America’s renowned Centers for Disease Control is a key Kazakhstan partner in fight against epidemic15 june 2015, 14:21
Dr. Alfiya Denebayeva and her colleagues have the important job of trying to prevent HIV/AIDS from spreading in Kazakhstan.
Their work at the Almaty AIDS Prevention and Control Center includes staying abreast of the latest techniques for monitoring, analyzing and treating the condition.
Dr. Denebayeva is one of 91 Central Asian medical professionals to receive state-of-the-art epidemiological training from the Almaty branch of one of the world’s most respected health organizations, the Atlanta-based Centers for Disease and Control Prevention, or CDC. Epidemiology is the medical specialty that deals with disease outbreaks and epidemics.
Dr. David McAlister heads the CDC’s 18-person Almaty office, which runs the epidemiological-training program and four others that support Kazakhstan’s health-care system. Dr. David McAlister, head of the Centers for Disease Control’s Almaty office, worked on epidemics in Africa for 10 years. Photo courtesy of CDC Almaty
Two of the four are programs to combat the specific threats of AIDS and influenza. Another deals with emerging epidemiological threats such as Crimean Congo Hemorrhagic Fever. The fifth addresses biological-threat safety and security.
The CDC opened in Atlanta as the Communicable Disease Center on July 1, 1946. Its initial objective was preventing malaria from spreading through the United States. Over the years it expanded into fighting all communicable diseases, and some non-communicable ones as well.
Recognizing that an epidemic in one nation can quickly leap across borders to pose a global threat, the CDC began opening offices in other countries decades ago. The Almaty regional office, which serves Kazakhstan, Kyrgyzstan, Uzbekistan and Tajikistan, opened in 1995.
CDC staff in Almaty help Kazakhstan health officials identify and contain contagious diseases. They also help them modernize medical laboratories, a key asset in the fight against epidemics, said Dr. McAlister, whose 10 years with the CDC have included combatting infectious diseases in Africa.
The Almaty CDC staff also works with veterinarians on diseases that can spread from animals to humans, such as avian flu and brucellosis. Kazakhstan medical professionals take CDC epidemiological training in an Almaty lab. Photo courtesy of CDC Almaty
And they team up with Kazakh and American health and defense officials to address the threat of biohazards – virulent diseases such as anthrax that terrorists and others would like to use as weapons of mass destruction.
Dr. Denebayeva, who is deputy director of epidemiology at the government-run Almaty AIDS Prevention and Control Center, took CDC epidemiological training in 2010.
She said trainees not only learn in the classroom but also by applying their new knowledge to real-world threats.
In fact, trainees “spend 25 percent of their time in classroom instruction and 75 percent in field instruction,” according to a CDC Almaty background sheet.
An important part of the training is learning to analyze information in order to obtain a better grasp of a threat, Dr. Denebayeva said.
Kazakhstan has a very low HIV/AIDS infection rate of less than 1 percent of the population, said Dr. McAlister, a Mississippi native who has a Ph.D. in microbiology and immunology from the University of Louisville.
Another bright spot in the country’s battle against the disease is that “it’s not in the general population now,” he said. Most cases involve intravenous drug users.
The CDC is working with Kazakhstan to prevent the disease from spreading to broader populations, including heterosexual couples. Once it gets to the general population, it becomes much more difficult to contain.
Dr. McAlister said the CDC Almaty office works with Kazakhstan medical professionals on “identifying people who may be infected, integrating them into the health-care system, making sure they’re treated with the appropriate drugs” and insuring they continue treatment. Not following treatment protocols can lead to drug-resistant strains of HIV.
Dr. Denebayeva said that during her CDC training, a key question she studied was whether antiretroviral therapy could prevent the spread of HIV between an infected man or woman and their heterosexual partner.Dr. Alfiya Denebayeva, who works in HIV/AIDS control, is one of the Kazakh professionals who has taken Centers for Disease Control epidemiological training. Photo courtesy of CDC Almaty
The results “confirmed the effectiveness of antiretroviral therapy as an important preventive measure and led to changes in the HIV treatment protocol in Kazakhstan,” she said.
Antiretroviral therapy is the use of drug combinations to prevent HIV from progressing to AIDS, which is almost always fatal.
In addition to fighting HIV/AIDS, the Almaty CDC office “works with the Ministry of Health to identify, test and report strains of influenza that occur in Kazakhstan to the World Health Organization,” Dr. McAlister said. The WHO is the world’s main flu-fighting organization.
A major challenge to containing influenza, which claims hundreds of thousands to millions of lives a year, is that it mutates annually. That means flu vaccines must be updated yearly to combat the latest strains.
“We help Kazakhstan identify new strains and track where they’re occurring,” Dr. McAlister said.
“We also give the WHO any information that may be pertinent to the creation of a new vaccine,” including sending samples of new strains to the organization’s Geneva headquarters. The CDC Almaty office also sends samples to the CDC headquarters in Atlanta.
Although the Ministry of Health is in charge of spotting an outbreak like influenza inside Kazakhstan’s borders, the CDC’s Almaty office helps Kazakh health-care professionals when asked, Dr. McAlister said. That includes advising them on how to recognize a particular disease and helping them analyze information they’ve gathered about it.
Because disease-testing laboratories are so crucial to the fight against disease, the CDC Almaty office has staff working solely on lab support, Dr. McAlister said. Dr. David McAlister takes part in the validation of rapid HIV tests at the Almaty AIDS Prevention and Control Center in Almaty. Photo courtesy of CDC Almaty.
“If the Ministry of Health thinks it has an issue with a laboratory’s quality, we’ll help them sort it out,” he said. “If we see any gaps, we’ll come up with a plan to address those gaps.”
The CDC also helps Kazakhstan laboratories achieve international accreditation, added Dr. McAlister, who has years of lab experience. He headed the medical microbiological lab at the Metro Health Medical Center in Cleveland and Amgen’s pharmaceutical quality control microbiology lab in Longmont, Colorado.
Some of the 91 health-care professionals in Central Asia who have received CDC epidemiological training have been lab directors, said Dr. McAlister, who also headed the regional public health laboratory in Tallahassee, Florida, and was on the faculty of Case Western Reserve University in Cleveland.
In addition to training nationals in the four countries that the Almaty CDC operation covers – Kazakhstan, Kyrgyzstan, Uzbekistan and Tajikstan – the office has trained health-care professionals from Turkmenistan.
Because some diseases – like avian flu and brucellosis – can spread from animals to humans, veterinarians have also received the training.
When there are outbreaks of animal diseases that could affect humans, the CDC Almaty office works with both the Health Ministry and the Agricultural Ministry, Dr. McAlister said.
An important piece of background on the Almaty CDC’s work on biohazards is that during the Cold War the Soviet Union was spending $1 billion a year on developing biological weapons – and some of the key facilities were in Kazakhstan.
That’s according to Dr. Ken Alibek, who gained worldwide fame in the late 1990s with his best-selling book “Biohazards.” It describes the massive effort the Soviet Union poured into its bioweapons program.
Dr. Alibek, a Kazakh who held a high-ranking position in the Soviet biological-weapons program before becoming a researcher and professor in the United States, is now helping Nazarbayev University in Astana create a medical school.
One of the Soviet repositories of anthrax and other virulent pathogens, which could have killed millions if unleashed, was in the Almaty area.
A few years ago Kazakhstan agreed to let the United States build a secure storage facility on the repository grounds to prevent incurable strains of disease from falling into the hands of rogue states or terrorists.
In addition to securing the pathogens, the idea was for Kazakh and American researchers to use the facility to “develop a robust disease detection and surveillance network,” Kenneth Myers, a top American involved in the project, said at the groundbreaking in 2010. The facility was completed in 2013.
The CDC Almaty office is now working with Kazakhstan and the U.S. Defense Threat Reduction Agency, which Myers headed, to keep a handle on the biohazards challenge.
Dr. Denebayeva’s firsthand knowledge of the CDC Almaty operation has made her a supporter of the epidemiological cooperation between Kazakhstan and the CDC.
Those who have taken the CDC’s training “are better equipped to identify and deal with public health problems in their fields,” she said. “They have the know-how and skills to properly collect, analyze and interpret data so they can make decisions based on the best available evidence. All that helps health departments come up with correct interventions quickly and efficiently.”
The big winners in this kind of cooperation, of course, are the people of Kazakhstan, the United States and the world.