Foreword

In the latter part of the twentieth century, some believed antibiotics and vaccines had led to the conquest of most infectious diseases, and we could then turn our full attention to non-infectious, chronic conditions. Later, alarming experiences with HIV/AIDS, SARS, a virulent strain of influenza, multiple-drug resistant tuberculosis and other newly-recognized maladies corrected that misimpression. We now recognize that the struggle between humans, microbes and other aspects of our environment is long and ever-changing, but never ending.

Alexandra Levitt’s book, Deadly Outbreaks, is a fascinating account of seven frightening public health mysteries encountered in the United States between 1976 and 2007. Five of the episodes resulted from infectious diseases, ranging from an old foe, malaria, to a more recently recognized one, hantavirus; others were due to an autoimmune condition and drug overdoses in a cluster of infants. These are gripping, suspenseful stories that are exceptionally well-written and highly instructive. Public health practitioners and students will benefit from the hard-won victories of epidemiologists described here, and in my opinion, one can hardly hope to learn important lessons for the future in a more enjoyable way. At the end of each episode, the author reviews and describes explicit lessons illustrated by the events and the reactions to them. Beyond the interesting science and methodology of epidemiology per se, the reader experiences vicariously the personal and professional mindsets of epidemiologists as they deal with substantial medical, bureaucratic, political and legal challenges, sometimes simultaneously, often while being well aware of the high-stakes consequences of their findings. A frequent theme is to remind us all of how complex processes associated with modernization can create new pathways for spread of disease or injury. Another theme concerns the value and importance of communication between practitioners of different specialties, such as physician-epidemiologists and veterinarians, for example.

This volume is in the finest proud tradition of Paul de Kruif’s Microbe Hunters (1926), which described the discovery of various microbes, and Berton Rouché’s Eleven Blue Men (1953), which described outbreaks of different diseases. Like the latter, Deadly Outbreaks describes the learn-by-doing approach to the practice of epidemiology by “disease detectives” at the U.S. Centers for Disease Control and Prevention’s Epidemic Intelligence Service (EIS) and at state and local health agencies. It is a timely reminder that the battle with infectious diseases and other outbreaks is an on-going struggle, as epidemiologists in each age are challenged by newly-emerged pathogens, newly-realized pathways for old pathogens, and other unpredictable surprises. And for all the welcome and powerful new tools of computers, faster communications and more sophisticated statistical techniques, we see how much still depends on inquiring minds and dogged determination.

Donald R. Hopkins, MD, MPH

Vice President, Health Programs

The Carter Center