Dutch Disease Detective Helps Four U.S. States Analyze Bioterrorism Data
Dr. Jennita Reefhuis loves solving puzzles. An epidemiologist from Holland with a background in birth defects epidemiology, Reefhuis was enjoying her first year as a CDC disease detective in the National Center on Birth Defects & Developmental Disabilities when Sept. 11 changed her world.
Rather than attend her brother's wedding in The Netherlands at the end of September, Reefhuis began an odyssey that would take her to four states over two months to assist with a critical, if overlooked, part of bioterrorism surveillance – data analysis.
After the attacks on the World Trade Center and Pentagon, hospitals were on alert for signs of bioterrorism. On September 20, Reefhuis attended meetings at the Washington, D.C. Health Department and was dispatched to the Virginia Health Department where she put her computer skills to use. She helped local officials collect and analyze surveillance data from area hospitals. Fortunately, there were no spikes in emergency room visits that indicated a bioterrorism event at that time.
"We never found anything – we were looking for any kind of bioterrorism – a certain set of symptoms or a combination of those symptoms that could point to a specific disease," said Reefhuis, who returned to Atlanta on October 2.
Two days later, she got another call – this time to go to Florida, where the first case of anthrax had been diagnosed. While some of the CDC disease detectives went to West Palm Beach where the patient lived, Reefhuis headed to the Florida State Health Department in Tallahassee.
"They already had information from emergency rooms all over the state, but they didn't have a system in place to track that information and look for peaks in emergency-room traffic," she said.
Reefhuis spent the weekend in her hotel room on a computer, creating an Excel spreadsheet that state officials could use to quickly compare the number of ER visits reported against the typical number of ER visits to area hospitals.
"If there were a sudden increase in the number of ER visits, that would trigger further attention to determine if the cause was a bioterrorism event," Reefhuis explained. "From early morning to late at night, I tried to get the program to work and I consulted with CDC people to make sure I was setting it up correctly." In the end, she was able to get the program to run smoothly and the state health officials still use the spreadsheet for their emergency room surveillance.
"It sounds very boring, but it's important to have good information in order to make good public health decisions. I love this type of work," said Reefhuis.
Most comfortable dealing with statistical data, Reefhuis admitted she never wanted to be a physician because of the frequent patient contact. Working as an epidemiologist in the EIS has allowed her to focus on the aspects of medicine that have always fascinated her, exploring how the human body works, and solving the puzzle of why it doesn't work in some people."
"For me, being an EIS officer is a perfect job," she said.
Her people shyness was put to the test when the inhalation anthrax trail in New York and Washington led to a postal plant in Hamilton, N.J. Reefhuis was part of the first CDC team deployed to New Jersey on October 18th.
"We got in at 9 p.m. and were placed in a conference room. There were 25 people around the table – all State Health Department and U.S. Postal Service staff," said Reefhuis, recalling that the meeting went until 1 a.m.
She said the task facing the team was huge. "Our goal was to determine the extent and means of exposure, and to prevent further illness," said Reefhuis, who helped create questionnaires and interviewed workers by phone and in person. And while other team members went to talk to patients or set up surveillance mechanisms, Reefhuis was assigned to learn everything about the postal plant – the process of how mail is handled, where it is sent and the location of each employee. She became such a common sight at the plant that one Postal Service supervisor walking with her joked with a group of employees that she would be his replacement when he went on vacation.
Reefhuis said, "We looked at how the postal facility functioned, searching for clues to how some of the workers were exposed to anthrax. We also tried to determine who had been at risk of being exposed and needed to take the antibiotics. We also made sure that all these people knew they needed to take antibiotics to reduce their risk of getting sick. Another purpose of determining the mail flow in the facility was to try to explain how people that did not work at the facility could have contracted anthrax."
After testing for spores throughout the plant, Reefhuis and other team members determined that the public section of the plant was clean. As a result, they assured the public that visited that part of the facility that they faced no risk of contracting anthrax and did not need medication. Approximately 1,069 workers and 178 business visitors who entered the non-public area of the plant were offered antibiotics as a preventive measure.
"In every assignment, I have been able to use something from my previous experience. In Florida I used my statistical skills and in New Jersey, I used my background in occupational epidemiology," she said.
Reefhuis, who went to New Jersey twice in November, finally returning on November 17, said she is certain of one thing: the EIS and CDC can be depended upon to respond when they are called.
"As a whole, all of us feel good about being able to help. I feel very honored," she said. "In EIS, you have a group of people who are willing to go out at a moment's notice. We have a unique range of qualities – MDs, epidemiologists and social scientists – who can investigate any disease. If you called and said it was urgent, you could get 40 people to go this afternoon without a problem. They would go anywhere…without even knowing the destination."
