The professional activities of EIS graduates demonstrate the significant contributions they make to the practice of public health. Approximately one hundred of them have been or are state epidemiologists, sixteen have been state health commissioners, and twelve have been deans of schools of public health. Others have had important positions at universities and colleges, such as chancellors, deans, and department chairs.

1. In the works, an Epidemic Intelligence Service
by Dr.Mahboob ali khan Phd
In a first of its kind move to deal with communicable diseases in the country,
India has quietly started training a small batch of public health professionals in
association with the Centers for Disease Control and Prevention (CDC),
Atlanta, to become part of an elite Epidemic Intelligence Service (EIS).
This was one of the agreements in the memorandum of understanding signed
during the visit of US President Barack Obama in November 2010, between the
National Centre for Disease Control (NCDC), CDC, Ministry of Health and the
Department of Health and Human Services of the US.
It also included establishment and operation of a Global Disease Detection
Centre in India, for which $926,666 was sanctioned for the first year.
The first EIS batch of 2012 with eight trained personnel will graduate in 2014
— there were 12 seats but all didn't get filled because of a very rigorous
selection process. With high hopes from the programme, the capacity has been
increased to 15 for the class of 2013 though the ministry insists that should the
right candidates not be found, seats would continue to be kept empty.
The two-year programme gives training in preventing disease outbreaks,
identifying them at inception if and when they happen, mitigating the impact
and taking immediate steps to manage the situation. The idea is to have mostly
regular employees of central or state health service or equivalent (local
autonomous bodies), apart from three self-sponsored candidates. The number of
self-sponsored candidates can be increased as per need. The applicants have to
hold at least MBBS and MD degrees, or MBBS degree with several years of
experience.
The candidates that are sponspored by the state are to receive their salaries for
the duration of the programme, while others are given a stipend of Rs 40,000
per month. There are plans to place such candidates in national programmes, but
there is no bond for these candidates to serve in government as the priority at
the moment is to have trained professionals, regardless of whether they work in
the private or public sectors.The Epidemic Intelligence Service (EIS) of the

2. Centers for Disease Control and Prevention (CDC) is a training program that,
since 1951, has trained over two thousand public health professionals in applied
epidemiology. It has had a significant impact on the practice of epidemiology
throughout the world.
In the 1940s, the U.S. Public Health Service (a uniformed service of the U.S.
government) developed an Office of Malaria Control in War Areas,
headquartered in Atlanta, Georgia, for the purpose of developing methods to
control and prevent malaria among the armed forces located both in the United
States and in areas of conflict— primarily in Southeast Asia. In 1946, the office
had successfully met its mission in developing appropriate control and
prevention measures, and it was no longer necessary to have approximately two
thousand professionals working solely on malaria. Dr. Joseph W. Mountin,
assistant U.S. Surgeon General, developed the concept of a Communicable
Disease Center (the original name of the CDC) dedicated to investigating
communicable diseases and developing appropriate control and prevention
measures. Alexander D. Langmuir, a professor at Johns Hopkins University
School of Hygiene and Public Health, was recruited as the senior epidemiologist
at the newly designated CDC.
Langmuir recognized the need for a cadre of epidemiologists who could
conduct investigations of the causes of epidemics from which control and
prevention measures could be identified. At the same time, the Korean War
raised concerns about biological warfare in the United States, and a major
defense would be the availability of epidemiologists who could immediately
investigate potential threats. The wisdom of developing such an applied
epidemiology training program was recognized, and twenty-two physicians and
one sanitary engineer began their training at EIS in July 1951.
From this initial endeavor the program has grown into an exemplary applied
epidemiology training program. Today, EIS officers are selected from a large
number of applicants for the sixty-five to seventy-five positions available each
year. Approximately 80 percent of incoming officers are physicians, with the
remaining being veterinarians, nurses, statisticians, demographers, biologists,
microbiologists, dentists, sanitary engineers, behavioral social scientists, and
other professionals. The incoming officers may have just completed their

3. professional training, or they may have had one or several years of experience
in their professional areas—which may have included work in public health.
The objectives of the EIS program are to train public health personnel in
epidemiology, provide epidemiologic services to states and other municipalities,
investigate disease and injury as they occur in communities, and develop and
recommend appropriate control and prevention measures.
The two-year training course begins with a three-week course that includes
discussions of the principles of epidemiology, biostatistics, public health
surveillance, field investigations, and laboratory science; and of specific
diseases prevalent throughout the United States and the world. A community
survey is conducted and hands-on computer training is also included.
Following this classroom training, the EIS officers are assigned to a specific
program either at CDC headquarters, in a field station, at another federal
agency, or at a state (or large city) health department for their two-year
commitment. The important criteria for an assignment is that the EIS officer
will have close supervision from a trained field epidemiologist and
opportunities to participate in epidemiological investigations.
The concept behind this applied, hands-on training is that epidemiology is best
learned by working on epidemics in communities as they occur, initially with
close supervision from an experienced epidemiologist. In addition to
responsibilities for field investigations, the officers will have other ongoing
responsibilities, such as working on public health surveillance, handling public
inquiries, writing reports, training other personnel in epidemiology, and
assisting in planning activities. During the two years in the EIS program, the
officers will also participate in some specialized short training programs and in
the annual one-week EIS Conference held every April.
EIS officers work on the full spectrum of public health problems, both
domestically and internationally. Initially, the emphasis was on infectious
diseases, but the focus has evolved to include all health conditions. Each year
EIS officers conduct hundreds of disease investigations. Major contributions
have been made in portraying the epidemiology of infectious diseases and
identifying appropriate control and prevention measures for hospital-acquired
infections, food-borne and waterborne diseases, respiratory diseases, and

4. emerging or reemerging infections such as Legionnaire's disease, toxic shock
syndrome, HIV/AIDS (human immunodeficiency virus/acquired
immunodeficiency syndrome), sexually transmitted diseases, hantavirus
pulmonary syndrome, and multi-drug-resistant tuberculosis. There has also been
strong epidemiological input in reproductive health, environmental and
occupational health problems, nutritional problems, chronic diseases, birth
defects, unintentional injury, and violence.
EIS officers are on call twenty-four hours a day, seven days a week. Depending
upon the situation, a multidisciplinary team can be rapidly assembled and
dispatched, and may include statisticians, laboratorians, nurses, veterinarians,
physicians, administrators, public-relations personnel, and secretaries from the
EIS and other CDC programs. Additionally, any laboratory or other equipment
not available in the field can be assembled by the team.
In all circumstances, approval has to be received from the appropriate
governmental agency or foreign government before the CDC team can travel to
the area in which the epidemic is occurring. The team will then remain in the
field as long as necessary in order to meet the objectives of the investigation.
Before departing a verbal report is given to the appropriate authorities,
following which a written report is prepared and distributed to those with a need
to know.
At the present time, there are approximately 2,500 alumni of the EIS program.
Approximately 75 percent of EIS graduates work for federal, state, or local
governments, or for international organizations in public health. Another 15
percent are on the staff of academic institutions, while most others are in a
private hospital-based practice. Though these individuals are not working
directly with public health, they serve as an important group of practicing
professionals who have been trained in preventive medicine and who continue
to stress prevention in their daily private practices.
The excellence of the EIS training has been recognized throughout the world,
and each year several health professionals from other countries are selected to
participate in the EIS program. However, the need for trained epidemiologists in
other countries has been greater than can be satisfied through the EIS program.
In 1979 the concept of a Field Epidemiology Training Program (FETP) was

5. developed with strong support from the World Health Organization's Southeast
Asia Regional office in Delhi, India. The first FETP was initiated in Thailand.
In addition to increasing the opportunities to provide hands-on training of a
country's own health professionals, the FETP makes it possible to train students
in each nation using their own health problems and resources. In 2000 there
were twenty FETP programs located throughout the world from which more
than nine hundred individuals have graduated. These two-year training
programs are patterned after the EIS program in the United States but modified
to meet the epidemiologic needs of each specific country.
Another activity developed by the EIS program is an epidemiology elective for
fourth-year medical and veterinary students. This is a one to two month
experience in the EIS program and provides opportunities for the students to
become familiar with field epidemiology. To date, 632 medical and veterinary
students have rotated through this program, participating in field investigations,
analyzing data, and attending meetings and conferences. Seventeen percent of
the medical students have returned to join the EIS program and more than 8
percent of them have continued in a public health career after graduation.
Another aspect of the EIS program is a preventive medicine residency program.
Officers who desire this additional training spend an extra year at CDC, and
split their time between headquarters and field assignments.
The professional activities of EIS graduates demonstrate the significant
contributions they make to the practice of public health. Approximately one
hundred of them have been or are state epidemiologists, sixteen have been state
health commissioners, and twelve have been deans of schools of public health.
Others have had important positions at universities and colleges, such as
chancellors, deans, and department chairs.
The concept of hands-on field experiences in the training of applied
epidemiologists has resulted in strengthening the practice of epidemiology and
public health in the United States as well as throughout the world. As the
emphasis on healthy people continues, and with the increasing recognition of
the importance of disease and injury prevention, the need for trained
epidemiologists experienced in applied epidemiology is apparent. The EIS
program helps satisfy this need.