Most States Letting Down Guard Against Infectious Disease

December 18, 2013

The United States has let its guard down against infectious disease, particularly at the state level, where 34 states have a score of 5 or lower on 10 indicators of public health protection, according to a new study published online yesterday by Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

The study looks at wide-ranging threats that include a spike in measles cases, the spread of dengue fever caused by climate change, bacterial resistance to overused antibiotics, disappointing influenza vaccination rates, and understaffed public health departments and antiquated lab equipment in an era of budget cuts.

Some states were found particularly wanting. Georgia, Nebraska, and New Jersey each achieved only 2 of 10 public health measures that pertain to infectious disease.

New Jersey, for example, made the cut when it came to mandating that healthcare facilities report treatment-related infections and transporting disease samples to reference laboratories in a timely manner. However, it flunked the other indicators, including:

  • meeting the nation's goal of vaccinating 90% of children aged 19 to 35 months against pertussis,

  • covering routine HIV screening under its Medicaid program,

  • vaccinating at least half its citizens aged 6 years and older against influenza in the 2012 to 2013 season, and

  • writing a climate change action plan that considers the effect on human health.

People living in states with poor infectious disease report cards are at a greater risk, said TFAH Executive Director Jeffrey Levi, PhD.

"If I lived in a jurisdiction where we have lower vaccination rates, and we're not planning for climate change, I would be worried," said Dr. Levi during a news conference yesterday.

New Hampshire led all states by satisfying 8 of the 10 public health indicators. It was 1 of only 17 states that increased or maintained their level of funding for public health services from fiscal 2011-2012 to 2012-2013.

The study by TFAH and RWJF noted that "states have the primary legal jurisdiction and responsibility for the health of their citizens."

Dr. Levi repeatedly stressed during the news conference that the war against infectious disease requires constant vigilance. Reiterating that point was Tom Inglesby, MD, chief executive officer and director of the Center for Health Security at the University of Pennsylvania Medical Center in Baltimore, Maryland.

"There's a widespread, mistaken belief that we have infectious diseases under control," said Dr. Inglesby, one of the study's peer reviewers. "This has led to complacency and letting down our guard."

One example of a lowered guard, noted Dr. Levi, is allowing parents to forego pertussis vaccination for their children on religious or personal grounds. These exemptions, he said, have contributed to pertussis outbreaks.

"We've become a little bit lax in granting these exemptions," he said.

Some improvements to the nation's bulwarks against infectious disease, such as toughening vaccination requirements, cost little, if any, money. Others, however, require big investments, Dr. Levi noted. He said he hopes that the study will persuade Congress to restore funding to agencies such as the Centers for Disease Control and Prevention and the National Institutes of Health, which have been hit hard by budget cuts.

A copy of the report, "Outbreaks: Protecting Americans from Infectious Disease," is available on the TFAH Web site.

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