Outbreaks: Protecting Americans from Infectious Diseases

The report includes a report card for how well states scored on 10 indicators of strategies being used to prevent and control infectious disease outbreaks. Some topics include vaccination rates, antibiotic-resistant Superbugs, Salmonella, the seasonal flu, healthcare-associated infections, HPV, HIV, TB, hepatitis, and the capabilities of state public health laboratories.

The Outbreaks: Protecting Americans from Infectious Diseases report finds the nation’s ability to prevent and control infectious disease outbreaks are hampered by outdated systems and limited resources.

The report, released today by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), finds that a majority of states (33) score 5 or lower out of 10 key indicators of policies and capabilities to protect against infectious disease threats. Three states tied for the lowest score, achieving two out of 10 possible indicators – Georgia, Nebraska and New Jersey. New Hampshire had the highest score, with 8 out of 10.

“From antibiotic-resistant Superbugs to Salmonella to the seasonal flu, infectious diseases disrupt lives and communities,” said Jeffrey Levi, PhD, executive director of TFAH. “Fighting these diseases requires constant vigilance. The bad news is that we found major gaps in the country’s ability to prevent, control and treat outbreaks, leaving Americans at an unacceptable level of unnecessary risk.”

Some key findings include:

  • One-third of states do not require healthcare facilities to report healthcare-associated infections (HAI). Approximately one out of every 20 hospitalized patients will contract a HAI.
  • Only one-quarter of states vaccinated at-least half of their population against the seasonal flu. The U.S. Centers for Disease Control and Prevention (CDC) recommends all Americans ages 6 months and older get vaccinated. Twenty percent of Americans get the flu each year.
  • Only two states (Connecticut and Delaware) and Washington, D.C. meet the U.S. Department of Health and Human Services (HHS) goal of vaccinating at least 90 percent of preschoolers (19- to 35-month olds) against the whooping cough.
  • Fewer than half of states require human papillomavirus (HPV) vaccinations, education for parents about the vaccine or funding for vaccinations. CDC and the American Academy of Pediatrics recommend the vaccination for both males and females at 11 or 12 years of age.
  • One-third of states do not cover routine HIV screening under their Medicaid program. More than 1.1 million Americans are living with HIV/AIDS, and almost one in five do not know they are infected.
  • Just over half of public health laboratories did not test their Continuity of Operations (COOP) plans either through a drill or real event last year.
  • Two-thirds of states decreased funding for public health from Fiscal Year (FY) 2011-12 to FY 2012-13.

The report’s indicators are developed in consultation with leading public health experts based on data from publicly available sources or information provided by public officials.

“Many infectious disease threats keep me up at night – from the emergence of a new deadly disease, such as the Middle East Respiratory Syndrome (MERS), to the prospect of bioterrorism, to antibiotic resistant infections, to the worsening of mosquito-borne illnesses being driven by changes in the climate,” said Tom Inglesby, MD, chief executive officer and director of the UPMC Center for Health Security.

Outbreaks provides a series of recommendations that address many of the major gaps in infectious disease control and prevention, including:

  • Strengthening fundamental capabilities – maintaining an expert workforce and giving them state-of-the-art tools required to conduct investigations to quickly detect, control and treat disease outbreaks;
  • Countering antibiotic resistance and prioritizing research and development of medical countermeasures should be top health and national security priorities;
  • Increasing the number of Americans receiving recommended vaccinations and routine screenings for particular diseases, since these are the safest and most effective ways to reduce infectious diseases in the United States;
  • Modernizing disease surveillance and ensuring public health laboratories have the equipment and capacity to not only test for routine problems like foodborne illnesses but also for new and large-scale threats like bioterrorism or a pandemic;
  • Supporting policies and incentives to reduce the number of healthcare-associated infections, ensuring Americans can receive safe care;
  • Improving global coordination to prevent and contain emerging new illnesses like MERS while maintaining defenses against “old-school” threats like malaria and tuberculosis;
  • Shoring up the nation’s public health preparedness capabilities to respond to major disease outbreaks or acts of bioterrorism to ensure new threats can be rapidly identified and contained; and
  • Countering complacency around HIV/AIDS, hepatitis B and C (HBV and HCV) and tuberculosis? including countering an alarming rise in new HIV infections among young gay men, and screening millions of Baby Boomers who may be infected with HCV and do not know they are at risk for developing serious liver disease as they age.

The report was supported by a grant from RWJF.

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH’s website. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from publicly available sources or were provided from public officials.

  • 8 out of 10: New Hampshire
  • 7 out of 10: Connecticut, Delaware, Minnesota, New York, North Carolina, Oregon, Rhode Island and Washington
  • 6 out of 10: California, Colorado, D.C., Hawaii, Maryland, Missouri, Pennsylvania, Tennessee and Virginia
  • 5 out of 10: Alaska, Florida, Illinois, Iowa, Louisiana, Maine, Massachusetts, Michigan, New Mexico, Oklahoma, South Carolina, South Dakota, Vermont and Wisconsin
  • 4 out of 10: Alabama, Idaho, Indiana, Kansas, Kentucky, Mississippi, North Dakota, Ohio, Texas, Utah and West Virginia
  • 3 out of 10: Arizona, Arkansas, Montana, Nevada and Wyoming
  • 2 out of 10: Georgia, Nebraska and New Jersey