This week in Atlanta, 80 doctors, veterinarians and other health care workers are descending upon the city. They will be the newest class of disease detectives for the Centers for Disease Control and Prevention. Their job will be to step up at a moment's notice to investigate any type of public health threat, do their best to identify the threat and "fix" it.
These health workers are technically officers of the CDC's Epidemic Intelligence Service or EIS — but disease detectives is much catchier description. For more than 60 years, EIS officers have been identifying the causes of disease outbreaks, probing public health issues, and recommending prevention and control measures. In the early 1950s, they studied the threat of biological warfare during the Korean War era, and most recently they worked on the Ebola outbreak in 2014. So far, more than 3,500 EIS officers have been trained by the CDC.
“CDC’s EIS officers are boots-on-the-ground disease detectives, central to finding and stopping outbreaks quickly," says CDC Director Tom Frieden, M.D., a former EIS officer. EIS officers "are our first line of defense … to prevent, detect, and respond to disease outbreaks. They are essential to protect global health security and keep Americans safe and healthy.”
Each year, 70-80 new EIS officers are selected from hundreds of applicants who apply to the two-year competitive fellowship program. In the first class in 1951, there were 22 physicians and one sanitary engineer in the all-male group. This year, the 2015 class is made up of 40 physicians, 29 Ph.D.s, nine veterinarians, one nurse and one physical therapist. Seventy percent of this year's class are women and 10 are international participants coming from as far away as China, India, Nigerian and Pakistan.
What they do
EIS officers who are accepted into the program get their assignments at the annual conference. Then they learn through on-the-job experience as well as through mentoring, case studies, exercises and classroom instruction.
They spend July in Atlanta for an intensive month-long orientation with courses that cover everything from biostatistics to public health ethics and law. After than, they head to their work assignments in August.
Many EIS officers are assigned to work at the CDC headquarters in Atlanta or other locations across the country. Others hold positions in state or local health department or CDC partner organizations.
Some of the EIS program's more well-known work includes:
Smallpox eradication campaign in Africa
Discovery of the connection between aspirin use and Reye syndrome
Discovery of the association between tampon use and toxic shock syndrome
Emergency response to New York City on 9/11 and to areas affected by hurricanes Katrina and Sandy
Veterinarian Jennifer McQuiston studied rabies and other zoonotic diseases as a CDC disease detective. (Photo: CDC)
What makes a good disease detective?
Veterinarian Jennifer McQuiston became an EIS officer more than 15 years ago, assigned to work on rabies and other zoonotic diseases with the CDC. She's still on staff at the CDC — now as scientific advisor for public affairs.
It takes a very specific sort of person to apply to the program, says McQuiston.
"Medical doctors with a very clinical orientation may not want to leave their practice and what they're doing," she says. "It's for people who love challenges and solving problems. People who love to think of serving the health of an entire community versus the health of an individual. People who love travel."
The class is diverse — not just doctors — because not all outbreaks and disasters require the help of only physicians. And whatever their field or their specialty, one key trait is flexibility, says McQuiston.
"The thing about outbreaks and investigations is that you never know when they are going to pop up. For the two years you are here, you are one of the folks who are going to spring to action. Every EIS officer deployed to work on Ebola, for example. "
EIS officers also typically have a very strong sense of public service.
"We are here as public servants and that's what we do," says McQuiston. "Officers come in with a very strong desire to change the world for the better."
Other important characteristics are the ability to communicate well and, of course, be talented in medicine.
"You also really have to be intellectually curious. Many of the times, the answers are not obvious to the question. These are sometimes brand new pathogens that are emerging so you have to have a very strong sense of intellectual curiosity and be very dogged in sorting out what's happening."
How things have changed
Although McQuiston specialized in diseases that can be transmitted from animals or insects to people, she was available and on-call to work on whatever came up. She was deployed to the World Trade Center on 9/11 and at various times has worked on flu, SARS and polio.
"You are trained in epidemiology and how to apply it to any situation," she says. So what the disease detectives of the '50s were doing may have been different, but the basic principles were the same.
"The tenants of EIS have stayed somewhat the same: being prepared to respond to whatever emergency hits, even though the emergencies change all the time. In 2005, it was to respond to Hurricane Katrina and many of us were deployed there. Some of the things that we're actually quite concerned about now are prescription drug overdoses. It's not exactly what might immediately come to mind, but these are today's issues."
With the broad range of investigations and the chance to make a difference, the disease detective experience truly is unparalleled, McQuiston says.
"If they didn't limit it two years, they'd stay forever."
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CDC disease detective Jefferson Jones (higher in story) investigates an outbreak of tickborne relapsing fever at a high school football camp in Arizona.
CDC disease detective Alex Millman (at right) investigates Chikungunya virus exposure among volunteer workers returning from the Dominican Republic.