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About

Measuring Preparedness

Health
Security Surveillance

National
Confidence Interval
8.2 - 8.7
National
Preparedness Level
8.4

What it Means

Actions to monitor and detect health threats, and to identify where hazards start and spread so that they can be contained rapidly.

How we Measure it

Health Security Surveillance Sub-domains

phsei: health surveillance epidemiological investigation

bmlt: biological monitoring laboratory testing

This is best viewed on desktop.

The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health. significance.

Measure
Measure Description
Source
m17
State health department participates in the Behavioral Risk Factor Surveillance System (BRFSS).
Measure Name

M17

Measure Source

Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Surveillance System Survey Questionnaire (BRFSS). Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Survey data analyzed by authors.

Data date(s)

2012-2015

Limitations

The state's extensiveness of participation in the BRFSS based on sampling and instrumentation is not measured, and varies widely across states.

m18
Number of epidemiologists per 100,000 population in the state, by quintile.
Measure Name

M18

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES) and ASTHO Profile of State and Territorial Public Health--2012 and 2016 Epidemiologists by Jurisdiction

Data date(s)

2012-2019

Limitations

The measure may overestimate the number of epidemiologists who are available to prepare for and respond to emergencies, because it counts all personnel regardless of the occupational settings in which they practice and the job responsibilities they perform. BLS and other national data sources on health provider supply have been shown to undercount certain types of professionals, and may differ considerably from the estimates available from state licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, this is unlikely to cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

m19
State health department participates in the Epidemic Information Exchange (Epi-X) System.
Measure Name

M19

Measure Source

Centers for Disease Control and Prevention (CDC), The Epidemic Information Exchange (Epi-X) Program

Data date(s)

2013

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

m20
State health department participates in the National Electronic Disease Surveillance System (NEDSS).
Measure Name

M20

Measure Source

Centers for Disease Control and Prevention (CDC), Division of Health Informatics and Surveillance (DHIS), National Electronic Disease Surveillance System (NEDSS)

Data date(s)

2013-2015

Limitations

The measure does not evaluate the quality or comprehensiveness of state participation in the system.

m22
State health department has a syndromic surveillance system that can report and exchange information.
Measure Name

M22

Measure Source

Association of State and Territorial Health Officials (ASTHO), ASTHO Profile of State Public Health: Volume Three

Data date(s)

2012, 2016, & 2019

Limitations

Data are self-reported by state public health agency personnel and may reflect differences in awareness, perspective and interpretation among respondents. The question used for the 2019 survey is different from the previous surveys in that it did not include a requirement for reporting to be electronic.

m217
State public health laboratory has implemented the laboratory information management system (LIMS) to exchange laboratory information and results electronically with hospitals, clinical labs, state epidemiology units, and federal agencies.
Measure Name

M217

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

m220
State has legal requirement for nongovernmental laboratories (e.g. clinical, hospital-based) in the state to send clinical isolates or specimens associated with reportable foodborne diseases to the state public health laboratory.
Measure Name

M220

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

m256
State public health laboratory participates in either of the following federal surveillance programs: Foodborne Diseases Active Surveillance Network (FoodNet) or National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet).
Measure Name

M256

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

m23
Percent of foodborne illness outbreaks reported to CDC by state and local public health departments for which a causative infectious agent is confirmed.
Measure Name

M23

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date <15Jan2020>.

Data date(s)

2012-2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

m289
State health department participates in a broad prevention collaborative addressing health care associated infections (HAIs).
Measure Name

M289

Measure Source

Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN), Prevention Status Reports

Data date(s)

2013

Limitations

The measure does not evaluate the quality, comprehensiveness, or effectiveness of HAI prevention collaboratives.

m290
State has a public health veterinarian.
Measure Name

M290

Measure Source

National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians

Data date(s)

2014 & 2015, 2017-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.

m265
State uses an Electronic Death Registration System (EDRS).
Measure Name

M265

Measure Source

National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)

Data date(s)

2014-2018, 2020-2021

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.

m801
State public health laboratory participates in the Centers for Disease Control and Prevention (CDC) Influenza surveillance program, and/or the World Health Organization (WHO) Influenza Surveillance Network.
Measure Name

M801

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The measure does not evaluate the quality or comprehensiveness of participation in the surveillance networks.

The ability of agencies to conduct rapid and accurate laboratory tests to identify biological, chemical, and radiological agents to address actual or potential exposure to all hazards, focusing on testing human and animal clinical specimens. Support functions include discovery through: active and passive surveillance (both pre- and post-event), characterization, confirmatory testing data, reporting investigative support, and ongoing situational awareness. Laboratory quality systems are maintained through external quality assurance and proficiency testing.

Measure
Measure Description
Source
m1
Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded Laboratory Response Network chemical (LRN-C) laboratories collect, package, and ship samples properly during an LRN-C exercise.
Measure Name

M1

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2013

Limitations

The measure is based on an exercise that includes only simulated samples, excluding real-life scenarios such as mislabeled specimens or specimens arriving at the laboratory at different times.

m1314
State public health chemical OR radiological terrorism/threat laboratory is accredited or certified by the College of American Pathologists (CAP) or Clinical Laboratory Improvement Amendments (CLIA).
Measure Name

M1314

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Certification may be based on simulated samples, since actual chemical samples are lacking. Selected responses from the 2018 survey have been corrected for Colorado and therefore no longer correspond to the originally published survey results

m208
State public health laboratory has a permit for the importation and transportation of materials, organisms, and vectors controlled by USDA/APHIS (U.S. Department of Agriculture/ Animal and Plant Health Inspection Service).
Measure Name

M208

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

m8
State public health laboratory has a plan for a 6-8 week surge in testing capacity to respond to an outbreak or other public health event, with enough staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A (H1N1).
Measure Name

M8

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

m9
State public health laboratory has a continuity of operations plan consistent with National Incident Management System (NIMS) guidelines.
Measure Name

M9

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

m11
State public health laboratory has a plan to receive specimens from sentinel clinical laboratories during nonbusiness hours.
Measure Name

M11

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the frequency of the plan being used or tested.

m12
State public health laboratory has the capacity in place to assure the timely transportation (pick-up and delivery) of samples 24/7/365 days to the appropriate public health Laboratory Response Network (LRN) reference laboratory.
Measure Name

M12

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

The measure does not evaluate the timeliness of the sample transport, or the whether the transport is available for all sentinel laboratories in the state.

m211
Percent of 10 tests for infectious diseases that the state public health laboratory provides or assures, including the study of the characteristics of a disease or organism in blood tests for arbovirus, hepatitis C, Legionella, measles, mumps, Neisseria meningitides serotyping, Plasmodium identification, Salmonella serotyping, Shigella serotyping, and Varicella.
Measure Name

M211

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

m216
Percent of 15 to 21 tests for infectious diseases that the state public health laboratory provides or assures including: antimicrobial susceptibility testing confirmation for vancomycin resistant Staphylococcus aureus, Anaplasmosis (Anaplasma phagocytophilum), Babesiosis (Babesia sp.), botulinum toxin-mouse toxicity assay, Dengue Fever, Hantavirus serology, identification of unusual bacterial isolates, identification of fungal isolates, identification of parasites, Klebsiella pneumoniae Carbapenemase (blaKPC) by PCR, Legionella by culture or PCR, malaria by PCR, norovirus by PCR, Powassan virus, rabies. The 2018 CLSS survey added 6 more items (i.e., Ebola, Chikungunya, Zika, Lyme disease, Candida auris, and Mobilized colistin resistance (MCR 1)), increasing the total to 21 tests.
Measure Name

M216

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

m2
Percent of Laboratory Response Network biological (LRN-B) proficiency tests successfully passed by Public Health Emergency Preparedness (PHEP) Cooperative Agreement-funded laboratories.
Measure Name

M2

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

Laboratories may not undergo proficiency testing for all assay capabilities.

m3
Percent of pulsed field gel electrophoresis (PFGE) subtyping data results for E. coli submitted to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M3

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not encompass time elapsed for specimen transport and identification, and is limited to foodborne agents that have PFGE subtyping.

m5
Percent of chemical agents correctly identified and quantified from unknown samples during unannounced proficiency testing during the state's Laboratory Response Network (LRN) Emergency Response Pop Proficiency Test (PopPT) Exercise.
Measure Name

M5

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2013-2017

Limitations

The measure does not consider the public health laboratory's ability to process a large number of samples.

m7
Number of additional chemical agent detection methods-beyond the core methods-demonstrated by Laboratory Response Network chemical (LRN-C) Level 1 or 2 laboratories in the state.
Measure Name

M7

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider all methods that the laboratory is capable of testing.

m286
Number of chemical threat and multi-hazards preparedness exercises or drills the state public health laboratory conducts or participates in annually.
Measure Name

M286

Measure Source

Association of Public Health Laboratories (APHL), All-Hazards Laboratory Preparedness Survey

Data date(s)

2013-2020

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

m287
Percent of pulsed field gel electrophoresis (PFGE) sub-typing data results for Listeria monocytogenes submitted by state and local public health laboratories to the CDC PulseNet national database within four working days of receiving samples from clinical laboratories.
Measure Name

M287

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider the volume of samples processed or quality of PFGE results, nor encompass time elapsed for specimen transport and identification.

m288
Number of core chemical agent detection methods demonstrated by Level 1 or 2 LRN-C laboratories in the state.
Measure Name

M288

Measure Source

Centers for Disease Control and Prevention (CDC), Office of Public Health Preparedness and Response (OPHPR), National Snapshot of Public Health Preparedness

Data date(s)

2011-2017

Limitations

The measure does not consider compliance with the standards set by the Clinical Laboratory Improvement Amendments (CLIA) and the College of American Pathologists (CAP) accreditation program, and whether proficiency is achieved annually for the methods reported. Selected responses from the original data source have been corrected for Colorado and therefore no longer correspond to the originally published results.

m911
State public health laboratory provides or assures testing for soil.
Measure Name

M911

Measure Source

Association of Public Health Laboratories (APHL). Comprehensive Laboratory Services Survey (CLSS). 2012 & 2014. Additional details about this measure are available from the source. Data have been compiled by APHL biennially since 2004. The CLSS covers the 50 states, the District of Columbia, and Puerto Rico. State-level data are not available to the public but can be accessed by public health laboratory directors, among others. Data were obtained directly from the source.

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing "provide or assure" standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event. Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

m902
State has a high-capability laboratory to detect chemical threats (Level 1 or 2 LRN-C laboratory).
Measure Name

M902

Measure Source

Centers for Disease Control and Prevention (CDC), National Center for Environmental Health (NCEH), Division of Laboratory Sciences (DLS), Emergency Response Branch (ERB)

Data date(s)

2016 & 2017

Limitations

The measure does not evaluate the quality or comprehensiveness of the laboratory capabilities.