Field Epidemiology Training in Brazil - Part I
In August of last year, the 11 participants in Brazil’s new field epidemiology training program were still in their first month of lectures when the program’s headquarters in Brasilia began receiving reports of clusters of illness in different parts of the country. People were sick, some were dying, and the causes of the illnesses were often elusive.
“We began hearing of outbreaks right away,” says medical epidemiologist Denise Garrett, M.D., M.Sc., EIS ‘96, CDC consultant for the training program, which is a collaborative effort of CDC, the CDC Foundation and the Brazilian National Health Foundation of the Ministry of Health. “As people began to know about the program, we received more requests for assistance. The trainees studied the basic tools of epidemiology, and then they went right into the field for on-the-job-training.”
Between September and October, seven disease outbreaks - ranging from hantavirus to contaminated medication - were reported to the field epidemiology training program (EPI-SUS) for investigation. Two trainees accompanied EPISUS consultant and CDC medical epidemiologist Douglas Hatch, M.D., M.P.H., EIS ‘87, to the town of Cristais, where over a hundred children were sick with hepatitis A. Meanwhile, Dr. Garrett headed to Rio de Janeiro with two trainees to investigate a cluster of unexplained deaths. Before she returned, Dr. Hatch and another group left again to conduct investigations on a farm in Espirito Santo, where workers were falling ill.
The disease cluster in Rio de Janeiro was particularly deadly and mysterious. Nine people died quickly after experiencing fever, hemorrhagic manifestations and headache. While awaiting laboratory results, the EPI-SUS team conducted an epidemiological study and identified risk factors linked to the deadly illness: exposure to rats and a neighborhood creek. Based on these risk factors, they implemented control measures and the outbreak was halted.
“This demonstrated how powerful the tools of epidemiology can be. You can make an impact even before your investigation is complete,” says Dr. Garrett.
CDC Foundation Enables Public Health Partnership - Part II
“Public health in Brazil has been among the best in the Americas for some time. But it is a huge country, and it has lacked the capacity to provide adequate and timely responses to public health emergencies,” says medical epidemiologist Carmen Sanchez-Vargas, M.D., of CDC’s Division of International Health. In recent years, however, Brazil has worked to correct this problem by decentralizing many public health functions so states and cities can identify and respond quickly to local disease outbreaks.
As a part of these changes in Brazil’s public health system, the Brazilian Ministry of Health’s National Health Foundation launched a project to improve national health surveillance, expand the country’s ability to respond to emerging infections, enhance communications technology, and establish a field epidemiology training program. To help implement this project - funded with a $300 million World Bank loan and matching funds from Brazil - the Ministry of Health turned to CDC for technical assistance. Because of the complexities of the two governments’ health agencies working directly together, the CDC Foundation helped forge a partnership between the Brazilian National Health Foundation and CDC. Awarded a $1.56 million contract for this purpose, the Foundation helped coordinate a key component of the project - the field epidemiology training program. The Foundation’s role in this effort has been facilitating the placement of CDC staff in Brazil to establish and operate the training program and monitoring the program priorities through annual site visits and progress reports to the Brazilian National Health Foundation.
“The Brazil epidemiology training program emphasizes service in the field - learning by doing,” says Jay McAuliffe, M.D., senior policy officer in CDC’s Office of Global Health. “Priorities in 2000 included hepatitis, foodborne disease, dengue fever and malaria. But the trainees not only investigated outbreaks, they are carrying out evaluations of surveillance systems and will develop reports with recommendations on changes that should be made.”
Dr. Sanchez-Vargas, EPI-SUS team leader with CDC says, “We have already seen, in its first year, the program’s contributions to public health in Brazil. We now have a group of public health workers who can produce answers when there is a threat to the health of the public and advise actions that the Ministry of Health can take to prevent the occurrence of disease in the population.”