Most States Not Ready to Handle Infectious Disease Outbreaks: Report

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THURSDAY, Dec. 18, 2014 (HealthDay News) -- Ebola's entrance into the United States -- along with Angelina Jolie's chickenpox and the National Hockey League's mumps outbreak -- have highlighted cracks in the nation's public health defense against infectious disease, according to a new health policy report released Thursday.

Half of U.S. states are poorly prepared to prevent, detect and respond to infectious disease outbreaks. That was the main conclusion of the report issued jointly by the Trust for America's Health and the Robert Wood Johnson Foundation.

"Ebola has served as a major wake-up call to the United States," said Jeffrey Levi, executive director of the Trust for America's Health.

"It's a reminder that an infectious disease anywhere is a threat everywhere, and Ebola has raised attention to serious gaps in our ability to manage disease outbreaks and contain their spread. It was very disturbing that many of the most basic infectious disease controls failed when tested," he said.

The report ranks states based on 10 indicators of preparedness. The indicators include funding of public health efforts, vaccination rates, infection control at medical centers, attempts to prepare for climate change, and surveillance efforts to track cases of HIV and E. coli.

Half the states scored five or lower on the list of 10 indicators. Five states tied for the top score. Maryland, Massachusetts, Tennessee, Vermont and Virginia all received a score of 8 out of 10, according to the report. Arkansas has the lowest score at 2 out of 10. No state received a perfect ranking.

"When I was in medical school, the leading experts declared that infectious diseases had been conquered in the United States. It's now clear how wrong they were," Dr. Eric Toner, senior associate at the University of Pittsburgh Medical Center's Center for Health Security, said of the report's findings.

Levi blamed the nation's half-hearted defense against infectious diseases on complacency, combined with a "tendency to focus on the newest and most alarming threat at the expense of maintaining a steady defense against ongoing and costly illnesses."

"When there is no major threat dominating headlines, we start letting our guard down, cut funds for programs, and then are caught off-guard and underprepared for the next outbreak," he said.

Levi and Toner broke down the infectious disease threats facing America into four main categories:

  • Traditional infectious diseases such as the flu, mumps, chickenpox and whooping cough. Vaccines are available for these diseases, but not enough people are getting them. The report noted that more than 2 million preschoolers, 35 percent of seniors and a majority of adults don't receive all of the recommended vaccinations.
  • Chronic infectious diseases for which complacency has hampered efforts to control their spread. Diseases in this category include HIV, tuberculosis and hepatitis. New HIV infections grew by 22 percent among young gay men and 48 percent among young black men between 2008 and 2010, the report found.
  • Emerging infections that will strike the United States as a result of climate change. These include mosquito-borne illnesses like chikungunya, West Nile virus, malaria and dengue fever, which have been striking the southern states more frequently.
  • Antibiotic-resistant bacteria and superbugs. More than 2 million Americans fall sick from antibiotic-resistant bacteria and more than 23,000 die from those infections each year, the report found.

States also did a particularly poor job of reducing infections of the blood caused by catheters placed into large veins during hospitalization, the report found. Just 10 states reduced the number of such infections between 2011 and 2012. Only 16 states performed better than the national baseline for these infections, the report found.

The new report "primarily reflects what we observed during the Ebola crisis," said Dr. Ambreen Khalil, an infectious disease specialist at Staten Island University Hospital in New York. "While some hospitals were very well prepared, most were not equipped to handle such cases or even identify the severity of the issue."

The report recommended a number of steps that can be taken to better defend the nation against infectious diseases, Levi said. These include:

  • Making sure each state has a well-trained public health workforce equipped with strong laboratories.
  • Developing and implementing solid containment strategies, including vaccination for contagious bugs and treatment of chronic infections.
  • Training hospitals to respond to outbreaks that could flood the facilities with huge numbers of patients, and regularly testing their preparedness.
  • Improving communications with the public, to keep them up to date on emerging threats without creating panic.
  • Increasing federal funding into research for vaccines, stronger antibiotics and other treatments that can counter outbreaks.

"Unfortunately, there is often a very limited market for these medical countermeasures," Toner said. "Therefore, there's not been a strong incentive for the industry to invest in research and development efforts. But vaccines and antimicrobial drugs are essential tools in fighting infectious disease."

More information

For more on the Outbreaks report, visit the Trust for America's Health.