of HIV infection. Promising new ways of preventing and treating HIV, including pre‐ and post‐exposure prophylaxis, are under evaluation. As evidence on the effectiveness of new interventions moves forward, CDC will ensure prompt and effective translation of research findings into sound public health practice. 18 | CDC ID Framework • Foodborne infections Each year in the United States, foodborne pathogens cause an estimated 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths (24,25). While approximately 1,000 U.S. foodborne disease outbreaks are reported annually (26), most foodborne illnesses do not occur as part of recognized outbreaks. Recent foodborne disease surveillance data indicate relative declines in incidence from 1996–2010 for infections associated with many key foodborne pathogens; however, the rate of Salmonella infections—the most common foodborne infection reported—has remained unchanged (27). In the United States, Salmonella infections sicken an estimated 1 million persons and result in an estimated $365 million in direct medical costs each year. Among its prevention activities, CDC tracks and investigates foodborne diseases in collaboration with state and local health departments and other partners, working to rapidly identify their sources and contain their spread. Vital to these efforts are extensive foodborne illness surveillance systems, such as the following: - Foodborne Diseases Active Surveillance Network (FoodNet), operated by the Emerging Infections Program, which conducts active surveillance for foodborne diseases - National Antimicrobial Resistance Monitoring System (NARMS), a collaboration among CDC, USDA/FSIS, and the U.S. Food and Drug Administration’s (FDA) Center for Veterinary Medicine to monitor drug‐resistant pathogens in food animals that might be transmitted to humans - PulseNET, a national network of public health laboratories that performs DNA ʺfingerprintingʺ on foodborne bacteria to detect outbreaks caused by contamination of centrally processed food products that are shipped to stores or restaurants in many different locations - Outbreak Response Team, which investigates local and multistate outbreaks of foodborne, waterborne, and enteric diseases. CDC also receives data on nationally notifiable conditions—including foodborne illnesses such as botulism, hepatitis A, salmonellosis, and shigellosis—on a weekly basis through the National Notifiable Diseases Surveillance System (NNDSS). In addition, CDC is working to advance the 2011 Food Safety Modernization Act—important legislation calling for new safety standards, expanded inspections and compliance, improved import safety, and increased surveillance of foodborne illness. Increased efforts are being directed toward improving coordination and data sharing with public health partners and the public; expanding surveillance networks; and enhancing epidemiologic and laboratory tools for detecting and investigating outbreaks and identifying sources of foodborne illnesses. Internationally, CDC continues to help strengthen and implement tools for early detection and response to foodborne disease outbreaks, including PulseNet International and the Global Food Infections Network. CDC also participates in the WHO Initiative to Estimate the Global Burden of Foodborne Disease, which generates data that nations can use to set food safety priorities and standards that enhance the safety of the global food supply. October 2011 | 19 • Chronic viral hepatitis Chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) is a silent epidemic in the United States, involving approximately 0.8–1.4 million persons infected with HBV (28) and an estimated 2.7–3.9 million persons with HCV infection (29). Many persons infected with HBV or HCV are unaware of their infection, placing them at risk for developing cirrhosis or liver cancer and unknowingly transmitting infection. A safe and effective vaccine against HBV has been available for nearly three decades, and universal vaccination against HBV among children, begun 1991, has led to substantial declines among younger age groups. No vaccine against HCV is available. While rates of HCV declined in the United States from 1992–2005 and have since plateaued, several states have reported increases in cases of HCV infection among adolescents and young adults, with injection drug use the most common risk factor (30). In January 2010, the Institute of Medicine (IOM) issued a report on prevention and control of hepatitis in the United States (31). The report outlined a series of recommendations for improving surveillance, public and healthcare provider knowledge, immunizations and other prevention services, and healthcare related to viral hepatitis. In response to the IOM report, HHS developed a comprehensive action plan (32) designed to improve prevention of viral hepatitis and related disease, to increase identification and linkage to care among infected persons, and to improve coordination of federal and partner efforts to reduce viral hepatitis. CDC is helping to lead many of the actions described in the plan, including improving education for patients, healthcare providers, and the public; expanding testing; enhancing surveillance activities; and promoting