EIS: Beyond Infectious Disease

When most people think of CDC's Epidemic Intelligence Service, infections like HIV/AIDS, Ebola virus, and hantavirus immediately come to mind. Those people are not wrong, they just don't have the whole story. Ask Rachel Avchen, a CDC disease detective who investigates ways to prevent developmental disabilities among children.

As a recent graduate with a Ph.D. in applied developmental psychology, Avchen concluded that one way to use her degree to its greatest advantage would be as part of CDC's elite cadre of disease detectives who help to protect the world's health and safety by preventing and controlling diseases and injuries.

"As an EIS Officer, I can impact society through public health, and translate the research that I do into real life situations," says Avchen.

While the EIS is known for the eradication of small pox from the planet, and investigations of outbreaks such as West Nile encephalitis and Ebola virus, Avchen would like people to know that the EIS focuses on more than infectious disease, but also birth defects and developmental disabilities, chronic disease, environmental hazards and injuries.

Recently, Avchen found herself on the frontlines of defense in assisting a community in California. A non-profit organization that serves children with visual impairments reported finding a greater number of blind infants due to retinopathy of prematurity, a condition that can occur in premature babies. Retinopathy of prematurity is caused by the detachment of the retina in the eye. Although the condition can often be corrected, it can lead to blindness if not caught early enough.

Avchen flew to California to investigate whether the elevated numbers in retinopathy of prematurity actually represented an increase in this community. After analyzing the files against an operational case definition, she and her colleagues concluded that there weren't enough cases that actually met the criteria to constitute an increase. Avchen and her co-team leader, EIS Officer Sharon Durousseau, recommended ways the organization could better track cases in order to determine the true number of retinopathy of prematurity cases themselves.

More recently, Avchen loaned her expertise to an investigation of kernicterus in full-term infants, a preventable disease that causes brain damage and that starts with severe jaundice. Members of a non-profit organization led by parents of children with kernicterus were concerned about the number of children developing the disease.

Jaundice results from too much bilirubin, a part of the red blood cell that is left after the cell dies. Elevated levels of bilirubin can cause a baby to look yellow or orange. Severe and untreated jaundice can cause kernicterus, a type of brain damage that can lead to anthetoid cerebral palsy, hearing loss, and vision and dental problems. It is easy to prevent kernicterus by placing severely jaundiced babies under a special lamp.

"For a child with kernicterus, a simple thing like writing is difficult, because mentally the child may be saying 'I want to write my name', but physically the child cannot get his hand down to the paper," Avchen says. "Stories like this make kernicterus real." The parents concerned about kernicterus were anxious for answers and Avchen was under pressure to move quickly.

Avchen and her colleagues worked expediently to provide information about kernicterus to parents and health care professionals.

In June 2001, Avchen published an article in CDC's Morbidity and Mortality Weekly Report.

"We were able to quickly inform public health officials across the country about cases of kernicterus in otherwise healthy term infants with jaundice," Avchen says.

Avchen is now hoping to pursue surveillance of kernicterus to determine the magnitude of the problem.

After EIS, Avchen plans to continue working in the public health arena.

"I think it is important not only to analyze data, but to apply that knowledge to real-life circumstances."