherpublichealthagenciesbyprovidinginformationaboutunusualcasesencounteredinthe - clinicalpracticesofitsmembers.Itmayalsoassistinoutbreakinvestigations,provideinformationon  physicianpractices,conductinvestigationsonthecauseofcertainillnesses,anddisseminateknowledge H aboutnewmicrobialthreats.PublishedworkfromtheInfectiousDiseasesSocietyofAmerica_EIN_Ԁisavailable m ontheinternetat:4Bon O  5  http://www.idsociety.org/EIN/pub_rpts/list.cfm.^  ^61OE:   7Ys - Emerginginfectionsappliedresearchemphasizesthedevelopmentoftoolsfordetecting,treating,and H preventinginfectiousdiseases;theidentificationofbehavioralfactors,environmental,andgeneticfactorsthat m influencediseaseemergenceandprevention;andevaluationofdiseasepreventionandcontrolstrategies. - Theultimategoalofemerginginfectionsresearchprojectsistointegrateadvancesinlaboratorydiagnosis  andepidemiologyintoroutinepublichealthpractice.#^  ^# H TheEmergingInfectionsProgram(_EIP_)isanetworkofhealthdepartmentsthatwasestablishedtoconduct -! populationbasedsurveillanceandresearch.The_EIP_Ԁnetworkisuniquelydesignedtoaddressnewinfectious " diseaseproblemswhenevertheyarise._EIP_Ԁactivitiesofthepastfewyearshaveincludedinvestigationsof H# _meningococcal_Ԁandstreptococcaldiseasesandthe_EIPs_Ԁhaveestablishedsurveillanceforunexplaineddeaths m$ andsevereillnessesinpreviouslyhealthpeople.Informationonthe_EIP_ԀnetworkcanbefoundontheCDC - % websiteat:4CYfO  5  http://www.cdc.gov/ncidod/osr/EIP.htm6O:   7Y.  & TheUniversalDataCollectionProgram(UDC)enrollspersonswithbleedingdisordersineachofthenations m"( 134federallyfundedhemophiliatreatmentcenters(_HTC_).ThepurposeofUDCistwofold:1)toestablisha -#) sensitivebloodsafetymonitoringsystemamongpersonswithbleedingdisorders;and2)tocollectauniform #* setofclinicaloutcomesinformationthatcouldbeusedtomonitortheoccurrenceofandpotentialriskfactors $H + forinfectiousdiseasesandjointcomplications.DatafromtheUDCaboutthedemographiccharacteristicsof m%!, theparticipants,theirbloodandfactorproductuse,andtheoccurrenceandtreatmentofjointandinfectious -&!- diseasesisdisseminatedroutinelytopublichealthworkers,healthcareproviders,healtheducators,and &". patientsinthebleedingdisordercommunity.Byusingpatientandproviderfocusgroupsandworkingclosely 'H#/ withthewiththe_HTCs_,CDChasbeenabletoincreaseparticipationofall_HTCs_Ԁsoonerthanexpectedand m($0 alsoincreaseparticipationofpersonsenrollinginthestudy.Data,information,andnewslettersfromtheUDC -)$1 arepublishedroutinelyonCDCswebsiteat:http://www.cdc.gov/ncidod/dastlr/HematologygԀ )%2   r    "  z    *  -/*9 A_@ d@eA PerformanceGoal: Applyscientificfindingstopreventandcontrolinfectiousdiseases  1 @v@*1111!5@*E`Odd dd H dd H dd dd @`A $ $,dd , dd ,B dd ,dd +  &** & PerformanceMeasure / / Target / / ActualPerformance / / Ref. / /Reducetheincidenceof O perinatalgroupB  streptococcalinfectionsto j 0.3per1,000livebirths. $ *  $ FY01: 0.3 O   FY00: 0.4    FY99: 0.9  z   FY01: 06/2002 O   FY00: 0.6(preliminary)   FY99: Exceeded/0.4 z  FY95: 1.3   B Page O 164  Ѐ  j Establish10surveillance   networkstomonitor  ^ antimicrobialresistance,   threatsfromtransfusionof C  blood/bloodproducts,and   infectiousdiseasesin ^  travelersand_immuno_Ԅ   suppressedandunder C  servedpopulations. $  $ FY03: 7networks    FY02: 7networks  f  FY01: 6networks  .  FY00: 5networks [    FY99: 4networks # !   F #  FY03: 9/2003   $ FY02: 9/2002  f%  FY01: Achieved/6  .&  FY00: Exceeded/6 [ '  FY99: Achieved/4 # (  FY98: 3  )  FY97: 3(baseline)  N * Page  ^, 164   - Increasethenumberof W . extramuralresearchawards / fordevelopment/improve r0 _ment_Ԁofdiagnostictestsfor 21 thestudyofantimicrobial W2 resistance,_STDs_,malaria, 3 Lymedisease,healthcare r4 associatedinfections,and 25 bloodsafety. $W6 $ FY01: 45awards W 7  FY00: 22awards 8  FY99: 22awards  9  FY01: Achieved W :  FY00: Achieved ;  FY99: Achieved <  FY97: 17  J= Page W > 164  ? Increaseparticipationby F@ 134hemophiliatreatment kA centersintheUniversal +B DataCollectionsystem. $C $ FY02: 100%participation FD  FY01: 100%participation sE  FY00: 󀀀90%participation ;F  FY99: 󀀀40%participation G   fH  FY02: 9/2003  FI FY01: 100% sJ  FY00 :Exceeded/100% ;K  FY99: Exceeded/70% L  FY98: 0%  fM Page^  ^ FN #^  ^|#164^  ^  kO Establish_EIP_Ԁsitesto 'P conductactivesurveillance Q andappliedresearchandto BR pilot/evaluateprevention g S andinterventionmeasures. $'!T $ FY01: 9sites 'U  FY00: 9sites V  FY99: 8sites  RW  FY01: Achieved 'X  FY00: Achieved Y  FY99: 7  RZ Page '[ #^  ^#164^  ^Ԁ \   r Verification/ValidationofPerformanceMeasures :Successfulaccomplishmentoftheseobjectiveswillbe "r] verifiedinpartusingdatasubmittedfromfundedstates.Intheseinstances,performancewillbeverified #:^ throughonsitetechnicalassistanceandperiodicvisitsandprogressreviews.Otherdataaremonitoredby _$_ useofpublishedandunpublishedstudiesandrecommendations.Additionalsystemsusedforverification % ` include:1)HepatitisCVirusCountySurveillanceProject,2)_PulseNet_Ԁand_FoodNet_,3)U.S.Influenza %z!a PhysiciansSurveillanceNetwork,4)_Foodborne_ԀOutbreakReportingSystem,and5)ActiveBacterialCore &:"b Surveillance(ABCs).ThefollowingsystemsreferencedinAppendixBarealsousedfordataverificationand _'"c validation:1)National_Nosocomial_ԀSurveillanceSystem(_NNIS_),2)NationalElectronicTelecommunication (#d SystemforSurveillance(_NETSS_),and3)PublicHealthLaboratoryInformationSystem(_PHLIS_).#^  ^] # (z$e  r    r    "  z    *     _ r    "  z    *   _   .z*m nY8($dx^ `E^ettec n # $# $ $ $ # $# $# $# $ # $# $# $# $ # $# $# $# $  $ $# $# $TotalProgramFunding(Dollarsinthousands)   FY2003: 0  0"  $ $$1,636,7400" $" $0* $ $(Estimate)M* $* $  FY2002: 0  0"  $ $$2,305,4190" $" $0* $ $(CurrentEstimate) * $* $  0 r    " $2,123,5000r $r $0* $ $ERF x* $* $  0 r 0r $r $0"  $ $$181,9190" $" $0* $ $nonERF  8* $* $ FY2001: 0  0"  $ $$180,9490" $" $0* $ $(Actual)^  ^]  * $* $  Mandate     CDCisresponsibleforleadingnationaleffortstodetect,respondto,andpreventillnesses/injuriesthatresult  H  fromthedeliberatereleaseofbiologicalorchemicalagents. m   Problem    #^  ^#^  ^_Bioterrorism_ԀpreparednesscontinuestobeapriorityfortheU.S.publichealthcommunity.#^  ^|#^  ^Asscientificand P  technologicaladvancesincreasetheeasewithwhichpersonsareabletoobtainand_weaponize_Ԁbiologicaland u  chemicalagents,thepotentialfor_bioterrorism_ԀtothreatenthehealthoftheU.S.publicalsocontinuesto 5  increase.Althoughtheprobabilityofanattackremainslow,thepotentiallycatastrophicimpactdemonstrates  thecriticalneedforlocal,state,andfederalpublichealthcapacitytorapidlydetect,identify,andrespondtoa P widespreadinfectiousdiseaseoutbreakorchemicalassault. u Preparingthenationtoaddressthedangersofbiologicalandchemicalterrorismisamajorchallengetopublic  healthandhealthcaresystems.#^  ^:#>^  ^Thetoolsandexpertise-#^  >^#>^  ^surveillance,epidemiology,laboratorycapacity,and P coordinatedcontrolmeasures#^  >^?#>^  ^Ԁ-thatwillbemostvaluableintheeventofabiologicalattackwillalsoaidpublic u healthintheinvestigationandcontrolofotherinfectiousdiseaseoutbreaks.However,thesetoolsmustbe 5 enhancedtoensureimplementationoftherapidresponsenecessarytominimizetheimpactofa_bioterrorism_  agent,suchassmallpoxorplague.#^  >^#^  ^Earlydetectionrequiresincreasedawarenessamongmembersofthe P medicalcommunity,whoareinthebestpositiontoreportsuspiciousillnessesandinjuries,andimproved u linkagesbetweenthehealthcareandpublichealthcommunities.Stateandlocalhealthagenciesrequire 5 enhancedcapacitytodetectandinvestigateunusualeventsandunexplainedillnesses,anddiagnostic  laboratoriesneedtobeequippedtorapidlyidentifybiologicalandchemicalagentsthatarerarelyseeninthe P  UnitedStates.Stateandlocalentitiesmustalsobetrainedtoreceiveanddistributethecontentsofan u! establishedpharmaceuticalstockpile.Fundamentaltotheseeffortsiscomprehensive,integratedplanning 5" andtrainingtoensurecorecompetencyintheprimaryelementsofpublichealthpreparednessandahigh # degreeofscientificexpertiseamongallpartners. P$  Strategies,Activities,andResources  5!& #^  ^#^  ^AdvanceshavebeenmadeattheStateandlocalleveltostrengthennationalcapacityfor_bioterrorism_ !' response.TheCDCcooperativeagreementprogram,PublicHealthPreparednessandResponsefor "X( _Bioterrorism_,currentlyprovidesfundingto50states,4localitiesand1U.S.territorytoenhancesomeorallof }#) theprimarycomponentsof_bioterrorism_Ԁpreparedness.#^  ^l"#^  ^Ԁ#^  ^$#^  ^CDCs_Bioterrorism_ԀPreparednessandResponse =$* activitiesareacrosscuttingeffortwhichintegratestheactivitiesofvariousofficesatCDC,theAgencyfor $ + ToxicSubstancesandDiseaseRegistry,andotherfederalentitiessuchastheFBI,theFederalEmergency %X!, ManagementAgency,andtheOfficeofJusticePrograms.#^  ^$#^  ^ԀCDCprovidesleadershipandcoordinationforthis }&"- nationalcapacitybuildingeffort,withemphasisoninterdependentfocusareas:  ='".  r 1)Deterrence/Prevention (`$0  r 2)PreparednessandResponseCapacity )(%1  r 3)SurveillanceandEpidemiologyCapacity U*%2 0 r 4)BiologicandChemicalLaboratoryCapacity+&3r $r $  r 5)NationalPharmaceuticalStockpile +'4  r 6)InformationandCommunicationsSystems ,H(5  r 7)WorkerSafety  u-)6  .*8 #^  ^&#^  ^Byimplementingandcoordinating_bioterrorism_Ԁpreparednessactivitiesatthefederallevel,CDCwillbebetter e abletosupportStateandlocalpartnersintheireffortstoestablishcomprehensive_bioterrorism_Ԁpreparedness % andresponseprograms.#^  ^)#^  ^Ԁ#^  ^i+#^  ^ActivitiesbeingimplementedattheCDC/_ATSDR_Ԁcomplementeffortsbeingmade  aroundthecountry.#^  ^+#^  ^ @  Linksto_DHHS_ԀStrategicPlan  % _Bioterrorism_Ԁperformancemeasuresrelateto_DHHS_ԀGoal5,Objective5.1:Improvethecapacityofthepublic  healthsystemtoidentifyandrespondtothethreatstothehealthofthenationspopulation.  L  Partnerships  5   CDCsprimarypartnersindevelopingnationalcapacityfor_bioterrorism_Ԁpreparednessandresponsearestate    andlocalhealthdepartments.Inaddition,CDCworkswithavarietyoffederalagencies,academic  X  institutions,andnongovernmentalorganizations,suchasAssociationofPublicHealthLaboratories(_APHL_), }   FoodandDrugAdministration(FDA),U.S.ArmyMedicalResearchInstituteforInfectiousDiseases =  (_USAMRIID_),NationalAssociationofCountyandCityHealthOfficials(_NACCHO_),NationalGovernors   Association(_NGA_),NationalEmergencyManagementAssociation(_NEMA_),InfectiousDiseaseSocietyof X  America(_IDSA_)andtheDepartmentofVeteransAffairs(VA).ExamplesofsomeofCDCscollaborative }  activitiesinclude:1)#^  ^,#^  ^ԀinteragencyagreementwiththeDepartmentofVeteransAffairsforprocurementof =  pharmaceuticalsandmedicalsuppliesthatcomprisetheNationalPharmaceuticalStockpile;#^  ^2#^  ^Ԁ2)cooperative   agreementwith_APHL_ԀforcoordinationoftheLaboratoryResponseNetwork;3)contractwith_Acambis_,Inc.for X developmentofanewsmallpoxvaccine;and4)#^  ^3#^  ^ԀcooperativeagreementswiththeNationalInstitutefor } StandardsandTechnology,theU.S.ArmySoldiersBiologicalandChemicalCommand,andtheOccupational = SafetyandHealthAdministrationforthedevelopmentofrespiratoryprotectionstandards.#^  ^I5#^  ^  #^  ^6# PresentationofPerformance  = ^  ^Asaresultoftheachievementoftheperformancemeasureslistedbelow,local,state,andfederal ` preparednessforbiologicalandchemicalterrorismhasbeenstrengthened.   #^  ^A7# PerformanceSummary @*  ^  ^InlightofthepossibilityofadditionalterroristattacksagainstAmericansdomestically,itiscriticalthatCDCbe h abletohelppublichealthagenciesandprofessionalsinallstatesandterritories,aswellasmanyothermajor (  cities,achievethesamelevelofplanning,preparedness,andtrainingthatexistinNewYorkandWashington. M! WithsupplementalfundsprovidedinFY2002,CDCwillbegintoaddressexistingdeficienciesbycreatinga  " nationwidecomprehensive,coordinatedemergencypublichealthpreparednessplanningandtraining h# program.Thesupplementalfundingwillacceleratetrainingopportunities,CDCfieldstaffassignments,and ($ CDCledemergencyresponseexerciseswouldbemadeavailabletoeverystateandterritory,aswellasthe M % majorcitiesdeemedtobemostatriskfromaterroristattack.#^  ^8#ԀCDCwillcontinueitseffortstostrengthen  !& nationalpreparednessfor_bioterrorism_Ԁbyfurtherdevelopingandmaintainingactivitiessuchasimproving !h' _preparedess_Ԁandresponsecapabilities,improvingcapacityforlaboratorydiagnosisofbiologicandchemical "(( agents,strengtheningsurveillancesystemsandepidemiologictoolsfordetectionof_bioterrorism_, M#) strengtheningthepublichealthworkforcecapacity,establishingcommunicationsandtrainingnetworksto  $* improve_bioterrorism_Ԁreadinessandresponse,maintainingtheNationalPharmaceuticalStockpile,and $h + buildingpartnershipstoensurecoordinated,comprehensiveplansforresponseto_bioterrorism_.Allofthese %(!, activitieswillcontinuetobeconductedatfederal,state,andlocallevels.^  ^ M&!-  r    "  z  r    "  z    * _ r    " _ z   .(*8  &% ^ProtectingHealthandPromotingPartnerships e   IIA.2aDeterrence/Prevention#^ %&A#   #^  ^@#_DHHS_,throughitsCentersforDiseaseControlandPrevention(CDC)regulation(i.e.SelectAgentRule),as  mandatedbytheAntiterrorismandEffectiveDeathPenaltyActof1996,hasoversightofthenational P LaboratoryRegistration/SelectAgentTransfer(LR/SAT)program.Thisrulerequiresthemonitoringof u approximately40biologicalagentsandtoxins( selectagents)thatposeaseverethreattopublichealthand 5  safety.ToadministertheSelectAgentRule,CDCrequirestheregistrationofspecificfacilitiesthattransferor   receivetheseagents.Thisistoensurethattheyareequippedandcapableofsafelyworkingwiththem.CDC  P mayalsoperforminspectionsonthesefacilitiesduringthe3yearregistrationperiod.TheSelectAgentRule u   alsorequiresCDCtomaintainsdataonshipmentsofselectagentsbetweenregisteredfacilitiesandworks 5   withlawenforcementagencieswhenviolationsoftheregulationoccuroraresuspectedofhavingoccurred.  ^     #^   gG#PerformanceSummary }   Toassistwithnationaldeterrenceefforts,CDCcontinuestoregisterandinspectlaboratoriesthattransferor E  receiveselectagents.InFY2001,55newregistrationswereissuedundertheLR/SATprogram,resultingina   totalof249 laboratoriescurrentlyregisteredandcertifiedwithCDCtotransferselectagents.DuringFY2001, `  CDCalsoimplementedaninter-agencyagreementwith_Edgewood_ԀChemicalBiologicalCentertoassistwith   facilityinspectionsefforts.ThisallowedCDCtocontinuefacilityregistrations,whilebothagenciesconducted E  facilityinspections.Throughthisagreementatotalof23inspectionswereperformedundertheSelectAgent  Rule,foracumulativetotalof60laboratoriesinspectedundertheprogram.Thesefiguresreflectthe ` cancellationof5facilityinspectionsduetothenationalterrorismeventsofSeptember11,2001.InFY01,   CDCdocumentedatotalof893transfersofselectagentsbetweengovernmentagencies,universities, E researchinstitutions,andcommercialentities.FollowingtheeventsofSeptember11th,CDCprovided  immediateassistancetoseveralfederalandstatelawenforcementagenciesaboutselectagentdatatoassist ` withcriminalinvestigativeefforts.CDCalsoprovidedconsultationto5statepublichealthlaboratoriesand75   nonstatepubichealthfacilities(federalgovernment,industry,academia,andinternational)onfacilitydesign, E constructionandcontainmentissues.  DuringFY2002,CDCwillinitiateeffortstoincorporatebothsecurityandtechnologicalupgradestotheselect   agentdatabase.Thiswillexpandourcapabilitiesofprovidingassistancetolawenforcementauthorities. E CDCwillalsoinitiateeffortsexpandprogrammaticinfrastructuretoincreasetimelinessoffacilityregistrations  andinspections.Additionally,CDCinconjunctionwiththeAssociationofPublicHealthLaboratorieswill `  providetrainthetrainerworkshopstoStatepublichealthlaboratorysafetyinstructorsonthesubjectsofsafe  ! laboratorypracticesandnewselectagentlegislation.^  ^  E"  r    "  z #^  ^Q#^  ^GoalbyGoalPresentationofPerformance#^  ^3R#^  ^  0%  #^  ^R#^  ^A_@ d@"A PerformanceGoal:0 " Continueeffortstoprotectthesafetyandsecurityof_laboratorians_Ԁregarding N"' thehandlingandprocessingofbiologicalagents. #(" $" $ @v@$1111!S@#^  ^R#^  ^*`dddd  dd B dd B dd E`O $ $, dd ,` dd ,4dd ,9dd +  +$)$ _+ PerformanceMeasure /s$ * / Target /s$ + /ActualPerformance /s$ , /Ref. =(s$ - _  =Inspectpublichealth %m!. laboratoriesinaccordancewith &-"/ theSelectAgentRule. 9/!R'"0 9 FY03: 120laboratories  %m!1 FY02: 90laboratories  &5"2 FY01: 65laboratories  b'"3 FY00: 50laboratories 9/!*(#4 9FY03: %m!5 FY02 &5"6 FY01: Achieved/65  b'"7 FY00: 36  *(#8 FY99: 14 9/!($9 9 Page %m!: 218 &-"; "93"  93Y2z33  0 l#   93YY݌;1/(#=l##l##   ;Ќ   r    "  z _ r    "  z _   */*D  &% ^IIA.2bPreparednessandResponseCapacity#^ %&I[#  e Theprospectofterroristsunleashingbiologicalorchemicalweaponsisaterrifyingone,inpartbecauseofa  fearoftheunknown.Itisexpectedthatanactofbiologicalorchemicalterrorismwilloccurwithnowarning. ` InordertoprotectthehealthofAmericans,CDCassistsstateandlocalhealthdepartmentsastheyprepareto   respondtodeliberateactsofterrorism.Awellplanned,rapidandeffectiveresponsewillbecriticalin E minimizingmorbidityandmortalityassociatedwithsucha_bioterrorism_Ԁevent.Acrossthecountry,statehealth   departmentofficialsarereconsideringthecapabilitiesoftheirdepartmentstorespondtoabiologicalor  ` chemicalterrorismincident.Traditionally,theresponsibilitiesofthestatehealthdepartmentshavebeen   diseasesurveillanceandmanagement.Healthdepartmentsnowaredefiningtheirrolestorespondeffectively E   toanintentionalreleaseofbiologicalorganismsorhazardouschemicalsintoanunsuspectingpopulation.     PerformanceSummary    CDCinitiatedacooperativeagreementprogramforstateandmajorlocalhealthdepartmentstohelpimprove M  theirpreparednessandresponsecapabilitiesfor_bioterrorism_.Stateandlocalgranteesarecompleting    comprehensiveassessmentsoftheircapacityfor_bioterrorism_Ԁpreparednessandresponse.Analysisofthese h  assessmentswillallowgranteestoprioritizetheirresourcesandefforts.Allthestatesandsometerritorieswill (  haveinitiatedsomepreparednessandresponseactivitiesinFY2002.BytheendofFY2002atleast48of M  the55statesandterritoriesreceivingfundingwillhavecompletedtheirvulnerabilityassessmentsand42will    havecompletedtheirdraftpublichealthemergencyresponseplans.Inaddition,state,territorial,andlocal h healthdepartmentswillhavebeguntobuildcriticalcommunicationlinkswithotherassetsinthehealthcare ( andemergencyresponsecommunity,e.g.,hospitals,emergencydepartments,acutecarecenters,police,fire, M EMS,localemergencymanagementagenciesandotherfirstresponseorganizations,toassesslocal   capacitiesandcoordinateresponses.Finally,acommunityemergencyresponsedemonstrationprogramwill h beestablishedtodevelopmethodologytoassureintegratedstateandlocalpublichealthemergencyresponse ( capabilities. M Threeexemplarcentersforpublichealthpreparednesshavebeenestablishedandareimplementingmodel h informationtechnologyprojectsthatwillprovideassistanceforstatesandlocalitiesdevelopingpublichealth ( informationsystems.CDChasalso#^  ^T#^  ^collaboratedwiththeDepartmentofJusticeindevelopmentofan M assessmentofpublichealthcapacityfor_bioterrorism_.   #^  ^Wh#^  ^ #^  ^Yi#^  ^ GoalbyGoalPresentationofPerformance #^  ^i#^  ^ (  #^  ^j#^  ^A_@ d@A PerformanceGoal:0 " EnhancethecapacityofCDCandstateandlocalhealthdepartmentstoprepare F" forandrespondtoabiologicalorchemicalterrorismevent. #" $" $ @v@ 1111!j@*`ddW dd dd ` dd 4Ydd 9` $ $, dd ,` dd ,` dd ,Xdd +  & b% b & PerformanceMeasure /+!& / Target /+!' / ActualPerformance /+!( / Ref. (+!)  (* ` dd dd ` dd ` ` dd ` Xdd X` $ $, dd ,` dd ,` dd ,Xdd +  &#")#" &Establishstateandlocal ""* _bioterrorism_Ԁpreparednessand G#+ responseplanningactivities. $$, $ FY03 :55statesorlocalities ""-  FY02: 55statesorlocalities O#.  FY01: 11statesorlocalities $/  FY00: 11statesorlocalities $z 0  FY99 :5statesorlocalities  %B!1  FY03:  ""2  FY02:  O#3  FY01 :Achieved/11 $4  FY00: Achieved $z 5  FY99: Exceeded/11 %B!6   o& "7 #^  ^ij#^  ^Page ""8 #^  ^Jr#^  ^218#^  ^r#^  ^Ԁ#^  ^r#^  ^ G#9 "93"  9bs2z33   $b ; 0 @4!   93bss݌ %"!< Ќ  #^  ^-s#^  ^&% ^IA.2cSurveillanceandEpidemiologyCapacity#^ %&pt# '(#=  Becauseacovertbiologicalorchemicalattackwillmostlikelybedetectedlocally,diseasetrackingsystemsat )$> stateandlocalhealthagenciesmustbereadytodetectunusualpatternsofdiseaseandinjury,and )b%? _epidemiologists_Ԁattheseagenciesmusthaveexpertiseandresourcesforrespondingtoreportsofrare, *"&@ unusual,orunexplainedillnesses.CDCisworkingtointegratesurveillanceforillnessresultingfrombiological G+&A andchemicalterrorismintotheU.S.diseasesurveillancesystems.CDCisalsodevelopingnewmethodsfor ,'B rapidlydetecting,evaluating,andreportingsuspicioushealtheventsthatmightindicatecovertterroristacts. ,b(C CDChasprovidedfundingfor_bioterrorism_Ԁsurveillanceandepidemiologycoordinationtoallstatehealth -")D departmentsandselectedmajormetropolitancitiesandterritories.  G.)E  /*F Y w   PerformanceSummary e  #^  ^Mt#^  ^Fundingforthiscomponentincludesawardsforbuildingcorecapacity,aswellasspecialprojects.#^  ^y#>^  ^InFY2000 - all50states,4localities,and1U.S.territorywerefundedforthecorecapacitycomponentofthecooperative  agreement.Additionally,eightprojectswereidentifiedtodevelopspecialsurveillanceandepidemiology H activities.#^  >^nz#^  ^Statesandlocalitieshaveusedtheircooperativeagreementfundstoenhancetheircapacityto m detect,investigateandmitigatehealththreatsposedby_bioterrorism_Ԁagents.#^  ^{#^  ^ #^  ^}#>^  ^Inaddition,expansionof_Epi_-X, - theEpidemicInformationExchange,anInternet-based,securecommunicationsystempromoteseasier,more  accurate,andreal-timereportingofsuspectoutbreaksorotheremerginghealththreats,includingthose  P relatedto_bioterrorism_.Increasedfundingforupgradingstateandlocalcapacityallowedforfunding14 u  additionalsitesandexpansionof_Epi_-Xtoalargernumberofpublichealthprofessionals._Epi_ԄXisalso 5   supportingthe#^  >^O}#^  ^Ԁdevelopmentofsecurecommunicationssystemsatthreejurisdictions(Florida,Kansas,and    Chicago).  T  Avarietyoftechnicalassistancehasbeencompleted,including:provisionofepidemiologicassistanceinthe y   investigationofanoutbreakofWestNilevirusinNewYork,#^  ^c#>^  ^enhancedsurveillancesupportfortheWorld 9  TradeOrganizationMinisterialConferenceinSeattle,DemocraticandRepublicanNationalConventions,and   2001SuperBowl.#^  >^#^  ^ T  #^  ^#^  ^ GoalbyGoalPresentationofPerformance#^  ^[#^  ^   A_@ d@$APerformanceGoal:0 " EnhancethecapacityofCDCandstate/localhealthdepartmentstorapidly U detectandinvestigatepotentialbiologicalevents." $" $ @v@{1111! @Ӏ#^  ^΃#^  ^ { * ` dd dd ` dd ` ` dd ` Xdd X `  $ $, dd ,` dd ,` dd ,dd +  &CC &PerformanceMeasure /B /Target /B /ActualPerformance /B /Ref.(B  (* `dd dd ` dd ` ` dd ` dd  `  $ $, dd ,` dd ,` dd ,dd +  &:: & Numberofstateandmajorcity  healthdepartmentsandother ^ sentinelsiteswithexpanded  epidemiologyandsurveillance C capacitytodetect,investigate   andmitigatehealththreatsby ^! _bioterrorism_. $" $FY03: 55sites  # FY02: 55sites  f$ FY01: 55sites  .% FY00: 40sites  [& FY99: 40sites  #'   ( FY03: ) FY02: f* FY01: Achieved/55  .+ FY00: Exceeded/55  [, FY99: 34  #- FY98:󀀀 0  .  #^  ^#Page / ^  ^218#^  ^# ^0 "93"  9^2z33   C2 0 @4!   93^݌(3  (Ќ  &% ^IIA.2d0 r LaboratoryCapacity#^ %&7# 5r $r $ Laboratorycapacityforbiologicagents:^  ^Becausemost_bioterrorist_Ԁagentshavelittlepublichealthimportance  .7 onaday-to-daybasis,thenationsabilitytorapidlydiagnosetheseinfectionsislimited,bothatthenational S!8 levelandinstateandlocalpublichealthlaboratories.CDCisresponsibleforprovidingthenationwithan "9 accurateandtimelydeterminationofanyetiologicagentcausingapublichealththreat,includingboth "n: naturallyoccurringdiseasesand_bioengineered_Ԁorganismsusedinabiologicalterrorismattack.CDCalso #.; ensuresthat_frontline_Ԁstateandlargecitypublichealthlaboratoriesarepreparedtorapidlyandaccurately S$< diagnoseagentscausingpublichealthproblems.Tomeettheseneeds,CDC,incollaborationwith_APHL_ % = establishedtheLaboratoryResponseNetwork.Thismultilevelnetworkofpublichealthlaboratoriesprovides %n!> essentialdiagnosticcapabilitiesinstateandlargemetropolitanareasandcentralized,state-of-the-artnational &."? referencecapacityatCDC.CDCsRapidResponseandAdvancedTechnologyLaboratorycanproviderapid S'"@ identificationofbiologicalagentsthatarerarelyseenintheUnitedStates.Otherdiseasespecificlaboratories (#A atCDCprovideadditionalresearchandsurgecapacityfordiagnostictestinginresponsetoanyincident. (n$B CDCandpartnershaveidentifiedthebiologicalagentsmostlikelytobeinvolvedinaterroristattackandare ).%C developingrapidassaystoassistindetectingtheseagentsatthestateandlocallevels. #^  ^#^  ^ S*%D  Laboratorycapacityforchemicalagents:#^  ^|#^  ^Chemicalattacksbyterrorists,suchasthereleaseofthedeadlygas +v'F _sarin_ԀinaTokyosubway,underscoretheneedtoquicklyandreliablydeterminetheidentityofthechemical ,6(G agent,findoutwhohasbeenexposed,anddeterminetheextentofexposure.Publichealthlaboratories [-(H currentlydonothavetheinfrastructuretotesthumansamplesforchemicalagents.Intheeventofa .)I chemicalterroristincident,notonlywouldtherebeaneedtoanalyzesamplesfrompersonswhowereactually .v*J exposedtoanagent,buttherealsocouldbeextensivedemandforservicesforpersonswhothinktheywere /6+K exposed.Toaddressthesedeficiencies,CDChasdevelopedarapidtoxicscreenthatcanidentifyupto150  e  differentagentsinabloodsample.  %  PerformanceSummary #^  ^#^  ^ @ Laboratorycapacityforbiologicalagents:_Laboratorians_Ԁfromall50stateshavebeentrainedinthehandling m andtestingofcriticalbiologicagents.Inadditionmanypublichealthlaboratoriesacrossthecountryhave - beenrenovatedandupgradedtoallowadequatesafetyforimproveddiagnosisofpotential_bioterrorism_  agents.Currently,55laboratoriesin53statesandlocalitiesreceivefundstoenhancetheircapacityfor  H identificationofbiologicagents.AlloftheselaboratoriesarealsomembersoftheLaboratoryResponse m  Network(_LRN_).The_LRN_Ԁisacollaborativepartnershiptoestablishfrontlinelabbased_biodetection_Ԁforrapid -   agentidentificationandcommunicationsneededtosupportsentinelsurveillance,epidemicresponse,and    populationbasedpublichealthdecisionmaking.NewrapidassaysarebeingdevelopedforrealtimePCR  H  andantigendetectionforpotential_bioterrorism_Ԁagents.#^  ^#^  ^ m   Laboratorycapacityforchemicalagents:CDChasfunded5laboratoriestoaddresschemicalagentsand   hasworkedwithgranteestoaccomplishthepurchase,installation,andtrainingassociatedwithnewstateof L  theartlaboratoryequipmentrequiredtocarryoutthishighly#^  ^i#^  ^measurementofnerveagentsinhumansamples q  andsuccessfullycompletedaroundofproficiencytestingtodemonstratetheirunderstandingofthemethod. 5  Additionally,statesarealsoreceivingtrainingonmeasurementofsulphurmustardsinhumansamples.#^  ^ #^  ^   CDCcapacity:CDChasorganizedteamsoflaboratoryprofessionalswhosesoleresponsibilityistoprovide u thelaboratoryservicesneededtorapidlyandaccuratelytriageandanalyzespecimensthataresuspectedto 5 bepotential_bioterrorism_Ԁthreatagents.#^  ^}#^  ^CDC'sRapidResponseandAdvancedTechnologyLaboratory  (_RRAT_)for_bioterrorism_Ԁwasestablishedtoreceivesuspectclinicalandenvironmentalsamplesforrapid P identification.SincetheWorldTradeCenterattackonSeptember11,2001untilthereportofthefirst u confirmedcaseofanthraxonOctober4,2001,anestimated7,500laboratorysampleswereprocessedat 5 CDC's_RRAT_Ԁandspecialtylaboratories.Inaddition,agentspecificlaboratoriesatCDChavebeen  establishedorstrengthenedtoperformconfirmatorytestingandstraincharacterizationofcriticalbiologic P agentsandprovidesurgecapacityduringanevent.#^  ^$#^  ^ u #^  ^#>^  ^CDChasdevelopedtestingmethodsfornerveagents,nitrogenmustards,sulfurmustards,_lewisite_,hydrogen  cyanide,_cyanogen_Ԁchloride,_BX_,_tricothecene_Ԁ_mycotoxins_,ricin,heavymetals,selectedtoxicindustrial P chemicals,andincapacitatingagents.#^  >^#^  ^ u   GoalbyGoalPresentationofPerformance #^  ^#^  ^ "  A_@ d@  APerformanceGoal:0 " EnhancethelaboratorycapacityofCDCandstateandlocalhealthdepartments Q$ torapidlyandaccuratelyidentifybiologicalandchemicalagentsthatcanpose ~ % aterroristthreat. F!&" $" $ @v@?"1111! ƫ@ #^  ^#^  ^*`dd dd ` dd ` ` dd ` dd  ` $ $, dd ,` dd ,` dd ,dd +  &"(" & PerformanceMeasure /c#) / Target /c#* / ActualPerformance /c#+ / Ref. (c#,  (*`dd dd ` dd ` ` dd ` dd ` $ $, dd ,` dd ,` dd ,dd +  &[$,[$ &Increasethenumberof $Z - laboratoriesintheLaboratory %!. ResponseNetwork. $?&!/ $ FY03 :140laboratories  $Z 0 FY02: 󀀀120laboratories %"!1  FY01: 󀀀100laboratories O&!2  FY00: 󀀀43laboratories '"3   'z#4  FY03: $Z 5 FY02:  %"!6  FY01: Achieved/100 O&!7  FY00: Achieved '"8  FY99: 43  'z#9 Page $Z : #^  ^#^  ^218#^  ^#^  ^ %!; "93"  92z33   &"= 0 @4!   93>݌  'Z#> Ќ  Increasethecapacityofstate ;)$? andmajorcitylaboratoriesto )%@ provideorgainaccesstorapid *V&A testingforpotential {+'B _bioterrorism_Ԁagents. $;,'C $ FY03: 60laboratories ;)$D  FY02: 54 laboratories  *%E FY01: 54laboratories *f&F  FY00: 40laboratories +.'G  FY99: 󀀀2laboratories  [,'H  FY03: ;)$I FY02: *%J FY01: Achieved/54 *f&K  FY00: Exceeded/43 +.'L  FY99: Exceeded/43 [,'M  FY98: 0 #-(N   .F*P Page ;)$Q #^  ^ܳ#^  ^218#^  ^.#^  ^ )%R "93"  92z33   {+'T 0 @4!   93ո݌ /;,'U /Ќ  PerformanceMeasure /d / Target /d / ActualPerformance /d / Ref. /d /Increasethenumberofrapid % diagnosticteststobe  developedforpotential @ _bioterrorism_Ԁagents. $e $ FY03: 15tests %   FY02: 10tests    FY01: 󀀀6tests  P   FY03:  %   FY02:     FY01 :Exceeded/7  P Page % #^  ^s#^  ^218#^  ^#^  ^  "93"  92z33   e 0 @4!   93K݌ %   Ќ  *`dd dd ` dd ` ` dd ` dd ` $ $, dd ,` dd ,` dd ,dd +  &   &Numberoflaboratories y  qualifiedtoprovidesurge 9  capacityforanalysisof   chemicalagents. $ T $ FY03: 5laboratories  y  FY02: 5laboratories A   FY01: 5laboratories    FY00: 4laboratories   l  FY03: y  FY02:  A   FY01: Achieved/5    FY00: Exceeded/5  l  FY99: 4   4  Page y ! #^  ^#^  ^218#^  ^#^  ^ 9 " Ѐ! ! 9GHIJKLMD(zxx9GHIJKLM"93"  92z33    T$ 0 @4!   93݌ y  % Ќ  *`dd dd ` dd ` ` dd ` dd ` $ $, dd ,` dd ,` dd ,dd +  &, %,  &Increasethenumberoftoxic  & substanceslikelytobeusedin P ' chemicalterrorismthatcanbe u ( rapidlymeasuredinbloodand 5 ) urine. $ * $ FY03: 150substances   + FY02: 150substances  X , FY01: 120substances  -  FY00: 100substances M .  FY99: 󀀀50substances   /  FY03:  0 FY02: X 1 FY01: Achieved/120  2  FY00: 90 M 3  FY99: Achieved/50  4  FY98: 󀀀0  x5 Page  6 #^  ^#^  ^218#^  ^#^  ^ P 7 "93"  942z33   5 9 0 @4!   934a݌  : Ќ  &% ^IIA2.eNationalPharmaceuticalStockpile#^ %&#  U<  r   #^  ^#^  ^CongressgaveCDCthemissiontomanageandoverseetheNationalPharmaceuticalStockpile(_NPS_)in > January1999.CDCwasexpectedbyJanuary1,2000tobecapableofmeetinganexpectedterroristthreat X? andmetthismandateontime,declaringthatithaddrugsandmedicalmaterielreadytodeployandanair }@ cargoservicereadytodeliverit.Oneoftwo_NPS_ԀProgramcomponentsisthe 12-hourPushPackage.A =A 12-hourPushPackagecanreachasitewithin12hoursofafederalordertodeploy.Therearetwelve12-hour B PushPackages#^  ^#>^  ^locatedthroughoutthecountry#^  >^#^  ^forsecurityreasonsandincaseofmultipleattacks.Ina XC terroristevent,CDCstaffwillmeetthearriving_NPS_,transfercustodytostateofficials,andoffertechnical }D assistanceon_NPS_Ԁorganization,repackaging,anddistributiontomedicationdispensingsites.Thesecond =E _NPS_ԀProgramcomponentis vendor-managedinventory(_VMI_),orastockpileofdrugsandmaterielmade F andstoredforCDCbyfirmsthatproduceordistributethem._VMI_Ԁismeanttohelptreatmanycasualtiesover XG time.DuringFY2000the12hourPushPackagebecamefullyoperationalandreadyfordeployment.#^  ^*#>^  ^ԀDuring }H FY2001_VMI_Ԁcontractswereawardedandthematerialtheyrepresentcameonlinereadyfordeployment. =I Maintainingandupgradingthematerialsandsupplies(purchaseofadditionalantidotes,antibiotics,medical J supplies,equipment,etc)inboththe12hourPushPackageand_VMI_Ԁwillcontinuetobeapriorityactivityof  XK the_NPS_ԀProgram.#^  >^#^  ^ }!L #^  ^ #^  ^InFY2002,the_NPS_Ԁprogramwillachieveandmaintainacapacitytoprovidepostexposureprophylaxisto12 "N millionpersonsforpossibleexposuretoanthrax,andanequalorgreaternumberofpersonswhomaybe #XO exposedtoplagueortularemia.Eachofthe50states,6U.S.Territories,andtheDistrictofColumbiawill }$ P continuetohavetheopportunitytoputaprocessinplacetoeffectivelymanageandusethe_NPS_Ԁshoulda =% Q deploymentoccurinaterroristorothercatastrophicevent.InFY2003the_NPS_Ԁprogramwillconduct %!R preparednessplanning,training,andexercises;sustainanthraxprophylaxiscapability;sustainnonanthrax &X"S vendormanagedinventorywith12hourpushpackagecapability;andcoverroutineoperationalexpenses }'#T suchaspersonnel,storage,andtransport.#^  ^d#^  ^ =(#U #^  ^#^  ^ PerformanceSummary  z    )X%W #^  ^#^  ^TheNationalPharmaceuticalStockpile(_NPS_)wasdeployedforthefirsttimeinresponsetotheSeptember * &X 11,2001terroristattacksinNewYorkCityandWashington,DC.CDCmobilizeda_NPS_Ԁ pushpackageto E+&Y NYCwithin7hoursofanapproveddeploymentaswellasapushpackagetoWashington,DCinthedays ,'Z followingtheattackonthePentagon.Theinitialpushpackageconsistedofover50palletsofmedical ,`([ materiel.Inaddition,the_NPS_Ԁprogram,alreadyon24hour,fullystaffedalertfromtheSeptember11thevent, - )\ arrangedCDCsimmediateresponsetothefirstcaseofanthraxinFlorida.Attherequestofthestateof E.)] Floridaandlocalofficials,CDCarrangedthroughthe_NPS_ԀprogramforthetransportationofCDC /*^ _epidemiologists_ԀanditsTechnicalAdvisoryResponseUnit(_TARU_)toFloridaandNorthCarolinatoinvestigate e theanthraxexposures.InOctoberandNovember,CDCusedthe_NPS_Ԁprogramtodeliveralmost3.75million % tabletsofthreedifferentantibiotics(_amoxicillin_,_ciprofloxacin_,and_doxycycline_)forpostexposureprophylaxis  ofemployeesinaffectedbuildings,postalworkers,mailhandlers,andpostalpatrons. @ #^  ^#^  ^ r GoalbyGoalPresentationofPerformance#^  ^g#^  ^    A_@ d@m  APerformanceGoal:0 " #^  ^#>^  ^Procure,maintainandupgradethematerialsandsuppliesintheNational  9 #^  >^#^  ^PharmaceuticalStockpileasnecessarytoaugmentfederal,stateandlocal f   responsetoa_bioterrorist_Ԁevent#^  ^E#^  ^.  " $" $ @`@' 1111! #@ #^  ^%#^  ^e*`dd dd ` dd ` ` dd ` dd `s#s#, dd ,` dd ,` dd ,dd +  &   & PerformanceMeasure /K  / Target /K  / ActualPerformance /K  /(K   (*`dd dd ` dd ` ` dd ` dd `s#s#, dd , dd , dd ,dd +  &C C  &#^  ^#^  ^Maintainanational B  pharmaceuticalstockpilefor g  deploymentinresponseto '  terroristuseofbiologicalor   chemicalagentsagainstthe B U.S.civilianpopulation.#^  ^#^  ^ 'g ' #^  ^#^  ^FY03: Maintainastockpileas B  pertheFY03_DHHS_ o  _Bioterrorism_ԀStrategicPlan  /  FY02: Maintainastockpile,   aspertheFY02_DHHS_ R _Bioterrorism_ԀStrategicPlan. w  FY01: Maintainanational 7 pharmaceuticalstockpilefor  deploymenttorespondto Z terroristuseofbiologicalor   chemicalagents,includingthe ?! abilitytomedicallytreat " civiliansforbiologicaland Z# chemicalagentsasdelineated $ intheDraft_HHS_Ԁ_Bioterrorism_ ?% StrategicPlan & #^  ^?#^  ^ FY00: Maintainanational !/ pharmaceuticalstockpilefor "b0 deploymenttorespondto #"1 terroristuseofbiologicalor G$2 chemicalagents,includingthe % 3 abilitytomedicallytreat %b!4 civiliansforbiologicaland &""5 chemicalagentsasdelineated G'"6 intheDraft_HHS_Ԁ_Bioterrorism_ (#7 StrategicPlan#^  ^A#^  ^ (b$8  FY99: Createastockpile, G*%: includingtheabilitytoprotect +&; 1million4millioncivilians +j'< fromanthraxattacks.#^  ^#^  ^ ',*(= ' #^  ^#^  ^FY03: B > FY02:   A  FY01: #^  ^ #>^  ^Thestockpile WD continuedtodevelop E throughouttheyear. Several zF 12-hourPushPackages :G becametheinitialresponse; _H VendorManagedInventory I becamethefollow-on zJ response.Together,these :K twostockpileresponse _L componentsbuiltthe M capacitytofullytreatorgive zN fullprophylaxis#^  >^#^  ^B.` hp x (#XBӀforselected :O threatagentstocitizensto _P anextentbeyondtheFY01 Q targetslistedintheDraft#^  ^#^  ^ zR _HHS_Ԁ_Bioterrorism_ԀStrategic :S Plan.#^  ^#^  ^  _ T  #^  ^#^  ^FY00: #^  ^#^  ^ԀExceeded/12-hour !V PushPackageand_VMI_ "JW componentsprovided o# X capacitybeyondtargets. /$Y  FY99: Achieved g*&a  '+'c 'Page B d 218#^  ^j#^  ^ g e "93"  92z33    g 0 @4!   93I݌̌  #^  ^#^  ^('#~  ( r    "  z    *      .* _ &% ^Providing_ԀCredibleInformationtoEnhanceHealthDecisions  2  e  IIA.2.f r InformationandCommunication _ Systems#^ %&# _  _#^  ^#Most_Ԁhealthdepartmentslackthemodern,secureelectronicsystemsneededtodetectdiseaseoutbreaks P rapidly,respondtooutbreaks,andcommunicatewithCDC,othergovernmentagencies,andthepublic u duringpublichealthemergencies.ThroughtheHealthAlertNetwork,CDCisaidingstateandlocalhealth 5  departmentstoraisetheircapacityandpreparednesstodealwithpublichealththreats!includingnotonly   _bioterrorism_Ԁbutalsoemerginginfectiousdiseases,chronicdiseases,andenvironmentalhazards.This  P meansthatthenationreapsthebenefitsoftheseinvestmentseveryday,notjustintheeventofachemical u   attack.Keyelementsaremoderninformationandcommunicationsystems,afullytrainedworkforce,and 5   robustorganizationalcapacitytoaddressthefullspectrumofpublichealthissues.Thenetworkallowshigh    speedInternetcommunications,includingearlywarningbroadcastalerts,amongCDCandstateandlocal  P  healthdepartments. u  Theneedforrapidcommunication,research,andresponsehasbecomeanessentialelementofpublic   health.Localoutbreakscandeveloprapidlyinto_pandemics_,previouslyunidentifieddiseasesemerge, P  contaminatedfoodordefectiveproductsaredisseminated,andthethreatof_bioterrorism_Ԁisincreasing.The u  availabilityofasecureWebbasedcommunicationsnetworkforpublichealthinvestigationandresponse 5  wouldsimplifyandexpeditetheexchangeofroutineandemergencypublichealthinformationbetweenCDC  andstateandlocalhealthdepartments.Intheabsenceofsuchanetwork,reportsanddiscussionsare P extremelydifficultandtimelyinvestigativeandpreventioneffortsaredelayed. y Tohelppublichealthofficialsshareinformationonoutbreaks,CDCofficiallylaunchedtheEpidemic  InformationExchange(_Epi_ԄX)._Epi_ԄXisthesecure,webbasedcommunicationssystemthatsimplifiesand T enables realtimesharingofroutineandemergencypublichealthinformationaboutdiseaseoutbreaksand } otheracutehealtheventsincludingthoserelatedto_bioterrorism_Ԁamongpubichealthofficialsatthelocal, = state,and federallevels._Epi_ԄXwasdesignedwithinputfromarangeofpublichealthofficialsand  organizations.Examplesof_Epi_ԄXreportsincludeinfectiousdiseaseoutbreaks;newlyrecognized ` environmental,product,occupationalandrecreationalhazards;recommendationsregardingavailabilityand $ useofvaccines;and_bioterrorism_Ԁthreatsandacts. I  PerformanceSummary  d  WithinfourhoursoftheattackontheWorldTradeCenter,theHealthAlertNetworkwasactivatedand ,! begantransmittingemergencymessagestothetop250publichealthofficialsin50States,7largecities Q" andGuam.Inthemonthsthatfollowed,over67healthalerts,advisoriesandupdatesweretransmitted # reachinganestimated1million_frontline_Ԁpublicandprivatephysicians,nurses,_laboratorians_,andStateand l$ localhealthofficers.UsinginstatesystemsbuiltwithCDCfunds,Stateswereabletoaugmentandtailor  ,% theHANalertstotheiruniquesituations.CDCanditsHANgranteesalsoestablishedandmaintained Q!& Internet_websites_Ԁtoprovideinformationtothepublic.SinceSeptember11ththerehavebeen73millionhits, "' 5millionvisits,and12millionrequestsforinformationontheCDC_bioterrorism_Ԁwebsite. "l( Asecondnationalconference,focusedonHealthAlertefforts(suchasinternetconnectivity,broadcast Q$* alert,anddistancelearning),washeldinAugust2001inColumbus,Ohio.Avarietyofcommunicationand % + programmanagementtoolshavebeendevelopedincludingLIST_SERVs_,E-mailgroupcodes,_websites_, %l!, andanACCESSdatabase.SitevisitsarecontinuingatalloftheHANprojectareasandtechnical &,"- assistancehasbeenprovided.InFY2001additionalHANfundingbecameavailablewhichincreasedthe Q'". numberoffundedstates/areasto_55._ (#/ ^  ^Toaddressthepublichealthproblemofbeingabletoshareinformationdelaysinreportingoutbreaks,CDC, ),%1 withtheinputofover300healthofficials,developedtheEpidemicInformationExchange(_Epi_ԄX)._EPI_ԄX Q*%2 waslaunchedinDecember2000.AsofSeptember30,2001,650publichealthofficials,includingallstate +&3 _epidemiologists_Ԁortheirdesignees,localhealthofficials,andmembersofthemilitary,participateon_Epi_ԄX. +p'4 _Epi_ԄX,whichhasmedicaleditorialstaffavailable24hours/day,7days/week,ismoderatedforqualityby ,4(5 CDCstaff.#^  ^#Respondingtoideasfrompublichealthofficials,_Epi_ԄXprovidessecurecommunicationsfor ]-(6 multistateoutbreakresponseteams,andplanstodeveloplinksbetweendiseasesurveillanceprograms .)7 andlocalhealthalertsystemsandimprovedsoftwaretoautomatetherecognitionofsimilardisease .x*8 outbreaksacrossjurisdictions.^  ^ /8+9 Ї GoalbyGoalPresentationofPerformance #^  ^#^  ^ e #^  ^X#^  ^ A_@ d@ APerformanceGoal:0 " EnhancethecapacityofCDCandstateandlocalhealthdepartmentsto  rapidlyandaccuratelycommunicatecriticalinformationaboutbiologicaland  chemicalterrorismevents. I" s#" s# @v@B1111! @Ӏ#^  ^#^  ^ B *`"dd dd dd  dd  dd `s#s#, dd ,` dd ,` dd ,dd +  &g g  & PerformanceMeasure / f / Target / f / ActualPerformance / f  / Ref. ( f   (*#`$dd dd ` dd ` ` dd ` dd `"s#s#, dd ,` dd ,` dd ,dd +    & ^  ^ &%Numberofstatesandmajor '   metropolitanareaswithhealth    sectordedicated  B  communicationssystemsto g   facilitate/expeditedetection '  andresponsetoterrorist   events. -#B  - FY03: 55states/areas  '  FY02: 55states/areas    FY01: 54 states/areas  R  FY00: 40states/areas     'G  ' FY03: '  FY02:   FY01: Achieved/55   R FY00: 40     FY99: 36 G   FY98: 󀀀0    !r  !#^  ^#^  ^Page#^  ^#^  ^ '  #^  ^#^  ^218#^  ^Y#^  ^   "93"  92z33   g  ! 0 @4!   93݌ /' " /Ќ  Numberofcommunitieswith + # advancedinformation  $ technologyandtrainingfor F% preparednessandresponseto k& chemicalandbiological +' terrorism. '( ' FY03: 5communities  + ) FY02: 󀀀5communities  *  FY01: 󀀀3communities V+  FY00: 3communities ', ' FY03: + - FY02:   .  FY01 :Achieved/3 V/  FY00: Achieved 0  FY99 :3 'K1 '#^  ^#Page + 2 ^  ^218#^  ^"#  3 "93"  9"2z33   F4 0 @4!   93"(#݌ 8#k5 8Ќ  Increasethenumberofstate ?6 andlocalpublichealth 7 professionalswhouse_Epi_ԄXto Z8 shareintelligenceregarding 9 outbreaksandotheremerging C: healtheventsincludingthose ; suggestiveof_bioterrorism_. 6,!^< 6 FY03: 󀀀750 ?=  FY02: 󀀀750 >  FY01: 󀀀230 j?  'WA ' FY03: ?B FY02:  C  FY01: Exceeded / 650 jD  'WF '^  ^Page ?G #^  ^&#^  ^218#^  ^2'#^  ^ H ! ! 9GHIJKLM(zxx9GHIJKLMDӀ#^  ^w'#^  ^ ZI  2?K 2Numberofreportsofdisease L outbreaksandotheremerging rM healtheventspostedon_Epi_ԄX 6,!2N 6 FY03: 400  O FY02: 300#^  ^q(#^  ^ 'zP ' FY03: #^  ^*#^  ^ Q  FY01: Achieved/197#^  ^{*#^  ^ zR  FY00: 0(baseline) 'BS '#^  ^*#^  ^Page#^  ^+#^  ^ T #^  ^+#^  ^218#^  ^,#^  ^ rU "93"  9,2z33   2V 0 @4!   93,,݌ 2WW 2Ќ  Increasethenumberofstates, FX majormetropolitanareaswith k Y accesstothenationalsecure +!Z publichealthcommunications ![ network,_Epi_ԄX. 6,!"F\ 6 FY03: 55  F]  '3!_ ' FY03: F`  FY00: 0(baseline) 3!b  '!c '#^  ^d,#^  ^Page#^  ^/#^  ^ Fd #^  ^/#^  ^218#^  ^90#^  ^ k e ! ! 9GHIJKLM(zxx9GHIJKLM"93"  9T12z33   +!f 0 @4!   93T11݌"!g  "Ќ  #^  ^~0#^  ^  r    r    "  z &% ^IIA.2.gWorkerSafety#^ %&2# /% i  Sincelocalresponderswillbethefirstonsceneofabiologicalorchemicalterrorismevent,thequalityof &r"k protectiveequipmentandclothingusedagainstbiologicalandchemicalweaponsiscriticaltotheresponse '2#l effort.Mechanismsforensuringthatrespiratorsandprotectiveclothingadequatelyprotectagainstchemical W(#m andbiologicalterrorismmustbeevaluated. )$n  PerformanceSummary *2&p  TheNationalInstituteforOccupationalSafetyandHealth(_NIOSH_)isdevelopingguidelinesandcertification _+&q standardsforvariousclassesofrespiratoryprotectiveequipment.Laboratoryandstaffcapabilitieswillbe ,'r acquiredtoprocesscertificationapplications.Userguidelinesspecifyingcautionsandlimitationsofusewill ,z(s bedevelopedanddisseminated.ANationalPersonalProtectiveTechnologiesLaboratorytostudyand -:)t developimprovedpersonalprotectiveequipmentforfirstrespondersandotherworkershasbeen _.)u established. /*v ЇInDecember2001,CDCdevelopedandimplementedstandardsforselfcontainedbreathingapparatus e (_SCBA_).CDCs_NIOSH_ԀwillacceptapplicationsfromrespiratormanufacturersbeginninginJanuary2002. % Itisanticipatedthatinearly2002,_SCBA_Ԁwillbeapprovedby_NIOSH_Ԁthatwillprovidefirstresponderswith  appropriatepersonalprotectionforresponseduringchemical,biological,radiologicalandnuclear(_CBRN_) @ actsofterrorism. e #^  ^E2#^  ^ #^  ^:#^  ^GoalbyGoalPresentationofPerformance  H rY<,(dz; `E ;xttSUu r s#s#     s#s#*'`(dd dd ` dd ` ` dd ` dd #`$s#s#,` dd , dd ,'dd ,dd +  &] ]  &Performance \  Measure /$  /Target /\  /Actual \  Performance /$  /Ref. /\  / Developcertification   standardsanduserguidelines @  forrespiratorstoprotect e workersandemergency % responders. $ $FY03: Establishcertification   standardsforairpurifying H  respiratorsagainstweapons m ofterrorism.Process - applicationssubmittedfor  certification. H  FY02: Establishcertification m standardsforselfcontained 5  breathingapparatusfor ! protectionagainstweapons P" ofterrorism.Process u# applicationsforcertification. 5$ Produceuserguidesfor % properuseofselfcontained P& breathingapparatusagainst u' weaponsofterrorism.  5( FY01: Issueareport ) reviewingindustrial X* chemicalsthatarepotential }+ weaponsofterrorism.Issue =, areportreviewingnational - andinternationalstandards  X. applicabletothe }!/ performanceofrespiratory ="0 protection. "1   #X2 FY03:  3 FY02: _SCBA_ 09 approved12/2001.  ]:  Processingof < applicationsbegin @= 01/2002.  e> FY01:  }B Vulnerability EC Assessment D Reportand `E TerrorismHazards  F Report03/2002.  E G  Page  H #^  ^:#^  ^218#^  ^.*lxQ% `EQeeep v s#s#    s#s#TotalProgramFunding(Dollarsinthousands) #^ %&J#   FY2003: 0  $631,0890z s#s#(Estimated)`z s#z s#  FY2002: 0  $630,9270z s#s#(CurrentEstimate) (z s#z s#  FY2001: 0  $555,6890z s#s#(Actual)U z s#z s#  XX ^ #^ XXL#Mandate     CDCprotectsthehealthofAmericanchildrenandadultsfromdisabilityanddeathassociatedwithvaccine  X  preventablediseasesbydevelopingandimplementingimmunizationprogramsandmonitoringvaccineuse. }   HealthBurden    kYm 5%!h p  `E@h<tt xkImmunizationsareamongthegreatestpublichealthachievementsofthe20thcentury.^  ^Vaccinesare `  responsibleforthecontrolofmanyinfectiousdiseases,including#^  ^&O#diphtheria,measles,mumps,and    xxs#s#pertussis,^  ^Ԁthatwereoncecommoninthiscountry.#^  ^%P#Ԁ E  Vaccinesarenowavailabletoprotectchildrenand  adultsagainstlifethreateningordebilitating ` diseases.Theseinterventionshavereducedcases   ofallvaccinepreventablediseasesbymorethan E 97%frompeaklevelsbeforevaccineswere  available,savinglivesandtreatmentand ` hospitalizationcosts.^  ^Appropriateadministrationof   safeandeffectivevaccinesremainsoneofthemost E successfulandcosteffectivepublichealthtoolsfor  preventingdisease,disability,anddeathand `  s#s#xxreducingeconomiccostsresultingfromvaccinepreventablediseases.#^  ^NR#   Despitegreatsuccessinloweringdiseaselevelsandraisingimmunizationcoveragerates,however,much  remainstobedonetoprotectchildrenandadultsworldwide.Approximately1milliontwoyearoldsinthe ` UnitedStateshavenotreceivedoneormoreoftherecommendedvaccines.Newvaccines,although    greatlybeneficialtopublichealth,complicateanalreadycompleximmunizationscheduleandmakeit E! increasinglydifficulttoensurecompletevaccination.Immunizationsarealsosubjecttoahigherstandardof " safetythanothermedicalinterventionsbecausetheyaregiventohealthypeople.Likeallmedical `# interventions,novaccineis100%safeoreffective.Vaccinesafetyactivitiesareneededtomaintainpublic  $ confidenceinimmunizations,preservehighcoveragelevels,preventaresurgenceofvaccinepreventable E!% diseases,anddetectadverseeventsquickly. "& Oneofthegreatestchallengesisextendingthesuccessinchildhoodimmunizationtoadults.Theburdenof # ( vaccinepreventablediseasesinadultsintheUnitedStatesisstaggering.Over30,000U.S.adultsdie E$) annuallyofinfluenza,_pneumococcal_Ԁinfections,andhepatitisB;thecosttosocietyexceeds$10billioneach % * year.^  ^Pneumoniaandinfluenzawerethe5thleadingcauseofdeathamongAfricanAmericansaged65 %`!+ yearsormore,basedon1998nationalmortalitydata,andthe7thleadingcauseofdeathinallpersonsaged & ", 65andolder.#^  ^Y#Ԁ E'"- Barriersalsoremaininachievingpolioeradication,andsupportisneededtoexpandmeaslescontrol (`$/ efforts.^  ^Polioviruscausesacuteparalysisthatcanleadtopermanentphysicaldisabilityandevendeath. ) %0 Beforepoliovaccinewasavailable,13,000to20,000casesofparalyticpoliowerereportedeachyearinthe E*%1 UnitedStates.Theseannualepidemicsofpoliooftenleftthousandsofvictims!mostlychildren!inbraces, +&2 crutches,wheelchairs,andironlungs.Developmentofpoliovaccinesandimplementationofpolio +`'3 immunizationprogramshaveeliminatedparalyticpoliocausedbywildpoliovirusesintheU.S.andthe , (4 entireWesternhemisphere.#^  ^[#ԀBeforemeaslesimmunizationwereavailable,nearlyeveryoneintheU.S.got E-(5 measles,resultinginapproximately3-4millionmeaslescaseseachyear.Anaverageof450 .)6 measles-associateddeathswerereportedeachyearbetween1953and1963.Inindustrializedcountries,up .`*7 to20%ofpersonswithmeaslesarehospitalized,and7%to9%sufferfromcomplicationssuchas / +8 pneumonia,diarrhea,orearinfections.Althoughlesscommon,somepersonswithmeaslesdevelop e encephalitis,resultinginbraindamage.Itisestimatedthatasmanyasoneofevery1,000personswith % measleswilldie.  MeaslesisoneofthemostinfectiousdiseasesintheworldandisfrequentlyimportedintotheU.S.In1998, e mostcaseswereassociatedwithinternationalvisitorsorU.S.residentswhowereexposedtothemeasles % viruswhiletravelingabroad.Morethan90%ofpeoplewhoarenotimmunewillgetmeaslesiftheyare  exposedtothevirus.AccordingtotheWorldHealthOrganization(WHO),nearly900,000deathsoccurred  @ amongpersonsindevelopingcountriesin1998.Inpopulationsthatarenotimmunetomeasles,measles e  spreadsrapidly.Ifvaccinationswerestopped,2.7millionmeaslesdeathsworldwidecouldbeexpected. %   AlthoughtheUnitedStateshasgreatlyreduceditsburdenofdiseasethroughimmunizations,ourchildren    areatriskduetotheoccurrenceofthesediseasesinothercountries.  @  +^ XXX ^+ Strategies,Activities,andResources  %  CDCprovidesnationalleadershipintheongoingefforttoprotectAmericaschildrenandadultsfrom   vaccinepreventablediseasesandtoensurethesafetyofvaccines.Beginningin1962,whenthefirst H  nationalefforttoimprovetheimmunizationstatusofchildrenwasproposed,CDChascounted m  immunizationamongitsmostvitalprograms,recognizingitasacorepublichealthactivityandperhapsthe -  bestexampleofeffectiveprimaryprevention.CDCsNationalImmunizationProgram(NIP)focuseson   severalmajorprogrammaticareas,includingchildhoodimmunization,adultimmunization,andglobalpolio H eradication. m AlthoughCDCisassistedbymanypartners,stateandlocalhealthagenciesplayaprimaryroleinhelping  NIPcarryoutitsmissionintheUnitedStates.CDCensuresqualityimmunizationservicesby:1)awarding H grantstostatesandlargelocalhealthdepartments;2)providingtechnical,epidemiologic,andscientific m assistancetostatesandlocalities;3)monitoringimmunizationcoverage;4)ensuringanadequatesupplyof - vaccinebyoverseeingpurchasesmadethroughCDCcontractsandmanagingtheVaccinesforChildren  (_VFC_)program;5)helpingstatesdevelopimmunizationregistries;and6)conductingresearchtodevelop H newandimproveddeliverystrategies.CDCincreasescommunityparticipation,education,andpartnerships m throughpublicinformationcampaigns,educationandtrainingforproviders,assistancetocommunitieson - buildingcoalitions,andpartnershipswithcommunitybasedorganizations,minorityorganizations,volunteer  groups,vaccinecompanies,professionalorganizations,andfederalagencies.#^  ^&e#^  ^ H #^  ^m#>^  ^Globaldiseaseeradicationandeliminationprogramsarealsocollaborativeefforts.CDCworkswithWHO, -! RotaryInternational,_USAID_,theTaskForceforChildSurvivalandDevelopment,UNICEF,otherCDC " components,andinternationalagenciestobolsterpolioeradicationeffortsbyprovidingscientificassistance H# andfinancialsupport.Thiscollaborationisuniqueamongpublichealthinitiativesfortheunprecedented m$ levelofpartnerships.#^  >^m#+^ XXX ^+ - % #^  ^Vp#^  ^TheUnitedStatesremainsatriskofimportationofmeaslesfromcountriesthathavenotyeteliminatedthe !H' disease.Therefore,CDCcontributedmorethan$4millioninFY2000tosupportthePanAmericanHealth m"( Organization(_PAHO_)initiativetoeliminatemeaslesfromtheWesternHemisphere.CDCprovides -#) epidemiologicandlaboratoryassistancefordiseasetracking,vaccineforoutbreakcontrol,andother #* supplementaryimmunizationactivities,andshortandlongtermassignmentsofCDCscientificstaffto $H + prioritycountries. m%!, #^  ^p#+^ XXX ^+CDCalsoplaysacriticalroleindevelopingimmunizationpolicybyprovidingtechnicalandscientificsupport &". topolicymakingadvisorygroups.ThesegroupsincludetheAdvisoryCommitteeonImmunization 'H#/ Practices(_ACIP_),theCommitteeonInfectiousDiseasesoftheAmericanAcademyofPediatricsandthe m($0 AmericanAcademyofFamilyPhysicians,theNationalVaccineAdvisoryCommittee(_NVAC_)oftheNational -)$1 VaccineProgramOffice,andtheAdvisoryCommissiononChildhoodVaccineoftheNationalVaccineInjury )%2 CompensationProgram,amongothers./^ XXX ^s/+^ XXX ^+ *H&3 /^ XXX ^v/>^  ^Althoughcoverageforpreschoolimmunizationishighinalmostallstates,pocketsofneed!areaswith -,'5 substantialnumbersofunderimmunizedchildren!continuetoexist.Theseareasareofgreatconcern ,(6 becauseofthepotentialforoutbreaksofvaccinepreventablediseases.CDCusesseveralstrategiesto -H)7 improveimmunizationcoverageinpocketsofneed._AFIX_Ԁ(Assessment,Feedback,Incentives,and m.*8 Exchange)isatoolforassessingimmunizationcoverageandprovidingfeedbacktoproviders!methods -/*9 thathaveresultedinhighercoveragerates.LinkageswiththeWomen,Infants,andChildren(_WIC_) e programhaveincreasedcoverageamonglowincomepreschoolchildren.Reminderandrecallsystems % (manuallygeneratedmailortelephoneappointmentreminders)consistentlyimprovepatientcompliancefor  scheduledhealthvisits.#^  >^;w#+^ XXX ^+ @  r    "  z    * /^ XXX ^{/^  ^Asaresultofalloftheseactivities,casesofvaccinepreventablediseasesareatornearalltimelows,and % childhoodimmunizationratesareatanalltimehigh.Infrastructurefundsareessentialtosustainthe  systemsthathaveresultedinthehighestimmunizationlevelseverrecorded.Thesefundsareusedto  @ implementprovenstrategiestoraiseimmunizationcoverage,conductdiseasesurveillance,implement e  outbreakcontrolmeasures,ensureaccesstoandappropriateadministrationofvaccines,performoutreach %   activities,developimmunizationregistrysystems,educateprovidersandparentsabouttheneedfortimely    immunization,andassessimmunizationcoveragelevelsandpocketsofunderimmunizedchildren,among  @  manyotheractivities.Infrastructureinvestmentsmustbemaintainedtoensurethatprovensystemsand e  highimmunizationlevelsarenotjeopardized.#^  ^a|#>^  ^ %  #^  >^#>^  ^ Linksto_DHHS_ԀStrategicPlan  @  Performancemeasuresrelateto_DHHS_ԀGoal1:Reducethemajorthreatstohealthandproductivityofall m  Americans,specificallyObjective1.7: