Review: Inside the outbreaks: the elite medical detectives of the Epidemic Intelligence Service by Mark Pendergrast

     Some of the most dangerous and fascinating work in the world goes on every day--right under or even inside our noses.  Mark Pendergrast's new book, Inside the outbreaks, documents years of heroic efforts by epidemiolists of the Epidemic Intelligence Service (EIS) to detect causes and preventions of deaths around the world.  It is truly amazing what these investigations cover, from hvac systems to health supplements, from house paint to mosquitoes. Any of these routine items can become deadly, given the right mistakes or oversights.  In many aspects, our lives are much more secure than our parents' or our grandparents'--and yet, new challenges and risks emerge every day. These people walk into hospitals where children are dying in the dozens, they fly into places where their planes are shot at, they ride or walk into remote villages where everyone has died. 
   One investigator was working on a salmonella outbreak in Connecticut and found that many of the patients were children, and these children owned turtles.  Visiting one house, the mother insisted that her boy always washed his hands after handling the turtle.  The investigator went to get a water sample and couldn't locate the turtle. The boy was "storing" it in his mouth.
   Another case involved septicemia cases associated with  hospital IV sets. Here the investigator solved the mystery by cutting apart the IV bottles and testing the components, ultimately finding that the soft plastic cap liner was the responsible agent, a new introduction switched from rubber. A clear example that change is not always a good thing.
   Social and economic issues play a huge role in public health--in the 1970's an investigation in Alabama found high lead blood levels in factory workers. After submitting his report to authorities, investigator Richard Levine came in to find his desk ransacked and all copies destroyed. And the state health officer tried to get Levine recalled.
   In more recent decades, EIS officers travel around the world.  Sudan, Somalia, Serbia, Rwanda--wherever violence has brought refugees, crowding and the subsequent diseases, EIS has gone. These heroes deserve our recognition.