In praise of CDC's heroic 'disease detectives'

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Almost 25 years ago, I began my career at CDC as an Epidemic Intelligence Service (EIS) officer assigned to the New York City Health Department. I investigated outbreaks of measles, typhoid, cryptosporidiosis, multidrug-resistant tuberculosis and more.  It was a remarkable time – two years of important, interesting learning and doing things that make a difference in people’s lives.

CDC’s EIS officers are boots on the ground disease detectives, central to finding and stopping outbreaks quickly.

Every day, EIS officers think about how they can do their job smarter, better, faster.

A disease detective tracking Ebola in Africa spearheaded the creation of a new tool to speed up one of the most difficult parts of disease detection: finding everyone exposed to and possibly infected by someone with a contagious disease. This task, called "contact tracing," is a key part of the on-the-ground work it takes to break the chain of disease transmission and end an outbreak.


That disease detective was EIS officer Ilana Schafer. She was in Uganda during the 2012 Ebola and Marburg hemorrhagic fever outbreaks.  Her job was to create and maintain centralized databases for the government and its NGO partners. Frustrated by the chaotic process, she told CDC’s Epi Info team on her return, “There has to be a better way to do this. People are dying and we can’t collect, analyze and act on the data fast enough.”

The result is an app that works well in places with limited network connectivity. It automatically updates as new information is added, and offers daily reports to guide follow-up. It’s being used now in the West Africa Ebola outbreak.

The development of this app coincides with the launch of the U.S. government’s Global Health Security Agenda to strengthen our national security by helping other nations prevent, detect and effectively respond to disease outbreaks.

Over the next five years, the initiative will strengthen the health infrastructure of at least 30 partner countries with 4 billion people. CDC and the Defense Threat Reduction Agency are investing $40 million this year in the effort, and we have requested an additional $45 million for this purpose in next year’s federal budget.

EIS is a global model for training in applied epidemiology. Since the 1980s, we’ve helped 40 other countries develop their own similar training like the Field Epidemiology Training Program (FETP). Trainees and graduates of these programs find and stop hundreds of outbreaks a year, usually without CDC’s direct involvement, which is exactly what we hope to see more of.

Most recently, two current FETPs and one graduate from FETP-Kenya went to Liberia to assist in the response to the West Africa Ebola outbreak. The Global Disease Detection Center in Kenya also sent a senior epidemiologist – a physician who had done his EIS training in the Ebola program – to Liberia.

Who takes on a job that requires them to go to places where disease is spreading? Who’s interested in a job that offers the same benefits reportedly advertised by Ernest Shackleton as he prepared to sail for the Antarctic in the early 1900s? ("Men Wanted for hazardous journey, small wages, bitter cold, long months of complete darkness, constant danger, safe return doubtful, honor and recognition in case of success.")

It turns out they’re a special breed and the CDC staff actually are generally averse to honor and recognition.

When I was in Uganda last year, I visited the cave where two tourists got the deadly Marburg virus in 2007. The cave is home to a python at least 12 feet long as well as more than 10,000 bats, many of which are infected with Marburg, a virus as deadly as Ebola but which didn’t have a movie made about it. Of these threats, what did my CDC colleagues tell me was the most concerning?  “It’s not the python or the Marburg…. It’s the cobras!” The cave is also home to deadly cobras, so our staff not only wear white biohazard suits but also leather chaps to guard against a cobra bite.

Recently I talked with a CDC scientist headed to work on the West Africa Ebola outbreak to set up a serology laboratory in Guinea. Beside her was a suitcase weighing 60 pounds with all the protective gear and lab equipment she must carry along. On her computer was a screensaver of her beautiful 18-month-old child, and we talked about what drives someone like her to be gone three weeks away from her family in hazardous conditions, deployed to help track this deadly virus and end the outbreak.  Not surprisingly, what drives her is her commitment to her job and to protecting people.

Marburg, Ebola and many other deadly diseases are out there. Early in April, a traveler returning to the U.S. from West Africa was thought to possibly have Ebola; the CDC lab tested specimens and found that he had Lassa hemorrhagic fever, a severe viral disease common in West Africa but seldom seen here. The patient was given supportive treatment and recovered.  This is the sort of potential disease outbreak CDC works to protect our county against every day.

EIS officers and their CDC-trained counterparts around the world are our first line of defense – our boots on the ground to prevent, detect and respond to disease outbreaks.  They are essential to protect global health security and keep Americans safe and healthy.