Sep 20, 2011 (CIDRAP News) – State and local public health laboratories have improved their ability to identify and report infectious disease and chemical threats, and health departments are making steady progress in readiness planning, such as deploying medicines and other supplies, the Centers for Disease Control and Prevention (CDC) said in a report today.
The 152-page report, titled "Public Health Preparedness: 2011 State-by-State Update on Laboratory Capabilities and Response Readiness Planning," is the fourth major preparedness assessment from the CDC and the third to report state-by-state performance. The last report was issued in September 2010.
Dr Ali Kahn, who directs the CDC's Office of Public Health Preparedness and Response, said in a statement today that the report shows good progress, while recognizing the challenges that state and local health departments face to keep the patterns moving forward. "These can include an evolving list of health threats to the continuing economic crisis that could impact the ability to protect the health of communities," he said.
The new report covers activities in the two preparedness areas that occurred from 2007 to 2010 in 50 states and 4 localities (Chicago, Los Angeles County, the District of Columbia, and New York City) that receive direct funds from the CDC's Public Health Emergency Preparedness cooperative agreement. It provides an overview of national-level data, along with fact sheets on lab and response readiness for each state and metropolitan area.
Lab improvements, with budget concerns
In the lab capability section, the CDC said capacities in most states and cities were strong, with most labs improving their ability to rapidly characterize infectious disease threats and send reports to CDC.
One benchmark is the ability to submit at least 90% of Escherichia coli tests to the CDC's PulseNet database within 4 days of receiving samples. According to the report, the number of states that met that mark increased from 29 in 2008 to 38 in 2010.
Facilities in the Laboratory Response Network (LRN) maintained high pass rates in tests to detect biological agents, with levels consistently higher than 90% from 2008 to 2010, according to the findings.
For the more advanced LRN labs, the average number of proficiency methods for rapid chemical agent detection rose from 6.7 in 2009 to 8.9 in 2010. The CDC noted that the detection methods are vital for determining the scope of chemical incidents, who needs treatment, and clues to agent origins.
In a surge-capacity exercise to test response to an event like Tokyo's sarin subway attack in 1995, higher-level labs decreased the hours spent processing and reporting 500 samples from 98 to 56 between 2009 and 2010, the CDC said.
An area of concern was that 12 states (24%) didn't meet the E coli reporting benchmark, which can slow the identification of outbreaks, according to the report. The most commonly reported reason was laboratory workforce issues. Seven states reported staff shortages and lack of trained staff. Five states reported that their ability to submit Listeria monocytogenes data was hampered by staff turnover and furloughs.
"These and other challenges are causing state and local planners to express concerns over the ability to sustain the real and measurable advances made in public health preparedness," the report states, adding that public health officials will likely need to make tough choices. The CDC encouraged state and local public health departments to focus on building capabilities that form a strong preparedness foundation.
Response readiness gains
To test response readiness, the CDC and state health officials hold annual technical assistance reviews (TARs) to assess plans for receiving, staging, storing, distributing, and dispensing items from the Strategic National Stockpile (SNS).
According to the report, the national average for state TAR scores climbed from 87 in 2007-08 to 94 in 2009-10. The authors noted that the acceptable score range was raised from 69 or higher to 79 or higher for 2009-10.
For 72 metropolitan areas that are part of the CDC's Cities Readiness Initiative, the average score rose from 68 in 2007-08 to 88 in 2009-10. Acceptable thresholds also rose for cities during the same period.
For states, functional areas that saw the greatest improvement from 2007-08 to 2008-09 were repackaging bulk SNS medications and other materials and coordinating hospital and alternative care facilities. Over the next two time periods, the top improvements were training, exercise, and evaluation; dispensing prophylaxis; and communications.
Sep 20 CDC press release
Sep 20 CDC public health preparedness report
Sep 21, 2010, CIDRAP News story "CDC says state and local preparedness improving"