Dear STD Prevention and Surveillance Directors and Managers,

You are probably aware that in May 2015, President Obama released the National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB). The National Action Plan outlines federal activities over the next five years to enhance domestic and international capacity to detect, prevent and contain outbreaks of antibiotic-resistant infections; maintain the efficacy of current and new antibiotics; and develop and deploy next-generation diagnostics, antibiotics, vaccines, and other therapeutics. The activities in the National Action Plan were included in the President’s FY 2016 Budget, and many were funded by Congress in the FY 2016 appropriations. CDC’s appropriations included $160 million in new CARB initiative funding for CDC, including some for new gonorrhea resistance-related activities.

I wanted to draw your attention to a funding opportunity for two CARB activities focused on gonorrhea resistance prevention and response, and encourage you to work with your state or local epidemiologist or laboratory to consider applying. These two activities are being supported through the ELC, or Epidemiology and Laboratory Capacity for Infectious Disease, funding mechanism, for which the FY2016 competitive announcement was published on March 14. This mechanism is used by CDC to provide 50 state, 6 local, and 8 territorial health department grantees with the financial and technical resources to strengthen essential epidemiologic, laboratory, and health information systems to detect, prevent, and control infectious diseases. The two new gonorrhea activities in the continuation funding are:

1. Antibiotic-resistant gonorrhea rapid detection and response activities (page 129), and
2. Antibiotic Resistance Laboratory Network (ARLN) gonorrhea activities (page 121).

Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity

As the antibiotic susceptibility of Neisseria gonorrhoeae declines, developing the ability to rapidly detect and respond to threats of antibiotic-resistant gonorrhea has become a pressing public health charge that can only be met through the bolstering of epidemiology- and laboratory-capacity at the local health jurisdiction level. In an effort to increase the thoroughness and timeliness with which reduced-susceptibility and resistant strains of gonorrhea are detected and mitigated, DSTDP seeks to fund up to nine jurisdictions to implement a series of Antibiotic-Resistant Gonorrhea Rapid Detection and Response Activities that fall within the following three over-arching strategies:

1. We aim to strengthen local resistant gonorrhea threat coordination and epidemiological capacity by supporting the hiring of staff to work on resistant gonorrhea surveillance, specimen processing, data-entry, and case investigation.
2. We aim to enhance the timely detection of resistant gonorrhea threats by enhancing local laboratory capacity to perform Etest to rapidly measure antibiotic susceptibility and to coordinate with the larger national network of laboratories working on issues of antibiotic resistance epidemiology (see ARLN).
3. We aim to enhance gonorrhea case investigations to identify transmission dynamics of emerging resistant gonorrhea threats by supporting the timely and thorough investigation of cases and their sexual and social networks.

This funding is best suited for states or ELC-eligible municipalities that have identified a local health jurisdiction partner with a) a categorical STD clinic that reports at least 200 cases of gonorrhea per year and b) an easily accessible state or local public health laboratory that routinely cultures gonorrhea specimens. This activity can be found in the ELC Continuation Guidance, Attachment K8, page 129.

Antibiotic-Resistance Laboratory Network (ARLN) Gonorrhea Activities

The funding will establish a network of regional public health laboratories that will provide cutting-edge laboratory support, including specialized reference and confirmatory testing for healthcare associated infections and other antibiotic resistance threats, support outbreak response, and conduct antibiotic susceptibility testing of bacterial AR threats, such as N. gonorrhoeae.

Because gonorrhea is an important component of CARB activities, CDC will begin funding an expanded scope of gonorrhea surveillance efforts through this coordinated funding mechanism this fiscal year. Once awarded, we will work with the funded labs to develop and implement protocols for antibiotic susceptibility testing for gonorrhea, and the labs will be involved with surveillance and response activities beyond what is currently done in the Gonococcal Isolate Surveillance Project (GISP). Following an implementation phase, these labs will assume the responsibilities for GISP susceptibility testing and lab activities. Including GISP laboratory activities in the ARLN has a number of benefits:

• The ARLN will have centralized laboratories in many regions of the country that have capacity to respond to a variety of emerging threats (e.g., foodborne pathogens, hospital-acquired infections, gonorrhea, tuberculosis, and many more);
• The ARLN will standardize public health laboratory operations for GISP-related activities to increase efficiency. It includes implementation of standard operating protocols for technical capabilities, and for laboratory data transfer and management system;
• Utilizing this mechanism will allow us to access additional resources to put toward GISP that we would not otherwise have access to, increasing the financial stability of GISP, and centralized coordination of CARB Action Plan-related activities; and
• Also, with the additional funds that are tied to CARB, this mechanism supports a broader and deeper scope of gonorrhea laboratory activities.The ARLN activities can be found in the ELC Continuation Guidance, Attachment K7, page 121.

We would like to encourage you to consider applying for these new gonorrhea resistance-related opportunities in conjunction with your state or local epidemiologist or laboratory.

Program technical assistance and general inquiries should be directed to Alvin Schultz, ELC Program Coordinator, (ashultz@cdc.gov). Questions specific to the Rapid Detection and Response Capacity activities should be directed to Ginny Bowen (vbowen@cdc.gov) and questions specific to the ARLN gonorrhea activities should be directed to John Papp (jpapp@cdc.gov).

Sincerely,

Gail Bolan, M.D.
Director, Division of STD Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
U.S. Centers for Disease Control and Prevention