U.S. training developing world's docs to detect outbreaks earlier

temples to HIV among children in Kyrgyzstan. Among the countries that are starting or have recently started programs are Iraq and Afghanistan. Haiti is under consideration too.

“It may be the single most important thing we do in global health,” CDC Director Thomas Frieden told McKay in an interview. “We’re all very attuned to the shortage of doctors and nurses in developing countries,” he said, but the shortage of epidemiologists and other public-health workers is even more acute given the impact they can have.

He is pushing for expansion of the program, estimating that at least one epidemiologist for every 200,000 people is needed to adequately measure disease threats. The CDC programs have produced about 2,200 graduates over thirty years. Had H1N1 flu been detected in Mexico two months earlier, a vaccine would have been ready before the largest peak of disease in the U.S. last fall, saving thousands of lives, he said.

In China, program officers have screened children to identify infant formula tainted with melamine, and traced 300 mysterious sudden deaths that occurred over three decades to a toxic mushroom. “We need about 80 new officers every year,” said Bob Fontaine, a CDC epidemiologist running the program. He hopes to reach that goal by 2015; this November, thirty-two new officers will start, he said.

Vietnam, plagued by severe acute respiratory syndrome in 2003 and the world’s second-highest number of H5N1 flu deaths since that year, launched a new field epidemiology training program in 2008 with funding from the U.S. Agency for International Development, the World Health Organization and other groups. About 75 percent of the country’s public-health workers lack training in epidemiology, according to Vice Minister for Health Trinh Quan Huan. “When an outbreak occurs, at the local level they do not have practical skills to collect data and respond,” he said.

Pham Van Hau, an infectious-disease physician in central Vietnam, is studying possible links between dengue fever and climate. Other officers have investigated rabies prevention and transmission of flu viruses between humans, pigs and poultry in a rural community.

Participants in Kazakhstan, Uzbekistan, and three other former Soviet countries are learning more quickly to detect Ebola, anthrax and other potential bio terror agents, funded in part by the CDC and the U.S. Department of Defense.

In a program in Addis Ababa, Ethiopia, launched last year, Million Tumato and a colleague dug into police log books to document health risks from an increasing number of motor-vehicle accidents. But local officials don’t always welcome investigations that might reveal outbreaks damaging to tourism or trade, Dr. Tumato found. When he uncovered a suspected case of cholera last year and turned it over to local health officials, they did not follow up, he said.

The programs also are costly, involving extensive oversight and mentoring as officers spend most of their time outside the classroom. To meet growing demand, the CDC is promoting shorter courses for local or regional officials that focus on more basic data-collection skills.