CDC Detectives Respond to Disease Outbreaks

CDC's Epidemic Intelligence Service (EIS) officers are elite global health sleuths.

EIS officers are epidemiologists, statisticians, veterinarians and doctors. In the event of a suspected disease outbreak, they are called on to answer key questions: what is causing people to get sick? How can we prevent disease from spreading and how can we prevent another outbreak? They are on CDC′s front lines, working 24/7 to save lives and protect people from health threats. As the best of the best, these Officers will continue to respond to the current outbreak, as they have responded to hundreds in the past. CDC′s Epidemic Intelligence Service is a unique two year program of service and training for health professionals interested in the practice of epidemiology, the study of the causes, distribution, and control of disease in populations.

Photo: Officer giving vaccinations in the field

Every year, CDC selects 70 to 80 individuals from among the nation′s top health professionals to enter the program and pursue training in applied epidemiologic skills.

CDC EIS officers must be ready to assist 24/7 when asked. In the US, local and state health departments that can′t find the source of a new public health problem can then request federal health agencies to help.
Like investigators at the scene of a crime, disease detectives begin by looking for clues and gathering information about what happened. Disease detectives have various jobs and may work in different places, such as in laboratories where they look for viruses, or bacteria in blood samples, or in public locations where an unknown outbreak is occurring.

Solving Mysteries around the World

In late September, 2006, headlines declared a "mystery illness" responsible for numerous deaths and almost two dozen seriously ill patients in the Latin American nation of Panama. As the Minister of Health, Camilo Alleyne, worked to keep people informed and calm, officials from the ministry and the Gorgas Memorial Institute of Health Research (GMIHR) in Panama City requested help from the CDC, Pan American Health Organization (PAHO), and U.S. Food and Drug Administration (FDA) in tracking the unknown killer.
Originally there were far more questions than answers: Is it contagious? Is it somehow related to West Nile Virus? Dengue fever? Influenza? No one knew for sure.

Doctors working in the Social Security hospital recognized and began to track a pattern of sickness; diarrhea and feverprogressed to acute kidney failure, paralysis, and death. It seemed to strike mostly men over 60 who were receiving treatments for high blood pressure, diabetes, or kidney disorders. The doctors reported the suspicious pattern to the Ministry of Health, which requested international help.

Closing in on a Killer Disease

Photo: Officer taking notes in the field

The director of GMIHR contacted CDC Global Health offices on October 2. CDC′s Global Disease Detection (GDD) division immediately began coordinating CDC′s response. Dr. Joshua Schier led CDC′s deployment team, which included two medical epidemiologists, a laboratorian, a neuro–epidemiologist, a bi–lingual epidemiologist, and risk communication specialist. They and others hit the ground running in Panama, gathering medical samples from patients, as well as from a variety of suspected poisoning sources, and sending them back to the labs in Atlanta.

Early evidence, such as no clustering of sickness within families and the fact that no healthcare providers were getting sick, suggested the event was not contagious. CDC′s team still tested specimens of kidney and nerve tissue while simultaneously examining products such as high blood pressure medication and simple cough syrup found in patients′ homes. Just nine days after the CDC team landed in Panama, diethylene glycol (DEG) – often used as an industrial solvent and component of antifreeze and brake fluid – was isolated as the deadly culprit.

“From the start, this took a lot of effort from a lot of people," says Dr. Carol Rubin, then chief of the Health Studies Branch, NCEH. "This amazing collaboration identified the probable cause of this syndrome within a remarkable 11 days of the initiation of the investigation by the Ministry of Health." Thanks to solid epidemiological detective work and constant evidence gathering on the ground in Panama, the answer was found.

Since 1951, over 3,000 EIS officers have responded to requests for epidemiologic assistance within the United States and throughout the world. Yet, CDC′s EIS program is only one part of a complex public health infrastructure designed to protect people from emerging disease threats at home and around the globe.