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. This testimony summarizes the February 1999 GAO report, GAO/HEHS-99-26.

GAO noted that: (1) surveillance of and testing for important emerging infectious diseases are not comprehensive in all states; (2) GAO found that most states conduct surveillance of five of the six emerging infections GAO asked about, and state public health laboratories conduct tests to support state surveillance of four of the six; (3) however, over half of state laboratories do not conduct tests for surveillance of penicillin-resistant S. pneumoniae and hepatitis C; (4) also, most state epidemiologists believe their surveillance programs do not sufficiently study antibiotic-resistant and other diseases they consider important; (5) many state laboratory directors and epidemiologists reported that inadequate staffing and information-sharing problems hinder their ability to generate and use laboratory data in their surveillance; (6) however, 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; (7) this lack of consensus makes it difficult for policymakers to assess the adequacy of existing resources or to evaluate where investments are needed most; (8) most state officials said the Centers for Disease Control and Prevention's (CDC) testing and consulting services, training, and grant funding support are critical to their efforts to detect and respond to emerging infections; (9) however, both laboratory directors and epidemiologists were frustrated by the lack of integrated systems within CDC and the lack of integrated systems linking them with other public and private surveillance partners; and (10) CDC's continued commitment to integrating its own data systems and to helping states and localities build integrated electronic data and communication systems could give state and local public health agencies vital assistance in carrying out their infectious diseases surveillance and reporting responsibilities.