Federal participation in the infectious diseases surveillance network focuses on CDC activities—particularly those of the National Center for Infectious Diseases (NCID), which operates CDC’s infectious diseases laboratories. Not All States Conduct Surveillance and Testing for Important Emerging Infections

While state surveillance and laboratory testing programs are extensive, not all include every significant emerging infectious disease, leaving gaps in the nation’s surveillance network. Slightly more than half the state laboratories use PFGE, which state and CDC officials believe could be valuable to most or all states’ diseases surveillance efforts. 1). Testing to support state surveillance of hepatitis C and penicillin-resistant S. pneumoniae occurs in fewer than half of the states. Epidemiologists and laboratory officials both said that public health officials often lack either basic computer equipment or integrated data systems that would allow them to rapidly share surveillance-related information with public and private partners. Most state officials believe they need to expand their infectious diseases surveillance programs. No Public Health Consensus Defines Core Capacities Needed for Surveillance System

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 this assistance has been essential to their ability to conduct infectious diseases surveillance and to take advantage of new laboratory technology. Laboratory testing and consultation. Training. 2). State officials also cited a need for training and technical assistance in information-sharing systems. 3). 4). Our survey results tend to support this view: surveillance of five of the six emerging infectious diseases we asked about is widespread among states, and surveillance of four of the six is supported by testing in state public health laboratories. Just over half of the state public health laboratories have access to molecular technology that many experts believe all states could use, and few states require the routine submission of specimens to their state laboratories for testing—a step urged by CDC. In addition, many state epidemiologists believe their surveillance programs do not sufficiently study all infectious diseases they consider important, including antibiotic-resistant conditions and hepatitis C.
Both laboratory directors and epidemiologists expressed concerns about the staffing and technology resources they have for surveillance and information sharing. This report discusses (1) the extent to which states conduct public health surveillance and laboratory testing of selected emerging infectious diseases, (2) the problems state public health officials face in gathering and using laboratory-related data in the surveillance of emerging infectious diseases, and (3) the assistance CDC provides to states for laboratory-related surveillance and the extent to which state officials consider it valuable.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the nation's infectious diseases surveillance network, focusing on the: (1) extent to which states conduct public health surveillance and laboratory testing of selected emerging infectious diseases; (2) problems state public health officials face in gathering and using laboratory-related data in the surveillance of emerging infectious diseases; and (3) assistance that the Department of Health and Human Services' Centers for Disease Control and Prevention (CDC) provides to states for laboratory-related surveillance and the value of this assistance to state officials.

What GAO Found

GAO noted that: (1) surveillance and testing for important emerging infectious diseases are not comprehensive in all states, leaving gaps in the nation's infectious diseases surveillance network; (2) GAO's survey found that most states conduct surveillance of five of the six emerging infectious diseases GAO asked about, and state public health laboratories conduct tests to support state surveillance of four of the six; (3) over half of the state laboratories do not conduct tests for surveillance of hepatitis C and penicillin-resistant S. pneumoniae; (4) many state epidemiologists believe that their infectious diseases surveillance programs should expand, and they cited a need to gather more information on antibiotic-resistant diseases; (5) just over half of the state public health laboratories have access to advanced molecular technology, which could be valuable to all states' diseases surveillance efforts; (6) few states require the routine submission of specimens or isolated quantities of a pathogen from patients with certain diseases for testing in state laboratories--a step CDC has urged them to adopt to improve the quality of surveillance information; (7) many state laboratory directors and epidemiologists reported that inadequate staffing and information-sharing problems hinder their ability to generate and use laboratory data to conduct infectious diseases surveillance; (8) participants in the surveillance network often lack basic computer hardware or integrated systems to allow them to rapidly share information; (9) many state officials told GAO that they did not have sufficient staffing and technology resources, and 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; (10) this lack of consensus makes it difficult to assess resource needs; (11) most state laboratory directors and epidemiologists placed high value on CDC's testing and consulting services, training, and grant funding and said these services were critical to their ability to use laboratory data to detect and monitor emerging infections; (12) state officials said CDC needs to better integrate its data systems and help states build systems that link them to local and private surveillance partners; and (13) state officials would like CDC to provide more hands-on training experience.