GLOBAL HEALTH | Addressing the world’s health challenges
15 April 2008
Disease Detectives Help Communities, Nations with Outbreaks
Epidemic Intelligence Service has trained epidemiologists since 1951
Atlanta -- For every deadly fire or explosion that happens around the world, large numbers of terrified people can be seen running from the devastation. A very few -- emergency responders -- run toward the smoke and flames.
A similar, but less well-known, phenomenon occurs when a lethal virus or bacterium invades a city or country, or an unknown chemical sickens or kills people in a community. When public health is at stake, epidemiologists run toward the danger.
Epidemiology is a branch of medicine that deals with the incidence, distribution and control of disease in a population. Epidemiologists -- sometimes called disease detectives -- do this work, and about 80 a year train in a two-year program called the Epidemic Intelligence Service (EIS) that is part of the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta.
“The subject areas that epidemiologists deal with encompass the entire spectrum of health,” EIS Director Dr. Douglas Hamilton told America.gov, “but the skill sets people use are quite similar. What epidemiologists do is fairly simple -- basically, we count things. And we define populations of interest and look for relationships.”
Most diseases do not happen randomly; they are related to environmental and personal characteristics that vary by place, time and people at risk. Epidemiologists collect data to learn who is prone to a disease, where disease risk is highest, when a disease is most likely to occur and its trends over time, what exposure its victims have in common, and more.
EPIDEMIC INTELLIGENCE
EIS was established with 23 students in 1951 as an early warning system for biological warfare and intentional epidemics. Today it is a surveillance-and-response unit for epidemics, including chronic disease and injuries, all over the world.
Over the decades, EIS officers have played critical roles in epidemics large and small -- in the efforts to eradicate smallpox; identify the method of HIV transmission, fight the U.S. obesity epidemic; and combat outbreaks of malaria in East Africa, measles in Tanzania, Rift Valley fever in Kenya and Zika virus, a relative of dengue, in Micronesia.
The highly competitive program is open to physicians, dentists, veterinarians, scientists and others with graduate degrees, and some without advanced degrees -- nurses, physician’s assistants, pharmacists.
In the current class of 80, Hamilton said, about half are physicians and 10 of the 80 are international students. Approximately 60 percent to 65 percent of students are women and 30 percent to 35 percent are members of ethnic minorities. Salaries range from $50,000 to $87,000 per year, depending on qualifications and experience.
New officers spend about a month in the classroom, getting oriented to public health, Hamilton said. “It gives them a sense of what it’s like to work for the federal government -- we have different responsibilities than say a hospital would -- and gets them to start to function together as a team.”
After that, the officers go on to individual assignments. Each year, about 35 percent of incoming officers are assigned directly to state or local health departments. The other 65 percent are assigned to CDC headquarters to work in areas that include environmental health, injury prevention, occupational safety and health, chronic diseases, infectious diseases and health statistics.
“EIS is training through service,” Hamilton said. “So they’re providing service and that’s how they learn.”
DISEASE DETECTIVES
At their main assignments, the officers conduct epidemiologic investigations, research and public health surveillance; serve the epidemiologic needs of state health departments; present papers at scientific and medical conferences; publish their work in the scientific literature; and communicate public health information to the media and the public.
The other part of their job is to serve on the front lines of national and international outbreaks and emergencies -- running toward the danger.
“When something big happens,” Hamilton said, “everyone goes.”
During the 2001 anthrax attacks against U.S. government offices, he added, “at that point I had 140 officers, and something like 132 of them ended up going out into the field to work on anthrax. With [the devastating 2005 Hurricane] Katrina, we had about 90 officers deployed and they went to Louisiana, Mississippi, Texas and Alabama.”
Since 1951, according to CDC, more than 2,700 EIS officers have responded to requests for epidemiologic assistance in the United States and worldwide.
Recent EIS investigations have included polio eradication in Africa and Asia, school-associated violent deaths in the United States, bioterrorism preparedness, a Hantavirus outbreak in the southwestern United States, West Nile virus outbreaks in the northeastern United States, and Ebola outbreaks in Uganda and the Democratic Republic of Congo.
In October 2006, CDC was asked to investigate several illnesses and deaths from kidney failure in Panama. When the epidemiologists “counted,” Hamilton said, “the one thing the [patients] had in common was cough syrup they had gotten from the government pharmacy.”
“The CDC team did an amazing job of identifying the risk factors, getting samples, shipping the samples back to CDC, and using a brand new lab test to measure diethylene glycol in compounds,” he added. Within about 24 hours, CDC had detected diethylene glycol, a sweet-tasting but highly toxic anti-freeze ingredient, in the cough syrup.
“Our Number 1 priority is to protect the health of the public,” Hamilton said. “And we’re using these skills to answer the questions it takes to do that.”
