Epidemic assistance by the Centers for Disease Control and Prevention: role of the Epidemic Intelligence Service, 1946-2005.

Since 1946, the Centers for Disease Control and Prevention has responded to urgent requests from US states, federal agencies, and international organizations through epidemic-assistance investigations (Epi-Aids). The authors describe the first 60 years of Epi-Aids, breadth of problems addressed, evolution of methodologies, scope of activities, and impact of investigations on population health. They reviewed Epi-Aid reports and EIS Bulletins, contacted current and former Epidemic Intelligence Service staff, and systematically searched the PubMed and Web of Science databases. They abstracted information on dates, location, staff involved, health problems, methods, and impacts of investigations according to a preplanned protocol. They assessed the methods presented as well as the quality of reports. During 1946-2005, a total of 4,484 investigations of health events were initiated by 2,815 Epidemic Intelligence Service officers. In the early years, the majority were in response to infectious agents, although environmental problems emerged. Investigations in subsequent years focused on occupational conditions, birth defects, reproductive health, tobacco use, cancer, violence, legal debate, and terrorism. These Epi-Aids heralded expansion of the agency's mission and presented new methods in statistics and epidemiology. Recommendations from Epi-Aids led to policy implementation, evaluation, or modification. Epi-Aids provide the Centers for Disease Control and Prevention with the agility to respond rapidly to public health crises.

Perspective: Swine-origin influenza: 1976 and 2009.

I am in a unique situation, having been involved in 2 major US public health events resulting from novel swine-origin influenza viruses. In 1976, I was Director of the Center for Disease Control (CDC, the name of the agency at the time) when a new influenza virus, characterized as an influenza A(H1N1) swine virus, was isolated from military recruits at Fort Dix, New Jersey. Subsequently, I led the CDC through the US response to this outbreak, which culminated in the decision to implement the swine flu vaccination program during which 45 million people were vaccinated over 10 weeks. The program was stopped after cases of Guillain-Barré Syndrome were identified following vaccination and when no spread of the virus occurred beyond Fort Dix. In 2009, as another new swine H1N1 virus was first identified and emergency response began, I was asked to be an advisor to the CDC Director in order that I might provide historical context to the novel H1N1 swine-origin outbreak and response. In this latter capacity, I have been able to observe and participate in discussions resulting in decision-making for the CDC's national response to this public health emergency as an unpaid consultant. This paper is a personal commentary on the similarities and dissimilarities of the 2 episodes.

Reflections on the 1976 swine flu vaccination program.

In 1976, 2 recruits at Fort Dix, New Jersey, had an influenza like illness. Isolates of virus taken from them included A/New Jersey/76 (Hsw1n1), a strain similar to the virus believed at the time to be the cause of the 1918 pandemic, commonly known as swine flu. Serologic studies at Fort Dix suggested that >200 soldiers had been infected and that person-to-person transmission had occurred. We review the process by which these events led to the public health decision to mass-vaccinate the American public against the virus and the subsequent events that led to the program's cancellation. Observations of policy and implementation success and failures are presented that could help guide decisions regarding avian influenza.