Epidemic Intelligence Service (EIS)
The Epidemic Intelligence Service (EIS) is a specialized program within the U.S. Centers for Disease Control and Prevention (CDC) that trains public health investigators to respond to infectious disease outbreaks and bioterrorism threats. Established in 1951, EIS was conceived during the Cold War to prepare the U.S. for potential biological attacks and to strengthen the nation's ability to manage disease crises. Over the years, its training has evolved to include a diverse range of professionals, encompassing various fields such as epidemiology, pharmacology, and veterinary medicine.
EIS officers undergo rigorous training similar to medical residency programs and are deployed to investigate disease outbreaks worldwide. Their work involves collecting data, analyzing disease transmission, and implementing control measures, which has included responses to notable health emergencies such as the COVID-19 pandemic and bioterrorism incidents. Since its inception, EIS has tackled over ten thousand cases globally, contributing significantly to public health advancements, including the eradication of smallpox.
With approximately 87% of its graduates pursuing careers in public health, the EIS has played a pivotal role in shaping health policies and practices both in the United States and internationally, aiding in the development of epidemiological training programs in multiple countries.
Epidemic Intelligence Service (EIS)
Definition
The Epidemic Intelligence Service (EIS) is a US government program that trains scientific professionals as public health investigators. The EIS is part of the Centers for Disease Control and Prevention (CDC).
Creation and Purpose
Cold War concerns regarding the potential of biological warfare motivated government scientists, including epidemiology expert Alexander Langmuir, to prepare effective medical defenses against epidemics infecting large populations. After World War II, Langmuir became chief epidemiologist at Atlanta's Communicable Disease Center (now called the Centers for Disease Control and Prevention). He emphasized surveillance techniques to evaluate the occurrence and distribution of diseases affecting groups. Seeking to train more epidemiologists to work for the CDC to document outbreaks, study pathogens, and reduce bioterrorism risks, Langmuir and colleagues created EIS in 1951.
Langmuir presented his goal for EIS in a March 1952 article in the American Journal of Public Health, stressing the need for epidemiologists who can quickly respond to infectious disease crises. He reported that the initial EIS recruits began training in Atlanta in July 1951 before conducting fieldwork for the remainder of a two-year commitment to EIS. Langmuir stated that EIS officers provided an essential epidemiological resource if the United States faced a biological attack. In peacetime, EIS personnel would aid in the comprehension of how infectious diseases are transmitted and how they can be prevented and controlled.
Selection and Training
EIS retained its basic structure into the early twenty-first century, adapting to incorporate scientific and medical developments and address evolving infectious diseases concerns. Initially, EIS sought applicants who were physicians. By the late twentieth century, EIS recognized the importance of an interdisciplinary approach, encouraging applicants with expertise in pharmacology, biostatistics, nutritional sciences, epidemiology, veterinary medicine, laboratory science, and other fields that complement public health work. EIS expects applicants to have earned professional degrees in their specialties and to have secured relevant licenses. Because EIS investigations often occur in other countries, administrators consider qualified applicants from countries outside the United States who can gain a security clearance to access restricted information and laboratory materials.
Approximately sixty to ninety people are selected annually to join EIS out of several thousand applicants. Several weeks of coursework begin in Atlanta every year in July, in a program often compared with a hospital residency. Each EIS officer receives a position with health departments or CDC centers, such as the National Center for Emerging and Zoonotic Infectious Diseases, which focus on specific concerns. EIS officers perform various professional tasks, including writing scientific reports for the CDC’s Morbidity and Mortality Weekly Report and attending the annual EIS conference, held each April.
EIS also offers several medical and veterinary medicine students the chance to participate in EIS epidemiology investigations for one to two months before they graduate from medical school. Some of those students are later selected for the main EIS program.
Disease Response
EIS officers respond to disease emergencies by traveling to infected areas, including disaster zones, immediately after learning of outbreaks. They collect specimens, interview patients, analyze the causes and transmission of diseases, and immunize vulnerable or high-risk populations. EIS also sends representatives to areas affected by unidentified (and emerging) diseases.
Early EIS investigations frequently involved the diseases of histoplasmosis, rabies, and norovirus infection. EIS officers have also assisted in controlling diphtheria epidemics, developing therapeutic oral hydration to treat cholera, and identifying pathogens associated with Legionnaires’ disease and acquired immune deficiency syndrome. They determined that the West Nile virus is transmitted to humans by mosquitoes. EIS personnel also developed methods to counter lethal microbes, including Lassa, Ebola virus, and hantavirus. They have investigated SARS, H1N1 influenza, and the proliferation of antibiotic-resistant microbes that spread infectious diseases.
After the terrorist attacks of September 11, 2001, EIS officers were dispatched to New York City and Washington, DC to survey sites around Ground Zero and the Pentagon for signs of biological warfare. EIS officers also investigated the distribution of anthrax spores through the US mail. EIS officers participate in bioterrorism exercises as part of their training to prepare as first responders in biological attacks. As the twenty-first century progressed, EIS officers also placed crucial roles in the COVID-19 pandemic of the early 2020s, as well as the mpox outbreak of 2022 and 2023.
Impact
By the early twenty-first century, the EIS had investigated more than ten thousand cases on six continents. A significant public health success attributed to EIS personnel includes eradicating smallpox.
As of 2023, approximately 87 percent of the estimated four thousand EIS graduates have pursued public health work after they completed their EIS service, extending the reach and influence of EIS. The number of state epidemiologists and health officials who received EIS training continues to grow. Four EIS alumni have served as directors of the CDC. Former EIS officers also have been leaders in organizations such as the Infectious Diseases Society of America, the National Foundation for Infectious Diseases, and the World Health Organization.
EIS representatives have assisted other countries in establishing epidemiological services, such as the Field Epidemiology Training Program (FETP) and the Field Epidemiology and Laboratory Training Program (FELTP). By 2023, FETP and FELTP had been established in eighty countries, many in Asia and Africa. EIS alums also helped create the European Programme for Intervention Epidemiology Training, a program that serves countries of the European Union.
Bibliography
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Altman, Lawrence K. "An Elite Team of Sleuths, Saving Lives in Obscurity." The New York Times, 6 Apr. 2010, p. D-5.
"Epidemic Intelligence Service: Promotion and Recruitment Tools." Centers for Disease Control and Prevention, www.cdc.gov/eis/recruitment.html. Accessed 2 Oct. 2024.
"Field Epidemiology Training Program (FETP)." Centers for Disease Control and Prevention, 17 Sept. 2024, www.cdc.gov/global-health-protection/php/programs-and-institutes/field-epidemiology-training-program.html. Accessed 2 Oct. 2024.
Koo, Denise, and Stephen B. Thacker. "In Snow’s Footsteps: Commentary on Shoe-Leather and Applied Epidemiology." American Journal of Epidemiology, vol. 172, no. 6, 2010, pp. 736-739.
Koplan, Jeffrey P., and Stephen B. Thacker. "Fifty Years of Epidemiology at the Centers for Disease Control and Prevention: Significant and Consequential." American Journal of Epidemiology, vol. 154, no. 11, 2001, pp. 982-984.
McKenna, Maryn. Beating Back the Devil: On the Front Lines with the Disease Detectives of the Epidemic Intelligence Service. New York: Free Press, 2004.
Pendergrast, Mark. Inside the Outbreaks: The Elite Medical Detectives of the Epidemic Intelligence Service. Boston: Houghton Mifflin Harcourt, 2010.
Scalera, Diana Robelotto. "Ready to Protect the Public's Health at a Moment's Notice: The Epidemic Intelligence Service." CDC Foundation, 16 Apr. 2018, www.cdcfoundation.org/blog/ready-protect-publics-health-moments-notice-epidemic-intelligence-service. Accessed 2 Oct. 2024.