Emerging Infectious Diseases:

Consensus on Needed Laboratory Capacity Could Strengthen Surveillance

HEHS-99-26: Published: Feb 5, 1999. Publicly Released: Feb 25, 1999.

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Pursuant to a congressional request, GAO reviewed the nation's infectious diseases surveillance network, focusing on the: (1) extent to which states conduct public health surveillance and laboratory testing of selected emerging infectious diseases; (2) problems state public health officials face in gathering and using laboratory-related data in the surveillance of emerging infectious diseases; and (3) assistance that the Department of Health and Human Services' Centers for Disease Control and Prevention (CDC) provides to states for laboratory-related surveillance and the value of this assistance to state officials.

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.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: In November 2000, the Office of the Assistant Secretary for Planning and Evaluation issued the report, "Assessing Core Capacity for Infectious Diseases Surveillance." The report was an important step forward in developing an analytic framework that could be used to help create consensus on core capacities needed at each level of government for effective national surveillance. The report identified gaps in the core capacity for infectious diseases surveillance and identified investment priorities for closing these gaps. While the report identified as one of the gaps the lack of a clear set of standards that defines the critical surveillance needs and associated capacity requirements at all levels of the system, the work of producing such a set of standards remained to be done. In the context of preparing to distribute cooperative agreement awards for public health emergency preparedness and response, CDC worked with HHS to get consensus from a broad array of public health partners and organizations on critical capacities, including critical benchmarks that must be met, and enhanced capacities related to bioterrorism, other infectious disease outbreaks, and other public health threats and emergencies. Laboratory capacity is included in this effort. However, some of the capacity definition is at a fairly general level.

    Recommendation: To improve the nation's public health surveillance of infectious diseases and help insure adequate public protection, the Director, CDC, should lead an effort to help federal, state and local public health officials create consensus on the core capacities needed at each level of government. The consensus should address such matters as the number and qualifications of laboratory and epidemiologic staff, laboratory and information technology and CDC's support of the nation's infectious diseases surveillance system.

    Agency Affected: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention


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