Inside the Outbreaks recounts a wide sweep of stories gleaned from outbreaks ranging from Manhattan to Mali, from cholera to birth defects, from hut-to-hut visits in the developing world to sophisticated mathematical models in the developed, and from a cluster of a few cases to pandemics involving millions of people.”

— Scott Holmberg, author of
Scientific Errors and Controversies in the U.S. HIV/AIDS Epidemic

About the Book


In Inside the Outbreaks: The Elite Medical Detectives of the Epidemic Intelligence Service, Mark Pendergrast takes readers on a riveting journey through the history of this remarkable organization, following EIS officers on their globetrotting quest to eliminate the most lethal and widespread threats to the world’s health. Over the years they have successfully battled polio, cholera, and smallpox, and in recent years have turned to the epidemics killing us now — smoking, obesity, and violence among them.


Since its founding by Alexander Langmuir in 1951 as a Cold War measure against biological warfare, the Epidemic Intelligence Service has waged war against every imaginable human (and sometimes animal) ailment. Suitcases packed, vaccinations ready, the mantra “time-place-person” on their lips, these young doctors — and veterinarians, dentists, statisticians, nurses, microbiologists, academic epidemiologists, social scientists, lawyers — call themselves “shoe-leather epidemiologists.” Always on call, often working 18-hour days during their two-year EIS stint, they have occasionally caught the bugs they were studying, but, astonishingly, only one officer has thus far died in the line of duty – in an airline crash.


EIS officers or alums identified new diseases such as Legionnaires’ disease, Lassa fever, Ebola, AIDS, hantavirus pulmonary syndrome, and Lyme disease. Others helped find the cause of killers such as neural tube defects,and eosinophilia-myalgia syndrome, thereby making it possible to prevent them. They contributed to the eradication of smallpox and have been critical in treating or preventing diarrheal diseases. For some conditions, such as chronic fatigue syndrome or Gulf War syndrome, EIS officers have brought a healthy skepticism to proposed causes.


EIS officers have not served without controversy, but for the most part, they have performed their tasks – difficult, dangerous, or dead-end, confusing, exciting, or tedious – without fanfare. They have saved countless lives in the process, preventing disease from spreading uncontrolled and diagnosing problems before they got out of hand. In fact, they may have saved your life, but you would not know it.


EIS alums have contributed significantly to the practice of public health as state health officials, staff of the World Health Organization, advisors to the Gates Foundation, professors of public health, and even as a U.S. surgeon general. The successful EIS model has spread internationally: former EIS officers on the staff of CDC have helped to establish nearly thirty similar programs in foreign countries.


EIS officers and alums have had an impact far beyond their original numbers. Today, with global public health bedeviled by substantial threats, the life-saving work performed around the world by these shoeleather epidemiologists is more essential than ever. The EIS program and its offspring have, in short, influenced and defined how field epidemiology and public health are practiced on our planet.



Houghton Mifflin Harcourt, 2010.

432 pages.

ISBN 978-0-15-101120-9




An interview with Mark Pendergrast


Speech to Rotary Club


A radio interview with Mark Pendergrast on Reach MD XM Radio


Children of Niger, singing


TV interview on EIS


Voice of America TV segment


Mark Pendergrast on Book TV, CSPAN2





Mark Pendergrast

Inside the Outbreaks: The Elite Medical Detectives of the Epidemic Intelligence Service


What the Reviewers Say:


“Since its creation in 1951, the Epidemic Intelligence Service has become a bulwark in the nation’s defense system against disease, often acting as the public’s emergency room. Its doctors have helped identify Legionnaires’ disease, Lyme disease, and toxic shock syndrome from superabsorbent tampons; stop outbreaks of diphtheria and other diseases before they could spread uncontrollably; discover the deadly Ebola and Lassa viruses; and trace paralyzing cases of polio to defective batches of the Salk vaccine. Other E.I.S. investigations have led the Food and Drug Administration to remove potentially lethal products from the market.  Indeed, the E.I.S. ‘may have saved your life, though you were probably unaware of it,’ Mark Pendergrast writes in his new book, Inside the Outbreaks, the first history of the program.” – Lawrence Altman, New York Times


“You can have your FBI, your CIA, your EPA, your ATF, your NASA and your NCIS. Heck, I’ll even throw in NCIS: LA. Keep it all — the whole alphabetical bundle. Just let me have my EIS and I’ll be happy. Healthy too. As Mark Pendergrast makes clear in his thorough, ambitious…new book, the Epidemic Intelligence Service — a little-known division of the Centers for Disease Control and Prevention — has been, for more than half a century, the home for intrepid warriors of science armed with good intentions and the latest medical knowledge about infectious diseases.” – Julia Keller, Chicago Tribune


“[Inside the Outbreaks] thus performs a double service. The compilation of case histories shows indisputably that it’s far more cost effective to pay the government to stem public health problems at the source than to rely on the private sector to treat the dozens — or millions — of people who would otherwise fall sick. Investing in public health, in other words, pays.  And, by documenting in spare language and without fanfare the real-life heroism of hundreds of public health detectives, Inside the Outbreaks may well leave even the most adamant Tea Party member swelling with pride in our government.” — Seven Days


“Plucky epidemiologists track the world’s ailments in this hectic public health saga [Inside the Outbreaks]. Pendergrast chronicles the exploits of the doctors, nurses, statisticians, and sociologists of the Centers for Disease Control’s Epidemic Intelligence Service, who jet around investigating the causes and remedies of disease outbreaks from Alabama to Zaire. Looming large is the ever-present, life-threatening problem of diarrhea, whose outbreaks they trace variously to contaminated water, iffy tofu, and Oregon cultists who in 1984 sprinkled salmonella into restaurant salad bars. The investigators also take on more exotic cases, including Ebola outbreaks, the post-9/11 anthrax letters, and a grade-school itching epidemic that turned out to be mass hysteria. These epidemiologists have also led long campaigns to eradicate smallpox—in Pendergrast’s telling, an epic struggle against both germs and cultural prejudices—and tried to abate social ills like smoking [and] obesity.…. The scientific fight against these cunning, deadly pathogens makes for an often engrossing browse.” — Publisher’s Weekly


“Pendergrast provides an exhaustive account of the ‘shoe-leather epidemiologists’ who trek to the world’s troubled spots when a serious or unusual disease strikes. [Inside the Outbreaks is] an impressive, occasionally awe-inspiring narrative about the CDC’s Epidemic Intelligence Service. The organization is comprised of idealistic young men and women who sign up for two years of training and field work, postings during which they can face Ebola in Africa, bird flu in Asia or other more routine clusters of salmonella food poisoning in America. When EIS was founded in 1951, it was a haven for doctors seeking to avoid the draft for the Korean War, and EIS recruits were envisioned as first responders in the case of biowarfare. The early EIS decades were largely devoted to infectious outbreaks — bat rabies, Asian flu, oyster-borne hepatitis, etc. — and EIS sleuthing then and now looks at patient histories and environmental clues, often conducting case-control studies. Pendergrast does not gloss over the moral shortcomings of the early years [such as] vaccines tested on prisoners or institutionalized children, nor does he ignore the role of bureaucratic in-fighting and politics. The author celebrates EIS’s successes and occasional triumphs—like the eradication of smallpox—and the commitment, intelligence and passion of its trainees and alums. Fans of medical mysteries will find scores of EIS case histories to slake their appetites in this meticulous history.” — Kirkus Reviews


“Pendergrast turns his focus to a department of the Centers for Disease Control that investigates outbreaks of illness around the globe. Formed in 1951, the Epidemic Intelligence Service (EIS) originated during the polio years and progressed through anthrax, salmonella, rabies, smallpox, HIV, and Ebola to the present day. You name it, they identified it. Appealing to CSI geeks, the individual stories unfold as mysteries: What is causing this outbreak of paralysis or death? Why are all of the high school kids or factory workers getting the flu? The EIS investigated norovirus on cruise ships and malaria in Niger. VERDICT:  A great reminder of the importance of public health, both in the United States and around the world, this is good reading for those who wonder whether vaccinations and other simple disease preventatives such as clean water and mosquito nets are relevant today. The zippy manga cover and engrossing tales will pull in nonfiction readers not usually up for medical history.” — Library Journal


“Wherever widespread illness breaks out, agents of the Epidemic Intelligence Service (EIS) will likely be dispatched to investigate. Operating under the auspices of the Atlanta-based Centers for Disease Control and Prevention (CDC), this corps of highly trained professionals, first assembled in 1951 when federal authorities feared biological warfare following WWII, has proven its worth many times over, stemming outbreaks of major diseases ranging from smallpox to polio…. The unsung heroes of the EIS get their due in this lengthy history and paean to their service.”  — Booklist


“FBI, CIA, CSI—there’s no shortage of three-letter agencies that solve the world’s deadly problems with brains and bravery, rather than pure brawn. All but unknown amongst this group is the EIS, the Epidemic Intelligence Service. As the shoe-leather branch of the Centers for Disease Control, the EIS consists of epidemiologists that use a combination of microbiology, forensic science, and old-fashioned detective work to deal with outbreaks as—and where—they happen. In that sense, these scientists are putting their lives on the line to hunt down serial killers whose body counts dwarf those of even the most notorious human criminals. Pendergrast ably recounts the last half-century of these cases in an episodic fashion, complete with the mystery, intrigue, and gory details of your favorite police procedural drama.” — Seed Magazine


“The investigators who cracked these cases were officers in the Epidemic Intelligence Service, a little-known federal public health program that has grappled with a staggering range of deadly and disabling afflictions — from polio and smallpox to swine flu and shigellosis — throughout the United States and around the world. The “disease detectives” who comprise this cadre are the subject of Mark Pendergrast‘s new book, Inside the Outbreaks, a history of EIS since its founding in 1951 under the auspices of what is now known as the Centers for Disease Control and Prevention.” — Burlington Free Press


“Inside the Outbreaks is a rare book of medical history — an intriguing and entirely original account of the Epidemic Intelligence Service, the medical detectives who track down and identify the lethal health threats that plague the United States and the larger world, from AIDS, polio and swine flu, on the one hand, to bogus drugs, contaminated food, and bioterrorism, on the other.  Richly detailed and elegantly written, Mark Pendergrast’s account fills an enormous gap in understanding the vital role of epidemiology in safeguarding our future.”  — David Oshinsky, author of Polio: An American Story.


“Mark Pendergrast is at his best when telling a big story, and this story is huge — nothing less than the development of epidemiology in the second half of the 20th century, in all its imagination and frustration, success and failure, selflessness and selfishness, controversy and, yes, heroism.”   — Tim Brookes, author of The End of Polio?


“Pendergrast has captured the rapid pulse, sweaty palms, and intellectual, geographic, political and personal challenges of EIS outbreak investigations.” — Joe McCormick, author of Level 4: Virus Hunters of the CDC


“In a direct, eloquent and understated manner, Mark Pendergrast has documented a largely unknown history that provides a window into the investigative work of generations of EIS Officers. Inside the Outbreaks is remarkable.” — Keiji Fukuda, Pandemic Influenza Special Advisor, World Health Organization


“From identification and control of hospital infections, contaminated hamburgers, toxic shock syndrome, untested alternative medicines, HIV, lead, and mercury, to battles against the scourges of millennia (smallpox, polio, measles, suicide), Pendergrast’s book is a tour de force.” — Karen Starko, (EIS ‘78)


“Brilliant sleuthing has reduced risks to our health.  But Pendergrast shows how every EIS success is followed by new problems.  Inside the Outbreaks is an intriguing, revealing, sobering look at the natural and person-made risks that stalk our daily activities.”  — Bill Foege, Senior Fellow, Global Health Program, Bill and Melinda Gates Foundation




Mark Pendergrast


Copyright 2010-2017 Mark Pendergrast