[Emerging Infectious Diseases]                                                         
[Volume 4 No. 3 / July - September 1998]

Special Issue

Enhancing State Epidemiology and Laboratory Capacity for Infectious
Diseases

Deborah A. Deppe
Centers for Disease Control and Prevention, Atlanta, Georgia, USA

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The Epidemiology and Laboratory Cooperative is an agreement that provides
state and large local health departments with resources to strengthen and
enhance basic capacity for public health surveillance and response for
infectious diseases. The funding is used to implement new technology,
upgrade systems, train staff, and purchase office and laboratory equipment.
Six of the 30 sites reported on their programs.

The Vermont Department of Health has undertaken statewide efforts to
improve communicable disease reporting through legislation. Before 1997,
public health law required physicians, nurses, hospital administrators, and
school and town health officials to report communicable disease (defined by
regulation) to the Commissioner of Health. Legislation proposed and passed
in 1997 required health maintenance organizations and managed care
organizations to report as well. This model law defines such information as
"confidential and privileged" and extends protection to investigations and
studies of disease outbreaks.

The Kansas Department of Health and Environment is building epidemiology
and laboratory capacity by expanding electronic surveillance and analysis,
enhancing surveillance for diarrheal disease, and integrating information
from other sources into the existing surveillance system. The new programs
are flexible so they can meet the challenges posed by new and emerging
infectious diseases as well as changing needs within public health.

The New York State Department of Health uses electronic communications to
enhance rapid reporting of communicable disease epidemiologic and
laboratory data within the state. In July 1997, seven counties began pilot
testing the New York Health Information Network (HIN), a secure Intranet
site. Web forms were designed for designated county personnel to submit
confidential case and supplemental information on 61 reportable
communicable diseases on the HIN. Since implementation, reports from local
health departments to the state have been more timely. Counties can easily
update and query their own data and can access statewide reports generated
by the state and posted on the HIN.

The Los Angeles County Department of Health Services has used pulsed-field
gel electrophoresis (PFGE) for outbreak investigations for 2 years.
Bacteria caused 140 (24%) of 576 reported outbreaks, 36% of health facility
outbreaks, but only 19% of community outbreaks. PFGE was used in 32
investigations, of which 29 (91%) were nosocomial. The most common
organisms were staphylococcus and enterococcus. In contrast, PFGE was used
in only 3 (4%) of 77 investigations of community bacterial outbreaks.
Health departments should consider the number, setting, and causes of
outbreaks that they investigate to determine if PFGE will be useful in
their investigation arsenal.

The Washington State Department of Health has developed a pilot electronic
laboratory-based reporting mechanism to route infectious disease reports
from a large managed care organization to local health agencies. The
overall goal is development of a generic electronic reporting mechanism.
For this project, Health Level 7 was identified as a common ground for
sharing data. Preliminary data suggest that timeliness and completeness of
reporting will improve. Adhering to nationally recognized standards and
codes may help reduce problems associated with transferring data; however,
no public health software or implementation package was available, so
resource-intensive customization was necessary.

The Maine Bureau of Health is attempting to characterize statewide
hepatitis C (HCV) prevalence through a review of existing databases
(hospital discharges, deaths, Medicaid registry, blood donor screening),
mandatory laboratory reporting with physician questionnaire follow-up, a
blinded seroprevalence survey in sexually transmitted disease clinics, and
a survey of gastroenterologists. Initial data indicate dramatic increases
in HCV-related hospitalization and in Medicaid expenditures during the
mid-1990s and an unexpectedly high proportion of patients with injection
drugassociated risk histories. Local surveillance data are useful for
public policy decisions and as educational tools for physicians and the
public.

Emerging Infectious Diseases
National Center for Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, GA

URL: ftp://ftp.cdc.gov/pub/EID/vol4no3/ascii/depp.txt

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