EIS e-Bulletin Issue August 2011 Vol. e6, Issue 2

Contents

Director's Notes Epi-Aids EISO Investigations EISO Publications EISO Presentations Notes from the Field Job Notices What's Happening? News of Current Officers Alumni Notes Obituary: David J. Sencer (EIS '75 Honorary) David J. Sencer, MD, MPH, Scholarship Fund

This publication is distributed to current EIS officers and alumni by the Scientific Education and Professional Development Program Office, Office of Surveillance, , and Laboratory Services, Centers for Disease Control and Prevention. Please send submissions to Douglas Hamilton ([email protected] or 404-498-6110).

Centers for Disease Control and Prevention Thomas R. Frieden, MD, MPH, Director

Stephen B. Thacker, MD, MSc, Deputy Director for Surveillance, Epidemiology, and Laboratory Services

Denise Koo, MD, MPH, Director, Scientific Education and Professional Development Program Office

David B. Callahan, MD, Director, Division Of Applied Sciences

Douglas H. Hamilton, MD, PhD, Director, Epidemic Intelligence Service Program

Michael Paul Reid, Managing Editor, Science Office

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Director's Notes (Return to top)

This spring was a virtual roller-coaster. The previous quarter started with the 60th anniversary EIS Conference, which after a last minute change of venue and the threat of an imminent government shutdown, managed to come off as one of the better conferences in recent years. This was thanks in no small part to our friends at the CDC Foundation who jumped in at the last minute with both staff and resources to guarantee that the conference would take place regardless of Congressional action.

Those of you who were fortunate to attend the celebratory events the weekend before the conference were able to hear presentations from a panel of notable EIS alumni and to attend the 60th Anniversary Gala banquet (which I heard my officers referring to as "the EIS Prom"). Among the many entertaining speakers was Dr. David Sencer who served as the lead-in act for Dr. Bill Foege. Dr. Sencer was at the top of his form and had the audience hanging on his every word. Little did we know, that was the last time that we would have the pleasure of hearing him speak publicly. Dr Sencer passed away a few weeks after the conference and will be missed by everyone in the CDC family and the community at large. Please make sure to read the obituary by Don Millar at the end of this Bulletin.

The next cohort of EIS officers, EIS 2011, is now on board and getting used to the vicissitudes of government service. The summer course this year was held at Emory in their brand new state-of-the-art Grace Crum Rollins School of Public Health, thanks to the generosity of the SPH faculty. Hopefully, the officers won’t expect the same degree of luxury with all of their training activities!

Finally, I wanted to let you know about a very welcome addition to the EIS family, David Callahan (EIS '99), who has been appointed as Director of the Division of Applied Sciences in SEPDPO. This is the division that houses the EIS Program along with several other fellowships. The SEPDPO OD announcement of his appointment follows:

I am pleased to announce that David Callahan will become Director, Division of Applied Sciences, Scientific Education and Professional Development Program Office, as of July 1. The Division of Applied Sciences oversees the EIS Program, the EIS Field Assignments Branch, the Preventive Medicine Residency/Fellowship, the Prevention Effectiveness Fellowship, and the Public Health Informatics Fellowship. Dr. David Callahan is a medical epidemiologist, a board certified family physician, and a Captain in the Commissioned Corps of the U.S. Public Health Service. David joined CDC in 1999 as an EIS officer assigned to San Diego. After completing EIS, he came to CDC headquarters, and from 2002 to 2005 served as a supervisor of field EIS officers in the State Branch, the organizational predecessor of EFAB. For the past six years, he has served as a medical epidemiologist with NCEH, most

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recently as the lead of the Asthma Epidemiology and Research team of the Air Pollution and Respiratory Health Branch. In that role, he has mentored EIS officers, CDC Experience fellows, and numerous other public health trainees. David also has a strong interest in the application of information technology to public health practice and training, having served as a medical editor for Epi-X and author of an informal technology newsletter.

As a U.S. Public Health Service commissioned officer at CDC, Captain Callahan has responded to disasters and public health emergencies, including the 2010 Gulf oil spill, the 2009 H1N1 influenza pandemic, Hurricane Katrina, the West Nile virus epidemic, and the terrorist events and anthrax bioterrorism attacks in the fall of 2001. In addition to his public health roles, David holds an academic appointment in the Department of Family and Preventive Medicine of , where he sees patients and teaches medical students and residents. He previously held a faculty appointment with the Medical College of Virginia while in private practice. He holds degrees from the College of William and Mary and the Medical College of Virginia. In his spare time, he enjoys running marathons, kayaking the local waterways, and spending time with his wife Cathi and his two teenage daughters.

Dave started EIS as one of my officers and is now my boss (kind of makes me feel like a proud parent) — hopefully, when my real children pick my nursing home, the transition will be equally painless!!

Doug Hamilton (EIS '91)

Epi-Aids (Return to top)

The following Epi-Aids have been issued since April 1, 2011:

Number Title Location Officer Diarrheal incidence in US medical 2011-044 personnel working with cholera Multistate Emily Cartwright patients in Haiti Assessment of neurologic illness 2011-045 associated with cholera treatment Haiti Cyrus Shahpar centers, Haiti Multistate outbreak of Salmonella Typhimurium infections associated Joanna Gaines 2011-046 Multistate with exposure to microbiology Linda Capewell laboratories

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Number Title Location Officer Investigations of human infections with highly pathogenic avian influenza 2011-047 A (H5N1) virus and human infection Bangladesh Aaron Storms with low pathogenic avian influenza A (H9N2) virus in Dhaka Investigation of hepatitis B, measles, mumps, rubella, and varicella zoster Roxanne Williams viruses seroprevalence and long-term American 2011-048 Abdirahman immune memory following hepatitis B Samoa Mahamud vaccination among children and young adults Legionellosis outbreak associated with Sara Tartof 2011-049 WA an acute care hospital Lee Hampton Teen driving practices and parental Sammy Gill 2011-050 perceptions of teen driving in rural ND Jennifer Cope North Dakota Tim Cunningham Outbreak of influenza with high Samuel Graitcer mortality in a facility for 2011-051 OH Alejandro Azofeifa developmentally disabled children and Loren Rodgers young adults — Portage County Assessing the nutrition environment in 2011-052 Multistate Alyson Goodman national parks Investigation of hepatitis C virus Mbaeyi Chukwuma 2011-053 (HCV) infections at an outpatient GA Aarti Agarwal hemodialysis facility 2011-054 Investigation of human rabies CA Brett Petersen Investigation of increase in pertussis 2011-055 among children in Minnesota aged 7– MN Sarah Kemble 12 years Investigation of rotavirus illness 2011-056 among elderly adults in a large IL Cristina Cardemil retirement community Legionnaires' disease outbreak Tarayn Fairlie 2011-057 LA associated with travel on a cruise ship Lindsay Kim Varicella outbreak in a highly Abdirahman 2011-058 TX vaccinated school population Mahamud 2011-059 Cancelled Increase in new diagnoses of HIV Candice Kwan 2011-060 infection among men who have sex RI Tim Minniear with men (MSM) Heat-related illness among migrant Nancy Fleischer 2011-061 farmworker populations in southern GA Aaron Storms

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Number Title Location Officer Multi-state Q fever outbreak 2011-062 Multistate Adam Bjork associated with a goat farm Investigation of severe fungal soft Robyn Fanfair 2011-063 MO tissue infections following a tornado Sarah Bennett Cluster of cases of suspected Guillain- Barré syndrome in residents of the 2011-064 AZ Brendan Jackson border area of Arizona and Sonora, Mexico The body burden of environmental 2011-065 contaminants in a vulnerable Ethiopia Ellen Yard population, Addis Ababa Bryan Christensen Chlorine gas exposure at poultry Sallyann Coleman- 2011-066 AR processing plant King Francisco Meza Investigation of increased number of Lindsay Kim 2011-067 cases among American Multistate Brian Baker Indians

Other Investigations Recently Conducted by EISOs (Return to top)

Officer Investigation Location Dates Knowledge, attitude, and practices (KAP) Monica investigation of arriving passengers from Selent 12/2010– Haiti about pre-travel vaccinations and the FL Valery Beau 1/2011 cholera Travel Health Alert Notice (T- De Rochars HAN), Miami Investigation of a trisomy 18 cluster in 1/2011– Noha Farag TX Brazos County Present Influenza Community Assessment for Noha Farag Public Health Emergency Response TX 2/2011 (CASPER), Harlingen Mam Investigation of reported pulmonary fibrosis NM 8/2010–4/2011 Ibraheem cluster Mam Measles case associated with international NM 2–3/2011 Ibraheem travel Mam 5/2011– Investigation of human plague NM Ibraheem Present Lara Information surveillance review in Ali Djibouti 5/2011 Jacobsen Addeh Refugee Camp Andrea Maternal drug use and its impact on WA 5/2011 Creanga neonates: Washington State, 2000–2008

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Officer Investigation Location Dates Prevalence of selected neglected tropical Aaron diseases and the effect of disease co- 5/2011– Bolivia Samuels infection on morbidity in Camiri, Santa Present Cruz Department Comparison of school and community- based mass drug administration delivery Aaron 1/2011– strategies for control of Schistosoma Kenya Samuels Present mansoni infections in Western Kenyan in areas with >25% prevalence Sudhir Investigation of nodding disease outbreak in Bunga, South Western Equatoria State (Mundri County), 6–5/2011 Jennifer Sudan South Sudan — May 2011 Foiltz

Recent Publications by Current Officers (Return to top)

Tohme RA, Yount KM, Yassine S, Shideed O, Sibai AM. Socioeconomic resources and living arrangements of older adults in Lebanon: who chooses to live alone? Ageing Soc 2011; 31:1–17.

Suarthana E, McFadden JD, Laney AS, Kreiss K, Anderson HA, Hunt DC, Neises D, Goodin K, Thomas A, Vandermeer M, Storey E. Occupational distribution of persons with confirmed 2009 H1N1 influenza. J Occup Environ Med 2010;52(12):1212–6.

Lanier WA, Hall JM, Herlihy RK, Rolfs RT, Wagner JM, Smith LH, Hyytia-Trees EK. Outbreak of Shiga-toxigenic Escherichia coli O157:H7 infections associated with rodeo attendance, 2009. Foodborne Pathog Dis. [In press.]

Marengo L, Ramadhani, T, Farag NH, Canfield MA, Should aggregate US census data be used as a proxy for individual household income in a birth defects registry? J Reg Manag. [In press.]

Ramadhani T, Canfield MA, Farag NH, Royle M, Correa A, Waller K, Scheuerle A. Do foreign- and U.S.-born mothers across racial/ethnic groups have a similar risk profile for selected socio-demographic and periconceptional factors? Birth Defects Research Part A. [In press.]

Neblett RC, Hutton HE, Lau B, McCaul ME, Moore RD, Chander G. Alcohol consumption among HIV-infected women: impact on time to antiretroviral therapy and survival. J Womens Health 2011;20:279–86.

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Neblett RC, Davey-Rothwell M, Chander G, Latkin CA. Social network characteristics and HIV sexual risk behavior among urban African American women. J Urban Health 2011;88:54–65.

Suarthana E, Laney AS, Storey E, Hale JM, Attfield MD. Coal workers' pneumoconiosis in the : regional differences 40 years after implementation of the 1969 Federal Coal Mine Health and Safety Act. Occup Environ Med 2011. [Epub ahead of print].

Yen C, Reyna Figueroa J, Sanchez Uribe E, del Carmen Hernandez L, Tate JE, Parashar UD, Patel MM. Monovalent rotavirus vaccine provides protection against an emerging fully heterotypic G9P[4] rotavirus strain in Mexico. J Infect Dis. [In press.] do Carmo GM, Yen C, Cortes J, Siquiera AA, de Oliveira WK, Cortez Escalante JJ, Lopman, B, Flannery B, de Oliveira LH, Carmo EH, Patel M. Decline in diarrhea mortality and admissions after routine childhood rotavirus immunization in Brazil: a time-series analysis. PLoS Medicine 2011;8(4): e1001024. doi: 10.1371/journal.pmed.1001024.

Yen C, Jakob K, Esona MD, Peckham X, Rausch J, Hull JJ, Whittier S, Gentsch JR, LaRussa P. Detection of fecal shedding of rotavirus vaccine in infants following their first dose of pentavalent rotavirus vaccine. Vaccine 2011 May 31;29(24):4151–5.

CDC. Physical activity levels of high school students — United States, 2010. MMWR 2011;60;773–7 (Submitted by MinKyoung Song).

CDC. Arthritis as a potential barrier to physical activity among adults with obesity — United States, 2007 and 2009. MMWR 2011;60:614–8 (Submitted by Kamil Barbour).

Ensrud KE, Barbour K, Canales MT, Danielson ME, Boudreau RM, Bauer DC, Lacroix AZ, Ishani A, Jackson RD, Robbins JA, Cauley JA. Renal function and nonvertebral fracture risk in multiethnic women: the Women's Health Initiative (WHI). Osteoporos Int 2011. [Epub ahead of print].

Creanga AA, Kamimoto L, Newsome K, D’Mello T, Jamieson D, Zotti M, Arnold K, Baumbach J, Bennett N, Blythe D, Farley M, Gershman K, Kirschke D, Lynfield R, Reingold A, Schaffner W, Thomas A, Zansky S, Finelli L, Honein M. Seasonal and pandemic 2009 influenza A virus infection during pregnancy: a population-based study of hospitalized cases. Am J Obstet Gynecol 2011; 204:S38–45.

Creanga AA, Shapiro-Mendoza CK, Bish CL, Zane S, Berg C, Callaghan W. Trends in ectopic pregnancy mortality in the United States: 1980–2007. Obstet Gynecol 2011;117:837–43.

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Creanga AA. Transplacental transmission of influenza: what do you know? Indian J Med Sci 2010;64: 529–31.

Cox CM, Neises D, Garten RJ, Bryant B, Hesse R, Anderson GA, Trevino-Garrison I, Shu B, Lindstrom S, Klimov AI, Finelli L. Human case of A(H3N2) virus infection, Kansas 2009. Emerg Infect Dis 2011;17. [Epub ahead of print]

Recent Presentations by Current Officers at National or International Meetings (Return to top)

Officer Presentation Meeting Date Are future health care workers 45th National Immunization protected against hepatitis B Conference (Washington, virus infection? Hepatitis B DC) vaccination coverage and Rania Tohme 3/2011 seroprotection among healthcare students at an academic institution in the United States, 2000–2010 Predicting the prevalence of NIOSH Intramural Eva coal workers’ pneumoconiosis Scientific Meeting (Salt 8/2010 Suarthana 40 years after implementation Fork, OH) of the Coal Act International Scientific Medical surveillance Eva Workshop on Indium- evaluation at a US indium 9/2010 Suarthana Related Lung Disease products facility (Morgantown, WV) Regional differences of coal American Thoracic Society workers’ pneumoconiosis International Conference prevalence in the United (Denver, CO) Eva States: 40 years after 5/2010 Suarthana implementation of the 1969 Federal Coal Mine Health and Safety Act Are depression and diabetes American Thoracic Society Jeneita Bell associated with asthma International Conference 5/2010 control? (Denver, CO) Surveillance of acute health CSTE Annual Conference effects among the general (Pittsburgh, PA) Jeneita Bell 6/2011 population during the Deepwater Horizon oil spill

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Officer Presentation Meeting Date Predicting the prevalence of NIOSH Intramural Eva coal workers’ pneumoconiosis Scientific Meeting (Salt 8/2010 Suarthana 40 years after implementation Fork, OH) of the Coal Act Symptom-based screening for American Thoracic Society triaging highly infectious International Conference tuberculosis in people living (Denver, CO) Lindsay Kim 5/2011 with HIV — Cambodia, Thailand, and Vietnam, 2006– 2008 Sex, sports, and contact CSTE Annual Conference Danielle transfer of vaccinia virus (Pittsburgh, PA) 6/2011 Tack following introduction of ACAM2000™ Knowledge, attitudes and CSTE Annual Conference practices of deer farmers (Pittsburgh, PA) Danielle following a cluster of rabies in 6/2011 Tack captive deer — Pennsylvania, July 2010 Acute exertional CSTE Annual Conference rhabdomyolysis and triceps (Pittsburgh, PA) John Oh compartment syndrome among 6/2011 high school football players — Oregon, 2010 Using hospitalization data to CSTE Annual Conference evaluate and improve invasive (Pittsburgh, PA) Mam pneumococcal disease 6/2011 Ibraheem surveillance — New Mexico, 2007–2009 Outbreak of carbapenem- CSTE Annual Conference resistant Klebsiella (Pittsburgh, PA) Tegwin pneumoniae associated with a 6/2011 Taylor long-term care facility — West Virginia, 2009–2011 Laboratory detection as first CSTE Annual Conference Tegwin indicator of influenza season (Pittsburgh, PA) 6/2011 Taylor — West Virginia, 2010 Muscle-strengthening in U.S. American College of MinKyoung youth: findings from NHANES Sports Medicine 5/2011 Song 1999–2006 Conference (Denver, CO)

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Officer Presentation Meeting Date Postneonatal hospitalization Society for Pediatric and and associated morbidity Perinatal Epidemiologic Andrea among singleton late preterm Research (SPER) 6/2011 Creanga infants: Massachusetts, 1998– (Montreal, Canada) 2005 Pediatric influenza Pediatric Academic hospitalizations during the Societies Annual Meeting Chad Cox 4/2011 2009 H1N1 Pandemic — (Denver, CO) United States, 2009–2010

Notes from the Field (Return to top) In the April print edition of the EIS Bulletin, the lead article reported on the involvement of EIS officers and alumni in response to the disaster in Haiti and the subsequent outbreak of cholera. The article was intended to present a description that conveyed the scope and diversity of the response, but was not meant to be an exhaustive account of all EIS activities.

Several of the people who participated in the response contacted me to express their concerns that colleagues who also participated in the response were not recognized in the April article. I asked them to submit descriptions of these other activities for inclusion in a future Bulletin. Their descriptions form this month’s "Notes from the Field." Doug Hamilton (EIS '91)

We’ll start with a list of all the EIS officers and alumni who worked on the Haiti response in some capacity (as of 6/15/2011), as follows:

Last First Year Last First Year Ackers Marta-Louise 1995 Balaban Victor 2003 Al-Samarrai Teeb 2009 Barbour Kamil 2010 Alvarado-Ramy Francisco 1999 Barrett Drue 1992 Anderson Mark 1996 Barzilay Ezra 2004 Andre Adolph 2001 Basavaraju Sridhar 2007 Mckenzie Beach Michael 1995 Angulo Frederick 1993 Beau De Valery 2010 Apostolou Andria 2009 Rochars Madsen Archer W. Roodly 2008 Belay Ermias 1994 Asamoa Kwame 2001 Bell David 1979 Avchen Rachel 2000 Beltrami John 1995 Azziz- Eduardo 2003 Bender Thomas 2009 Baumgartner

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Last First Year Last First Year Bennett Diane 1984 Dunkle Stacie 2010 Bennett Sarah 2010 Eaton Danice 2002 Bilukha Oleg 2002 Eberhard Mark 1983 Blank Susan 1990 El Bcheraoui Charbel 2009 Bloland Peter 1989 Ellerbrock Tedd 1986 Bowen Anna 2003 Ellingson Katherine 2006 Braden Christopher 1993 Espey David 1993 Bradley Heather 2010 Fiore Anthony 1995 Brennan Muireann 1996 Fishbein Daniel 1983 Brett Meghan 2010 Fleischer Nancy 2010 Bridges Carolyn 1996 Fox Leanne 2002 Brown Allison 2010 Funk Renee 2002 Brown Clive 1993 Gaines Joanna 2010 Broz Dita 2009 Gargano Julia Marie 2009 Brunkard Joan 2006 Gershman Mark 2005 Caceres Victor 1995 Glover Maleeka 2003 Cantey Paul 2007 Gomez Thomas 1990 Capewell Linda 2009 Gould L Hannah 2005 Cartwright Emily 2009 Grant Juliana 2005 Castro Kenneth 1983 Gregory Cria 2008 Cetron Martin 1992 Grohskopf Lisa 1999 Chang Michelle 2003 Grube Steven 2009 Chiller Tom 2001 Haddad Maryam 2001 Chorba Terence 1983 Hall Aron 2006 Choudhary Ekta 2009 Hamilton Douglas 1991 Cookson Susan 1995 Hampton Lee 2009 Coronado Victor 1991 Handzel Thomas 2000 Cortes Jennifer 2008 Harris Julie 2007 Da Costa Isabela 2008 Hausman Leslie 2006 Ribeiro Heffelfinger James 1997 Dailey Janine 2009 Hlavsa Michele 2005 Date Kashmira 2008 Hocevar Susan 2009 Deitchman Scott 1987 Holtz Timothy 1999 Dentinger Catherine 1997 Howard Christopher 2007 Dominguez Kenneth 1991 Husain Farah 2008 Dott Mary 2001 Iuliano Danielle 2008 Dowdle Walter 1991 Ivy Wade 2009 Dowell Scott 1993 Jackson Brendan 2010 Dubray Christine 2006 Jacobson Lara 2010

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Last First Year Last First Year Jain Seema 2004 Painter John 1999 Jentes Emily 2008 Parise Monica 1993 Jereb John 1990 Parker Amy 2005 Joseph Djenaba 2005 Petersen Brett 2009 Kahn Emily 1997 Philen Rossanne 1988 Kattan Jessica 2009 Piercefield Emily 2007 Kemble Sarah 2010 Pinheiro Germania 2003 Kim Lindsay 2010 Posey Drew 2003 King Michael 2003 Quick Robert 1990 Kit Brian 2009 Redwood Yanique 2008 Kohl Katrin 1997 Reed Caitlin 2009 Lackritz Eve 1988 Rey Araceli 2005 Langer Adam 2006 Riggs Margaret 2005 Likos Anna 2003 Roels Thierry 1994 Loharikar Anagha 2009 Routh Janell 2010 Lowther Sarah 2008 Roy Sharon 2001 Lynch Michael 2002 Rubin Carol 1990 Lyss Sheryl 1999 Safran Marc 1993 Mace Kimberly 2009 Sansom Stephanie 1998 Macedo De Alexandre 2002 Sauber-Schatz Erin 2009 Oliveira Schillie Sarah 2007 Mach Ondrej 2004 Scott Cheryl 1993 Marston Barbara 1990 Selent Monica 2009 Massoudi Mehran 1994 Shahpar Cyrus 2010 Mast Eric 1987 Sidibe Kassim 2001 Mba-Jonas Adamma 2010 Silk Benjamin 2008 McMorrow Meredith 2004 Sinks Thomas 1985 Meites Elissa 2008 Slutsker Laurence 1987 Menon Manoj 2005 Smith Theresa 1997 Mintz Eric 1989 Sobel Jeremy 1995 Miramontes Roque 2006 Sosin Daniel 1986 Monterroso Edgar 1991 Sotir Mark 2002 Morof Diane 2009 Sprecher Armand 2009 Mortenson Eva 2009 St Louis Michael 1985 Murphree Rendi 2009 Steinhardt Laura 2010 Naughton Mary 1999 Sullivent Ernest 2004 Neil Karen 2008 Swerdlow David 1989 O'Connor Katherine 2010 Tai Eric 2006 O'Reilly Ciara 2004 Tappero Jordan 1992

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Last First Year Last First Year Tauxe Robert 1983 Wiktor Stefan 1991 Thomas Cynthia 2008 Williams Holly 1996 Thomas Peter 2002 Willis Matthew 2009 Tohme Rania 2009 Wortley Pascale 1992 Tomashek Kay 1997 Wright Jennifer 2002 Townes David 2008 Yanni Emad 2005 Vagi Sarah 2008 Yard Ellen 2009 Valderrama Amy 2006 Yen Catherine 2009 Verani Jennifer 2006 Yip Fuyuen 2004 Vernon Andrew 1978 Yusuf Hussain 1994 Walldorf Jenny 2009 Zhou Weigong 2001 Waterman Stephen 1981 Zucker Jane 1990 Watson John 1989

• Haiti Response Vignette — Nancy Fleischer (EIS '10)

I worked as the surveillance epidemiologist with the National Sentinel Surveillance System (NSSS) during September–October 2010. I was in Haiti during the postearthquake, precholera calm, when the surveillance systems were running relatively smoothly. The majority of my time was spent trying to improve reporting by the surveillance sites, working with my local counterpart at the Ministère de la Santé Publique et de la Population (MSPP) to improve capacity, and preparing for a new data- entry form to be rolled out with an upcoming training. From a personal perspective, the most valuable part for me was having a chance to work with a ministry of health in another country. Although I have spent much time working in other countries, I have mostly worked at the local level and have not previously worked with a national government. Through our interactions I could see the many challenges that ministries of health — MSPP in particular — face in making public health decisions. The site visits that I conducted with my MSPP counterpart were valuable in helping us learn about the obstacles to data reporting through NSSS. In fact, it was on one such site visit shortly after I left that my counterpart and my successor as NSSS coordinator first encountered the emerging cholera situation.

• Notes from Haiti — Joanna Gaines (EIS '10)

I was part of the first EISO team deployed as part of the Haiti cholera response. I was actually at our officer basic course training with Katie O’Connor (EIS '10) and Janell Routh (EIS '10) when we first learned about the outbreak; we spoke with our instructors and prepared to leave early if necessary. They actually gave us some great tips about what to pack for our first international deployment! Emily Cartwright (EIS '09) was the

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2nd-year food-and-water EISO who joined us in the field. She brought extensive experience, having handled two outbreaks of cholera in Cameroon and having returned from her most recent trip just a few days before we left for Haiti.

From the moment we hit the ground, we worked virtually around the clock. We had enormous support from CDC's Emergency Operations Center as well as CDC staff already in Haiti. Our team headed out into the field in the Artibonite Department to start the first case-control study of the outbreak, only to be sent back to the embassy under the threat of Hurricane Thomas before data collection was complete. Katie O’Connor and Janell Routh returned to Artibonite, and Anagha Loharikar (EIS '09) replaced Emily, because Anagha also had cholera experience. Katie O’Connor took the helm of the case- control study, and Janell Routh undertook the first mortality study in the Artibonite Department. Katie and Janell both worked with an incredible team of local enumerators who trekked many miles each day. One visit to a case-patient’s home required at least a 2-hour car ride followed by a 2-hour hike up a river to reach their home!

• Lee Hampton (EIS '09)

The first month of the Haiti cholera response focused on determining the scale of the epidemic and providing information and training materials on how to prevent, identify, and treat cholera for health care providers and community workers who had never experienced a cholera outbreak. By the second month, the epidemic was clearly larger and more severe than originally believed, and mortality rates were much higher than the target mortality rate of <1%. As a result, CDC further increased the emphasis placed on providing support for clinical providers, particularly in terms of funding and training. The EISOs in CDC's Emergency Operations Center (EOC) did much of the work to make this support for providers happen, simultaneously developing new guidance on oral rehydration points for treating cholera in the community, estimates for the costs of these oral rehydration points as well as larger cholera treatment centers, new and updated cholera training materials, and tools for assessing cholera treatment sites that would provide information for improving clinical quality and allocating resources. Allison Brown (EIS '10) played a key role during the first month of the outbreak response in developing detailed materials in English, French, and Haitian Creole for training Haitian providers. Despite multiple other demands on her time, she generously stayed in the EOC for an extra week in late November to help with the new projects that went with the increased focus on supporting clinical services. Among her other accomplishments, she put together the first version of the site assessment tools that field staff in Haiti could use for evaluating a treatment center’s facility, resources, and operations. Brendan Jackson, (EIS '10) brought a wonderful can-do attitude and competence in updating and creating training materials for Haitian providers. Brendan was especially

EIS e-Bulletin, Vol. e5, Issues e4 14 adept at taking training materials that had already been through the EOC clearance process and rapidly adapting them to more accessible formats. For example, in a very short time, he took the material developed for a cholera treatment brochure and turned it into a poster for hanging on clinic walls where providers were more likely to use it. Brendan also did an excellent job of tracking and shepherding training documents and videos through the multistage EOC process of edit, review, translate, and distribute, working closely with the community health team, especially Dr. Anna Bowen (EIS '03) on several projects. Furthermore, at the same time he was managing the clinical training materials in the EOC, Brendan was also putting together the protocol for a study in the central province of Haiti to better characterize the impact of the epidemic by using interviews and serologic testing, a study that he successfully conducted a few months after leaving the EOC. Ellen Yard (EIS '09) and Julia Gargano (EIS '09) signed up to work on the EOC’s Surveillance and Epidemiology Team but were reassigned to the clinical support group at the last minute. They gamely took on the responsibility of developing site assessment tools, which became a new urgency within a few hours of their starting because the tools had to be available at any moment. Over the next 2 weeks, Ellen and Julia’s calm and sensible demeanors were invaluable as they revised the questionnaires for site assessments on the basis of feedback from other groups in the EOC and in Haiti and in response to frequent changes in available resources. Emily Cartwright (EIS '09) and Anagha Loharikar (EIS '09) and officers in CDC's Enteric Disease Division had already been to Haiti and worked on the cholera response in the field when they were recruited during Tuesday Morning Seminar to come to the EOC to create guidance on oral rehydration points. By using their field experience, Emily and Anagha created the initial specifications for a simple site staffed by community health workers where people could come for oral rehydration and possible referral to a cholera treatment center. Because no detailed specifications for such a place had been disseminated by any organization and because asking five people about oral rehydration point organization would get seven different answers, Emily and Anagha were basically in uncharted territory; however, they did a great job in developing solid specifications quickly. Jenny Waldorf (EIS '09) joined the EOC effort in early December after her trip to join the Haiti field team was cancelled because of the violence surrounding Haiti's presidential elections. Despite unintentionally becoming involved with the EOC, she picked up several projects already under way with great aplomb, including revising the existing training materials to update the guidance on antibiotics, getting final approval for the oral rehydration point specifications, and developing cost estimates for those points. Jenny also put her French skills to good use by reviewing the translations of documents that needed to be used by Haitian French speakers.

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Amy Freeland (EIS '09) started with the water safety team before kindly lending her skills to the clinical team. In particular, Amy did a wonderful job developing clear, understandable algorithms and explanatory text for a new training module on the treatment of malnourished children with cholera developed by Ann Bowen’s community outreach team in conjunction with the clinical team. Despite having to take on the project with minimal preparation, Amy produced excellent material for the new module in a very short time while juggling the input of two very different groups. As a behavioral scientist, I joined Lara Jacobson (EIS '10) from CDC's International Emergency and Refugee Health Branch (IERHB) for a mixed-methods knowledge, attitude, and practice survey. Lara oversaw the quantitative portion of the survey while I collected qualitative data. In less than 2 weeks, Lara’s team had interviewed >500 households. Visiting households and the regional marketplace, I spent many hours speaking with local women about the supplies they had received from different distribution efforts by nongovernmental organizations, heard countless stories of personal tragedies, and did my best to answer their questions about where this "maladie" had come from and how to protect their families.

I have never seen anything quite like what I saw in Haiti, and it was an experience that has undoubtedly shaped my EIS experience. I have never been more thankful for the opportunity to do my job or to work with such incredible people. The enormous challenges of collecting data under such physically and emotionally draining circumstances cannot be overstated. Our investigation would not have been possible without the incredible support we had.

Job Notices (Return to top)

· Epidemiologist, NASA (Houston, Texas)

Epidemiology International (EI) is hiring a doctoral-level Epidemiologist with environmental/occupational health research experience to support NASA’s Lifetime Surveillance of Astronaut Health (LSAH) program, provide scientific guidance in the field of occupational epidemiology, further the development of core capabilities within the epidemiology support provided to NASA, and support work with other customers.

This full-time position is located in Houston, Texas. The successful candidate can begin immediately.

Job Summary Epidemiologist with strong methodologic and analytical skills who provides technical support in the design and implementation of environmental/occupational research endeavors.

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Responsibilities — Design, conduct, and provide scientific oversight for epidemiology studies. — Provide consultation to Space Medicine on spaceflight exposure epidemiologic issues. — Identify areas for improved health of active and retired astronauts. — Attend scientific conferences, professional societies, and inter-industry associations. — Work with International Partners to develop meta-analysis techniques, compare data, and report out. — Guide the development and enhancement of new LSAH programs. — Publish results. — Lead scientific direction of LSAH and epidemiology team. — Assist in recruiting, hiring, retaining epidemiologists. — Identify partnerships with university programs.

Abilities/Skills — Demonstrated success as a principal investigator or co-investigator. — Experience in designing, conducting, and providing scientific oversight for epidemiology studies. — Familiarity with SAS® and STATA®. — Experience leading teams. — Track record in overseeing data management, statistical analyses, database development, and quality assurance. — Experience in working directly with diverse customers, external collaborators, outside universities, and international entities to develop strong collaborative working relationships. — Proven strong presentation and written communication skills as evidenced through past publications. — Highly motivated, independent worker with enthusiasm for public health research. — Ability to work independently as well as to effectively communicate and collaborate in a team environment. — Excellent oral and written communication skills. — Strong analytic skills.

Education and Experience Required Candidates must have (1) a doctoral degree in epidemiology, biostatistics, or health informatics; (2) a master’s degree in epidemiology, biostatistics, or health informatics; and (3) a minimum of 3–5 years relevant experience in occupational epidemiology in an industry or federal setting.

Interested candidates should submit a cover letter and résumé to [email protected]. Please include "Houston Occupational Epidemiologist" in the subject line of the e-mail.

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• New York City Department of Health and Mental Hygiene — Assistant Commissioner for Chronic Disease Prevention

The New York City Department of Health and Mental Hygiene, Division of Health Promotion and Disease Prevention seeks a motivated, dynamic Assistant Commissioner to oversee a newly established Bureau of Chronic Disease Prevention. The Bureau, which comprises the Physical Activity and Nutrition Program, the Built Environment Unit, and the Nutrition Policy Unit, has primary responsibility in the Department to develop and implement innovative programs and policies to increase opportunities for healthy eating and physical activity. The Bureau achieves its goals through implementing neighborhood- and population-level programs, and developing policy and legislative and regulatory strategies. To achieve the widest, most sustainable population-level impact, the Bureau focuses on policy, systems, and environmental changes, especially those that make the default behavior the healthy behavior.

The Bureau oversees a grant from CDC. This obesity-reduction initiative is conducted by using three primary strategies: increasing the availability of healthy foods (e.g., increasing the number and hours of farmers markets), decreasing the availability of unhealthy foods (e.g., using media campaigns to reduce the consumption of sugar- sweetened beverages), and increasing opportunities for physical activity (e.g., using a website to better connect New Yorkers with free physical activities resources and classes made available by the Parks Department.)

The Assistant Commissioner will direct, oversee, manage, and assess all activities, policies and operations of the Bureau of Chronic Disease Prevention. More specifically, the Assistant Commissioner will

— determine the strategic direction for the Bureau, including development of measurable goals, objectives, targets, and metrics for assessment and tracking progress; — direct planning, implementation, and evaluation of all programmatic activities; — oversee program and administrative staff and manage the Bureau budget, including hiring, purchasing, and administering the contract portfolio; — coordinate policy, advocacy, and development activities; — direct chronic disease-related research efforts and oversee development of publications; — develop and participate in cross-divisional and cross-departmental opportunities to reduce population-level risk factors for chronic diseases and conditions; — collaborate with city, state, and federal agencies; — engage and contract with community-based organizations and other chronic disease prevention stakeholders and experts; and — represent the agency nationally and as a spokesperson with the news media.

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Preferred Skills Strong organizational, leadership, and management abilities; minimum of 5 years of administrative and supervisory experience; excellent interpersonal and supervisory skills; ability to manage multiple priorities and motivate staff; ability to work well and communicate effectively; content area knowledge (including obesity, nutrition, and physical activity); strong competency in epidemiologic analysis and using data to inform, drive, and improve programming; experience in developing and implementing programs that emphasize policy, systems, and environmental changes to support and influence health-seeking behaviors; ability to develop, organize, direct, and evaluate programs; ability to communicate effectively in public forums; and strong skills in providing effective interaction with the medical community and other governmental, voluntary, and health care organizations.

Apply online with a cover letter and salary information at http://www.nychealthcareers.com; in the "JVN" search window, enter 141041.

• California Prison Health Care Services — Headquarters (Sacramento) — Physician Epidemiologist

Under the general supervision of the Chief, Epidemiology/Surveillance and Aerosol Transmissible Disease Regulation Section, the Physician and Surgeon (P&S), Correctional Facility (CF), of the Public Health Unit, serves as the lead for the epidemiology and surveillance program and serves as an infectious disease and public health subject matter expert and consultant. Together with the Program Development Section, develops programs designed to prevent and control outbreaks of communicable diseases, conducts public health program evaluations, conducts cost-effectiveness and other analyses used in proposing policy changes, develops quality measures, ensures reports and information are disseminated to required agencies and interested stakeholders. The P&S serves as the lead for complex outbreak and contact investigations and coordinates with institutional, state, and local public health departments in these investigations; provides public health consultation to Chief Medical Executives at correctional institutions, clinical providers, and public health nurses; represents the California Prison Health Care Services (CPHCS) at meetings with a variety of stakeholders.

Knowledge and Abilities Knowledge of principles and methods of public health, infectious disease, epidemiology, disease surveillance, and public health policy. Keeps abreast of developments and trends in public health, and infectious diseases; principles and practices of medical research; principles and methods of training of technical staff.

Ability to lead and coordinate complex and varied activities in the field of epidemiology, surveillance, and public health; coordinates and participates in public health evaluation and research; analyzes situations accurately and takes effective action.

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Desirable Qualifications Empathetic understanding of patients in a correctional facility; willingness to work in a state correctional facility; alertness; keenness of observation; tact; patience; emotional stability; and demonstrated leadership ability.

Master’s of public health degree with an emphasis in epidemiology; completion of a 3- year residency program and board certification in preventive medicine, completion of 2 years with the Epidemic Intelligence Service of the Centers for Disease Control and Prevention; experience working in a correctional institution setting; experience working in public health; and experience working on outbreak investigations, epidemiologic studies, and cost-effectiveness analyses.

Special Physical Characteristics Persons appointed to this position are expected to reasonably have and maintain sufficient strength, agility, and endurance to perform during stressful (physical, mental, and emotional) situations encountered on the job without compromising their health and well- being or that of their fellow employees or the inmates.

Contact Theresa Reina, Analyst Centralized Hiring Unit Workforce Development California Prison Health Care 916-445-1066 (Desk) 916-327-0824 (Fax) Internet: http://www.ChangingPrisonHealthCare.org

• The Association of American Medical Colleges (Washington, DC) — Director of Health Disparities and Quality Research Policy

The Association of American Medical Colleges (AAMC) represents all 134 accredited U.S. and 17 accredited Canadian medical schools; approximately 400 major teaching hospitals and health systems, including 62 U.S. Department of Veterans Affairs medical centers; and nearly 90 academic and scientific societies. Through these institutions and organizations, the AAMC represents 125,000 faculty members, 75,000 medical students, and 106,000 resident physicians.

Through its many programs and services, the AAMC strengthens the world's most advanced medical care by supporting the entire spectrum of education, research, and patient care activities conducted by our member institutions. The AAMC and our members are dedicated to the communities we serve and are steadfast in our desire to earn and keep the public's trust for the role we play in improving the nation's health.

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Reporting to the Chief Scientific Officer and working closely with the Chief Diversity Officer, the Director of Health Disparities and Quality Research Policy will lead in developing a research and policy strategy to help increase the visibility and cachet of health disparities research in academic medicine. The individual will bring his or her experience in health disparities research, credibility with the health disparities research community, and familiarity with policies related to health disparities to the position. The Director will also be responsible for strengthening AAMC’s connection to the Agency for Healthcare Research and Quality while maintaining a collaborative working relationship with other AAMC units.

Education/Experience/Knowledge The Director of Health Disparity and Quality Research Policy will hold a PhD or MD with at least 6 years of related experience in health disparity research. An understanding of the legislative, regulatory, and policy development processes as well as the Agency for Healthcare Quality and Research is strongly preferred. The qualified candidate will have a record of scholarly achievement as evidenced by publications in peer-reviewed journals and/or data reports; demonstrated ability to develop, manage, and complete multiple high-visibility projects and policy studies in a team environment, whether working as a team member or team lead; and a documented track record for strategic thinking and problem solving.

The ideal candidate will demonstrate the following:

— Ability to lead, manage, and implement a strategy for an AAMC health disparities research and policy agenda. — Ability to design and implement research studies and program evaluation to assess health disparities research activities of member institutions, agencies, and other stakeholders. — Effectiveness with individuals at various levels of authority and with member organizations and other stakeholders. — Ability to work both independently and collaboratively in a diverse and rapid- pace professional environment. — Excellent written and verbal communication skills. — Knowledge of qualitative research, familiarity with extracting data from databases, validation of data integrity, data analysis, and report writing. — Flexibility in adapting to emerging priorities and constituent requests while maintaining a focus on priorities.

At the AAMC we not only offer a genuine work-life balance, a stable work environment, an outstanding benefit program, and compensation, but at the AAMC you will have the opportunity to use your intellect, energy, enthusiasm, and talent to realize your potential and make a difference.

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Qualified applicants are encouraged to submit a cover letter and CV to our Internet site at http://www.jobpath.com/Jobs/Associationofamericanmedical/Director_Sp_Of_Sp_Health _Sp_Disparities_Sp_And_Sp_Quality_Sp_Research_Sp_Policy/J8B46Z6CJF3ZLDC8T VQ.

• Miami-Dade County Health Department — Chief Medical Officer and Epidemiologist

The Chief Medical Officer and Epidemiologist is an executive position within the Miami-Dade County Health Department reporting to the MDCHD Administrator and planning and directing the program of Epidemiology and Public Health Services.

Duties The Epidemiology Program identifies and analyzes disease trends and implements interventions to promote and protect the health of Miami-Dade residents. The Epidemiology Program acts as a resource for health care providers and the public regarding health questions and concerns and provides public health education and messaging. The Medical Director plays a major role in maintaining the Health Department’s partnerships with the medical infrastructure, other government agencies, and Miami-Dade’s citizens. Other duties include providing medical and public health practice expertise and technical/administrative direction, internally to MDCHD programs such as immunizations, epidemiology, women’s/preventive health, public health preparedness, public health laboratory, community health and planning, tuberculosis, sexually transmitted diseases, HIV/AIDS, Women, Infants & Children Program, clinic administration support staff, school health, and environmental health.

NOTE: Incumbent might be required to perform emergency duty before, during, and/or beyond normal work hours or days.

Qualifications The ideal candidate will have experience in public health management, communicable disease control and epidemiology, and clinical medicine; he or she should possess the following:

— MD or DO degree and be licensed in the state of Florida (required). — Administrative/supervisory experience. — At least 5 years of experience working in the field of communicable disease control and epidemiology at a federal, state, county, or city level (required). — Board eligibility in such specialties as pediatrics, internal medicine, infectious disease, family practice, public health, and general preventive medicine (required). — Master's degree in public health or related field from an accredited school of public health (1 year of experience as a medical officer in a public health agency may be substituted for the master's degree).

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— Valid Florida driver's license (desirable). — Knowledge of the structure and content of the English language, including the meaning and spelling of words, rules of composition and grammar, and pronunciation; strong written and oral communication skills (comparable knowledge of Spanish language recommended.) — Significant experience in working with or in the health care community.

Location: Doral, Florida.

Salary Range: $120,000–150,000 /yr.

How to apply https://peoplefirst.myflorida.com.

Position Number: 64084552 (refer to the People First advertisement for complete details). If you have questions, please contact Juan Hurtado at 305-513-3485 or [email protected].

What's Happening? — Births, Marriages, and Other Significant Events in the Lives of Current Officers (Return to top)

• Erin Koers (EIS '09) and Joey Nichols were married in a ceremony on June 4 in Indianapolis.

Figure 1. Erin Koers and Joey Nicholas.

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• Willie Lanier (EIS '09) reports, "Oliver William Lanier was born on Monday, June 27, 2011, at 5:27 p.m., Mountain Time. He weighed 8 lbs., 6.2 oz., and was 20 inches long. He came out screaming and it was music to our ears! Both he and mom are home now and all is well."

Figure 2. The Lanier family.

• Aarti Agarwal (EIS '10) gave birth to a son, Arjun Zakai Gandhi, on July 1, 2011. Mom and son are back home and doing well.

Figure 3. Arjun Zakai Gandhi.

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Alumni Notes — Publications or Significant Events Submitted by Alumni (Return to top)

• Alexa Oster (EIS '07) sends news of her new daughter, Sonoma Kate Oster, born on April 15, 2011, and weighing in at 9 lbs., 3oz. Alexa reports, "Mom, dad, and baby are doing great. Carter is excited to be a big brother."

Figure 4. Sonoma and Carter Oster.

• Lisa Fitzpatrick (EIS '98) recently received the "Take Wing Award" from the University of Missouri. This annual award is presented to a "graduate who has demonstrated excellence in his or her chosen field and exceeded the expectations of peers in the practice of medicine, academic medicine, or research." (Additional information is available at http://www.med.umkc.edu/alumni/take_wing.shtml.)

• Jevon McFadden (EIS '09) just missed the current officer news deadline and is now an alumnus. "I just wanted to let you know that my daughter, Kaia Marie McFadden, was born on Sunday, July 3. She was 8 lbs., 5 oz."

Figure 5. Kaia Marie McFadden.

• Mehran Massoudi (EIS '94) was recently named as the 2011 "USPHS Scientist of the Year." [Now if they would only give him credit for his 2 years of service in EIS, he’d be a really happy camper.]

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Obituary, David J. Sencer (EIS '75 Honorary), November 10, 1924–May 2, 2011 (Return to top)

Prepared by Don Millar (EIS '61)

David J. Sencer, MD: CDC Director Extraordinaire!

During 32 years at CDC (1961–1993), I had seven bosses1 and of these, Dr. Sencer had the greatest influence on my career as a CDC leader. During the same period, seven directors served CDC2 (I aspired to the job but never got it!); of these, Dr. Sencer had the greatest influence in making CDC the multi-variegated prevention agency it now is. Yet, in the news stories of Dr. Sencer’s passing, his "swine flu decisions" and the "National Influenza Immunization Program of 1976" drew most attention. It repeated the old stories.

In a vicious op-ed piece in on December 21, 1976, the swine flu program was malignantly mischaracterized as a "fiasco" in the headline, and "sorry debacle" in the body of the story.3 Even the official and critical analysis of the program by Harvard University professors found this characterization unwarranted.3 Nonetheless, it stuck and reporters regurgitated the same pejorative language 35 years later at Dr. Sencer’s passing.

In Shakespeare’s Julius Caesar, Mark Antony says, "The evil that men do lives after them/The good is oft interred with their bones."4 The sad thing is that the only aspect of the swine flu program that was evil is the prejudicial media depiction of it. In retrospect, Dr. Sencer’s swine flu decisions, especially his courageous choice to "stockpile vaccines in the immune systems of vaccinees, not warehouses," were thoroughly prudent, given the scientific understanding of influenza pandemics in 1976.5,6

The National Influenza Immunization Program of 1976 pioneered many historic innovations, including sophisticated methods for identifying the virus, epidemiologic direction of decision making, governmental procurement of multiple influenza vaccines, age-specific vaccine recommendations, the most extensive vaccine field trials in history, first informed consent forms for vaccination, and surveillance for both disease and untoward effects of immunization. It was the latter "Trojan horse"7 that caused a moratorium of the campaign in late 1976 because of a "possible association" of "swine flu vaccines" with Guillain Barré syndrome.5,8 In the wake of adverse publicity,3 Dr. Sencer was fired by the incoming Secretary of Health, Education, and Welfare,5 who then commissioned the analysis by the Harvard professors.3 I concluded that this study was, from its outset, a biased contrivance to justify the unprecedented dismissal of the CDC Director.5

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That swine flu vaccines caused Guillain Barré syndrome was never proven conclusively, and when 2009 pandemic influenza A (H1N1) — swine flu — finally reappeared, scientific evidence demonstrated that persons vaccinated in 1976 had protection against the disease in 2009!9 Hardly a fiasco to be sure, but the smear against Dr. Sencer persisted throughout his lifetime, a disservice that threatens to obscure the good he did. Here, I focus on just three of Dr. Sencer’s noble contributions, leaving the rest to historians who are already writing about him.

Ensured the Success of Global Eradication When the U.S. bilateral West and Central African Smallpox Eradication/Measles Control program achieved victory in 1970,10 the World Health Organization's global smallpox eradication campaign was being launched, but it was vulnerable to a lack of trained, experienced personnel. Dr. Sencer supported the WHO global smallpox eradication program until the world was declared free of smallpox in late 1979. This support was hinted at in the WHO history of the global smallpox eradication campaign11 mentioned in a book by the director of the WHO global program,12 and more fully described in a recent book by Dr. Sencer’s successor as CDC Director, Dr. William H. Foege.13

A vivid impression of Dr. Sencer’s support is seen in the list of international personnel who served in the Indian Smallpox Eradication Program14; personnel from CDC provided by Dr. Sencer exceeded by four-fold those from any other nation and included Dr. Sencer’s two top deputies! Dr. Sencer’s role in ensuring global "zeropox" prompted me to tell CDC Smallpox Warriors celebrating the 40th anniversary of the start of CDC’s West and Central African Smallpox Eradication/Measles Control Program, "If any one man deserves credit for winning the World War on Smallpox, that man is David J. Sencer."15

Changed the Face of the Nation’s Prevention Agency When Dr. Sencer became CDC Director in 1966, "CDC" meant "Communicable Disease Center." When he was fired in February 1977, "CDC" stood for "Center for Disease Control."5 As Elizabeth Etheridge wrote, "The hallmark of the Sencer years was growth."5 Dr. Sencer came to CDC with a broad vision of prevention.5 I remember that he spent months in Washington as Acting Assistant Secretary for Health looking around the U.S. Public Health Service for programs he thought fit CDC’s prevention mission in its broadest sense. Hence, when he was fired as Director, CDC had acquired not only a new name but new missions in chronic disease, environmental health, family planning, health promotion, international , nosocomial infection control, and — very important to me — the National Institute for Occupational Safety and Health (NIOSH),5 which I directed for 12 years (1981–1993)! Although many of Dr. Sencer’s dreams for CDC were implemented by his successors, especially Dr. Foege, the current CDC, a broad-based agency leading in all kinds of prevention, is attributable to Dr. David. J. Sencer.

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Was a Great Boss, Friend, and Encourager In the Joseph Mountin Lecture of 1986, I noted that innovation, the implementation of "an idea of genius . . . requires two other ingredients — a boss willing to give it a try — and subordinates willing to carry it out."16 I said that in the context of Bill Foege’s brilliant innovation for attacking smallpox at its weakest point, which we dubbed "Escalation Eradication" and ultimately was responsible for eradicating smallpox throughout the world.13 Dr. Sencer was a consummate example; he always encouraged and supported effective innovation.

When David Sencer died, I lost a personal friend whose contributions to me continued throughout his life. Dr. Sencer appointed me to my first two senior leadership positions at CDC (his successor, Dr. Foege, did the next three; both are accountable for my career as a senior leader at CDC.). In 1966, when Dr. Sencer chose me to lead the Smallpox Eradication Program, I had recently returned from the London School of Hygiene and Tropical Medicine, restive about the changes in "my" Smallpox Unit while I was gone10; I was not sure I had a future at CDC. Dr. Sencer’s choosing me to lead his Smallpox Eradication Program, including the West and Central African Smallpox Eradication/ Measles Control Program5 ended the uncertainty and permanently changed my life. Smallpox eradication and measles control in Africa had thrilling moments as victory loomed a year and a half sooner than expected. But, it was not always thus; at an early point, I was deeply discouraged. I approached Dr. Sencer and frankly asked him whether he would not be better served if I stepped aside for a more senior leader. He would have none of it. "Just keeping doing your job!" he said.

Later, when victory was assured, Dr. Sencer said to me, "Let’s take the lessons you learned in Africa and apply them in the United States."10 He put me in charge of a new Division of State and Community Services in which he consolidated CDC’s domestic disease control programs; it soon became the Bureau of State Services (BSS).5 Here too, were thrilling moments, elimination of fatal lead poisoning among children; reduction of measles to a disease dependent on importation; and the first downturn in the incidence of gonorrhea since the epidemic began! In 1976, when the swine flu program became a reality, he had me lead its implementation.

In the wake of media abuse of the swine flu program, David Sencer was wrenched from my life for several years. He returned to and resumed his outreach to me, usually with requests to join him in doing things at CDC. In early March 2011, he asked me to join him for a meeting on March 18 with CDC’s influenza experts to discuss recent experience with 2009 pandemic influenza A (H1N1) (i.e., "novel swine flu"). I thoroughly enjoyed it as always when David Sencer involved me in anything. A major topic was the PERT Chart for the 1976 "swine flu program" developed by Seth Liebler and coworkers5; the original covered the walls of my office! March 18 was the last time I saw Dr. Sencer.17

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As a boss and as a friend, Dr. Sencer gave me two gifts that were crucial. He had confidence in me when I had little in myself, and he provided encouragement when I most needed it. He did so first in 1966 by selecting me to lead CDC's Smallpox Eradication Program; he continued to do so throughout his life!

Rest in peace, dear friend.

J. Donald Millar, MD, DTPH (London), EIS '61

Notes/References 1. In chronologic order: Drs. Alexander D. Langmuir, D.A. Henderson, David J. Sencer, William H. Foege, James O. Mason, William L. Roper (briefly), and David Satcher. 2. In chronologic order: Drs. Clarence L. ("Larry") Smith, James L. ("Go-Go") Goddard, David J. Sencer, William H. Foege, James O. Mason, William L. Roper, and David Satcher. 3. Neustadt RE, Fineberg HV. The Swine Flu Affair: Decision-Making on a Slippery Disease. Washington, DC: US Department of Health, Education, and Welfare; 1978: 70. US Printing Office No. 017-000-00210-4. 4. Shakespeare W. Julius Caesar, Act III, Scene II. In: Clark WG, Wright WA, eds. The Complete Works of William Shakespeare. Vol. 2. Book Club Ed. Garden City, NY: Nelson Doubleday, Inc.; [undated]: 585. 5. Etheridge EW. Sentinel for Health. Berkeley, CA: University of California Press; 1992. 6. Dowdle WR, Millar JD. Swine influenza: lessons learned. Med Clin North Am 1978;62:1047–57. 7. Sencer DJ, Millar JD. Reflections on the 1976 swine flu vaccination program. Emerg Infect Dis 2006;12:29–33. 8. Millar JD, Osborn JE. Precursors of the Scientific Decision-Making Process Leading to the 1976 National Influenza Immunization Program. Influenza in America 1918–1976. New York, NY: Neale Watson Academic Publications, Inc.; 1977. 9. Hancock K, Veguilla V, Lu X, et al. Cross-reactive antibody responses to the 2009 pandemic H1N1 influenza virus. N Engl J Med 2009;361:1945–52. 10. Ogden HG. CDC and the Smallpox Crusade. Atlanta, GA: US Department of Health and Human Services, Public Health Service, Centers for Disease Control; 1987. HHS Publication No. (CDC) 87–8400. Available at: http://globalhealthchronicles.org/smallpox/record/view/pid/emory%3A15n1g. Accessed August 11, 2011. 11. Fenner F, Henderson DA, Arita I, Jezek Z, Ladyi ID. Smallpox and Its Eradication. Geneva, Switzerland: World Health Organization; 1988. Available at: http://whqlibdoc.who.int/smallpox/9241561106.pdf. Accessed August 11, 2011. 12. Henderson DA. Smallpox: The Death of a Disease. Amherst, NY: Prometheus Books, 2009. 13. Foege WH. House on Fire: The Fight to Eradicate Smallpox. Berkeley, CA: University of California Press; 2011. 14. Basu RN, Jezek, Z, Ward NA. The Eradication of Smallpox from India. New Delhi, India: World Health Organization, South-East Asia Regional Office; 1979.

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15. Millar JD. Revisited: the Smallpox Eradication/Measles Control Program in West and Central Africa. Presented at the Centers for Disease Control and Prevention's 40th Anniversary of Smallpox Pioneers Meeting, July 15, 2006, Atlanta, GA. 16. Millar JD. Seasons in the sun. The 7th Annual Joseph Mountin Lecture, October 27, 1986, Centers for Disease Control, Atlanta Georgia. 17. Millar JD. Dr. David J. Sencer: remembered. Presented at A Celebration of the Life of David J. Sencer, November 10, 1924–May 2, 2011, Emory University Rollins School of Public Health, Rollins Auditorium, June 10, 2011.

David J. Sencer, MD, MPH, Scholarship Fund (Return to top) In 2008, the Rollins School of Public Health at Emory University established the David J. Sencer, MD, MPH, Scholarship Fund, with generous support from the Sencer family. This endowment provides scholarship support for an MPH student who personifies the characteristics Dr. Sencer demonstrated throughout his career. Scholarships are awarded to state and local public health professionals who are experienced problem solvers in community health and health care delivery, and who exemplify leadership and service in the field of public health.

To make a gift to the scholarship fund in memory of Dr. Sencer, visit Emory’s secure online giving page at https://secure.www.alumniconnections.com/olc/pub/EMR/onlinegiving/showGivingForm .jsp?form_id=1374. From the Select Direction drop-down menu, click on Rollins School of Public Health. From the Select Fund drop-down menu, click on David J. Sencer MD, MPH Scholarship Fund. Click the Next button to complete the online gift form.

To make a gift by check, please send it to the Rollins School of Public Health, Office of Development and External Relations, 1518 Clifton Road, NE, Mailstop 1518-002-8BA, Atlanta, GA 30322.

The Rollins School of Public Health notifies the Sencer family of each gift made in memory of Dr. Sencer. To speak with an RSPH staff member about your gift, please call 404-712-8687.

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