In The Field with the CEFO Program

Posted on by Aaron Fleischauer

I became a Career Epidemiology Field Officer (CEFO) in July 2008 after accepting an assignment with the North Carolina Division of Public Health in Raleigh.  My initial projects focused on increasing capacity for disaster epidemiology, evaluating communicable disease surveillance, and conducting case, cluster, and outbreak investigations.  These early projects provided great learning experiences, but my most rewarding experience was during the 2009 H1N1 influenza pandemic when my role as CEFO provided an important liaison function between state and federal public health agencies.   During this time, I was appointed Chief of Operations and tasked with overseeing the epidemiology, surveillance, and countermeasures teams.  Even though it was a hectic time I was thrilled to put all my training and past experience to work!

Our epidemiology and surveillance teams put in long hours to monitor the scope and scale of the pandemic and provide actionable information to local health departments and the public.  The highlights of our year-long response were two investigations that showcased both our epidemiologic capacity and our ability to collaborate in an intense environment. 

In the North Carolina Division of Public Health Coordination Center during the H1N1 pandemic, April 2009
In the North Carolina Division of Public Health Coordination Center during the H1N1 pandemic, April 2009

These investigations occurred during the summer of 2009 when two clusters of oseltamivir-resistant pandemic H1N1 virus were identified and investigated in North Carolina.  The first cluster involved two cases at a summer camp in western North Carolina, which were likely the very first instance of person-to-person transmission of a Tamiflu resistant virus.  The second cluster occurred on an oncology ward at a major academic medical center and did in fact represent the first instance of sustained person-to-person transmission.  Identification of this event led to an urgent report to the World Health Organization as a ‘Public Health Event of International Concern’.  Helping with this report was one of my greatest achievements as a CEFO.

Since the pandemic, I have helped investigate a number of infectious disease outbreaks such as cryptosporidiosis in a summer camp and Clostridium perfringens intoxication at a youth conference. Being the CEFO has afforded me the opportunity to lead or support these investigations, but more importantly to train others in this craft.
A typical day as a CEFO could involve a phone call from a county health department to discuss a reportable disease event or it could involve collaborating on an evaluation of the state’s surveillance system with researchers from local universities.  Regardless of how the days are spent, building epidemiologic capacity (i.e., biosurveillance) is our primary mission and each CEFO supports this mission through different avenues in their host state.  The CEFO program is a partnership and I’m grateful to have this opportunity to continue to serve CDC by also serving the state of North Carolina.

CEFO Program Background: 

Following the Anthrax attacks in 2001, CDC created the Career Epidemiology Field Officer (CEFO) program in early 2002.  The CEFO program is comprised of EIS-trained CEFOs who work with states and large local health departments to develop and enhance epidemiologic and emergency response capacity. The mission of each CEFO is determined by the needs of the state or local health department and the skills of each officer.  However, the overarching goals of the program are to:

  • Advance the science of public health practice in the areas of emergency preparedness and response.
  • Support epidemiologic capacity and execution of priorities within the Public Health Emergency Preparedness (PHEP) grant by providing consultation and support to health department Preparedness Director or PHEP Grant Administrator on policy development, the writing and reviewing of public health emergency plans, and the development of exercises to address all hazards.
  • Serve as liaison officers and trusted interlocutors between health departments, Emergency Operations Center staff, and CDC or HHS programs in order to enable and coordinate timely and appropriate engagement of federal assets needed in support of health department emergency responses, and
  • Engage with key partners, including emergency responders, healthcare providers, and other agencies or organizations that have responsibilities for preparedness and response, to prioritize and address the most urgent needs identified by the health departments, while assuring that these interactions take place in a “seamless manner.”

For more information on the CEFO Program visit:

Posted on by Aaron Fleischauer

7 comments on “In The Field with the CEFO Program”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    I Co Chair Pandemic in St. Louis MO. how may I get your list of the urgent needs and priorities your group came up with?

    The CEFO Program is a critical part of the emergency preparedness and response public health process. I hope that we can also find ways of including more people from the disability community in thde emergency planning part of the process. Emergency public health response should take the needs of the disability population into account. Access to care is an issue since the big majority of the disabled don’t drive and are a transit dependent population along with many seniors. Accessibility needs improving for access to diagnostic equipment, exam tables and exam rooms. And critical information on emergency preparedness and response needs to be available in multiple formats, including Braille, Large Print, audio version, and simple language/picture usage to explain complex ideas. Websites need to be card reader accessible; and Public Health emergency response programs need to have outreach officers on staff that know American Sign Language and know how to make use of communications programs for the disabled like the California Relay Service for The Deaf.

    This informal post assited me very much! Saved the blog, very interesting categories everywhere that I see here! I appreciate the information, thank you.

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Page last reviewed: April 30, 2012
Page last updated: April 30, 2012