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

by Mark Pendergrast

Since its founding in 1951, the Epidemic Intelligence Service has waged war on every imaginable ailment. When an epidemic hits, the EIS will be there to crack the case, however mysterious or deadly, saving countless lives in the process. Over the years they have successfully battled polio, cholera, and smallpox, to name a few, and in recent years have turned to the epidemics killing us now—smoking, obesity, and gun violence among them. 

The successful EIS model has spread internationally: former EIS officers on the staff of the Centers for Disease Control have helped to establish nearly thirty similar programs around the world. EIS veterans have gone on to become leaders in the world of public health in organizations such as the World Health Organization. 

Inside the Outbreaks takes readers on a riveting journey through the history of this remarkable organization, following Epidemic Intelligence Service officers on their globetrotting quest to eliminate the most lethal and widespread threats to the world’s health.

Genres: Nonfiction, Science, History, Medicine, Medical, Health, Biology

614 pages, ebook

First published January 1, 2010

About the author

Mark Pendergrast was born and raised in Atlanta, Georgia, the fourth of seven children in a family that valued civil rights, the environment, sailing, reading, and games of chase and charades. He earned a B.A. in English literature from Harvard, taught high school and elementary school, then went back to Simmons College for a masters in library science and worked as an academic librarian—all the while writing freelance articles for newspapers and magazines. In 1991, he began writing books full time, which allows him to follow his rather eclectic interests.

Pendergrast’s books have been published in 15 languages. For God, Country & Coca-Cola was named a notable book of the year by the New York Times, and Discover Magazine chose Mirror Mirror as one of the top science books of the year. Pendergrast has given speeches to professional groups, business associations, and college audiences in the United States, Canada, the U.K., and Germany. He has appeared on dozens of television shows, including the Today Show, CBS This Morning, and CNN, and has been interviewed on over 100 radio programs, including All Things Considered, Marketplace, Morning Edition, and many other public radio shows. He lives in Colchester, Vermont.

Reviews

[Daniel · Rating 2 out of 5]

It's too bad that Tracy Kidder didn't write this book. The material is intrinsically fascinating, not only for physicians and epidemiologists, but for anyone with a general interest in epidemics and public health. The author is at his best when going into more depth with the HIV epidemic, anthrax bioterrorism, and when describing his own travels in Africa tagging along with Epidemic Intelligence Service teams. However most of the book consists of frustratingly superficial 1/2 to 1 page descriptions of virtually every epidemic investigation launched by the EIS from its founding in the early 1950s to the recent swine flu outbreak. I was really torn because there are really important and interesting topics here: the campaign to eradicate smallpox, the ups and downs of polio immunization, the African hemorrhagic fevers. But at times I nearly quit reading, bored by the staccato presentation of too many incomplete stories.

[Ashley · Rating 2 out of 5]

This book was such a disappointment. Instead of a critical history of the EIS that places the organization in its historic and political context, Pendergrast delivers what seems to be little more than a summary of the EIS' cases.

The short vignettes all sort of blur into each other after a while. Plus, this format means that you never really learn much about any outbreak or EIS personality-- they just kind of come and go without reason. On one hand, I suppose that is how it must feel to track down epidemics. On the other hand, for a reader it means the book is rarely engaging.

Pendergrast has the research for a great book about EIS and the CDC's relationship to politics, international diplomacy, and personalities. Sadly, he delivered a book that doesn't move beyond the cases or reflect critically on the organization. It's okay as a quick reference, but to really learn about public health there are several better books.

[Corinne Edwards · Rating 4 out of 5]

Have you even heard of the Epidemic Intelligence Service? Until my younger sister began getting a degree in public health, I had no idea it even existed. It's a group of people who spend two years going out into the "field" and being, really, disease detectives. When there is an outbreak of bizarre symptoms, EIS officers are there to investigate and try to diagnose. If there are multiple cases of known diseases, such as E. coli or H1N1, they rush to try and determine the source of each case to decide if there is an epidemic and if so, how to stop it. They're like a disease CSI unit, tracing clues and interviewing "suspects".

Seriously, it's interesting stuff. This book is a history of the EIS and is told, almost exclusively, in short vignettes. There is some political stuff in there, of course, because it's an agency that's supported by the government, but mostly it's just stories of diseases! We learn about the discovery of Ebola, the eradication of Smallpox, the Polio vaccination effort, SARS and on and on. Your heart will break at the horrible stories of cholera epidemics and refugee camps - EIS officers literally travel the globe with only one goal: to stop people from getting sick.

After reading this book I feel like we, as citizens of this earth, owe so much to these public health workers. They are on the front lines when all kinds of terrifying diseases are spreading and they put their own lives on the line to try to spare us, spare me, from illness. They fight for clean water for everyone, for food safety regulations and hospital sanitation regulations. I found this book fascinating. Granted, the book is clearly biased towards the organization - it's all very LOOK how amazing this is! But based on the stories, I just can't disagree. I love this new knowledge that I have and I certainly have a greater awareness of how lucky I am to live in a clean, safe place.

I have tried other books on this subject and couldn't make myself finish them, so I'm telling you, if you have any interest in epidemiology, I totally recommend this one.

[Eldon Farrell · Rating 4 out of 5]

It's rare that a book takes me this long and still receives a favorable mark. While this was highly detailed, I also found it entertaining :)

[Katelyn]

It was loaned to me by a fellow epidemiology buff who insisted I read it. I'm quite glad of the insistence. Swashbuckling scientists traveling all over the world to treat patients and locate the elusive origin of disease, early morning eurekas, investigating bacterial sources in clandestine ways - it's like FBI for the CDC. What's not to love? This book exposed me to the EIS and the remarkable people behind the outbreaks. As I read about the eradication of smallpox as a culmination of ever-widening ripples, I saw how it mirrored the cases in the book building off one another, interweaving and connecting.

I was unnerved at how the government could muzzle the leaders of the program at times, and how the impact of war and politics halted the progress of saving lives. I picked up a few tips among the barrage of information: don't eat potato salad at picnics. (Really, anything that has the potential to breed bacteria, don't eat without observing how it's prepared in a community setting. So many cases could've been prevented.) Use narrow-necked containers for drinking stations to prevent contamination (i.e. washing hands in the same water). A lot of EIS members avoided contracting the medical cases they were investigating through sheer dumb luck. Most importantly, sanitation and clean drinking water are paramount to stopping epidemics and improving overall health.

The following, which I'll leave you with, stuck out to me as one of the key reasons to be an EIS officer and contribute to the cause:

EIS officers continue to fight one battle at a time, one outbreak at a time, adding incrementally to our knowledge base and inching towards solutions. "EIS is the emergency room of public medicine," said EIS alum Jim Buehler. "For many problems, the things you study with the tools of field epidemiology are the most superficial manifestations of things that go deeper - racism, poverty, under-employment, inadequate access to medical care. We come in to sort out what tipped the balance so that bad things happened. But we seldom deal with the underlying causes." Yet Epidemic Intelligence Service officers can shine a spotlight and suggest solutions.

[Stephen · Rating 2 out of 5]

This book covers fascinating material about the frontlines in disease outbreaks, the CDC's EIS, unfortunately the author gets in the way (or perhaps more problematically, is often completely absent.) I decided half way through that this book really presents the information, the research, etc, in a way that would be a prelude to a great non fiction book.

The book is organized, basically as a series of often short (less than a page) vignettes of cases seen by EIS officers (and sometimes by former EIS officers, one has to look carefully), presented chronologically. I only got a direct sense of the nature of diseases, and a bit about epidemiology, not so much about the EIS officers, and the EIS program. Finally, in the last paragraph, we are told about the training process (EIS officers generally join the program for two years shortly after gaining their Doctorate, before moving on to a longer term position). It would have been well to show more than a glimpse, and to show it at the beginning.

I can think of a dozen unexplored questions. How do EIS officers compare to other public health scientists who take on similar roles (we see many of them in the book, without much comment). How did the EIS change over time? Despite the chronological organization, we don't see that (maybe because we don't see a clear picture of how the organization exists at any time). In fact, the chronology hinders. There are diseases that are investigated multiple times, and often the first time (or first few times) no one knows what causes the disease. What changed that allowed later EIS officers to come to an answer. Was it just advancing science? Or had methods change? Etc. etc.

I could go on in what I didn't get, but in short this is a book about disease, not about disease hunters. I don't have any problems reading about disease (that's why I finished this book) but it's not what this book is supposed to be about. The EIS provides the eyes through which we see disease--which means we're almost always looking away from the EIS. And frankly, I don't think the repetitive vignette style really helps explain anything about diseases.

[Pancha · Rating 2 out of 5]

This is a broad overview of some of the cases covered by the Epidemic Intelligence Service (EIS). It reads like a bulked up chronology line, so rather than follow the mystery of Legionnaire's Disease to completion in one section, you get get the fractured chunks of it in chronological order. You also don't get a good feel for the various EIS agents. If you're looking for basic information, this book is fine, but if you want something more comprehensive and personal I suggest one of the memoirs of the agents in question.

[Zora · Rating 2 out of 5]

Other reviewers have identified the problem with this book. Although there is good research behind this – interviews, internal memos, interviews w/ surviving children if the principles are dead – the very short incident reports become quickly irritating. I felt as if I were reading a series of 300 word essays written by a diligent B+-average junior in high school. That it is presented in time order means that many opportunities for analysis, examining context, and finding meaning were lost. It's...plodding, is what it is. I did a lot of skimming in the second half.

[Meg · Rating 3 out of 5]

A disjointed collection of stories from the EIS, a branch of the CDC, this book is successful primarily because the stories are so compelling. Pendergrast returns to many of the same diseases again and again, which does help to improve the book's unity. An excellent book if you have to pick it up and put it down again many times.

[Terri · Rating 4 out of 5]

A very interesting book about the EIS (epidemic intelligence service). The men and women who investigate outbreaks for the CDC all over the world. Each told in short highlights, it brought back memories of so many things I had forgotten abotu from Toxic Shock Syndrome, to SARS. It brings life to the stories of people who work under the radar many times but save us when we dont even know it.

[Mary Alice · Rating 2 out of 5]

It's like so many blurbs about the EIS. Little stories, many unconnected. Couldn't get a feel for any of the characters.

[Mary Ronan Drew · Rating 3 out of 5]

Read my review on my blog:

http://maryslibrary.typepad.com/my_we...

[lawyergobblesbooks · Rating 3 out of 5]

Interesting stuff but the book lacks focus and reads like a summary.

[James Frederick · Rating 3 out of 5]

This was a really interesting book and I learned a LOT. I had never even heard of the Epidemic Intelligence Service. Who knew there was this group of doctors and researchers who jetted off to investigate epidemics, vaccinate people, etc, etc, etc? The idea is fascinating and particularly apt, given the worldwide pandemic we are now contending with. I am wondering what part the EIS is playing in this, as we speak.

The best parts of this book read like a cross between a good mystery and a medical thriller. Unfortunately, large parts of this LONG book read like a cross between a diary and a medical journal. Those with degrees in science and medical doctors would almost certainly rate this higher than I did.

What was not really said in the book in any detail is how this group is allowed to operate across international borders. I gather that foreign governments reach out and request assistance from the EIS when they run into a situation that they cannot work out, on their own. But what about when a country might have something to hide? The EIS is part of the CDC, which is part of the US government. I imagine there are countries out there that would want nothing to do with having G men digging about.

This book was a bit frightening in the sense that there are SO many different things out there that can kill us and/or make us really sick. It is good to know that there are highly skilled people that are working really hard to sort it all out and protect people from this stuff. But the politics and corporate interests that interfere with public health and doing the right thing just make me sad.

[Amy Mills · Rating 3 out of 5]

Interesting, but weirdly organized. Rather than have all the entries on, say, smallpox together, they instead come up grouped by the time period in which they occurred. If the date is your primary concern, that's probably fine, but I suspect most people would rather have the topics grouped together.

Overall, this feels much more like a primer for people looking for more sources than an actual informative book. It is informative in itself, but it's more like an encyclopedia of disconnected articles in order by time than a literary account.

Also worth noting: the actual text stops about 2/3 of the way through, and the remaining third is taken up by references and a hyperlinked index. So, great starting resource if you're interested in the topic, but a bit disappointing as a read in itself.

[Hank Parker · Rating 5 out of 5]

Who knew how many toxins and pathogens lurk in our surroundings, ready to do us in? Mark Pendergrast has written a well-researched, chillingly factual account of a little-known branch of the Centers for Disease Control and Prevention which, since 1951, has battled dozens of disease outbreaks—from all-too-familiar scourges like smallpox, polio, and AIDS to obscure but equally terrifying afflictions like Marburg virus and Lassa Fever.

Most people have never heard of the Epidemic Intelligence Service which labors without fanfare to track down and check the spread of the world’s most deadly diseases. The dangerous and tireless work of EIS scientists has made us all safer. Mr. Pendergrast has done a great service by sharing their story with us.

[Nightwitch · Rating 2 out of 5]

The actual writing was fine, but as other reviewers have mentioned, this was essentially a summary of EIS's cases, and that is how it is presented, with descriptions ranging in length from a paragraph or two to perhaps two pages; they are presented chronologically, and the only thing linking e.g. outbreaks of the same disease is a footnote at the bottom of the page. I dipped in and out of this for several months until I'd finally finished reading it, but it never got more than mildly interesting. A history of a specific illness or class of illnesses, or a more narrative overview of the history of the EIS, would have been far more interesting than this was. It felt like reading an EIS-specific Wikipedia in book format.

[Brianne Ramos-Aiken · Rating 2 out of 5]

I hate quitting on books, but I can't take it anymore. I'm 15% of the way through and it's taken me months to get through. This book is so boring! It's literally the entire history of the EIS told in 4-paragraph snippets of each epidemic they investigated. So repetitive and the second it starts to add color or talk about something interesting, it moves on in the next paragraph.

I wanted this book to be good because public health is a fascinating field, but in trying to manage such a huge breadth of information, it ended up not providing enough depth to keep you engaged for even a few minutes.

[Anne Exler · Rating 3 out of 5]

I'm listed in the acknowledgements for a little bit of research assistance so this book has been on my shelf for years. I'm currently in an online trivia league mini-season all about the history of disease and epidemics, so it was a good time to finally read the whole book. It's lots of short vignettes, so a bit choppy, but it would have been hard to corral the hundreds of stories and people into anything that's still comprehensive but more flowing. My favorite part was the very last section when the author job shadows EIS officers in Africa.

[Eliot · Rating 5 out of 5]

Let me start by saying this is an absolutely fantastic book; a great look at a largely unknown, and certainly unappreciated group of people. Delving into the formation of the EIS, as well as its contributions to the CDC. Illustrating some of the many heroic instances of EIS officers work, this is a beautiful book. However, it is easy to pick up and put down, and this is likely just my pace given this genre, but it took me a good amount of time to finally reach the end. Regardless, absolutely worth it.

[Rebecca · Rating 2 out of 5]

Interesting subject matter and well researched. However, just a bunch of small stories told in short sections with no logical organization. Succeeding paragraphs do not necessarily have anything to do with previous ones. Sometimes this is true within a single paragraph. Also, I felt that the work of the EIS was not approached critically at all. All admiration without any criticism of mistakes or unethical behavior (and some things described are very unethical).

[Asuka · Rating 3 out of 5]

This is really my favourite topic to read. Ever. But this book was just okay. The writing is clear enough, but it's a very, VERY, long list of cases the EIS members dealt with, and each case only takes up a page or two. It would have been more engaging if it was a selection of the most interesting or unsolved cases. Too bad because the work of CDC and EIS should be much more well known. They do courageous and amazing work.

[Jestine Myers · Rating 2 out of 5]

I learned many things I never knew before from reading this book. I am not a fan of non-fiction, but this one worked for me. I also liked that sections were distinct from one another so I didn't lose the thread of the message if there were breaks between one chapter or section and the next. There were a few examples I felt to graphic for young children (some specific sexual practices that were described in detail from a clinical aspect), but overall it was informative.

[Carolyn · Rating 2 out of 5]

A bit of a tough book to rate - interesting and I learned many things from reading it, but I believe it would have benefitted from being much narrower in its scope. Instead of telling lots of short stories about epidemics and diseases, which often feel incomplete and left me with more questions than answers, perhaps the book might have been better if it focused on fewer stories but did a deeper dive into them.

[Jacky · Rating 3 out of 5]

I think I would have given this more stars if he had spent a little more time talking about each investigation/outbreak. He jumped around a lot and most stories only got two or three paragraphs. I understand that there was a lot to talk about, but I feel like more details would have added to the stories.

[Avalon Kalika · Rating 4 out of 5]

I know it was a history of the EIS as a whole, but I would have loved more depth into some of the cases. I eventually got into the swing of how short the description of each outbreak was, but I really struggled with it at first. Overall though, very informative! I perhaps would have benefitted more by reading slower but time was of the essence as I could not bring it to Scotland with me.

[Graham · Rating 3 out of 5]

Definitely more a series of vignettes than a comprehensive history, but nevertheless is an interesting overview of the first 50 years or so of the EIS, running up until right around the beginning of the Obama administration. A reminder of how pioneering this country once was in the field of public health both at home and abroad; also a depressing reminder of just how far we've fallen.

[Jane Thompson · Rating 4 out of 5]

Medical History

This is a long History of infectious diseases and how they were discovered by the CDC. It shows that these diseases are found every where and that they occur even in the United States. It is educational and shows how even new diseases are found and controlled.

[Allie · Rating 3 out of 5]

This was very interesting subject matter. However, the writing just wasn’t very good. The book basically followed a “This happened, and this is what we did, and this happened, and we did this” trajectory. I would have appreciated more of an effort at a storyline.

[Lucy · Rating 4 out of 5]

This was fascinating. The reason I didn't give 5 stars is because it wasn't the easiest to read. It reads like a collection of catalogue entries, really, which I found a little difficult to keep track of due to the choppy manner of the book. Otherwise, I enjoyed the hell out of it.