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Vol. LXIV, No. 1
January 6, 2012

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Tobacco, HIV/AIDS and Tuberculosis
CDC’s Frieden Speaks on Infectious Disease Prevention

Dr. Thomas R. Frieden
Dr. Thomas R. Frieden

NIAID welcomed Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, to deliver the recent Kinyoun Lecture. During his presentation, “A Public Health Approach to Infectious Disease Prevention and Control for the 21st Century,” Frieden discussed a wide range of diseases affecting people both within the United States and around the world, including tuberculosis, HIV/AIDS, malaria and tobacco-related illnesses.

“We are all connected by the air we breathe,” said Frieden, recounting his work on tuberculosis control in New York City. He said his mentor during his New York tenure, physician Karel Styblo, “asked me a single question that changed my life.” After looking through extensive records Frieden compiled on TB in New York, Styblo asked, “How many of them did you cure?” Frieden said he didn’t know.

The next day, Frieden began a system that would regularly review the status of every TB patient in New York City. Through this experience, he came to realize that accountability for patients you treat is “the underlying principle of tuberculosis control.”

Frieden views TB control as a useful model for public health practice for other diseases. He emphasized rigorous surveillance as being “fundamental to public health,” as is standardized treatment and patient-centered care.

Tuberculosis had once been the leading cause of death for people under age 65 in New York City. In the 20th century, deaths due to TB decreased by 99.9 percent in the city and throughout the United States. But TB continues to take a toll on the rest of the world. In 2010, there were 8.8 million cases of TB worldwide, including 1.4 million deaths.

The World Health Organization and CDC are concerned with TB, as well as with other infectious diseases around the world. There are 1.8 million deaths each year due to HIV/AIDS, 2.5 million from diarrheal infections and almost 800,000 from malaria.

Infectious diseases cause 25 percent of all deaths worldwide; that number could be higher if it included malnutrition deaths driven by disease. As one example of infectious diseases’ toll, more Americans have died from AIDS than from all wars since the Civil War.

Frieden (l) accepts a Kinyoun Lecture commemorative sculpture from NIAID director Dr. Anthony Fauci.

Frieden (l) accepts a Kinyoun Lecture commemorative sculpture from NIAID director Dr. Anthony Fauci.

Photos: Bill Branson

“Supporting global health is good for Americans,” said Frieden. He explained that supporting global health protects Americans from health threats and is good for American security because it promotes stability in key countries.

“It creates a tremendous amount of good will around the world toward America and Americans that you can’t buy with money,” said Frieden of putting resources into global health. “Most importantly though, it’s the right thing to do, and it is what a great country like the United States of America does.”

CDC’s approach to global health is similar to its approach within the U.S. Frieden discussed CDC’s recently created framework for preventing infectious diseases. “It is a roadmap to improve our ability to prevent infectious diseases through a strengthened, adaptable, multi-purpose U.S. public health system.”

On the global health front, CDC’s work includes technical assistance, efforts to strengthen laboratories’ diagnostic capacity and field epidemiology training programs.

On the domestic side, Frieden identified 6 key areas as “winnable public health battles in the U.S.” These include tobacco control; nutrition, physical activity, obesity and food safety; health care-associated infections; motor vehicle injuries; teen pregnancy; and HIV/AIDS. “These are all areas where we can do a lot to make a big difference with tools we have today,” he said.

“Look at what is happening to tobacco, HIV, TB and malaria. Already, more people are killed by tobacco than by HIV, TB and malaria combined,” Frieden continued. “If we don’t take urgent action against tobacco now, in this century 1 billion people will be killed by tobacco. Tobacco is now the world’s single leading agent of death.”

NIH and CDC have worked together in the past on initiatives related to influenza, HIV, TB and viral diseases. Frieden hopes that the two agencies can identify even more opportunities to collaborate in the future “to help people live healthier, safer, longer and more productive lives both in this country and around the world.”

The Kinyoun Lecture honors Dr. Joseph J. Kinyoun who, in 1887, founded the Laboratory of Hygiene, forerunner of NIH, to study infectious diseases. NIAID sponsors the Kinyoun Lecture series, which highlights advances in the understanding of infection and immunity. NIHRecord Icon

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