Inside Investigations: CDC’s Disease Detective Conference

Groundbreaking and life-saving investigations by CDC EIS officers, also known as disease detectives, are the highlight of the 65th Annual Epidemic Intelligence Service (EIS) Conference May 2-5 in Atlanta. Sessions on Zika, e-cigarettes, and non-traditional investigations into injury, violence, environmental health, and chronic diseases will also be featured at the annual conference sponsored by the Centers for Disease Control and Prevention.

CDC Director Tom Frieden, M.D., M.P.H., opens the conference with remarks on May 2, followed by presentations by members of the recently created Laboratory Leadership Service, a competency-based program similar to EIS focused on training fellows in laboratory quality management, the science of biosafety, and leadership.

Margaret Hamburg, M.D., former FDA commissioner and currently a foreign secretary of the National Academy of Medicine, will present the Langmuir Lecture, the preeminent public health lecture in the United States. Past Langmuir Lecture speakers have included Abraham Lilienfeld, Sir Richard Doll, Geoffrey Rose, and Jonas Salk.

During the past year, many EIS officers supported CDC’s response to the Zika epidemic. They will present:

• Guillain-Barré Syndrome (GBS) Outbreak – Bahia State, Brazil, 2016:

CDC Zika investigators identified a cluster of GBS cases in the Salvador area of Brazil. The location and timing of the GBS outbreak coincided with the introduction and spread of Zika virus in Brazil, suggesting a possible link.

• Zika Virus Disease in Returning U.S. Travelers – 2010-2016: Before the current Zika outbreak in the Caribbean became big news, CDC researchers identified 11 travel-related cases of Zika among travelers returning to the U.S. from visits to Pacific Islands.
• Ongoing Zika virus transmission — Puerto Rico, November 23, 2015–February 15, 2016.  Puerto Rico is at the forefront of CDC’s domestic Zika response. This presentation describes the ongoing EIS investigations of the Zika outbreak in this U.S. territory.

Zika is far from the only health threat EIS officers investigated over the past year. Other featured presentations during the conference demonstrate the wide range of public health activities that EIS officers are involved in at CDC, including:

• Mycoplasma hominis Surgical Site Infections Following Receipt of Amniotic Tissue Product—Ohio, 2015:  CDC investigated a cluster of surgical site infections in Ohio in October 2015. All patients had received an amniotic tissue product from the same donor; investigators found that 27 vials of product from this donor were distributed to 7 states. Of the 9 Ohio patients who received it, 2 developed infections with M. hominis. Amniotic tissue, obtained from the innermost layer of the placenta, is used in wound management – but this CDC investigation demonstrates that the product may not be free of contamination by microorganisms that can result in disease transmission.
• Increased Cases of Syphilis among Pregnant Women and Infants — United States, 2012–2014:

National data show a 25 percent increase in syphilis cases among pregnant women from 2012 to 2014. In 2014, nearly 1 in 4 women with syphilis were pregnant. There was also a 37 percent increase in infants born with syphilis and a 67 percent increase in syphilis-related stillbirths during 2012–2014, although the overall number was small. While nearly half of all syphilis cases among pregnant women in 2014 were in non-Hispanic blacks, the biggest increases during 2012–2014 were in American Indians/Alaska Natives (200 percent) and non-Hispanic whites (47 percent).

• Prevalence of Failure to Floss among Adults – U.S. 2009-2012: Do you floss every day? You should – but if you don’t, you’re not alone. Nearly a third of American adults never floss, and only about 31.5 percent told CDC researchers they flossed every day in the last week. Failure to floss is more common in some groups than in others.
• Getting Too Close to Wildlife: Risk Factors Associated with Injury from Bison Encounters – Yellowstone National Park, 2000-2015:

Bison freely roam throughout Yellowstone National Park. People can be injured when they get too close to the very large, wild animals. CDC and the National Park Service note that people injured by bison generally were within 9 feet of the animal; about half were taking photos. To protect people and bison, the park requires people to view bison at a distance of 75 feet.

• Severe Illness Associated with a Novel Synthetic Cannabinoid – Mississippi, April 2015:

When a clinician at the University of Mississippi Medical Center in Jackson noticed an unusual number of patients seeking emergency care after using synthetic cannabinoids, CDC helped investigate. Of the 721 cases and 9 deaths statewide, investigators took a closer look at the records of 119 UMMC patients, including 3 deaths. Lab analysis showed that 71 percent tested positive for a synthetic cannabinoid – and more than three fourths of the positive tests identified MAB-CHMINACA, a particularly potent synthetic cannabinoid. This outbreak, the investigators report, was “unprecedented in magnitude and severity.”

• Invasive Nontuberculous Mycobacteria Infections among Cardiothoracic Surgery Patients – Hospital A, Pennsylvania, 2010-2015:

Heater-cooler units used to regulate body temperature during open heart surgery may have exposed some 1,300 patients to nontuberculous mycobacteria (NTM) infections at a Pennsylvania hospital, CDC investigators found. The disease detectives were called in to find the source of the infections in a cluster of patients. The findings are the first in the U.S. to suggest that NTM aerosolization by the heater-cooler units might cause invasive infections.

• Violent Death among the Homeless – National Violent Death Reporting System, 17 States, 2005-2013:

About a half million people are homeless in America every day. To better understand violent death in this population, CDC researchers analyzed data from the 17 states participating in the National Violent Death Reporting System from 2005-2013. Homeless homicide victims were 3 times more likely than non-homeless victims to die from injuries inflicted by a blunt or sharp object, and homeless suicide victims were 1.6 times more likely to use hanging as a means of suicide than were the non-homeless.

• Alaska Resident Infected with a Novel Species of Orthopoxvirus – Alaska, 2015: The smallpox vaccine protects against all kinds of orthopoxviruses – but since elimination of smallpox and the end of routine smallpox vaccination, orthopoxvirus infections have begun to pop up. In this case, CDC disease detectives isolated a never-before-seen member of this virus family from an Alaska resident living in a woodland setting in the Alaskan interior.
• Special Session on E–Cigarette Advertising: Invited speakers will address four different perspectives on e-cigarette advertising to young people: social marketing tactics targeted to youth, e-cigarette advertising exposure among middle- and high-school students, comparing marketing claims to laboratory evidence, and policies that might reduce e-cigarette advertising exposure among youth.

Members of the media interested in attending the EIS conference should contact the CDC Media Office at 404-639-3286 or media@cdc.gov. Visit http://www.cdc.gov/eis/conference.html for more information.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES