July 19, 2012
58th Bauer Lecture
“Globalization, Mitigation, and Emerging Infectious Diseases: Tales from the Crypt”
Martin Cetron, M.D., Director of the Division of Global Migration & Quarantine at the Centers for Disease Control (CDC), delivered
the 58th Louis H. Bauer Lecture on May 14, 2012, during Opening Ceremonies of the 83rd Annual AsMA Scientific Meeting in Atlanta, GA.
At the start of the lecture, Dr. Cetron stated that “Globalization means that global health issues are in your backyard, in your neighborhood; they’re local; it’s not just something across an ocean.” He then discussed his division, which started as the
Foreign Quarantine Service in the late 18th century dealing immigration health issues. It came to the CDC in 1967 with all its responsibilities to prevent the introduction and spread of disease in the U.S., which is done by monitoring and regulating animals, inanimate cargo, and humans. There is also a public health responsibility. The best way to ensure the control of diseases is to make sure that people in a globally mobile population don’t pose a threat and are as healthy as possible. This means the program has a dual mission: to take care of the globally mobile population as it moves around the globe and to prevent the importation of infectious threats.
Dr. Centron demonstrated how, in this age of migration, there have been dramatic changes, resulting in high-speed and highvolume globalization and global migration. There is a greater volume of circular migration now. However, the patterns of infectious diseases moving through people haven’t really changed. The manner and speed have changed, which gives the CDC new imperatives.
Dr. Centron also talked about the history of immigration and quarantine, which was born in Venice during the time of the Black Plague. The term comes from the Latin ‘quarantina’, meaning 40 days, which is how long ships were asked to stay outside a port before passengers or cargo could disembark. In that time period, travel took much longer, but in the 21st century, there has been a dramatic reduction in the length of time it takes to travel around the world (it is now 72 hours or less, depending on connections) and the fact that the world’s population has exploded. Of the over 7 billion people now in the world, over 1 billion international arrivals occur every year. This speed and volume of movement present unique challenges to monitoring diseases, especially with the emergence of jet travel. As a result, there has been an over 400% increase in the web of traffic between and across continents. Also, movement patterns are circular: people who are living outside their country of birth often return to it.
This means that infectious diseases still create problems – for example, one-third of the world’s population is infected with tuberculosis (TB). In the United States, there is a 3.6/100,000 rate as of 2010. To address this, regulations have changed to allow more screening, which has strengthened reduction and treatment of TB and reduced the import threat. Bed nets and large-scale drug treatments have rolled back malaria, and cases of parasite infections have been reduced. However, there are threats caused by the changing environment, vulnerable humans, and carrier animals, along with the rise of drug-resistant strains of diseases and the globalization of food. Where global diseases are concerned, it is a small world.
Dr. Centron ended his lecture with a discussion of what the CDC and his division currently do to try to keep people healthy.
The CDC produces “The Yellow Book,” which contains health information for international travelers. There is also a biomosaic
program to try to visualize migration and demographics in order to predict emerging infectious diseases, as well as continued
surveillance and regulation.
The lecture is available for download from IntelliQuest Media, Inc. In the photo below, Martin Centron, M.D. (center), receives a certificate and honorarium from William Ercoline (right), representing the sponsor, Wyle, while Fanancy L. Anzalone (left), President of AsMA, looks on.