Jennifer Gordon Wright, DVM, MPH, DACVPM Veterinarians at CDC Jennifer Gordon Wright, DVM, MPH, DACVPM Auburn University, 1998 jgwright@cdc.gov

Presentation Today Why veterinarians and public health? How I came to be where I am Opportunities for employment Veterinarians at CDC How can you start a career in the federal or state government?

Public Health “ is what we, as a society, do collectively to assure the conditions in which people can be healthy.” Institute of Medicine, The Future of Public Health, 1988

Serving the Nation in All Components of the Veterinary Oath Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.

Links Between Human and Animal Health Antibiotic Resistance Foodborne Disease Emerging Diseases Bio- Agro- Terrorism Mental Health Injuries Occupational Health Environmental Health

Emerging and Re-emerging Zoonoses, 1996–2005 Nipah Virus Hendra virus Multidrug resistant Salmonella Lyme Borreliosis West Nile Cryptosporidiosis Reston virus Venezuelan Equine Encephalitis E.coli O157 Lassa fever Yellow fever Ebola Monkeypox Influenza A(H5N1) Rift valley Fever NV-CJD Ross River virus Equine morbillivirus Nv-CJD E.coli non-O157 West Nile Virus Reston Virus Brucellosis Hantavirus pulmonary syndrome Leptospirosis Recent outbreaks Influenza / Madagascar CCHF / Afghanistan, Iran Tularemia / USA, Kosovo Yellow fever / Ivory Coast Brucellosis / Mongolia E. coli 0157 / Canada Hantavirus / US BSE-vCJD/ UK Nipah virus / Malaysia Avian Influenza / Hong Kong West Nile / USA, Canada Ebola / Gabon, Congo BSE /Canada Monkeypox / DRC/ US SARS / Global Avian Influenza H5N1

Veterinarians Preventing Zoonoses in Clinical Practice Rabies Ascarids and Hookworms Toxoplasmosis Cat Scratch Fever Salmonellosis Scabies, ringworm Brucellosis; Undulant fever Psittacosis Tick-borne diseases Other Veterinarians in clinical practice are practicing public health every day that they step into an exam room and educate a client on the prevention of rabies, parasites, tick borne diseases and other infectious processes.

The long and winding road… Bachelor of Science in Microbiology, Auburn University Interest in working at CDC, but in what capacity? DVM from Auburn University, 1998 Planned a career in small animal practice Turning point – a lecture in sophomore PH lecture about a human case of plague Went into practice for a few years Found the EIS program while searching the web for jobs Began MPH work in 2000, worked at CDC Entered EIS in July 2002 Growing up, my parents were always watching the news and I can remember being concerned about Salmonella and “food poisoning” from an early age. When I went to college I knew I wanted to be a veterinarian, but I wasn’t sure what I wanted to major in, until my interest in infectious disease re-surfaced with a microbiology course. I majored in microbiology before going on to veterinary school. Once in vet school I assumed I would graduate and open a small animal, possibly even feline only, practice. It wasn’t until my sophomore year, in our public health course, when we covered a case study that really intrigued me. The case involved a lady who presented to the ER with a fever of unknown origin. In the end, she wound up dying with a diagnosis of plague. Upon investigation, it was determined that her cat had died recently and she had nursed him while he was sick – the cat also had plague and the owner contracted it while caring for her pet. My first thought was – that I didn’t realize plague still existed, and secondly what a cool career that would be, to investigate such cases. But I still didn’t realize that was really a career option, or how to get there. So when I graduated, I went into practice for a few years, first in a feline only practice, then one of the largest small animal practices in Atlanta. After about 6 months in my first job – I came home one night and started surfing the web looking for information on CDC – determined to find a better job and quality of life! I hit upon the EIS program, the Epidemic Intelligence Service, which we’ll talk about in just a few minutes, and quickly realized these were the people who investigated cases such as the one of the woman with plague. I knew this was what I had to do! Unfortunately, the educational requirements for veterinarians included either a public health degree, or public health experience. So I went back to school to get a master’s of public health, kept working in the clinic, and found a part-time job in the foodborne and diarrheal diseases branch at CDC.

The Department of Health and Human Services is the principal agency in the United States government for protecting the health and safety of all Americans and for providing essential human services.

History of CDC 1946 - Communicable Disease Center founded in Atlanta by Dr Joseph W Mountin 400 employees, mostly engineers and entomologists working on malaria prevention Original focus on vectorborne and zoonoses Growing awareness that expansion to all communicable diseases was necessary

CDC in 1944 Return to top.

History of CDC continued 1950 – Korean War –threat of biological warfare loomed Dr Alexander Langmuir – emphasis on epidemiology and surveillance to guard against threats to public health Created CDC’s Epidemic Intelligence Service (EIS) “Disease Detectives”

Key CDC Successes 1955: Surveillance data used to trace polio and influenza epidemics, leading to national guidelines for use of vaccines 1962 – 1977: Global smallpox eradication Mid 1970s – 1980s: Identified the cause of Legionnaires Disease and toxic-shock syndrome 1981: Acquired Immunodeficiency Syndrome first mentioned in MMWR

CDC today One of 13 components of DHHS >8000 employees Headquarters – Atlanta, Morgantown, Ft. Collins, Cincinnati, Hyattsville State health departments International reputation Applies research and findings to improve daily lives Respond to health emergencies Not just infectious diseases Chronic diseases, injuries, workplace hazards, disabilities, environmental health threats

CDC in 2006 “ The function of developing and protecting health must rank even above that of restoring it when it is impaired. “ Hippocrates

How CDC operates Jurisdiction over: Cruise ships docking in US ports Importation of people/animals with communicable disease Otherwise, need invitation of the state or reservation to assist

Veterinarians at CDC As of December 2005 Just under 100 vets currently work at CDC, in multiple capacities

Veterinarians at CDC Epidemiologists Laboratory animal veterinarians Laboratory research Health Educators

Epidemiologists EIS program Outbreak investigations Research and surveillance Policy recommendations

What is the EIS Program? Epidemic Intelligence Service (aka “Disease Detectives”) Established in 1951 Mission: To prevent & control communicable diseases A 2 year training program in applied epidemiology Domestic and International Service Respond to Requests for Epidemiologic Assistance So I’ve mentioned EIS several times, and you are probably wondering ‘what is EIS’? Entry into the EIS program would be the next step in a career as public health veterinarian and epidemiologist for many of you, so I’m going to take a few minutes to introduce you to the program. Many of the vets present during the lunch session are EIS “graduates” and will be happy to talk about their experiences with the program. The EIS program was established in 1951, following the start of the Korean war, as an early warning system against biological warfare and man-made epidemics. EIS officers are often referred to as ‘disease detectives”, and are ready to travel at a moment’s notice. EIS is a 2 year training program in applied epidemiology that teaches and reinforces quantitative skills, research design, epidemiologic judgment, communications skills, and surveillance skills. EIS officers respond to requests for domestic and international service. As an EIS officer you never know where you will be going next, so you should always keep your bag packed and your passport ready!

EIS continued 55-75 officers, 6-9% are veterinarians Applications are due in October for the following year’s class Additional training or experience in public health encouraged prior to application http://www.cdc.gov/eis/about/about.htm

Legionnaires' Disease/Norwalk virus Where do EIS Officers Train? TB in immigrants Lead screening Legionnaires' Disease/Norwalk virus Copper in drinking water Cryptosporidiosis E. coli EIS officers train in either a state based position, or a CDC office in Cincinnati, OH; Ft. Collins, CO; Morgantown, WVA or Atlanta, GA. EIS officers have worked with hanta virus, hurricane reponses, norwalk virus outbreaks on cruise ships, the west nile outbreak which began in NYC in 1999, 9/11 and the resultant anthrax outbreaks, just to name a few. EIS Officers played a key role in the global eradication of smallpox; are currently working towards eradicating polio and guinea worm,and discovered how the AIDS virus was transmitted. West Nile Virus/Anthrax Forest Fires Bombing Hurricane Hugo Cyclosporiasis Hanta Virus Hurricanes Malaria Norwalk Virus

Polio Eradication: Ghana and Nepal

Cost of effectiveness of Brucella vaccine, Egypt

Tularemia outbreak, Martha’s Vineyard

Oral Rabies Vaccine Effectiveness

Q fever outbreak, Bosnia-Herzegovina

Collecting bats in the Philippines, 1998

Sept 11, 2001 – New York City

Anthrax letters, 2001

FMD Surveillance, UK May 2001 Serosurvey of sheep to lift quarantine in infected areas

Rocky Mountain Spotted Fever, Arizona, 2004

Norwalk virus outbreaks on cruise ships, 2002

Monkeypox Outbreak, 2003

E. coli Outbreaks in Petting Zoos

Response to Hurricanes Katrina and Rita, 2005

Collecting swamp water for Leptospirosis testing, Florida, 2005

Laboratory Animal Veterinarians Care for CDC research animals Horses, non-human primates, rabbits, ferrets, etc Instrumental during Monkeypox outbreak for arranging transport of potentially infected animals from the Midwest for testing purposes Laboratory animal medicine residency/board certification desirable, but not 100% necessary to work in the office

Laboratory research Influenza, Salmonella, E. coli, parasitic diseases, as a few examples Additional schooling – MS or PhD necessary to assist in most laboratories Emerging Infectious Diseases Fellowship

Health Educators Healthy Pets, Healthy People website Consultations to TV shows Publicize important health messages “House MD” – message on 3/7 episode regarding risks of eating unpastuerized cheese Prudent use of antimicrobials in veterinary curriculum Develop educational activities around outbreak investigation/research findings

Student/Recent Graduate Opportunities State and local health departments Opportunities with USDA, FDA Public Health Service co-step program* CDC - Summer student employment CDC – Epidemiology elective Emerging Infectious Diseases fellowship http://www.cdc.gov/phtrain/ So as a student, the next step for many of you would be to explore electives in public health. You can always check with you state and local health departments for opportunities, as well as the agencies we discussed earlier today. In addition, I will have some flyers out during the lunch session from the University of maryland about some employment and elective opportunities. The PHS has a co-step program for summer opportunities, as well as a paid program for senior students. CDC has a summer student employment program and an epidemiology elective program. Announcements for the summer employment program usually appear on the CDC job openings website during the winter. The epidemiology elective is a mini-introduction to EIS, usually lasting 6-8 weeks with a defined project and a chance to assist with outbreak investigations. Deadlines are May 30th of your junior year and more information can be obtained from this website. *currently limited opportunities due to budget

Epidemiology Elective http://www.cdc.gov/eis/applyeis/elective.htm September through June 6-8 weeks Defined project, often a chance to assist with outbreak investigations Deadline: May 30th of your Junior year No financial support for living expenses, etc; support for investigation related travel

Emerging Infectious Diseases Fellowship 1 year program Field of degree must in some way be applicable to research program US Citizens only Application deadline is mid-February each year Must be graduating before start fellowship

Personnel Systems Civil Service Commissioned Corps of US Public Health Service Military Services (Air Force, Army) Fellows Contractors I’d like to take just a few minutes to introduce you to the Public Health service, since I’m sure you have been wondering why a navy officer is talking to you about CDC, or better yet, a Delta pilot….There are many personnel systems within the federal governmen and the majority of veterinarians at CDC are either civil servants or officers in the Public Health Service.

USPHS Com Corps Veterinarians Who are we and what do we do? How do you get a job with the Com Corps of the Public Health Service? The public health service is a uniformed service, not a branch of the military, although our roots are with the Navy. The public health service is rapidly deployable in the event of a national emergency, such as 9/11 or the hurricanes of recent years. Over 80% of PHS vets had the opportunity to work in Mississippi, Louisiana or Texas this fall following the hurricanes and many of us were on the road with less than 24 hours notice. The PHS also offers some opportunities for students, through a junior co-step program, and a paid program, usually with USDA, during your senior year. The Surgeon General is the top PHS officer.

What are our roles? Emergency Response Force for the Nation In addition to serving as the nation’s emergency response force to public health emergencies, PHS officers work in: Epidemiology and surveillance Laboratory animal medicine Pathology and other laboratory sciences Entomology Food safety and zoonoses control Bio/chem terrorism preparedness and security Quarantine and inspection Drug safety Environmental health and toxicology

Appointment Process Step 1: PHS Application Step 2: Identify vacancy Step 3: Accept offer Step 4: Call to active duty

Summary Exciting career opportunities at CDC exist for veterinarians About 35-40% of CDC veterinarians are PHS officers Training programs are important entry points EIS class is a great entry point Epidemiology elective – invaluable experience Additional education (MS, MPH, PhD) a plus In summary, there are many varied and exciting career opportunities for you as a public health veterinarian. Many times training programs serve as important entry points for a career at a certain agency, such as the EIS program at CDC, or the Veterinary services career program at USDA. We often work in positions not exclusively designated for veterinarians. Veterinarians currently make up approximately half a percent of the US public health workforce and 2.8% of the federal workforce. As a large number of PH veterinarians are projected to retire in the coming years, the need for vets in PH is growing.

I hope I’ve been able to give you a quick over view of some of the opportunities available in the federal government, and especially here at CDC. My email address is on the screen and I’m always happy to answer questions about EIS, the PHS, or CDC in general. jgwright@cdc.gov

Acknowledgments Nina Marano, CDC Marguerite Pappaniou, U Minn Jennifer McQuiston, CDC Diane Gross, CDC Marta Guerra, CDC Steve McLaughlin, CDC Kristy Murray, U Texas - Houston Paul Arguin, CDC Joel Montgomery, CDC Kathy Perdue, NIH Linda Demma, CDC