Accurate epidemiologic information is essential for making good decisions about developing, implementing, monitoring, and evaluating health policies. To ensure the quality of information gathered, CDC created the Epidemic Intelligence Service (EIS) in 1951. Since then, approximately 32 countries have developed field epidemiology and allied training programs (FETPs) based on the EIS model, all sharing a common principle of training through service.
In the 1990s, work began to create a unified global network, and in 1999, the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) was formed. TEPHINET is dedicated to strengthening international public health capacity by enhancing competencies in applied epidemiology and public health practice. Nearly all of the 32 FETPs in the network began as partnerships between national ministries of health, the Division of Epidemiology and Surveillance Capacity Development (formerly the Division of International Health) of CDC's Coordinating Office for Global Health, and the World Health Organization (WHO).
This supplement to the MMWR highlights the work of epidemiologists who have graduated from TEPHINET member programs. The articles were developed from abstracts presented in Beijing, China, at the Third Global Scientific Conference of TEPHINET during November 8--12, 2004. Major funding for the conference was provided by the Bill and Melinda Gates Foundation. Approximately 230 field epidemiologists from 40 countries participated to share best practices and new ideas in field epidemiology, surveillance, response, and training. The reports selected for publication in this supplement focus on the contributions TEPHINET members and their trainees and graduates have made in surveillance of and response to emerging infectious diseases. They reflect the broad impact of the training programs.
Field epidemiology trainees studied major emerging problems of global concern (e.g., avian influenza in Thailand) and common outbreaks (e.g., salmonellosis and varicella in China). Trainees applied their skills to investigate occupational injuries in Zimbabwe, evaluate a tuberculosis control program in Kazakhstan, and adapt statistical methodologies used for industrial quality control to estimate vaccination coverage in India. The Canadian contribution highlights the application of epidemiologic methods to improve product safety for cochlear implants, and two papers discuss how to use case-control methodology to identify risk factors for brucellosis in Kyrgyzstan and neonatal tetanus in Uganda.
A key characteristic of TEPHINET members' training-through-service programs is their location in national ministries of health. This enables TEPHINET to offer global and regional organizations access to public health professionals who conduct surveillance and respond to health threats. Network members serve more than half of the world's population, including the United States (Figure). Just as EIS provides critical personnel for the U.S. public health system, FETPs in TEPHINET provide essential staff to their own countries and regions.
As founding members of TEPHINET, WHO and CDC maintain close partnerships with the organization. With assistance from WHO and CDC, TEPHINET is piloting a continuing quality improvement process that is expected to lead to steady improvement in the quality of science and level of service that FETPs provide. In addition to its training and capacity building role, TEPHINET is a member of WHO's Global Outbreak Alert and Response Network (1) and provides experts for WHO investigative teams.
The new International Health Regulations require each nation to have competent public health personnel for epidemic surveillance and response (2). TEPHINET and its member programs will be major participants in achieving this goal. TEPHINET, WHO, and CDC are currently working together to create new FETPs in seven countries or regions worldwide.
Much of the work of FETP staff, trainees, and graduates is accomplished as they fulfill duties in their national public health systems and has not been published. Because of the value of this applied science, we are pleased at this opportunity to share a selection of the many excellent studies produced by TEPHINET member programs and their graduates.
Stephen B. Blount, MD
Roberto Flores, MD
The following persons assisted in the publication of this supplement: Edmond F. Maes, PhD, Angeli Abrol, MHSc, Linda Carnes, DrPA, Georgina Castro, MPH, Ra Shel Cromwell, MPH, Kathy Harben, Valerie Kokor, MBA, Brenda Lawver, Sharel Mitchell, Patricia Simone, MD, Coordinating Office for Global Health, CDC.
The following persons served as peer reviewers for these proceedings: Frederick J. Angulo, DVM, PhD, Thomas Clark, MD, Nancy Rosenstein, MD, Division of Bacterial and Mycotic Diseases, David Shay, MD, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Janet Blair, PhD, Career Development Division, Office of Workforce and Career Development; Maryam B. Haddad, MPH, MSN, Division of TB Elimination, National Center for HIV, STD, and TB Prevention; Rafael Harpaz, MD, John S. Moran, MD, Epidemiology and Surveillance Division, John Stevenson, MS, Immunization Services Division, National Immunization Program; Mark Papania, MD, Office of the Chief Science Officer, Bettylou Sherry, PhD, Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion; Victor M. Caceres, MD, Robert Fontaine, MD, Karen Gieseker, PhD, Rubina Imtiaz, MBBS, Donna Jones, MD, Edmond Maes, PhD, James M. Mendlein, PhD, Henry Walke, MD, Mark White, MD, FACPM, Coordinating Office for Global Health, CDC.
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Date last reviewed: 4/6/2006