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The U.S. Centers for Disease Control and Prevention (CDC) has called 2014 an “unprecedented” year as the agency continues its response — “the largest global effort in the agency’s history” — to the Ebola epidemic.

However, in its year-end review, CDC noted nine other “mission critical” areas it addressed this year — most of which, not surprisingly, are important in Canada as well and will represent ongoing priorities.

The agency categorized those areas as:

New Infectious Disease Threats

1. Ebola disease in West Africa. However, CDC director Dr. Tom Frieden cautioned, “Americans will be 100% safe only when we succeed in stopping Ebola at its source in West Africa.”

Credit: Andrea Catellani

2. Antibiotic resistance and preventing healthcare-associated infections. “Every day we don’t act to better protect antibiotics will make it harder and more expensive to address drug resistance in the future,” according to Dr. Beth Bell, director of CDC’s National Center for Emerging and Zoonotic Infectious Diseases. “Drug resistance can undermine both our ability to fight infectious diseases and much of modern medicine.” For the first time, the Canadian government produced a roadmap for addressing the issue of resistance. Antimicrobial Resistance and Use in Canada: A Federal Framework for Action, released in late November, identified three strategic areas — surveillance, stewardship and innovation — and four priorities for action: establishing and strengthening surveillance systems; promoting the appropriate use of antimicrobials; enhancing the regulatory framework for veterinary medicines and medicated feed; and promoting development of new drugs.

3.Enterovirus D-68 (EV-D68), the previously rare virus that has primarily affected children, sometimes resulting in paralysis.

4. Middle Eastern Respiratory Syndrome (MERS-CoV), the viral respiratory illness first reported in Saudi Arabia in 2012, showed a dramatic increase in cases during 2014. “In this interconnected world we live in, we expected MERS-CoV to make its way to the United States. We have been preparing since 2012 for this possibility,” Dr. Frieden said.

Ongoing Infectious Disease Threats

5. The HIV/AIDS pandemic, which CDC said “continues to be one of the world’s most important public health challenges.”

6. Polio, which is on the brink of global elimination, “but we risk losing hard-won ground,” the CDC report said.

Laboratory Safety

7. In mid-2014, CDC learned of several breaches in laboratory safety. They included a shipments of live anthrax and a highly pathogenic influenza strain, and the discovery of forgotten, live smallpox samples. At the time, Dr. Frieden called the mistakes “totally unacceptable behaviour” by CDC staff. At the time, steps were taken to tighten lab security, but in the year-end report, Dr. Leslie Dauphin (PhD), acting associate director for laboratory science and safety, said “Safety improvement is a continuous process.”

Leading Causes of Death

8. Cardiovascular diseases.

9. Smoking.

10. Fatal overdoses of prescription drugs. “All too often, and in far too many communities, the treatment is becoming the problem,” Dr. Frieden said.~TM