At a glance
CDC opened a country office in Brazil in 2003 focused on controlling the HIV epidemic. The work has broadened to other public health threats in the country, including workforce development, pandemic preparedness and response, neglected tropical disease and antimicrobial resistance (AR). In 2020, CDC opened the South America Regional Office in Brazil focused on engagement across South America.
Overview
Since opening an office in Brazil, CDC has expanded to working in other health areas in Brazil and works closely with the Ministry of Health (MOH), Oswaldo Cruz Foundation (Fiocruz), and other partners to maintain strong collaboration in program planning, monitoring and evaluation, epidemiologic surveillance, and laboratory systems strengthening. In 2020, CDC launched the South America Regional Office, based in Brazil, as part of the agency's global health approach to include regional engagement.
Pandemic Preparedness and Response
Strategic focus
CDC’s pandemic preparedness and response efforts provide support to enhance Brazil’s ability to prevent, detect, and respond to infectious disease outbreaks. CDC works with partners to strengthen Brazil’s public health systems by providing technical expertise in disease surveillance, laboratory systems, and emergency response. Examples of CDC’s work in this area include:
- Expanding the genomic surveillance capacity by supporting partners to identify genetic characteristics and monitor any mutations of SARS-CoV-2, influenza, and respiratory syncytial viruses.
- Providing technical assistance to Brazil’s National Laboratory Quality Technical Working Group (NLQTWG). This group was created to establish and implement a formal process to improve the quality of public health laboratories.
- Supporting the MOH in establishing a Public Health Emergency Management Program aimed to improve preparedness and response to disease outbreaks as well as climate-related disasters.
- Partnering with Fiocruiz and other partners to conduct a mass testing and vaccination campaign during the COVID-19 pandemic in Maré, one of the most vulnerable communities in Rio de Janeiro.
Key achievements
- By July 2022, scientists at Fiocruz had shared over 50,000 virus samples from COVID-19 into a global data bank.
- The NLQTWG successfully institutionalized a formal process for quality management improvement of their public health laboratory.
- Portuguese-speaking epidemiologists and laboratory experts were deployed to investigate COVID-19 spread.
- The mass-testing and vaccination campaign in Maré led to a 154% relative increase in case detection and reporting to official databases and reduced weekly reported deaths by 46% from September 2020 to April 2021.
Workforce Development
Strategic focus
A strong workforce is needed to detect and control potential public health threats. Through training and assistance, CDC is working with Brazil to strengthen its public health workforce.
CDC provides technical support to Brazil's Field Epidemiology Training Program (FETP), called EpiSUS. This program trains Brazilian field epidemiologists to rapidly respond to emerging health threats by gathering critical data and turning it into evidence-based action. FETP graduates have played important roles in responding to public health emergencies like zika, chikungunya, yellow fever, floods, and mudslides.
In 2024, CDC worked with World Health Organization (WHO) and I-TECH to bring the Informatics and Data Science for Health (IDASH) Program to five countries in South America, with substantial participation in Brazil. IDASH is a 12-month competency-based fellowship program that provides training and mentorship to current and future public health leaders in the areas of public health informatics and data science.
Key achievements
- In 2023, more than 3,100 Frontline, 697 Intermediate, and nearly 170 Advanced residents graduated from FETPs in Brazil.
- In 2017, Brazil's FETP became the first program in Latin America to receive accreditation from the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET). It was reaccredited in 2023.
HIV and TB
Strategic focus
Through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), CDC partners with the MOH and state and municipal health departments to assist Brazil in reaching HIV epidemic control. CDC provides technical leadership and direct assistance to enhance HIV programming, monitoring, evaluation, and epidemiological surveillance. For instance, together with Fiocruz and other partners, CDC supports the A Hora É Agora (AHA) Project, which aims to enhance the local response to the HIV epidemic in five Brazilian cities: Campo Grande, Curitiba, Florianópolis, Fortaleza, and Porto Alegre.
The A Hora É Agora (AHA) Project strengthens health services in combined prevention, promotion of HIV testing, early detection of the virus and other sexually transmitted infections, and rapid initiation and adherence to treatment. In 2022, the Knowledge Translation Unit was created. This unit is responsible for developing the activities of the Practical Approach to Care Kit (PACK) program in Brazil. The PACK program provides guidance and training to health care providers in HIV focused health centers to take a whole-person approach by simplifying the process of providing primary care beyond HIV prevention and treatment. Additionally, CDC has gathered data that tracks the recency of HIV infections in individuals. This provides data used to improve modeling of advanced HIV infection and identify areas where infections are more likely to occur.
CDC provides technical assistance to strengthen data collection for analysis and decision-making and works closely with the country's National Tuberculosis Program (NTP) on shared priorities for TB control. The NTP and CDC conducted a survey of catastrophic costs associated with TB which showed the harsh impacts of TB on families. CDC supports active finding of latent TB cases and provision of prophylaxis.
Key achievements
- CDC collaborated with Fiocruz to establish a master’s level monitoring and evaluation program focusing on HIV. Over 50 students have graduated from the master’s and certificate program.
- In 2022 the AHA provided 41 million HIV test and there were 709,00 new pre-exposure prophylaxis (PrEP) initiations.
- As of 2024, PACK in Brazil has trained 20 municipal Masters, who in turn trained over 200 on-site Champion Trainers.
- CDC increases workforce capacity for PrEP by using a massive online training course for healthcare workers across the country. As of 2024, nearly 12,000 students enrolled in the project.
Antimicrobial Resistance and Infection Prevention and Control
CDC supports many activities to improve healthcare infection prevention and control (IPC) and slow the spread of antimicrobial resistance (AR) and other emerging threats in Brazil. The country is part of CDC's Global Antimicrobial Resistance Laboratory and Response Network (Global AR Lab and Response Network) and the Global Action in Healthcare Network (GAIHN)-Healthcare-Associated Infection Module. Through this network, CDC works with Ministry of Health in Brazil, Fiocruz, ANVISA and academic partners to:
- Strengthen laboratory AR detection methods and AR surveillance reporting in 25 sentinel labs and hospitals throughout the country.
- Support two pilot hospitals to implement AR detection and IPC response for emerging AR threats such as carbapenem-resistant Enterobacterales and carbapenem-resistant Acinetobacter baumannii.
- Provide trainings and strengthen Candidemia laboratory surveillance and antifungal susceptibility testing capacity in over 30 sentinel hospital labs.
- Develop and implement innovative methods to support HAI surveillance through GAIHN-HAI.
- Strengthen detection, reporting, and response for emerging resistance in Bordetella pertussis (whooping cough).
Key achievements
- As of September 2023, 2,122 bacterial and 292 fungal specimens were submitted by sentinel labs to the national reference lab participating in the Global AR Lab and Response Network-Fiocruz collaboration for advanced AR testing.
- Between 2022 and 2023, over 1,000 laboratorians were trained in both bacteriology and mycology as part of the Global AR Lab and Response Network -Fiocruz collaboration.
- With CDC support through GAIHN-HAI, a multidisciplinary team at Hospital Moinhos de Vento published on the genomic epidemiology of SARS-CoV-2 in Porto Alegre and described a SARS-CoV-2 variant (CK.1) that was not previously identified in Brazil.
- The national laboratory network expansion of molecular diagnosis for Bordetella pertussis led to the identification of one positive tests in 2022, 2 positive tests in 2023, and 130 positive tests by May 2024.
Neglected Tropical Diseases
Strategic focus
CDC also works to address the presence of neglected tropical diseases (NTDs)—including chagas disease, leishmaniasis, lymphatic filariasis, and trachoma. These diseases significantly impact health in Brazil, especially among people experiencing poverty.
Key achievements
In collaboration with Brazilian laboratories, CDC developed a test using multiplex immunoassay technology, which allows the detection of multiple diseases in one test. This allows public health workers to gather important public health data about these diseases at a much lower cost compared to traditional methods that test one disease at a time.
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