Epidemic Intelligence Service (EIS)
History of the EIS
- Threat of Biological Warfare. The Korean War brings the threat of biological warfare. As a result, the EIS training program begins under the leadership of Alexander D. Langmuir, MD, MPH. The first class is composed of 22 physicians and one sanitary engineer. EIS officers quickly become known as the "disease detectives."
- Polio Epidemic. During the national polio epidemic, EIS officers trace 260 polio cases to unsafe vaccines made in California’s Cutter Laboratories by setting up a national surveillance system. In a matter of weeks, surveillance and epidemiologic investigation restores public confidence and confirms the vaccine's safety when produced under rigid controls. By 1956, half as many polio cases are reported as the year before.
- Asian Flu. The Asian flu pandemic emerges in Hong Kong with millions of cases and thousands of deaths. EIS officers quickly set up a surveillance system enabling national control activities for the United States.
- Cancer Cluster. CDC expands its reach into chronic disease by sending EIS officers to investigate a cancer cluster in Niles, Illinois. As a result, CDC discovers a connection between leukemia and birth defects.
- Global Population. CDC becomes involved in tackling global population issues, assigning an EIS officer to work on family planning.
- Smallpox Eradication. CDC formally begins the worldwide smallpox eradication campaign in Africa. In 1977, the last case of smallpox is reported. Two years later, the world is declared smallpox-free.
- Malnutrition and Famine. EIS officers work in the Nigerian-Biafran war zone, further expanding into malnutrition and famine relief. Paul Schnitker becomes the first and only EIS officer to die in the line of duty when his plane crashes en route to Nigeria.
- NIOSH. The National Institute for Occupational Safety and Health (NIOSH) becomes part of CDC. EIS officers begin research into occupational health.
- Lead Exposure. EIS officers join the local health department in El Paso, Texas, to investigate lead exposure associated with an ore smelter. This investigation increases the scientific understanding of lead poisoning in children. Many studies have since documented the public health threat, including lower IQs among children, posed by poorly controlled lead emissions from lead smelters around the world. The United States removed lead from gasoline in 1976.
- Vinyl Chloride. EIS officers investigate liver cancer deaths of B.F. Goodrich employees in Louisville, Kentucky. A new occupational hazard, vinyl chloride, is discovered, and the Occupational Health and Safety Administration (OHSA) sets standards.
- Lassa Fever. The EIS helps set up a field laboratory in Sierra Leone to study the cause of the deadly Lassa fever found in Lassa, Nigeria, in 1969.
- Ebola. EIS officers go to Zaire and Sudan to investigate a mysterious fever that sends its victims into shock with massive external and internal hemorrhages. Of 318 people infected, 280 (90%) die. This new illness is named after a nearby river, Ebola.
- Legionnaires Disease. CDC investigators discover that a bacterium causes Legionnaires disease. This finding solves two earlier mysteries—a 1965 outbreak in Washington, D.C.'s St. Elizabeth's Hospital and a 1968 outbreak in Pontiac, Michigan (referred to as "Pontiac fever") that left more than 60 county health workers ill. In a 1976 epidemic, 221 people became sick and 34 died following an American Legion Convention in Philadelphia. More than 20 EIS officers investigated this outbreak.
- Reye Syndrome. An EIS officer suspects a connection between aspirin use and Reye syndrome, a rare neurological disease found mainly in children. Reye syndrome kills 40% of its victims and leaves many others brain damaged. After studies in Ohio and Michigan, articles are published revealing its connection to aspirin.
- Environmental Health. The EIS expands work into environmental health, investigating a major heat wave sweeping the Midwest. High-risk groups, such as the elderly, chronically ill, infants, and urban dwellers, are identified. Surveillance provides evidence for preventive measures and policy changes, including providing transportation to air-conditioned shelters.
- Toxic Shock Syndrome. EIS investigations quickly find an association between toxic shock syndrome (TSS) and menstruating women. Tampons are revealed as a major cause, leading to one brand's removal from the market.
- HIV/AIDS. An EIS officer and a Los Angeles physician publish an MMWR article describing the occurrence of Pneumocystis carinii pneumonia among homosexual males. This was the first major article on what later became the HIV/AIDS pandemic.
- Toxic-Oil Syndrome. In May, an outbreak of severe lung disease occurs in Spain. EIS officers aid the Spanish government and find a connection to the use of an illegally marketed industrial oil sold door-to-door as cooking oil. By December, more than 13,000 people are hospitalized, and 246 die from toxic-oil syndrome (TOS).
- Intentional Food Poisoning. The EIS investigates outbreak of Salmonella food poisoning in a small Oregon town caused by intentional contamination of restaurant salad bars by members of a religious commune. This the first known bioterrorist event in the United States. Two commune members served time in prison for their role in the event.
- HIV Seroprevalence Surveys. EIS officers assist state and local health departments in conducting HIV seroprevalence surveys. This comprehensive surveillance approach helps public health organizations monitor the levels of HIV infection in high-risk populations and prioritize, target, and evaluate HIV prevention activities.
- Eosinophilia-Myalgia Syndrome. EIS officers investigate the association between the use of L-tryptophan (LT), and Eosinophilia-myalgia syndrome (EMS). LT was a common dietary supplement used for insomnia, depression, and PMS. CDC informs state health departments of a newly recognized syndrome. EMS spurs one of the first nationwide non-infectious epidemic surveillance projects.
- Hurricane Andrew. After Hurricane Andrew decimates much of southern Florida, EIS investigators find an extensive need for mental health services following disasters.
- E. coli.Hundreds become ill with bloody diarrhea. An EIS officer traces the outbreak to E. coli-contaminated hamburgers served at a fast-food chain in four western states within the United States.
- Drinking Water. In Milwaukee, 403,000 people become ill from drinking water contaminated with Cryptosporidium, a protozoan parasite. EIS officers investigate this outbreak which leads to the adoption of a federal mandate for all water utilities to test for Cryptosporidium once a month.
- Kidney Failure. In Haiti, 86 children are diagnosed with acute anuric renal (kidney) failure, and 77 die. An investigation of the outbreak finds that the children had consumed a locally manufactured acetaminophen syrup later found by CDC to be contaminated with diethylene glycol (DEG). Following a recall and public information campaign, new cases decline sharply.
- West Nile Virus. EIS officers investigate an unusual outbreak of encephalitis in a limited area of the northeastern United States. The diagnosis is West Nile virus, which is transmitted from mosquitoes to birds and humans. As a result, state public health departments conduct intensive mosquito and vector control activities. Surveillance continues as a preventive measure.
- Bioterrorism. CDC increases efforts in bioterrorism preparedness, training EIS officers to recognize the signs of a bioterrorism event during disease outbreaks.
- 9/11 Terrorist Attacks. EIS responds to the attack on the World Trade Center. Thirty-four EIS officers deploy to New York City, the largest-ever single deployment to one location (at that time).
- Intentional Anthrax Attacks. EIS investigates the first case of intentional infection of anthrax in Florida. The resulting investigation reveals 22 cases in multiple locations. Preparation for a potential bioterrorism attack spotlights the importance of identifying unusual health events early and executing a quick, coordinated response to prevent large-scale infections.
- SARS. The SARS outbreak begins in China and rapidly spreads as infected people fly internationally. The disease spreads to 29 countries before it is contained. Over 100 EIS officers are involved, with 18 officers who deploy internationally.
- Hurricane Katrina. CDC deploys 98 EIS officers to areas affected by the hurricane and evacuation centers.
- H1N1 Pandemic Flu. EIS responds to the emergence and spread of H1N1, which results in unusually high influenza activity in the United States throughout the summer and fall of 2009. At its highest level, 49 states report widespread influenza infection.