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Section 2: Snapshots of Public Health Preparedness in States and Directly Funded Localities

The purpose of these snapshots is to provide information on public health preparedness activities in the 50 states, DC, and the directly funded localities of Chicago, New York City, and Los Angeles County.

The snapshots present data from CDC and partner publications that were available at
the time of reporting and do not cover all preparedness activities that state and local public
health departments have conducted. However, this effort represents a first step in presenting a more comprehensive picture of public health preparedness. For more information on current state preparedness activities, please contact the state public information officer (see directory at

Each snapshot provides an example of a reallife response or exercise that was enhanced by the cooperative agreement, narrative from the state or locality describing how the cooperative agreement has improved public health preparedness, and data on specific preparedness activities. The data are organized under one of three key public health preparedness areas: disease detection and investigation, public health
laboratories, and response. The preparedness activities support CDC preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages of an event.

The following table summarizes the snapshots on select public health preparedness activities conducted by the 50 states and 4 directly funded localities. For data points that do not cover all states and localities, the number responding is noted (some data sources did not collect information on the localities or did not have a 100% response rate).

The Big Picture for All States and Directly Funded Localities Disease

Disease Detection and Investigation

The sooner public health professionals can detect diseases or other health threats and investigate their causes and effects in the community, the more quickly they can minimize population exposure.

Table. Disease Detection and Investigation Activities in States and Localities

Category of Activities Specific Activity Percentage of Responding States and Localities
Detect and Report Could receive and investigate urgent disease reports 24/7/3651 100%
Primary method for receiving urgent disease reports*2
  • Telephone
  • Electronic reporting
  • Fax
Linked state and local health personnel to share information about disease outbreaks across state lines (through the CDC Epi-X system)3 100%
Conducted year-round surveillance for seasonal influenza4 [50 states and DC] 100%

* Telephone, fax, and electronic reporting are all viable options for urgent disease reporting, as long as the public health department has someone assigned to receive the reports 24/7/365.

1 CDC, DSLR; 2005;

2 CDC, DSLR; 2006;

3 CDC, Epi-X; 2007;

4 HHS, OIG; 2007

Public Health Laboratories

Public health laboratories test and confirm agents that can threaten health. For example, advanced DNA “fingerprinting” techniques and subsequent reporting to the CDC database (PulseNet) are critical to recognize nationwide outbreaks from bacteria that can cause severe illness, such as E. coli O157:H7 and Listeria monocytogenes.

Table. Public Health Laboratory Activities in States and Localities

Category of Activities Specific Activity Percentage of Responding States and Localities
Detect and Report Number of laboratories in the Laboratory Response Network*1 155
Number receiving E. coli O157:H7 samples (partial year, 9/06 – 2/07)2 [50 states] 46
  • Mean percentage of test results submitted to CDC database within 4 days
Number receiving Listeria monocytogenes samples (partial year, 9/06 – 2/07)2 [50 states] 26
  • Mean percentage of test results submitted to CDC database within 4 days
Had a laboratory information management system that could create, send, and receive messages3 (8/05 – 8/06) [50 states and DC] 86%
  • System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06)
Had a rapid method to send urgent messages to frontline laboratories that perform initial screening of clinical specimens3 (8/05 – 8/06) [50 states and DC] 100%
Crosscutting Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) 67%
Conducted exercise to test chemical readiness that met CDC criteria†4 (8/05 – 8/06) 85%

* This number only includes LRN laboratories in the 50 states. There are a total of 163 LRN laboratories.

† Data for chemical terorism agent exercises were collected for Level 1 and 2 laboratories

1 CDC, DBPR; 2007;

2 CDC, DSLR; 2007;

3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007;

4 CDC, DSLR; 2006


Planning provides a framework for how a public health department will respond during an emergency. The plans can be tested through external reviews, exercises, and real events. After-action reports assess what worked well during an exercise or real event and how the department can improve.

Table. Response Activities in States and Localities

Category of Activities Specific Activity Percentage of Responding States and Localities
Control Developed a public health response plan, including pandemic influenza response, crisis and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 100%
State plan to receive and distribute SNS assets reviewed by CDC2 [50 states] 98%
- Mean score on CDC technical assistance review (1-100) 79
Total number of cities in the Cities Readiness Initiative3 72
Crosscutting Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)
- Hospitals 91%
- Local/regional emergency management agencies 93%
- Federal emergency management agencies 70%
Public health department staff participated in training to support cooperative agreement activities4 100%
Public health laboratories conducted training for first responders5 (8/05 – 8/06) [46 states and DC] 70%
Activated public health emergency operations center as part of a drill, exercise, or real event*†6 (partial year, 9/06 – 2/07) 67%
Conducted a drill or exercise for key response partners to test communications when power and land lines were unavailable†6 (partial year, 9/06 – 2/07) 43%
Improve Finalized at least one after-action report with an improvement plan following an exercise or real event†6 (partial year, 9/06 – 2/07) 98%

* Activation means rapidly staffing all eight core ICS functional roles in the public health emergency operations center with one person per position. This capability is critical to maintain in case of large-scale or complex incidents, even though not every incident requires full staffing of the ICS.

† States were expected to perform these activities from 9/1/2006 to 8/30/2007. These data represent results from the first half of this period only.

1 CDC, DSLR; 2006;

2 CDC, DSNS; 2007;

3 CDC, DSNS CRI; 2007;

4 CDC, DSLR; 1999-2005;

5 APHL, Chemical Terrorism Preparedness; May 2007;

6 CDC, DSLR; 2007



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