Public Health Preparedness:

A CDC Report on the

 Public Health Emergency Preparedness

Cooperative Agreement

February 2008

Mobilizing State by State
Table of Contents

Executive Summary 3

Background 6

Methods 11

Section 1: Public Health Preparedness in the States and DC 12

Disease Detection and Investigation	 13

Public Health Laboratories	 16

Response	 21

Moving Forward 27

Section 2: Snapshots of Public Health Preparedness in States

and Directly Funded Localities	 	 	 	 	 	 	 29

Appendices

Appendix 1: Cooperative Agreement Funding	 	 141

Appendix 2: DHS National Preparedness Guidelines and Priorities	 145

Appendix 3: Overview of CDC Preparedness Activities	 147

Appendix 4: Overview of ASPR Preparedness Activities 153

Appendix 5: Data Sources and Methods	 155

Appendix 6: Category A and B Biological Agents 161

Mobilizing State by State

Public Health Preparedness: Public Health Preparedness: Mobilizing State by State


Public Health Preparedness: Mobilizing State by State

Executive Summary

Public health threats are inevitable. Being 

prepared for these threats can save lives and 

protect the health and safety of the public 

and emergency responders. The Centers for 

Disease Control and Prevention (CDC) works 

to support public health preparedness for all 

hazards, including natural, biological, chemical, 

radiological, and nuclear events. This work falls 

under one of the agency’s overarching health 

protection goals: “People prepared for emerging 

health threats - people in all communities will 

be protected from infectious, occupational, 

environmental, and terrorist threats.” CDC 

has established nine preparedness goals to 

strategically direct resources towards achieving 

this overarching goal.

The events of September 11, 2001, and the 

subsequent anthrax attacks both highlighted the 

importance of public health during emergencies 

and showed weaknesses in public health’s ability 

to respond during a potential crisis. In 2002, 

Congress authorized funding for the Public 

Health Emergency Preparedness cooperative 

agreement (hereafter referred to as the 

cooperative agreement) to support preparedness 

nationwide in state, local, tribal, and territorial 

public health departments. As of 2007, the 

cooperative agreement has provided more than 

$5 billion to these public health departments. 

CDC administers the cooperative agreement 

and provides technical assistance to public health 

departments. This report outlines progress and 

challenges. It also describes how CDC and its 

partners are working to address these challenges.

Progress continues. With support from 

the cooperative agreement, public health 

departments have improved their ability to 

respond to emergencies.

Public health departments can better detect and 

investigate diseases because of improvements 

in the public health workforce and in data 

collection and reporting systems. • The number of epidemiologists in public 

health departments working in emergency 

response has doubled from 115 in 2001 

to 232 in 2006.* Epidemiologists detect 

and investigate health threats and disease 

patterns and work to minimize the negative 

effects of a health threat in a community.

• The number of users for the Epidemic 

Information Exchange (Epi-X), a secure 

CDC-based communications system that 

helps track disease outbreaks, has increased 

to 4,646 in 2006, up from 890 in 2001. 

Users are primarily from state and local 

health departments (75%). 

• All state public health departments now can 

receive and evaluate reports of urgent health 

threats 24/7/365, whereas in 1999 only 12 

could do so. Previously, it was often difficult 

for clinicians to reach a public health 

professional after normal work hours.

* For 38 states and the District of Columbia (DC) responding to Council of State and Territorial Epidemiologists (CSTE) 

 surveys.
 Public Health Preparedness: Mobilizing State by State

Public health laboratories have increased 

capability to test for biological and chemical 

threats and to communicate information. • The number of state and local public health 

laboratories able to detect biological agents 

has increased to 110 in 2007, from 83 in 

2002.

• The number of state and local public health 

laboratories able to detect chemical agents 

has increased to 47, from 0 in 2001. 

• All states now have public health 

laboratories that can quickly communicate 

with clinical laboratories. In 2001, only 

20 states reported having public health 

laboratories with this capability. Once a 

threat is confirmed in one laboratory, other 

laboratories need to be quickly alerted since 

they might receive related case samples 

(indicating that the threat is spreading). 

• More than twice the number of state public 

health laboratories are conducting exercises 

to test their ability to handle, confirm, and 

report results for chemical agents (from 16 

in 2003 to 38 in 2006).

Public health departments have developed 

response plans, implemented a formalized 

command structure, and conducted exercises. 

Such activities were rare prior to 2001. • All states now have plans to receive, store, 

and distribute the Strategic National 

Stockpile (SNS), a national repository of 

antibiotics, other life-saving medications, 

and medical supplies. 

• Seventy-three percent of states reviewed 

have satisfactorily documented their SNS 

planning efforts.

• In 2005, public health departments in 

50 states and DC trained public health 

professionals about their roles and 

responsibilities during an emergency as 

outlined by the Incident Command System, 

while in 1999 only 14 did so.

• All states now participate in the Health 

Alert Network, which allows for the 

rapid exchange of critical public health 

information. 

Challenges remain. Building on progress in 

public health preparedness will require ongoing 

commitment. • Public health departments report difficulties 

in recruiting and retaining qualified 

epidemiologists, according to a 2006 CSTE 

survey. 

• Disease surveillance systems need to be 

strengthened. In 2007, 16 states did not 

report any plans to electronically exchange 

health data with regional health information 

organizations (networks of healthcare 

provider organizations that allow the 

electronic sharing of health information 

among members). 

• To facilitate surveillance, public health 

departments need to ensure an appropriate 

legal framework before a disaster occurs; 

otherwise, states may be unable to share 

critical public health information with other 

jurisdictions.
Public Health Preparedness: Mobilizing State by State

• The public health laboratory workforce 

needs improvement. Thirty-one state public 

health laboratories reported difficulty 

recruiting qualified laboratory scientists, 

and 39 state public health laboratories 

reported needing additional staff to perform 

polymerase chain reaction, a rapid DNA 

testing technique to quickly identify 

bioterrorism agents, according to a 2007 

Association of Public Health Laboratories 

survey. 

• Public health laboratories need to increase 

the use of advanced technology and broaden 

testing abilities, including radiological 

testing. Currently, no state public health 

laboratory can rapidly identify priority 

radioactive materials in clinical samples.

• Public health departments need to sustain 

a system of all-hazards planning, training, 

exercising, and improving. This system 

should be ready to help at-risk populations, 

such as the elderly and others who may need 

help controlling chronic diseases. 

• Public health and other response 

agencies need interoperable emergency 

communication systems. In 2007, the 

Department of Homeland Security reported 

that many cities and metropolitan areas have 

established multi-agency communications, 

but more progress is needed to expand 

interoperable communication across 

jurisdictions and levels of government.

Moving forward. CDC is working with state 

and local public health departments on initiatives 

that include:

• Increasing the use of electronic health 

data for preparedness and response by 

networking surveillance systems and using 

real-time data;

• Expanding laboratory testing; • Establishing commercial partnerships 

to supply needed medicines to at-risk 

populations during an emergency; 

• Developing and evaluating a core 

curriculum for preparedness through the 

Centers for Public Health Preparedness, a 

national network of academic institutions 

with a common focus on public health 

preparedness;

• Improving legal preparedness by helping 

states and other jurisdictions implement 

public health mutual aid agreements, which 

enable sharing of supplies, equipment, 

personnel, and information during 

emergencies;

• Exercising public health systems to 

continuously improve capability and 

demonstrate readiness; and

• Collaborating with partners to develop 

accreditation programs for state and local 

public health preparedness. 

Achieving the overarching goal, “people prepared 

for emerging health threats,” is critical to the 

health and safety of our communities. This 

report represents CDC’s commitment to sharing 

information on a program that contributes to 

this goal.
 Public Health Preparedness: Mobilizing State by State

Background

Public health threats are inevitable. Being 

prepared can save lives and protect the health 

and safety of the public and emergency 

responders during disasters. A prepared public 

health system involves continual improvement 

of the system’s ability to prevent, protect against, 

respond to, and recover from the consequences 

of emergencies. 

The Centers for Disease Control and Prevention 

(CDC) works to support public health 

preparedness for all hazards, including natural, 

biological, chemical, radiological, and nuclear 

events. This work falls under one of the agency’s 

overarching health protection goals: “People 

prepared for emerging health threats - 

people in all communities will be protected 

from infectious, occupational, environmental, 

and terrorist threats.” CDC has established 

nine preparedness goals to strategically direct 

resources towards achieving this overarching 

goal. These goals are associated with six public 

health preparedness activities: prevent, detect and 

report, investigate, control, recover, and improve 

(Table 1). 

The events of September 11, 2001, and the 

subsequent anthrax attacks both highlighted the 

importance of public health during emergencies 

and showed weaknesses in public health’s ability 

to respond during a potential crisis. According 

to a 2002 Institute of Medicine report, the 

public health infrastructure suffered from 

“vulnerable and outdated health information 

systems and technologies, an insufficient and 

inadequately trained public health workforce, 

antiquated laboratory capacity, a lack of realtime surveillance and epidemiological systems, 

ineffective and fragmented communications 

networks, incomplete domestic preparedness 

and emergency response capabilities, and 

communities without access to essential public 

health services.”1

1 Institute of Medicine, The Future of the Public’s Health in the 21st Century; 2002

“

“

When people ask me what’s the biggest challenge in public health, I 

have an easy answer. For large-scale disasters and more routine threats 

to health, the major problem we face in public health is complacency. 

We’ve made a lot of progress in our preparedness efforts, but we’re 

not done yet. We need long-term investment to really get us where we 

want to be. 

— Dr. Julie Gerberding, CDC Director
Public Health Preparedness: Mobilizing State by State

In 2002, Congress authorized funding for 

the Public Health Emergency Preparedness 

cooperative agreement (hereafter referred 

to as the cooperative agreement) to support 

preparedness nationwide in public health 

departments.2,3 Within each funded jurisdiction, 

public health departments at the state, local, 

tribal, and/or territorial levels work together to 

improve preparedness. 

CDC administers the cooperative agreement 

and provides technical assistance to state, 

territorial, and major metropolitan public 

health departments. This technical assistance 

leverages CDC expertise in disease detection 

and investigation, public health laboratories, 

and response, including crisis communication. 

CDC’s longstanding working relationships with 

public health departments are critical to the 

success of this program. 

2 The cooperative agreement funds 

50 states, four metropolitan areas (Chicago, Los Angeles County, New York City, and 

Washington, DC), five territories (Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, and the U.S. Virgin 

Islands), and three freely associated states (the Federated States of Micronesia, Palau, and the Marshall Islands).

3

 CDC began funding selected public health departments in 1999, but the cooperative agreement’s support of 62 

jurisdictions did not begin until 2002. 

Table 1: CDC Preparedness Goals

Pre-Event

Prevent

Goal 1

Increase the use and development of interventions known to 

prevent human illness from chemical, biological, radiological 

agents, and naturally occurring health threats.

Event

Detect and Report

Goal 2

Decrease the time needed to classify health events as 

terrorism or naturally occurring in partnership with other 

agencies. 

Goal 3

Decrease the time needed to detect and report 

chemical, biological, radiological agents in tissue, food or 

environmental samples that cause threats to the public’s 

health. 

Goal 4 Improve the timeliness and accuracy of communications 

regarding threats to the public’s health.

Investigate

Goal 5

Decrease the time to identify causes, risk factors, and 

appropriate interventions for those affected by threats to the 

public’s health.

Control

Goal 6

Decrease the time needed to provide countermeasures and 

health guidance to those affected by threats to the public’s 

health.

Post-Event

Recover

Goal 7 Decrease the time needed to restore health services and 

environmental safety to pre-event levels.

Goal 8 Improve the long-term follow-up provided to those affected 

by threats to the public’s health.

Improve

Goal 9

Decrease the time needed to implement recommendations 

from after-action reports following threats to the public’s 

health.
Public Health Preparedness: Mobilizing State by State

As of 2007, the cooperative agreement has 

provided more than $5 billion to public health 

departments (Figure 1). Appendix 1 presents 

historical cooperative agreement funding levels 

for each funded public health department. 

The cooperative agreement supports:

• Collaboration among state, local, tribal, 

and territorial public health departments, 

research universities, and other responder 

agencies;

• Rapid identification of biological and 

chemical agents by public health laboratories 

across the country;

• Quick and accurate communication across 

local, state, and federal levels;

• Ongoing enhancement of state and local 

public health programs through a cycle of 

planning, exercising, and improvement 

plans;

• Protecting the health of the community and 

first responders during an emergency; and

• Helping communities recover from 

emergencies.

Collaborating for preparedness. Local response 

agencies, including public health departments, 

are usually the first to respond during an 

Quick and Effective Collaboration – Minnesota Bridge Collapse

When the Interstate 35W bridge collapsed in Minneapolis in 2007, public health professionals 

were ready. According to the Minnesota Department of Health, cooperative agreement funding 

allowed public health to expand, strengthen, and exercise systems that contributed to a fast and 

effective response.

Within 10 minutes of the incident, state public health staff, hospitals, and emergency medical 

services began monitoring real-time information on the number of patients, their condition, 

and available hospital space. Local, state, and federal agencies worked together to determine if 

harmful substances were released into the environment and initiated measures to protect public 

health during the cleanup. State and local public health staff coordinated behavioral health and 

grief support services using a network of registered and credentialed volunteers.

Figure 1: Cooperative Agreement Allocated Funding, Fiscal Year 2002-2007

(in millions)

Source: HHS Press Releases; 2002-2007 – data for all 62 funded jurisdictions
Public Health Preparedness: Mobilizing State by State

emergency. For multi-state or severe emergencies, 

CDC may be asked to provide additional public 

health resources and coordinate response efforts 

across multiple jurisdictions. CDC monitors and 

often responds to major events that are potential 

nationwide health threats (Figure 2). 

The National Preparedness Guidelines, published 

by the Department of Homeland Security 

(DHS), establish a vision, capabilities, and 

priorities for national preparedness. CDC 

preparedness goals support the target capabilities 

outlined in the National Preparedness Guidelines 

in areas such as detecting threats, public health 

laboratory testing, and communications. See 

Appendix 2 for more information on the 

National Preparedness Guidelines and DHS 

preparedness priorities.

CDC works under the strategic leadership of 

the Assistant Secretary for Preparedness and 

Response (ASPR) in the Department of Health 

and Human Services (HHS). Under the National 

Response Framework, HHS is responsible for 

coordinating federal assistance to supplement 

state, local, and tribal resources in response 

to public health and medical care needs for 

potential or actual emergencies. To achieve this, 

HHS works with other federal departments, 

including DHS, the U.S. Department of 

Agriculture (USDA), the Department of 

Defense, the Department of Veterans Affairs, 

the Department of Justice, and the Department 

of State. Appendices 3 and 4 detail how CDC 

and ASPR offices are currently working towards 

improving preparedness.

CDC and pubic health department partners 

include the American Public Health Association, 

the Association of Public Health Laboratories 

(APHL), the Association of Schools of Public 

Health, the Association of State and Territorial 

Health Officials, the Council of State and 

Territorial Epidemiologists (CSTE), and the 

National Association of County and City Health 

Officials (NACCHO). These organizations 

share best practices and lessons learned, conduct 

research, and provide training to public health 

professionals. 

CDC Field Deployments

From October 2006 through September 

2007, CDC deployed more than 170 

staff to 31 states to assist public health 

department investigations. The health 

problems included an unexplained 

cluster of patients with neurologic 

disease, tuberculosis, and hurricanerelated health threats.4

4CDC, Division of Emergency Operations (DEO) Epi-Aid data; 2007
10 Public Health Preparedness: Mobilizing State by State

Source: CDC, DEO data; 2001-2007

Figure 2: Timeline of CDC Emergency Responses

Presidential inauguration (January)

Marburg virus (March)

Hurricane Katrina (August)

Hurricanes Rita and Wilma (September)

Space shuttle Columbia disaster (February)

SARS (March)

Monkeypox (June)

Northeast blackout (August)

Hurricane Isabel (September)

Ricin, tularemia, and anthrax 

 (October)

California wildfires (October)

Domestic influenza (December)

Mad cow disease (December)

Ongoing monitoring of potential 

nationwide health threats

World Trade Center attack (September)

Anthrax attack (October)

Hurricanes Charley, Frances, Ivan, 

 and Jean (August)

Summer Olympics (August)

Republican National Convention 

 (August)

Influenza vaccine shortage (October)

Asian tsunami (December)

Mumps (April)

Tropical storm Ernesto (August)

E. coli in spinach (September)

E. coli (December)

XDR/MDR tuberculosis (May)

Hurricane Dean (August)

 Avian influenza (January)

 BioWatch (February)

 Guam typhoon (February)

 Ricin domestic response (February)

 Cities Readiness Initiative (March)

 G8 Summit (June)

 Democratic National Convention (July)

 West Nile virus (August)

Local, state, and 

federal agencies 

must collaborate 

to effectively 

prepare for 

and respond to 

emergencies.
11 Public Health Preparedness: Mobilizing State by State

This report presents existing information 

on selected state and local public health 

preparedness activities and describes how the 

cooperative agreement and other CDC programs 

support these preparedness efforts. Data 

presented in this report come from CDC (i.e., 

data reported by states as part of the cooperative 

agreement and data from other CDC programs), 

APHL, CSTE, and others. More detailed 

information on each data source and methods is 

presented in Appendix 5. 

This report is specific to the Public Health 

Emergency Preparedness cooperative agreement 

and does not directly address other preparedness 

grant programs, including those administered by 

ASPR, which assists hospitals in preparing for 

emergencies, and by DHS, which focuses more 

broadly on supporting all emergency responders, 

including law enforcement and firefighters. 

Public health departments may have used a 

combination of federal and state funding to 

improve public health preparedness.

The report addresses areas of public health that 

are critical to preparedness, including disease 

detection and investigation, public health 

laboratories, and response. Disease detection and 

investigation and public health laboratories help 

confirm the presence of health threats. During 

a response, public health professionals and other 

first responders use this information to lessen the 

public health effects of an emergency. 

Section 1 of this report contains aggregate 

national information on progress and challenges 

in public health preparedness and how CDC 

is working to address these challenges. Section 

1 focuses on the 50 states and DC. These data 

reflect collaborative efforts of federal, state, local, 

tribal, and territorial public health. 

Section 2 presents snapshots with response or 

exercise examples and data for the 50 states, DC, 

Chicago, Los Angeles County, and New York 

City. Information on funded territories and freely 

associated states is not presented because most of 

the existing data sources did not include them.

This report is a first step in presenting a more 

complete picture of public health preparedness. 

It does not represent all progress and challenges 

or comprehensively assess federal, state, and local 

preparedness. 

CDC, ASPR, and their partners continue 

working to define public health preparedness and 

collect data to better characterize preparedness. 

Measuring preparedness is critical to evaluate 

progress. 

Methods
12 Public Health Preparedness: Mobilizing State by State

Section 1: Public Health 

Preparedness in the States and DC 

Section 1 presents data on disease detection and investigation, public health laboratories, and response. 

These essential activities support all nine CDC preparedness goals. Table 2 describes some of the key 

improvements compared to 2001. 

Table 2: Progress in Public Health Preparedness, 2001-2007

Then (2001)

1 Now (2007)2

Disease 

Detection and 

Investigation

Some state public health 

departments did not have 

enough epidemiologists to 

investigate the suspected 

disease cases and had to 

borrow untrained staff from 

other programs.

The cooperative agreement supports 

additional staff in every state to 

monitor and investigate diseases 

and respond to emergencies. 

Other public health professionals 

have also been trained to provide 

support when preparedness staff are 

overwhelmed.

Laboratory 

Testing

Some state public health 

laboratories could not 

perform rapid tests for 

anthrax because they lacked 

equipment, supplies, or 

trained staff. 

Every state has at least one public 

health laboratory that can perform 

rapid tests for anthrax and other 

bioterrorism agents, and 47 public 

health laboratories can test for a 

variety of chemical agents.

Response:

Relationships 

with First 

Responders

State and local public health 

departments had not fully 

anticipated the extent of 

coordination needed among 

first responders.

Public health departments in every 

state have established relationships 

and conducted exercises with 

emergency management and

other key players.

Response:

Coordination

An ad-hoc center at CDC 

helped coordinate state and 

local response efforts.

Emergency operations centers 

are in place at CDC and almost all 

state public health departments to 

coordinate response activities, and 

roles and responsibilities are defined 

across multiple agencies and 

jurisdictions.

Response:

Communication

Public health professionals 

did not have a system 

in place to communicate 

effectively with physicians 

during a crisis.

All state public health departments 

have systems to communicate 

rapidly with physicians and the 

public.

Response:

Intervention

Major metropolitan areas did 

not have the ability to provide 

medicine to large portions of 

their population in the case of 

a bioterrorist event.

Major metropolitan areas are 

working to provide medicines to 

100% of their population within 48 

hours.

1 Government Accountability Office, Public Health Response to Anthrax Incidents of 2001 (GAO-0

4-152); 2003; 2 CDC data; 2007
1

3 Public Health Preparedness: Mobilizing State by State

Disease Detection

and Investigation:

Improving the Public Health Workforce 

and Disease Surveillance

The sooner public health professionals can 

detect the source and spread of diseases or 

other health threats and investigate their effects 

in the community, the more quickly they can 

protect the public. Progress in disease detection 

and investigation supports CDC preparedness 

goals in the areas of prevention, detection and 

reporting, investigation, and recovery.

Using cooperative agreement funds, public health 

departments have improved their abilities to 

detect and investigate diseases by enhancing the 

public health workforce and disease surveillance 

systems.

A skilled public health workforce.

Epidemiologists, or “disease detectives,” detect 

and investigate health threats and disease 

patterns. They might identify contaminated 

food causing illness, assess the number of people 

injured and types of injuries resulting from a 

disaster, or determine causes of a sudden onset 

of fever in a community. They also work to 

minimize the negative effects of a health threat in 

a community. 

According to a 2006 CSTE survey, the total 

number of epidemiologists in state public health 

departments working in emergency response has 

doubled since 2001 (Table 3). 

A connected public health workforce. 

The increase in the users of the Epidemic 

Information Exchange (Epi-X), a secure CDCbased communications system that helps track 

disease outbreaks, suggests that public health 

professionals are more connected (Table 3).

Epi-X users represent state health departments 

(38%), local health departments (37%), CDC 

and other federal agencies (22%), and other 

organizations, such as poison control centers 

(3%).

6

Through Epi-X, these users report outbreaks and 

other public health events to CDC and receive 

notifications about developing health threats 

through daily electronic summaries. When a 

report is of special importance, users receive 

immediate e-mails or emergency notification 

(i.e., pager, “land line” phone, or cell phone).

Enhancing disease surveillance systems.

Epidemiologists need health-related data to 

detect disease patterns, estimate effects, and 

determine the spread of illness. Surveillance-the 

ongoing and systematic collection, analysis, and 

interpretation of data-is critical to detect disease 

5CSTE, Epidemiological Capacity Assessment (ECA); 200

6 – data for 50 states, DC, and 4 territories

6CDC, Epi-X data; 200

7

Increased Workforce Capacity

In 2006, the cooperative agreement funded 

531 epidemiologists. The majority of 

these epidemiologists specialized either in 

emergency response (291) or infectious 

diseases (199).

5

Table 3: Public Health Workforce for Disease Detection and Investigation, 

2001-2006

Indicator Then (2001) Now (2006) Percent 

Increase

Epidemiologists in public health departments 

working in emergency response

1 115 232 102%

Epi-X users

2 890 4,646 422%

1 CSTE, ECA; 200

6 - data for 38 states and DC; 2 CDC Epi-X data; 2006
1

4 Public Health Preparedness: Mobilizing State by State

outbreaks as early as possible and to ensure that 

public health professionals are aware of the 

number and geographic distribution of illness. 

To help detect disease patterns, all state public 

health departments now can receive urgent 

disease reports 24/7/365 (Table 4). Previously, it 

was often difficult for clinicians to reach a public 

health professional after regular work hours.

In addition, CDC, state and local public health 

departments, and other partners are developing 

flexible and innovative surveillance systems for 

a wide range of emergencies, including disease 

outbreaks, bioterrorism, and natural disasters. In 

2007, 44 states reported evaluating health data to 

detect unusual patterns that could be associated 

with health threats.

7

The CDC Early Aberration Reporting System 

(EARS) is one surveillance system state and local 

health departments use to monitor notifiable 

diseases and detect unusual spikes indicating 

disease outbreaks. EARS tracks data from sources 

such as hospital emergency departments, 911 

emergency calls, and school absenteeism. In 

2007, EARS was used in approximately 100 

state and local public health departments and 

international sites. It has been used during 

hurricane seasons and at several national events.

8

Another surveillance system that CDC 

administers is BioSense, which provides local, 

state, and federal public health and healthcare 

organizations with access to the same data, at 

the same time. In other words, if an emergency 

occurs, every level of public health will be able to 

see healthcare data from their community in near 

real-time. This can decrease delays in recognition 

of a problem and enhance emergency response. 

As of November 2007, BioSense had 423 

hospitals transmitting real-time data, covering 

38 states and 71 major metropolitan areas. Over 

1,500 federal military and veterans’ outpatient 

facilities also transmitted data.

9

In preparation for a possible influenza pandemic, 

states are also improving systems to monitor 

seasonal influenza. In 2006, 28 states reported 

conducting surveillance for seasonal influenza 

throughout the year, while in 2007, all states and 

DC reported doing so.10, 11 Routine surveillance 

of influenza viruses can characterize circulating 

strains to help experts develop annual vaccines 

and identify strains with pandemic potential.

Challenges for Disease Detection and 

Investigation

Several challenges continue to hinder public health 

departments’ ability to collect and effectively use 

information.

Shortages in the epidemiology workforce.

Public health departments still face barriers in 

recruiting and retaining qualified epidemiologists. 

According to the 2006 CSTE survey, most state 

and local public health departments reported 

difficulty in hiring epidemiologists. Although the 

number of epidemiologists has increased since 

2001, in 2006, state public health departments 

reported needing 34% more epidemiologists than 

they had to provide full capacity nationwide.12

Other public health professionals, such as 

information technology specialists, are also 

needed to support emerging data sharing and 

communication initiatives. The aging public 

health workforce, high retirement rates, barriers 

to recruitment and retention, and the need to 

train the existing workforce in new methods 

and technology are all issues needing continuous 

attention. 

7CDC, DSLR Mid-Year Report Review data; 200

7

8

 CDC, Division of Bioterrorism Preparedness and Response (DBPR) EARS data; 2007

9

 CDC, Division of Integrated Surveillance Systems and Services BioSense data; 2007 10 CDC, Pandemic Influenza State Self-Assessments data; 2006 - data presented for 49 states 11 HHS OIG, Memorandum Report—Laboratory Preparedness for Pandemic Influenza; published October 200

7 12 CSTE, ECA; 2006

Table 4: Public Health Disease Reporting Systems, 50 States and DC, 1999-2005

Indicator Then (1999) Now (2005) Percent 

Increase

Public health departments that can receive 

urgent disease reports 24/7/365 12

1 512 325%

1 HHS, Office of the Inspector General (OIG), Status of State 24/7 Urgent Disease and Public Health Emergency Reporting 

 Systems; published February 2005; 1999 data; 

2

CDC, DSLR data; 2005
15 Public Health Preparedness: Mobilizing State by State

Networking disease surveillance systems. 

During emergencies, public health professionals 

need to alert both clinicians and the public 

quickly. A unified network of surveillance systems 

from hospital organizations, physician practices, 

public health departments, and other data sources 

can provide public health professionals with the 

best available information to protect community 

health. 

Although public health departments have made 

progress in disease surveillance, more work needs 

to be done to integrate these systems. In 2007, 16 

states did not report any plans to electronically 

exchange health data with regional health 

information organizations (networks of healthcare 

provider organizations that allow the electronic 

sharing of health information among members).13

In addition, quickly sharing public health 

information across jurisdictions is important 

during emergencies, such as when displaced 

individuals need care out-of-state. Without 

ensuring an appropriate legal framework before 

a disaster occurs, states may be unable to provide 

critical public health information to other 

jurisdictions.

Epidemiologists 

and other 

public health 

professionals 

help protect 

population health 

after a chlorine 

spill.

In January 2005, a freight train transporting 

chlorine and other chemicals collided with a 

parked train in downtown Graniteville, South 

Carolina. The rupture of one car released about 

63 tons of liquid chlorine near residential and 

commercial districts. This accident caused nine 

deaths and forced at least 529 people to seek 

medical treatment. Local public health and 

emergency management officials investigated 

the damage. Since chlorine exposure was a 

serious public health threat, area residents were 

evacuated. Schools and businesses were closed.

Public health professionals coordinated 

emergency medical services, monitored 

hospital care, assessed the number of casualties, 

and supported disaster mortuary services. 

Through interviews and medical chart reviews, 

epidemiologists collected data on symptoms, 

exposures, and demographics. With this 

information, public health professionals could 

track and alleviate the long-term effects.

This accident was the worst chemical train 

wreck in the United States since 1978. 

Established response plans and partnerships 

helped South Carolina public health 

professionals respond quickly and effectively. 

The cooperative agreement helped fund 

activities that improved response. Because 

many nuclear and industrial facilities and rail 

lines were in the area, local public health and 

emergency management departments had taken 

an all-hazards approach to emergency response 

planning, with a focus on hazardous materials 

training. Coordination among agencies was also 

a priority.

Please refer to Section 2 for response examples for each state and 

directly funded locality.

South Carolina Public Health Effectively 

Responds to a Chlorine Spill

13

 CDC, DSLR Mid-Year Progress Report Review data; 2007
1

6 Public Health Preparedness: Mobilizing State by State

Public Health Laboratories:

Improving Laboratory Testing for 

Biological and Chemical Threats, 

Communication, and Training

Public health laboratories are critical in 

identifying disease agents, toxins, and other 

health threats found in tissue, food, or other 

substances. They also play a large role in alerting 

others about emerging health threats, and 

training and supporting clinical laboratories. The 

cooperative agreement has funded public health 

laboratories to hire and train staff, and acquire 

equipment. This supports CDC preparedness 

goals in the areas of prevention, and detection 

and reporting. 

Expanding testing. Public health laboratories 

have expanded their ability to perform rapid tests 

for biological and chemical agents. Previously, 

many state and local public health laboratories 

had to ship samples to CDC in Atlanta, Georgia, 

for testing.

Now, as shown in Table 5, identification of 

biological agents (e.g., anthrax or plague) 

and chemical agents is possible through the 

Laboratory Response Network (LRN). The LRN 

is a national network of local, state, and federal 

public health laboratories; military, international, 

agricultural, and veterinary diagnostic 

laboratories; and food and environmental testing 

laboratories. 

Table 5: Laboratory Testing Capabilities, 2001-2007 

Indicator Then Now (2007) Percent 

Increase

State and local public health 

laboratories that can detect 

biological agents

83 (2002) 110 33%

Public health laboratories that can 

test for and/or handle toxic chemical 

agents:

Level 1 laboratories

* 0 (2001) 10

-

Level 2 laboratories 0 (2001) 37

-

Level 3 laboratories 0 (2001) 15

-

Source: CDC, DBPR LRN data; 2001-2007

* Level 1 laboratories serve as surge capacity laboratories for CDC and can test for an expanded number of chemical 

agents, including nerve agents, mustard agents, and toxic industrial chemicals. Level 2 laboratories are also surge 

capacity laboratories but can test for a more limited panel of agents. Level 3 laboratories work with hospitals and 

other first responders within their jurisdiction to maintain competency in clinical specimen collection, storage, and 

shipment.
17 Public Health Preparedness: Mobilizing State by State

This network supports the laboratory facilities and 

trained staff to respond to biological and chemical 

terrorism and other public health emergencies. 

In 2007, the LRN had 163 member laboratories 

capable of detecting biological agents (of which 

110 are state and local public health laboratories). 

In addition, 62 LRN laboratories can test for and/

or handle chemical agents. As shown in Figure 3, 

90% of the U.S. population lived within 100 

miles of a LRN laboratory in 2007.14

Improving communication among 

laboratories. Once a threat is confirmed in one 

laboratory, other laboratories need to be quickly 

alerted since they might receive related case 

samples (indicating that the threat is spreading). 

To enable this communication, CDC manages 

a secure communication system among LRN 

member laboratories. In addition, public health 

laboratories need to communicate with the 

thousands of clinical and commercial laboratories 

Figure 3: U.S. Population within 100 Miles of a LRN Laboratory, 50 States and DC, 2007

Source: CDC, DBPR LRN data; 2007

Laboratory Response Network

Some of the ways CDC supports LRN member laboratories include:

• Sharing tests used to confirm biological and chemical agents;

• Enabling secure communications on emerging and emergency issues;

• Developing training curricula;

• Implementing a quality assurance program; and

• Providing vaccines to protect laboratory workers from dangerous agents.

14CDC, DBPR LRN data; 2007
18 Public Health Preparedness: Mobilizing State by State

monitoring health through routine testing. These 

laboratories serve as early alert systems and can 

be the first to confirm a potential health threat. 

All states now have public health laboratories 

that can communicate rapidly with these 

laboratories (Table 6).

Training laboratory staff. Expanding training 

for clinical laboratory workers is key because they 

are often the first to confirm diseases leading 

to public health threats. In 2002, state public 

health laboratories offered 65 classes to fewer than 

3,000 clinical laboratory scientists on testing for 

biological agents; while in 2006, states offered 500 

classes to more than 8,000 laboratory scientists.15

Public health laboratories also need to conduct 

exercises to practice emergency response protocols. 

Figure 4 shows the increasing number of state 

public health laboratories conducting exercises to 

handle Category A biological agents (high-priority 

agents that pose a risk to national security) and 

chemical agents (toxic substances such as cyanidebased compounds, heavy metals, and nerve 

agents). Refer to Appendix 6 for a list of Category 

A and B biological agents.

Table 6: Laboratory Communications, 2001-2006

Indicator Then (2001) Now (2006) Percent 

Increase

States with public health 

laboratories that could 

communicate with clinical and 

commercial laboratories (through 

email or fax to multiple recipients)

201 512 155%

1 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; published October 2002 - data for 46 states

 and DC

2 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; published May 2007 - data for 50 states

 and DC

Figure 4: Public Health Laboratories Conducting at Least One Exercise for 

Biological and Chemical Agents, 2003-2006

Source: CDC, DSLR data; 2003-2006

Note: Data for chemical terrorism agent exercises were collected for Level 1 and Level 2 laboratories. 

15APHL, unpublished data; 2002 and 2006

Communication 

among 

laboratories and 

public health 

departments is 

key, as outbreaks 

identified in one 

location can also 

be present in 

others.
19 Public Health Preparedness: Mobilizing State by State

The public health response to a 2006 outbreak 

of E. coli infections showed how cooperative 

agreement funding has improved states’ ability 

to respond. The response to the outbreak 

highlighted the importance of collaboration 

and communication among public health 

professionals in the 26 affected states.

In September 2006, state public health 

departments began investigating an outbreak 

of infections caused by E. coli O157:H7, a 

dangerous foodborne bacterium, to determine 

who the outbreak was affecting and how patients 

had contracted the infection. Public health 

professionals interviewed both ill and unaffected 

individuals to identify the source of the outbreak 

and determined that pre-packaged fresh spinach 

was the likely cause. 

The Food and Drug Administration (FDA) 

advised consumers not to eat fresh spinach, and 

CDC sent messages out to the public health 

community via the Health Alert Network 

(HAN) and Epi-X to alert them of a nationwide 

outbreak. Federal and affected state health public 

information officers quickly disseminated and 

updated critical health information about the 

outbreak to public health partners, clinicians, and 

the news media. 

Meanwhile, state public health laboratories 

performed DNA “fingerprinting” tests, or pulsedfield gel electrophoresis (PFGE), to distinguish 

strains of E. coli. Laboratories submitted 

information about these strains to PulseNet, a 

national network of laboratories coordinated by 

CDC that consists of state and local public health 

departments and federal agencies (CDC, FDA, 

and USDA). Through PulseNet, public health 

professionals across the country could compare 

the DNA fingerprints to determine if their 

state had cases of E. coli related to the outbreak. 

PulseNet confirmed the outbreak in multiple 

states.

Public health departments and laboratories in 10 

states isolated E. coli strains from bags of spinach 

retrieved from patient households and performed 

tests to match these to E. coli strains isolated 

from patients. Local, state, and federal health 

officials collaborated to identify and report cases, 

communicate with consumers, and identify the 

source of the outbreak. A joint team of CDC, 

FDA, USDA, and California public health 

professionals visited selected farms, tracing the 

bacteria to the source.

Rapid identification of the bacterium causing the 

outbreak and tracking to the food source resulted 

in a nationwide recall of fresh spinach products. 

Joint laboratory and epidemiology investigations 

were critical for this rapid response.

Please refer to Section 2 for response examples for each 

state and directly funded locality.

Coordinated Public Health Response Rapidly 

Identifies the Source of E. Coli Outbreak

Joint 

laboratory and 

epidemiology 

investigations 

are critical for a 

rapid response 

to disease 

outbreaks.
20 Public Health Preparedness: Mobilizing State by State

16APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; published in May 2007 - data for 50 states and DC 17

 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; published in May 2007 - data for 50 states and DC 18 CDC, DBPR LRN data; 2007 19 CDC, National Center for Environmental Health (NCEH) data; 2007 20 CDC, NCEH data; 2007

Challenges for Public Health Laboratories

Boosting the laboratory scientist workforce to 

ensure rapid and accurate testing. In a 2007 

APHL survey, 31 state public health laboratories 

reported difficulties recruiting qualified 

laboratory scientists. Moreover, 39 reported 

needing additional staff to perform polymerase 

chain reaction, a rapid DNA testing technique 

to quickly identify bioterrorism agents.16 This 

reflects a nationwide shortage of highly skilled 

laboratory workers to confirm potential health 

threats. 

Ensuring secure electronic communication.

Although 44 state public health laboratories 

have Laboratory Information Management 

Systems supporting laboratory functions, 19 

of those laboratories cannot send or receive 

electronic messages that meet CDC standards 

for exchanging, communicating, and protecting 

data.17 Without such electronic communication, 

it is impossible to rapidly monitor and integrate 

laboratory test results at the national level during 

an emergency. 

Broadening the range of laboratory testing.

States vary in the extent to which they can test 

for biological and chemical agents. For instance, 

all states have at least one laboratory that can 

test for the biological agents that cause anthrax, 

bubonic plague, tularemia, and brucellosis, but 

eight are not able to test for the highly infectious 

agent that causes Q fever.18 For chemical agents, 

9 states can test for blistering agents (such as 

mustard gas); 13 states for volatile organic 

compounds (chemicals such as benzenes, which 

can have short- and long-term health effects); 

28 states for nerve agents (including manmade 

chemical warfare agents such as sarin or VX 

nerve agent); and 30 states for blood metals 

(such as mercury and lead).19

Although state public health laboratories can 

test for biological and chemical agents in blood 

or urine, they cannot test for chemical agents 

outside of these human clinical samples, such as 

in an unknown white powder. Laboratories are 

also limited in their ability to rapidly test large 

quantities of samples for chemical agents. 

Another challenge is that no state public 

health laboratory can rapidly identify priority 

radioactive materials in clinical samples.20 This 

could delay medical treatment decisions when a 

possible radiological exposure has occurred. 
21 Public Health Preparedness: Mobilizing State by State

Response:

Improving Communication Systems and 

Increasing Planning, Training, and Exercising

Public health professionals are on the front 

lines during an emergency. Establishing 

emergency response plans was an initial focus 

of the cooperative agreement. Now, CDC is 

emphasizing exercises that test systems and 

validate training to ensure that plans will work 

during a real event. These activities support CDC 

preparedness goals in the areas of prevention, 

detection and reporting, investigation, control, 

recovery, and improvement. 

 

Quickly communicating up-to-date 

information. During an emergency, 

communication from public health professionals 

must be fast and accurate. In 2007, all states 

had plans for crisis communication with first 

responders and healthcare providers during an 

emergency.21

In addition, CDC’s Health Alert Network 

(HAN) and state-level HANs provide a 

mechanism for users, including state and local 

public health departments, hospitals, and 

physicians, to rapidly exchange critical public 

health information. The number of states 

responding to a test HAN message from CDC 

in 30 minutes or less has increased by 48% since

2003 (Figure 5).22 

Figure 5: Public Health Departments Responding to Test HAN Messages in 30 

Minutes or Less, 50 States and DC, 2003-2007

Source: CDC, HAN data; 2003-2007

 21 CDC, DSLR Mid-Year Progress Report Review data; 2007

22 CDC, HAN data; 2003-2007

Public Health

Information Network

As part of the Public Health Information 

Network (PHIN), CDC has 

established standards for exchanging, 

communicating, and protecting 

electronic information both among 

public health departments and with 

healthcare, environmental, homeland 

defense, and other partners. To assist with 

implementing PHIN standards, CDC 

works with each state or local public 

health department funded through the 

cooperative agreement. CDC provides 

assistance with gap analyses, selfassessments, project plans, and sharing 

promising practices.
22 Public Health Preparedness: Mobilizing State by State

Developing emergency response plans. As 

of 2006, all state public health departments 

reported having public health emergency 

response plans. A key element of these plans is 

detailing roles, responsibilities, and responses 

to an emergency using the Incident Command 

System (ICS).23

Distributing the Strategic National Stockpile 

(SNS). CDC manages the SNS, a national 

repository of antibiotics, other life-saving 

medications, and medical supplies, to help public 

health departments respond to emergencies. The 

SNS is positioned across the country. In 2001, 

few states had up-to-date, written plans for 

receiving, staging, and distributing SNS assets. 

In contrast, today all states have such plans. 

Nevertheless, states vary in the sophistication and 

maturity of the coordination and exercising of 

those plans. 

CDC works closely with state, local, and tribal 

agencies to help identify and fix SNS planning 

gaps. CDC reviews the plans annually on a scale 

from a low of 0 to a high of 100. The 

reviews include the public health department’s 

coordination with traditional and nontraditional 

community partners; receiving, staging, and 

distributing medical materiel; state legal statutes 

to aid in the rapid dispensing of medications; 

and the type and frequency of training, 

exercising, and evaluation of response plans. 

In 2006-2007, 73% of the states reviewed 

satisfactorily documented their planning efforts, 

which is reflected in a review score of 69 or 

higher (Table 7).

Planning for pandemic influenza. Since 

2006, the cooperative agreement has provided 

specific funding to public health departments 

to prepare for pandemic influenza. As part of 

this effort, every state developed a pandemic 

influenza response plan. Previously, most states 

did not have completed plans addressing areas 

such as enhancing surveillance and laboratory 

capacity, managing vaccines and antivirals, and 

implementing community containment measures 

to reduce influenza transmission.24 In addition, 

states held summits bringing together partners 

from state and local public health departments, 

businesses, schools, hospitals, and other 

organizations to plan for a potential pandemic.

Training to enhance public health 

preparedness. An increasing number of 

staff is now trained to support preparedness 

and response activities (Figure 6). Subjects 

covered in the training courses included 

ICS, risk communication, quarantine and 

isolation, mental health services during and 

after emergencies, and working with at-risk 

populations.25

In addition, following the anthrax attacks 

of 2001, CDC developed the “Forensic 

23 The Incident Command System (ICS) is the organizational structure for managing incidents that require response from 

different jurisdictions and disciplines. ICS lays out standard roles and responsibilities for the incident commander and 

staff.

24

 CDC, Pandemic Influenza State Self-Assessments data; 2006

Table 7: CDC Reviews of State Strategic National Stockpile Plans, 50 States, 2006-

2007

Review Score Number of States

69-100 36

0-68 13

Review in progress* 1

Source: CDC Division of Strategic National Stockpile (DSNS) data; 2006-2007

*CDC has not completed reviewing all states using a new numerical technical assistance review tool. 

CHEMPACK

CDC’s CHEMPACK program has placed 

over 1,600 containers of nerve agent 

antidotes. Locations are determined by 

state and local agencies to help ensure a 

rapid response to emergencies involving 

chemical releases. Thirty-nine states 

already have containers, and seven 

additional states are in the process of 

obtaining them.

Emergency 

response 

planning helps 

responders 

from different 

jurisdictions and 

disciplines work 

together.
23 Public Health Preparedness: Mobilizing State by State

Figure 6: States Offering Training Courses to State and Local Public Health 

Professionals, 50 States and DC, 1999-2005

Source: CDC, DSLR data; 1999-2005

25At-risk or vulnerable population groups may have additional needs before, during, and after an incident in one or 

more of the following functional areas: maintaining independence, communication, transportation, supervision, and 

medical care. Individuals in need of additional response assistance may include those who have disabilities; who live 

in institutionalized settings; who are elderly; who are children; who are from diverse cultures, who have limited English 

proficiency, or who are non-English speaking; or who are transportation disadvantaged.

Exercises Test Public Health Systems and 

Foster Partnerships

In November 2006, a mass vaccine dispensing exercise was coordinated by the Navajo Area Indian Health 

Services and the Navajo Division of Health. The exercise provided almost 24,000 seasonal influenza 

vaccines at 15 different sites around the Navajo Nation (about 25,000 square miles). The exercise simulated 

a response to a pandemic influenza outbreak. The exercise also tested risk communication and the SNS 

delivery systems. Several dispensing sites vaccinated as many as 1,000 people per hour during peak times.

The Navajo public health system is large and complex, consisting of tribal and federal health agencies as well 

as agencies from three states and multiple counties. During the exercise, these health agencies worked with 

the Navajo Police, the National Guard, the National Park Service, and others using ICS. The cooperation 

demonstrated by these different agencies during the exercise will contribute to future successful emergency 

responses. 

Please refer to Section 2 for response examples for each state and directly funded locality.
24 Public Health Preparedness: Mobilizing State by State

Epidemiology” course as a tool for state and local 

public health departments and law enforcement 

agencies to improve joint investigations of 

terrorism. As of 2004, over 14,000 public 

health and law enforcement professionals 

had participated in this course, and staff are 

continuing to be trained. 

Exercising emergency response plans and 

validating training. Exercises test emergency 

response plans with personnel from across 

agencies and organizations.26 Exercises can 

provide valuable experience and knowledge 

because people, technology, and equipment are 

put into action to test their ability to respond. 

Figure 7 illustrates a steadily increasing 

number of exercises conducted by public 

health departments in the 50 states and DC. In 

addition, public health departments routinely 

evaluate exercises or real events and identify 

needed improvements. 

CDC specifically coordinates exercises with state 

and local public health departments to test plans 

for the receipt and distribution of the contents of 

the SNS. The number of CDC-coordinated SNS 

exercises has increased from 0 in 2001 to 18 in 

2006 (Figure 8).

Cities Readiness Initiative

The cooperative agreement funds cities 

to distribute medications to their entire 

population within 48 hours. The Cities 

Readiness Initiative began with 21 cities 

in 2004 and has expanded to 72 cities. 

This includes more than 500 counties, 

covering 56% of the U.S. population.27

Because of the complexity of providing 

medicine to so many people, the program 

involves ongoing planning and exercises. 

For instance, in a June 2007 exercise, 

Philadelphia postal workers delivered 

more than 50,000 mock packages of 

emergency medication to people in 

their homes, exercising a novel delivery 

method. Similar exercises occurred in 

Boston and Seattle.

26 Exercises provide opportunities to test capabilities and improve performance in a risk-free environment. The three 

types of exercises include tabletop exercises, which involve discussing responses to emergency scenarios and focus on 

training and problem solving; functional exercises, which test and evaluate capabilities and functions in responding 

to a simulated emergency, such as a disease outbreak; and full-scale exercises, which test and evaluate multi-agency, 

multi-jurisdictional coordinated response to an actual deployment of resources under crisis conditions as if a real 

incident had occurred.

27CDC, DSNS Cities Readiness Initiative data; 2007

Exercises test 

plans, validate 

training, 

and build 

relationships so 

people know 

their roles and 

responsibilities 

during an 

emergency.

Figure 7: Public Health Preparedness Exercises, 50 States and DC, 1999-2005

Source: CDC, DSLR data; 1999-2005 
25 Public Health Preparedness: Mobilizing State by State

Challenges for Response

Ensuring public health uses an “all-hazards” 

approach to preparedness. Because of the 

many competing priorities for public health 

departments’ resources, being prepared to 

respond to a wide variety of emergencies remains 

a challenge. In 2006, all states and DC reported 

having plans covering biological agents, but 

fewer reported having plans covering radiation 

(43) or nerve agents (27).28

Retaining experienced public health response 

personnel. Ensuring that public health 

departments retain qualified response personnel 

is an ongoing challenge. A number of state and 

local agencies have difficulties retaining SNS 

coordinators. 

Building and maintaining relationships.

To build and maintain relationships with 

response partners, public health professionals 

need to continue planning and exercising with 

other government agencies and the community. 

Building these relationships requires other 

responders to recognize the importance of public 

health in emergency response. In 2006, most 

states and DC reported having developed ICS 

roles and responsibilities with hospitals (90%) 

and local/regional emergency management 

agencies (92%), but fewer (73%) had developed 

them with federal emergency management 

agencies.29

Developing interoperable communication 

systems. Multiple agencies can work together 

more effectively during an emergency if all 

communication systems can “talk” to each 

other. In 2007, DHS reported that many cities 

and metropolitan areas have established multiagency communications, but more progress is 

needed to expand interoperable communication 

across jurisdictions and levels of government.30

Figure 8: Annual Number of Joint SNS Exercises to Test Response Plans, 50 States 

and DC, 2001-2006

Source: CDC, DSNS data; 2001-2006

Note: Figure 8 only includes joint state/CDC exercises. States also conduct exercises independently that are not

included in these numbers. 

28 CDC, DSLR data; 2006

29 CDC, DSLR data; 2006

30

 DHS, Tactical Interoperable Communications Scorecards: Summary Report and Findings; 2007
26 Public Health Preparedness: Mobilizing State by State

Moreover, the report noted that some of the 

communications planning and exercises among 

response agencies did not include public health 

departments. 

Monitoring environmental health.

Environmental effects from an emergency, such 

as a chemical spill, need to be monitored over 

extended periods to track potential long-term 

health outcomes. In 2007, 11 states did not 

report any activities related to having systems 

that can track environmental exposures and 

adverse events over the long term.31

Helping at-risk populations during 

emergencies. CDC’s experience responding to 

Hurricanes Katrina and Rita showed that CDC 

and state public health departments must address 

the needs of at-risk populations in an emergency. 

For example, the elderly and others with chronic 

diseases need help to control diseases such as 

diabetes and heart conditions when health 

systems are not available.

Exercises Prepared Public Health Response 

to a Meningitis Outbreak

When a meningococcal meningitis outbreak 

occurred at a local high school in Los Angeles, 

California, in 2006, the local public health 

department responded. 

The public health department was ready 

because vaccination exercises had been 

conducted before the outbreak. The exercises 

provided public health department staff 

experience in working directly with the local 

and county law enforcement agencies, fire 

departments, and emergency medical services. 

This was valuable during the meningitis 

outbreak because collaboration resulted in 

effective site security, traffic control, and 

emergency medical technician response at the 

high school. 

The County of Los Angeles Department of 

Public Health reported that “before, the setup 

and response to a disease outbreak took far 

longer, sometimes an entire day or more; 

site organization and management was often 

overwhelming, and at times chaotic.” A timely 

response reassured students and their parents 

that they were being well taken care of by 

the Department of Public Health during this 

outbreak.

Please refer to Section 2 for response examples for each state and 

directly funded locality.

31 CDC, DSLR Mid-Year Progress Report Review data; 2007
2

7

Public Health Preparedness: Mobilizing State by State

Moving Forward: 

CDC and Public Health Departments Are 

Working to Address Challenges

Public health professionals need to continually 

train and exercise to improve performance. 

Laboratory and other equipment must be 

maintained to work well during an emergency. 

Response plans must be updated to address 

emerging health threats. Accordingly, an 

ongoing national commitment to public health 

preparedness will allow state, local, tribal, and 

territorial public health departments to maintain 

their current abilities and take the next steps 

necessary to improve emergency response. 

Public health departments still face many 

challenges in improving preparedness. Appendices 

3 and 4 present information on CDC and ASPR 

activities to strengthen preparedness. Examples of 

CDC initiatives are presented below. • Electronic data for preparedness. CDC 

is establishing standards and providing 

technical assistance to allow the exchange of 

electronic health data across organizational 

and jurisdictional boundaries. 

• Laboratory testing. CDC is working with 

state public health laboratories to expand 

their biological and chemical testing abilities. 

For radiological testing, CDC is developing 

rapid laboratory methods to analyze 

radioactive materials in clinical samples and 

build capacity in state or federal laboratories 

to measure radioactive contaminants in these 

samples. 

• At-risk populations. CDC has established 

commercial partnerships to supply needed 

medicines to at-risk populations during an 

emergency. With these partnerships, CDC 

can quickly supply childhood vaccines, 

medications for a variety of chronic diseases, 

or other medicines. 

• Public health workforce and training.

CDC and its partners developed the MetaLeadership Summit for Preparedness, a 

nationwide program that trains business, 

government, and non-profit leaders to act 

effectively during times of crisis. In addition, 

the Centers for Public Health Preparedness, 

a national network of academic institutions 

with a common focus on public health 

preparedness, are developing a national 

preparedness core curriculum. 

• Legal preparedness. CDC’s initiatives 

include enhancing training courses on legal 

preparedness for public health professionals 

and other first responders. In addition, CDC 

is helping states and other jurisdictions 

implement public health mutual aid 

agreements, which enable sharing of supplies, 

equipment, personnel, and information 

during emergencies.

• Technical assistance to public health 

departments. CDC provides ongoing 

technical assistance to public health 

departments to help address preparedness 

challenges. The technical assistance includes 

sharing CDC public health expertise, 

identifying promising practices, providing 

guidance for exercises, and developing 

performance goals.

• Exercising public health systems. CDC 

joins other federal agencies in requiring 

that public health departments and other 

response agencies receiving federal funds 

exercise capabilities using Homeland 

Security Exercise and Evaluation Program 

principles. Exercises range from discussionbased tabletop exercises used to discern 

gaps in emergency response plans to fullscale operations-based exercises that test 

communication and coordination within the 

community’s entire response system. 
28 Public Health Preparedness: Mobilizing State by State

• Standards for preparedness. CDC and 

NACCHO are collaborating on Project 

Public Health Ready to develop standards for 

local public health preparedness. CDC is also 

working with partners to develop a voluntary 

accreditation program for state and local 

public health departments. 

• Measuring public health preparedness. 

CDC is expanding and improving 

preparedness data to present a clearer picture 

of the status of public health preparedness 

in the United States and to promote 

accountability, as reinforced by the Pandemic 

and All-Hazards Preparedness Act, signed in 

December 2006. These data will assist CDC 

and public health departments in identifying 

specific areas for improvement. CDC is 

committed to developing appropriate, 

specific, measurable, and validated 

performance measures to foster improvement 

in public health preparedness.

Achieving the overarching goal, “people prepared 

for emerging health threats,” is critical to the 

health and safety of our communities. This 

report represents CDC’s commitment to sharing 

information on a program that contributes to this 

goal. Future reports will show the extent to which 

CDC and public health departments are making 

progress towards achieving preparedness goals.
29 Public Health Preparedness: Mobilizing State by State

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 

http://www.nphic.org/regions.asp). 

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).

Section 2: Snapshots of Public 

Health Preparedness in States

and Directly Funded Localities
30 Public Health Preparedness: Mobilizing State by State

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. 

Detect & 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 79%

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 67%

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) 57%

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) [46 states] 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; 3APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4CDC, DSLR; 2006

The Big Picture for All States and Directly Funded Localities

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 100%

Primary method for receiving urgent disease reports*2

- Telephone 81%

- Electronic reporting 13%

- Fax 6%

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
31 Public Health Preparedness: Mobilizing State by State

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; 3CDC, DSNS CRI; 2007; 4CDC, DSLR; 1999-2005; 5APHL, Chemical Terrorism Preparedness; May 2007; 6CDC, DSLR; 2007

Response

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.
32 Public Health Preparedness: Mobilizing State by State

In March 2007, numerous tornadoes 

swept across the state of Alabama. 

Two of these tornadoes seriously 

affected residents, particularly 

in the towns of Enterprise and Miller’s Ferry which 

reported fatalities. Hundreds of homes were destroyed 

or suffered major damage. The Governor activated the 

state emergency operations center and declared a state of 

emergency. The Alabama Department of Public Health 

(ADPH) put its 24 emergency response teams on alert 

for statewide deployment. Public health nurses and social 

workers assisted in shelters managed by the American 

Red Cross. In addition, surveillance nurses investigated 

emergency room visits made by first responders and 

tornado victims who presented with burns because of 

exposure to an unknown chemical at a school. 

Throughout the response, ADPH coordinated with local 

public health departments, emergency management 

agencies, non-profit organizations, and others to mitigate 

health threats across Alabama. ADPH provided a mobile 

unit for those residents who needed tetanus shots, 

first aid, and masks. ADPH arranged for commercial 

pharmacies to provide medications to people who had 

lost theirs in the tornado. Walking teams of public 

health nurses and social workers also visited badly-hit 

neighborhoods to assess for unmet needs. ADPH also 

issued press releases to warn citizens of the dangers 

that often follow disasters, including carbon monoxide 

poisoning when using gasoline powered generators 

and poor water quality in homes with private wells. 

Cooperative agreement funds allowed ADPH to provide 

these critical services to Alabama residents.

Snapshot of Public Health Preparedness

Below are activities conducted by Alabama in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Alabama Responds to Severe Tornadoes 

Prepared public health professionals protect community health during emergencies.

Alabama

http://www.adph.org/aldph.asp

According to the Alabama Department of 

Public Health, the cooperative agreement 

is valuable because health departments have 

a greater capacity to respond to emergencies 

than they did prior to the cooperative 

agreement. The cooperative agreement has 

provided training to prepare staff to deal 

with many types of events, equipment such 

as communication gear, computers, and stateof-the-art tools to detect biological agents, 

and additional staff that have led ADPH’s 

response to numerous emergencies.
33 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Alabama laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 1

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Alabama SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 92

Number of Alabama cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No 

response

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

Alabama
34 Public Health Preparedness: Mobilizing State by State

The Alaska Division of Public 

Health (DPH) seized an opportunity 

in 2007 to exercise response to an 

outbreak that was similar to an 

influenza pandemic scenario, which could potentially 

overwhelm public health, emergency response, and health 

care systems. In late January, a northern Alaskan hospital 

in the town of Barrow started receiving pediatric patients 

suffering with respiratory syncytial virus (RSV), the 

most common cause of respiratory tract infection among 

children younger than 1 year old. Within one month, 

the town had already seen triple their annual number of 

RSV cases. With cases occurring across Alaska, patients 

quickly filled all of the available pediatric intensive 

care units in the state and necessitated the use of adult 

ICU beds for overflow. DPH activated its Emergency 

Operations Center (EOC) and coordinated an interagency teleconference to share outbreak information 

with all partner agencies and to address the immediate 

needs of medical communities in affected cities. The 

teleconference included representatives from public health 

and emergency response agencies at the local and state 

levels, hospitals, and the Alaska Native Tribal Health 

Consortium. 

In addition, epidemiologists started a statewide program 

to track the spread of RSV and other respiratory illnesses. 

The EOC used this information to track possible hot 

spots in an attempt to stem any other outbreaks similar in 

size and scope to the one in Barrow. The EOC was able to 

train DPH staff in their roles in an emergency and engage 

partner agencies in their expected roles during a large-scale 

event. The public information team was able to practice 

developing and disseminating risk communication and 

public education materials for a statewide event.

Snapshot of Public Health Preparedness

Below are activities conducted by Alaska in the area of public health preparedness. They support CDC preparedness goals 

in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages of an 

event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Alaska Exercises Pandemic Influenza Plan during a Real Outbreak 

Exercising response plans during real events improves preparation for future large-scale events.

Alaska

http://www.hss.state.ak.us/dph/dphpp/default.cfm

According to the Alaska Division of Public 

Health, the cooperative agreement is 

valuable because funds have been critical in 

connecting important stakeholders for an allhazards approach to preparedness. Bringing 

together hospitals, environmental health 

organizations, tribal health organizations, 

homeland security, local emergency 

management, and first responders is crucial in 

all-hazards preparedness.
35 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Alaska laboratories in the Laboratory Response Network1 2

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 2

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Alaska SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 80

Number of Alaska cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Alaska
36 Public Health Preparedness: Mobilizing State by State

Phoenix, Arizona received 576 

evacuees by plane from New Orleans 

within one week of Hurricane 

Katrina’s landfall in 2005. Because of 

cooperative agreement funding, the Arizona Department 

of Health Services had the resources to coordinate 

the sheltering of evacuees, conduct effective infection 

control and health screening, and implement an on-site 

clinic at the shelter. Local organizations and the medical 

community also contributed resources to assist the 

evacuees over the two weeks of public health and medical 

operations. 

Public health activities included the administration of 

vaccines, tuberculosis screening, laboratory analyses of 

patient samples, pharmacy services, emergency medical 

services transports, hospital referrals, behavioral health 

services, food safety inspections, and comprehensive 

infection control and sanitation services.

The clinic served both evacuees housed at the shelter and 

other evacuees who arrived independently. Medical and 

epidemiological data were collected at the clinic, and 

other data also were obtained from various organizations 

providing health services to evacuees. In total, 826 

patients were seen at the clinic, for a total of 1,427 

visits. Because of the comprehensive infection control 

measures taken at the shelter throughout the operation no 

outbreaks were detected, although many patients reported 

symptoms related to infectious diseases.

Snapshot of Public Health Preparedness

Below are activities conducted by Arizona in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Arizona Responds to an Influx of Hurricane Katrina Evacuees 

Partnerships play key roles in comprehensive emergency response.

Arizona

http://www.azdhs.gov/phs/edc/edrp

According to the Arizona Department 

of Health Services, the cooperative 

agreement is valuable because funds have 

supported all required planning, development, 

implementation, monitoring activities, and 

resources to improve Arizona’s capability to 

respond to a public health emergency. Five 

years prior to the cooperative agreement, no 

one program was solely dedicated to public 

health emergency preparedness and response. 

Since then, the state has consolidated its 

two public health preparedness and response 

offices into a single Bureau of Emergency 

Preparedness and Response.
37 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Arizona laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 22

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 77%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 3

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 67%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Arizona SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 86

Number of Arizona cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Arizona
38 Public Health Preparedness: Mobilizing State by State

In September 2005, the Arkansas 

Department of Health (DOH) 

activated and fully staffed its 

Emergency Operations Center 

(EOC) as reports began coming in that thousands of 

Katrina evacuees were on their way by plane, car, and bus 

to Arkansas. The state’s greatest concern was how to house 

and feed the evacuees while simultaneously preventing the 

spread of disease in mass shelters. 

DOH accomplished hundreds of logistical tasks during 

this mass evacuation, including processing thousands of 

applications for services ranging from medical assistance 

and social services to temporary employment assistance 

(TEA). During the months of September and October, 

more than 12,000 applications were processed. Benefits 

authorizing food stamps amounted to $2.3 million. 

Arkansas Medicaid applications were approved for 1,315 

people and TEA benefits totaled $78,871.

In the end, approximately 31,000 evacuees were processed 

through the Arkansas system. In addition, coordination 

with CDC allowed for an epidemiological team to assess 

the health status of the evacuees. Rapid needs assessments 

and evaluations of the impact on environmental services 

systems allowed for a more efficient response to Hurricane 

Katrina. The Arkansas Public Health Laboratory also 

conducted drinking water analysis for several months 

following Hurricane Katrina. Increased laboratory 

infrastructure provided through preparedness initiatives 

was essential to manage increased workloads.

Snapshot of Public Health Preparedness

Below are activities conducted by Arkansas in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Arkansas Assists Hurricane Katrina Evacuees 

Coordination of government programs improves public health in the wake of devastating emergencies.

Arkansas

http://www.healthyarkansas.com

According to the Arkansas Department 

of Health, the cooperative agreement is 

valuable because Arkansas has been able 

to convert from statewide telephone line 

and modem communications systems to a 

real-time high speed 24/7 intranet system. 

In addition, the cooperative agreement has 

had immeasurable effects on the state public 

health laboratory, especially in the clinical 

microbiology, molecular diagnostics, and 

virology testing units. Arkansas has moved 

from traditional time-consuming methods 

to modern methods that can identify most 

Category A agents in a fraction of the time.
39 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Arkansas laboratories in the Laboratory Response Network1 2

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 21

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Arkansas SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 83

Number of Arkansas cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Arkansas
40 Public Health Preparedness: Mobilizing State by State

July 2006 was the hottest July 

on record for California. When 

temperatures climbed well above 100 

degrees and stayed there for weeks, 

the health and safety of the public was threatened. At least 

100 deaths were attributed to extreme heat.

Many of the early heat-related fatalities were elderly 

people or those living alone. To target this high-risk 

group, California Department of Health Services (CDHS) 

staff contacted all long-term care facilities in the state 

to check temperatures inside the facilities and provide 

advice to those without air conditioning. Local health 

department workers contacted single-room occupancy 

hotels to inquire about frail and elderly residents who 

needed assistance. Seventy-five cooling centers were 

opened at fairgrounds and other locations to provide safe 

shelter for residents without access to air conditioning. 

Information on how to avoid heat-related illnesses was 

disseminated through news conferences and releases and 

posted on state agency websites.

To coordinate these activities, the CDHS activated its 

Joint Emergency Operations Center (JEOC). Unlike 

some emergency events, heat waves last for extended 

periods of time. The activation of the JEOC allowed 

CDHS to successfully coordinate intra- and interagency 

response activities for the duration of the heat wave. Both 

the physical structure of the JEOC and previous staff 

training ensured that a consistent high-level response was 

maintained. Following the summer heat wave, a task force 

of state and local partners convened and developed an 

interim contingency plan for future heat emergencies.

Snapshot of Public Health Preparedness

Below are activities conducted by California in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

California’s Response to Life-Threatening High Temperatures 

Strong emergency operation capacity maintains high-level response for extended emergencies.

California

http://bePreparedCalifornia.ca.gov/epo

According to the California Department 

of Health Services, the cooperative 

agreement is valuable because funding 

has provided resources for training in the 

Standard Emergency Management System 

(SEMS) and other aspects of emergency 

preparedness. California has been able to 

upgrade biological and chemical laboratories, 

develop a new emergency operations center, 

and develop protocols compliant with SEMS 

and NIMS. The state has greatly improved its 

preparedness capability at both the state and 

local levels to address potential public health 

threats.
41 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of California laboratories in the Laboratory Response Network1 21

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 257

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 91%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 3

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 33%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

California SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 97

Number of California cities in the Cities Readiness Initiative3 7

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

California
42 Public Health Preparedness: Mobilizing State by State

The 20th annual “Taste of Chicago” 

festival was held in 2007 and drew 

an estimated 3.5 million people. 

Many hailed from the tri-state area, 

while others traveled from across the United States as 

well as overseas. However, for the first time in the event’s 

history, the festival was marred by a salmonella outbreak 

that affected almost 800 people. Compared to the 

typical salmonella case count of only 300 per year in the 

Chicago area, this outbreak was unprecedented in both 

number and scope and tested the city’s ability to respond 

effectively to contain the outbreak and inform the public. 

The Chicago Department of Public Health called upon 

many resources in order to contact patients and conduct 

interviews as part of the epidemiological investigation. 

Staff were able to investigate and trace the source of 

salmonella back to a single dish from a single vendor. 

During the outbreak investigation, the department’s 

resources were stretched thin by other concurrent healthrelated incidents. Some of these incidents included the 

discovery of imported counterfeit toothpaste, 

continued monitoring of West Nile Virus activity, and 

the citywide response to the health-endangering heat 

wave. The response to all of these events required a wellorganized and trained organization capable of carrying 

out multi-faceted tasks and adapting to rapidly-evolving 

situations.

Snapshot of Public Health Preparedness

Below are activities conducted by Chicago in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza†4 —

*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.

† Localities were not asked to respond to this question.

Chicago Responds to Salmonella Outbreak at a Citywide Food Festival 

Robust public health capabilities are needed to respond to multiple emergencies.

Chicago

http://egov.cityofchicago.org

According to the Chicago Department 

of Health, the cooperative agreement is 

valuable because previously, it would have 

been difficult to have the surge capacity to 

respond to large-scale or multiple events 

as the public health infrastructure and 

resources became depleted. Chicago has been 

able to hire staff with relevant expertise in 

preparedness. Additional resources have also 

enabled the city to increase competencies and 

response capabilities of its staff.
43 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Chicago laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):*2

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):*2

Had a laboratory information management system that could create, send, and receive 

messages*3 (8/05 – 8/06) —

-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 specimens*3 (8/05 – 8/06) —

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) N/A

*Localities were not asked to respond to this question.

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Chicago SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 88

Participated in the Cities Readiness Initiative2 Yes

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities3 Yes

Public health laboratories conducted training for first responders*4 (8/05 – 8/06) —

Activated public health emergency operations center as part of a drill, exercise, or real 

event†‡5 (partial year, 9/06 – 2/07) No

Conducted a drill or exercise for key response partners to test communications when 

power and land lines were unavailable‡5 (partial year, 9/06 – 2/07) No

Improve Finalized at least one after-action report with an improvement plan following an 

exercise or real event‡5 (partial year, 9/06 – 2/07) Yes

* Localities were not asked to respond to this question.

† 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.

‡ Localities 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 CRI; 2007; 3 CDC, DSLR; 1999-2005; 4 APHL, Chemical Terrorism Preparedness; May 2007; 5 CDC, DSLR; 2007

Chicago
44 Public Health Preparedness: Mobilizing State by State

In the last weeks of December 

2006, two major winter storms hit 

Colorado. The first storm brought 

the Denver metropolitan area to a 

standstill; the second storm, which caused relatively minor 

problems in Denver, moved east and paralyzed the rest of 

the state with up to 4 feet of snow and drifts as high as 10 

feet.

The Colorado Department of Public Health and 

Environment (DPHE) began monitoring the situation as 

soon as the state’s Division of Emergency Management 

activated several state agencies. Although DPHE was not 

initially activated with the other agencies, it soon became 

apparent that DPHE needed to respond when reports 

came in that thousands of families were without power 

for 3 days or more. Without power for an extended time, 

food safety, sanitation, extreme cold, and transportation 

became serious public health concerns. Among other 

activities, public health workers rapidly assessed disrupted 

health sectors, monitored pharmaceutical supplies, located 

and assisted at-risk populations, and developed public 

health messages for the public.

Public health involvement is critical to help coordinate 

response and ensure continued access to needed care. 

Persistent efforts of Colorado public health officials during 

this incident made clear the important role of public 

health in emergency planning and response.

Snapshot of Public Health Preparedness

Below are activities conducted by Colorado in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Colorado Responds to Major Winter Storms 

Public health has an important role in every kind of emergency.

Colorado

http://www.cdphe.state.co.us/epr

According to the Colorado Department 

of Public Health and Environment, the 

cooperative agreement is valuable because

funding has allowed Colorado to set rigorous 

public health preparedness goals and devise 

a framework to achieve them. Without the 

cooperative agreement, no state funding 

would have been available for these public 

health efforts, and progress in emergency 

preparedness and response would not have 

been possible.
45 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Colorado laboratories in the Laboratory Response Network1 7

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 80

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 35%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 5

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 0%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Colorado SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 87

Number of Colorado cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Colorado
46 Public Health Preparedness: Mobilizing State by State

In April 2006, the Connecticut 

Department of Public Health 

(DPH) conducted a full-scale 

seven-day exercise to test the state’s 

ability to order, receive, and distribute medications 

from the CDC Strategic National Stockpile (SNS) in 

the event of a public health emergency. An outbreak of 

a deadly infectious disease was simulated in which the 

local pharmaceutical supply ran out. The cooperation of 

federal, state and local government agencies, hospitals, 

municipalities, and schools was critical to the success of 

this exercise.

The exercise involved a mock receipt, storage, and staging 

of medical assets from the SNS and the distribution of 

assets to seven local public health departments and four 

hospitals across the state that acted as local points of 

dispensing (POD) and treatment centers, respectively. 

DPH delivered simulated medications to distribution 

points throughout the state within 24 hours of receipt. 

Local public health officials then worked to dispense 

1,000 regimens per hour to residents and hospitals. 

DPH collaborated with the Department of Emergency 

Management and Homeland Security (DEMHS) to plan 

this exercise according to Federal Homeland Security 

Exercise and Evaluation Program guidelines. Local public 

health departments that did not host a POD provided 

planning and operational support. DPH, DEMHS, 

and participating localities and hospitals activated their 

respective emergency operations centers and used the 

Incident Command System throughout the response. As 

a result, PODs distributed medication to a total of 1,539 

volunteer “patients” across the state. This was the first time 

dispensing throughput had been documented in great 

detail, and the data will serve as a baseline on which to 

improve mass dispensing.

Snapshot of Public Health Preparedness

Below are activities conducted by Connecticut in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Connecticut’s Statewide Exercise to Distribute Emergency Medications 

Exercises are critical to ensure successful federal-state-local interactions during an emergency.

Connecticut

http://www.ct.gov/dph

According to the Connecticut Department 

of Public Health, the cooperative 

agreement is valuable because the state has 

been able to build several key preparedness 

components and bring authority and 

legitimacy to planning for emergencies 

that might never have happened without 

the cooperative agreement. Newly hired 

staff for planning have also been critical for 

exercising, improved communications, and 

standardization of planning activities.
47 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Connecticut laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 17

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Connecticut SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 69

Number of Connecticut cities in the Cities Readiness Initiative3 2

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

Connecticut
48 Public Health Preparedness: Mobilizing State by State

Delaware’s Division of Public Health 

(DPH) was concerned that its public 

health response and recovery plans 

did not meet the needs of all people, 

especially at-risk populations (identified as children, 

disabled, homeless, economically disadvantaged, medically 

fragile, institutionalized, or persons temporarily injured). 

Emergency planning for at-risk populations includes 

making provisions and developing systems that meet the 

needs of all individuals. 

Over the last 3 years, DPH has completed substantial 

work to reach and plan for these populations. Response 

plans and exercises incorporated at-risk population 

groups, such as individuals with visual impairments in a 

2004 large-scale, functional exercise, and also 319 people 

with special needs added to the 911 registry during a 

2007 call center exercise. DPH provided tips for helping 

at-risk populations to all first responders in the state and 

also developed a guide for emergency planners to help 

address the needs of at-risk populations. DPH also 

distributed almost 6,000 specialized publications for atrisk populations regarding actions to take in a disaster 

(developed in Braille, Spanish, large print, and audio). 

These activities support emergency response capabilities 

that can reach and protect the health of all Delaware 

residents.

Snapshot of Public Health Preparedness

Below are activities conducted by Delaware in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Delaware Ensures Preparedness Efforts for All Residents 

Addressing the needs of at-risk populations helps public health departments serve all residents.

Delaware

http://www.dhss.delaware.gov/dhss/dph

According to the Delaware Division of 

Public Health, the cooperative agreement 

is valuable because funding has provided 

several critical components for building a 

strong preparedness response plan. Delaware 

has been able to hire the staff needed to 

operate daily and emergency operations, 

purchase and stockpile equipment and 

supplies to support mass prophylaxis of the 

population during public health emergencies, 

and purchase electronic systems that were not 

in place prior to the cooperative agreement.
49 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Delaware laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 8

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 75%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) No

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Delaware SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 94

Number of Delaware cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Delaware
50 Public Health Preparedness: Mobilizing State by State

One morning in July 2007, an 

alarming number of dead birds, 

accompanied by an unknown 

powder, were reported at multiple 

transit stations across the District of Columbia. Transit 

officials who had not been notified of any planned 

pest control activities became suspicious of a chemical 

terrorism threat.

Public health officials and animal specialists monitored 

the situation both on site and remotely with regional 

and federal emergency response coordination. The fire 

department and emergency responders were able to 

immediately investigate the chemical on-site, and the 

Federal Bureau of Investigation also became involved 

due to the potential for this incident to have a nexus to 

terrorism. Within hours the chemical agent was identified 

as a skin and eye irritant and an ingredient commonly 

found in laundry detergents and rat poison. In total, 

between 70 and 90 birds died across seven transit stations. 

Humans were not harmed. 

Local emergency response was able to successfully contain 

this situation within 5 hours because of effective 

collaboration among local, regional, and federal partners 

in public health, law enforcement, and public safety; onsite and remote emergency response coordination and 

operations at both regional and federal levels; and the 

ability of emergency responders to immediately conduct 

environmental tests.

Snapshot of Public Health Preparedness

Below are activities conducted by District of Columbia in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Electronic 

Reporting

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza†4 Yes

*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

District of Columbia Responds to a Chemical Incident 

Cross-jurisdictional collaboration plays a key role in emergency response.

District of Columbia

http://bioterrorism.doh.dc.gov/biot/site

According to the District of Columbia 

Department of Health, the cooperative 

agreement is valuable because it has allowed 

the District of Columbia to build capabilities 

and expand capacity in a wide variety of 

public health emergency preparedness areas. 

These have included syndromic and disease 

surveillance, interoperable communications, 

planning, preparedness and response, 

chemical and biological laboratory testing, 

mass prophylaxis/vaccination, and other key 

initiatives to build a District that is stronger, 

more resilient, and better prepared to handle 

natural, manmade, or technological disasters.
51 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of District of Columbia laboratories in the Laboratory Response Network1 3

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):*2

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):*2

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

*Localities were not asked to respond to this question.

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

District of Columbia SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 91

Participated in the Cities Readiness Initiative2 Yes

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities3 Yes

Public health laboratories conducted training for first responders4 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†5 (partial year, 9/06 – 2/07) No

Conducted a drill or exercise for key response partners to test communications when 

power and land lines were unavailable†5 (partial year, 9/06 – 2/07) No

Improve Finalized at least one after-action report with an improvement plan following an 

exercise or real event†5 (partial year, 9/06 – 2/07) Yes

*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.

† Localities 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 CRI; 2007; 3 CDC, DSLR; 1999-2005; 4 APHL, Chemical Terrorism Preparedness; May 2007; 5 CDC, DSLR; 2007

District of Columbia
52 Public Health Preparedness: Mobilizing State by State

In May 2007, a university student 

went to the student health service 

center with a rash-like illness that 

was diagnosed as measles and later 

confirmed through subsequent testing. It had been over 

20 years since the last case of measles in Alachua County. 

The student was a member of a religious group that, 

while not prohibiting vaccination, did not actively receive 

immunizations. Investigations proved that several other 

members of this religious group had been ill, with one 

potential case having returned from a major festival in 

India. Because of the highly contagious nature of measles, 

the public health department needed to respond quickly 

and conduct ongoing monitoring.

The Alachua County Health Department established a 

basic Incident Command System (ICS) structure for the 

measles outbreak. While all of the staff involved had been 

trained in ICS and most had used it in major hurricane 

deployments, this was their first use of the system in a 

biological event. Public health workers are now convinced 

that this training and the system itself provided a 

better framework to identify activities and outcomes, 

track completion of assignments, and allow for proper 

accounting of the associated costs. 

Public health workers responded by conducting 

surveillance of the entire primary care medical community 

for new cases, looking back for unreported cases (four 

were found), setting up immunization clinics at the 

religious group’s headquarters, school sites, and satellite 

clinics, and establishing an ongoing “rash room” entrance 

for diagnosis and prevention of potential new cases from 

entering the general population. As a result, no further 

cases occurred, and the incident was closed in June, only 

one month after the first diagnosis.

Snapshot of Public Health Preparedness

Below are activities conducted by Florida in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Florida Responds to a Measles Outbreak 

Epidemiological investigations are critical for effective surveillance in public health emergencies.

Florida

http://www.doh.state.fl.us/demo

According to the Florida Department 

of Health, the cooperative agreement is 

valuable because funds have allowed the state 

to hire dedicated preparedness personnel to 

coordinate and facilitate planning, training, 

and exercising of public health and response 

partners. Florida also has been able to provide 

ICS training that has drastically increased 

the state’s ability to respond, eliminate 

duplication of efforts, and maximize the use 

of resources.
53 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Florida laboratories in the Laboratory Response Network1 5

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 17

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 82%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Florida SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 86

Number of Florida cities in the Cities Readiness Initiative3 3

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

Florida
54 Public Health Preparedness: Mobilizing State by State

When severe wildfires struck 

southeast Georgia in spring 

2007, the public health district 

office, which covers 16 counties 

and 17 local public health departments, opened its 

district operations center. From there, the district staff 

coordinated with local health departments to respond to 

the fire and deal with the smoky conditions which had 

increased the public health risk for respiratory problems. 

The district also helped health department staff give 

protective masks and tetanus shots to first responders 

working in wooded areas. 

The district public information officer informed the 

community, media, and local emergency response 

agencies about the wildfires through numerous public 

service announcements, press releases, and the district’s 

website. Nurse managers and staff went door-to-door 

to provide information about the smoke to residents 

living in more remote areas. Local “hangouts” were 

used to get information out to the public and the 

emergency management agency set up a hotline to 

address community questions and concerns. Town hall 

meetings also were held to inform the public and allow for 

questions. 

Since 2001, communication between local agencies 

(first responders and others) and public health has 

increased significantly. Today, public health is included in 

emergency planning and response. As a result of increased 

partnership and communication, the counties affected 

by the wildfires have not seen an increase in respiratory 

problems. In addition, first responders are now protected 

from tetanus infection for future emergency response 

situations outdoors.

Snapshot of Public Health Preparedness

Below are activities conducted by Georgia in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Electronic 

Reporting

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Georgia Responds to Wildfires 

Better communication increases comprehensive and coordinated emergency response.

Georgia

http://health.state.ga.us/programs/emerprep

According to the Georgia Division of 

Public Health, the cooperative agreement 

is valuable because funding has built a 

strong, statewide foundation for preparedness 

through extensive planning and training 

efforts combined with procurement of 

critical assets necessary in a response. This 

infrastructure has benefits in daily operations 

and has proven itself in several actual 

emergency incident responses.
55 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Georgia laboratories in the Laboratory Response Network1 7

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 13

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 85%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 8

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 25%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) No

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Georgia SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 24

Number of Georgia cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Georgia
56 Public Health Preparedness: Mobilizing State by State

In June 2007, the Hawaii 

Department of Health (HDOH), 

along with the United States 

Postal Service (USPS), conducted 

a full-scale exercise of the Biohazard Detection System 

(BDS). This exercise, called the Maka’ala II exercise, was 

developed to test a multi-agency response to the detection 

of anthrax spores in the USPS mail sorting facility located 

near the Honolulu International Airport. The exercise 

planning team was composed of multiple agencies 

from the federal (USPS, Federal Fire Department), 

state (HDOH, state civil defense, Sheriff’s Department, 

Department of Transportation), and local (Department 

of Emergency Management, Honolulu Police, Honolulu 

Fire, and Honolulu Emergency Medical Services) levels. 

Maka’ala II tested response team members and their roles 

and actions during an activation and alert of the BDS at 

the mail sorting facility. HDOH participation was part of 

the USPS overall response plan to a BDS alarm. HDOH 

partnered with USPS to establish a dispensing clinic for 

USPS-purchased medications. The purpose of the clinic 

was to screen postal employees and dispense medication 

to protect against anthrax as needed. After proceeding 

through a decontamination area, the USPS employees 

came to the dispensing clinic and were quickly processed 

and issued medication. 

Snapshot of Public Health Preparedness

Below are activities conducted by Hawaii in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Hawaii Exercises the Biohazard Detection System with the Postal Service 

Full-scale exercises involving multiple agencies ensure a coordinated response to public health incidents.

Hawaii

http://hawaii.gov/health/emergencyprep

According to the Hawaii Department 

of Health, the cooperative agreement is 

valuable because funds have provided the 

state with the opportunity to make much 

progress in preparedness that otherwise 

would have been impossible. The state has 

been able to increase personnel, purchase 

software, build an information technology 

infrastructure, produce public information 

materials, and hold workshops and exercises.
57 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Hawaii laboratories in the Laboratory Response Network1 3

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 9

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 78%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 1

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Hawaii SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 72

Number of Hawaii cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Hawaii
58 Public Health Preparedness: Mobilizing State by State

In June 2006, the Idaho 

Department of Health and Welfare 

(IDHW), in partnership with the 

seven district health departments 

(DHDs) and the Idaho Bureau of Homeland Security, 

conducted a full-scale exercise involving the CDC 

Strategic National Stockpile (SNS). This exercise covered 

over 46 different locations, involving over 5,800 state and 

local public health personnel, emergency responders, and 

volunteers, representing 52 agencies overall. 

State officials requested the deployment of SNS from 

federal partners, and DHDs prepared to receive and 

distribute SNS materials. DHDs also practiced providing 

preventive medicines on a mass scale to the public. 

DHDs noted the importance of robust volunteer 

participation to allow them the opportunity to better 

plan their distribution operations and understand how to 

adjust their plans to maximize effectiveness. Overall, the 

objectives of the exercise were met, including practicing 

roles and responsibilities under the Incident Command 

System and providing coordinated and accurate 

information to the public. Opportunities for 

improvement were identified and subsequently addressed. 

These included the need for continual training and 

refinement of plans and the recognized need to involve 

state and local health departments within the multiagency coordination system at the state emergency 

operations center. 

Snapshot of Public Health Preparedness

Below are activities conducted by Idaho in the area of public health preparedness. They support CDC preparedness goals 

in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages of an 

event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Idaho Conducts Full-Scale Exercise of the Strategic National Stockpile 

Exercising operational plans highlights areas of improvement for a more effective response.

Idaho

http://www.healthandwelfare.idaho.gov

According to the Idaho Department of 

Health and Welfare, the cooperative 

agreement is valuable because public health 

has become an active partner in statewide 

response efforts and has developed many 

relationships with state agency response 

partners, including border states and 

Canadian partners. Cooperative agreement 

funding has provided an opportunity to 

improve Idaho’s public health preparedness 

and response infrastructure by both state and 

local public health entities.
59 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Idaho laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 26

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 35%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Idaho SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 90

Number of Idaho cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals No

- Local/regional emergency management agencies Yes

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

Idaho
60 Public Health Preparedness: Mobilizing State by State

The Illinois Public Health Mutual 

Aid System (IPHMAS) program is 

a state and local partnership that 

provides mutual aid between all local 

health departments during emergencies. Local health 

departments provide program management and resources, 

and the state health department provides communication 

and administrative coordination. This innovative system 

allows local health departments to respond to emergencies 

more quickly and effectively. The work of IPHMAS and 

its developers was recognized nationally by the American 

Public Health Association with the 2007 Milton and Ruth 

Roemer Prize for Creative Local Public Health Work.

The program is routinely exercised and was successfully 

used in two recent incidents. In 2007, the Kane County 

Health Department used IPHMAS to request nurses 

to assist in providing over 1,700 immunoglobulin 

vaccinations to people exposed to Hepatitis A through an 

infected food handler. Over 15 local health departments 

in Illinois responded to this request for assistance. In 

addition, in 2006, after several severe storms resulted 

in power outages for several days, the East Side Health 

District in East St. Louis requested additional staff. The 

St. Clair County Health Department was able to provide 

shortly after the request was made.

Snapshot of Public Health Preparedness

Below are activities conducted by Illinois in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Illinois Develops a Public Health Mutual Aid System 

Innovative system helps deploy local public health resources across the state during an emergency.

Illinois

http://www.idph.state.il.us/Bioterrorism/default.htm

According to the Illinois Department of 

Public Health, the cooperative agreement 

is valuable because funding has enabled 

the Department to focus on public health 

preparedness and response, identify gaps, and 

take corrective actions to improve the state’s 

emergency response capabilities. Illinois can 

be more prepared for public health threats 

by providing the necessary resources of staff, 

equipment, training, and supplies; enhancing 

cooperation and coordination between 

multiple layers of state and local government; 

and creating a new preparedness “culture” in 

the Illinois public health system.
61 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Illinois laboratories in the Laboratory Response Network1 3

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 72

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 43%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 17

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 47%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Illinois SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 91

Number of Illinois cities in the Cities Readiness Initiative3 2

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

Illinois
62 Public Health Preparedness: Mobilizing State by State

During a 2007 nationwide outbreak 

of botulism from contaminated 

commercial food products, the 

Indiana State Department of Health 

(ISDH) investigated cases, monitored recall efforts, and 

relayed information to health care providers, local health 

departments, and the public.

The work of epidemiologists, public health coordinators, 

and communications specialists was crucial. Field 

epidemiologists facilitated communication between 

the local and state health departments and increased 

investigative capacity. Central office epidemiologists 

tracked cases, assisted local health departments with 

case investigations, and coordinated with other ISDH 

program areas and CDC. In addition, the Public Health 

Emergency Surveillance System allowed near real-time 

evaluation of chief complaint data from 73 hospitals 

statewide. Chief complaints that suggested botulism 

infection were immediately forwarded to an ISDH 

epidemiologist for investigation. 

District public health coordinators assisted the ISDH 

Food Protection Program in contacting local health 

departments to determine the effectiveness of the recall. 

Field public information officers prepared news releases, 

answered media inquiries, and staffed media interviews, 

including a news conference with the State Health 

Commissioner. State-of-the-art personal communications 

systems with wireless handheld devices and statewide 

networks were essential to providing timely, seamless 

communication. The Indiana Health Alert Network 

was used to rapidly communicate with large numbers of 

people in different disciplines and locations throughout 

the response.

Snapshot of Public Health Preparedness

Below are activities conducted by Indiana in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Fax

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Indiana Responds to a Nationwide Botulism Outbreak 

Well-trained staff and established communications systems are critical for effective emergency response.

Indiana

http://www.in.gov/isdh/bioterrorism

According to the Indiana State Department 

of Health, the cooperative agreement 

is valuable because funds have greatly 

improved personnel and infrastructure 

for public health preparedness. Without 

this funding source, having state and local 

personnel devoted to preparedness, the 

health alert system, and increased syndromic 

surveillance activities would not have been 

possible, and continued maintenance would 

not occur.
63 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Indiana laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 22

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Indiana SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 91

Number of Indiana cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

Indiana
64 Public Health Preparedness: Mobilizing State by State

In 2006, Iowa was the center 

of a national mumps epidemic, 

accounting for nearly 2,000 of 

the 2,600 cases nationwide. Iowa 

typically experiences only five cases of mumps per year. 

Based on an outbreak investigation by epidemiologists 

from the Iowa Department of Public Health (IDPH), 

Iowa quickly determined that 18 to 25 year olds were 

most at risk. IDPH launched a vaccination program 

targeting this population. Local public health departments 

set up vaccination clinics based on CDC Strategic 

National Stockpile exercises to administer the vaccines. 

Within a month of beginning the vaccination campaign, 

the number of reported mumps cases decreased by 65%. 

Within 2 months, the mumps epidemic was stopped. 

Prior to the recent investment in public health 

preparedness and infrastructure, the department lacked 

trained epidemiologists and other staff necessary for an 

effective response. In addition, this response allowed 

IDPH to utilize plans and procedures that were in place 

and allowed them to improve response for future public 

health emergencies.

Snapshot of Public Health Preparedness

Below are activities conducted by Iowa in the area of public health preparedness. They support CDC preparedness goals 

in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages of an 

event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Iowa Responds to the Largest Mumps Outbreak in 20 Years 

Epidemiologists can investigate outbreaks and target interventions to protect the population.

Iowa

http://www.protectIowaHealth.org

According to the Iowa Department of 

Public Health, the cooperative agreement 

is valuable because prior to the cooperative 

agreement, public health had a limited role 

in responding to emergencies at the state or 

local level. Without this funding, Iowa would 

have been unable to address or complete the 

tasks to develop a public health preparedness 

system and continue to support future system 

enhancements.
65 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Iowa laboratories in the Laboratory Response Network1 3

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 39

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 77%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 6

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 33%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Iowa SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 88

Number of Iowa cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies No

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

Iowa
66 Public Health Preparedness: Mobilizing State by State

The summer of 2007 brought 

multiple weather disasters to Kansas. 

In early May, tornadoes struck the 

southwest portion of the state, 

followed by massive flooding that affected over one third 

of the counties in Kansas. The city of Greensburg in 

Kiowa County was almost destroyed by one of the largest 

tornadoes ever recorded by the National Weather Service, 

and a state of disaster emergency was declared.

The Kansas Response Plan was activated and the Division 

of Emergency Management opened the State Emergency 

Operations Center (SEOC). The Kansas Department of 

Health and Environment (KDHE) played several roles in 

the response efforts, and public health preparedness staff 

assisted in the coordination of public health functions 

at the SEOC. Additional services provided by KDHE 

included the monitoring of air quality, debris disposal, 

and the restoration of the public water system in the city 

of Greensburg. KDHE also was able to rapidly 

disseminate fact sheets on health hazards related to mold 

to the public. KDHE served as the lead for the public 

health response efforts within the SEOC and helped staff 

the center, coordinate health and medical activities, and 

secure health and medical supplies and equipment to 

support local response.

Snapshot of Public Health Preparedness

Below are activities conducted by Kansas in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Fax

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Kansas Responds to Multiple Weather Emergencies 

A strong public health system allows for successful response to multiple disasters.

Kansas

http://www.kdheks.gov/biot

According to the Kansas Department of 

Health and Environment, the cooperative 

agreement is valuable because it has funded 

additional staff and updated technologies, 

training, exercising, surveillance capabilities, 

risk communications, laboratory capacity, and 

overall preparedness planning. Approximately 

half of the funding has been provided to local 

health departments for local preparedness 

activities.
67 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Kansas laboratories in the Laboratory Response Network1 2

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 6

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 50%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Kansas SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 93

Number of Kansas cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

Kansas
68 Public Health Preparedness: Mobilizing State by State

In September 2005, the Kentucky 

Department for Public Health 

(KDPH) deployed public health 

workers to assist the Mississippi 

Department for Public Health in Hurricane Katrina 

recovery efforts. Through improvements in infrastructure 

and training using funds from the cooperative agreement, 

KDPH strike teams were ready for deployment to a 

disaster region. Continuing partnerships with emergency 

management, sanitation, and hospitals allowed KDPH 

to send six teams over a three-month period through the 

Emergency Management Assistance Compact system. 

Teams consisted of public health environmentalists, 

nurses, pharmacists, and public health preparedness 

planners from both state and local public health 

departments. They assisted with food safety, food salvage 

and disposal, food- and water-related illness, water 

sampling, clean water sources, special needs shelters, and 

distribution of medications. 

During this critical time, KDPH used newly implemented 

information technology, such as interactive video 

conferencing, to allow public health officials to 

communicate “face-to-face” with response partners across 

the state and assist in planning for the 6,000 evacuees 

that were coming to Kentucky. Constant collaboration 

between state agencies helped connect displaced people 

with medical and social services. The web-based Health 

Alert Network and satellite radios were used to share 

information throughout the response. The online 

Kentucky Health Emergency Listing of Professionals for 

Surge was used to register volunteers for assistance, as 

well as evacuees coming into Kentucky. A toll-free phone 

center in the newly equipped KDPH Operations Center 

received calls from evacuees and volunteers.

Snapshot of Public Health Preparedness

Below are activities conducted by Kentucky in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Electronic 

Reporting

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Kentucky Deploys Public Health Teams to Support Hurricane Recovery 

Local investments in public health preparedness can support nationwide response efforts.

Kentucky

http://chfs.ky.gov/dph/epi/preparedness

According to the Kentucky Department for 

Public Health, the cooperative agreement 

is valuable because funds have addressed 

critical needs in Kentucky’s capacity to 

respond to the growing magnitude of public 

health threats and emergencies. The majority 

of funds have been placed at the local level 

since response to disasters occurs first at the 

local level. In addition, the necessary staff 

have been available to carry out projects and 

purchase new technologies.
69 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Kentucky laboratories in the Laboratory Response Network1 3

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 36

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 92%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) No

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) N/A

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) N/A

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Kentucky SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 85

Number of Kentucky cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No 

Response

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Kentucky
70 Public Health Preparedness: Mobilizing State by State

In the event of public health 

incidents of suspicious and possibly 

criminal origin, public health and 

law enforcement agencies must 

coordinate their investigations closely to reach shared 

objectives (e.g., determining where, when, and how 

the incident occurred). In an effort to promote close 

collaboration, the Los Angeles County Department 

of Public Health (LACDPH) developed and signed a 

memorandum of understanding (MOU) with the Federal 

Bureau of Investigation (FBI) that guides the course 

of joint investigations. Under the MOU, LACDPH 

developed written protocols for sharing public health 

information with FBI and protocols for FBI to share 

threat intelligence information with LACDPH. 

LACDPH and FBI conducted a nationally unprecedented 

day-long, full-scale joint investigation exercise in March 

2007 to test the recently developed joint investigation 

protocols with over 100 LACDPH and FBI personnel. 

The exercise tested the ability of the two agencies to 

conduct a joint investigation of a covert bioterrorism 

event; conduct joint patient interviews with field staff 

from both agencies following established protocols at 

multiple sites; and exchange mission critical information 

in a timely manner. LACDPH and FBI activated their 

respective operations centers, deployed representatives 

at each agency’s operations center, exchanged situational 

analysis information, and tested their ability to jointly 

manage the event following Incident Command System 

standards.

Snapshot of Public Health Preparedness

Below are activities conducted by Los Angeles County in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza†4 —

*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.

† Localities were not asked to respond to this question.

Los Angeles County Collaborates with the Federal Bureau of Investigation 

Cross-jurisdictional investigation protocols promote timely and coordinated response.

Los Angeles County

http://www.labt.org

According to the Los Angeles County 

Department of Public Health, the 

cooperative agreement is valuable because

it has enriched public health infrastructure 

across the board and has contributed to 

improvements in staff, equipment, and 

systems. More than 165 new positions have 

been added to work on preparedness efforts, 

and needed equipment and technologies have 

been purchased. Finally, the funding has 

allowed the county to improve detection and 

response to local emergencies, such as disease 

outbreaks and wildfires, which have served to 

prepare the department for addressing larger 

scale emergencies.
71 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Los Angeles County laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):*2

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):*2

Had a laboratory information management system that could create, send, and receive 

messages*3 (8/05 – 8/06) —

- 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 specimens*3 (8/05 – 8/06) —

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

*Localities were not asked to respond to this question.

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Los Angeles County SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 87

Participated in the Cities Readiness Initiative2 Yes

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities3 Yes

Public health laboratories conducted training for first responders*4 (8/05 – 8/06) —

Activated public health emergency operations center as part of a drill, exercise, or real 

event†‡5 (partial year, 9/06 – 2/07) Yes

Conducted a drill or exercise for key response partners to test communications when 

power and land lines were unavailable‡5 (partial year, 9/06 – 2/07) No

Improve Finalized at least one after-action report with an improvement plan following an 

exercise or real event‡5 (partial year, 9/06 – 2/07) Yes

* Localities were not asked to respond to this question.

† 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.

‡ Localities 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 CRI; 2007; 3 CDC, DSLR; 1999-2005; 4 APHL, Chemical Terrorism Preparedness; May 2007; 5 CDC, DSLR; 2007

Los Angeles County
72 Public Health Preparedness: Mobilizing State by State

The second annual Operation 

Prepare field deployment exercise 

occurred throughout Louisiana 

during the summer of 2007. 

Participating agencies included the Louisiana Department 

of Health and Hospitals, the Office of Public Health 

(OPH), and the Center for Community Preparedness. 

This community outreach effort focused on educating 

Hurricane Katrina- and Rita-affected communities and 

at-risk populations through crisis literature and surveys 

about preparation for evacuation and disasters. The 

event also tested the ability of public health agencies 

and partners to reach at-risk populations during an 

emergency, their knowledge and ability to operate within 

the National Incident Management System, and their 

communications plans and equipment. OPH teams also 

used the opportunity to provide free health screenings 

(with blood pressure checks, immunizations, and mental 

health consultations) via mobile clinics. 

The exercise was conducted in phases across the state. 

Educational efforts targeted housing development 

residents, the Vietnamese population of the New Orleans 

area, displaced Hurricane Katrina residents living in 

Baton Rouge, rural residents in low-lying marsh areas, 

and elderly residents in areas affected by Hurricane Rita. 

Dozens of emergency response and public health agencies, 

businesses, non-profit organizations, and churches 

partnered with OPH to make Operation Prepare a success.

Snapshot of Public Health Preparedness

Below are activities conducted by Louisiana in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Louisiana Deploys Staff Statewide during Operation Prepare 

Community outreach is critical in addressing the needs of at-risk populations.

Louisiana

http://www.dhh.louisiana.gov/office/?ID=276

According to the Louisiana Office of 

Public Health, the cooperative agreement 

is valuable because without the funding, the 

state would not have been able to coordinate 

emergency response activities, hire additional 

staff to coordinate emergency response 

activities, or provide proper training for its 

staff. The cooperative agreement also has 

provided for new equipment and supplies that 

have improved Louisiana emergency response.
73 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Louisiana laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) No

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) N/A

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) No

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Louisiana SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 82

Number of Louisiana cities in the Cities Readiness Initiative3 2

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) No

*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

Louisiana
74 Public Health Preparedness: Mobilizing State by State

The Maine Center for Disease 

Control and Prevention, Office 

of Public Health Emergency 

Preparedness (OPHEP), in 

coordination with key partners, has established a 

partnership for state pandemic influenza preparedness 

planning. The focus is in establishing practical, statewide, 

and community-based procedures that could prevent or 

delay the spread of pandemic influenza and help reduce 

the burden of illness communities would experience 

during an outbreak. 

Rather than the classic model of multiple sub-state 

departments, Maine’s public health infrastructure consists 

of a combination of state, community, and private 

agencies that have collaboratively established a public 

health network. Therefore, the development of countylevel plans was determined to be the most practical and 

operational approach to local planning. The planning 

networks merged community, emergency, and medical 

response while also employing comprehensive groups of 

local constituents.

Challenges and significant successes have been realized 

from the development of planning networks representing 

formerly divergent and culturally different professions. A 

statewide operational plan for Maine has been developed 

and will be updated by April 2008. The cooperation of 

the community, emergency, and medical response was 

contingent upon the success of this planning process.

Snapshot of Public Health Preparedness

Below are activities conducted by Maine in the area of public health preparedness. They support CDC preparedness goals 

in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages of an 

event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Maine’s Partnership for Pandemic Influenza Increases Preparedness 

Comprehensive planning prepares communities before an actual emergency.

Maine

http://www.maine.gov/dhhs/boh

According to the Maine Department 

of Health and Human Services, the 

cooperative agreement is valuable because

funds have improved Maine’s ability to detect, 

treat, and prevent injuries and diseases that 

threaten the health of its citizens as a result 

of natural or manmade events. In partnership 

with federal, state, and local agencies, a 

coordinated system will address natural 

disasters (e.g., floods and disease outbreaks), 

as well as terrorist acts (e.g., the release of 

biological, chemical, or nuclear agents).
75 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Maine laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 11

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 18%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Maine SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 51

Number of Maine cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

Maine
76 Public Health Preparedness: Mobilizing State by State

The daily work of epidemiologists in 

public health departments involves 

routine data collection about disease 

patterns and trends. However, in 

2005 a field epidemiologist at the Maryland Department 

of Health and Mental Hygiene (DHMH) emphasized the 

need for immediate response to potential health threats. 

In March, DHMH received a report from Maryland’s 

eastern shore about a letter containing white powder. The 

epidemiologist immediately initiated the DHMH white 

powder protocol and communication network, which 

had been established after the anthrax letter threats of 

2001. Within hours, another letter with white powder was 

reported from the far western region of the state. Again, 

the epidemiologist initiated the white powder protocol, 

with the additional recommendation that the situations 

across the state be linked and investigated further. 

DHMH leadership followed this recommendation and 

moved quickly to involve law enforcement officials in 

Maryland. Ultimately, the Federal Bureau of Investigation 

became involved due to related letters found in Kentucky 

and as far away as Alaska. Subsequent laboratory testing 

determined that the white powder was not anthrax. 

Further investigations led to one man as the source of 

all of the threatening letters and supported a criminal 

conviction. This response demonstrates the importance 

of having well-trained staff, relationships with law 

enforcement, and plans in place before a potential event 

occurs.

Snapshot of Public Health Preparedness

Below are activities conducted by Maryland in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Maryland Responds to Letters Containing White Powder

State and local surveillance helps identify emergencies at the national level.

Maryland

http://bioterrorism.dhmh.state.md.us

According to the Maryland Department 

of Health and Mental Hygiene, the 

cooperative agreement is valuable because

funds have allowed Maryland to hire and 

train staff, purchase needed equipment, and 

conduct exercises. Public health preparedness 

accomplishments have included developing 

emergency plans, conducting drills to prepare 

for mass vaccinations, and implementing an 

around-the-clock call system to make experts 

available during emergencies.
77 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Maryland laboratories in the Laboratory Response Network1 9

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 22

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 91%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 12

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 75%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Maryland SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 64

Number of Maryland cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Maryland
78 Public Health Preparedness: Mobilizing State by State

When measles broke out in Boston 

in 2006, the disease had not had a 

large-scale presence in the United 

States for over 5 years. The first case 

in this outbreak was an unvaccinated man from India 

who had arrived in Boston and was confirmed to have 

measles 2 weeks after his arrival. Boston Public Health 

Commission (BPHC) and Massachusetts Department 

of Public Health (MDPH) officials were immediately 

concerned about the potential of a larger outbreak. 

BPHC and MDPH identified people exposed to measles, 

located immunization histories, and determined the need 

for quarantine. BPHC used its syndromic surveillance 

system to help detect measles in emergency rooms. BPHC 

alerted healthcare providers via factsheets and podcasts 

and also interacted with the media to educate the public 

(in multiple languages) about symptoms, prevention 

strategies, and vaccination. BPHC also used the Incident 

Command System (ICS) to manage the response and 

share information throughout the outbreak. By the end of 

the outbreak, more than 2,500 doses of vaccines were 

administered. Over 800 doses of vaccines were 

administered by BPHC directly, and the remaining 

were administered through emergency preparedness 

partnerships with local health centers, occupational 

health providers, and other healthcare providers. These 

partnerships for vaccinations were created with support 

from the Cities Readiness Initiative (funded by the 

cooperative agreement).

Snapshot of Public Health Preparedness

Below are activities conducted by Massachusetts in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Massachusetts Responds to a Measles Outbreak 

Global travel may introduce new or unfamiliar diseases and increase the risk of disease outbreaks.

Massachusetts

http://www.mass.gov/dph/emergencyprep

According to the Massachusetts Department 

of Public Health, the cooperative 

agreement is valuable because prior to 

receiving cooperative agreement funding, the 

Department did not carry out initiatives to 

improve preparedness. These funds are critical 

for an enhanced state laboratory, disease 

surveillance capabilities, response capacity, 

and information technology.
79 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Massachusetts laboratories in the Laboratory Response Network1 2

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 22

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 64%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 6

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 0%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Massachusetts SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 63

Number of Massachusetts cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

Massachusetts
80 Public Health Preparedness: Mobilizing State by State

In 2004, the Michigan Department 

of Community Health (MDCH) 

created the Michigan Emergency 

Drug Delivery and Resource 

Utilization Network (MEDDRUN) to bridge the gap 

between available medical resources through caches 

of medications, such as nerve agent antidotes and 

supplies pre-deployed around the state. These caches are 

strategically placed within immediate reach of helicopters 

and ground transportation for the rapid delivery of 

supplies to hospitals and other health care facilities during 

a disaster. 

By approaching this project using multi-disciplinary 

planning that included emergency management, law 

enforcement, public health, health care, and emergency 

medical services, MDCH created an innovative network. 

MEDDRUN received national recognition from the ASH 

Institute for Democratic Governance and Innovation 

at Harvard University’s John F. Kennedy School of 

Government, receiving second place out of a pool of 

other innovative, homeland security-based programs. 

By drawing on resources from both the cooperative 

agreement and the HHS hospital preparedness program, 

MDCH promoted collaboration and coordination at all 

levels of government and the private sector to protect 

Michigan residents.

Snapshot of Public Health Preparedness

Below are activities conducted by Michigan in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Michigan Creates a Network to Rapidly Deliver Medications and Supplies 

Innovative programs at the state level can become models for other states to follow.

Michigan

http://www.michigan.gov/mdch

According to the Michigan Department 

of Community Health, the cooperative 

agreement is valuable because it has been 

critical to facilitate all public health and 

health care related activities. Significant 

upgrades to a previously deteriorating 

public health infrastructure have benefited 

the public’s health in many ways. Funding 

also has enhanced Michigan’s state and 

local ability to respond to non-bioterrorism 

related emergencies, such as influenza vaccine 

shortages and disease outbreaks.
81 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Michigan laboratories in the Laboratory Response Network1 9

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 33

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 5

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Michigan SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 88

Number of Michigan cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Michigan
82 Public Health Preparedness: Mobilizing State by State

In August 2007, the Interstate 35W 

bridge across the Mississippi River in 

Minneapolis, Minnesota collapsed, 

leaving 13 people dead and nearly 

100 injured. Hospitals, emergency medical services, and 

state public health staff were alerted within minutes of the 

incident and began monitoring real-time information on 

the patients, where they were transported, their condition, 

and the status of hospital availability. Within hours of the 

incident, most patients had been rescued, triaged, and 

transported to hospitals.

After the initial collapse, the Minnesota Department 

of Health and other state and federal agencies assisted 

the City of Minneapolis to find potentially harmful 

substances as a result of the bridge collapse, and also 

initiated public health protection measures during 

the cleanup and demolition that followed. Air, water, 

and bridge materials were sampled or monitored and 

no public health hazards were detected, providing 

critical information to responders and the surrounding 

community.

Multiple communication strategies led to effective 

information sharing among public health departments, 

the media, and the public. Local and state public health 

staff coordinated behavioral health and grief support 

services using the Medical Reserve Corps and a statewide 

network of registered and credentialed volunteers. In 

coordination with the American Red Cross, public 

health professionals supported families through the 

recovery phase and planned for long-term support. Prior 

regional planning and coordination had clarified specific 

responsibilities and means of communication during an 

emergency.

Snapshot of Public Health Preparedness

Below are activities conducted by Minnesota in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Minnesota Responds to Interstate Bridge Collapse 

Information sharing is critical to effective emergency response.

Minnesota

http://www.health.state.mn.us/oep

According to the Minnesota Department 

of Health, the cooperative agreement is 

valuable because it has allowed the state to 

implement systems and foster partnerships 

that otherwise would not have been possible. 

The dedicated funding has allowed Minnesota 

to develop additional emergency response and 

preparedness activities and programs.
83 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Minnesota laboratories in the Laboratory Response Network1 3

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 87

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 94%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 15

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 93%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Minnesota SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 81

Number of Minnesota cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies No

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

Minnesota
84 Public Health Preparedness: Mobilizing State by State

Mississippi used cooperative 

agreement funding to improve 

preparedness, specifically for 

communication and medical care 

for displaced individuals. Recently, the Mississippi State 

Department of Health (MSDH) used the Mississippi 

Health Alert Network (HAN) to notify the state’s 

healthcare system of a serious outbreak of pertussis 

(whooping cough). HAN allowed one person to notify 

every participating physician, every hospital, and many 

other medical providers (over 5,000 contacts) in about 

6 hours, with a verified delivery rate approaching 90%. 

Previously, this process was very labor intensive, taking a 

minimum of 12 to 14 hours with a 50% success rate. 

In addition, following Hurricane Katrina, MSDH realized 

that it did not have the medical surge capacity to care for 

the thousands of individuals with special medical needs 

displaced by the storm. The cooperative agreement is 

funding medical surge capacity enhancement that utilizes 

Mississippi’s community college system. Buildings on 

selected campuses are being equipped to act as special 

medical needs shelters for use in the event of storms, a 

pandemic outbreak, or other natural or man-made 

disaster. Enough hospital-grade equipment, medical 

supplies, and pharmaceuticals are being purchased to 

enable each surge capacity site to care for at least 100 

patients and 100 caregivers, plus staff. MSDH is also 

upgrading electrical power systems to enable climate 

control and life support systems to function in the event 

of power loss. Showers and bathrooms are being retrofitted for use by physically challenged individuals and to 

meet the Americans with Disabilities Act requirements. 

During the next disaster, Mississippi will be more 

prepared to care for displaced people who need ongoing 

medical care. 

Snapshot of Public Health Preparedness

Below are activities conducted by Mississippi in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Mississippi Improves Communication and Surge Capacity 

Identifying and filling gaps in the public health system improves emergency response.

Mississippi

http://www.msdh.state.ms.us

According to the Mississippi State 

Department of Health, the cooperative 

agreement is valuable because it has covered 

salaries for bioterrorism surveillance nurses 

in each of the nine public health districts. 

Mississippi also has been able to add a testing 

area with enhanced security within their 

main laboratory that allows for routine and 

overflow testing.
85 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Mississippi laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 3

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 33%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Mississippi SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 96

Number of Mississippi cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

Mississippi
86 Public Health Preparedness: Mobilizing State by State

Missouri contributed to the 

laboratory response in the 2006 

E. coli outbreak in spinach, the 

largest foodborne disease outbreak 

in the United States since 1993. Prior to the cooperative 

agreement, the Missouri State Public Health Laboratory 

(MSPHL) did not have adequate staff, equipment, or 

communication systems to rapidly respond to an event 

the size of the 2006 outbreak. Now, MSPHL provides a 

wide variety of testing 365 days per year. 

During the outbreak, trained staff were able to rapidly 

confirm the strain type of all E. coli specimens sent to 

the laboratory, determine if they matched the strains 

associated with the national spinach E. coli investigation, 

and establish that the E. coli strains in Missouri were 

not part of the national outbreak. MSPHL also received 

specimens quickly because of the new statewide 

courier service. Parallel laboratory and epidemiologic 

investigations were crucial in identifying the source of this 

outbreak. Concurrent collection of case information 

by epidemiologists in affected states and sharing of data 

between states and CDC led to rapid identification of the 

suspected food source and targeted public health action.

Snapshot of Public Health Preparedness

Below are activities conducted by Missouri in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Missouri Responds to Multi-State E. Coli Outbreak

Laboratory and epidemiologic investigations are crucial to rapidly identify the source of disease outbreaks.

Missouri

http://www.dhss.mo.gov/BT_Response

According to the Missouri Department of 

Health and Senior Services, the cooperative 

agreement is valuable because it has 

allowed the state to hire staff, purchase new 

equipment, draft guidances, and prepare 

training and educational opportunities for 

its workforce. Missouri has been able to 

create the Center for Emergency Response 

and Terrorism to work on issues related to 

preparedness caused by natural or deliberate 

events. Its staff have received invaluable 

training in disaster response that was put to 

great use during the response to Hurricane 

Katrina.
87 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Missouri laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 29

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 93%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) No

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) N/A

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Missouri SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 85

Number of Missouri cities in the Cities Readiness Initiative3 2

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

Missouri
88 Public Health Preparedness: Mobilizing State by State

When Montana state and local 

health departments learned of a 

multi-drug resistant tuberculosis 

(MDR TB) case in 2006, urban 

and rural counties worked seamlessly with the state 

health department TB program to prevent the spread of 

the disease. First, the local health department issued an 

isolation order restricting the infected patient’s travel. 

Because the infected patient had planned to travel 

internationally from an airport located in an adjacent, 

urban county, that county’s public health department 

also issued an order restricting flight from that airport. 

To restrict air travel from any other city, the regional 

CDC quarantine office and airline were notified. The 

infected patient was permitted to travel, within specified 

parameters, to a hospital for treatment. When no longer 

contagious, the patient was allowed to return home. 

After-hours communication and relationships among state 

and local laboratories facilitated the exchange of clinical 

testing results. In addition, a communicable disease nurse 

was dedicated to manage the complex public health and 

medical issues related to this case.

Cooperative agreement funds contributed to the 

successful response. Local health authorities could rapidly 

issue a county isolation order because Montana had 

reviewed and updated its public health statutes, including 

isolation and quarantine authorities, and local public 

health departments adopted and updated their protocols. 

Montana also updated its high-level biosafety laboratory 

with the infrastructure needed to protect staff from highly 

infectious samples, such as MDR TB.

Snapshot of Public Health Preparedness

Below are activities conducted by Montana in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Montana Responds to a Case of Multi-Drug Resistant Tuberculosis 

Clear isolation and quarantine statutes contribute to a more timely and authoritative response.

Montana

http://www.dphhs.mt.gov/PHSD

According to the Montana Department of 

Public Health and Human Services, the 

cooperative agreement is valuable because

without funding, the completion of state, 

local, and tribal public health workforce 

assessments, as well as public health worker 

training in risk communication and other 

topics related to preparedness, would not have 

been possible. The cooperative agreement 

also has enabled the state to provide Incident 

Command System training at the state, local, 

and tribal levels.
89 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Montana laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 5

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) N/A

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Montana SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 80

Number of Montana cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

Montana
90 Public Health Preparedness: Mobilizing State by State

In early January 2007, a major 

winter storm hit central Nebraska. 

Power lines failed and left parts 

or all of 59 counties without 

power. As part of the response and recovery efforts, the 

Nebraska Department of Health and Human Services 

(DHHS) activated the DHHS situation room and 

coordinated response actions. It also staffed the public 

health component of Nebraska Emergency Management 

Agency’s (NEMA) Emergency Operations Center 

and coordinated resources with local public health 

departments. DHHS provided field kits and supplies to 

NEMA and supported public information efforts from 

the period immediately following the disaster throughout 

initial recovery. Furthermore, DHHS issued news releases 

to the media and provided web content on relevant public 

health and safety topics. 

At the local level, DHHS assisted local water employees 

by providing support and copies of emergency plans 

and information about seasonal influenza to local public 

health departments. In addition, DHHS participated in 

weekly teleconferences with volunteer organizations that 

addressed issues such as food stamps and behavioral health 

needs. As a result, DHHS established additional food 

stamp assistance, arranged for behavioral health assistance 

to state and local employees, and promoted a crisis 

counseling hotline.

Snapshot of Public Health Preparedness

Below are activities conducted by Nebraska in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Electronic 

Reporting

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Nebraska Responds to a Major Winter Storm 

Multi-agency coordination and public health expertise improves emergency response.

Nebraska

http://www.dhhs.ne.gov/emergency_preparedness

According to the Nebraska Department 

of Health and Human Services, the 

cooperative agreement is valuable because

it has greatly strengthened state, regional, and 

local preparedness and response capacities by 

providing financial support for activities that 

were previously not possible.
91 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Nebraska laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 28

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 54%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Nebraska SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 66

Number of Nebraska cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

Nebraska
92 Public Health Preparedness: Mobilizing State by State

The Public Health Coordinating 

Center (PHCC) is the operational 

coordinating center for the Nevada 

State Health Division (NSHD) and 

includes the Health Emergency Operations Center. Public 

health emergencies occurring in Nevada may require 

NSHD to assist local public health authorities, other state 

and federal agencies, multiple jurisdictions, and border 

states in coordinating public health actions. To coordinate 

these activities, PHCC is compliant with the National 

Incident Management System and compatible with the 

Incident Command System (ICS) that is used by state and 

local responders in a unified command structure. 

The PHCC can receive, analyze, and display information 

about a specific incident to enable timely decision-making 

and coordinate resources. NSHD has exercised the 

PHCC following the guidelines of the Homeland Security 

Exercise and Evaluation Program, which utilizes a cycle of 

progressively complex exercises. The most recent exercise 

involved a pandemic influenza scenario that quickly 

overwhelmed the resources of local medical facilities. ICS 

was practiced as each functional group (finance, logistics, 

operations and planning) was given the opportunity 

to share information about how their roles and their 

decisions during this type of public health emergency 

affect other areas of command.

Snapshot of Public Health Preparedness

Below are activities conducted by Nevada in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Electronic 

Reporting

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Nevada Exercises its Unified Command Structure 

Operational coordinating centers organize activities during the course of an emergency.

Nevada

http://health.nv.gov

According to the Nevada State Health 

Division, the cooperative agreement is 

valuable because the state has developed 

a critical statewide infrastructure that 

allowed for the purchase of essential systems 

and equipment. For example, redundant 

communication systems have been developed 

through the purchase of a network system in 

Las Vegas. Funding has also covered personnel 

costs at both the state and local levels to hire 

and maintain staff to complete preparedness 

activities.
93 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Nevada laboratories in the Laboratory Response Network1 2

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 7

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 86%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) No

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) N/A

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Nevada SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 34

Number of Nevada cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No 

Response

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Nevada
94 Public Health Preparedness: Mobilizing State by State

Over the past 4 years, the New 

Hampshire Department of Health 

and Human Services, Division of 

Public Health Services (DPHS) and 

the New Hampshire Department of Safety, Homeland 

Security and Emergency Management (HSEM) have 

worked together on a daily basis in an all-hazards 

approach to prepare New Hampshire for potential public 

health emergencies. Some specific areas of focus include 

disaster behavioral health response, Strategic National 

Stockpile coordination, hospital preparedness, volunteer 

coordination, and pandemic planning, training, and 

exercises. 

A pandemic would require a coordinated regional 

approach to response. Therefore, 19 All-Health Hazards 

Regions (AHHR) were formed to include all 234 New 

Hampshire communities. As of late summer 2007, 14 

AHHRs had completed a pandemic influenza supplement 

to their all-hazards public health plan, with the remaining 

five in progress. All 19 AHHRs have conducted tabletop 

exercises of their all-health hazards plan for public health 

response. Pandemic influenza funds from the cooperative 

agreement were distributed to AHHRs to support 

enhanced regional response plans, including community 

medical surge. These efforts have increased the capacities 

of the public health and health care systems within these 

regions to respond to public health emergencies.

Snapshot of Public Health Preparedness

Below are activities conducted by New Hampshire in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Regional All-Hazards Planning and Exercising Implemented

A regional approach to preparedness increases the response capacity of all communities.

New Hampshire

http://www.dhhs.state.nh.us/dhhs/cdcs/ppcc.htm

According to the New Hampshire 

Department of Health and Human Services, 

the cooperative agreement is valuable 

because it led to a functional partnership 

between DPHS and Homeland Security 

and Emergency Management. Through this 

partnership the state has been able to develop 

a strong public health emergency planning 

and response team, develop the appropriate 

plans, and create a regional, community 

partnership preparedness mentality that will 

be key to a successful response and recovery. 

Success stories have included the development 

of a chemistry lab, the All-Health Hazard 

Regions, and statewide sites for medical 

supply dispensing.
95 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of New Hampshire laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 8

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 50%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 1

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 0%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) No

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) N/A

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

New Hampshire SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 69

Number of New Hampshire cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals No

- Local/regional emergency management agencies No

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

New Hampshire
96 Public Health Preparedness: Mobilizing State by State

In June 2006, the Middlesex 

County Public Health Department 

in New Jersey, in cooperation with 

the United States Postal Service 

(USPS) in Edison, New Jersey, conducted a multi-agency 

emergency public health exercise with an alarm activation 

of a postal facility’s Biohazard Detection System (BDS) for 

the presence of anthrax spores within the mail handling 

machinery. Planning began for this exercise in December 

2005 and involved a number of tabletop exercises that 

brought together federal, state, and local agencies. 

The plans emphasized agency goal coordination, role 

assignment among the agencies, and multi-agency task 

assignment along a single timeline. This exercise was the 

first of its type conducted on the east coast and the second 

conducted nationwide.

Several major strengths were identified during the exercise. 

Each of the participating agencies understood its mission 

and executed their respective responsibilities. Incident 

Command System (ICS) roles and responsibilities were 

quickly established and executed. The participating USPS 

employees yielded positive feedback to the exercise. 

Lessons learned from this exercise will be used in future 

planning for BDS exercises nationwide. Areas which 

need improvement were also identified. More planning is 

needed for a long-term response as these efforts will likely 

take place over several days, if not longer. The hospital 

emergency response personnel required additional training 

in the ICS and National Incident Management System.

Snapshot of Public Health Preparedness

Below are activities conducted by New Jersey in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

New Jersey Conducts the First Anthrax Drill on the East Coast 

Multi-agency exercises strengthen a locality’s ability to respond to a public health emergency.

New Jersey

http://www.state.nj.us/health/er

According to the New Jersey Department of 

Health and Senior Services, the cooperative 

agreement is valuable because it has enabled 

New Jersey to increase the capability of public 

health and environmental laboratories to 

rapidly and accurately screen for and confirm 

biological and chemical agents; establish an 

electronic Communicable Disease Reporting 

& Surveillance System; enhance real-time 

reporting and investigation relationships 

among state and local partners; create a state 

Health Alert Network system for emergency 

notification and alerting; develop a statewide 

capability to receive, distribute, and manage 

the Strategic National Stockpile; develop a 

statewide public health emergency planner 

corps; and provide emergency preparedness 

workforce education.
97 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of New Jersey laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 83

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 96%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) No

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

New Jersey SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 92

Number of New Jersey cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals No

- Local/regional emergency management agencies Yes

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

New Jersey
98 Public Health Preparedness: Mobilizing State by State

An international participant at a 

2007 science and engineering fair 

in New Mexico was hospitalized 

with symptoms of measles, later 

confirmed by the state public health laboratory. Measles, 

though eradicated in the United States and other 

countries, still exists in many parts of the world. The 

teenage girl was likely infectious while traveling and at the 

science and engineering fair. Since the teenage girl had 

traveled from India to Atlanta and then to Albuquerque, 

the New Mexico Department of Health (NMDOH) 

was concerned about possible exposure at airports, hotels 

where the teenage girl stayed, and at the science and 

engineering fair which had approximately 5,000 attendees 

and 1,200 judges. 

NMDOH immediately began working with CDC to 

identify people who might have been exposed during 

plane flights or at airports. NMDOH also held a 

vaccination clinic for fair attendees and a separate clinic 

for other members of the public who thought they 

might have been exposed. Effective risk communication 

managed the public perception of the measles case, 

educated the public about the disease, and encouraged 

people to get vaccinated. These rapid responses by state 

public health officials and epidemiologists and the use of 

quick communication strategies helped reduce the chance 

that measles would spread in the communities.

Snapshot of Public Health Preparedness

Below are activities conducted by New Mexico in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

New Mexico Responds to an Imported Measles Case 

Epidemiological investigations and public information campaigns are key to disease outbreak response.

New Mexico

http://www.health.state.nm.us/ohem

According to the New Mexico Department 

of Public Health, the cooperative agreement 

is valuable because it has contributed to 

overall improvements in New Mexico’s public 

health system by allowing the state to increase 

its planning and exercise capabilities as well as 

reach out to local populations.
99 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of New Mexico laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 9

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 0%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) No

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) N/A

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

New Mexico SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 67

Number of New Mexico cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

New Mexico
100Public Health Preparedness: Mobilizing State by State

In February 2006, the New York 

City Department of Health and 

Mental Hygiene (NYC DOHMH) 

investigated a case of naturally 

occurring inhalation anthrax, the first case in the United 

States in 30 years. A New York City resident, a dancer and 

drummer, collapsed after a performance in Pennsylvania, 

and Pennsylvania authorities contacted New York City 

officials. Through telephone interviews and laboratory 

testing, NYC DOHMH epidemiologists confirmed that 

the inhalation anthrax case was contracted while the man 

was working with untreated animal hides used to make 

drums.

NYC DOHMH immediately contacted all potentially 

exposed individuals to determine if others were at risk for 

inhalation anthrax, arranged for preventive medication as 

necessary, conducted laboratory tests on collected samples, 

and collaborated with local, state, and federal agencies to 

design initial sampling plans. NYC DOHMH proactively 

alerted hospitals through its Health Alert Network and 

automated mass notification software. In addition, NYC 

DOHMH hosted citywide hospital teleconferences 

to address questions and concerns from providers. In 

collaboration with the Environmental Protection Agency 

and other agencies, NYC DOHMH coordinated efforts 

to examine and clear residences, workplaces, and vehicles 

associated with the anthrax case for re-occupancy.

NYC DOHMH also helped to effectively communicate 

public messages to schools and residents through 

community meetings, fact sheets, and media updates. 

Crisis counseling was available at all community meetings 

and provided to those who received preventive treatment. 

During this response, NYC DOHMH demonstrated its 

ability to coordinate response across regional and agency 

lines.

Snapshot of Public Health Preparedness

Below are activities conducted by New York City in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza†4 —

*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.

† Localities were not asked to respond to this question.

New York City Responds to a Case of Inhalation Anthrax

Coordinated recovery efforts help communities return to normal after an emergency.

New York City

http://www.nyc.gov/html/doh/html/bt/bt.shtml

According to the New York City 

Department of Health and Mental 

Hygiene, the cooperative agreement is 

valuable because it has provided the city 

with resources to fund staff, equipment, 

and supplies (or contracts with vendors) 

to perform its preparedness activities. This 

funding stream has been critical in allowing 

every part of the agency to improve its 

emergency response role.
101 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of New York City laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):*2

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):*2

Had a laboratory information management system that could create, send, and receive 

messages*3 (8/05 – 8/06) —

-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 specimens*3 (8/05 – 8/06) —

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) N/A

*Localities were not asked to respond to this question.

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

New York City SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 97

Participated in the Cities Readiness Initiative2 Yes

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities3 Yes

Public health laboratories conducted training for first responders*4 (8/05 – 8/06) —

Activated public health emergency operations center as part of a drill, exercise, or real 

event†‡5 (partial year, 9/06 – 2/07) Yes

Conducted a drill or exercise for key response partners to test communications when 

power and land lines were unavailable‡5 (partial year, 9/06 – 2/07) No

Improve Finalized at least one after-action report with an improvement plan following an 

exercise or real event‡5 (partial year, 9/06 – 2/07) Yes

* Localities were not asked to respond to this question.

† 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.

‡ Localities 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 CRI; 2007; 3 CDC, DSLR; 1999-2005; 4 APHL, Chemical Terrorism Preparedness; May 2007; 5 CDC, DSLR; 2007

New York City
102Public Health Preparedness: Mobilizing State by State

When dozens of people in 

two neighboring counties 

began reporting symptoms of 

gastrointestinal illness in August 

2005, the New York State Department of Health (DOH) 

and local public health departments quickly mounted an 

outbreak investigation. Case findings soon suggested the 

source of illness to be an upstate New York water spray 

park. Tests by the state public health laboratory quickly 

identified the cause as Cryptosporidium, a microscopic 

parasite which may cause profuse diarrhea, anorexia, and 

vomiting. The spray park voluntarily closed after tests 

confirmed the presence of the microorganism in the park’s 

recirculating water system.

Statewide notification to health care providers and a 

coordinated public information campaign resulted in 

over 2,300 reported cases from 36 counties. The timely 

and comprehensive response prevented further spread of 

the infection into the community. The investigation also 

resulted in many public health improvements, including 

“healthy swimming” public awareness campaigns, training 

of spray park operators to reduce the risk of future 

outbreaks, and new regulations requiring spray parks to 

use proper sterilization and health promotion measures. 

This case illustrates how good public health emergency 

planning can enhance disease surveillance, laboratory 

testing, risk communication, and environmental 

mitigation. Thorough evaluation and follow-up to identify 

an outbreak improves response and reduces the effect that 

a communicable disease can have on a community.

Snapshot of Public Health Preparedness

Below are activities conducted by New York in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

New York Responds to an Outbreak of Gastrointestinal Illness 

Clear and coordinated communication is critical for timely and comprehensive response.

New York

http://www.health.state.ny.us/environmental/emergency

According to the New York State 

Department of Health, the cooperative 

agreement is valuable because it has 

contributed greatly in advancing the state’s 

readiness to respond to health emergencies. 

The state has been able to build a system and 

structure to develop, maintain, and manage 

capacities that support health emergency 

preparedness and response activities. 

Resources have been placed into existing 

systems at state and local public health 

departments and with key partners.
103 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of New York laboratories in the Laboratory Response Network1 5

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 71

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 83%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 40

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 85%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

New York SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 95

Number of New York cities in the Cities Readiness Initiative3 3

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

New York
104Public Health Preparedness: Mobilizing State by State

The most significant innovation to 

enhance North Carolina’s response 

ability to public health crises was the 

creation of the seven Public Health 

Regional Surveillance Teams (PHRSTs). These regional 

offices cover all 100 counties across the state to give the 

North Carolina Office of Public Health Preparedness and 

Response the capability to work closely with local public 

health departments and first responders in all aspects of 

preparedness planning, training, and exercise. In addition, 

these seven regional teams act as highly trained and 

organized epidemiology strike teams. 

Each PHRST team includes an epidemiologist, an 

industrial hygienist, a nurse consultant, a pharmacist, a 

veterinarian, and an administrative support technician. 

These teams are essential in providing training to state 

and local health care providers, responding to hurricanes, 

supporting disease investigations, and assisting local 

health directors in public health emergencies. Together 

these teams provide a layered, scaleable response for local, 

regional, state, and national resources to protect and serve 

the residents of North Carolina.

Snapshot of Public Health Preparedness

Below are activities conducted by North Carolina in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

North Carolina Develops Regional Surveillance Teams 

Highly trained public health responders support preparedness functions across the state.

North Carolina

http://www.epi.state.nc.us/epi/phpr

According to the North Carolina Office 

of Public Health Preparedness and 

Response, the cooperative agreement is 

valuable because it has supported local and 

regional public health laboratory capacities, 

epidemiological capacity, and education and 

training of public health responders locally, 

regionally, and at the state level. Funding 

from the cooperative agreement also has 

allowed North Carolina to form a dedicated 

Office of Public Health Preparedness and 

Response.
105 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of North Carolina laboratories in the Laboratory Response Network1 5

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 24

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 96%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 2

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 50%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

North Carolina SNS plan reviewed by CDC2 In 

Progress

- Score on CDC technical assistance review (1-100) N/A

Number of North Carolina cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

North Carolina
106Public Health Preparedness: Mobilizing State by State

In August 2007, the town of 

Northwood, North Dakota was hit 

by a tornado with sustained winds 

ranging from 165 to 200 miles per 

hour. Nearly every building was damaged in the town 

of about 1,000 people. The tornado’s path was five miles 

long and nearly one mile in width. One person was killed 

and eighteen others were injured.

In the early morning after the tornado struck, the North 

Dakota Department of Health (NDDoH) emergency 

operations center (EOC) was activated and in contact 

with both the state EOC and Grand Forks Public Health 

Department. Throughout the week, the NDDoH 

responded to requests for assistance from the city of 

Northwood, Grand Forks Public Health Departments, 

and the North Dakota Division of Emergency Services. 

One system that proved useful during the response was 

the WebEOC, which linked local and state EOCs and 

allowed others to keep abreast of the latest activities. 

The utilization of the Incident Command System (ICS) 

to organize public health and medical response under 

state emergency operations procedures allowed for a 

coordinated and effective response. Many divisions and 

NDDoH employees contributed to the response efforts. 

The ICS enabled multiple agencies and individuals to 

participate in the coordinated efforts at state and local 

levels.

Snapshot of Public Health Preparedness

Below are activities conducted by North Dakota in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Electronic 

Reporting

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

North Dakota Responds to Northwood Tornado 

Incident Command System ensures a well-coordinated and effective response.

North Dakota

http://www.ndhealth.gov/epr

According to the North Dakota Department 

of Health, the cooperative agreement 

is valuable because it has enabled North 

Dakota to build a substantial public health 

and preparedness response capacity that 

would not have existed through any other 

means. A public health response system 

has been built at state and local levels and 

consists of many major components.
107 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of North Dakota laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 7

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

North Dakota SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 77

Number of North Dakota cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

North Dakota
108Public Health Preparedness: Mobilizing State by State

Since 2001, the Ohio Department 

of Health (ODH) has conducted, 

observed, or participated in more 

than three dozen exercises testing 

plans for pandemic influenza, bioterrorism response, 

nuclear power plant events, joint information center 

operation, and multi-agency emergency response. 

Leveraging existing approaches across Ohio, ODH 

operates a regional strategy for seven areas in the state. 

This method ensures everyone from a small township 

to a major metropolitan area have the baseline ability to 

respond to a public health emergency. The strategy also 

promotes cost-effective surge and systems reliability for 

communities within each region.

Using federal guidance, ODH and its partners are 

developing recommendations for medical standards of 

care during an emergency. The goal of these protocols is 

to save the greatest number of lives when resources are 

scarce. While planning is directly connected to preparing 

for an influenza pandemic, the protocols are applicable 

to other significant public health emergencies. Another 

important component being utilized by ODH is the 

Incident Command System (ICS). ODH has used ICS for 

public health emergencies since 1997. ICS operates with a 

strategy to ensure adequate and redundant staffing during 

a prolonged event. Several thousand key staff from state 

and local public health agencies have been trained and 

their agencies attained National Incident Management 

System compliance. ODH continues to provide or fund 

training in ICS.

Snapshot of Public Health Preparedness

Below are activities conducted by Ohio in the area of public health preparedness. They support CDC preparedness goals 

in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages of an 

event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Ohio Develops Robust Plans for Public Health Emergency Preparedness 

Strong all-hazards plans enable greater response capabilities.

Ohio

http://www.prepareohio.com

According to the Ohio Department of 

Health, the cooperative agreement is 

valuable because it has allowed Ohio to build 

a critical planning and response personnel 

infrastructure for most preparedness 

initiatives. A robust and redundant 

communication system which is interoperable 

with other state response partners, hospitals, 

and local health departments has been 

implemented due entirely to funding from 

the cooperative agreement.
109 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Ohio laboratories in the Laboratory Response Network1 2

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 99

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 95%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 12

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 92%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) N/A

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Ohio SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 94

Number of Ohio cities in the Cities Readiness Initiative3 3

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals No

- Local/regional emergency management agencies Yes

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) Yes

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) Yes

*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

Ohio
110Public Health Preparedness: Mobilizing State by State

The ice storms that swept across 

Oklahoma in early 2007 provided a 

real-world test of public health and 

medical emergency preparedness. 

Leadership of the Oklahoma State Department of Health 

(OSDH) fully activated the OSDH Situation Room 

and established an Incident Command System (ICS) to 

coordinate the agency’s statewide response activities. 

The Oklahoma Health Alert Network and EMSystem, 

a real-time communications and resource management 

tool, provided emergency communications to hospital 

and medical system partners. Emergency radio networks 

also were used for messaging, particularly to those areas 

where no electricity was available. In addition, during 

the ice storms, the Commissioner of Health mandated 

carbon monoxide exposure/poisoning to be a reportable 

condition and urged rapid distribution of flyers and 

written warnings about the dangers of carbon monoxide 

poisoning in affected communities. 

The OSDH chose to build upon the state’s existing, wellestablished all-hazards emergency management backbone 

rather than develop new, stand-alone programs for 

preparedness and response. Public health emergencies are 

now routinely handled through the establishment of ICS. 

OSDH is recognized by other lead response organizations, 

such as the Oklahoma Department of Emergency 

Management and the Oklahoma Office of Homeland 

Security, as a key partner in statewide initiatives that 

ensure coordinated and effective planning for all types of 

emergency responses.

Snapshot of Public Health Preparedness

Below are activities conducted by Oklahoma in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Electronic 

Reporting

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Oklahoma Responds to Statewide Ice Storms 

All-hazards emergency response planning promotes effective use of resources and infrastructure.

Oklahoma

http://www.health.ok.gov/bt

According to the Oklahoma State 

Department of Health, the cooperative 

agreement is valuable because it has been 

fundamental to developing and sustaining 

the enhanced infrastructure that did not 

previously exist. Funding has allowed for 

additional personnel who have dedicated their 

efforts to the program and have successfully 

completed training pursuant to cooperative 

agreement guidelines. The funding has 

also helped build local and community 

collaboration and capability.
111 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Oklahoma laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 9

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 1

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) N/A

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Oklahoma SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 91

Number of Oklahoma cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No 

Response

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Oklahoma
112Public Health Preparedness: Mobilizing State by State

In 2006, the Oregon Public Health 

Division (OPHD) completed 

the PandORa (Pandemic Oregon 

Activity) full-scale exercise. The 

exercise involved the scenario of a widespread outbreak 

of a new influenza virus that resulted in hundreds of 

victims falling ill in communities throughout the state. 

Participating organizations included OPHD, more than 

30 local public health departments, 50 hospitals, two 

tribal health departments, the Oregon Board of Pharmacy, 

Oregon National Guard, and state agencies of emergency 

management, administrative services, education, 

transportation, and the fire marshal. 

Key successes and best practices identified during 

the exercise included collaboration between the Joint 

Information Center and the Operations Section, 

teamwork among staff experts in epidemiology and 

immunizations, strong knowledge and practical 

application of the Incident Command System, and 

frequent monitoring and correction of inaccurate media 

reports. OPHD also identified key opportunities for 

improvement that are essential to successfully managing 

the pandemic influenza threat and apply directly to other 

potential disasters. These improvements included the 

need for a larger agency operations center, clarification 

of the public health-based resource request and filing 

process between public health and the State Emergency 

Coordination Center, incorporation of a formal 

documentation management system, and additional 

training in emergency management software applications. 

The lessons learned from this exercise will help OPHD 

improve response to future emergencies.

Snapshot of Public Health Preparedness

Below are activities conducted by Oregon in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Oregon Completes Pandemic Influenza Full-Scale Exercise 

Exercises allow states and localities to test their abilities to respond to potential disasters.

Oregon

http://www.oregon.gov/DHS/ph/preparedness

According to the Oregon Public Health 

Division, the cooperative agreement 

is valuable because it has dramatically 

increased the capacity, expertise, and 

integration of public health with emergency 

response agencies within the state. The state 

has been able to hire and train staff in areas 

of communicable diseases, epidemiology, and 

information systems, and they have proven 

critical for local public health departments 

during this time of increased scarcity of 

public funds.
113 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Oregon laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 12

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) N/A

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) N/A

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Oregon SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 68

Number of Oregon cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

Oregon
114Public Health Preparedness: Mobilizing State by State

In February 2006, a New York City 

resident fell seriously ill while visiting 

Pennsylvania and was quickly rushed 

to a hospital. When the bioterrorism 

agent Bacillus anthracis, or anthrax, was suspected, the 

hospital laboratory contacted public health officials to 

transport a blood sample to the Pennsylvania Department 

of Health (PA DoH) laboratory that confirmed the 

presence of anthrax bacteria. Despite the fact that it was 

a holiday, the PA DoH lab quickly tested the specimen 

and provided the necessary information to the appropriate 

officials, including officials in New York City and at the 

Federal Bureau of Investigation.

This response benefited from cooperative agreement 

funding because it allowed for additional epidemiologic 

and laboratory capacity at the PA DoH. In addition, 

forensic epidemiology training developed and promoted 

by CDC and the U.S. Department of Justice enhanced 

the joint forensic epidemiological investigation effort 

between public health and law enforcement partners. 

To respond to the incident, PA DoH used handheld 

communication devices and employed the Health Alert 

Network to advise health care providers of emergencies, 

strengthen relationships with law enforcement officials 

and other responders in different jurisdictions, and risk 

communications.

Snapshot of Public Health Preparedness

Below are activities conducted by Pennsylvania in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Pennsylvania Responds to a Case of Anthrax 

Joint investigation capacity promotes rapid and coordinated emergency response.

Pennsylvania

http://www.dsf.health.state.pa.us

According to the Pennsylvania Department 

of Health, the cooperative agreement is 

valuable because it has provided critically 

needed funding to purchase equipment and 

services such as the Learning Management 

System, personal protective equipment, 

as well as funded space renovations and 

equipment for an expanded high security 

laboratory and training laboratory.
115 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Pennsylvania laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 60

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 83%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 4

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Pennsylvania SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 60

Number of Pennsylvania cities in the Cities Readiness Initiative3 2

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

Pennsylvania
116Public Health Preparedness: Mobilizing State by State

In December 2006, an elementary 

school student died from 

encephalitis, an inflammation of 

the brain. When two additional 

cases in school-aged children followed, a cooperative 

epidemiologic investigation between CDC and the Rhode 

Island Department of Health (RIDOH) determined that 

all three cases were linked to the bacteria Mycoplasma 

pneumoniae. School districts were reporting higher 

than normal rates of absenteeism because of respiratory 

illness and pneumonia, the most common result of 

M. pneumoniae infection. The state emergency operations 

center was activated at the request of RIDOH. In 

addition, RIDOH activated a unified command structure, 

which included RIDOH, the Rhode Island Department 

of Education (RIDE), and the Rhode Island Emergency 

Management Agency. 

RIDOH communicated the risk of infection to healthcare 

providers, elected officials, and the public. RIDOH also 

distributed hand sanitizers and educational materials 

related to hand hygiene and cough etiquette to all schools 

in the state. A 3-day antibiotic distribution clinic with 

voluntary laboratory testing was established at one 

elementary school, and school nurses helped to institute 

a short-term active surveillance system for possible cases 

of pneumonia. RIDOH also worked with RIDE to draft 

and implement school policies and recommend school 

closures where appropriate. As a result, in the elementary 

school community in which two cases of neurological 

illness occurred, 100% of the community members were 

offered protective antibiotics and 97% accepted them. 

This was accomplished over the New Year’s holiday 

weekend. A significant portion of the affected families 

participated in testing for M. pneumoniae in collaboration 

with CDC epidemiologists, who helped track infections. 

A prospective surveillance system also was instituted to 

monitor for possible clusters of M. pneumoniae and its 

serious complications.

Snapshot of Public Health Preparedness

Below are activities conducted by Rhode Island in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Rhode Island Responds to a Mycoplasma Outbreak 

Community involvement and outreach are critical for successful public health emergency response.

Rhode Island

http://www.health.state.ri.us/environment/biot

According to the Rhode Island Department 

of Health, the cooperative agreement is 

valuable because it has enabled Rhode Island 

to hire staff, purchase laboratory instruments 

and field monitoring equipment, build an 

information technology infrastructure, and 

enhance communication systems among state 

and local partners.
117 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Rhode Island laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 5

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 80%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Rhode Island SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 83

Number of Rhode Island cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

Rhode Island
118Public Health Preparedness: Mobilizing State by State

In January 2005, an industrial 

freight train collision resulted in a 

release of 63 tons of liquid chlorine 

near residential, commercial and 

industrial districts in the small town of Graniteville, South 

Carolina. Nearly 5,500 residents were forced to evacuate. 

More than 500 people needed medical attention for 

possible chlorine exposure, which can result in corrosive 

damage to the eyes, skin, and lungs and lead to eventual 

respiratory failure and even death. 

Diverse response teams were critical to address the wide 

range of needs for a successful response. Responders 

conducted environmental testing in homes, schools and 

factories and decontaminated the area for safe return. 

Public health workers coordinated emergency medical 

services, monitored hospital care, assessed the number 

of casualties, and supported disaster mortuary services. 

Epidemiologists and environmental health scientists 

monitored the chemical exposures and their long-term 

effects on the residents. 

Funding from the cooperative agreement had helped to 

develop South Carolina’s preparedness plans. Local 

emergency management and public health departments 

already had an all-hazard response plan in place because 

of the nuclear facilities, industrial facilities, and numerous 

rail lines in the area. Coordination among agencies was 

also a priority in planning. These established emergency 

response plans and partnerships helped South Carolina 

respond quickly and effectively to this incident.

Snapshot of Public Health Preparedness

Below are activities conducted by South Carolina in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Fax

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

South Carolina Responds to a Train Collision and Toxic Spill 

All-hazard approach in planning improves preparedness for emergencies.

South Carolina

http://www.scdhec.net/administration/ophp

According to the South Carolina 

Department of Health and Environmental 

Control, the cooperative agreement is 

valuable because with this funding, the 

department has been able to begin an 

ambitious program to strengthen the public 

health infrastructure. South Carolina has 

been able to make tremendous progress in 

improving public health and community 

preparedness for responding to bioterrorism, 

weapons of mass destruction, disease 

outbreaks, natural and technological hazards, 

and other threats to the public’s health.
119 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of South Carolina laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 5

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 80%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 4

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 0%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

South Carolina SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 58

Number of South Carolina cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) Yes

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) Yes

*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

South Carolina
120Public Health Preparedness: Mobilizing State by State

The South Dakota pandemic 

influenza tabletop exercise was held 

in November 2006. The primary 

purpose of the exercise was to test 

the execution of the state’s pandemic influenza plan 

during all phases of a simulated pandemic influenza 

event. Fifty participants and observers represented South 

Dakota state public health, emergency management, 

transportation, education, human services, and 

information agencies. The exercise scenario simulated 

the spread of avian influenza virus from Southeast Asia 

to North American cities and, eventually, to the state of 

South Dakota.

Participants reviewed state and local plans for isolation 

and quarantine, laboratory capacity to identify influenza 

virus types, means to distribute resources, communication 

plans with the public and between state and local 

emergency operations, and the state unified command 

structure. Key findings from this exercise identified both 

areas in which South Dakota was well-prepared for this 

type of public health emergency and improvements 

that could be made in preparation for future events. 

Improvements or clarification could be made in resource 

allocation/tracking, definition of state/local roles, policies 

for personnel, school closures, antiviral release, and travel 

restriction.

Snapshot of Public Health Preparedness

Below are activities conducted by South Dakota in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

South Dakota Learns from a Pandemic Influenza Exercise 

Exercising prepares states to effectively manage partners’ responses during an emergency.

South Dakota

http://www.doh.sd.gov

According to the South Dakota Department 

of Health, the cooperative agreement is 

valuable because the state has been able 

to develop relationships and expertise that 

have enabled the development of planning 

and response to emerging health threats in a 

much more coordinated and effective manner. 

Cooperative agreement funding has also 

enabled South Dakota to increase activities 

related to planning, training, and building 

effective and mutually beneficial relationships.
121 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of South Dakota laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 22

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 86%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) No

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

South Dakota SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 52

Number of South Dakota cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

South Dakota
122Public Health Preparedness: Mobilizing State by State

In August 2006, approximately 

150,000 people attended the 

Tennessee Walking Horse National 

Celebration in Shelbyville, 

Tennessee. One of the horses was confirmed to have 

rabies. Because horses may transmit the rabies virus to 

people, the Tennessee Department of Health (TDH) 

responded rapidly to assess public health risks for rabies 

among people who reportedly had contact with the horse. 

Coordination with local, regional, state, and federal 

public health officials contributed to quick notification 

of the public regarding rabies transmission risk. TDH 

immediately initiated an extensive public messaging 

campaign via print and television to communicate the 

risks associated with attending the event and contact with 

the rabid horse. The Tennessee Health Alert Network, 

CDC Health Alert Network, and Epi-X were used to 

quickly correspond with regional and local public health 

departments, emergency departments, and CDC about 

assessment and treatment for people exposed to the horse. 

In addition to media communications, 4,200 attendees 

were contacted by letter. TDH consulted with 53 people 

who were exposed to the rabid horse and recommended 

boosters or post-exposure treatment as appropriate. The 

cooperative agreement supported TDH’s preparedness 

infrastructure to effectively mobilize communication 

networks, including the Public Information Line and 

the Public Health Emergency Preparedness Program 

Universal Call Distribution Support Line to handle high 

call volume.

Snapshot of Public Health Preparedness

Below are activities conducted by Tennessee in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Tennessee Responds to a Rabies Exposure at a Mass Gathering 

Broad range communications networks are critical to inform the public about disease risks.

Tennessee

http://health.state.tn.us/ceds/bioterrorism.htm

According to the Tennessee Department 

of Health, the cooperative agreement is 

valuable because it has funded salaries, 

travel, trainings, equipment, and exercises 

to support public health preparedness. Had 

Hurricanes Katrina and Rita occurred prior to 

the cooperative agreement, certain safeguards 

would not have been in place to aid in 

those particular responses. Preparedness for 

threats and emergencies has been enhanced 

through awareness, training, knowledge, 

and establishment of a laboratory dedicated 

to responding to chemical/biological 

emergencies.
123 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Tennessee laboratories in the Laboratory Response Network1 4

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 16

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 81%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 7

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 86%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Tennessee SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 85

Number of Tennessee cities in the Cities Readiness Initiative3 2

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Tennessee
124Public Health Preparedness: Mobilizing State by State

Over 425,000 evacuees came to 

Texas within days of Hurricane 

Katrina’s landfall, in need of help and 

services from federal, state, and local 

agencies. Many areas throughout the state provided shelter 

to approximately 140,000 people who had no place to 

live. The city of San Antonio alone provided shelter for 

37,500 at an old factory, shopping mall, and KellyUSA, a 

civilian business park and former military base. 

Public health staff were on hand to help with evacuees’ 

immediate medical needs. The San Antonio Metropolitan 

Health District coordinated counseling services and 

suppliers for the most common medications for diabetes, 

hypertension, and heart disease. Pharmacists filled 3,000 

prescriptions for evacuees at KellyUSA alone, and those 

with more urgent needs were transported to area hospitals. 

A network of agencies and professionals set up a 24-hour 

mental health clinic at KellyUSA to identify and treat 

people who needed psychiatric medications. The Texas 

Health and Human Service Commission also extended 

office hours to help people access benefits for Medicaid, 

food stamps, and prescriptions.

San Antonio community partners, including nonprofits, 

businesses, the faith community, and the public, all 

contributed greatly to the community’s response. For 

example, businesses provided food and discounted hotel 

rates for evacuees and also provided communications 

services and equipment for shelters. Public health 

professionals in cooperation with these and other partners 

worked to ensure a coordinated response that protected 

the health of thousands of evacuees.

Snapshot of Public Health Preparedness

Below are activities conducted by Texas in the area of public health preparedness. They support CDC preparedness goals 

in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages of an 

event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Texas Responds to an Influx of Hurricane Katrina Evacuees 

Community partnerships are critical during public health emergencies.

Texas

http://www.dshs.state.tx.us/preparedness

According to the Texas Department of State 

Health Services, the cooperative agreement 

is valuable because it has strengthened 

the state’s ability to conduct public health 

surveillance and epidemiological studies 

through Epidemiology Response Teams. 

Funding has allowed Texas to hire and train 

staff and purchase needed communication 

systems, computers, and other equipment. 

Texas’s response to Hurricanes Katrina and 

Rita showed the readiness level achieved 

through cooperative agreement funding.
125 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Texas laboratories in the Laboratory Response Network1 16

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 32

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 94%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 16

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 69%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Texas SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 97

Number of Texas cities in the Cities Readiness Initiative3 3

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

Texas
126Public Health Preparedness: Mobilizing State by State

In 2006, a long-haul truck driver 

who had just arrived in Salt 

Lake City, Utah, from Seattle, 

Washington, showed up at an 

emergency room with skin lesions and a fever. The 

attending physician in the emergency room determined 

that the appearance of the lesions was compatible with the 

symptoms of smallpox infection. Immediately recognizing 

the complexity of the situation, the physician notified 

the Salt Lake Valley Health Department. The emergency 

room was immediately closed and anyone present at the 

time the truck driver arrived was not allowed to leave. 

After consulting with the Utah Department of Health 

(UDOH) and CDC, a sample was taken to the UDOH 

laboratory for testing. It was quickly determined that the 

man fortunately did not have smallpox, but instead had 

atypical chicken pox. 

Quick response and resolution occurred because 

individuals involved in this response were trained to 

communicate with both the local and state public health 

departments. The state laboratory was equipped with the 

technology to quickly confirm whether the truck driver 

had smallpox. Utah has the capability to complete rapid 

testing, which takes only a matter of hours, whereas 

before the cooperative agreement, the sample would have 

required transportation to CDC in Atlanta, Georgia, 

for confirmation. All select bioterrorism agents can 

now be tested within the state. Also, local public health 

departments have working relationships with the hospitals 

in their area, which were fostered due to cooperative 

agreement funds.

Snapshot of Public Health Preparedness

Below are activities conducted by Utah in the area of public health preparedness. They support CDC preparedness goals 

in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages of an 

event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Utah Responds to Potential Smallpox Case 

Localized laboratory testing capabilities ensure the rapid confirmation of potential diseases.

Utah

http://health.utah.gov/bt

According to the Utah Department of 

Health, the cooperative agreement is 

valuable because it has allowed Utah 

to develop an all-hazard response plan, 

implement systems for surveillance and 

detection, enhance laboratories, and increase 

capabilities in communications.
127 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Utah laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 35

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 94%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 4

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) No 

Response

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Utah SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 66

Number of Utah cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Utah
128Public Health Preparedness: Mobilizing State by State

Vermont conducted Operation 

Pandemic Influenza, a full-scale, 

2-week exercise in July 2007, to 

evaluate a multi-faceted, statewide 

response to a pandemic avian influenza outbreak. The 

emergency scenario included the discovery of avian 

influenza on a poultry farm in southern Vermont and the 

quarantine of students at two Vermont colleges.

The exercise provided an opportunity for state 

departments of health and agriculture, hospitals, 

universities, emergency management, and the National 

Guard to practice critical skills required should the state 

need to activate public health emergency plans. Partners 

tested disease surveillance, epidemiologic investigation, 

and response to detect and control the spread of pandemic 

influenza, as well as laboratory capacity to test and 

confirm clinical samples. The exercise also simulated the 

request, receipt, storage, and dispensation of Strategic 

National Stockpile assets from CDC. Delivery of 

influenza vaccine by community clinics and the system 

to monitor distribution and use of influenza vaccine were 

also tested.

The Health Alert Network was tested to rapidly exchange 

information among health professionals. The state 

emergency operations centers also were activated. The 

new emergency management system, DisasterLAN, was 

effectively used to keep key state support roles updated 

on critical information. Information also was provided to 

the public through activation of the Crisis and Emergency 

Risk Communication plan.

Snapshot of Public Health Preparedness

Below are activities conducted by Vermont in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Vermont’s Full-scale Exercise of Operation Pandemic Influenza

Extensive exercising is important to test the readiness of all components of an emergency response plan.

Vermont

http://healthvermont.gov/e_ready.aspx

According to the Vermont Department 

of Health, the cooperative agreement 

is valuable because the state now has 

a dedicated Office of Public Health 

Preparedness & Emergency Medical 

Services that coordinates all work in this 

area. Laboratory abilities to test numerous 

chemical and biological agents have increased 

substantially, and the necessary staff are in 

place in times of emergency.
129 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Vermont laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 3

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) No

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Vermont SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 90

Number of Vermont cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals No

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) No

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

Vermont
130Public Health Preparedness: Mobilizing State by State

In April 2007, a mass shooting 

occurred on the college campus of 

Virginia Polytechnic Institute and 

State University, commonly known 

as Virginia Tech. The shooting left 34 people dead and 

26 others injured. The collaborative effort of regional 

hospitals, emergency medical services, and state and local 

public health departments resulted in a quick response. 

Before the shootings, the events of September 11 had 

increased attention to mass casualty preparedness and 

response, and federal funding helped establish a regional 

health system model ready for such a response. For 

example, regional collaborative planning, training, and 

exercising resulted in increased experience, improved 

communications, and closer relationships among 

responders. During the Virginia Tech shootings, the 

close relationship between state and local public health 

and the Virginia healthcare system led to improved 

communications and a better response overall. The low 

overall mortality rate of victims, despite limitations given 

the rural health care system, was evidence of a successful 

response.

A key lesson learned was that mass casualty situations can 

occur anywhere, including rural areas with limited to no 

access to trauma centers. Organization and leadership, 

possible alterations in care standards, education, 

communications, transportation, triage and legal issues 

all emerged as important issues. Lessons learned from 

the Virginia Tech incident will assist Virginia healthcare 

and public health systems to improve planning for future 

emergencies.

Snapshot of Public Health Preparedness

Below are activities conducted by Virginia in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Virginia Responds to the Shootings at Virginia Tech 

Partnerships are critical for cohesive response to mass casualty incidents.

Virginia

http://www.vdh.state.va.us/epr

According to the Virginia Department 

of Health, the cooperative agreement is 

valuable because it has allowed for many 

improvements that contribute to the state’s 

overall emergency and preparedness response 

capabilities, including additional staff at local, 

regional, and state levels within the health 

department and state laboratory. In addition, 

Virginia has been able to build an incident 

and unified command structure that did not 

exist before 2002, as well as build redundant 

communications systems within public health 

and healthcare systems statewide.
131 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Virginia laboratories in the Laboratory Response Network1 2

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 29

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 86%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 6

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Virginia SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 97

Number of Virginia cities in the Cities Readiness Initiative3 2

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Virginia
132Public Health Preparedness: Mobilizing State by State

The Washington State Department 

of Health co-sponsored the fourth 

annual Pacific Northwest Cross 

Border Workshop with the British 

Columbia Ministry of Health in May 2007. Partnerships 

among the border states have led to successful responses 

to incidents such as SARS and a Salmonella pet food 

outbreak. Over 200 public health and emergency 

management professionals represented the Canadian 

western provinces, the northwest United States, the Native 

American and First Nations tribes, and the two federal 

governments. 

Expert presentations and group discussions were 

conducted on epidemiology, surveillance, public health 

laboratories, emergency management, communications, 

and public health law. The meeting also covered special 

topics in cross-border initiatives, tribal preparedness, 

pandemic influenza planning, and similarities and 

differences in planning betweefn the United States and 

Canada.

Effective cross-border response in a public health 

emergency will require planned, coordinated activities by 

multiple agencies. Barriers to effectiveness include lack 

of familiarity with the roles and identities of appropriate 

responders, lack of established lines of intra- and 

interagency communications and data sharing, lack of 

planning and agreements for sharing scarce resources, and 

failure to address legal or jurisdictional issues that may 

restrict international cooperation. The workshops have 

been successful in identifying areas in which cooperation 

can be strengthened as well as partners’ ability to 

respond to both national and international public health 

emergencies.

Snapshot of Public Health Preparedness

Below are activities conducted by Washington in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Washington Co-Sponsors Public Health Initiatives 

Cross-border collaboration bolsters disease surveillance and response during an emergency.

Washington

http://www.doh.wa.gov/phepr

According to the Washington State 

Department of Health, the cooperative 

agreement is valuable because state and local 

public health jurisdictions have been able to 

build critical programs and infrastructure to 

support preparedness and response activities. 

Funds have been used to hire staff in all 

program areas, purchase vital equipment and 

software, and support training, planning, and 

exercise efforts.
133 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Washington laboratories in the Laboratory Response Network1 6

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 101

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 97%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 10

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Washington SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 90

Number of Washington cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) No

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) Yes

*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

Washington
134Public Health Preparedness: Mobilizing State by State

In September 2005, the 

Governor of West Virginia 

requested that the state receive, 

temporarily house, and support 

Hurricane Katrina evacuees. Within 24 hours, state 

agencies and their partners developed and implemented a 

plan for the anticipated arrival of the evacuees. The state 

received approximately 300 Hurricane Katrina evacuees 

from New Orleans at the Charleston, West Virginia 

airport, where registration, clothing, food, and initial 

medical screening and treatment were provided. Evacuees 

then were moved to an Army National Guard base as 

part of Operation Safe Haven, where they were housed, 

linked to both short- and long-term service needs, and 

reconnected with friends and family. This month-long 

operation was managed by the West Virginia Department 

of Health and Human Resources (WVDHHR). 

Operation Safe Haven was a multi-agency operation that 

coordinated activities through the National Incident 

Management System. The WVDHHR provided 

command and control for the overall operation in 

addition to coordinating medical care, providing 

behavioral health services, public health services, 

social services, case management, and community 

communications. The American Red Cross coordinated 

the provision of food and staffed housing units. The 

National Guard provided facility support, transportation, 

staff support, and security. Universities and the private 

sector generously provided resources otherwise not 

available to support the operation. Coordination and 

partnership among state agencies, private sector agencies, 

and the volunteer community demonstrated that 

preparedness in unaffected states enables rapid response to 

incidents in neighboring states and nationwide.

Snapshot of Public Health Preparedness

Below are activities conducted by West Virginia in the area of public health preparedness. They support CDC 

preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare 

for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

West Virginia Responds to Hurricane Katrina – Operation Safe Haven

Capability of unaffected states enables strong support for national incidents.

West Virginia

http://www.wvdhhr.org/healthprep

According to the West Virginia Department 

of Health and Human Resources, the 

cooperative agreement is valuable because

it has allowed for the development of 

an All-Hazard Public Health Emergency 

Response Plan and increased communication 

capabilities statewide. Almost no comparison 

can be made between the previous system and 

what is in place today.
135 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of West Virginia laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) Yes

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

West Virginia SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 61

Number of West Virginia cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

West Virginia
136Public Health Preparedness: Mobilizing State by State

In September 2006, Wisconsin 

public health officials reported a 

cluster of E. coli O157:H7 infections 

to CDC. Through the use of an 

advanced “DNA fingerprinting” technique called pulsedfield gel electrophoresis (PFGE), staff at the Wisconsin 

State Laboratory of Hygiene (WSLH) were the first in 

the nation to identify the bacterial strain that sickened 

hundreds and caused three deaths in the spinach E. coli

O157:H7 outbreak. By comparing PFGE patterns, or 

“DNA fingerprints,” in the Pulsenet national database, 

CDC determined that within 1 month, 183 people across 

26 states had been infected by the same strain. Joint 

epidemiology and laboratory investigations were critical in 

identifying the source of this outbreak.

The WSLH staff received the 2007 PulseNet PulseStar 

award from CDC and the Association of Public 

Health Laboratories for their efforts. Funding from the 

cooperative agreement was critical in providing WSLH 

with the laboratory capacity to successfully identify the 

bacterial strain that swept across the nation. Both the 

bacterial strain and outbreak source were identified 

rapidly, and public health communications regarding 

food safety, E. coli infection, and product recall were 

quickly developed to protect people from further spread 

of infection. Individual states can have a significant 

role in stemming nationwide disease outbreaks through 

well-equipped and staffed laboratories and epidemiology 

divisions.

Snapshot of Public Health Preparedness

Below are activities conducted by Wisconsin in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Wisconsin Identifies E. coli in Spinach during 2006 Nationwide Outbreak 

Laboratory and epidemiology capacity is critical for rapid response to national disease outbreaks.

Wisconsin

http://dhfs.wisconsin.gov/preparedness

According to the Wisconsin Department of 

Health and Family Services, the cooperative 

agreement is valuable because it has led to 

a dramatic increase in Wisconsin’s capacity to 

conduct disease surveillance, epidemiological 

investigations, laboratory testing, and rapid/

secure communications through the Health 

Alert Network. The state also has established 

and operated 12 local public health 

departments and tribal preparedness consortia 

to maximize funding, resources, personnel, 

and planning.
137 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Wisconsin laboratories in the Laboratory Response Network1 3

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 117

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 89%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 8

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 88%

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) Yes

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) No

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) Yes

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) Yes

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Wisconsin SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 86

Number of Wisconsin cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies Yes

- Federal emergency management agencies Yes

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) No

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) No

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) Yes

*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

Wisconsin
138Public Health Preparedness: Mobilizing State by State

In 2006, Wyoming participated in 

a multi-state pandemic influenza 

tabletop exercise, Operation Wide 

Open Spaces, that focused on 

strategies to mitigate the spread of disease and to assess 

the availability of local resources should a pandemic occur. 

Video conferencing technology brought together 31 

bordering counties in Wyoming, Colorado, Kansas, and 

Nebraska, covering a population size of approximately 

850,000. The exercise included representatives from 

four state, six regional, and ten local public health 

departments; the Indian Health Service; and other state 

and local agencies.

The exercise scenario involved avian influenza cases 

identified in airline passengers arriving in the United 

States from Asia. Participants discussed effective and 

timely cross-border and public communication strategies, 

cross-jurisdictional and multi-level information sharing, 

isolation and quarantine measures, and use of nontraditional partnerships. The Incident Command System 

was also exercised, enabling people from different agencies 

and jurisdictions to work together. In addition, the 

Wyoming Department of Health conducted drills leading 

up to and during the exercise to test communication 

systems, such as the Health Alert Network, the new 

emergency communication management system, 

two-way radios, satellite phones, and remote video/

teleconferencing. Wyoming identified areas of strength 

which served the state well during this tabletop exercise, 

as well as areas for improvement. This allowed the state to 

strengthen its response capabilities should a real influenza 

pandemic occur in the future.

Snapshot of Public Health Preparedness

Below are activities conducted by Wyoming in the area of public health preparedness. They support CDC preparedness 

goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages 

of an event. These data are not comprehensive and do not cover all preparedness activities.

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.

Detect &

Report

Could receive and investigate urgent disease reports 24/7/3651 Yes

- Primary method for receiving urgent disease reports*2 Telephone

Linked state and local health personnel to share information about disease outbreaks 

across state lines (through the CDC Epi-X system)3 Yes

Conducted year-round surveillance for seasonal influenza4 Yes

*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

Wyoming Participates in a Multi-state Pandemic Influenza Exercise 

Exercises highlight strengths and enhance response during a real incident.

Wyoming

http://wdh.state.wy.us/sho/hazards

According to the Wyoming Department 

of Health, the cooperative agreement 

is valuable because it has allowed the 

department to hire staff to improve disease 

surveillance and laboratory testing, working 

relationships with the Eastern Shoshone and 

Northern Arapaho tribes, and preparedness 

at the county level; enhance laboratory 

capabilities by implementing rapid testing 

methods, training clinical laboratory 

staff, and establishing a courier system to 

rapidly transport samples to public health 

laboratories; and implement a communication 

system to rapidly disseminate health alerts.
139 Public Health Preparedness: Mobilizing State by State

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. 

Detect & Report

Number of Wyoming laboratories in the Laboratory Response Network1 1

Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) 4

- Percentage of test results submitted to CDC database (PulseNet) within 4 days 100%

Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):2

- Number of samples received (partial year, 9/06 – 2/07) None

- Percentage of test results submitted to CDC database (PulseNet) within 4 days N/A

Had a laboratory information management system that could create, send, and receive 

messages3 (8/05 – 8/06) No

- System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06) N/A

Had a rapid method to send urgent messages to frontline laboratories that perform 

initial screening of clinical specimens3 (8/05 – 8/06) Yes

Crosscutting

Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06) No

Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06) N/A

1 CDC, DBPR; 2007; 2 CDC, DSLR; 2007; 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007; 4 CDC, DSLR; 2006

Response

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. 

Control

Developed a public health response plan, including pandemic influenza response, crisis 

and emergency risk communication, and Strategic National Stockpile (SNS)1, 2 Yes

Wyoming SNS plan reviewed by CDC2 Yes

- Score on CDC technical assistance review (1-100) 72

Number of Wyoming cities in the Cities Readiness Initiative3 1

Crosscutting

Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:1 (8/05 – 8/06)

- Hospitals Yes

- Local/regional emergency management agencies No

- Federal emergency management agencies No

Public health department staff participated in training to support cooperative 

agreement activities4 Yes

Public health laboratories conducted training for first responders5 (8/05 – 8/06) Yes

Activated public health emergency operations center as part of a drill, exercise, or real 

event*†6 (partial year, 9/06 – 2/07) Yes

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) Yes

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) Yes

*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

Wyoming
140Public Health Preparedness: Mobilizing State by State
141 Public Health Preparedness: Mobilizing State by State

Table 1: Cooperative Agreement Funding Allocation, FY 2002-2007

Jurisdiction FY 20021 FY 2003*1 FY 20042 FY 2005†2 FY 2006‡2 FY 2007§2 Total FY 

2002-2007

Alabama $14,900,443 $15,598,792 $12,910,651 $14,405,196 $14,813,276 $12,951,863 $85,580,221

Alaska $6,395,720 $6,502,762 $5,205,459 $5,868,019 $6,110,696 $5,838,752 $35,921,408

American 

Samoa $544,481 $576,463 $444,499 $561,855 $621,074 $547,830 $3,296,202

Arizona $16,422,170 $17,586,381 $16,470,314 $18,924,112 $19,853,184 $17,681,799 $106,937,960

Arkansas $10,951,709 $11,390,938 $9,339,265 $10,465,767 $10,831,516 $9,389,729 $62,368,924

California $60,816,245 $64,203,968 $59,319,441 $68,062,495 $72,029,121 $65,303,030 $389,734,300

Chicago $11,447,312 $11,378,246 $12,563,491 $14,014,304 $14,057,525 $15,703,041 $79,163,919

Colorado $14,575,766 $15,508,850 $13,654,314 $15,543,448 $15,894,493 $14,009,943 $89,186,814

Connecticut $12,581,705 $13,145,748 $10,828,647 $12,149,799 $12,668,280 $11,324,491 $72,698,670

Delaware $6,744,505 $6,889,271 $5,518,506 $6,295,104 $6,563,586 $5,911,495 $37,922,467

District of 

Columbia $11,273,558 $11,360,917 $11,985,069 $12,566,917 $7,562,416 $9,898,128 $64,647,005

Florida $40,581,081 $43,832,162 $37,583,527 $43,854,875 $47,080,106 $42,467,776 $255,399,527

Georgia $23,225,251 $24,935,506 $21,575,121 $24,931,530 $25,990,548 $23,156,267 $143,814,223

Guam $777,788 $679,585 $515,976 $690,478 $868,854 $771,758 $4,304,439

Hawaii $7,697,208 $7,910,098 $6,384,925 $7,184,997 $7,464,696 $6,418,428 $43,060,352

Idaho $7,880,688 $8,131,994 $6,588,258 $7,462,364 $7,824,227 $6,637,005 $44,524,536

Illinois $26,201,381 $28,315,621 $23,718,971 $26,922,367 $27,588,405 $24,575,584 $157,322,329

Indiana $18,536,799 $19,530,623 $16,262,765 $18,468,758 $19,103,844 $16,965,990 $108,868,779

Iowa $11,514,786 $11,953,663 $9,816,873 $10,940,911 $11,250,544 $9,779,223 $65,256,000

Kansas $10,985,143 $11,408,553 $9,354,215 $10,459,139 $11,019,457 $9,548,745 $62,775,252

Kentucky $13,998,067 $14,649,896 $12,105,282 $13,549,995 $14,090,005 $12,441,275 $80,834,520

Los Angeles

County $24,591,171 $27,856,971 $27,069,695 $30,833,561 $31,178,436 $30,712,150 $172,241,984

Louisiana $14,949,145 $15,602,245 $12,913,581 $14,382,879 $14,936,760 $13,243,220 $86,027,830

Maine $7,838,322 $8,046,341 $6,600,682 $7,424,912 $7,685,678 $6,526,615 $44,122,550

Marshall 

Islands $306,025 $561,544 $434,158 $560,134 $623,738 $550,238 $3,035,837

Cooperative Agreement Funding

Appendix 1

Table 1 presents cooperative agreement funding for states, localities, territories, and freely associated states from FY 2002–2007.

continues on next page
142Public Health Preparedness: Mobilizing State by State

Jurisdiction FY 20021 FY 2003*1 FY 20042 FY 2005†2 FY 2006‡2 FY 2007§2 Total FY 

2002-2007

Maryland $16,791,405 $17,774,011 $14,756,853 $17,131,387 $18,133,509 $16,047,435 $100,634,600

Massachusetts $19,134,801 $20,181,459 $17,640,158 $19,933,739 $20,197,272 $18,039,563 $115,126,992

Michigan $27,125,655 $28,731,577 $26,896,854 $30,057,553 $30,340,068 $26,992,552 $170,144,259

Micronesia $446,522 $653,415 $497,837 $623,034 $733,508 $649,441 $3,603,757

Minnesota $15,952,086 $16,821,680 $14,701,780 $16,735,319 $16,990,908 $15,591,574 $96,793,347

Mississippi $11,332,975 $11,782,347 $9,671,470 $10,809,190 $11,149,255 $9,722,248 $64,467,485

Missouri $17,456,448 $18,369,845 $15,952,563 $18,212,581 $18,695,498 $16,566,343 $105,253,278

Montana $7,008,529 $7,147,269 $5,775,627 $6,475,076 $6,728,463 $5,982,933 $39,117,897

Nebraska $8,809,733 $9,079,368 $7,377,335 $8,269,079 $8,547,285 $7,324,390 $49,407,190

Nevada $9,448,659 $9,975,108 $8,927,588 $10,312,883 $10,740,080 $9,340,451 $58,744,769

New 

Hampshire $7,751,193 $7,986,786 $6,465,014 $7,340,273 $7,609,049 $6,447,504 $43,599,819

New Jersey $23,732,611 $25,185,572 $21,047,364 $24,554,977 $25,095,585 $22,337,726 $141,953,835

New Mexico $9,049,687 $9,342,376 $8,803,295 $9,767,256 $10,112,893 $8,690,645 $55,766,152

New York $29,418,122 $31,675,790 $28,493,781 $31,499,224 $32,201,357 $28,874,622 $182,162,896

New York 

City $22,828,585 $23,586,023 $25,864,757 $28,535,849 $28,742,088 $28,822,589 $158,379,891

North 

Carolina $22,919,940 $24,462,186 $20,433,395 $23,094,942 $24,056,483 $21,306,097 $136,273,043

North Dakota $6,429,710 $6,509,688 $5,223,458 $5,847,548 $6,063,487 $5,839,560 $35,913,451

Northern 

Marianas 

Islands

$314,371 $585,043 $450,446 $584,096 $671,401 $593,312 $3,198,669

Ohio $30,275,149 $32,012,830 $27,626,951 $31,183,708 $32,187,334 $28,837,726 $182,123,698

Oklahoma $12,682,086 $13,228,697 $10,899,049 $12,193,074 $12,552,423 $11,101,950 $72,657,279

Oregon $12,616,956 $13,237,862 $10,906,827 $12,521,422 $13,132,689 $11,468,821 $73,884,577

Palau $192,061 $521,761 $406,583 $515,482 $536,951 $471,804 $2,644,642

Pennsylvania $32,340,936 $34,178,922 $30,735,407 $34,485,058 $34,864,545 $31,306,870 $197,911,738

Puerto Rico $13,478,640 $14,103,331 $11,641,389 $13,016,943 $13,167,668 $11,445,404 $76,853,375

Rhode Island $7,333,840 $7,513,164 $6,048,030 $7,001,977 $7,185,100 $6,073,925 $41,156,036

South 

Carolina $13,931,820 $14,634,027 $12,091,813 $13,617,772 $14,135,585 $12,548,500 $80,959,517

South Dakota $6,680,506 $6,798,496 $5,441,461 $6,111,718 $6,347,032 $5,878,521 $37,257,734

continues on next page
143 Public Health Preparedness: Mobilizing State by State

Jurisdiction FY 20021 FY 2003*1 FY 20042 FY 2005†2 FY 2006‡2 FY 2007§2 Total FY 

2002-2007

Tennessee $17,665,877 $18,635,684 $15,488,192 $17,380,881 $18,158,899 $16,418,187 $103,747,720

Texas $51,421,771 $55,684,954 $51,803,533 $59,464,754 $62,045,438 $56,222,601 $336,643,051

Utah $9,971,636 $10,404,357 $8,501,910 $9,632,487 $10,138,504 $8,878,797 $57,527,691

Vermont $6,355,413 $6,453,782 $5,198,685 $5,837,490 $6,052,340 $5,843,658 $35,741,368

Virgin Islands 

(US) $419,235 $639,297 $488,051 $623,850 $734,858 $650,661 $3,555,952

Virginia $20,758,682 $22,068,328 $19,924,893 $22,766,355 $23,915,622 $21,300,739 $130,734,619

Washington $18,121,902 $19,214,353 $16,978,969 $19,341,607 $19,965,603 $17,735,544 $111,357,978

West Virginia $9,025,861 $9,271,321 $7,540,254 $8,439,010 $8,683,141 $7,412,363 $50,371,950

Wisconsin $16,940,986 $17,821,131 $14,811,846 $16,806,704 $17,367,490 $15,868,646 $99,616,803

Wyoming $6,099,142 $6,171,022 $4,908,897 $5,528,786 $5,750,124 $5,748,448 $34,206,419

TOTAL $918,000,000 $970,000,000 $849,586,000 $962,777,000 $991,440,000 $896,736,525 $5,588,539,525 

* Includes $100 million Smallpox Supplement

† Includes $100 million Pandemic Influenza Supplement

‡ Includes $225 million Pandemic Influenza Supplement

§ Includes $175 million Pandemic Influenza Supplement

1 CDC 2

 HHS Press Releases
144Public Health Preparedness: Mobilizing State by State
145 Public Health Preparedness: Mobilizing State by State

DHS National Preparedness Guidelines and Priorities

Appendix 2

DHS established the National Preparedness 

Guidelines (formerly the National Preparedness Goal) 

in September 2007. The guidelines include a series of 

national priorities to guide preparedness efforts that 

meet the nation’s most urgent needs. The priorities 

reflect major themes and recurring issues identified 

in national strategies, presidential directives, State 

and Urban Area Homeland Security Strategies, the 

Hurricane Katrina Reports, and other lessons-learned 

reports. The priorities will be updated or refined 

over time as the nation implements the National 

Preparedness Guidelines or encounters changes 

in the homeland security strategic environment. 

These priorities are also applicable to public health 

preparedness. 

The Guidelines provide three planning tools to help 

government officials achieve these priorities: the 

National Planning Scenarios, the Target Capabilities 

List (TCL), and the Universal Task List (UTL). 

The National Planning Scenarios are designed to 

identify the broad spectrum of tasks and capabilities 

needed for all-hazards preparedness. The TCL is a 

comprehensive catalog of capabilities to perform 

homeland security missions, including performance 

measures and metrics for common tasks. The UTL is 

a library and hierarchy of tasks by homeland security 

mission area. For more information, see 

www.fema.gov/pdf/government/npg.pdf.

National Preparedness Priorities

• Expand Regional Collaboration

• Implement the National Incident 

Management System and National Response 

Plan

• Implement the National Infrastructure 

Protection Plan

• Strengthen Information Sharing and 

Collaboration Capabilities

• Strengthen Interoperable Communications 

Capabilities

• Strengthen Chemical, Biological, 

Radiological, Nuclear, and Explosive 

Detection, Response, and Decontamination 

Capabilities

• Strengthen Medical Surge and Mass 

Prophylaxis Capabilities

• Strengthen Planning and Citizen 

Preparedness Capabilities
146Public Health Preparedness: Mobilizing State by State
147 Public Health Preparedness: Mobilizing State by State

The mission of CDC’s terrorism preparedness and emergency response activities is to prevent 

death, disability, disease, and injury associated with urgent health threats by improving 

preparedness of the public health system, the healthcare delivery system, and the public. 

CDC has made all-hazards preparedness and emergency response a priority and is building 

and enhancing systems at the local, state, and federal levels. For more information, see http://

emergency.cdc.gov/.

Coordinating Office for Terrorism Preparedness and 

Emergency Response (COTPER) 

COTPER coordinates terrorism preparedness and emergency response activities across CDC 

and strategically distributes funds to other CDC centers and offices. COTPER is comprised of 

the following divisions: • The Division of State and Local Readiness (DSLR) administers the Public Health 

Emergency Preparedness cooperative agreement, which funds state and local efforts to 

build and strengthen their infrastructure and capabilities to respond to and recover from 

a public health emergency and provides consultation and technical assistance to promote 

these efforts. DSLR also manages the Centers for Public Health Preparedness program, 

located in 27 universities across the country, and supports eight Advanced Practice 

Centers, which are local public health departments that develop cutting-edge tools and 

resources that help other local public health departments prepare for, respond to, and 

recover from emergencies. 

• The Division of Strategic National Stockpile (DSNS) supports and maintains the 

Strategic National Stockpile (SNS), a national repository of antibiotics, antiviral drugs, 

chemical antidotes, antitoxins, life-support medications, intravenous administration 

equipment, airway maintenance supplies, and medical/surgical items. During a public 

health emergency, state and local public health systems and resources may become 

overwhelmed. The SNS is designed to supplement and re-supply state and local public 

health departments in the event of such an emergency. DSNS also provides technical 

assistance to local officials to help ensure that local, state, and federal agencies can work 

together to receive, stage, store, and distribute SNS assets.

• The Division of Emergency Operations (DEO) is CDC’s command center for the 

coordination of emergency response to domestic and international public health threats 

and is staffed 24/7/365. The Director’s Emergency Operations Center (DEOC) is 

equipped with state-of-the-art communications technologies to support information 

pipelines with state, federal, and international partners. The DEOC is the CDC contact 

for state public health departments for reporting potential public health threats.

• The Division of Select Agents and Toxins (DSAT) regulates the possession, use, and 

transfer of biological agents and toxins (select agents) that could pose a severe threat to 

public health and safety.

• The Office of the Director (OD) manages strategy, goals setting, budget formulation, 

communication, and science for terrorism preparedness and emergency response 

activities. In addition, OD manages the Career Epidemiology Field Officer program, 

which recruits and supports skilled epidemiologists in state and local public health 

Overview of CDC Preparedness Activities

Appendix 3
148Public Health Preparedness: Mobilizing State by State

departments. Public health departments can choose to spend cooperative agreement 

funds to support a field officer in their public health department. 

Other centers within CDC also contribute to public health preparedness and are described 

below in alphabetical order.

Coordinating Center for Environmental Health and Injury 

Prevention (CCEHIP)

CCEHIP plans, directs, and coordinates public health research, programs, and laboratory 

sciences that improve health and eliminate illness, disability, and/or death caused by injuries or 

environmental exposures. The following highlights public health preparedness activities within 

national centers of CCEHIP: • The National Center for Environmental Health/Agency for Toxic Substances and 

Disease Registry (NCEH/ATSDR) conducts ongoing projects to improve surveillance 

systems, laboratory capacity, and emergency response. NCEH/ATSDR is improving 

various surveillance systems for chemical exposures, hazardous substance spills, and 

morbidity following disasters. Upgrades of CDC laboratories enhance their capacity 

to respond to chemical and radiological terrorism and to analyze toxins via improved 

analytical methods. NCEH/ATSDR is also working with state and local public health 

departments to improve response to chemical, nuclear, and radiological terrorism.

• The National Center for Injury Prevention and Control (NCIPC) links to the 

injury care community to decrease morbidity and mortality from injuries caused by 

explosions. NCIPC is moving towards this goal through curriculum development for 

health care providers, the development of clinical guidelines in blast injury management, 

improvement of field triage for large-scale blast injuries, and translation of lessons learned 

from international and U.S. military experience. 

Coordinating Center for Health Information and Service 

(CCHIS)

CCHIS provides leadership and promotes innovation in public health informatics, health 

statistics, health marketing, and scientific communications. The following describe the many 

ways in which the national centers within CCHIS are enhancing communications to help 

detect and respond to emergencies. • The National Center for Health Marketing (NCHM) strengthens health 

communications networks across federal, state, and local levels with such projects as Epi- X, the Public Health Training Network, and the National Public Health Radio Network. 

NCHM’s Emergency Communication Branch provides leadership for cross-agency 

emergency risk communication during emergencies, and ensures that CDC coordinates 

with state and local public health departments in providing critical health protection 

information to the public, clinicians, emergency responders, and other stakeholders. The 

emergency response component of the CDC-INFO Contact Center and Translation 

Services for Emergency Information enhances dissemination of emergency information 

to the public by translating emergency requests in up to 150 different languages.
149 Public Health Preparedness: Mobilizing State by State

• The National Center for Public Health Informatics (NCPHI) coordinates BioSense, 

the near real-time biosurveillance system that provides health situational awareness using 

existing data from healthcare organizations across the country. Through PHIN, NCPHI 

provides technical assistance and guidance to state and local partners to implement 

interoperable public health information systems allowing for the exchange of data 

across organizational and jurisdictional boundaries. The LRN Real Time Laboratory 

Information Exchange also equips LRN labs to securely share data in real time according 

to industry standards.

• The National Center for Health Statistics (NCHS) develops and conducts data 

collection activities to monitor the nation’s health and provides expertise in data 

collection and analysis to state and local partners through collaborative efforts. Examples 

of such efforts include the California Health Interview Survey and New York City’s 

Community Health and Nutrition Examination Survey, work with state vital statistics 

offices to improve state data collection activities, and assisting states in data collection 

needs related to disasters such as Hurricane Katrina. NCHS also provides leadership 

in developing classification standards for reporting morbidity and mortality and in 

monitoring adoption of electronic health records by health providers.

Coordinating Center for Health Promotion (CoCHP)

CoCHP seeks to increase the potential for full, satisfying, and productive living across the 

lifespan for all people, in all communities. CoCHP preparedness activities include providing 

technical expertise in epidemiology, surveillance and communications for populations with 

physical and development disabilities and chronic diseases, pregnant and lactating women, 

reproductive-age women, infants, the elderly, and school-age children in emergencies. 

Additional activities include: • The National Center on Birth Defects and Developmental Disabilities (NCBDDD)

is conducting ongoing projects to develop and strengthen intramural research and 

surveillance capacity related to emergency preparedness for at-risk populations. In 

particular, NCBDDD is investigating the states of pre-event and post-event readiness 

among at-risk populations affected by Hurricanes Katrina and Rita.

• The National Center for Chronic Disease Prevention and Health Promotion 

(NCCDPHP) has a number of publications addressing the burden and needs 

surrounding persons with chronic diseases following natural disasters. Activities include 

strengthening emergency response surveillance efforts through rapid telephone surveys 

administered through the Behavioral Risk Factor Surveillance System; collaborating 

in the review of mental health response cards following Hurricane Katrina; examining 

agricultural issues to assist in achieving the goal of a safer, healthier, secure, and equitable 

food supply (e.g., food security, influences on economics and food production, food 

access); examining provisions for oral health following Hurricane Katrina; and developing 

conceptual models, analytic reports, guidance, and incident response plans for pregnant, 

postpartum, or lactating women and infants.
150Public Health Preparedness: Mobilizing State by State

Coordinating Center for Infectious Diseases (CCID)

CCID strives to protect health related to infectious diseases. The following highlights CCID’s 

ongoing public health preparedness activities, including developing vaccines, enhancing 

diagnostic methods of select bioterrorism agents, and improving the LRN. • The Influenza Coordination Unit (ICU) is ensuring that the diverse activities related 

to pandemic or seasonal influenza preparedness and response activities are coordinated, 

effective, and efficient. ICU works with other CDC divisions and offices to continuously 

improve the CDC Pandemic Influenza Operations Plan, plan and participate in agencywide exercises, and manage portfolios of related pandemic influenza projects.

• The National Center for Immunization and Respiratory Diseases (NCIRD), as part of 

the Anthrax Vaccine Research Program, is conducting a large-scale human clinical trial of 

the anthrax vaccine, as well as further immunological studies in animals. NCIRD is also 

developing an anthrax immune globulin for eventual storage in the SNS.

• The National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED)

is working to improve surveillance, diagnostic and molecular methods, and laboratory 

capacities for a number of select bioterrorism agents, including smallpox, botulism and 

plague. NCZVED also seeks to quicken the detection and response to bioterrorism 

agents in water and food.

• The National Center for Preparedness, Detection, and Control of Infectious 

Diseases (NCPDCID) manages the LRN, the global consortium of reference and 

national laboratories whose goal is to decrease the time needed to detect biological and 

chemical agents that can harm the public and respond to these events with detection 

and identification capacities and surveillance support. The Division of Bioterrorism 

Preparedness and Response (DBPR) is primarily responsible for managing the LRN and 

preparedness activities within CCID. In addition, NCPDCID tests for the continuing 

effectiveness of existing drugs against bioterrorism agents and prepares U.S. ports of entry 

to reduce the risk of natural or intentional introduction of infectious diseases into the 

country. 

Coordinating Office for Global Health (COGH)

COGH provides leadership and works with global partners to increase life expectancy and years 

of quality of life, and also to increase global preparedness to prevent and control natural and 

manmade threats to health. • The Global Terrorism Preparedness and Emergency Response program is developing and 

implementing a pre-event strategy for CDC’s external engagements with international 

public health partners in terrorism preparedness and emergency response. 

• COGH also coordinates international response with the Director’s Emergency 

Operations Center during international emergency response events and serves as 

the principal CDC point-of-contact for CDC programs, federal agencies, foreign 

governments, and other organizations concerned with international terrorism 

preparedness and response.
151 Public Health Preparedness: Mobilizing State by State

National Institute for Occupational Safety and Health (NIOSH)

NIOSH provides leadership to prevent work-related illness, injury and death through 

information gathering, scientific research, and translation of knowledge gained into products 

and services. The NIOSH Emergency Preparedness and Response Office takes primary 

responsibility to serve as the focal point of technical expertise; facilitate rapid and specific onsite support; and advance research and collaboration to enhance preparedness and response 

efforts. • NIOSH is a cooperating agency in the Worker Safety and Health Support Annex of the 

National Response Plan. In the aftermath of disasters, NIOSH provides assistance on 

occupational exposure assessments, provides guidance on personal protective equipment, 

and develops and disseminates guidelines to integrate worker safety and health into site 

operations. NIOSH works with multidisciplinary teams to develop procedures for followup evaluations of worker injuries, conducts health hazards evaluations, and provides 

technical assistance to local, state, and federal governmental agencies to assess potential 

health effects from workers’ exposures in the recovery zone.

• In addition, NIOSH has developed an aggressive research portfolio to address a 

wide range of research needs in the emergency response community. For example, 

NIOSH conducts research to address the critical need for effective personal protective 

technologies, such as respirators, chemical-resistant clothing, hearing protectors, and 

safety goggles and glasses that provide a barrier between the worker and an occupational 

safety or health risk.

Office of the Director (OD)

OD manages and directs the activities of CDC and coordinates the CDC response to 

emergencies. Public health preparedness activities within the OD include security, legal 

preparedness, and workforce training. OD also coordinates the placement of Senior 

Management Officials (SMOs), who function as the chief CDC representatives within selected 

states. SMOs oversee CDC resources, provide technical assistance, and serve as a point of 

contact during emergencies. In 2007, 11 states and DC had permanent SMOs, and 5 states and 

2 territories had SMOs who provide support only during an emergency. The following offices 

participate in CDC preparedness activities: • The Office of the Chief Operating Officer (OCOO) ensures that federal assets 

and critical infrastructure are safeguarded by providing security for CDC facilities 

and the SNS. OCOO also manages secure intelligence communication systems and 

HealthImpact.net (an internal CDC system) to support terrorism preparedness projects.

• The Office of Chief of Public Health Practice (OCPHP) develops the legal 

preparedness of CDC programs, front-line public health practitioners, policy makers, 

and partners in related sectors (e.g., emergency management, law enforcement, judiciary, 

and health care) to effectively address terrorism, other public health emergencies, and 

additional national public health priorities. OCPHP focuses on improving all four core 

elements of public health legal preparedness: laws and legal authorities; the competency 

of multi-sector practitioners to apply those laws effectively; coordinated implementation 

of laws across sectors and jurisdictions; and actionable information on best practices 

in legal preparedness. In addition, OCPHP is implementing the Social Distancing 

Law Project to assess 18 states’ capacity to implement quarantine and other nonpharmaceutical interventions during an influenza pandemic or other threat.
152Public Health Preparedness: Mobilizing State by State

• The Office of Enterprise Communication (OEC) promotes effective and efficient 

communication networks both within CDC and with external partners. During an 

emergency situation that requires a CDC response, OEC provides information and 

communication support within the Joint Information Center. OEC developed the CDC 

Employee Guide for Influenza Pandemic Preparedness and conducted pandemic influenza 

crisis and emergency risk communication training in collaboration with HHS. 

• The Office of Workforce and Career Development (OWCD) plans, directs and 

manages workforce training programs for public health preparedness. The Epidemic 

Intelligence Service (EIS) program trains high-level epidemiologists for placement in 

state and local public health departments. The management and staff of LRN reference 

laboratories are also trained in preparedness, implementation of the Select Agent 

Program, and testing protocols. In addition, OWCD provides targeted preparedness 

training for emergency responders.
153 Public Health Preparedness: Mobilizing State by State

CDC works under the strategic leadership of ASPR, the principal advisor to HHS on issues related to 

bioterrorism and other public health emergencies that affect the civilian population. ASPR coordinates 

and integrates public health emergency preparedness activities among federal, state, and local officials. 

ASPR has also been a lead partner in the development of a U.S. government-wide pandemic influenza 

strategic plan and coordinated subsidies for states to stockpile antiviral drugs to help respond in case of 

an influenza pandemic. The planning, coordination, and operational functions of ASPR are conducted 

by four offices:

Office of the Biomedical Advanced Research and Development 

Authority (BARDA)

BARDA is responsible for providing coordination and expert advice regarding the development and 

procurement of public health medical countermeasures, or pharmaceuticals (e.g., vaccines, antitoxins, 

and preventive and therapeutic drugs) that protect against health threats during emergencies. Through 

the Public Health Emergency Medical Countermeasures Enterprise—an interagency effort that also 

includes CDC, FDA, and the National Institutes of Health—BARDA coordinates efforts to define and 

prioritize requirements for public health emergency medical countermeasures, product development 

and procurement, and related research. BARDA is also responsible for setting strategies for the 

deployment and use of medical countermeasures stored in the SNS.

Office of Preparedness and Emergency Operations (OPEO)

OPEO is responsible for developing operational plans, analytical products, and training exercises to 

ensure the preparedness of ASPR, HHS, the federal government, and the public to respond to public 

health and medical threats and emergencies, both domestically and internationally. OPEO is also 

responsible for ensuring that ASPR has the systems, logistical support, and procedures necessary to 

coordinate HHS operational response to acts of terrorism and other public health and medical threats 

and emergencies. The following programs are administered within OPEO: • The Hospital Preparedness Program (HPP) helps hospitals and health care systems to 

prepare for and respond to public health emergencies. Current program priority areas 

include interoperable communication systems, bed tracking, personnel management, fatality 

management planning and hospital evacuation planning. During the past 5 years, HPP 

funds have also improved bed and personnel surge capacity, decontamination capabilities, 

isolation capacity, pharmaceutical supplies, training, education, drills, and exercises. Hospitals, 

outpatient facilities, health centers, poison control centers, emergency medical services, and 

other healthcare partners work with the appropriate state or local health departments to 

acquire funding and develop healthcare system preparedness through this program. Funding is 

distributed directly to the health department of the state or political subdivision of a state (i.e., 

cities and counties).

• The National Disaster Medical System (NDMS) is a federally coordinated system that 

augments the nation’s medical response capability. The overall purpose of the NDMS is to 

establish a single integrated national medical response capability for assisting state and local 

authorities in dealing with the medical impacts of major peacetime disasters and to provide 

Overview of ASPR Preparedness Activities

Appendix 4
154Public Health Preparedness: Mobilizing State by State

support to the military and the Department of Veterans Affairs medical systems in caring 

for casualties evacuated back to the U.S. from overseas armed conventional conflicts.

• The Healthcare and Public Health Sector Critical Infrastructure Protection 

Program leads a unique public and private sector partnership in protecting the essential 

goods, services, and functions of healthcare and public health that, if destroyed or 

compromised, would negatively affect the nation’s ability to respond to emergencies and 

care for its citizens.

Office of Medicine, Science, and Public Health (OMSPH)

OMSPH is responsible for providing expert medical, scientific, and public health advice on 

domestic and international medical preparedness policies, programs, initiatives, and activities. 

OMSPH serves as the ASPR liaison to health and science professional organizations for 

domestic and international issues. 

Office of Policy and Strategic Planning (OPSP)

OPSP is responsible for policy formulation and coordination for preparedness and response 

strategic planning. In coordination with other ASPR and HHS offices, OPSP analyzes proposed 

policies and presidential directives and regulations, and develops short- and long-term policy 

and strategic objectives.
155 Public Health Preparedness: Mobilizing State by State

Data presented in Sections 1 and 2 of this report come from a variety of sources. Footnotes in 

the report provide information on the specific source and timeframe for each data point. The 

purpose of the information below is to provide additional details about data sources. Listed 

alphabetically below are the specific sources of data, the time frame in which the data were 

collected, and any additional information needed to understand the data. 

APHL 

APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; October 2002:

APHL conducted the first survey in this series to establish a baseline status of state public 

health laboratories regarding bioterrorism preparedness as of December 31, 2001. Self-reported 

data were collected about personnel, facilities/biosecurity, clinical laboratory connectivity, 

equipment/supplies, transportation/courier service, integrated data management, and training 

from 46 states, 1 territory, and DC, for a 92% response rate.

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

conducted the fifth survey in this series to assess the effects of preparedness funding on state 

public health laboratory readiness for bioterrorism. Self-reported data were collected about 

funding, workforce, laboratory connectivity and integration, sample intake and laboratory 

testing, and reporting capabilities during the period from August 31, 2005 to August 30, 

2006. All 50 states, DC, and Puerto Rico responded, for a total sample size of 52 with a 100% 

response rate. Puerto Rico’s responses were not included in the data presented.

APHL, Chemical Terrorism Preparedness: In the Nation’s State Public Health Laboratories;

May 2007: APHL conducted its third annual Chemical Terrorism Laboratory Preparedness 

Survey of public health laboratories to assess their capacity and capability to respond to 

chemical terrorism from August 31, 2005 to August 30, 2006. Self-reported data were collected 

on funding, testing capability and capacity, workforce, coordination and response planning, and 

all-hazards receipt and testing. Responses were received from 46 states and DC, for a response 

rate of 90%.

APHL, unpublished data provided for 2006 and 2002: APHL provided unpublished survey 

data for the number of clinical laboratorians that participated in state-sponsored training to 

perform rule-out testing for biological agents. The training covered rule-out testing, packing 

and shipping, and biosafety guidelines.

CDC

CDC, DBPR EARS data; 2007: Data about EARS consist of program information from 

DBPR in CCID. 

CDC, DBPR LRN data; 2007: Data about the LRN consist of program information from 

DBPR in CCID. More details about LRN data follow.

Data Sources and Methods

Appendix 5
156Public Health Preparedness: Mobilizing State by State

• Percentage of population within 100 miles of a LRN laboratory: DBPR used census data for 

the year 2000 to determine the proportion of the U.S. population within 100 miles of 

a laboratory participating in the LRN. Analysis for this report was conducted in August 

2007.

• Number of laboratories within the LRN: This report represents the number of LRN 

laboratories as of November 2007.

• Laboratory testing for biological and chemical agents: State and local laboratories in the 

LRN are subject to routine proficiency testing to confirm accuracy of testing for a range 

of biological and chemical agents. These proficiency tests are conducted throughout the 

year, and the data were updated as of September 2007.

CDC, DEO data; 2007: DEO tracks major events that may have public health consequences. 

CDC monitors and often responds to these major events.

CDC, DEO Epi-Aid data; 2007: These data consist of program information from Epi-Aid, 

a program of CDC assistance in epidemiologic field investigations on request from states, 

localities, and abroad. DEO coordinates these regular deployments of field teams throughout 

the year and records the number, type, length, and locations of field investigations.

CDC, Division of Integrated Surveillance Systems and Services BioSense data; 2007: Data 

about BioSense consist of program information from the Division of Integrated Surveillance 

Systems and Services in NCPHI.

CDC, DSLR data; 1999-2005: DSLR requested information from states regarding the 

progress made in preparedness from 1999 through August 30, 2005, at the end of the first five 

budget periods of the cooperative agreement.

CDC, DSLR data; 2003-2006: States were required to submit information annually on their 

preparedness activities during the reporting period from August 31 through August 30.

CDC, DSLR data; 2007: DSLR collected performance measure data from states, territories, 

and localities for budget period 7 of the cooperative agreement. Data presented in this report 

reflect the partial year period from September 1, 2006 through February 28, 2007. States will 

submit additional data for the latter half of the year.

CDC, DSLR Mid-Year Progress Report Review data; 2007: DSLR reviewed state public 

health departments’ status in various areas of preparedness through narrative information 

reported as part of the cooperative agreement. DSLR uses the reviews to develop consultation 

plans and regional workshops to work on areas identified as needing improvement.

CDC, DSNS data; 2001-2007: CDC annually reviews state plans to receive, stage, store, and 

distribute pharmaceutical and medical supplies during an emergency. The review tool is based 

on a 100-point scale and covers 13 functional areas. Program consultants rate the plans based 

on the evidence provided and their professional judgment and experience. CDC uses review 

scores to help identify areas needing further improvement in planning and training. Scores were 
157 Public Health Preparedness: Mobilizing State by State

presented for states with completed reviews from September 2006 through December 2007. 

One state did not have a complete review as of January 2007. DSNS also tracks the number of 

joint state and CDC SNS exercises, and data are presented for 2001-2006.

CDC, DSNS Cities Readiness Initiative (CRI) data; 2007: These data consist of program 

information from the CRI.

CDC, Epi-X data; 2007: These data consist of program information from Epi-X, a CDC 

communications system that helps track disease outbreaks. CDC’s CCHIS maintains an active 

registry of qualified and trained users of the Epi-X system. The report presents figures based on 

end-of-calendar-year numbers of registered Epi-X users.

CDC, HAN data; 2003-2007: CDC’s CCHIS tests states and localities’ ability to respond to a 

test message within 30 minutes or less. The report presents data from 2003 through 2007.

CDC, NCEH data; 2007: Data consist of NCEH program information. NCEH works 

with state and local public health departments to improve response to chemical, nuclear, and 

radiological terrorism.

CDC, Pandemic Influenza State Self-Assessments data; 2006: As part of the cooperative 

agreement pandemic influenza supplemental funding, states and localities completed a 

pandemic influenza self-assessment in April 2006. Progress was reported in a number of key 

activities as “completed,” “in progress,” or “not started.” Data were reported for 49 states.

CSTE

CSTE, Epidemiological Capacity Assessment (ECA); 2006: CSTE surveyed state and 

territorial public health departments in 2006 to determine the current status of core 

epidemiologic capacity, competence-specific training needs, and barriers to recruitment and 

retention of epidemiologists. The 50 states, DC, American Samoa, the Northern Mariana 

Islands, Puerto Rico, and the U.S. Virgin Islands responded, for a 93% response rate. The 2006 

ECA summarized 2006 data and changes in epidemiologic and surveillance capacity since 2001 

and 2004 for the 39 public health departments that participated in assessments all 3 years. 

HHS

HHS Press Releases; 2002-2007: HHS publishes press releases on the amount of funding 

allocated to state, local, and territorial public health departments through the cooperative 

agreement.

HHS OIG, Status of State 24/7 Urgent Disease and Public Health Emergency Reporting 

Systems; February 2005: OIG reviewed public health departments’ 24/7 urgent disease and 

public health emergency reporting systems and reported that 12 states and Los Angeles County 

had these systems in place prior to cooperative agreement funding in 1999.
158Public Health Preparedness: Mobilizing State by State

HHS OIG, Memorandum Report—Laboratory Preparedness for Pandemic Influenza; 

October 2007: OIG surveyed public health laboratory officials in the states and DC concerning 

their ability to conduct year-round influenza surveillance, among other critical tasks related to 

pandemic influenza.

Methods for Developing Section 2 Snapshots

State and local public health preparedness officials reviewed data presented in their respective 

snapshots. Corrections to the data during the specific time frames were accepted.

To develop text boxes on why public health departments value the cooperative agreement, CDC 

reviewed narrative submitted by grantees summarizing progress from 1999 – 2005. The text 

box was adapted from this information and reviewed by the relevant state or local public health 

department. Their changes were incorporated.

To develop examples of public health department responses or exercises, CDC reviewed 

documentation from partner organizations and grantee progress reports to identify a topic. 

These topics were then confirmed with the appropriate officials, and supporting materials were 

requested from state and local public health departments. CDC staff developed the examples 

based on these materials and submitted the content to the relevant state or local public health 

department for review. Their changes and recommendations were incorporated. 

Most examples were developed using public health department documents. Sources for the 

examples outside of these documents are listed below.

Multiple States

ASTHO. State Public Health Successful Response Stories [online]. [cited 2007 Jul 30]. 

Available from URL: http://www.astho.org/pubs/SuccessStoriesMainPage.htm. Used to support 

examples for: Arkansas, Georgia, Missouri, Nebraska, Pennsylvania, Rhode Island, and 

Tennessee.

California

ASTHO. Public Health Preparedness: California – Heat Wave [online]. 2007. [cited 2007 Jul 

30]. Available from URL: http://www.astho.org/pubs/2007HillSuccessCA.pdf

Massachusetts 

Smith S. Outbreak stopped: Facing a potential measles epidemic, health workers employed 

high-tech alerts, old-fashioned quarantines [online]. The Boston Globe 2006 Jul 31 [cited 2007 

Jul 31]. 

New York City

Chan S. New York City man has inhalation anthrax, officials say [online]. The New York Times 

2006 Feb 23 [cited 2007 Aug 27]
159 Public Health Preparedness: Mobilizing State by State

South Carolina • Nieratko J. Train derailment highlights public health preparedness [online]. 

ASTHO Report 2005;13:1. Available from URL: http://www.astho.org/pubs/

FallASTHOReport2005.pdf

• Hinshaw D. At least 220 treated at area hospitals. The State 2005 Feb 7; Sect. A-1 (col. 

3)

• O’Connor J. Training, resources made response to leak smooth; much of S.C. illequipped for such a crisis. The State 2005 Jan 9; Sect. A-1 (col. 1)

Utah 

Testimony of A. Richard Melton, DrPH, deputy director, Utah Department of Health: Hearing 

before the Subcomm. On Bioterrorism and Public Health Preparedness of the Senate Comm. 

On Health, Education, Labor, and Pensions, 109th Cong., 2nd Sess. (2006). Available from 

URL: http://www.astho.org/pubs/03-16-06MeltonTestimony.pdf
160Public Health Preparedness: Mobilizing State by State
161 Public Health Preparedness: Mobilizing State by State

Category A Agents

The U.S. public health system and primary healthcare providers must be prepared to address various 

biological agents, including pathogens that are rarely seen in the United States. High-priority agents 

include organisms that pose a risk to national security because they can be easily disseminated or 

transmitted from person to person; result in high mortality rates and have the potential for major 

public health impact; might cause public panic and social disruption; and require special action for 

public health preparedness. Category A agents are listed below:

• Anthrax (Bacillus anthracis)

• Botulism (Clostridium botulinum toxin) 

• Plague (Yersinia pestis) 

• Smallpox (variola major) 

• Tularemia (Francisella tularensis) 

• Viral hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa, 

Machupo])

Category B Agents

The second-highest priority agents include those that are moderately easy to disseminate; result in 

moderate morbidity rates and low mortality rates; and require specific enhancements of CDC’s 

diagnostic capacity and enhanced disease surveillance. Category B agents are listed below:

• Brucellosis (Brucella species) 

• Epsilon toxin of Clostridium perfringens

• Food safety threats (e.g., Salmonella species, Escherichia coli O157:H7, Shigella)

• Glanders (Burkholderia mallei)

• Melioidosis (Burkholderia pseudomallei)

• Psittacosis (Chlamydia psittaci) 

• Q fever (Coxiella burnetii) 

• Ricin toxin from Ricinus communis (castor beans)

• Staphylococcal enterotoxin B

• Typhus fever (Rickettsia prowazekii)

• Viral encephalitis (alphaviruses [e.g., Venezuelan equine encephalitis, eastern equine encephalitis, 

western equine encephalitis])

• Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)

Category A and B Biological Agents

Appendix 6
162Public Health Preparedness: Mobilizing State by State

Page 4 (from top)

Federal Emergency Management Agency. 

Photographer: Jocelyn Augustino. Flooding 

damage in New Orleans after Hurricane 

Katrina.

CDC Public Health Information Library. 

Photographer: James Gathany. Feeding 

mosquito.

Page 5 (from top)

Indiana State Department of Health. 

Strategic National Stockpile exercise, public 

health working with emergency management.

National Institutes of Health Biodefense 

Image Library. Photographer: Arthur 

Friedlander. Anthrax bacteria in monkey 

tissue.

Page 6

CDC Public Health Information Library. 

Photographer: James Gathany. CDC Tom 

Harkin Global Communications Center.

Page 9

Arkansas Department of Health. Buses 

arriving with Hurricane Katrina evacuees.

Page 11

Oregon Department of Human Services, 

Public Health Division. Public health staff 

during an exercise.

Page 13

National Institutes of Health Biodefense 

Image Library. Credit: Rocky Mountain 

Laboratories. Salmonella in lettuce.

Page 15

South Carolina Department of Health and 

Environmental Control. Graniteville train 

derailment.

Page 16

Missouri Department of Health and Senior 

Services, Missouri State Public Health 

Laboratory. Public health laboratory scientist 

working to identify enteric pathogens such as 

salmonella.

Page 19

National Institutes of Health Biodefense 

Image Library. Credit: Rocky Mountain 

Laboratories. E. coli.

Page 20

Pennsylvania Department of Health, Bureau 

of Laboratories. Microbiologist testing 

samples in a negative pressure glove box.

Page 23

Navajo Area Indian Health Services. Mass 

vaccination exercise coordinated by the 

Navajo Area Indian Health Services and the 

Navajo Division of Health.

Page 25

Indiana State Department of Health. 

Strategic National Stockpile exercise.

Page 26

Virginia Department of Health. Pandemic 

influenza exercise in the public health 

Emergency Coordination Center.

Page 27

Michigan Department of Community 

Health. Resources from the Michigan 

Emergency Drug Delivery and Resource 

Utilization Network (MEDDRUN).

Page 28

Wisconsin Department of Health and Family 

Services. Photographer: Del Brown. Public 

health staff reviewing laboratory test results 

during the 2006 E. coli outbreak in spinach.

Photo Credits
163 Public Health Preparedness: Mobilizing State by State

Agency for Toxic Substances and Disease Registry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ATSDR

Assistant Secretary for Preparedness and Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ASPR

Association of Public Health Laboratories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . APHL

Association of State and Territorial Health Officials . . . . . . . . . . . . . . . . . . . . . . . . . . . ASTHO

Centers for Disease Control and Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CDC

Coordinating Center for Environmental Health and Injury Prevention . . . . . . . . . . . . CCEHIP

Coordinating Center for Health Information and Service. . . . . . . . . . . . . . . . . . . . . . . . CCHIS

Coordinating Center for Health Promotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CoCHP

Coordinating Center for Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CCID

Coordinating Office for Global Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . COGH

Coordinating Office for Terrorism Preparedness and Emergency Response . . . . . . . . . COTPER

Council of State and Territorial Epidemiologists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CSTE

District of Columbia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DC

Division of Bioterrorism Preparedness and Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . DBPR

Division of Emergency Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DEO

Division of Select Agents and Toxins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DSAT

Division of State and Local Readiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DSLR

Division of Strategic National Stockpile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DSNS

Early Aberration Reporting System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . EARS

Epidemic Information Exchange . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Epi-X

Epidemiological Capacity Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ECA

Fiscal Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FY

Food and Drug Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FDA

Health Alert Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HAN

Hospital Preparedness Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HPP

Incident Command System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ICS

Influenza Coordination Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ICU

Laboratory Response Network. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LRN

National Center for Environmental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NCEH

National Center for Immunization and Respiratory Diseases . . . . . . . . . . . . . . . . . . . . NCIRD

National Center for Injury Prevention and Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . NCIPC

National Center for Preparedness, Detection, and

	 Control of Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NCPDCID

National Center for Health Marketing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NCHM

National Center for Health Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NCHS

National Center for Public Health Informatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NCPHI

National Center for Zoonotic, Vector-Borne, and Enteric Diseases . . . . . . . . . . . . . . NCZVED

National Disaster Medical System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NDMS

National Institute for Occupational Safety and Health . . . . . . . . . . . . . . . . . . . . . . . . NIOSH

Office of Biomedical Advanced Research and Development Authority . . . . . . . . . . . . . BARDA

Office of the Chief Operating Officer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OCOO

Office of Chief of Public Health Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OCPHP

Office of Enterprise Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OEC

Office of the Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OD

Office of Inspector General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OIG

Office of Medicine, Science, and Public Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OMSPH

Office of Policy and Strategic Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OPSP

Office of Preparedness and Emergency Operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OPEO

Office of Workforce and Career Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OWCD

Public Health Information Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PHIN

Pulsed-field gel electrophoresis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PFGE

Senior Management Official . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SMO

Strategic National Stockpile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SNS

U.S. Department of Agriculture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . USDA

U.S. Department of Health and Human Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HHS

U.S. Department of Homeland Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DHS

Acronyms
This report was developed by the Coordinating Office for Terrorism Preparedness and Emergency 

Response, Centers for Disease Control and Prevention under the direction of 

Richard E. Besser, MD 

Director, Coordinating Office for Terrorism Preparedness and Emergency Response 

Ann O’Connor, MPA 

Enterprise Communications Officer 

Craig W. Thomas, PhD 

Chief, Outcome Monitoring and Evaluation Branch, Division of State and Local Readiness 

Project Team 

Diane Caves, Team Leader 

Mark Biagioni, Analyst 

Ellen Wan, Analyst 

Production Team 

Laurie Schnepf 

Linda Tierney 

Analytical and Data Support 

Rich Ann Baetz 

Patricia Bolton 

Delia Easton 

David Hurst 

Aniket Kulkarni 

Anita McLees 

Davis Patterson

Other Contributors 

Jon Altizer, consultant 

Amy Elkavich, editor 

Ryan Grover, consultant 

Lynne McIntyre, editor 

Todd Prydybasz, graphic designer 

Special thanks to 

Association of Schools of Public Health 

Association of State and Territorial Health Officials 

Association of Public Health Laboratories 

Council of State and Territorial Epidemiologists 

National Association of County and City Health Officials 

Subject matter experts from across CDC