Epidemic Intelligence Service Officers Research Articles

Characterizing the Role of International Graduates of the Epidemic Intelligence Service in Increasing the Epidemiological Capacity and Diversity of the United States Public Health Workforce.

A trained and diverse public health workforce is needed to respond to public health threats. The Epidemic Intelligence Service (EIS) is an applied epidemiology training program. Most EIS officers are from the United States, but some are from other countries and bring unique perspectives and skills. To characterize international officers who participated in the EIS program and describe their employment settings after training completion. International officers were people who participated in EIS and who were not US citizens or permanent residents. We analyzed data from EIS's application database during 2009-2017 to describe officers' characteristics. We used data from the Centers for Disease Control and Prevention's (CDC's) workforce database for civil servants and EIS exit surveys to describe jobs taken after program completion. We described the characteristics of the international officers, jobs taken immediately after program completion, and duration of employment at CDC. Among 715 officers accepted in EIS classes of 2009-2017, 85 (12%) were international applicants, with citizenships from 40 different countries. Forty (47%) had 1 or more US postgraduate degrees, and 65 (76%) were physicians. Of 78 (92%) international officers with available employment data, 65 (83%) reported taking a job at CDC after program completion. The remaining took a public health job with an international entity (6%), academia (5%), or other jobs (5%). Among 65 international officers who remained working at CDC after graduation, the median employment duration was 5.2 years, including their 2 years in EIS. Most international EIS graduates remain at CDC after program completion, which strengthens the diversity and capacity of CDC's epidemiological workforce. Further evaluations are needed to determine the effects of pulling away crucial talent from other countries needing experienced epidemiologists and to what extent retaining those persons can benefit public health globally.

An Outbreak of Breakthrough Infections by the SARS-CoV-2 Delta Variant in a Psychiatric Closed Ward.

BackgroundA rapid decline in immunity and low neutralizing activity against the delta variant in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinees has been observed. This study describes an outbreak of coronavirus disease 2019 (COVID-19) breakthrough infections caused by the SARS-CoV-2 delta variant in a psychiatric closed ward.MethodsData from epidemic intelligence service officers were utilized to obtain information regarding demographic, vaccination history, and clinical data along with SARS-CoV-2 PCR test results for a COVID-19 outbreak that occurred in a closed psychiatric ward.ResultsAmong the 164 residents, 144 (87.8%) received two doses of vaccines and 137 (95.1%) of them received ChAdOx1 nCoV-19 vaccine. The mean interval between the second vaccination and COVID-19 diagnosis was 132.77 ± 40.68 days. At the time of detection of the index case, SARS-CoV-2 had spread throughout the ward, infecting 162 of 164 residents. The case-fatality ratio was lower than that in the previously reported outbreak before the vaccination (1.2%, 2/162 vs. 6.9%, P = 0.030). Prolonged hospitalization occurred in 17 patients (11.1%) and was less prevalent in the vaccinated group than in the unvaccinated group (8.5% vs. 25.0%, P = 0.040).ConclusionThe findings of this study highlight that while vaccination can reduce mortality and the duration of hospitalization, it is not sufficient to prevent an outbreak of the SARS-CoV-2 delta variant in the present psychiatric hospital setting.

An Interview with the Ottawa Hospital’s Chief of Staff Dr. Virginia Roth

Dr. Virginia Roth is an infectious disease physician who has been the Ottawa Hospital’s Chief of Staff since 2018 and was the first woman to hold this position at TOH. An alumnus of the University of Ottawa Faculty of Medicine, she has also worked as an Epidemic Intelligence Service Officer at the U.S. Centers for Disease Control and Prevention (CDC) and as Director of Infection Control at TOH. She also holds an Executive MBA from the Telfer School of Management. We sat down with Dr. Roth in late-September to talk more about her career path and professional roles, the ongoing COVID-19 pandemic, and any advice for medical students as they navigate their own education and careers.

CDC’s Zika Response — Role of Epidemic Intelligence Service Officers in 2016–2017

CDC’s Zika Response — Role of Epidemic Intelligence Service Officers in 2016–2017

The direction of restructuring of a Korea field epidemiology training program through questionnaire survey among communicable disease response staff in Korea.

We used a survey about the need for an educational training of infectious disease response staff in Korea Centers for Disease Control and Prevention (KCDC) and officer in metropolitan cities and provincial government to conduct field epidemiological investigation. The survey was conducted from January 25 to March 15, 2016. A total of 173 participants were selected from four different groups as follows: 27 clinical specialists, 22 Epidemic Intelligence Service (EIS) officers, 82 KCDC staff, and 42 local health department officials. Results revealed that 83% of KCDC staff and 95% of local health department officials agreed on the need for educational training to strengthen capability of personnel to conduct epidemic research and investigation. The level of their need for training was relatively high, while self-confidence levels of individuals to conduct epidemic research and investigation was low. It was concluded that there was a need to develop training programs to enhance the ability of public health officials, EIS officers, KCDC staff, and local health department personnel to conduct epidemic research and investigation.

Epidemic Assistance by the Epidemic Intelligence Service, Centers for Disease Control and Prevention, 2005-2014.

Background:Epi-Aids, or epidemiologic assistance investigations, are an important mechanism through which Centers for Disease Control and Prevention supports public health organizations. We described the characteristics of Epi-Aids conducted during 2005–2014 and summarized the publication outcome of Epi-Aid related scientific information products.Methods:We performed a descriptive analysis of all Epi-Aids conducted during January 1, 2005–December 31, 2014; investigations were categorized by health topic and geographic distribution. We highlighted investigations of substantial public health importance, e.g., multistate investigations and investigations of epidemics and pandemics. We identified the Epi-Aid publication outcome by searching PubMed for Epi-Aid related publications, which included Morbidity and Mortality Weekly Reports (MMWRs) and peer-reviewed publications with an Epidemic Intelligence Service Officer (EISO) as a coauthor. We calculated publication timeliness and categorized publications by journal impact factor.Results:During the study period, 698 EISOs and their collaborators participated in 807 Epi-Aids throughout the United States and globally. Approximately 81 Epi-Aids were conducted annually (range, 62–104); 632 (78.3%) were infectious disease-related; 161 (20.0%) were international, supporting 68 countries. As of June 2015, EISOs, in collaboration with partners, published 131 MMWRs and 280 scientific manuscripts on the basis of the 807 Epi-Aids conducted during the study period; 394 (48.8%) Epi-Aids resulted in publications in 80 peer-reviewed journals.Conclusions:EISOs play a critical role in conducting Epi-Aids, which require qualified field epidemiologists who can rapidly respond to requests for assistance during public health emergencies. Publications based on Epi-Aids share new knowledge with the scientific community, furthering progress of public health science and practice.

Communicating Science: The Role of Centers for Disease Control and Prevention's Field-Based Epidemic Intelligence Service Officers, 2009-2014.

A highly skilled public health workforce is needed for responding to health threats, and that workforce must be able to communicate its scientific findings effectively. We evaluated the scientific communication effectiveness of the Centers for Disease Control and Prevention's (CDC's) field-based Epidemic Intelligence Service officers (EISOs). A descriptive analysis of all scientific information products produced and submitted for institutional clearance by CDC's field-based EISOs during 2009-2014. The number of abstracts, journal manuscripts, Morbidity and Mortality Weekly Reports (MMWRs), and other information products approved by CDC during 2009-2014; the number of those products published; and of those published, the number cited in the scientific literature. During 2009-2014, a total of 152 field-based EISOs produced 835 scientific information products, including 437 abstracts, 261 manuscripts, and 103 MMWRs. The majority of scientific information products submitted for clearance were abstracts (52.3%), and infectious diseases (75.3%) constituted the majority of topics. Among the 103 MMWRs and 261 manuscripts cleared, 88 (85%) and 199 (76%) were published, respectively, with the majority also infectious disease-related. The 199 published manuscripts were cited in the scientific literature 2415 times, and the 88 published MMWRs were cited 1249 times. Field-based EISOs published their work in 74 different peer-reviewed medical and public health journals, with 54% published in journals with impact factors of 1 to 5. Field-based EISOs' publications are a measurable marker that reflects proficiency in epidemiology, written communication, and professionalism, and those publications are a direct reflection of EISOs' contribution to local and state health departments. Our study establishes a baseline for future evaluations of publication outcome of scientific information products by EISOs. Information released by EISOs provides health professionals with the scientific knowledge necessary for improving their practice and helps CDC achieve a broader societal, environmental, cultural, and economic impact.

Structural Factors of the Middle East Respiratory Syndrome Coronavirus Outbreak as a Public Health Crisis in Korea and Future Response Strategies.

The recent Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak has originated from a failure in the national quarantine system in the Republic of Korea as most basic role of protecting the safety and lives of its citizens. Furthermore, a number of the Korean healthcare system’s weaknesses seem to have been completely exposed. The MERS-CoV outbreak can be considered a typical public health crisis in that the public was not only greatly terrorized by the actual fear of the disease, but also experienced a great impact to their daily lives, all in a short period of time. Preparedness for and an appropriate response to a public health crisis require comprehensive systematic public healthcare measures to address risks comprehensively with an all-hazards approach. Consequently, discussion regarding establishment of post-MERS-CoV improvement measures must focus on the total reform of the national quarantine system and strengthening of the public health infrastructure. In addition, the Korea Centers for Disease Control and Prevention must implement specific strategies of action including taking on the role of “control tower” in a public health emergency, training of Field Epidemic Intelligence Service officers, establishment of collaborative governance between central and local governments for infection prevention and control, strengthening the roles and capabilities of community-based public hospitals, and development of nationwide crisis communication methods.

Strengthening epidemiologic investigation of infectious diseases in Korea: lessons from the Middle East Respiratory Syndrome outbreak.

The recent outbreak of Middle East Respiratory Syndrome (MERS) coronavirus infection in Korea resulted in large socioeconomic losses. This provoked the Korean government and the general public to recognize the importance of having a well-established system against infectious diseases. Although epidemiologic investigation is one of the most important aspects of prevention, it has been pointed out that much needs to be improved in Korea. We review here the current status of the Korean epidemiologic service and suggest possible supplementation measures. We examine the current national preventive infrastructure, including human resources such as Epidemic Intelligence Service officers, its governmental management, and related policies. In addition, we describe the practical application of these resources to the recent MERS outbreak and the progress in preventive measures. The spread of MERS demonstrated that the general readiness for emerging infectious diseases in Korea is considerably low. We believe that it is essential to increase society’s investment in disease prevention. Fostering public health personnel, legislating management policies, and establishing research centers for emerging infectious diseases are potential solutions. Evaluating international preventive systems, developing cooperative measures, and initiating improvements are necessary. We evaluated the Korean epidemiologic investigation system and the public preventive measures against infectious diseases in light of the recent MERS outbreak. We suggest that governmental authorities in Korea enforce preventive policies, foster the development of highly qualified personnel, and increase investment in the public health domain of infectious disease prevention.

In Memoriam: M. Colin Jordan, MD

M. Colin Jordan, former Infectious Diseases Division Director and Professor of Medicine at both the University of Minnesota and the Oregon Health and Science University (OHSU), died April 8, 2015. Colin lived an exceptional life, touching patients and colleagues with his excellence and high expectations as a physician and scientist and his rare combination of warmth and nurturing with cutting, yet understated, humor. He did not talk much about his past, so few may know he was born in a bomb shelter in England in 1941, came to the United States aboard the Queen Elizabeth at age 6, and was signed by Walt Disney studios as a dancer at the age of 12. Colin was an accomplished college baseball player, and after graduation from Loyola Marymount he was offered a contract with the Los Angeles Angels; however, instead of becoming a baseball player, he decided to go into medicine. After medical school at Creighton, he trained at the University of Washington (UW), where he worked with many outstanding clinicians, including their stellar Infectious Diseases group and Bill Kirby, with whom he wrote one of his first papers. His time at UW helped inspire his career, including his becoming an Epidemic Intelligence Service (EIS) officer from 1970 to 1972. An early indication of both his talent and humor was his publication in the American Journal of Public Health, from an EIS investigation, entitled “Salmonellosis among restaurant patrons: the incisive role of a meat slicer”. After stints as a faculty member at UCLA and Davis, he became Division Chief at the University of Minnesota, serving from 1984 to 1998. At Minnesota, where I had the pleasure of working with him, he developed a strong multi-institution Division into a warm and collegial group. From 1998 to 2005, he served as Chief of ID and the first E.H. Cooley Professor of Medicine at OHSU. A staunch believer that scientifically well trained clinicians can provide important insights and have a major role in research, he made many contributions to the understanding of cytomegalovirus infection including, particularly, its transmissibility through sexual contact, murine models of disease, the biology of latency, resistance to antivirals, and molecular detection for diagnostic and research uses. Everywhere he served or led, he influenced students, other trainees, patients, and peers with not only his critical thinking as a scientist and clinician, but also his decency, fairness and compassion, and his low tolerance for puffery and pretension, the latter remarkable for an accomplished academician and almost as rare then as now. He helped motivate and propel many students and trainees into successful careers as physicians and scientists. As he watched medicine and science becoming a business, rather than the calling and commitment which he advocated for and lived by example, it's impossible to know whether Colin ever dreamed of again standing on a major league baseball field. In any case, to all whose lives he touched, he will always be seen as a Major League physician, scientist, and, most important, friend. He leaves his wife, Pamela Lahrs, his previous spouses, Bonnie Baskin and Patricia Jordan, daughters Teresa and Angela, son Colin Jr., and 4 grandchildren. Many fascinating aspects of his life and work, from that bomb shelter to academia, and of his generous personality are captured in his enjoyable book, “Briefings from a Doctor's Foxhole”. If desired, donations in his honor can be made to OSHU or the charity of your choice.

Strengthening epidemiologic investigation of infectious diseases in Korea: lessons from the Middle East respiratory syndrome outbreak

The recent outbreak of Middle East respiratory syndrome (MERS) coronavirus infection in Korea resulted in large socioeconomic losses. This provoked the Korean government and the general public to recognize the importance of having a well-established system against infectious diseases. Although epidemiologic investigation is one of the most important aspects of prevention, it has been pointed out that much needs to be improved in Korea. We review here the current status of the Korean epidemiologic service and suggest possible supplementation measures. We examine the current national preventive infrastructure, including human resources such as Epidemic Intelligence Service officers, its governmental management, and related policies. In addition, we describe the practical application of these resources to the recent MERS outbreak and the progress in preventive measures. The spread of MERS demonstrated that the general readiness for emerging infectious diseases in Korea is considerably low. We believe that it is essential to increase society's investment in disease prevention. Fostering public health personnel, legislating management policies, and establishing research centers for emerging infectious diseases are potential solutions. Evaluating international preventive systems, developing cooperative measures, and initiating improvements are necessary. We evaluated the Korean epidemiologic investigation system and the public preventive measures against infectious diseases in light of the recent MERS outbreak. We suggest that governmental authorities in Korea enforce preventive policies, foster the development of highly qualified personnel, and increase investment in the public health domain of infectious disease prevention.

Epidemic Intelligence Service Officers and Field Epidemiology Training Program in Korea

Korea has adopted Epidemic Intelligence Service (EIS) officers through the Field Epidemiology Training Program (FETP) since 1999 for systematic control of emerging and re-emerging infectious diseases. Graduates of medical schools in Korea are selected and serve as public health doctors (PHDs) for their mandatory military service. The duration of service is 3 years and PHDs comprise general practitioners and specialists. Some PHDs are selected as EIS officers with 3 weeks basic FETP training and work for central and provincial public health authorities to conduct epidemiological investigations. The total number of EIS officers is 31 as of 2012. The Korea Centers for Disease Control and Prevention (KCDC) has 12 specialists, whereas specialists and each province has one or two EIS officers to administer local epidemiological investigations in 253 public health centers. The Korean EIS officers have successfully responded and prevented infectious diseases, but there is a unique limitation: the number of PHDs in Korea is decreasing and PHDs are not allowed to stay outside Korea, which makes it difficult to cope with overseas infectious diseases. Furthermore, after 3 years service, they quit and their experiences are not accumulated. KCDC has hired full-time EIS officers since 2012 to overcome this limitation.

Dengue Fever in South Korea, 2006–2010

To the Editor: Dengue fever is an acute, febrile disease caused by a flavivirus and is transmitted by Aedes spp. mosquitoes (1). South Korea is not considered as a region to which dengue virus is endemic because it is located above 35°N latitude and has an isotherm of 10°C in winter, which potentially limits year-round survival of Aedes aegypti mosquitoes (1,2). Thus, dengue fever was seldom recognized as a public health concern in South Korea. However, the first case of dengue fever in South Korea was reported in 1995 in a woman who had traveled to Sri Lanka (3). A second case was found in a sailor who had worked in countries in Africa in 2000 (4). Since 2001, dengue fever has been a notifiable infectious disease in South Korea because of concerns about increasing international travel as a source of infection and because the less efficient potential dengue vector, Ae. albopictus mosquitoes, were found in this country. All cases reported through the surveillance system should be complemented by thorough epidemiologic investigations to determine whether a case was imported or originated in South Korea. Thus, we analyzed dengue fever–associated data from the Korea Centers for Disease Control and Prevention. During 2006–2010, a total of 367 suspected cases were reported by physicians through the National Infectious Disease Surveillance System. IgM ELISA and reverse transcription PCR results identified 324 cases as dengue fever. Investigation of 34 cases could not be completed because some cases were in foreigners and in Korean persons who resided in foreign countries, left South Korea after diagnosis, or could not be reached by the contact information that was provided. Investigation of 290 cases was completed by reviewing medical records and by interviews. Interviews were conducted by provincial and Korea Centers for Disease Control and Prevention Epidemic Intelligence Service officers, who used a standardized investigation form. All 290 case-patients had a history of international travel before onset of dengue fever symptoms. Destination information was available for all 290 case-patients; 17 countries were identified. Visitors to the Philippines (34.1%) contributed the largest number of cases, followed by visitors to Indonesia, India, Thailand, Vietnam, Cambodia, Laos, Malaysia, Myanmar, Bangladesh, China, East Timor, Maldives, Palau, Sri Lanka, Brazil, and Nigeria (Table). These countries are in areas to which dengue fever is endemic or have reported cases (1). Table Presumptive country of origin of imported dengue fever cases, South Korea, 2006–2010 The time interval between the last day of travel and symptom onset was known for 272 (93.8%) of the 290 case-patients. A total of 271 case-patients had traveled within 14 days before symptom onset, and 89 (32.7%) had symptom onset or were given a diagnosis of dengue fever during travel. Symptoms developed within 7 days after travel in 171 (62.9%) persons and 8–14 days after travel in 11 (4.0%) persons. Mean ± SD duration from the last day of travel to symptom onset among 182 case-patients who had symptom onset after travel was 3.20 ± 2.61 days. Our results indicate that all investigated case-patients had a history of international travel and times of symptom onset during or after travel but within the incubation period for dengue infection. One case-patient had a time to symptom onset of <34 days. This person was eventually given a diagnosis of infection with Epstein-Barr virus but was tested for dengue virus. Because the incubation period exceeded that for dengue virus incubation, this case was classified as an asymptomatic dengue virus infection and an Epstein-Barr virus infection. Most dengue cases in South Korea are likely imported, and most presumptive countries from which dengue fever originated are in Southeast and southern Asia. These countries are popular holiday destinations for persons from South Korea. Because of distances, few tourists from South Korea travel to Africa and South America (5). China is the most popular destination for travelers from South Korea. However, the proportion of persons who acquired dengue infection in China was low (0.7%) because most persons who traveled to China went to Beijing or Shanghai, not to areas in southern China where dengue epidemics have occurred (5,6). We report that all dengue fever cases in South Korea during 2006–2010 were imported by persons who had traveled abroad. Global expansion of dengue virus and an increase in international travelers have increased the likelihood of additional cases of dengue fever. In addition, Ae. albopictus mosquitoes have been detected in South Korea and can potentially transmit autochthonous dengue infection, as reported in Croatia, France, and Hawaii, USA (7–9). Thus, more intensified surveillance and investigations should be focused on dengue transmission by Ae. albopictus mosquitoes in South Korea.

Epidemic Intelligence Service Investigations of Respiratory Illness, 1946-2005

Infectious respiratory pathogens were the suspected cause of 480 outbreaks investigated by the Centers for Disease Control and Prevention's Epidemic Intelligence Service officers during 1946-2005. All epidemic-assistance investigation reports and associated articles from scientific journals were reviewed. Investigations identified 25 different infectious respiratory pathogens including, most frequently, tuberculosis, influenza, and legionellosis. Other bacterial-, viral-, and fungal-related pathogens also were identified. Epidemic-assistance investigations were notable for first identifying Legionnaires disease and Pontiac fever, hantavirus pulmonary syndrome, and new strains of human and avian influenza, as well as emerging challenges (e.g., multidrug-resistant tuberculosis and pneumococcus). The investigations provided clinical insights into such diseases as pulmonary anthrax and identified high risks of serious respiratory illnesses for persons infected with human immunodeficiency virus, other immunocompromised persons, and persons with diabetes. They identified settings placing persons at high risk of acquiring disease, including nursing homes, prisons, homeless shelters, and hospitals. Travel also placed persons at risk. Key environmental factors related to spread of diseases and occupational risks for brucellosis and psittacosis were identified. The outbreak investigations constitute a wealth of prevention experience and provide the basis for recommendations to mitigate outbreaks and reduce future risks.

Epidemic Intelligence Service Officers by Class Year, 1951-2005

Epidemic Intelligence Service Officers by Class Year, 1951-2005

Epidemic Assistance by the Centers for Disease Control and Prevention: Role of the Epidemic Intelligence Service, 1946-2005

Since 1946, the Centers for Disease Control and Prevention has responded to urgent requests from US states, federal agencies, and international organizations through epidemic-assistance investigations (Epi-Aids). The authors describe the first 60 years of Epi-Aids, breadth of problems addressed, evolution of methodologies, scope of activities, and impact of investigations on population health. They reviewed Epi-Aid reports and EIS Bulletins, contacted current and former Epidemic Intelligence Service staff, and systematically searched the PubMed and Web of Science databases. They abstracted information on dates, location, staff involved, health problems, methods, and impacts of investigations according to a preplanned protocol. They assessed the methods presented as well as the quality of reports. During 1946–2005, a total of 4,484 investigations of health events were initiated by 2,815 Epidemic Intelligence Service officers. In the early years, the majority were in response to infectious agents, although environmental problems emerged. Investigations in subsequent years focused on occupational conditions, birth defects, reproductive health, tobacco use, cancer, violence, legal debate, and terrorism. These Epi-Aids heralded expansion of the agency's mission and presented new methods in statistics and epidemiology. Recommendations from Epi-Aids led to policy implementation, evaluation, or modification. Epi-Aids provide the Centers for Disease Control and Prevention with the agility to respond rapidly to public health crises.

Vaccine-preventable Diseases, Immunizations, and the Epidemic Intelligence Service

During 1946-2005, vaccine-preventable diseases were the topic of approximately 20% of all epidemic-assistance investigations by the Centers for Disease Control and Prevention. Both in the United States and abroad, current and former Epidemic Intelligence Service officers have played a critical role in describing the epidemiology of vaccine-preventable diseases, contributing to development of immunization policies, participating in the implementation of immunization programs, and establishing effective means for assessing adverse events following immunization. As newer vaccines are developed and introduced, they will continue to play similar roles and most likely will be involved increasingly in investigations of the factors that affect people's willingness to accept vaccination for themselves or their children.

Introduction: The Centers for Disease Control and Prevention's Epi-Aids--A Fond Recollection

The Epidemic Intelligence Service (EIS) has served the United States and the world for >58 years by being an extraordinary apprenticeship in the fundamentals of practical field epidemiology: a training program, a professional entry point, the basis for lifelong careers, and a closely supervised and mentored opportunity for research, analysis, and community service. Epidemic-assistance investigations, a key element of the EIS experience, are the written summaries of each field investigation undertaken by the EIS officer. The resulting reports enter the record of the Centers for Disease Control and Prevention (CDC), provide scientific feedback to the state and locality where the epidemic or health problem occurred, and often form the basis for a subsequent manuscript to be submitted to a peer-reviewed medical journal. The EIS Program was created in 1951 to be a defense against potential bioterrorism, serve the immediate needs for field investigation, and provide for future workforce demands by combining epidemiology and laboratory science. During the past 60 years, CDC and public health practitioners have broadened their areas of responsibility by adding programs in reproductive health, environmental health, chronic diseases, nutrition, injury control and prevention, and noncommunicable disease risk factors. Epidemic-assistance investigations have evolved similarly. The papers in this Journal supplement reflect the evolution of public health responsibilities and the growth and development of CDC. They are a testimony to the value of clear, concise information and analysis, communicated to those who need to know as a public health and societal good.

Health Care-Associated Infection Outbreak Investigations by the Centers for Disease Control and Prevention, 1946-2005

Since 1946, Centers for Disease Control and Prevention (CDC) personnel have investigated outbreaks of infections and adverse events associated with delivery of health care. CDC Epidemic Intelligence Service officers have led onsite investigations of these outbreaks by systematically applying epidemiology, statistics, and laboratory science. During 1946-2005, CDC Epidemic Intelligence Service officers conducted 531 outbreak investigations in facilities across the United States and abroad. Initially, the majority of outbreaks involved gastrointestinal tract infections; however, in later years, bloodstream, respiratory tract, and surgical wound infections predominated. Among pathogens implicated in CDC outbreak investigations, Staphylococcus aureus, Enterococcus species, Enterobacteriaceae, nonfermentative Gram-negative bacteria, or yeasts predominated, but unusual organisms (e.g., the atypical mycobacteria) were often included. Outbreak types varied and often were linked to transfer of colonized patients or health care personnel between facilities (multihospital outbreaks), national distribution of contaminated products, use of invasive medical devices, or variances in practices and procedures in health care environments (e.g., intensive care units, water reservoirs, or hemodialysis units). Through partnerships with health care facilities and local and state health departments, outbreaks were terminated and lives saved. Data from investigations invariably contributed to CDC-generated guidelines for prevention and control of health care-associated infections.

Fifty-Five Years of International Epidemic-Assistance Investigations Conducted by CDC's Disease Detectives

For more than 60 years, the Centers for Disease Control and Prevention (CDC) has used its scientific expertise to help people throughout the world live healthier, safer, longer lives through science-based health action. In 1951, CDC officially established the Epidemic Intelligence Service to help build public health capacity. During 1950–2005, CDC’s Epidemic Intelligence Service officers conducted 462 international epidemiologic field investigations in 131 foreign countries and 7 territories. Investigations have included responding to emerging infectious and noninfectious disease outbreaks, assisting in disaster response, and evaluating core components of public health programs worldwide. Approximately 81% of investigations were responses to infectious disease outbreaks, but the proportion of investigations related to chronic and other noninfectious conditions increased 7-fold (6%–45%). These investigations have contributed to detecting and characterizing new pathogens (e.g., severe acute respiratory syndrome–associated coronavirus) and conditions, provided insights regarding factors that cause or contribute to disease acquisition (e.g., Ebola hemorrhagic fever), led to development of new diagnostics and surveillance technologies, and provided information upon which global health policies and regulations can be based. CDC’s disease detectives will undoubtedly continue to play a critical role in global health and in responding to emerging global disease threats.