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A Look into Advanced Molecular Tools Used by the CDC to Advance Public Health

MAY 24, 2016 | LORRAINE L. JANECZKO, MPH
Cutting-edge technologies help public health professionals detect and respond to infectious disease outbreaks more rapidly and effectively than traditional methods. The Centers for Disease Control and Prevention’s Epidemic Intelligence Service (EIS) officers presented a few of their resources to their colleagues in a special session on May 3, Using Advanced Molecular Tools to Direct Public Health Action, at the 65th Annual EIS Conference in Atlanta, Georgia.
 
“Being in genomics in 2016 is like being in PCs in the 1980s. We’re using DOS as our operating system, we’re using WordStar as our word processor, and ten years from now, this is all going to look very different. There is a lot of opportunity here, especially for incoming epidemiologists who have a talent for data, are interested in working with big data and who have a passion for public health science,” Greg Armstrong, MD, director of the Office of Advanced Molecular Detection (AMD) at the Centers for Disease Control and Prevention, said in his introduction.
 
“In 2007, a new generation of nanotechnologies became available that could sequence DNA on a scale previously unimaginable,” Dr. Armstrong said, adding that under the AMD initiative, Congress is allocating funds to modernize CDC’s program. “Its objective is to bring next-generation sequencing bioinformatics and related technologies to bear against public health threats, starting here at CDC and soon thereafter in the broader public health system. Based on industry projections, we’re going to continue to see an increase in throughput in automation and a decrease in costs, all of which will increase the applicability of these technologies.”
 
Alexa Oster, MD, described how she and her colleagues use molecular sequence data to identify and respond to HIV transmission clusters.
 
“This is an exciting time for using molecular surveillance data for HIV prevention. Identifying and interrupting transmission is clearly what we’re aiming to do in public health. Effective prevention tools, such as medical care, antiretroviral therapy, and pre-exposure prophylaxis are available, but it’s critical to know where to focus efforts for maximum impact. Identifying growing clusters of active transmission can help target interventions to interrupt transmission,” she said in her talk.
 
Dr. Oster explained that drug resistance testing is recommended for all HIV-infected persons in the United States as the standard of care. A person with HIV who visits their HIV care provider and is tested for HIV drug resistance is automatically entered into the national HIV surveillance system. Their specimen is sent to a lab and the genetic sequence generated is electronically reported to the local or state health department, which forwards the de-identified data, including demographics, to the CDC.
 
Because HIV mutates over time, people with genetically similar HIV strains may be more closely related in transmission, so researchers can compare sequences and use their degree of similarity to examine epidemiologic relationships. They can infer potential transmission partners, clusters of related sequences and the extent of outbreaks so they can monitor them and tailor prevention strategies to individual patients.
 


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