Annual Performance Plan and Report

Topics on this page: Goal 3. Objective E | Table of Related Performance Measures | Analysis of Results | Plans for the Future | Objective Progress Update Summary

Goal 3. Objective E: Reduce the occurrence of infectious diseases

Infectious diseases continue to be a significant health threat in the U.S. and around the world because of increased and rapid global travel, increased importation of foods, and increased resistance to available drugs. Infectious diseases include vaccine-preventable diseases, foodborne illnesses; HIV and AIDS; and tuberculosis. They also include infections acquired in healthcare settings and infections transmitted by animals and insects.

HHS coordinates and encourages collaboration among the many federal agencies involved in vaccine and immunization activities. CDC has primary responsibility for reducing the occurrence and spread of infectious diseases in the U.S. population. CDC provides significant support to state and local governments; strengthens infectious disease surveillance, diagnosis, and treatment; and collaborates with federal and international partners to reduce the burden of infectious diseases throughout the world. FDA and CDC work together to prevent and control foodborne illness outbreaks, and FDA works with international drug regulatory authorities to expedite the review of drugs used to combat infectious diseases.

Infectious diseases exact a significant toll on human life. The prevention and reduction of infectious diseases is a priority for HHS, which is being achieved though the coordinated efforts of AHRQ, CDC, CMS, OASH, and other HHS experts.

Within HHS, components such as CDC, FDA, and NIH lead efforts toward reducing the occurrence of infectious diseases. Other HHS components and offices that contribute to combating infectious diseases include ASPR, HRSA, IHS, NIH, OASH, and OGA. HHS will use a variety of approaches to reduce the occurrence of infectious diseases. The Office of the Secretary led this Objective’s assessment as a part of the Strategic Review.

Objective 3.E Table of Related Performance Measures

Reducing foodborne illness in the population. By December 31, 2013, decrease the rate of Salmonella Enteritidis (SE) illness in the population from 2.6 cases per 100,000 (2007-2009 baseline) to 2.1 cases per 100,000. (Lead Agency - FDA; Measure ID - 212409)

Achieve and sustain immunization coverage in children 19 to 35 months of age for one dose of measles, mumps, and rubella (MMR) vaccine. (Lead Agency - CDC; Measure ID - 1.2.1c)

Increase the percentage of adults aged 18 years and older who are vaccinated annually against seasonal influenza (Lead Agency - CDC; Measure ID - 1.3.3a)

Reduce the proportion of persons with an HIV diagnosis at later stages of disease within three months of diagnosis (Lead Agency - CDC; Measure ID - 2.1.8)

Increase the number of adults and children internationally with advanced HIV infection receiving antiretroviral therapy (ART). (Lead Agency - CDC; Measure ID - 10.A.1.5)

Reduce the incidence (per 100,000 population) of healthcare associated invasive Methicillin-resistant Staphylococcus aureus (MRSA) infections (Lead Agency - CDC; Measure ID - 3.3.2a)⁷¹

Decrease the rate of cases of tuberculosis among U.S.-born persons (per 100,000 population). (Lead Agency - CDC; Measure ID - 2.8.1)

American Indian and Alaska Native patients, aged 19-35 months, receive the following childhood immunizations: 4 DTaP (diphtheria, tetanus, and acellular pertussis); 3 IPV (polio); 1 MMR (measles, mumps, rubella); 3 or 4 Hib (Haemophilus influenzae type b); 3 HepB (hepatitis B); 1 Varicella (chicken pox); 4 Pneumococcal conjugate. (Lead Agency - IHS; Measure ID - 24)

Analysis of Results

Salmonella is the leading known cause of bacterial foodborne illness and death in the United States.  Each year, food contaminated with Salmonella causes an estimated 1.2 million illnesses and between 400 and 500 deaths.  Salmonella Enteritidis (SE), a subtype of Salmonella, is the second most common type of Salmonella and accounts for approximately 20 percent of all Salmonella cases in humans.  The most significant sources of foodborne SE infections are shell eggs (FDA-regulated) and broiler chickens (USDA-regulated).  To significantly reduce foodborne illness and death, the FDA and CDC have joined forces and made the reduction of SE infections attributable to shell eggs a Priority Goal for FY 2015.  The illness rate from calendar year 2013 was 2.6 illnesses per 100,000.  The rate has decreased over the last few years, but is still above the yearly targets.  However, if the rate continues to decrease at the present rate, it is possible we could meet the target before 2015.  Eggs are not the only source of SE illnesses; chicken is also a major source, and there are other sources as well.

CDC works to tackle the biggest health problems causing death and disability in America. For young children this means promoting immunization coverage for recommended vaccines. Prior to wide-spread immunization nearly all children in the U.S. came down with the measles and about 500 people a year would die, 48,000 would be hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness. CDC exceeded its target with 92 percent of children 19 to 35 months of age receiving MMR vaccination.

Influenza is another major public health problem in the United States and globally. In the United States, on average 5-20 percent of the populationcontracts the flu, more than 200,000 people are hospitalized, and approximately 36,000 people die from seasonal flu-related causes. In 2010, CDC’s Advisory Committee on Immunization Practices (ACIP) recommended the seasonal influenza vaccine for everyone 6 months of age and older. In FY 2012 CDC revised its flu measure to reflect the CDC’s priorities to meet the new standards of vaccinations for everyone 6 months and older. In FY 2013 the number of adults that received a flu vaccination increased to 42 percent, however CDC did not meet its goal.

More than 1.1 million people in the United States are living with HIV infection, and almost 1 in 6 (15.8 percent) are unaware of their infection. Prior to 2012, CDC tracked the percentage of people diagnosed with HIV infection at earlier stages of disease (not CDC stage 3: AIDS). From 2007-2010, the percentage of people identified at earlier stages of disease steadily improved to almost 56 percent. Per the HHS Secretary’s memo (April 2012) on implementing a common set of core indicators across federal agencies, CDC has revised this indicator definition to conform to a new cross–agency definition. FY 2012 data indicates that 24 percent of persons diagnosed with HIV were diagnosed late in the course of infection, an improvement over 2011 results and exceeding the target. CDC also tracks the number of adults and children internationally in 23 countries included in the President's Emergency Plan for AIDS Relief (PEPFAR) with advanced HIV infection receiving antiretroviral therapy (ART). In FY 2014, CDC and CDC-supported partners in the PEPFAR countries and the Asia and Central Asia regional offices, in close collaboration with the Ministry of Health in each country, provided life-saving antiretroviral therapy (ART) for 4,292,400 HIV-infected adults and children (of which, 2,995,300 are receiving direct support and an additional 1,297,100 are benefiting from essential technical support provided by CDC), an 18 percent increase compared to FY 2013 and a 63 percent increase compared to FY 2012, exceeding the target.

In alignment with HHS National Action Plan to Prevent Healthcare-Associated Infections, CDC has developed guidelines and plans to reduce infections associated with healthcare settings, including but not limited to invasive Methicillin-resistant Staphylococcus Aureayus (MRSA) infections.  Preliminary data show that the national incidence of healthcare-associated invasive MRSA infections (hospital onset and invasive healthcare-associated MRSA in other healthcare settings, such as dialysis centers), decreased 32 percent between CY 2008 and CY 2013 (final data pending until January 31, 2015).

Another condition the CDC is actively addressing in a collaborative manner includes tuberculosis (TB).  Effective control efforts by CDC and its 68 state and local partners contributed to the lowest number of U.S. Tuberculosis (TB) cases since national reporting began in 1953.  Data indicate 9,582 cases in 2013, or 3.0 per 100,000 population and 1.2 for U.S. born population. Reflecting program effectiveness, the United States consistently ranks among the lowest TB incidence countries in the world.

In other areas related to decreasing infectious diseases, IHS is measuring the percentage of American Indian and Alaska Native children 19 to 35 months of age receiving a combined series of immunizations consistent with the CDC’s Advisory Committee on Immunization Practices standards and schedule that includes coverage for diphtheria, tetanus, whooping cough, polio, measles, mumps and rubella, Hepatitis B, influenza, chicken pox and pneumonia.  The childhood combined immunization series was updated in FY 2013 in accordance with the revised Healthy People 2020 and CDC childhood immunization guidelines; therefore, subsequent results will differentiate the use of the 3 or 4 dose Hib vaccine for individual patients.  As a result of this change in immunization schedule, the FY 2013 result set a new baseline of 74.8 percent.  The 2014 result of 75.4 percent exceeded the target by 0.6 percent.

Plans for the Future

Because the current Priority Goal measure for reducing Salmonella Enteritidis (SE) infections includes all infections related to chickens, determining which infections are attributable to shell eggs (as opposed to broiler chickens) makes it difficult to determine whether the FDA’s egg rule is having the desired effect of reducing the likelihood that contaminated shell eggs are the cause for a particular infection. CDC is working with FDA to explore the use of multiple statistical approaches to estimate source attribution. In particular, CDC and FDA are working to obtain data suitable for a “food product” model used in other countries to link contamination rates in foods to illness incidence. The FDA will continue inspections of large and small egg producers, while continuing to refine its egg rule enforcement policies with straightforward inspection, re-inspection, and warning strategies, aiming to reduce Salmonella Enteritidis infections each year through 2015.

Immunization continues to be one of the most cost-effective public health interventions. CDC supports immunization efforts nationwide such as maintaining infant measles, mumps, and rubella immunization coverage at 90 percent. To combat influenza in FY 2014 - 2016, the CDC has set a target of increasing the percentage of adults aged 18 years and older who are vaccinated annually against seasonal influenza to 56 percent. Consistent reductions year over year are expected in the proportion of persons with an HIV diagnosis at later stages of disease within three months of diagnosis, monitoring the effectiveness of efforts to decrease the number of domestic HIV infections diagnosed at later stages of disease. In addition, in FY 2015 and FY 2016 the number of adults and children internationally with advanced HIV infection receiving antiretroviral therapy is expected to increase. The CDC will continue to maintain effective control efforts with its 68 state and local partners contributing to the low and declining tuberculosis rates in the U.S. For other infectious diseases such as MRSA infections, CDC's FY 2016 targets are currently flat to FY 2015 targets since CDC is in the process of revising the MRSA measure to be more nationally representative.

IHS, beginning in FY 2013, updated its childhood combined immunizations series in accordance with the revised CDC Immunization Guidelines and Healthy People 2020.  IHS expects performance to improve in FY 2016 setting a target of 76.8 percent.   IHS works through the twelve Area Immunization Coordinators to ensure that IHS meets or exceeds the childhood combined immunizations measure.

Objective Progress Update Summary

HHS demonstrated progress toward this objective as shown by the representative performance measures described in the HHS Annual Performance Plan and Report. Further evidence of progress is described below.

• In 2013, NIH released a Strategic Plan that outlined several research activities to address a growing public health concern. The newly NIH-funded "Clinical Research Network on Antibacterial Resistance,” a consortium of more than 20 investigators nationwide with experience in diverse areas related to antibacterial resistance, will conduct early-stage clinical evaluation of new antibacterial drugs, perform clinical trials to optimize currently licensed antibacterial drugs to reduce the risk of resistance, test diagnostics, and examine best practices in infection control programs to prevent the development and spread of resistant infections.
• In FY 2013, accomplishments of the CDC’s Viral Hepatitis Action Plan included:
• The release of new US Preventive Services Task Force hepatitis C testing recommendations with a grade B in alignment with CDC hepatitis C testing recommendations released in 2012
• Renewed commitment and update of the Viral Hepatitis Action Plan for 2014-2016.
• Hosting the launch of the Know Hepatitis B campaign in collaboration with the CDC and White House Initiative for AAPIs.
• Dissemination of a letter from the Directors of Civil Rights from the Departments of Justice, Health, & Education to all schools of medicine, dentistry, nursing, and allied health professions regarding the updated CDC guidelines for the Updated CDC Recommendations for the Management of Hepatitis B Virus-Infected Health-Care Providers and Students in response to cases of discrimination against individuals with hepatitis B.
• Conducting a multidisciplinary, technical consultation on HCV in Persons Who Inject Drugs (PWID), producing a report with recommendations for action, and increasing awareness and federal coordination.

The Department is continuing to support and execute the programs contributing to this objective, monitoring progress, performance, and program integrity while adjusting to any budgetary constraints or changes to programmatic demands.