/ BY JACQUELINE
DETWILER /I
↓ THE BODY MECHANIC
COLUMNS28 April 2019 _ PopularMechanics.comF YOU WERE a Facebook friend of Dr. Daniel Pastula
around 2014, you might have started to wish you’d gone
to medical school. In one photo he posted, he was drink-
ing a frozen cocktail on an island in Micronesia called
Yap, where giant stones were once used as money. In
another, he was wearing sunglasses on the beach in
Fiji. At the time, Pastula was an officer in the Centers
for Disease Control’s Epidemic Intelligence Service (EIS),
a two-year training appointment often called the “disease
detective program.” He was in Yap to investigate and man-
age an outbreak of the mosquito-borne virus chikungunya.
In Fiji, it was dengue and Guillain-Barré.
The EIS program was started during the Cold War to
create a group of people who could be quickly deployed to
halt outbreaks such as those from, for example, biological
weapons. When a health department requests urgent
help from the CDC, at least one EIS officer and/or other
subject-matter experts travel to the front line, whether
it’s in Miami or Sierra Leone. Together with local health
officials and clinicians, they determine whether there is
a legitimate epidemic, create a list of cases, and put out a
health advisory. Then they do what’s called descriptive
epidemiolog y—graphing the who, what, where, and when
of the cases involved. Then they try to figure out why.
One of the CDC’s most complicated recent mysteries
struck a dozen kids who lived along the front range of the
Rocky Mountains in late summer 2014. The children all
came dow n w ith a cold, followed by wea kness in their arms
or legs. Some had a drooping face. It wasn’t polio, but itlooked similar. The CDC put out a call: Was there anyone in the current EIS
classes with a specialty in spinal cord lesions? There was.
Pastula, who is now an assistant professor of neurology, infectious dis-
eases, and epidemiolog y at the University of Colorado School of Medicine
and Colorado School of Public Health, packed a bag and drove down to Den-
ver to meet the people who had been working with the sick children. Naming
the new disease acute flaccid myelitis (AFM), the team started making histo-
grams of when the disease had occurred (called epicurves), and maps of where.
One prevalent theory was that a respiratory virus that had been striking peo-
ple around the same time, called enterovirus D68, was responsible for AFM.
“It had some plausibility because enterovirus D68 is related to the poliovirus,
although it hadn’t really been described to cause this,” says Pastula. But it was
difficult to prove: You’d have to biopsy the children’s spinal cords, which could
further damage them. The team collected samples of the fluid that surrounds
the brain and spinal cord (cerebrospinal fluid) as a proxy measure, but they
couldn’t consistently find any particular virus.
The outbreak abated naturally
in late 2014, but has returned
twice, in 2016 and 2018. Five
years later, the CDC still doesn’t
know what causes A FM, but they’re
disinclined to give up. A lab at
CDC Atlanta is currently using
advanced genetic sequencing tech-
niques to search for previously
undetected viruses in the samples
in advance of the next outbreak,
expected in 2020. (Many think
the two-year pattern has to do with
herd immunity and when children
who have been totally unexposed
to the virus reach the age when
infection is likely.) They’re also
considering genetic and immuno-
logical factors that could explain
why some children get AFM and others don’t. “Epidemiology assumes two
things,” says Pastula. “Diseases don’t happen at random, and there are risk
factors that affect your chance of getting them.” Until AFM is solved, the CDC
will be looking for those factors. You can find them on the front lines, wash-
ing the heck out of their hands.What Is the Epidemic
Intelligence Service?
A two-year training program for
doctors, nurses, veterinarians, and
certain categories of public-health
researchers, the EIS exists so that
the CDC can shift resources around
the world whenever a disease
threatens public health. People in
the program undergo four weeks
of lectures and training at CDC
Atlanta, nicknamed epidemiol-
ogy boot camp, and then can be
deployed to locations around the
world to investigate urgent out-
breaks on the ground. There are 120
to 160 EIS officers at any time.Inside the Centers for Disease
Control’s Cold War–era training
program to halt epidemics.The Disease
Detectives
A Centers for Disease Control Epidemic Intelligence
Service training exercise. (The bodies are mannequins.)