Tuesday, May 11, 2010, 6 p.m. — Mark Pendergrast will discuss his book, Inside the Outbreaks, and sign books afterward. Dartmouth Bookstore, 33 North Main Street, Hanover, NH 03755-2098. Phone: 603-643-2348.
Archive for March, 2010
July 22, 2010, 7 p.m. — Mark Pendergrast will be discussing his book, Inside the Outbreaks, at the Flying Pig Bookstore in Shelburne, Vermont, and signing books afterwards. 5247 Shelburne Road, Shelburne, VT 05482. Phone: 802-985-3999.
Thursday, April 29, 2010, noon — Mark Pendergrast will appear on Vermont Public Radio’s “Vermont Edition” show to discuss Inside the Outbreaks, issues facing public health, and respond to callers on this live show. Email your questions and comments to Vermont Edition any time to email@example.com. To call in during the live broadcast at noon call 1-800-639-2211.
Thursday, May 6, 2010, 7 p.m. — Mark Pendergrast will be giving a talk about his book, Inside the Outbreaks, at the Burlington, Vermont, Barnes & Noble bookstore and signing books afterwards, at 102 Dorset Street, South Burlington, VT 05403
March 28, 2010
In the United States, diarrhea is usually considered a nuisance, the subject of jokes. But in the developing world, diarrhea kills some 2 million children a year. It is the third leading cause of death in children under five, and the leading culprit is unclean water. In 2006, I followed EIS officer Ciara O’Reilly in rural Western Kenya, near Lake Victoria, as she and her colleagues assessed the impact of the Safe Water System (SWS) in selected elementary schools. In Inside the Outbreaks, in Chapter 22, I wrote about this trip. Earlier in the book I explained the origin of this inexpensive, low-tech solution. It started with horrendous cholera outbreaks in Africa and then in 1991 cholera leapt to Peru, the first appearance in Latin America in nearly a hundred years. If untreated, cholera can kill within 24 hours due to dehydration. (My book also relates the invention of “oral rehydration solution,” a life-saving drink, but that’s another story). EIS officers discovered that even when water was properly treated to kill bacteria, it was often re-polluted when people dipped water out of storage containers, since their hands carried the germs. So the CDC began to supply not only a dilute bleach solution (called WaterGuard in Kenya) but to provide narrow-mouthed water containers, the opening too small to allow a hand to enter. There are spigots near the bottom.
As I saw in rural Kenya, the Safe Water System works. Absenteeism and illness among students in the schools were down in contrast to the control schools without the program. I also saw the source of the water some of the schools were drinking. A ten minute walk from one school led to a stagnant pool of fetid water. As we watched, emaciated cows, their ribs showing, came over to drink. An old man, a member of the local Luo tribe, also came up and began to yell across the ravine, waving his arms and pointing at his head. Our translator told us what he was saying. The water made people sick, crazy in the head. A local Catholic charity had promised to dig a well, but then the priest spearheading the effort was killed in a car crash, and it never happened. Please help!
Obviously, the Safe Water System is a stop-gap measure. In an ideal world, all people should be able to turn a tap and fill a glass with clean water. But the huge cost of this infrastracture improvement is unlikely to be diverted from our spending on weapons, etc., in the near future. So in the meantime, the SWS is a valuable tool. After her two-year EIS service, Ciara O’Reilly, an Irish native, stayed on with the CDC in Atlanta and is working to bring cleaner water to the world.
Studies in seven countries on three continents have yielded a consistent result: use of the SWS decreased diarrhea risk by around 40% (though it does not kill viruses – rotavirus is a major child-killing cause of diarrhea, the subject of another blog perhaps). Through partnerships with dozens of organizations from all sectors (private, NGO, UN, governments, community groups), the Safe Water System has been instituted in over 20 countries and protects three million people per month. CDC and its partners are now trying to figure out how to get the SWS to more people — particularly the world’s poorest people. The CDC has engaged schools, clinics, and HIV self-help groups to expand access to ever-more-remote locations.
Wednesday, April 21, 2010, 12:30 p.m. Mark Pendergrast will give a presentation about the Epidemic Intelligence Service at the annual EIS conference on April 21, 2010, at 12:30 p.m. – 1:30 p.m. It is held at the Crowne Plaza Hotel, Atlanta Perimeter at Ravinia in Atlanta, GA, just off the perimeter highway I-285, at 4355 Ashford Dunwoody Road. Pendergrast will discuss the importance and evolution of the EIS, giving specific examples. He will also discuss the process of research and writing Inside the Outbreaks. The EIS conference is free and open to the public, and it is one of the best and most varied scientific conferences out there — and few know about it. Anyone can register at http://www2a.cdc.gov/eis/conference/register_OPEN.asp. Note: On-line registration will close on April 5th. For general information about the conference, see http://www.cdc.gov/eis/Conference.html.
Welcome to my first blog. (Actually, I wrote a different essay originally, but Amazon wanted to run it as an exclusive entry on their website for my book, so that’s where you can read it.) I plan to write a new blog entry once a week (on Sundays), but we’ll see whether I can stick to that schedule. My new book, Inside the Outbreaks, a history of the Epidemic Intelligence Service (a part of the CDC) is due out in April. I just got a copy of the book, so it is off the presses. It took over five years to research and write. I wished that I could write it more quickly, but it was a complex story involving many different characters and diseases. It certainly kept my attention the entire time. Still, everyone I knew kept telling me that now would be the perfect time for the book to come out. Hurry up!
Avian flu was exploding around the world! Monkeypox had invaded America’s heartland!
Hurricane Katrina devastated New Orleans, and EIS officers descended.
Here in Vermont, an unusual number of people in a state office building in Bennington came down with sarcoidosis, a mysterious, still unexplained disease.
In Panama, EIS officers traced 46 children’s deaths to a liquid expectorant cold medicine contaminated with diethylene glycol sold by a Chinese firm as harmless glycerine.
Rift Valley fever struck in northeastern Kenya.
Cans of Castleberry’s canned Hot Dog Chili Sauce caused botulism in the United States.
A bizarre neurological illness in Minnesota slaughterhouse workers was traced to aerosolized pig brains.
Marburg and Ebola virus struck in Uganda, while Ebola killed in the Democratic Republic of the Congo, then hit Uganda.
Children across the U. S. played the “choking game,” in which they nearly strangled themselves in order to experience a brief euphoria caused by cerebral atoxia. An EIS officer documented 82 resulting deaths.
A nation-wide Salmonella saintpaul epidemic sickened over 1,400 people in the United States and was finally traced to hot peppers imported from Mexico.
In April 2009 a completely new H1N1 influenza strain with genetic components from swine, birds, and humans emerged in the United States and Mexico. The media called it “swine flu.” Over the next few months, it spread throughout the world, creating a new pandemic.
And still I kept working on the book, and still my friends kept telling me that now would be the perfect time for the book to come out.
But guess what? Now is the perfect time for the book to come out, and next week, and next year, and next decade. One thing I have learned from my research is that nature (and human interaction with nature) will continue to provide surprise epidemics and public health problems on a regular basis.
When Alexander Langmuir moved to the CDC and then founded the Epidemic Intelligence Service in 1951, many of his friends told him he was crazy. Antibiotics and vaccines would soon make infectious diseases obsolete. He was focusing on a dying field.
That turned out not to be the case. Bacteria quickly adapted to resist antibiotics. Vaccines were useful but difficult, even in the United States, to get to all the children. And vaccines would cause their own problems and controversies.
In addition, EIS officers have tried to deal with seemingly intractable problems caused by human behavior – smoking, drinking, poor diet, and lack of exercise are killing us more surely than microbes.
So, unfortunately, now is a great time for Inside the Outbreaks to come out, and the lessons to be learned from it will be applicable into the indefinite future. In future blogs, I will deal with these public health issues in more detail. I think I’ll write about the immense death toll of unclean water in my next entry.
April 22, 2010: Mark Pendergrast will be giving a talk and signing Inside the Outbreaks at the Barnes & Noble on 2900 Peachtree Road in Atlanta, Georgia, on April 22 at 7 p.m. Please call 404:261-7747 for more information.