EIS Comes Full Circle with Renewed Bioterrorism Surveillance

Dr. Kristy Murray is used to keeping her bags packed. Currently the sole EIS officer focused on bioterrorism preparedness, Murray can be called at a moment's notice to potential incidents at any point around the globe. Since joining the EIS in 1999 and being assigned to CDC's bioterrorism preparedness and response program in Atlanta, Murray has been involved in several investigations, including investigating an outbreak of unknown illness in New York City that later turned out to be West Nile encephalitis.

"During my second week as an EIS officer, I was called to help with the investigation. It was unusual because it was a cluster of cases of encephalitis," recalls Murray. "A cluster of unexplained illnesses could be a key indicator for bioterrorism. Other red flags could be cases of pulmonary anthrax or large numbers of people becoming ill in a short period of time. However, early on, the characteristics of this epidemic were thought to be consistent with a natural outbreak."

Like all EIS officers, Murray's job is to isolate the cause of an outbreak, prevent its spread and get out public health messages to people who could have been exposed. The 28-year old veterinarian and graduate of Texas A&M University is among the youngest in her EIS class. Murray says she always planned to be a veterinarian specializing in small animal medicine until she discovered the excitement of public health service while doing field work for CDC as part of a post-doctoral fellowship.

"I really enjoy being off at a moment's notice and not really knowing what's going to happen next," she says.

Her detective work helped public health authorities determine that the West Nile virus was transmitted through mosquitoes, prompting officials to take steps to control the mosquito population. Murray has since helped set up a national surveillance system to track West Nile virus, focusing on early-warning signs such as increased fatalities among birds and horses, who often are struck with the virus before humans.

In November 1999, Murray was part of a team that traveled to Seattle when the local health department asked CDC to help set up disease surveillance at area hospitals for infectious diseases that could possibly originate from an act of bioterrorism during the World Trade Organization (WTO) conference. Officials anticipated thousands of protesters, from environmentalists to trade union leaders, who came to oppose the WTO's free-trade stance. Fortunately, no public health threat materialized.

"We were set up in eight emergency rooms and were looking for spikes in different syndromes consistent with an early epidemic that might be related to bioterrorism," says Murray, who did face her share of hazards. She found herself caught in the middle of clashes between riot police and angry protesters while commuting between the hospital and her hotel.

"I'm probably one of the only EIS officers who can say they've been tear gassed in the line of duty," she says.

Murray also participated in bioterrorism exercises at the local, state and federal level, including exercises in Denver, New Orleans and Baltimore, and one organized through the military at Ft. Benning, Georgia. During the exercises, CDC and local public health and law enforcement personnel simulated how they would respond to an actual bioterrorism event to test the readiness of the local and federal public health infrastructure, clarify roles and improve teamwork across organizations.

"My role as the EIS officer was to determine what was going on biologically – to find the common link to the outbreak using classic epidemiology and to get out public health messages to people who could have been exposed. Exercises like these and strengthening our public health infrastructure will prepare us to detect, respond to, and prevent outbreaks more quickly."

She expresses pride in being part of the bioterrorism surveillance effort. "Bioterrorism concerns during the Korean War in the 1950's led to the establishment of the EIS. We've almost come full circle."

According to Murray, the renewed focus on bioterrorism is a result of better awareness in the United States of biological weapon capabilities in other countries, underscored most recently by Iraq during the Persian Gulf War. The 1984 outbreak of Salmonella food poisoning in Oregon caused by intentional contamination of restaurant salad bars is the only known case of bioterrorism in the United States.

Murray notes that all states now have bioterrorism coordinators and more resources in the form of CDC grants to strengthen states' public health infrastructure and capability to track diseases, whether from bioterrorism or not.

"Not only will we be able to respond more quickly to a bioterrorism event, we also will be able to better handle natural outbreaks, which is good for everyone," she says.

As her EIS assignment comes to an end in July 2001, Murray hopes to continue to work in the public health arena with a career at CDC.

"I love what I do. When I get up in the morning, I want to go to work. I think I'm very, very lucky."