Similarly, state public health laboratories commonly performed tests to support state surveillance of tuberculosis, pertussis, cryptosporidiosis, and virulent strains of E. coli. However, over half of the laboratories did not test for hepatitis C, and about two-thirds did not test for penicillin-resistant S. pneumoniae. Over three-quarters of the responding epidemiologists told us that their surveillance programs either leave out or do not focus sufficient attention on important infectious diseases. Officials Report That Staffing Constraints and Weak Information Sharing Impede Surveillance of Emerging Infections

As part of our surveys and field interviews, we asked state officials to identify the problems they considered most important in conducting surveillance of emerging infectious diseases. Public health officials told us that the multitude of databases and data systems, software, and reporting mechanisms burdens staff at state and local health agencies and leads to duplication of effort when staff must enter the same data into multiple systems that do not communicate with one another. Further, the lack of integrated data management systems can hinder laboratory and epidemiologic efforts to control outbreaks. Public Health Consensus on Core Capacities Needed to Conduct Surveillance Does Not Exist

Although many state officials are concerned about their staffing and technology resources, public health officials have not developed a consensus definition of the minimum capabilities that state and local health departments need to conduct infectious diseases surveillance. Many state laboratory directors and epidemiologists said such assistance has been essential to their ability to conduct infectious diseases surveillance and to take advantage of new laboratory technology; however, a small number of laboratory directors and epidemiologists believe CDC’s assistance has not significantly increased their ability to conduct surveillance of emerging infections. Laboratory Testing, Consultation, and Training Assistance Are Viewed as Critical

Many state laboratory directors and epidemiologists told us that CDC’s testing, consultation, and training services are critical to their surveillance efforts. Where almost all states and most state laboratories reported that they monitor antibiotic-resistance in tuberculosis, far fewer reported monitoring penicillin-resistant S. pneumoniae. In response to state and local requests for greater integration of systems, CDC established a board to formulate and enact policy for integrating public health information and surveillance systems.
Why GAO Did This Study

Pursuant to a congressional request, GAO discussed public health surveillance of emerging infectious diseases, focusing on the role of state laboratories.

What GAO Found

GAO noted that: (1) surveillance of and testing for important emerging infectious diseases are not comprehensive in all states; (2) GAO found that most states conduct surveillance of five of the six emerging infections GAO asked about, and state public health laboratories conduct tests to support state surveillance of four of the six; (3) however, over half of state laboratories do not conduct tests for surveillance of penicillin-resistant S. pneumoniae and hepatitis C; (4) also, most state epidemiologists believe their surveillance programs do not sufficiently study antibiotic-resistant and other diseases they consider important; (5) many state laboratory directors and epidemiologists reported that inadequate staffing and information-sharing problems hinder their ability to generate and use laboratory data in their surveillance; (6) however, 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; (7) this lack of consensus makes it difficult for policymakers to assess the adequacy of existing resources or to evaluate where investments are needed most; (8) most state officials said the Centers for Disease Control and Prevention's (CDC) testing and consulting services, training, and grant funding support are critical to their efforts to detect and respond to emerging infections; (9) however, both laboratory directors and epidemiologists were frustrated by the lack of integrated systems within CDC and the lack of integrated systems linking them with other public and private surveillance partners; and (10) CDC's continued commitment to integrating its own data systems and to helping states and localities build integrated electronic data and communication systems could give state and local public health agencies vital assistance in carrying out their infectious diseases surveillance and reporting responsibilities.