Emerging Infectious Diseases

The surveillance of an testing for important emerging infectious diseases are not comprehensive in all states. Most states conduct surveillance of five of the six emerging infections GAO asked about tuberculosis, virulent strains of E. coli, whooping cough, cryptosporidium parvum, hepatitis C, and pencillin-resistant streptococcus pneumoniae and state public health laboratories conduct tests to support state surveillance of four of the six. However, more than half of state laboratories do not conduct tests for surveillance of penicillin-resistance S. pneumoniae and hepatitis C. Also, most state epidemiologists believe that their surveillance programs do not sufficiently study antibiotic resistance and other diseases they consider important. Many state laboratory directors and epidemiologists reports that inadequate staffing and information-sharing problems hinder their ability to generate and use laboratory data in their surveillance. However, public health officials have not agreed on a consensus definition of the minimum capabilities that state and local health departments needs to conduct infectious diseases surveillance. This lack of consensus makes it difficult for policymakers to assess the adequacy of existing resources or to evaluate where investments are needed most. GAO recommends that the Director of the Centers for Disease Control and Prevention (CDC) lead an effort to help federal, state, and local public health officials create consensus on the core capabilities needed at each level of government. Most state officials said that CDC's testing and consulting services, training, and grant funding support are critical to their efforts to detect and respond to emerging infections. However, both laboratory directors and epidemiologists were frustrated by the lack of integrated information systems within CDC and the lack of integrated systems linking them with other public and private surveillance partners. GAO summarized this report in testimony before Congress, Emerging Infectious Diseases: National Surveillance System Could Be Strengthened, by Bernice Steinhardt, Director of Health Services Quality and Public Health Issues, before the Subcommittee on Public Health, Senate Committee on Health, Education, Labor, and Pensions. GAO/T-HEHS-99-62, Feb. 25 (10 pages).

GAO noted that: (1) surveillance and testing for important emerging infectious diseases are not comprehensive in all states, leaving gaps in the nation's infectious diseases surveillance network; (2) GAO's survey found that most states conduct surveillance of five of the six emerging infectious diseases GAO asked about, and state public health laboratories conduct tests to support state surveillance of four of the six; (3) over half of the state laboratories do not conduct tests for surveillance of hepatitis C and penicillin-resistant S. pneumoniae; (4) many state epidemiologists believe that their infectious diseases surveillance programs should expand, and they cited a need to gather more information on antibiotic-resistant diseases; (5) just over half of the state public health laboratories have access to advanced molecular technology, which could be valuable to all states' diseases surveillance efforts; (6) few states require the routine submission of specimens or isolated quantities of a pathogen from patients with certain diseases for testing in state laboratories--a step CDC has urged them to adopt to improve the quality of surveillance information; (7) many state laboratory directors and epidemiologists reported that inadequate staffing and information-sharing problems hinder their ability to generate and use laboratory data to conduct infectious diseases surveillance; (8) participants in the surveillance network often lack basic computer hardware or integrated systems to allow them to rapidly share information; (9) many state officials told GAO that they did not have sufficient staffing and technology resources, and public health officials have not agreed on a consensus definition of the minimum capabilities that state and local health departments need to conduct infectious diseases surveillance; (10) this lack of consensus makes it difficult to assess resource needs; (11) most state laboratory directors and epidemiologists placed high value on CDC's testing and consulting services, training, and grant funding and said these services were critical to their ability to use laboratory data to detect and monitor emerging infections; (12) state officials said CDC needs to better integrate its data systems and help states build systems that link them to local and private surveillance partners; and (13) state officials would like CDC to provide more hands-on training experience.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Team: Phone: