On December 18, 2014, the Trust for America’s Health, in conjunction with the Robert Wood Johnson Foundation, released its report Outbreaks: Protecting Americans from Infectious Diseases 2014. The report looks at states across ten criteria related to fighting infectious disease such as increasing or maintaining funding, vaccinating at least half of the population six months and older for seasonal influenza, and requiring the reporting of all CD4 and HIV viral load data. States are scored on whether they meet the criteria with a total of 10 points possible. States’ scores ranged from a low of two (one state) up to a high of eight (five states).

The report highlights areas that need to be addressed as well as makes recommendations to strengthen public health at all levels. Some of the reports highlights include the following:

• Twenty-eight states reported increasing or maintaining public health funding between fiscal years 2012/2013 and 2013/2014.
• Only 14 states vaccinated at least half their population over six months of age for seasonal influenza between fall 2013 and spring 2014.
• Only 15 states have complete climate change adaptation plans that highlight the impact climate change has on human health.
• Thirty-eight states met the national performance target of testing 90% of reported E. coli 0157 cases within four days.

Ebola frames much of the discussion around preparedness for novel infections. The report notes that confronting Ebola in the United States identified gaps that exist around infection control practices, adequate supplies of personal protective equipment (PPE), and lack of medical countermeasures. These deficiencies raise concerns regarding how to sustain preparedness between disease outbreaks and other emergencies. The report also looks at other infectious diseases such as Enterovirus D-68, where an outbreak resulted in 1,152 confirmed cases across 49 states as of December 18, 2014 [1], and Chikungunya, a mosquito-borne disease that has sickened over 10,000 people in Puerto Rico and was transmitted for the first time in the United States this summer [2].

Critical concerns remain across the spectrum of infectious disease to handle not only outbreaks but persistent diseases such HIV, hepatitis B and C, and tuberculosis. An estimated 70% of individuals living with HIV do not have their virus suppressed [3]. Of the up to 3.2 million persons living with chronic hepatitis C, only a fraction are aware of their infection [4]. Multidrug Resistant Tuberculosis (MDR-TB) poses a global threat with 480,000 estimated cases in 2013 [5].

The report also examines and makes recommendations for national focus areas including the following:

• Maintaining and modernizing public health capabilities.
• Enhancing surge capacity and infection control to ensure better prepared health systems.
• Changing healthcare and public health norms to increase vaccination rates and combat antimicrobial resistance.

Two challenges in the report have also been consistently raised by NACCHO. The first is graying of the workforce, with many qualified individuals leaving the field through retirement. The second is continuing decreases in funding for public health. Declines in funding exacerbates workforce decreases as retiring staff are not replaced and other positions are eliminated. Since 2008, 51,000 positions have been lost at the state and local level. As funding decreases, the ability to sustain infectious disease preparedness and continue the fight against persistent disease and new threats is challenged.

Local public health departments are on the frontlines of infectious disease preparedness and response. For Ebola, local health departments are critical for coordinating stakeholders, proving clear and accurate information, and monitoring individuals at risk for Ebola Virus Disease. Local health departments are also vital for the day-to-day management of infectious disease. The NACCHO’s 2013 National Profile of Local Health Departments emphasizes that infectious disease programs including surveillance, screening for disease, and immunization are some of the top programs and services provided directly and most frequently by local health departments. Local health departments recognize the issues that are outlined in the report and serve as a vital player in addressing them. Local health departments are working with their partners everyday to limit the spread of infectious disease through the following activities:

• Ensuring coordination and collaboration between public health and the healthcare system to achieve common goals such as increased vaccination rates and suppressed HIV viral loads.
• Conducting training exercises to ensure public health and healthcare staff remain in a state of preparedness regardless of the infectious disease threat.
• Developing risk communication strategies to ensure partners, media, and the general public have all the information needed regarding the risk and the steps to stop transmission.
• Advocating for public health needs including sufficient funding and staffing.

Local health departments will continue to serve as the leaders in protecting their communities against infectious disease.

About Chris Aldridge
Chris Aldridge is the Senior Director for Infectious Diseases at NACCHO. His work includes oversight of the Epidemiology, HIV/STI, Immunization and Infectious Disease projects, as well as coordinating those with Emergency Preparedness, Environmental Health, Food Safety, and Disability initiatives. Email: [email protected]