International Emergency and Refugee Health Branch in CDC
|Name||International Emergency and Refugee Health Branch (IERHB), CDC|
|Address||4770 Buford Highway, Atlanta, Georgia 30341||Internet||http://www.cdc.gov/nceh/ierh/default.htm|
+1 (770) 488-3526
|Fax||+1 (770) 488-7829||Director||Acting Director: Bradley A. Woodruff|
By Jeremy Shoham
Most people have heard of the Centre for Disease Control and Prevention - known as CDC. Based in Atlanta, Georgia, CDC is part of the Department of Health and Human Services in the US government and deals with matters of public health. CDC's work mainly involves public health in the US (more than 95% of CDC funding). The International Emergency and Refugee Health Branch (IERHB) within the CDC is less of a household name. Formed within the last three years, this branch has now become the formal centre of CDC humanitarian emergency activities overseas. The focal person for IERHB nutrition activities within IERHB is Bradley Woodruff. Up until 1996 he worked in the CDC Hepatitis Branch but joined the unit dealing with humanitarian emergencies (a precursor to IERHB) in 1996. Field Exchange interviewed Bradley by phone.
Bradley recalled that CDC's involvement in emergency work overseas began with the Biafran crisis at the end of the 1960s. This introduction to international emergency work was marked by the tragic death of a CDC staff member who was killed in a plane crash while on mission. In the late 1970s CDC sent various staff to assist with epidemiological work in the Kmer refugee camps in Thailand. The first staff member to be employed specifically for full-time work in humanitarian emergencies was Mike Toole in the mid 1980s. Mike's extensive experience of refugee and other emergency programmes made this appointment a coup for CDC. Mike worked alone until the early 1990s. The appointment of additional full-time 'humanitarian emergency' staff resulted in the coalescing of their activities into a unit (1994). Staff from this unit assisted UNHCR and UNICEF in their responses to the refugee crisis in Zaire following the genocide in Rwanda. CDC staff realised that NGOs were relatively ill-prepared to respond to such a large emergency. As a result, OFDA funded training of staff from US PVOs (US NGOs). CDC were involved in writing curriculum and evaluating the pilot training. The formal formation of a branch within CDC dealing with humanitarian emergencies - IERHB, only occurred in 1998
IERHB now has 9 full-time staff including 5 medical epidemiologists, a statistician/epidemiologist, a public health assistant, and administrative support. The branch has access to all CDC staff which ensures wide-ranging technical expertise and laboratory support.
Focus of activities
The main areas of IERHB activity are:
- Emergency response
- Training and Capacity Development
- Operational Research
- Programme Evaluation
- Information Dissemination
Bradley explained that IERHB works with organisations that need epidemiological or public health expertise and provides technical assistance upon request. Collaborating organisations include branches of the US government (OFDA, USAID etc.), UN agencies, international and local NGOs and governments. Most of the NGOs are US NGOs "as European NGOs tend to have more 'in-house' epidemiological expertise" - although Bradley felt that this was changing.
The types of work undertaken by IERHB include
- epidemiological surveillance
- rapid health assessment
- health and nutrition assessment surveys
- outbreak investigations
- disease control programmes
- training in public health and epidemiology
- evaluation of health services
IERHB and nutrition
All IERHB staff have nutritional epidemiological expertise and can undertake or advise on nutritional assessments. Staff tend to work overseas for 4-12 week periods. Bradley acknowledged that "this makes it difficult to get involved in long term problem solving".
Bradley explained that IERHB do not get very involved in assessing food security leaving approaches like household food economy and livelihood analysis to other agencies with greater expertise. He did however admit to a sense within IERHB that there is a need to start thinking about how to better integrate food security and anthropometric assessment information.
The branch is also asked to undertake epidemiological work on micro-nutrient deficiency outbreaks. They were asked by UNHCR and WFP to investigate the riboflavin deficiency outbreak amongst the Bhutanese refugees. The excellent laboratory back-up of CDC makes IERHB ideal for this type of work.
Bradley affirmed that being involved in nutritional surveys and assessments can place IERHB in politically sensitive situations as "results may not always be what agencies want to hear". However, "CDC/IERHB's reputation and track-record is such that most agencies trust the objectivity of findings".
IERHB is a WHO collaborating centre for emergency preparedness and response which means that WHO can theoretically call them up at any time for help. IERHB also assist in training staff from the US government, UN agencies, INGOs, universities, and ministries of health in foreign governments. Staff also attend scientific meetings and assist in curriculum design. In the nutrition field, training is limited to epidemiology and assessment. IERHB are not involved on the nutritional intervention side.
Research activities of IERHB
A number of nutrition related research programmes have been completed by IERHB. One study in Tanzanian refugee camps found that iron dosages three times a week were effective in treating moderate and severe anaemia.
There has also been research into optimal anthropometric measures of malnutrition in adolescents. This research came about following the reported high levels of severe anaemia and malnutrition in adolescents in Kakuma refugee camp. A study in Kakuma and three Dadaab camps in Kenya found that, using WHO anthropometric criteria, prevalence of wasting amongst adolescents was very high whereas under five wasting and mortality levels were low. At the same time food security in the camps appeared to be adequate. There were similar findings amongst Bhutanese refugees. This led IERHB to question the applicability of the WHO guidelines on anthropometric assessment of adolescents and to IERHB's involvement in the recent SCN publication on optimal ways to measure nutritional status of adolescents (see this edition of Field Exchange).
Another study completed by IERHB has involved looking at outcome indicators (mortality and morbidity) in 52 camps in stable situations (after emergency related mortality has stabilised) in relation to nutrition and health indicators. The aim of this study is to determine which variables lead to best outcome. Results are soon to be published.
On-going research in the branch includes developing field-friendly techniques for measuring iron, vitamin A and iodine status. A recent survey conducted by IERHB found a 4% prevalence of bitot spots amongst adolescents but when blood samples were taken back to CDC prevalence of low serum vitamin A was over 30%. Bradley felt that this showed how important it is to develop field techniques for serum assays as clinical diagnosis can be so problematic. "Basically, we need to develop something like a haemocue but for Vitamin A."
IERHB are also hoping to conduct research into standardising case definitions of scurvy. As many as three case definitions have been used by the same agency. Bradley is hoping for an opportunity to conduct simultaneous clinical and biochemical assessment.
IERHB wish to expand their R & E activities and are currently talking with Epicentre in France and two US universities about potential collaboration.
It appears that other parts of CDC may be more susceptible to political pressures than IERHB. For example, CDC efforts to conduct research into needle exchange programmes to prevent spread of HIV in the US and epidemiological studies of the effectiveness of gun control programmes were resisted in the past for political reasons. Bradley could only think of two reasons why IERHB activities might be curtailed: conflict with US foreign policy and security concerns. As examples, "Travel to Iran was not allowed due to foreign policy towards Iran while work in Burundi has been disallowed in the past for security reasons". However, the fact that CDC's main constituency are state health departments, which have a great influence on CDC's overall operation, means that CDC generally have a fair degree of autonomy over what they do while IERHB have even less political interference because their work is based overseas and therefore rarely poses a threat to political interests. CDC has no legal regulatory authority, either within the US or overseas.
Bradley believes that there is still limited understanding internationally of CDC's work and that "CDC provides a unique centralised repository of epidemiological expertise". Only a few other countries, such as Canada and France, have similar centres and these centres may not have the same degree of involvement in overseas work. Bradley also believes that increasing awareness of CDC and its work is stimulating other countries to think about developing similar in-house government epidemiological expertise and that this can only be a good thing.
More like this
FEX: Centres for Disease Control and Prevention (CDC), International Emergency and Refugee Health Branch (IEHRB)
Name: Centres for Disease Control and Prevention (CDC), International Emergency and Refugee Health Branch (IEHRB) Website: http://www.cdc.gov/ Address: Centres for Disease...
Address 8, rue Saint-Sabin, 75004 Paris Telephone 00 33 1 40 21 28 48 Name of Director Dominique Legros Fax 00 33 1 40 21 28 03 Overseas...
FEX: Issue 12 Editorial
Dear Readers Two topical themes emerge in this edition of Field Exchange. The first is food security interventions which do not involve free hand-outs of food aid; the second...
by Annalies Borrel The 26th ACC/SCN meeting was held from the 8th to 15th of April in Geneva. The Working Group on Nutrition in Emergencies, made up of NGO, bilateral and UN...
Position: Senior Nutrition Technical Specialist TBBC - Thailand Burma Border Consortium (www.tbbc.org) TBBC Overview: TBBC is seeking a Senior Nutrition Technical Specialist...
FEX: Scurvy outbreak among South Sudanese adolescents and young men – Kakuma refugee camp, Kenya, 2017-2018
Read the postscript to this article here. Summary of research1 Location: Kenya What we know: Refugee populations dependent on food assistance are at risk of micronutrient...
FEX: A Review of the advances and challenges in nutrition in conflicts and crises over the last 20 years
Abbreviated version of unpublished paper Food distribution at the ICRC kitchen in Tonj. By Frances Mason and Anna Taylor This paper is a shortened version of the complete...
Bradley A.Woodruff, MD MPH, Medical Epidemiologist International Emergency and Refugee Health Branch U.S. Centers for Disease Control and Prevention This field article from...
Examination for scurvy in Tanzania An article in the last issue of Field Exchange presented a review of the approaches that agencies and others use for identifying...
By Oleg O Bilukha and Curtis Blanton Dr. Oleg Bilukha is a Medical Epidemiologist with the International Emergency and Refugee Health Branch (IERHB), Centers for Disease...
Name MERLIN (MEDICAL EMERGENCY RELIEF INTERNATIONAL) Headquarters LONDON, ENGLAND Headquarters staff 40 Telephone 44 171 487 2505 No Of Overseas staff 60 Fax 44 171 487...
By Lucy Maina-Gathigi, Louise Mwirigi, Veronica Imelda, Dr Oleg Bilukha, Eva Leidman, Lucy Kinyua and Kibet Chirchir View this article as a pdf Lucy Maina-Gathigi is a...
Name Medecins Sans Frontieres - France (MSF-F) Chief Executive Phillippe Biberson Headquarters Paris, France No of Headquarters staff 100 Telephone (33) 1 40 21 29 29 No Of...
At the 31st Standing Committee on Nutrition (SCN) session held recently in New York (21-25 March, 2004), progress of the Nutrition in Emergencies Working Group (NEWG) was...
FEX: The potential role of local academia in protracted crises – the example of the American University of Beirut
By Amelia Reese Masterson, Hala Ghattas and Fouad M Fouad Amelia Reese Masterson was a Visiting Fellow at the Center for Research on Population and Health at the American...
Summary of published research1 Haemacue survey in Tanzania Five cross-sectional surveys were conducted in refugee camps in north and east Africa between 2000-2002 to assess...
en-net: FUNDING FOR COMMUNITY BASED NGO
Holystic Nutrition Org, is a community based NGO located in Obuasi, Ghana. The organization is currently running a project: SMALCHILD Project. Save the MALnourished CHILD...
FEX: Issue 17 Editorial
Dear readers, Ethical considerations figure prominently in this issue of Field Exchange. A field article written by Dr. Eva Grabosch tackles the problem of providing...
New publications1,2 In July last year the ACC/Sub-committee on nutrition published two reports on the assessment of nutritional status in emergencies. One report deals with...
Address 169 Booterstown Avenue, Blackrock, Co. Dublin Formed 1973 Telephone 353-1-288 5385 Director Justin Kilcullen Fax 353-1-288 3577 Overseas staff 15 expats / 150...
Reference this page
Jeremy Shoham (2001). International Emergency and Refugee Health Branch in CDC. Field Exchange 12, April 2001. p21. www.ennonline.net/fex/12/agencyprofile