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Eurosurveillance, Volume 6, Issue 3, 01 March 2001
Articles
The Field Epidemiology Training Program (FETP) in Germany

Citation style for this article: Petersen LR, Breuer T, Hamouda O, Ammon A. The Field Epidemiology Training Program (FETP) in Germany. Euro Surveill. 2001;6(3):pii=219. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=219
Andrea Ammon1, Osamah Hamouda1, Thomas Breuer1, Lyle R. Petersen2
1
Robert Koch-Institut, Berlin, Germany
2 Centers for Disease Control and Prevention, Fort Collins, USA

The German Field Epidemiology Training Programme (FETP), which started in January 1996, is part of a national effort to improve research capacity for the epidemiology of infectious diseases in Germany (1). The aim of the two year programme is to develop a cadre of epidemiologists capable of performing outbreak investigations, epidemiological research, and surveillance at an international standard measured in articles published in international peer-reviewed journals. These epidemiologists will also be instructed to train future epidemiologists and public health personnel. The programme is similar to the Epidemic Intelligence Service (EIS) at the Centers for Disease Control and Prevention (CDC) in the United States and the European Programme for Intervention Epidemiology Training (EPIET) (2,3). The German Federal Ministry for Education and Research funded the costs of a senior epidemiologist who was seconded from the CDC to help initiate this programme.

The programme started with two trainees in January 1996, with funding from the federal health ministry. Three additional cohorts of three trainees each subsequently started their training in 1998, 1999, and 2000 at the Robert Koch-Institut (RKI). Ten of the 11 trainees enrolled so far were physicians and one a veterinarian. Each trainee was required to complete at least one outbreak investigation, one surveillance project, and one research project, and to present his or her work at a scientific conference, participate as a trainer in epidemiology courses, and write at least one article both each in a peer reviewed scientific journal and in the national epidemiological bulletin. Since the second training cohort, all trainees have also completed a two-week rotation in the laboratories of the RKI. This helped them to understand the laboratory aspects of their investigations and further strengthened the working relationships between the epidemiologists and laboratory staff.

The simultaneous development of EPIET was crucial to the development of Germany’s FETP. The German trainees’ participation in the EPIET training modules has allowed them to be part of a larger network of infectious disease epidemiologists in Europe, thus developing both German and European networks of epidemiologists simultaneously. The number and quality of the training modules developed by EPIET could not have been developed in Germany with the resources available at the time. Furthermore, EPIET provided a crucial external evaluation of the German FETP through periodic site visits. Three EPIET trainees from other countries have trained or are being trained at the RKI, and four Germans have trained or are training in other countries as part of EPIET.

The German FETP trainees and EPIET trainees who have trained in Germany have completed 41 outbreak investigations, with the number increasing from four in 1996 to 13 in 2000 (figure). German FETP trainees participated in three multinational outbreak investigations of people returning from overseas travel and were part of a team from the World Health Organization (WHO), helping with an outbreak investigation in Romania (4-7). For their research projects, trainees were responsible for writing study protocols, conducting studies, analysing the data, and writing publications. Twenty short term research and surveillance projects were initiated from 1996 through 2000 (focusing on, for example, hepatitis B and C among dentists, the prevalence and risk factors of methicillin resistant Staphylococcus aureus in nursing homes, and influenza vaccination coverage in Germany). The trainees have also given 72 scientific presentations at conferences and, on the basis of their research studies or outbreak investigations, have contributed to 24 scientific manuscripts that are currently in press or have been published in refereed journals or international bulletins. They were the first authors of 16 of these articles (examples 8-14). In addition, they have written 25 articles for the German epidemiological bulletin.

 

Although the principal focus of the national infectious disease epidemiology programme was domestic, the integration of Germany into the European Union demanded that the programme has an international presence. The collaboration in training through EPIET and the participation of Germany in international outbreaks in Europe have already been mentioned. To help build the capacity for providing international epidemiological technical assistance, German FETP trainees have participated in three month assignments in Chad, Burkina-Faso (15), and India as part of the WHO’s global polio eradication effort, as well as in missions to Bahrain and Zimbabwe.

Experiences in many countries have shown that a minimum training period of two years is required to train a field epidemiologist. Since only three trainees have been enrolled each year. Many have therefore called for more rapid and less expensive alternatives, such as shortening the training period to one year. Nevertheless, the long term commitment to high quality, applied training is now paying off in many ways. Both FETP and EPIET have produced specialists with a high degree of technical competence who are now assuming key positions where they will be able to continue to work in the field of infectious disease epidemiology in the long term. All eight German FETP graduates have found employment. Two are now working as epidemiologists at the RKI, two are in charge of infectious disease epidemiology for state health departments in Germany, two work at local health departments with a focus on epidemiology, one is working at the Public Health Laboratory Service’s Communicable Disease Surveillance Centre in London, and one is a consultant for WHO.

Since January 2001, a new German law for infectious diseases, the Act for Prevention and Control of Infectious Diseases in Man, has been in place. Several of the new epidemiological programme’s activities, including the results of trainees’ outbreak investigations, provided an impetus for the enactment of the law and were included in the law’s formal justification. In addition to redefining the entire national system of infectious disease surveillance, the law has created a legal basis for a leading role of the Robert Koch Institut for national epidemiological surveillance and investigation. The FETP will continue to be a high priority for the foreseeable future, particularly in light of the law’s new demands for enhanced capacity for infectious disease epidemiology at all levels of government.


References
  1. Petersen LR, Ammon A, Hamouda O, Breuer T, Kießling S, Bellach B, et al. Developing national epidemiologic capacity to meet the challenges of emerging infections in Germany. Emerg Infect Dis 2000; 6: 576-84.
  2. Thacker SB, Goodman RA, Dicker RC. Training and service in public health practice, 1951-1990 – CDC’s Epidemic Intelligence Service. Public Health Rep 1990; 105: 599-604.
  3. Moren A, Rowland M, Van Loock F, Giesecke J. The European Programme for Intervention Epidemiology Training. Eurosurveillance 1996; 1: 30-1.
  4. Fisher IST, Crowcroft N. Enter-net/EPIET investigation into the multinational cluster of Salmonella Livingstone. Eurosurveillance Weekly 1998; 2: 980115. (http://www.eurosurv.org/1998/980115.html)
  5. Hasseltvedt V. Salmonella Paratyphi B phage type Taunton in travellers to south west Turkey. Eurosurveillance Weekly 1999; 3: 990826. (http://www.eurosurv.org/1999/990826.html)
  6. Handysides S. Meningococcal infection in pilgrims returning from the haj: update. Eurosurveillance Weekly 2000; 5: 000413. (http://www.eurosurv.org/2000/000413.htm)
  7. CDC. Outbreak of aseptic meningitis associated with multiple enterovirus serotypes – Romania, 1999. MMWR Morb Mortal Wkly 2000; 49: 669-71.
  8. Lyytikäinen O, Ziese T, Schwartländer B, Matzdorff P, Kuhnhen C, Jäger C, et al. An outbreak of sheep-associated Q fever in a rural community in Germany. Eur J Epidemiol 1998;14:193-9.
  9. Lyytikäinen O, Hoffmann E, Timm H, Schweiger B, Witte W, Ammon A, et al. An explosive outbreak of influenza A among adolescents in a skiing school. Eur J Clin Microbiol Infect Dis 1998; 17: 128-30.
  10. Ammon A, Petersen L, Karch H. A large outbreak of hemolytic uremic syndrome (HUS) caused by an unusual sorbitol-fermenting strain of Escherichia coli O157:H-. J Infect Dis 1999; 179: 1274-7.
  11. Vieth UC, Kunzelmann M, Diedrich S, Timm H, Ammon A, Lyytikäinen O, et al. An echovirus 30 outbreak with a high meningitis attack rate among children and household members at four day-care centers. European J Epidemiol 1999; 15: 655-8.
  12. Hauri AM, Ehrhard I, Frank U, Ammer J, Fell G, Hamouda O, et al. Serogroup C meningococcal disease outbreak associated with discotheque attendance during carnival. Epidemiol Infect 2000; 124: 69-73.
  13. Fell G, Hamouda O, Lindner R, Rehmet S, Liesegang A, Prager R, et al. An outbreak of Salmonella blockley infections following smoked eel consumption in Germany. Epidemiol. Infect 2000; 125: 9-12.
  14. Ammon A, Reichart PA, Pauli G, Petersen LR. Hepatitis B and C among Berlin dental personnel: incidence, risk factors, and effectiveness of barrier prevention measures. Epidemiol Infect 2000; 125: 407-13.
  15. Rehmet S, Müller B. Kick polio out of Africa. Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2000; 43: 22-7.


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