EIS, Epidemic Intelligence Service
The most important organization you may never have heard of
Of course if you are an OCD reader of my previous blogs, you have seen my references to the Epidemic Intelligence Service of the Centers for Disease Control and Prevention (CDC) and its legendary founder, Dr. Alexander Langmuir. Although I had been assigned to audit the course upon entering active duty in the US Public Health Service in 1957 on my way to becoming a “toxicologist” in the Technical Development Laboratories of the CDC in Savannah, GA, and had an abiding interest in this remarkable organization, I hadn’t a clue as to its amazing reach and influence around the world until I read the book, “Inside the Outbreaks, The Elite Medical Detectives of the Epidemic Intelligence Service” by Mark Pendergrast (Houghton Mifflin Harcourt, 2010).
CDC is remarkable for both its geographic and illness span. Although it started as the Communicable Disease Center, with a major focus on all kinds of infectious disease epidemics, it now embraces subjects such as gun violence and environmental toxins such as lead and mercury in culinary water supplies. EIS officers are mostly MDs but the program also includes veterinarians, dentists, statisticians, nurses, anthropologists, sociologists, microbiologists, epidemiologists, etc.
Thanks to the stellar reputation of Dr. Langmuir and his success in attracting only top students to participate in the EIS course, EIS officers have been in high demand throughout the world. EIS officers only go where they have been invited, but their assistance has been requested around the world. These hardy souls have answered the call to places that bear little resemblance to conditions in the US. That can mean eating what the natives eat (Use your imagination) and sleeping in primitive huts. And traveling by whatever is available: bicycle, dogsled, elephant, camel, boats, you name it. They are hardy adventurers who will go anywhere to do what is necessary even at the risk of their own lives. And there have been a few who paid the ultimate price.
Langmuir stressed the importance of doing “shoe leather” epidemiology by which he meant getting out into the field and talking with those most affected by any outbreak. You can’t learn the essentials by staying in your hotel and watching TV and reading the local newspapers. How is the disease spread? Direct contact with bodily fluids (as in Ebola) or droplet and/or airborne as in influenza. What is the incubation period? What percentage of patients are asymptomatic? What percentage fatal? What age distribution? How do you tell when the peak incidence will occur?
The answers to these and other questions requires people in the field collecting data from all appropriate sources. Who are these people? A surprising number come from the ranks of the Epidemic Intelligence Service. These are the frontline troops who merit more attention than they get.
Gordon Short, MD