Well, I'm delighted to be here today to welcome Dr. Neil Vora who's a commissioned Corps Officer with the CDC based in New York City. Dr Vora, thank you so much for the taking the time to speak with me today. >> Thank you for having me. >> You were a CDC Epidemic Intelligence Service Officer back in 2013, 2014, is that correct? >> 2012 through 2014. >> Okay, and could you tell us the audience a bit about what your work with as a CDC EIS officer was? >> So the Epidemic Intelligence Service is a training program. It recruits mostly people with doctoral degrees, but it actually takes on a variety of different people. And I was there from 2012 through 2014 as an EIS officer. I was based in Atlanta and I feel very passionately about the control of what are called zoonotic diseases or a human diseases that have animal origins. So I worked the Poxvirus and Rabies Branch at CDC for those two years. >> Terrific. And did you investigate any outbreaks while you were there? >> I had the privilege of working on a variety of different outbreaks. So, rabies fortunately is a very rare disease in the United States now on, but around the world, it causes over 50,000 deaths a year in humans and most of these human deaths from rabies are related to dog bites. But in the course of my time as an EIS officer, I investigated rabies cases here in the United States. I also had the opportunity to work internationally on rabies control efforts in places including Taiwan, Nigeria and other outbreaks that I worked on included the discovery of a novel poxvirus in the country of Georgia. And so again, I had the privilege of working on an outbreak investigation like that. >> Now when you talked about investigating a case here, I presume it's an animal case, is that correct? Or was it human case? >> So there are very few animal diseases in the United States that are reportable to government authorities. But rabies is one of those diseases because rabies is basically the most lethal infectious disease there is. If you get rabies and you don't get prevention, intervention with vaccines in a timely fashion and you start showing symptoms, basically 100% of people will unfortunately die. But during my time as an EIS officer there were some rabies cases in humans. >> Here in the United States? >> Here in the United States. And so some of these cases were related to people who had acquired infection internationally, and then started showing symptoms when they arrived in the United States, when they return to the United States. But we also came across a situation where a recipient of an organ, so a human who had received an organ as a intervention to cure the disease, he had actually ended up acquiring rabies through that organ transplantation because the donor had unknowingly died of rabies. >> Wow. >> And so this speaks to in the modern age, we have amazing medical intervention such as organ transplantation, but there are a lot of different biosafety considerations. And organ transplantation is undoubtedly a very safe procedure, generally speaking, but there are infectious considerations that the healthcare community is mindful of. >> Now was this organ transplantation in this country? >> This organ transportation had occurred in this country. The donor was someone who was an avid hunter and he had hunted raccoons before his death around seven and 18 months approximately, I believe, before his death and he had sustained bites from raccoons. Now raccoons along the eastern seaboard are known reservoirs for rabies, and unfortunately, this man did not get vaccination after those raccoon bites, ended up dying of rabies. But because it's so rare in the United States in humans, it wasn't really considered at the time of his death that he might have rabies and his organs were then procured and transplanted into other people. >> I see, I see. Which country has the most rabies cases? >> There's a variety of countries around the world that have a large burden of rabies in humans and most of these human rabies cases are related to dog bites. And so we typically think of countries in parts of Asia and parts of Africa as having a higher burden of rabies. And again, these deaths are preventable because we have very effective vaccines that can prevent rabies after someone gets bitten by a rabid animal. And so a lot of the work that CDC does is about building capacity, both in the United States and abroad, to intervene on these public health threats. And the work we do even internationally firstly, these are ethically the right thing to do because saving lives is such a strong imperative, ethically, but on top of that it also brings benefits to the United States because a health threat anywhere is a health threat everywhere in this interconnected world. >> Sure. So, in this country we vaccinate dogs or at least many communities have mandatory dog vaccination. How important a role do you think dog vaccinations is and should cats be vaccinated since they also can harbor rabies and live in people's homes? >> Rabies vaccination is very important in certain domestic animals including dogs. I can't really comment further on like the dog and the cat situation just because I no longer I'm a subject matter expert in rabies and it's been a number of years since I've worked with the data on that. But generally speaking, there are variety of different societies, professional societies in the United States and the CDC as well that have recommendations on vaccinations for both humans and domestic animals. And I encourage people to review those recommendations, talk to their health care provider or their veterinarian but these recommendations are made with in keeping with the best science available, trying to save lives of both humans and animals. >> So when you went to investigate the an outbreak who was in charge during that crisis? Is it the CDC EIS officer, is it the local health department, is it the local elected official? In your experience, what is the process involved in investigating an outbreak? >> There's a variety of different people involved in any outbreak investigation. And and in fact one thing I've learned very clearly since I've started in public health in 2012 is that public health is a team sport. We can't do public health with just one individual, one hero, it's not at all like that. >> Correct. >> We work with a lot of different people. And particularly in the type of work that I do with animal-borne diseases are diseases that originated from animals that spill over into humans. It requires a One Health approach, which is this interdisciplinary approach where you bring in epidemiologist. So people who understand population level health, we bring in physicians, veterinarians, ecologist, mammalogist, communication specialist. It's really a very large effort in any outbreak investigation. So there's not always a very clear this person's in charge. I mean we do sometimes have a clear reporting structure and I think that's important in any emergency in incident command type structure. But at the same time a lot of different people play a very important part in the investigation. I'll also say that when CDC does investigations, domestically, we have to be invited into any jurisdiction before the CDC completes its investigation. >> That was my next question. >> Okay, great. Exactly. And even internationally it's not like the CDC can go to some other country because they are sovereign states. And so CDC when we do international work, it's upon invitation by that country that requesting assistance from the CDC. The last thing I would say on this though, is that even though the CDC might work in various parts of the world or in various parts of the country, it's very important that CDC doesn't just go in and do its work and leave. A large focus of our work gets on capacity building. So we want to give tools for outbreak investigation and public health improvements to our colleagues that are working locally so that they can do that type of work themselves without relying on external assistance. >> So in your experience when you have investigated outbreaks and there was a need to communicate to the public, would you fulfill that role or would somebody in the local health department do that? >> It's a combination depending on the scenario and when we work domestically in a variety of different local counties or cities the ideal scenario is that the local health authorities are taking the lead on the investigation and not CDC because it's they know their community, they know what the needs are in different ways than the CDC. So we each bring our own different expertise. What CDC brings to the table is perhaps the science and the experience in working with a particular disease, but the local health department and the local health authorities really know the situation better that's actually happening on the ground. So when it comes to those media interviews, normally it's the decision by the local health authority about who's going to do the the media interviews. If CDC does do interviews with the media, a variety of different people from CDC might conduct those interviews including EIS officer. So Epidemic Intelligence Service Officers. So I had that opportunity even as an EIS officer when I was still a trainee where I got to do media interviews, and those are I think very important experiences. >> Absolutely, public communication is paramount. So tell us a little bit about the work that you're doing now. Now you're working for the CDC as Commissioned Corps Officer, but you're based in New York City. >> That's so. >> So there are CDC officers stationed in various parts of the country. So in what capacity then do you work? >> CDC has headquarters mostly in Atlanta, but there are a number of other headquarted sites such as in Colorado, Puerto Rico, Ohio, but most of CDC is in Atlanta. But at the same time CDC is also stationed its staff in various parts of the country and around the world, in fact. So I happen to be stationed right now in New York City. I'm a New Yorker. So this is something that's very close to my heart and I love the opportunity to be able to give back to my community. So my work really focuses on emergency preparedness and response. I mostly deal with infectious diseases, but I also work on other topics ranging from natural disasters to preparedness for terrorists attacks, whether nuclear, chemical or otherwise, but the vast majority of my work is on infectious diseases. So, being able to identify outbreaks quickly, being able to respond to outbreaks quickly, doing public communication, capacity building. So a variety of these different areas and emergency preparedness and response. >> Now what happens if, I mean one of our most important tools is a vaccines to be able to prevent a disease from happening through vaccination. What happens in certain circumstances where the public refuses to get vaccinated, for example, with the measles outbreaks that have been going on? How can we overcome some of this vaccine hesitancy that is happening and threatening all of the advances that we've made in controlling some of these diseases? >> It's very important in public health that we act with the best science available. And very clearly we know that vaccines that are recommended by a variety of different professional societies and other bodies in the United States have evidence-based recommendations on which vaccines to use and the schedule with which these vaccines should be given to people. But there is, unfortunately, in the current age quite a bit of misinformation out there about the safety of vaccines for example, and that is threatening some of the public health gains that we've seen in recent years. So we have seen outbreaks happen in communities that might be refusing to use vaccines and these are outbreaks that are completely preventable. So, as someone who cares so deeply about the about public health and the control of infectious diseases, it's very hard to see these situations where communities are experiencing outbreaks of completely preventable diseases. And with that there is a very big risk that people will die or they will suffer long-term consequences. So we strongly recommend that people have these conversations with their healthcare providers and get accurate information and make sure that when people are doing their research into what they should be doing for their own health that they go to reliable resources. So, I would recommend that people review websites such as the CDC website where we have good strong information on the safety of vaccines and what vaccines are recommended. And using these reliable information sources I think people can then make more informed decisions for their own health. >> For the students in the audience who might be interested in pursuing a career such as yours, what advice would you have to give to young people who are interested in pursuing careers in disease control, disease investigation? >> I love what I do. I think it's a privilege to wear this uniform, to serve the government, to serve my country in outbreak control and infectious disease control. In my own case, I am pursuing a childhood dream right now. I'm living my childhood dream. I had seen this movie called Outbreak as a teenager and I was just so drawn by the idea of chasing dangerous diseases around the world. And around that same time my father, who I watched the movie with, my father told me about this thing called the Epidemic Intelligence Service, EIS. Because he had happened to sit by an EIS officer one day on a plane ride. And so that kind of planted the seed in my mind about pursuing this type of work and I would say that people can follow their dreams. You can make these things happen. Keep an open mind, learn what's out there, expose yourself to a lot of different ideas and different career tracks. So I happen to be a physician but CDC has all types of people with a variety of different expertise. Not just physicians but veterinarians, scientists, communication specialists, lawyers all types of people because public health is a team sport, right? And so we all contribute to that same mission of saving lives 24/7. And the final thing I would say on this is that it's just such a thrilling career because you get to have the impact on a large number of people, you get to save lives on a daily basis and at the same time everyday is different. One day you are working with data in the office investigating a new outbreak, the next week you might find yourself in a different country working on an entirely different disease, the following week you might be doing an interview like this. It's very different every week, every day, almost. So I love what I get to do and I would say that it's the greatest privilege of my life. >> Well, it's been a delight to speak with you about public health and about your career, and I'd like to thank you all for watching this particular interview. Until next time. Thank you.
