Global Fungal Disease Surveillance and Capacity

Fungal diseases pose a significant public health threat. Infections may be opportunistic, affecting those with weakened immune systems or living with HIV/AIDS, hospital or community acquired, and a growing number are multidrug-resistant. The outcome of this NOFO is to reduce illness and death due to fungal diseases and improve the clinical outcomes for patients with fungal disease. Some activities supporting this goal include monitoring trends in fungal disease burden, improving diagnostic capacity and treatment availability, and raising awareness among the public about the threat of fungal diseases. This NOFO addresses both known and emerging fungal pathogens. Strategies for this NOFO are four-fold: increase fungal surveillance by building epidemiology and laboratory capacity; support identification of known and emerging fungal pathogens for timely response; promote workforce development and provide training in the prevention and control of fungal diseases and increase awareness of fungal disease among the public; and monitor and evaluate the impact of these interventions and assess and refine performance metrics. These strategies are intended to promote health equity at the programmatic, infrastructural and policy levels. This NOFO recognizes that recipients may work to build the capacity to prevent and control specific fungal pathogens or may respond to emerging fungal pathogens or issues, such as antimicrobial resistance. As one of the only public health groups devoted to the prevention and control of fungal infections, MDB works with partners worldwide to understand who gets fungal infections, and why, by using epidemiologic, microbiologic, and bioinformatics approaches. MDB responds to emerging fungal threats, such as azole-resistant Aspergillus infections and COVID-19 associated aspergillosis. MDB partnered to identify and respond to an unknown pathogen in Pakistan in 2015, which turned out to be C. auris, a life-threatening, multidrug-resistant fungus that subsequently rapidly spread across the United States. MDB is responsive to emerging fungal needs across the globe. CDC's Containment Strategy keeps new or rare forms of antibiotic resistance from spreading. Containment complements foundational CDC strategies, including improving antibiotic use and preventing infections, and builds on existing detection and response structure. In Colombia, surveillance for Candida infection early in 2016 primed the country to rapidly detect and respond to invasive Candida auris later that year, and hospital surveillance sampling demonstrated transmission in health care settings. Histoplasmosis is a common fungal infection throughout much of Latin America in both immunocompromised and immunocompetent people. It rivals tuberculosis as a cause of death in people living with HIV in the region. However, it is widely underdiagnosed. CDC is partnering to improve access to diagnostic testing and treatment to reduce illness and death. Sporothrix brasiliensis is an emerging fungal pathogen in South America which CDC is responding to. Unlike its better-known relative, Sporothrix schenckii, which is found in the environment, S. brasiliensis causes zoonotic infections and can spread explosively between cats and from cats to humans. One Health approaches are likely to be effective in minimizing spread of S. brasiliensis. Death from cryptococcal meningitis in immunosuppressed people can be prevented with improved access to antifungal medications. Partnering with countries in sub-Saharan Africa, CDC has worked to improve sustainable access to these life-saving drugs and provide education to healthcare provider on their use, ultimately preventing deaths in people living with HIV/AIDS. MDB has provided technical assistance to research on development of antimicrobials for drug resistant pathogens, such as Candida auris.