Epidemic Intelligence Service Research Articles

Stephen Luby: promoting the importance of water for health

Stephen Luby: promoting the importance of water for health

Outbreak Investigations around the World: Case Studies in Infectious Disease Field Epidemiology

Outbreak investigations are fascinating stories. Mark S. Dworkin, Epidemic Intelligence Service (EIS) Class of 1994, has compiled 19 first-hand accounts of case studies in infectious disease epidemiology and presents them in chronological order. The first is Kenrad Nelson’s 1964 investigation of leptospirosis associated with swimming in an irrigation ditch in rural Washington; the last Patricia Quinlisk’s evaluation of a 2006 mumps epidemic in Iowa. In between are investigations involving 8 bacterial infections, 6 viruses, 1 helminth (Taenia solium), 1 protozoan (Cryptosporidium sp.), and a misdiagnosis of Entamoeba histolytica. Fourteen of the outbreaks occurred in the United States; of the remaining 5, one each occurred in Portugal, Israel, Egypt, Gabon, and Liberia. In general, the stories are told as first-person accounts, use an informal style, and include personal reflections. Many chapters, but not all, include epidemic curves, maps, tables, exhibits, and lessons learned. I especially enjoyed reading about Paul Blake’s experience with a cholera outbreak in Portugal, Charles Jennings and measles in Illinois, Daniel Bausch and Ebola in Gabon, and reading both chapters by Jeffrey Davis—toxic shock syndrome and cryptosporidiosis. As an instructor of epidemiology, I read the book seeking a complementary text for students. The informal style does make enjoyable reading but does not translate into an appropriate textbook. Several of the chapters are too long. One chapter is written by multiple authors, told from 4 points of view, and is very difficult to read. The lessons learned are organized chronologically, not by content. Some lessons are redundant; other areas of epidemiology are not adequately explored, e.g., sampling strategies, study design, questionnaire development and data analysis, population screening, and noninfectious diseases. However, I like the concept of first-hand accounts to supplement epidemiology textbooks. Could one format the chapters as unknowns like that of New England Journal of Medicine case studies? Could outbreak investigations be written in the style of Berton Roueche as medical mysteries, but supplemented with epidemic curves, maps, and lessons learned? I recommend this book to all infectious disease epidemiologists, EIS officers, and infectious diseases clinicians interested in the aura of outbreak investigations. I also encourage the editor to consider a reformatted second edition to enhance the book’s usefulness as a complementary text in epidemiology coursework.

Smallpox — the death of a disease

Smallpox — the death of a disease, written by D.A. Henderson, provides a personal accounting of the strategies, decisions, and combined global efforts leading to the eradication of smallpox. Henderson, a recognized smallpox expert who served as the first director of the WHO Smallpox Global Eradication Unit, discusses the events leading to the World Health Assembly’s (WHA’s) decision to commit to a major global eradication effort. He provides a firsthand, behind-the-scenes view of the politics, opinions, strategies, and personalities that enabled or hindered this massive undertaking. Medically oriented and general readers interested in public health and/or smallpox would likely enjoy reading this personal perspective on smallpox eradication. Henderson prefaces the book by describing how his career in public health began by fulfilling a Selective Service requirement to serve in a uniformed service. This led him to a US Public Health Service position with the Epidemic Intelligence Service (EIS) at the CDC. What started out as an assignment to fulfill a requirement, admittedly approached with lukewarm enthusiasm, soon blossomed into a lifelong passion and career in public health. Henderson’s focus on smallpox began while he was chief of the CDC surveillance section. He created a smallpox unit to plan strategies for responding to and containing importations of the disease into the US, where smallpox was, at that point, eliminated as an endemic disease. The unit also initiated a program to eradicate smallpox in 20 African nations where the disease remained endemic. Henderson provides a description of the disease and the virus, a historical accounting of its impact on the population, and a description of the early efforts to combat the epidemic. These early efforts included the use of variolation (intentionally infecting someone with smallpox virus by rubbing it into the skin) to produce a more localized, mild infection. Edward Jenner’s development of a safer vaccine (based on cowpox virus) and the subsequent achievement of larger-scale production utilizing freeze drying to provide heat stability for transportability provided the final tool necessary to attempt smallpox eradication. In subsequent chapters, Henderson walks the reader through the discussions, sometimes heated arguments, and the political turning points for the WHA and WHO that led to a broader, more supported global commitment to eradication. He also describes the challenges during the start-up of the WHO unit charged to lead the effort. These challenges ranged from determining utilization of limited budget and personnel resources to developing overall strategies, multi-country programs, and on occasion, garnering political will and support for eradication in countries with remaining disease. The book provides more detailed descriptions of eradication efforts in Brazil, Indonesia, India, Nepal, Afghanistan, Pakistan, Bangladesh, and multiple countries in Africa, including Ethiopia and Somalia (the final two countries with smallpox). Despite specific challenges in each country, it is clear that eradication was possible only through the efforts of the dedicated, in-country program personnel working long hours for months at a time, identifying smallpox outbreaks in cities and remote villages, administering vaccine, and following up to assure that vaccinations were successful. Henderson closes his book relating his recent experiences in returning his focus to smallpox while helping the US government address the new threat that smallpox virus now poses as a potential bioterrorist weapon. His and other previous eradication experts’ experiences with the disease, diagnosis, vaccine, control strategies, and program development were invaluable planning and policy resources for a government that thought it had closed the book on smallpox almost two decades earlier. This book is well written and provides the reader with a personal look into the smallpox eradication effort from the vantage point of someone who lived the story firsthand. Relating his personal recollections and experiences from a viewpoint that encompasses the entirety of the eradication effort across multiple countries, the author allows the reader to gain an appreciation of the strategic and political nuances of eradicating the same disease in different places. Throughout the book, Henderson readily identifies key individuals who had significant roles in moving the eradication initiative forward and is not shy in identifying those he felt served as passive or, in some cases, active obstacles. His willingness to share these frank perceptions, even if sometimes more forthright than one might expect from a historical perspective, makes readers feel at times they are privy to details more likely to be shared by the author over a cup of coffee rather than in a book. The findings and conclusions in this report are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

In Memoriam: George Martin Baer (1936–2009)

George Martin Baer, DVM, MPH, who for many years was chief of the Rabies Laboratory in the Division of Viral and Rickettsial Diseases at the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA, died suddenly at his home in Mexico City on June 2, 2009, at the age of 73. He was an eminent veterinary virologist whose book, The Natural History of Rabies, the second edition of which was published in 1991, is the major reference work in the field. He has been widely acclaimed as “the father of oral rabies vaccination” as a result of his discovery of a strain of rabies virus (SAD strain) that immunizes foxes when given into the mouth cavity. His intensive work on the development of baits for vaccine administration to canines paved the way for successful mass fox vaccination campaigns conducted in Switzerland, several other European countries, and Canada. Dr Baer was born in London in 1936, but after the outbreak of World War II his family moved to the United States, and he was brought up in New York. He attended Cornell University in Ithaca, New York, and received a bachelor of science degree in agricultural sciences in 1954 and a Doctor of Veterinary Medicine degree in 1959. In 1961, he earned a Master of Public Health degree from the University of Michigan at Ann Arbor. He then came to CDC as an Epidemic Intelligence Service Officer, initially assigned to the New York State Health Department in Albany, where he first became interested in rabies. He subsequently joined the CDC Southwest Rabies Investigations Laboratory in Las Cruces, New Mexico, and from 1966 through 1969 was a consultant for the Pan American Health Organization in Mexico. He returned to CDC in Atlanta in 1969 to become chief of the Rabies Laboratory and served until his retirement in August 1991. He and his family then moved to Mexico City, where he founded a diagnostic laboratory and continued to use his expertise on rabies as a member of the Mexican International Steering Committee for the Rabies in the Americas Conference. Dr Baer was a valued supporter of and reviewer for Emerging Infectious Diseases and will be greatly missed. We offer our condolences to his wife, Maria Olga, and daughters, Katherine, Alexandra, and Isabella, as well as to his 4 granddaughters.

The need for computerized tracking systems for resource-limited settings: the example of Georgetown, Guyana

Transfusion MedicineVolume 19, Issue 3 p. 149-151 The need for computerized tracking systems for resource-limited settings: the example of Georgetown, Guyana S. V. Basavaraju, Corresponding Author S. V. Basavaraju U.S. Centers for Disease Control and Prevention, National Center for HIV/AIDS, viral Hepatitis, STD, and TB Prevention, Division of Global AIDS, HIV Prevention Branch, Medical Transmission Team, Atlanta, GA, USASridhar V. Basavaraju, U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, 1600 Clifton Road, NE, MS E-04, Atlanta, GA 30333, USA, Tel.: 404 639 6341; fax: 404 639 8114;e-mail:[email protected]Search for more papers by this authorJ. P. Pitman, J. P. Pitman U.S. Centers for Disease Control and Prevention, National Center for HIV/AIDS, viral Hepatitis, STD, and TB Prevention, Division of Global AIDS, HIV Prevention Branch, Medical Transmission Team, Atlanta, GA, USASearch for more papers by this authorN. Henry, N. Henry U.S. Centers for Disease Control and Prevention, Guyana,Search for more papers by this authorC. McEwan, C. McEwan Guyana National Blood Transfusion Service, GuyanaSearch for more papers by this authorC. Harry, C. Harry U.S. Centers for Disease Control and Prevention, Guyana,Search for more papers by this authorL. Hasbrouck, L. Hasbrouck U.S. Centers for Disease Control and Prevention, Guyana,Search for more papers by this authorL. Marum, L. Marum U.S. Centers for Disease Control and Prevention, National Center for HIV/AIDS, viral Hepatitis, STD, and TB Prevention, Division of Global AIDS, HIV Prevention Branch, Medical Transmission Team, Atlanta, GA, USASearch for more papers by this author S. V. Basavaraju, Corresponding Author S. V. Basavaraju U.S. Centers for Disease Control and Prevention, National Center for HIV/AIDS, viral Hepatitis, STD, and TB Prevention, Division of Global AIDS, HIV Prevention Branch, Medical Transmission Team, Atlanta, GA, USASridhar V. Basavaraju, U.S. Centers for Disease Control and Prevention, Epidemic Intelligence Service, 1600 Clifton Road, NE, MS E-04, Atlanta, GA 30333, USA, Tel.: 404 639 6341; fax: 404 639 8114;e-mail:[email protected]Search for more papers by this authorJ. P. Pitman, J. P. Pitman U.S. Centers for Disease Control and Prevention, National Center for HIV/AIDS, viral Hepatitis, STD, and TB Prevention, Division of Global AIDS, HIV Prevention Branch, Medical Transmission Team, Atlanta, GA, USASearch for more papers by this authorN. Henry, N. Henry U.S. Centers for Disease Control and Prevention, Guyana,Search for more papers by this authorC. McEwan, C. McEwan Guyana National Blood Transfusion Service, GuyanaSearch for more papers by this authorC. Harry, C. Harry U.S. Centers for Disease Control and Prevention, Guyana,Search for more papers by this authorL. Hasbrouck, L. Hasbrouck U.S. Centers for Disease Control and Prevention, Guyana,Search for more papers by this authorL. Marum, L. Marum U.S. Centers for Disease Control and Prevention, National Center for HIV/AIDS, viral Hepatitis, STD, and TB Prevention, Division of Global AIDS, HIV Prevention Branch, Medical Transmission Team, Atlanta, GA, USASearch for more papers by this author First published: 25 June 2009 https://doi.org/10.1111/j.1365-3148.2009.00925.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume19, Issue3June 2009Pages 149-151 RelatedInformation

Shannon Hader

Shannon Hader

A Conversation With Jacob Brody

Jacob Brody is Professor Emeritus of Epidemiology at the School of Public Health at the University of Illinois at Chicago where he served as Dean from 1985 tol992. Under his guidance the School doubled in size and increased its research funding 700%, while developing a national model for teaching and implementing public health practice. His service at the Centers for Disease Control (Epidemic Intelligence Service) and at the National Institutes of Health from 1957 to 1985 included assignments in Costa Rica, Bangladesh, Panama, Russia, Alaska, and Hiroshima. He created the US government's epidemiology programs for neurology, alcoholism, and aging. In 1957, the American Medical Writers Association honored him for the Best Book on a Medical Subject for Physicians. He became President of the American Epidemiologic Society in 1980 and the following year was presented the Distinguished Service Medal of the U.S. Public Health Service and cited as the most decorated member of the Public Health Service. In 2000, he received the prestigious Lilienfeld Award from the American Public Health Association for outstanding contributions, leadership, and research in epidemiology. He has authored more than 250 scientific publications and in 2002 he was recognized as being among the top 0.5% of the most frequently cited authors in the field.

Florida Epidemic Intelligence Service Program: The First Five Years, 2001–2006

The Florida Epidemic Intelligence Service Program was created in 2001 to increase epidemiologic capacity within the state. Patterned after applied epidemiology training programs such as the Centers for Disease Control and Prevention Epidemic Intelligence Service and the California Epidemiologic Investigation Service, the two-year postgraduate program is designed to train public leaders of the future. The long-term goal is to increase the capacity of the Florida Department of Health to respond to new challenges in disease control and prevention. Placement is with experienced epidemiologists in county health departments/consortia. Fellows participate in didactic and experiential components, and complete core activities for learning as evidence of competency. As evidenced by graduate employment, the program is successfully meeting its goal. As of 2006, three classes (n=18) have graduated. Among graduates, 83% are employed as epidemiologists, 67% in Florida. Training in local health departments and an emphasis on graduate retention may assist states in strengthening their epidemiologic capacity.

10th Annual Conference on New and Re-emerging Infectious Diseases

10th Annual Conference on New and Re-emerging Infectious Diseases

Knowledge and Use of Preexposure and Postexposure Prophylaxis Among Attendees of Minority Gay Pride Events, 2005 Through 2006

Knowledge and Use of Preexposure and Postexposure Prophylaxis Among Attendees of Minority Gay Pride Events, 2005 Through 2006

Alex Langmuir and CDC

To the Editor: We were surprised and disappointed by the brevity of your article commemorating the 60th anniversary of the establishment of the Communicable Disease Center (CDC) (1). We realize that the accomplishments of the center and its derivative agencies are vast and that to give them full recognition would require far more space in Emerging Infectious Diseases than might be feasible. Nevertheless, your article that appropriately identified Joe Mountin as the administrative father of the center omitted any mention of Alex Langmuir, arguably the most influential of the infectious disease leaders over the years. Langmuir's creation and direction of the Epidemic Intelligence Service epitomized CDC's role in infectious diseases. His legacy deserves recognition in any chronicle of CDC, no matter how short.

The Epidemic Intelligence Service: The Centers for Disease Control and Prevention's Disease Detectives

A physician explains the mission of the Epidemic Intelligence Service program and its contribution within the Centers for Disease Control over the last 50 years. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

Beating back the devil: on the front lines with the disease detectives of the Epidemic Intelligence Service

Beating back the devil: on the front lines with the disease detectives of the Epidemic Intelligence Service

David Heymann—WHO's public health guru

David Heymann is the Representative of the Director General for polio eradication at the WHO. Before that he was Executive Director of WHO’s communicable diseases cluster which includes WHO’s programmes on infectious and tropical diseases and he led the public-health response to severe acute respiratory syndrome (SARS) in 2003. In the mid to late 1990s Heymann was Director of WHO’s programme on emerging and other communicable diseases and before that was the chief of research activities in WHO’s global programme on AIDS. Before joining WHO Heymann worked for 13 years as a medical epidemiologist in sub-Saharan Africa on an assignment from the US Centers for Disease Control and Prevention (CDC). He worked on a range of projects including improving control and surveillance of infectious diseases with special emphasis on the childhood immunisable diseases including measles and polio African haemorrhagic fevers poxviruses and malaria. While based in Africa Heymann investigated the first outbreak of Ebola in Yambuku (former Zaire) in 1976 then in the second outbreak of Ebola in 1977 in Tandala and in 1995 directed the international response to the Ebola outbreak in Kikwit. Before 1976 one of Heymann’s first public-health jobs was in India as a medical officer in the WHO smallpox eradication programme. (excerpt)

Evaluation of field training in the epidemic intelligence service: Publications and job choices

Background Since 1951, the Centers for Disease Control and Prevention's Epidemic Intelligence Service (EIS) has provided training in applied epidemiology to physicians, nurses, veterinarians, dentists, and doctoral-level health scientists. About one third of these EIS officers have been trained in the setting of state and local health departments (the field). Methods To evaluate two specific outcomes of field EIS training, the authors reviewed the published work and career choices of field EIS officers after completing the program. The EIS classes of 1991–1996 were selected for study. A field officer was defined as an EIS Officer who completed at least the second year of a 2-year EIS assignment in a state or local health department position. Results During this period, 430 EIS officers completed the program; 117 (27.2%) were field officers. Of these, 84 (71.8%) published one or more scientific paper as first author for a total of 202 first authored manuscripts in over 50 different journals, an average of 1.7 (range, 0–8) per officer. Most (71%) were on infectious disease topics; 16% were on environmental health or injury control topics, and 11% were on chronic diseases. Field officers were more likely than headquarters-based officers to choose positions in state or local health departments for their first job after graduating (32/117 [27.4%] versus 22/313 [7.0%]; relative risk = 3.9, 95% confidence interval = 2.4–6.4). Conclusions EIS training in the field has contributed to the scientific literature and to the strengthening of public health infrastructure at the state and local level.

West Nile virus: a brief review.

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA (JTW); and Chicago Department of Public Health (SIG, JTW), Chicago, IL

A strategy of containment.

Discusses the efforts of epidemiologists such as David L. Heymann to conduct research and surveillance of epidemics such as SARS in order to break the transmission of disease. Heymann spent two years in India administering smallpox vaccinations. In 1976, thoroughly hooked on international public health, he returned to the U.S. to join the Centers for Disease Control and Prevention's epidemic intelligence service. When the agency heard about an unusual respiratory infection spreading at an American Legion convention in Philadelphia, Heymann was sent on his first outbreak investigation. Instead of flu, the illness turned out to be a new one, later dubbed Legionnaire's disease. Heymann and a team of researchers created an emerging and infectious disease program to act as a useful tool in outbreak alert and response. The WHO formally unveiled its Global Alert and Response Network in 2000, but SARS was the first multicountry outbreak the coalition faced. Heymann, too, has a new role, having been charged with WHO's current attempt to completely eradicate an old disease from the world--this time, polio. Just six countries have wild poliovirus transmission within their borders, but political squabbles have bogged down immunization efforts in some areas.

Veterinarians and public health: the Epidemic Intelligence Service of the Centers for Disease Control and Prevention, 1951-2002.

Public health affords important and exciting career opportunities for veterinarians. The Epidemic Intelligence Service Program (EIS) of the Centers for Disease Prevention and Control (CDC) is a two-year post-graduate program of service and on-the-job training for health professionals, including veterinarians, who are interested in careers in epidemiology and public health. EIS serves as a major point of entry into the public health arena. Veterinarians applying to the program must have a Master of Public Health or equivalent degree, or demonstrated public health experience or course work. EIS officers are assigned to positions at CDC headquarters or in state and local health departments. During two-year assignments, they are trained in applied epidemiology, biostatistics, conducting outbreak investigations, emergency preparedness and response, and scientific communications. They conduct epidemiologic outbreak and other investigations, perform applied research and public health surveillance, serve the epidemiologic needs of state health departments, present at scientific and medical conferences, publish in the scientific literature, and disseminate vital public health information to the media and the public. EIS officers apply their training and skills to actual public health problems and issues, establish mentorships with recognized experts from CDC and other national and international health agencies, and travel domestically and internationally. Since 1951, 195 veterinarians have graduated from the program and gone on to make substantial contributions to public health in positions with federal, state, or local governments, academia, industry, and non-governmental organizations.

U.S. Military Officer Participation in the Centers for Disease Control and Prevention's Epidemic Intelligence Service (1951–2001)

The Epidemic Intelligence Service (EIS) was created in 1951 to provide epidemiologists to investigate natural and intentional disease epidemics. From an initial class of 23 U.S. citizens, the program has evolved into a globally recognized, hands-on learning experience, accepting approximately 65 to 75 new officers each year. The first U.S. military epidemic intelligence service officer (EISO) was accepted into the program in 1994. Since that time, 12 such officers have completed, or have begun, EIS training. They have comprised 2.1% of all EISOs from 1994 to 2001 and 0.47% of all EISOs. This total has included nine Air Force veterinarians, one Army veterinarian, one Army physician, and one Navy physician. Each military EISO had the opportunity to lead investigations of significant public health events (e.g., Ebola, monkeypox, malaria, Nipah virus, West Nile fever, and anthrax outbreaks). All graduates from the military returned to active duty assignments in operational medical units, research institutes, or the intelligence community.

Converging issues in veterinary and public health.

Converging issues in veterinary and public health.