The Emerging Infections Network - a Tool to Improve Public Health and Clinician Communications

BACKGROUND:  In the early 1990s, the Institute of Medicine identified emerging infections as a potential public health threat.  This was highlighted by a 1993 hantavirus outbreak which was first identified by astute clinicians.  In 1995, the Centers for Disease Control and Prevention (CDC) entered into a Cooperative Agreement with the Infectious Diseases Society of America (IDSA) to develop the Emerging Infections Network (EIN), a provider-based emerging infections sentinel network.  Recently, CDC has sought to strengthen links between public health and clinicians.  Since EIN is a network of physicians with participation of public health officials, it may be an effective tool to achieve this objective.  Our goal was to determine how EIN facilitates communication between clinicians and public health. 

METHODS:  Using CDC guidelines for evaluating a public health reporting system we characterized key system attributes (usefulness, simplicity, acceptability, and stability).   Data were collected through CDC staff and EIN committee member interviews; a program site visit; and document review. 

RESULTS:  EIN manages an electronic listserv and sends members periodic short surveys on infectious disease topics (queries).  Usefulness: Select groups at CDC engage with IDSA EIN on a daily basis. Examples include using EIN to post CDC guidance during a 2012 fungal meningitis outbreak and, calls for additional cases (Pantoea infections, February 2013; Bipolaris infections, November 2013). Query-generated data have resulted in 3 peer-reviewed manuscripts with clinical and public health co-authors between April 2011–April 2012, on antibiotic stewardship/resistance and infection control. Simplicity: Listserv and query functions are simple to use with 3–5 listserv posts daily and 5–10 queries annually.   Acceptability: While the 1597 EIN members represent approximately 20% of the total IDSA physician membership, EIN membership has grown 9% in 2013.   Current use of EIN at CDC is limited, with only 8 of 17 divisions in CDC’s Office of Infectious Diseases having participated in a query between 2006 and 2011. At the state and major metropolitan level, 19 state, or deputy state, epidemiologists and city public health department directors and 12 state public health veterinarians subscribe to the listserv. Stability: While currently stable, EIN’s small staff (n =2) render it sensitive to factors such as turnover.

CONCLUSIONS:  EIN serves as a useful tool, enhancing communication between clinicians and public health officials but would benefit from increased IDSA membership, enhanced visibility within CDC, and increased representation from state and local public health practitioners.