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For traveling epidemiologist, disease has no borders

He loves the thrill of tracking down disease and stopping it in its tracks

From the December ACP Observer, copyright 2005 by the American College of Physicians.

By Janet Colwell

During the 1980s, Jamaican officials—beset by rampant crime against island visitors—wanted to revive the flagging tourist industry. While tourists responded to safer, all-inclusive resort packages, they also received an unwanted side effect: a serious out break of dysentery.

Desperate to avoid a public health and public relations fiasco, the government in 1990 turned to Herbert L. DuPont, FACP. Dr. DuPont, age 67, an epidemiologist from Houston and ACP Governor for the South Texas Chapter, was an established expert on enteric diseases. He and Robert Steffen, MD, from the University of Zurich, flew to Jamaica to track down the dysentery source and halti its recurrence.

What ensued was a seven-year project in which the epidemiologists identified two diarrhea-producing E. coli attacking the tourists. It's just one of many memorable cases for Dr. DuPont, who relishes playing the investigator.

"Infections may not be glamorous, but you can nail them down and that's very gratifying," he said. "If I asked you to name 10 diseases that we know the cause of or that we can treat or cure, you largely would be talking about infectious diseases."

Roads not taken

Forty years ago, when Dr. DuPont graduated from Emory University School of Medicine in Atlanta, the Pentagon was searching for doctors to serve in Vietnam. Instead, Dr. Dupont landed a job as an epidemic intelligence service officer at the Centers for Disease Control and Prevention (CDC) in Atlanta. The two-year stint set the course for his career.

As part of the CDC's investigative team, Dr. Dupont had to be ready to travel to the site of an emerging epidemic at a moment's notice. He tracked down malaria in Pakistan, shigellosis in Yugoslavia and salmonella in a Baltimore nursing home. He also helped develop vaccines for infectious causes of diarrhea, a big problem in the military.

The CDC sent him to the University of Maryland to work on research and take "epidemic calls," he said. "It was an exciting, exhilarating experience—nternational travel, infectious diseases, public health and epidemiology. All the things I've gone on to do."

Dr. DuPont stayed at the university until 1973, completing an infectious disease fellowship and becoming an associate professor. From there, he went to the University of Texas-Houston School of Medicine and School of Public Health, where he is currently director of the Center for Infectious Diseases, as well as professor of epidemiology and chief of internal medicine at St. Luke's Episcopal Hospital and vice chair of the department of medicine at Baylor College of Medicine. At the same time, he still manages several international research projects.

Staying in the trenches

"I always did it all—research, international medicine, clinical work, student and resident teaching, and administration," he said. "I've always been in the middle of the action. I don't want to miss anything."

Maintaining this juggling act requires the help of reliable support people and, in recent years, taking advantage of technology. Dr. DuPont carries a Blackberry and uses e-mail to manage projects overseas. That's allowed him to reduce his travel schedule.

Whether on the road or at home in Houston, it's the thrill of discovery that keeps him going. He relishes arriving at an outbreak site and plotting the "epidemic curve" (number of cases each day) that will tell him how a disease got started. If everyone got sick around the same time, that's caused by exposure to a common source of contaminated food or water. If illness cases are farther apart, he suspects the disease is being passed from one person to another.

In Jamaica, for example, he traced the path of infection back to a common source: resort kitchens. That allowed the ministry of health to target its educational programs and microbiologic food analyses and institute treatments, efforts that led to an eventual 72% drop in cases of travelers' diarrhea.

Dr. DuPont is frequently called in to consult on infectious disease situations, including the avian flu threat. He sees the upsurge in infectious disease outbreaks in recent years—Legionnaires disease and Lyme disease, among others—as part of a disturbing pattern.

"We went from the late 1940s to 1976 with almost no important nationwide infectious disease problems, so the government effectively moved money into cancer and heart disease," he explained. "The result was that all public health efforts atrophied, and today you can't pick up a newspaper without reading about a new microbial threat to this country."

While technology will help with solutions, he said, it will largely be epidemiological and public health principles that will defeat emerging infectious diseases. In the meantime, Dr. Dupont said he continues to resist offers to take on a bigger administrative load.

"I elected to stay in the trenches and assume responsibilities that allowed me to keep slugging it out with international disease issues," he said. "I think it was the greatest single decision I made in my career."

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