Feature

They have been called "disease detectives" or the James Bonds of the medical profession: the Epidemic Intelligence Service (EIS) officers who scope the country looking for clues on epidemics that could undermine the nation's health and safety.

And since Sept. 11, they have been keeping a watchful eye on bioterrorism threats and preparing for biowarfare.

A handful of psychologists--now turned epidemiologists--are among them. As EIS officers, they are ready to respond at a moment's notice to public health emergencies--from data collection and analysis to quarantines and mass immunizations.

"Those who are a part of EIS are prepared to enter into a wide variety of situations and to respond and assess public health situations--whatever the particular situation is," says psychologist W. Rodney Hammond, PhD, director of the Centers for Disease Control and Prevention (CDC) Division of Violence Prevention. Currently, his role is to provide training assignments for EIS officers.

EIS, a unit of the CDC, was formed in 1951 as a warning system against biological attack, largely due to fears that the Russians were developing biological agents. Despite these fears, officers haven't had to deal with a bio-war attack in 50 years--until the anthrax cases following the Sept. 11 attacks.

A total of 136 EIS officers assisted state and local public health agencies in the weeks following Sept. 11; officers were deployed to New York, Florida, New Jersey, Washington, D.C., and Connecticut to monitor for signs of bioterrorism-related illnesses. Thirty-four EIS officers--the largest single deployment to one location in the program's history--were called to New York City Sept. 14 to monitor the types of injuries and illnesses.

"Unfortunately, there is concern that we will have to deal with the threat of bioterrorism again," says Doug Hamilton, EIS program director. "I guess the program has come full circle."

Psychologist and EIS officer Rachel Avchen, PhD, was part of the first EIS team to arrive Sept. 14 in New York City. Most of the 34 officers were assigned to emergency departments at hospitals near the World Trade Center. Avchen was one of three assigned to monitor the type of injuries and illnesses among rescue workers. Her team noticed inhalation problems of rescue workers at ground zero, which led to obtaining better respirators.

COMBINING DISCIPLINES

Each year 65 to 75 EIS officers are chosen for the two-year postgraduate program, where officers receive on-the-job training in epidemiology with assignments at state and local health departments or the CDC headquarters. "I was interested to get in a research setting, and [EIS] gave me an opportunity to develop certain research skills," says clinical psychologist Drue Barrett, PhD, a 1994 EIS alumna. "Psychologists learn to deal in individual settings, and in EIS, you learn to deal with the population perspective...by looking at health in a broader sense."

While in the program, Barrett worked as an EIS officer in CDC's Cardiovascular Health Program. She analyzed data on the association between alcohol use and physical activity level, as well as evaluated the risk factors for cardiovascular disease by state. Barrett also assisted the EIS response team in New York in assessing the needs of residents living near ground zero. From Atlanta, she helped the team select an appropriate, existing standardized measure of post-traumatic stress disorder (PTSD) cases around ground zero. While under no obligation to assist after finishing the EIS program, Barrett volunteered because of her background with investigating and measuring PTSD.

"When you come to EIS, you are not treated differently because you are a psychologist," Barrett says. "People come in with a variety of backgrounds, and they are all given the same training."

EIS officer Hammond says the diversity of the program is part of its attraction. "The beauty of EIS is that many disciplines combine to do the EIS work," he says.

Originally, EIS included mostly physicians who concentrated on infectious diseases. But, as the epidemiology program matured, "we have tried to address a wide spectrum of health problems and have moved on to chronic disease, environmental issues, injuries and violence," Hamilton says. "The scope of the focus has expanded and the type of people applying to the program has diversified."

About 25 percent of the program is now PhD-level scientists in the social or behavioral sciences, nutrition, biostatistics or epidemiology.

EIS officers' far-reaching work in the last 50 years has included leading a worldwide effort to eradicate smallpox in the late 1970s, restoring public confidence in polio vaccines during a polio epidemic in 1955, and identifying how the AIDS virus is transmitted. More recently, officers have investigated E. coli, hantavirus, West Nile virus, the obesity epidemic and patterns in suicide and homicide.

"When you look at the kinds of major health problems concerning this century, there is no question that environment, lifestyle and behavior combine to create the major health issues that we are trying to prevent," Hammond says.

Psychologists are an important segment in helping to fight many of these issues, he adds. "Psychologists have a unique form of interest and expertise that can contribute greatly when they become part of the public health community, such as EIS," Hammond says.

EXPANDING CHALLENGES

Since Sept. 11, the EIS program has expanded officer training to respond to growing threats of bioterrorism.

"There have been a number of changes since 9/11, but the basic focus of the program remains unchanged--training people in applied epidemiology and applying it to a whole spectrum of areas in public health," Hamilton says.

Officers now receive an extra week of training before they are assigned to a department. The four-week "overview" training in epidemiology contains one week devoted just to bioterrorism agents, such as chemical and radiological agents, and smallpox.

Officers also receive training in risk communication (such as how to most effectively communicate the relative risk) and mental health responses to disasters--areas where Hamilton says a psychologist's background is especially helpful.

The outlook for the EIS program is promising: Last October, U.S. Department of Health and Human Services Secretary Tommy Thompson testified to the Senate Appropriations Subcommittee that more highly trained experts in epidemiology were needed. The EIS program has since received additional funding and increased class size this year.

For Avchen, her term is coming to an end. However, she plans to continue the work she did as an EIS officer at CDC's National Center on Birth Defects and Developmental Disabilities.

As a psychologist, Avchen focused on children with developmental disabilities. As an EIS officer, she was able to apply that research and encourage policy change to reduce those risks.

"I never wanted to be doing research just for the sake of doing research. I wanted it to have an application," Avchen says. "That's why public health appealed to me so much."

Further Reading

For more information on EIS, visit www.cdc.gov/epo/dapht/eis.