Boots on the Ground: Reports from CDC’s Disease Detectives

The Centers for Disease Control and Prevention (CDC) is holding its 67th annual Epidemic Intelligence Service (EIS) Conference April 16-19, 2018 in Atlanta. The annual gathering of disease detectives showcases cutting-edge investigations and often life-saving outbreak responses by EIS officers and their laboratory counterparts, the Laboratory Leadership Service (LLS) fellows.

“CDC’s EIS officers are our front line of defense for health threats both domestically and abroad,” said CDC director Robert R. Redfield, MD. “These dedicated professionals deploy more than 200 times in any given year to help investigate outbreaks and respond to other public health crises, and the knowledge we gain during EIS investigations helps inform future prevention efforts that save lives and protect people’s health.”

CDC principal deputy director Anne Schuchat, MD, will open the conference with remarks on April 16.

This year, the conference incorporates four special sessions that will explore critical public health topics, including the Rohingya refugee crisis in Bangladesh, the need for innovative use of “big data” in public health, the 1918 influenza centenary, and the U.S. opioid overdose epidemic.

Another new feature: on April 17, four EIS officers will give a behind-the-scenes look at their investigations in a TED-style talk. The TED-style talks will cover:
• Using geographic information systems (GIS) to conduct a vaccination campaign in Somalia.
• Tracking, testing, and building lab capacity for Legionella.
• Preventing HIV and the untold story of men who have sex with men in rural America.
• Discovering the inadequate nutritional value of food among incarcerated people during a foodborne outbreak investigation.

On April 18, the 20th Surgeon General of the United States, Vice Adm. Jerome M. Adams, MD, MPH, will give this year’s Alexander D. Langmuir Lecture on “Better Health through Better Partnerships.” Adams is committed to maintaining strong relationships with the public health community and forging new partnerships with non-traditional partners, including business and law enforcement. He oversees the operations of the U.S. Public Health Service Commissioned Corps, which has approximately 6,500 uniformed health officers who serve in nearly 600 locations around the world to promote, protect and advance the health and safety of our nation and our world.

During the past year, EIS and LLS officers have conducted responses to numerous public health threats. Noteworthy presentations at this year’s conference include:

• Occupational patterns in drug and opioid overdose deaths-Drug overdose mortality in the United States has increased by 137 percent between 2000 and 2014, largely driven by opioid-related overdoses. Opioids are often prescribed for work-related injuries, which can vary by occupation. Six occupational groups had significantly higher mortality from drug overdose, including: construction, extraction (e.g., mining), food preparation/serving, healthcare practitioners, healthcare support, and personal care.

• Post-traumatic stress symptoms among international humanitarian aid workers-International relief projects commonly take place in the context of political upheaval, putting aid workers at high risk for violence and exposure to human suffering that can lead to negative mental health outcomes. This investigation identified five potential risk factors for post-traumatic stress in aid workers: previous treatment for mental illness, being female, older age, having children, and fewer organizational support services.

• Initial public health laboratory response after Hurricane Maria-Within 27 days of Hurricane Maria, CDC’s lab team identified 16 CDC and state health laboratories to perform specimen testing on five high-priority infectious diseases (rabies, influenza, leptospirosis, salmonella, and tuberculosis). The response resulted in a sustainable specimen transport system that reestablished clinical testing and surveillance of priority infectious diseases in Puerto Rico, and informed public health interventions.

• Arsenic toxicity associated with dietary mineral supplements- Ingredients in dietary supplements are not independently verified. This investigation identified dietary supplements with arsenic concentrations that may increase risk for cancer and other illnesses.

• Hepatitis A outbreak among homeless people- Hepatitis A virus outbreaks can occur in settings with poor sanitation and crowding. This investigation identified that a Hepatitis A outbreak in Arizona among homeless people was molecularly identical to an outbreak in San Diego.

• Mental, behavioral, and developmental disorders among children living in poverty-An estimated 17.4 percent of U.S. children aged 2 to 8 years old had at least one diagnosed mental, behavioral, or developmental disorder. Children living in poverty were more likely to have a mental, behavioral, or developmental disorder (22.1 percent) compared to children who were not living in poverty (13.9 percent).

• Salmonellosis outbreak at a chili and chowder cook-off-After a chili and chowder cook-off featuring 11 local vendors, which was attended by about 2,500 chili and chowder aficionados, the Accomack County Health Department received reports of gastrointestinal illness among event attendees. Epidemiologic and laboratory analyses provided evidence that a specific chowder was the most likely outbreak source; however, the original source of Salmonella is unknown.

• Monkeypox re-emerging in Nigeria-Nigeria had no reported cases of monkeypox between 1978 and September 2017, when the disease came roaring back. This ongoing outbreak is the largest of the West African clade of monkeypox ever recorded (216 suspected cases, 80 confirmed cases, and five deaths were recorded from 14 out of 36 states as of January 31, 2018).

Source: CDC