US Complacent on Infectious Disease Threats, Report Shows

Megan Brooks

December 17, 2015

The United States has to do more to boost its ability to prevent and control infectious disease outbreaks, according to the third annual report card, released today, on the nation's infectious disease preparedness.

More than half of states (28) received a score of five or fewer of 10 key indicators related to preventing, detecting, diagnosing, and responding to outbreaks, according to the report from Trust for America's Health and the Robert Wood Johnson Foundation.

Seven states (Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon, and Utah) tied for the lowest score, at three of 10, whereas Delaware, Kentucky, Maine, New York, and Virginia tied for the top spot, achieving a score of eight of 10.

Sustained Interest, Investment Lacking

"We conduct the outbreaks report to examine the country's policies to respond to ongoing emerging infectious disease threats, including new threats such as [Middle East respiratory syndrome coronavirus] and antibiotic-resistant superbugs, as well as resurging illnesses like whooping cough, gonorrhea, and tuberculosis," Jeffrey Levi, PhD, executive director of Trust for America's Health, said during a press briefing today.

"Most infectious diseases are preventable, but we found overall that we haven't made the investments to put in place many of the basic protections that could avoid significant numbers of outbreaks and save billions of dollars in unnecessary healthcare costs," he said.

"The country's interest in infectious diseases tends to ebb and flow. When there is a new scary threat, like Ebola last year, there is a major ramp up, but once there is a sense that an outbreak is contained, we fall back to a place of complacency," Dr Levi added.

Some of the Key Findings From the Report

  • Preparing for emerging threats: Although significant advances have been made in preparing for public health emergencies, including potential bioterror or natural disease outbreaks, gaps remain and have been exacerbated as resources have been cut. "Insufficient resources have led to 15 state public health laboratories not having a biosafety professional on staff," Dr Levi reported.

  • Antibiotic-resistant infections: More than 2 million Americans contract antibiotic-resistant infections each year, resulting in more than 23,000 deaths, $20 billion in direct medical costs, and more than $35 billion in lost productivity. Dr Levi called antibiotic-resistant infections "one of the scariest threats" the US faces.

  • Healthcare-associated infections: About one of every 25 people who are hospitalized each year contracts a healthcare-associated infection, leading to some 75,000 deaths a year. "Last year, only nine states were able to reduce the number one significant form of these infections: infections contracted through central blood lines," Dr Levi said.

  • Influenza vaccinations: Only 18 states vaccinated at least half of their population against influenza last season. The national average is only 47.1%. Rates are lowest among young and middle-aged adults (only 38% of 18- to 64-year-olds are vaccinated).

  • Childhood vaccinations: There has been a resurgence of measles and whooping cough in some communities and states. "While more than 90% of all US kindergarteners have received all their vaccinations, we are still seeing pockets of communities where the rates are much, much lower," Dr Levi said. More than 28% of preschoolers do not receive all recommended vaccinations.

  • HIV/hepatitis C: There has been a "troubling" new hepatitis C epidemic, mostly in young adults in rural and suburban areas, Dr Levi said. "Infections have increased 150% between 2010 and 2013, related at least in part to people who have become dependent on prescription painkillers who start using heroin as an alternative. We must get this problem under control quickly before it continues to increase and spread." One of the most effective ways to do this, he said, is through syringe exchange programs. However, only 16 states and Washington, DC, explicitly authorize these programs.

  • Food safety: Roughly 48 million Americans fall ill from a foodborne illness each year; 39 states met the national performance target of testing 90% of Escherichia coli O157 cases within 4 days in 2013.

Outbreaks Are "Inevitable"

Dan Hanfling, MD, from the UPMC Center for Health Security, Baltimore, Maryland, noted that "infectious diseases cost the country around $120 billion dollars each year. Fighting infectious diseases requires constant vigilance, but this is a lesson we tend to forget and tragically continue to relearn."

An expert in medical mass casualty response, Dr Hanfling told reporters "from having been on the front lines of the anthrax attacks in response in 2001 to being a part of the team addressing Ebola and what we correctly anticipated to be its arrival on US shores last year, I've seen over and over again where we have failed to sufficiently invest in and sustain many basic defenses against infectious disease threats."

He added, "Disease outbreaks, whether they start as an act of Mother Nature, or as a result of bioterrorism, can be hard to predict, but the one thing we know is that they are inevitable."

The report, Outbreaks: Protecting Americans From Infectious Diseases, makes several priority recommendations, including:

  • increase resources to ensure every state can maintain and modernize basic capabilities, such as epidemiology and laboratory abilities, that are needed to respond to new and ongoing outbreaks;

  • update disease surveillance to be real-time and interoperable across communities and health systems to better detect, track, and contain disease threats;

  • incentivize the development of new medicines and vaccines, and ensure systems are in place to effectively distribute them when needed;

  • decrease antibiotic overuse and increase vaccination rates;

  • improve and maintain the ability of the health system to be prepared for a range of potential threats, such as an influx of patients during a widespread outbreak or the containment of a novel, highly infectious organism that requires specialty care;

  • strengthen efforts and policies to reduce healthcare-associated infections;

  • take strong measures to contain the rising hepatitis C epidemic and other sexually transmitted infections, particularly among young adults; and

  • adopt modern strategies to end AIDS in every state and city.

The full report and state-by-state materials are available on Trust for America's Health's website.

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