Most states can successfully conduct public health surveillance in compliance with IHR 2005. However, full state-level capacity for compliance was not found on any assessment response. Additional efforts are needed to ensure the ability of the United States to meet its IHR 2005 obligations.
Most states reported use of risk assessments to determine the need to notify CDC about unusual or unexpected events. In addition, ≈50% of states reported the use of risk assessment when initiating a formal investigation. IHR 2005 emphasizes the use of risk assessments to notify WHO about public health emergencies, rather than about specific events. The use of risk assessments in notifying CDC can help determine whether notification is necessary and ensure timely notification without waiting for laboratory confirmation.
Most (>80%) states reported having 1 POC for reporting chemical, radiologic, foodborne, infectious, and zoonotic events. All states should have a POC to facilitate prompt assessment and appropriate reporting. Such contacts also can assist in assessing events outside their areas of expertise or with unknown cause.
Reports of capacity to transmit daily notifications to CDC suggest that data collection and transmission capacity has improved substantially in recent years. The ability to transmit reports to CDC is a critical function, which allows for national situational awareness in high-profile events and public health emergencies.
Not all respondents included unusual or unexpected events on their state’s reportable conditions lists. Adding this criterion would help ensure that conditions having the potential to become public health emergencies can be recognized and reported in a timely manner.
Internal and external relationships of each state can play a role in reporting. Most states have formal information-sharing systems with other agencies within their state. Such dissemination of information within a state increases the likelihood that IHR reportable events are appropriately evaluated and reported. Other agencies may have knowledge that could be incorporated into a risk assessment.
About 50% of respondents reported participation in cross-jurisdictional electronic surveillance and having reporting systems for foodborne and infectious diseases. Public health surveillance across state jurisdictions is as important as the sharing of information within a state. Neighboring states can be alerted to public health emergencies that have the potential to become widespread or even global.
Our assessment has several limitations. First, only states were assessed; neither territories nor local health departments were included. Circumstances are sufficiently different in the territories; no conclusions about their capacity should be drawn because they are likely to have different reporting practices and capacities. Future assessments should focus on identifying and documenting capacities for IHR 2005 compliance in at least a sample of jurisdictions at the local or county level. Second, our assessment relied on self-reporting, which in some instances may have led to inaccuracies or bias. Data were made anonymous before analysis so that states would not be singled out as having suboptimal reporting practices or capacities. Therefore, we could not inquire about potential discrepancies.
To enable the United States to fully meet its IHR 2005 obligations, all states should include unusual or unexpected events or outbreaks on their state lists of reportable conditions. In addition, states and CDC should work toward further development of the nationally notifiable conditions list and the timeframes for reporting. The capacity to transmit records to CDC on a daily basis is key to full compliance with IHR 2005. Risk assessments of unusual or unexpected events should be performed to determine whether they meet requirements for notification to CDC as a potential PHEIC. Performing such risk assessments will enable timely notification to CDC, even before laboratory confirmation. Furthermore, state POCs are likely to facilitate recognition and reporting of potential public health emergencies within their respective states.
State health departments should work to ensure that their counterparts in state government and in local health departments understand the requirements of IHR 2005; reporting exercises may help accomplish this goal. All health officials, particularly those at the state level, should have a basic understanding of these international regulations, especially the reporting and notification timeframes and practices. Reporting exercises would give state and local health officials the ability to assess potential public health emergencies in a practice environment and allow a broader perspective of when notification is necessary.
Expansion of cross-jurisdictional surveillance and reporting systems also would benefit national recognition and investigation of public health emergencies, especially for foodborne illness and infectious diseases. Such systems are not explicitly required by IHR 2005 but would assist states in the assessment and timely reporting of public health emergencies, both of which are necessary for compliance. National, state, and local government agencies should assist states in implementing these practices and developing appropriate infrastructures.