Start with grisly slides of gangrenous limbs and feet swollen with fungus-filled nodules. For good measure, add some photos of foot-long guinea worms and eyes running with pus. Then throw in tips from real scientists on how to track disease outbreaks and unravel their mysterious causes. How much more fun could you possibly have at summer camp?
I, at least, am having a rollicking good time as a visiting journalist at Disease Detective Camp, now in its fifth year at the Centers for Disease Control and Prevention in Atlanta. In my own day, summer camp meant sleeping in cabins, canoeing on the lake, and guzzling bug juice. Today, it's equally likely to mean an intensive workshop at the Orlando Ballet, space camp at NASA, or secret-agent camp at Pali Adventures. But Disease Detective Camp has a unique mission—to get kids interested in careers in public health. And if you think that sounds unlikely, consider this: high school juniors and seniors have come from as far as Utah and the Netherlands to participate. Gaining admission here is only slightly easier than getting into Harvard. "We had 514 applicants this year for 52 spaces," says coordinator Trudi Ellerman.
Not to worry. It's not all gory slides before lunch. During the week, these teenagers will go through a mock version of the Epidemic Intelligence Service training program—a two year, post-graduate program that doctors, veterinarians, and public health specialists complete to become field epidemiologists, or "disease detectives." The teenagers will help unravel a simulated foodborne infection (beware the taco bar), pin down the cause of a fatal disease outbreak in a Southwestern town, and hold a mock press conference to explain to a worried nation what's going on. "There's no high like solving a disease outbreak," says CDC epidemiologist Ralph Cordell, who talks to the kids about disease transmission (and makes them squirm with his stomach-turning slides). "Collecting the data, pulling it together, asking the right questions, working with a team of people—it's just outrageously satisfying."
As it turns out, there are already several teens here who want to become epidemiologists. Caroline Gillis, 17, of Easton, Md., was drawn to the field after a seventh-grade science teacher assigned her class The Hot Zone, Richard Preston's bestseller about Ebola virus. Gillis reread the book several times, then followed up with volumes on malaria, yellow fever, and syphilis. David Kronenberger, 16, of Houston, was hooked by learning about bizarre fungi. He arrives at Disease Detective Camp fresh from a stint at tropical disease camp in Costa Rica (where, fortunately, no one was required to catch any tropical diseases—only learn about them).
From Day 1 at the CDC, the teenagers are taught how to form a hypothesis about a disease outbreak and conduct an investigation. The key lies only partly in state-of-the-art technology. At least half the challenge is figuring out the right questions to ask. Who has contracted the disease? Where have they been? Why were they exposed to this pathogen? Posing the right questions can suggest a common source of infection—a tainted batch of tomatoes, perhaps, or a contaminated ventilation system. "Disease is not randomly distributed," Dr. Denise Koo, a CDC official, tells the group. "There's a reason why certain people get it."
To demonstrate, Koo walks the participants through a number of true cases, starting with an outbreak of salmonella (a.k.a. food poisoning) that struck Ohio, Michigan, Georgia and Alabama in 1981. To the scientists' dismay, there appeared to be no common threads among the victims. They moved in different social circles, ate at different restaurants and lived in different parts of town. They ranged in age from 1 month to 76 years old, although nearly 30 percent clustered in the 20-to-29 category. Whatever was causing the illness, however, it was re-infecting the patients. Week after week, they tested positive for the bacteria.
Then one woman shook the ailment. Investigators paid her a call in an attempt to figure out why. "She had just learned she was pregnant," says Koo. "Why would that make a difference?" Several of the teens speculate that the woman gave up alcohol upon learning that she was expecting. It's a good guess. In fact, what she had given up was marijuana. Suddenly the preponderance of young adults among the victims started to make sense. But confirming the hypothesis meant that investigators had to obtain samples of the pot—not an easy task if you happen to be a representative of the U.S. government. "What do you do—call and ask them to bring in their marijuana?" asks Koo. Investigators managed to reassure patients that they had no interest in arresting people, only stopping the outbreak. In the process, they confirmed that the source was manure-tainted pot from Latin America.
Mystery solved. But there was still one nagging question. If pot was to blame, how could they account for the sick infants? The answer lurked in one of the most basic modes of disease transmission. "Their mothers were rolling [joints], then preparing formula or baby food without washing their hands," says Koo.
After working through the case studies, the campers divide into teams to solve their own disease outbreak (modeled on a real 2003 outbreak in Arizona). They form a hypothesis as to the cause, then fan out across a mock town to interview 57 residents (all CDC employees playing roles of real victims and their neighbors). There are challenges. One resident speaks only Spanish. Another is panicked over an ill child and asks more questions than she answers. But most, to a reporter anyway, seem unusually cooperative. Middle-aged women even give their ages without balking.
When the teen investigators are done gathering data, analysis quickly confirms their suspicion. The disease is Rocky Mountain Spotted Fever, a tickborne infection that can prove fatal if not treated promptly. This year every team arrives at the right conclusion. Past groups haven't always done so well. "Getting the right answer depends on asking the right questions," says Ellerman. "When they don't, you see them get very frustrated. These are highly motivated kids."
Outbreak solved, the campers get to meet with one of the scientists who solved the actual outbreak and learn the details of the tickborne disease. They then divide into teams for the press conference. Some of the teens will represent CDC officials, while others play reporters, and a third group fills out the audiovisual team that mans the cameras. The meeting is held in the actual room where CDC officials brief the press, complete with the blue-velvet backdrop and CDC logo.
As the press conference unfolds, I am amazed how skillfully the teenagers conduct themselves. Most of the reporters ask excellent questions, and the officials respond authoritatively, using information they have only just learned. There are a few off-the-wall queries, but officials are not flustered. One young man posing as Stephen Colbert asks if he could be infected by swallowing a tick—a highly unlikely scenario. There are giggles from around the room. But Danielle Blemur, 17, of Kennesaw, Ga., steps calmly up to the mike. "I'm not really sure at this time," she says with admirable poise. "But you might want to see your doctor."
At least the group manages to avoid what CDC press officer David Daigle calls "the complete train wreck" of a gum-chomping, eyes-rolling group from years past. The archived videotape shows that one "official" burst out laughing when questioned about a child who had died. "It's best not to laugh when the subject is death," says Daigle.
The rest of the week will include a tour of the CDC's film studio (where public-service videos are taped), a visit to the lab that monitors foodborne outbreaks, a chance to perform DNA analysis on an E. coli strain, a lecture on polio eradication, and a global health fair where kids can talk one-on-one with CDC officials from many different divisions. Gillis finds a woman who works in a biosecurity level 4 lab and two others doing immunization campaigns in Africa. Kronenberger comes away with college and career advice. By the end, both are more inspired than ever to go into public health. Epidemiologists like Dr. Cordell (with the gory slides) have helped confirm their choice. "I get great satisfaction from this field," he says. "I know there are people alive and healthy today because of things I've done." That's a big message to take home from a summer camp.