Dr. Rohit Chitale

Truth is often stranger than fiction for the Centers for Disease Control and Prevention’s (CDC) elite force of disease detectives. Keeping a watchful eye on the emergence of potentially lethal pathogens and other disease agents is the daily responsibility of the CDC’s epidemiologists like me. We explore the trajectories of various outbreaks, including anthrax and E.coli O157, diseases occurring right here at home in the US, where powerful disease surveillance systems continually look for cases of illness. But most nations have an inability to rapidly detect and report disease events, and frequently governments are reluctant to do so (like China was with SARS).  So what happens then?

In Fall 2006, Dr. Ray Arthur established the CDC’s Global Disease Detection Operations Center (GDDOC), to help the US’ primary disease control agency be prepared for emerging global disease threats. This center is the first of its kind at CDC, and one of only a few similar centers globally. The analysts at the center comprise a multi-disciplinary team of PhD-trained as well as physician and veterinary epidemiologists. These broad yet overlapping skill-sets allow the analysts to see the world from a human, animal, and population medicine perspective, and makes for some interesting scientific, multi-disciplinary discussion in an environment focused on real-world disease detection and outbreak response.

A key function of the GDD Operations Center: Event-based surveillance

The GDDOC uses a method of “disease event” detection called ‘event-based surveillance’ to constantly look for disease events around the world. Though the CDC is concerned with human health, about 80% of emerging infectious disease threats arise from animals; hence, it is crucial to look at animals and their health as sentinels for human illness.

The GDDOC uses various sources to look for disease events, including Internet-based foreign language media reports, blogs, and websites in about 40 languages. It then takes the source reports–from media, various CDC expert staff or partners, or sometimes even foreign physician reports–and verifies the information. You can’t always believe what you read in the media or on a website, or even see on a map. You have to verify it, and in this business, it has to be done quickly.  The GDDOC leverages the skills of CDC’s disease experts in the US and CDC’s impressive global footprint, including staff in over 60 countries and all six WHO regions worldwide, to find out what’s really going on in a country.

Global Health Diplomacy and Security

The work of the GDDOC is based on systems and processes developed at the World Health Organization (WHO) in Geneva, Switzerland. The International Health Regulations (IHR), a legal document significantly revised in 2005 and signed by 194 countries worldwide, provides key guiding principles for the GDDOC. It sets forth criteria that countries can use to assess potential or real disease events, to determine if they are, or could become, a Public Health Emergency of International Concern (PHEIC).

This approach introduces the concept of ‘all hazard’ and context-specific risk assessment, and mainly removes the pathogen-specific disease reporting mandated by the IHR since 1969, when the document was originally created. The US Government has been a strong leader in the implementation of the IHR; in fact, the GDDOC and its parent division have been named the first and presently only WHO Collaborating Center for Implementation of IHR National Surveillance and Response Capacity. The GDDOC and its parent division are critically involved in health diplomacy and health security, with the mission of protecting the health of the citizens of the United States and the global community. The Division and CDC’s other international programs are critical partners in President Obama’s Global Health Initiative (GHI).

Breadth and Impact

Working in the GDDOC provides a birds-eye view of the CDC and the various pieces of the US Government and global partners that are involved in public health. In terms of diseases, it surveys the world for emerging or re-emerging diseases and in a given day the analysts discuss several diseases occurring in many countries. In a place filled with many of the world’s disease experts, it can be tough to be a scientist, yet in terms of diseases, we work with far more breadth than depth. Nonetheless, my time in the GDD Operations Center has been exciting, instructive, and I think has made a positive, real-time difference for global public health, and for science.

Dr. Rohit Chitale

Rohit A Chitale is an epidemiologist and one of the first analysts involved in establishing the CDC’s Global Disease Detection Operations Center. Dr. Chitale received his PhD in Epidemiology from the Johns Hopkins Bloomberg School of Public Health, his Masters of Public Health from the University of California, Los Angeles (UCLA), and his BA in Economics from the University of Maryland, College Park. He holds faculty appointments at the Johns Hopkins Bloomberg School of Public Health and the Rollins School of Public Health at Emory University. Dr Chitale can be reached at rchitale@cdc.gov.

 

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