By Tonia Twichell
Daniel Pastula, MD, in long pants and mosquito repellent
during a chikungunya virus outbreak in 2013 in Yap State,
Federated States of Micronesia. Photos courtesy of Daniel
(May 2018) Straight out of residency and searching for a way to pursue his
combined interests in epidemiology and neurology, Daniel Pastula, MD,
MHS, joined the Centers for Disease Control and Prevention’s office in
Fort Collins in 2013 where he tracked diseases spread by ticks,
mosquitoes and sand flies.
What he expected to be mostly a desk
job – his supervisor told him he would not travel often – changed with
sudden outbreaks of several arboviruses. No longer tied to his desk,
Pastula trekked to Missouri, Micronesia, Fiji, the U.S. Virgin Islands,
Georgia, Ohio and finally Puerto Rico.
“I’ve been pretty busy,”
said Pastula, who assisted in tracking and fighting the spread of Zika,
dengue, chikungunya, Heartland, Bourbon, Jamestown Canyon and La Cross
viruses, as well as Guillain-Barré syndrome and acute flaccid myelitis
among other diseases.
During his travels Pastula met with
physicians, patients and public health officials in remote locales, and
he spent more than a few sunless days in hospital basements.
where they usually keep medical records,” said Pastula, now a CU
assistant professor of neurology, infectious disease and epidemiology
who was recently appointed to the Colorado Board of Health.
digging deep into dusty contents of those buried records, Pastula
nurtured his disparate interests of neurology and epidemiology, an
unlikely combination given that few neurologists are also
“I always thought I’d have to pick one or the
other – either neurology or public health – because very few people I
know of do both.”
“I Liked Talking to People”
school and college Pastula became captivated by the book “And the Band
Played On” about the HIV-AIDS epidemic during the 1980s.
thought it was fascinating how all these public health experts were able
to piece together the cause of the outbreak just by meeting with
clinicians and patients, sometimes in their homes, and systematically
asking all kinds of questions. That’s really what got me interested in
public health and epidemiology.
“I already knew I was interested
in science and that I liked talking to people. I just didn’t know all
the ways one could put them together.”
One clue came during a
neurology lecture in his first year of medical school at Duke University
when the instructor discussed the epidemiology of amyotrophic lateral
sclerosis (ALS) including clusters of the disease discovered in Guam,
the Kii Peninsula of Japan, and among Italian soccer players.
Pastula stayed after class to talk to Richard Bedlack, MD, PhD, who in turn invited him to spend time in his ALS clinic.
first clinical experience ended up being in the ALS clinic learning
about ALS and neurology but also about its epidemiology. I did my other
core rotations, but I kept coming back to neurology and working with Dr.
He stayed an extra year in medical school to earn his
master’s degree in clinical research by studying ALS epidemiology.
During that time he asked mentors and friends about choosing between
neurology and public health.
“Several people said ‘Why don’t you just ,do both?’”
a residency at University of California, San Francisco, Pastula decided
that the CDC seemed like the ideal place to do that.
On the Road
of Pastula’s time as a CDC Epidemic Intelligence Service officer was
spent among teams of researchers focused on measuring and curbing the
spread of disease around the United States and the world.
He loved the teamwork and the opportunity to immerse in local culture while traveling in remote areas.
go to the local restaurants and try to learn local language. You’d get
laughed at a bit, but then everyone appreciates you trying. I made
friends in various places.”
Pastula was often at a site during
the height of an outbreak, and the disease cycle could be hard to watch.
He especially remembers the chikungunya virus outbreak in Micronesia.
Pastula, MD, discussing mosquitoes in 2013 on “Island Chat
with Martina,” Yap State radio, Federated States of Micronesia.
large portion of the population was just really sick. They couldn’t
walk and had horrible fevers and were bedridden for days to weeks. That
was really hard to watch. So was the Guillain-Barré syndrome cluster in
Fiji, where a handful of people were paralyzed and on ventilators. It’s
hard to watch what people with Guillain-Barré go through here in our
hospital, let alone in some rural areas of Fiji.”
In 2016, one
year after joining the University of Colorado, the Puerto Rican
Department of Health and CDC asked Pastula to assist in developing a
surveillance system in Puerto Rico to determine whether the Zika
virus, which was just hitting the island, was related to clusters of
Guillain-Barré. So Pastula and his public health colleagues from the
Puerto Rican Department of Health and CDC designed a system that allowed
clinics and hospitals to report cases of the syndrome. He spent weeks
collecting medical records for baseline numbers.
As a result, several papers were published showing that the Zika virus is probably a risk factor for Guillain-Barré.
that Zika causes the syndrome in everyone, but it seems to contribute
to an increased risk in Guillain-Barré. Exactly how that is, we don’t
fully understand. We suspect it might be an autoimmune mechanism, where
Zika virus may trick the body into attacking nerves.”
Fighting Disease in Colorado
the outbreak of so many viruses in the past few years, Pastula says
many of them have likely been around for a while but have become better
“I think a lot of the diseases have been there for
centuries and I think we’re just now defining them. Maybe what everyone
historically called malaria wasn’t always malaria at all and we’re just
finally identifying it correctly now. That being said, as populations
move closer to animals and areas that humans haven’t typically lived,
are we going to see new diseases? I think that’s possible. It definitely
shows the importance of public health, epidemiology and surveillance.
The only way we’re going to know about new outbreaks is through good
public health surveillance.”
For vector-borne diseases, he
advocates prevention techniques - long pants, long sleeves, socks,
insect repellent, air-conditioning or window screens indoors, removal of
standing water - which can foil many arboviruses, and he faithfully
adhered to them while on the road because the chance of contagion was
“The first rule of an outbreak investigation is don’t get
the disease that you’re studying,” he said. “I was walking around in 95
degree, humid weather in long pants and insect repellent.”
Does that mean no tropical vacations?
“Not at all. But I think my family rolls their eyes at me a little because I’m constantly saying ‘Wear insect repellent.’”
his position on the state board of health, he’ll be called on to use
his expertise to help limit infectious outbreaks, but he’s also become
familiar with a broad range of issues facing the board, such as
community paramedic programs assisting rural patients with chronic
disease care and updating the food safety code to match evidence-based
“I thought it would be a good way to use my skill set to give back to my state.”
traveling the globe fighting disease, Pastula largely concentrates on
Colorado, where West Nile is the most common arbovirus. He’s also been
involved in treating and researching a cluster of acute flaccid myelitis possibly associated with enterovirus D-68 that affected children in Colorado.
As a consultant, Pastula could be recruited to travel again to help with a crisis.
“At the end of the day, if I can be of help anywhere, I’m happy to go and do whatever is needed.”