Disease detectives

An epidemic intelligence service, to combat outbreaks of illness before they spread, is much needed

Now in its second year of training, India's so-called epidemic intelligence service (EIS), run by the National Centre for Disease Control, frames a welcome effort to equip public health professionals to be the bulwark of the country's defence system against communicable diseases. Modelled on a US programme of the same name, and a result of the collaboration with the Centres for Disease Control and Prevention in Atlanta, Georgia, the EIS will comprise medical professionals trained in the science of tracking down outbreaks of illness as they occur, so as to stop them before they spread, across states.

In the US, where the EIS originated in 1951 as an early warning system against a covert biological attack, the service has successfully battled polio, cholera, the ebola virus and smallpox, to name just a few. For India, where, according to 2008 data, an estimated 21 per cent of deaths were caused by infectious and parasitic diseases, the fight against communicable disease forms an essential component of the public health challenge. As the annual rash of reports about recurrent Japanese Encephalitis or Acute Encephalitis Syndrome shows, the current system is inadequate to both detect the origins and prevent outbreaks of such diseases.

It is true that many of India's public health problems could be dramatically reduced with better sanitation, hygiene and clean water. But while old factors driving ill-health persist, India is in a state of epidemiological transition, as evidenced by the emergence of new strains of bacteria immune to antibiotics. As such, it is important that practitioners are able to investigate outbreaks, design and analyse epidemiological studies and evaluate surveillance data, particularly as big data in healthcare becomes ever more useful in generating and suggesting predictive interventions. There is also a global dimension. Seventy five per cent of recently identified emerging infectious diseases affecting humans are zoonotic in nature and are thought to have originated in developing countries. As SARS and H1N1 showed, new and deadly pathogens can quickly overtake the protocols to arrest their spread. The EIS would build India's capacity to respond to these challenges by equipping healthcare professionals with the epidemiological skills critical for generating evidence, while strengthening reporting systems for both common and unusual diseases.

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