Trust for America’s Health Report:
Public Health and Clinical Laboratories Need to be Ready for New Disease Threats

When it comes to detecting and responding to disease outbreaks, more than half of the U.S. scores a five or lower out of 10 on a readiness scale, according to a new report from the Trust for America's Health (TFAH). The document also makes a number of recommendations for public health laboratories.

The report, entitled "Outbreaks: Protecting Americans from Infectious Diseases," calls on states to maintain and modernize basic capabilities such as epidemiology and lab abilities needed to respond to new and ongoing outbreaks.

"Public health labs must have the staff and capabilities to rapidly detect and test for potential infectious disease outbreaks. Quickly understanding where an outbreak is occurring—or about to occur—is key to preventing or controlling an outbreak," Rich Hamburg, deputy director of TFAH, told National Intelligence Report.

As to clinical labs, staff must be trained to ensure familiarity and adherence with protocols for handling, packaging and preparing dangerous pathogens and waste for transport, TFAH said.

New Disease Threats Deserve Attention
New national infectious disease threats deserving a redoubling of professional efforts are: MERs-CoV and antibiotic-resistant superbugs and resurging illnesses including whooping cough, tuberculosis and gonorrhea, TFAH said in a statement.

"Health care professional societies and unions, hospital administrators, laboratories and others must ensure their workforces are informed and well-trained on appropriate procedures for newly emerging and ongoing threats," the TFAH report said.

Also, new diagnostics are needed to respond to threats, and a collaboration among labs and test manufacturers can possibly bring them about, according to the Association of Public Health Laboratories (APHL).

"The number of antimicrobial-resistant organisms continues to increase globally. It will be important for test manufacturers, in collaboration with laboratories, to develop new diagnostics to detect these changing threats," said Chris Mangal, APHL's director of public health preparedness and response.

"Public health laboratories play a critical role for surveillance of antimicrobial resistance. Data from these labs can shape the development of new antibiotics and promote better stewardship of antibiotic use," she also told National Intelligence Report.

Electronic Reporting and Messaging Important
Speaking of data, the TFAH report also recommended public health labs boost electronic reporting to enable real-time data sharing with public health officials.

The APHL Informatics Messaging Services (AIMS) is a secure cloud-based environment that accelerates implementation of public health messaging solutions, according to Mangal. It offers secure electronic data messaging needed across the public health community and provides shared services to aid in the transport, validation, translation and routing of electronic data, Mangal said.

Key Findings: Biosafety, Infections, HIV
The TFAH report, released in December, shared these key findings, among others:

• Only 36 states have a biosafety public health professional. The job entails responsibilities relative to detection, diagnosis and containing disease outbreaks. Mangal told National Intelligence Report that reductions in Public Health Emergency Preparedness (PHEP) funding have, over time, eroded biosafety programs. But public health labs accessed Centers for Disease Control (CDC) Epidemiology and Laboratory Capacity (ELC) Ebola supplemental funding to rebuild these biosafety programs. The labs also turned to clinical labs to strengthen their system, she said. "One success is the hiring of biosafety officers across the country," she said, adding that APHL calls for increased funding for the PHEP Cooperative Agreement and ELC to enable labs to respond to threats.
• One out of 25 hospitalized patients gets a health care-associated infection, which leads to 75,000 deaths annually.
• Only nine states reduced standardized infection ratio for central-line-associated bloodstream infections between 2012 and 2013.
• More than two million Americans contract antibiotic-resistant infections each year, leading to more than 23,000 deaths, TFAH noted. The superbugs reportedly cost health care $20 billion and result in more than $35 billion in lost productivity.
• More than 1.2 million Americans live with HIV, and about one in eight do not know they have it.

America's Infectious Disease Report Card
Here's a look at how TFAH said U.S. states scored on readiness for disease outbreaks with zero the lowest and 10 the highest possible score:

• 8 out 10: Delaware, Kentucky, Maine, New York, Virginia
• 7 out of 10: Alaska, California, Maryland, Massachusetts, Minnesota, Nebraska
• 6 out of 10: Arkansas, Illinois, Iowa, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Vermont, West Virginia, Wisconsin
• 5 out of 10: Arizona, Colorado, Connecticut, Georgia, Hawaii, Mississippi, Missouri, Montana, Pennsylvania, Rhode Island, Texas, Washington
• 4 out of 10: Alabama, District of Columbia, Florida, Indiana, Louisiana, Nevada, South Carolina, South Dakota, Tennessee, Wyoming
• 3 out of 10: Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon, Utah

Trust for America's Health is a Washington, D.C.-based non-profit organization that says it is focused on prioritizing disease prevention. The report was done in partnership with the Robert Wood Johnson Foundation.

Takeaway: More than half of U.S. states scores a five or lower on key indicators related to diagnosing and responding to infectious disease outbreaks, a new Trust for America's Health report finds. Laboratory executives are urged to ensure workers are informed and prepared for threats. Electronic reporting and data messaging; and collaboration among labs and test manufacturers toward new diagnostics are still other implications for labs.