Eurosurveillance - Volume 6, Issue 3, 01 March 2001

It is fitting that the group of articles describing various field epidemiology training programmes published here should appear in 2001, the 50th anniversary of the Epidemic Intelligence Service (EIS) of the Centers for Disease Control and Prevention (CDC). Were he still alive today, Alex Langmuir (founder of EIS) would be delighted to see how well established and successful such training programmes have become in Europe. Similar ‘on-the-job’ training programmes intended to provide health professionals with the practical skills needed to conduct relevant and timely applied epidemiological investigations in the ‘real world’ of public health are also burgeoning in Latin America, Asia, and Africa. Some of these training programmes are being developed and offered jointly with local academic institutions, others involve formal partnerships with CDC itself, and some are stand alone efforts of local public health agencies.

The Epidemic Intelligence Service (EIS) - the two year applied epidemiology training programme of the United States (US) Centers for Disease Control and Prevention (CDC) - celebrates its 50th anniversary in 2001. Developed during the Korean war, only five years after CDC was established, the stimulus behind developing the EIS was a lack of trained field investigators should biological agents be intentionally used against the US population. It was, however, clear to Alexander Langmuir, the head of epidemiology at CDC and founder of the EIS, that his trainees would engage in a wide range of activities and help fill gaps in the US for epidemiologists with the skills and practical field experience to investigate and control naturally occurring outbreaks of diseases.

Early in the 1980s, those involved in public health held symposiums to assess the training of epidemiologists in France showed inadequacies in the teaching of field epidemiology. Hitherto epidemiology in France had been largely confined to research. Evolution of public health practice, with an increasing demand to base decisions on epidemiological data, made it necessary to develop a network of intervention epidemiologists trained to work with standardised methods.

Within the widening European Union, large-scale movements of people, animals and food-products increasingly contribute to the potential for spread of communicable diseases. The EU was given a mandate for public health action only in 1992, under the Treaty of European Union ("Maastricht Treaty"), which was broadened in the 1997 with the Treaty of Amsterdam. While all EU countries have statutory requirements for notifying communicable diseases, national and regional communicable disease surveillance practices vary considerably (1). The Network Committee (NC) for the Epidemiological Surveillance and Control of Communicable Diseases in the EU was established in 1998 to harmonise these activities.

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. 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). 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.

In 1994, the Instituto de Salud Carlos III (ISCIII; Carlos III Health Institute) of the Spanish Ministry of Health and the Consumer (MSC) created the Programa de Epidemiología Aplicada de Campo (PEAC; Applied Field Epidemiology Programme). The programme is managed by the Centro Nacional de Epidemiología (National Epidemiological Centre) in collaboration with the Escuela Nacional de Sanidad (National School of Health), and supported by General Direction for Health and Consumer of MSC and the Health Councils (Consejerías de Sanidad) of the autonomous regions. The PEAC runs a masters degree programme in applied field epidemiology, in which degrees are conferred by the National School of Health. As PEAC is a national programme, it forms a part of the European Program for Intervention Epidemiology Training (EPIET) and is a member of the Network Training for Epidemiology Public Health Intervention (TEPHINET), the association of 27 regional and national programmes of the acting Intervention Epidemiology Training Programs.

The five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) have a long tradition of collaboration in communicable disease epidemiology and control. The state epidemiologists and the immunisation programme managers have met regularly to discuss common challenges and exchange experiences in surveillance and control of communicable diseases. After the three Baltic countries (Estonia, Latvia and Lithuania) regained independence in 1991 and the Soviet Union dissolved, contacts were made across the old iron curtain in several areas, such as culture, education, business, military and medicine. Each of the Nordic communicable disease surveillance institutes started projects with partners in Estonia, Latvia, Lithuania or the Russian Federation. The projects were in such diverse areas as HIV surveillance and prevention (1), vaccination programmes and antibiotic resistance. In the mid 1990s the Nordic state epidemiologists noted that there was duplication of efforts and only slow progress towards controlling communicable diseases in the region. Thus, to use the resources more efficiently and to improve the relationships with the Baltic partners, the state epidemiologists set out to co-ordinate their bilateral efforts. They felt that the Nordic network, which had worked so well, could easily be extended eastwards.