II 

110TH CONGRESS 

2D SESSION S. 3476 

To amend the Public Health Service Act to improve the Nation’s surveillance 

and reporting for diseases and conditions, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

SEPTEMBER 11, 2008 

Mr. HAGEL (for himself and Mr. BINGAMAN) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to improve the 

Nation’s surveillance and reporting for diseases and conditions, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘National Integrated 

5 Public Health Surveillance Systems and Reportable Con6 ditions Act’’. 


rfrederick on PROD1PC67 with BILLS
2 

•S 3476 IS

1 SEC. 2. PURPOSES. 

2 The purpose of the programs authorized under this 

3 Act is to strengthen public health surveillance systems and 

4 disease reporting by— 

5 (1) delineating existing grant mechanisms at 

6 the Centers for Disease Control and Prevention de7 signed to enhance disease surveillance and reporting 

8 by improving and modernizing capacity at the State 

9 and local level— 

10 (A) to identify and monitor the occurrence 

11 of infectious diseases and other conditions of 

12 public health importance; 

13 (B) to detect new and emerging infectious 

14 disease threats; and 

15 (C) to identify and respond to disease out16 breaks; 

17 (2) expanding eligibility for grantees; 

18 (3) increasing funding to ensure all States and 

19 jurisdictions have appropriate surveillance and re20 porting capacity and can provide comprehensive elec21 tronic reporting, including laboratory reporting; 

22 (4) delineating existing applied epidemiology, 

23 laboratory science, and informatics fellowship pro24 grams designed to reduce documented workforce 

25 shortages for these essential public health profesVerDate Aug 31 2005 04:50 Sep 12, 2008 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3476.IS S3476

rfrederick on PROD1PC67 with BILLS
3 

•S 3476 IS

1 sionals at the State and local level and increasing 

2 funding for these programs; 

3 (5) expanding the Epidemic Intelligence Serv4 ice; 

5 (6) delineating a refined process for estab6 lishing a list of nationally notifiable diseases and 

7 conditions; 

8 (7) improving binational surveillance of diseases 

9 in the United States and Mexico border region, in10 cluding developing improved standards and protocols 

11 for binational epidemiology, surveillance, laboratory 

12 analyses, and control of infectious diseases between 

13 the two nations; and 

14 (8) establishing a forum to permit review and 

15 identification of best surveillance practices with a 

16 particular focus on improving coordination of ani17 mal-human disease surveillance. 

18 SEC. 3. STRENGTHENING PUBLIC HEALTH SURVEILLANCE 

19 SYSTEMS. 

20 Title XXVIII of the Public Health Service Act (42 

21 U.S.C. 300hh et seq.) is amended by adding at the end 

22 the following: 


rfrederick on PROD1PC67 with BILLS
4 

•S 3476 IS

1 ‘‘Subtitle C—Strengthening Public 

2 Health Surveillance Systems 

3 ‘‘SEC. 2821. EPIDEMIOLOGY-LABORATORY CAPACITY 

4 GRANTS. 

5 ‘‘(a) IN GENERAL.—Subject to the availability of ap6 propriations, the Secretary, acting through the Director 

7 of the Centers for Disease Control and Prevention, shall 

8 establish an Epidemiology and Laboratory Capacity Grant 

9 Program to award grants to eligible entities to assist pub10 lic health agencies in improving surveillance for, and re11 sponse to, infectious diseases and other conditions of pub12 lic health importance by— 

13 ‘‘(1) strengthening epidemiologic capacity; 

14 ‘‘(2) enhancing laboratory practice; 

15 ‘‘(3) improving information systems; and 

16 ‘‘(4) developing and implementing prevention 

17 and control strategies. 

18 ‘‘(b) ELIGIBLE ENTITIES.—In this section, the term 

19 ‘eligible entity’ means an entity that— 

20 ‘‘(1) is— 

21 ‘‘(A) a State health department; 

22 ‘‘(B) a local health department that meets 

23 such criteria as the Director of the Centers for 

24 Diseases Control and Prevention determines for 

25 purposes of this section; 


rfrederick on PROD1PC67 with BILLS
5 

•S 3476 IS

1 ‘‘(C) a tribal jurisdiction that meets such 

2 criteria as the Director of the Centers for Dis3 ease Control and Prevention determines for 

4 purposes of this section; or 

5 ‘‘(D) a partnership established for pur6 poses of this section between one or more eligi7 ble entities described in subparagraph (A), (B), 

8 or (C) and an academic center; and 

9 ‘‘(2) submits to the Secretary an application at 

10 such time, in such manner, and containing such in11 formation as the Secretary may require. 

12 ‘‘(c) USE OF FUNDS.— 

13 ‘‘(1) IN GENERAL.—An eligible entity shall use 

14 amounts received under a grant under this section 

15 for core functions described in this subsection in16 cluding— 

17 ‘‘(A) building public health capacity to 

18 identify and monitor the occurrence of infec19 tious diseases and other conditions of public 

20 health importance; 

21 ‘‘(B) detecting new and emerging infec22 tious disease threats, including laboratory ca23 pacity to detect antimicrobial resistant infec24 tions; 


rfrederick on PROD1PC67 with BILLS
6 

•S 3476 IS

1 ‘‘(C) identifying and responding to disease 

2 outbreaks; 

3 ‘‘(D) hiring necessary staff; 

4 ‘‘(E) conducting needed staff training and 

5 educational development; and 

6 ‘‘(F) other activities that improve surveil7 lance as determined by the Director of the Cen8 ters for Disease Control and Prevention. 

9 ‘‘(2) DEVELOPMENT AND MAINTENANCE OF IN10 FORMATION EXCHANGE.— 

11 ‘‘(A) NATIONAL STANDARDS.—Not later 

12 than 180 days after the date of the enactment 

13 of this subtitle, the Secretary, acting through 

14 the Director of the Centers for Disease Control 

15 and Prevention, and in consultation with the 

16 National Coordinator for Health Information 

17 Technology, shall issue guidelines for public 

18 health entities that— 

19 ‘‘(i) are designed to ensure that all 

20 State and local health departments and 

21 public health laboratories have access to 

22 information systems to receive, monitor, 

23 and report infectious diseases and other 

24 urgent conditions of public health impor25 tance; and 


rfrederick on PROD1PC67 with BILLS
7 

•S 3476 IS

1 ‘‘(ii) are consistent with standards 

2 and recommendations for health informa3 tion technology by the National Coordi4 nator for Health Information Technology, 

5 and by the American Health Information 

6 Community (AHIC) and its successors. 

7 ‘‘(B) SECURE INFORMATION SYSTEMS.— 

8 An eligible entity shall use amounts received 

9 through a grant under this section to ensure 

10 that the entity has access to a web-based, se11 cure information system that complies with the 

12 guidelines developed under subparagraph (A). 

13 Such a system shall be designed— 

14 ‘‘(i) to receive automated case reports 

15 of State and national reportable conditions 

16 from clinical systems and health care of17 fices that use electronic health records and 

18 from clinical and public health labora19 tories, and to submit reports of nationally 

20 reportable conditions to the Director of the 

21 Centers for Disease Control and Preven22 tion; 

23 ‘‘(ii) to receive and analyze, within 24 

24 hours, de-identified electronic clinical data 

25 for situational awareness and to forward 


rfrederick on PROD1PC67 with BILLS
8 

•S 3476 IS

1 such reports immediately to the Centers 

2 for Disease Control and Prevention at the 

3 time of receipt; 

4 ‘‘(iii) to manage, link, and process dif5 ferent types of data, including information 

6 on newly reported cases, exposed contacts, 

7 laboratory results, number of people vac8 cinated or given prophylactic medications, 

9 adverse events monitoring and follow-up, in 

10 an integrated outbreak management sys11 tem; 

12 ‘‘(iv) to geocode analyze, display, re13 port, and map, using Geographic Informa14 tion System technology, accumulated data 

15 and to share data with other local health 

16 departments, State health departments, 

17 and the Centers for Disease Control and 

18 Prevention; 

19 ‘‘(v) to receive, manage, and dissemi20 nate alerts, protocols, and other informa21 tion, including Health Alert Network and 

22 Epi-X information, as appropriate, for 

23 public health workers, health care pro24 viders, and public health partners in emer25 gency response within each health departVerDate Aug 31 2005 04:50 Sep 12, 2008 Jkt 069200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S3476.IS S3476

rfrederick on PROD1PC67 with BILLS
9 

•S 3476 IS

1 ment’s jurisdiction and to automate the ex2 change and cascading of such information 

3 with external partners using national 

4 standards; 

5 ‘‘(vi) to have information technology 

6 security and critical infrastructure protec7 tion as appropriate to protect public health 

8 information; 

9 ‘‘(vii) to have the technical infrastruc10 ture needed to ensure availability, backup, 

11 and disaster recovery of data, application 

12 services, and communications systems dur13 ing natural disasters such as floods, tor14 nados, hurricanes, and power outages; and 

15 ‘‘(viii) to provide for other capabilities 

16 as the Secretary determines appropriate. 

17 ‘‘(C) LABORATORY SYSTEMS.—An eligible 

18 entity shall use amounts received under a grant 

19 under this section to ensure that State or local 

20 public health laboratories are utilizing web21 based, secure systems that are in compliance 

22 with the guidelines developed by the Secretary 

23 under subparagraph (A) and that— 

24 ‘‘(i) are fully integrated laboratory in25 formation systems; 


rfrederick on PROD1PC67 with BILLS
10 

•S 3476 IS

1 ‘‘(ii) provide for the reporting of elec2 tronic test results to the appropriate local 

3 and State health departments using cur4 rently existing national format and coding 

5 standards; 

6 ‘‘(iii) have information technology se7 curity and critical infrastructure protection 

8 to protect public health information (as de9 termined by the Secretary); 

10 ‘‘(iv) have the technical infrastructure 

11 needed to ensure availability, backup, and 

12 disaster recovery of data, application serv13 ices, and communications systems during 

14 natural disasters including floods, torna15 does, hurricanes, and power outages; and 

16 ‘‘(v) address other capabilities as the 

17 Secretary determines appropriate. 

18 ‘‘(D) OTHER USES.—In addition to the ac19 tivities described in subparagraphs (B) and (C), 

20 an eligible entity (including the entity’s public 

21 health laboratory) may use amounts received 

22 under a grant under this section for systems 

23 development and maintenance, hiring necessary 

24 staff, and staff technical training. Grantees 

25 under this section may elect to develop their 


rfrederick on PROD1PC67 with BILLS
11 

•S 3476 IS

1 own systems or use federally developed systems 

2 in carrying out activities under this paragraph. 

3 ‘‘(d) PRIORITY.—In allocating funds under sub4 section (f)(2) for activities under subsection (c)(2)(B) (re5 lating to secure information systems), the Secretary shall 

6 give priority to eligible entities that demonstrate need. 

7 ‘‘(e) REPORTS.—Not later than September 30, 2009, 

8 and each September 30 thereafter, the Secretary shall 

9 submit to Congress an annual report on the activities car10 ried out under this section by recipients of assistance 

11 under this section. 

12 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section 

14 $180,000,000 for each of fiscal years 2009 through 2012, 

15 of which— 

16 ‘‘(1) not less than $88,000,000 shall be made 

17 available each such fiscal year for activities under 

18 subsection (c)(1); 

19 ‘‘(2) not less than $60,000,000 shall be made 

20 available each such fiscal year for activities under 

21 subsection (c)(2)(B); and 

22 ‘‘(3) not less than $32,000,000 shall be made 

23 available each such fiscal year for activities under 

24 subsection (c)(2)(C). 


rfrederick on PROD1PC67 with BILLS
12 

•S 3476 IS

1 ‘‘SEC. 2822. FELLOWSHIP TRAINING IN APPLIED PUBLIC 

2 HEALTH EPIDEMIOLOGY, PUBLIC HEALTH 

3 LABORATORY SCIENCE, PUBLIC HEALTH 

4 INFORMATICS, AND EXPANSION OF THE EPI5 DEMIC INTELLIGENCE SERVICE. 

6 ‘‘(a) IN GENERAL.—The Secretary, acting through 

7 the Director of the Centers for Disease Control and Pre8 vention, may carry out activities to address documented 

9 workforce shortages in State and local health departments 

10 in the critical areas of applied public health epidemiology 

11 and public health laboratory science and informatics and 

12 may expand the Epidemic Intelligence Service. 

13 ‘‘(b) SPECIFIC USES.—In carrying out subsection 

14 (a), the Secretary, acting through the Director of the Cen15 ters for Disease Control and Prevention, shall provide for 

16 the expansion of existing Council of State and Territorial 

17 Epidemiologists and Association of Public Health Labora18 tories fellowship programs operated through the Centers 

19 for Disease Control and Prevention in a manner that is 

20 designed to alleviate shortages of the type described in 

21 subsection (a). 

22 ‘‘(c) OTHER PROGRAMS.—The Secretary, acting 

23 through the Director of the Centers for Disease Control 

24 and Prevention, may provide for the expansion of other 

25 applied epidemiology training programs that meet objecVerDate Aug 31 2005 04:50 Sep 12, 2008 Jkt 069200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S3476.IS S3476

rfrederick on PROD1PC67 with BILLS
13 

•S 3476 IS

1 tives similar to the objectives of the programs described 

2 in subsection (b). 

3 ‘‘(d) WORK OBLIGATION.—Participation in fellow4 ship training programs under this section shall be deemed 

5 to be service for purposes of satisfying work obligations 

6 stipulated in contracts under section 338I(j). 

7 ‘‘(e) GENERAL SUPPORT.—Amounts may be used 

8 from grants awarded under this section to expand the 

9 Public Health Informatics Fellowship Program at the 

10 Centers for Disease Control and Prevention to better sup11 port all public health systems at all levels of government. 

12 ‘‘(f) AUTHORIZATIONS OF APPROPRIATIONS.—There 

13 are authorized to be appropriated to carry out this section 

14 $39,500,000 for each of fiscal years 2009 through 2012, 

15 of which— 

16 ‘‘(1) not less than $5,000,000 shall be made 

17 available in each such fiscal year for epidemiology 

18 fellowship training program activities under sub19 sections (b) and (c); 

20 ‘‘(2) not less than $5,000,000 shall be made 

21 available in each such fiscal year for laboratory fel22 lowship training programs under subsection (b); 

23 ‘‘(3) not less than $5,000,000 shall be made 

24 available in each such fiscal year for the Public 


rfrederick on PROD1PC67 with BILLS
14 

•S 3476 IS

1 Health Informatics Fellowship Program under sub2 section (e); and 

3 ‘‘(4) not less than $24,500,000 shall be made 

4 available for expanding the Epidemic Intelligence 

5 Service under subsection (a). 

6 ‘‘SEC. 2823. NATIONALLY NOTIFIABLE DISEASES AND CON7 DITIONS. 

8 ‘‘(a) IN GENERAL.—At the request of the Council of 

9 State and Territorial Epidemiologists, the Director of the 

10 Centers for Disease Control and Prevention shall assist 

11 the Council in developing or improving a process for 

12 States to conduct surveillance and submit reports to the 

13 Director on nationally notifiable diseases and conditions. 

14 ‘‘(b) LIST OF NATIONALLY NOTIFIABLE DISEASES

15 AND CONDITIONS.—The process under subsection (a) 

16 shall include a list of nationally notifiable diseases and 

17 conditions as follows: 

18 ‘‘(1) The Council of State and Territorial Epi19 demiologists and the Director of the Centers for Dis20 ease Control and Prevention will jointly develop— 

21 ‘‘(A) not later than 1 year after the date 

22 of the enactment of the National Integrated 

23 Public Health Surveillance Systems and Report24 able Conditions Act, a list of nationally 

25 notifiable diseases and conditions; and 


rfrederick on PROD1PC67 with BILLS
15 

•S 3476 IS

1 ‘‘(B) a process for reviewing the list on an 

2 annual basis and, as appropriate, modifying the 

3 list, taking into account newly recognized dis4 eases and conditions of public health impor5 tance and advances in diagnostic technology. 

6 ‘‘(2) A disease or condition will be included on 

7 the list only if a majority of the States represented 

8 on the Council approve such inclusion. 

9 ‘‘(3) The list will include standard definitions 

10 for confirmed, probable, and suspect cases for each 

11 nationally notifiable disease or condition. 

12 ‘‘(4) The list will distinguish between— 

13 ‘‘(A) diseases and conditions of urgent 

14 public health importance for which immediate 

15 action may be needed; and 

16 ‘‘(B) diseases and conditions for which re17 porting is less urgent and mainly for the pur18 pose of monitoring trends and evaluating public 

19 health intervention programs. 

20 ‘‘(c) NOTIFICATIONS TO CDC.—The process under 

21 subsection (a) shall provide for reporting to the Director 

22 of the Centers for Disease Control and Prevention as fol23 lows: 

24 ‘‘(1) For diseases and conditions described in 

25 subsection (b)(4)(A), reporting will occur— 


rfrederick on PROD1PC67 with BILLS
16 

•S 3476 IS

1 ‘‘(A) by telephone or by using a system de2 scribed in section 2821(c)(2)(B); and 

3 ‘‘(B) within 24 hours of the State making 

4 a determination that a disease or condition 

5 meets the criteria for national reporting for 

6 that disease or condition. 

7 ‘‘(2) For diseases and conditions described in 

8 subsection (b)(4)(B), reporting will occur— 

9 ‘‘(A) by using a system described in sec10 tion 2821(c)(2)(B); and 

11 ‘‘(B) only if funding is sufficient for the 

12 State to conduct individual case surveillance 

13 and to have the necessary systems to support 

14 electronic reporting. 

15 ‘‘(d) DEFINITIONS.—In this section, the term ‘na16 tionally notifiable’, with respect to a disease or condition, 

17 means included on the list developed pursuant to sub18 section (b). 

19 ‘‘SEC. 2824. IMPROVING BINATIONAL SURVEILLANCE AND 

20 NOTIFICATION. 

21 ‘‘(a) FINDINGS.—The Congress finds as follows: 

22 ‘‘(1) Nearly 1,000,000 people cross the inter23 national border between the United States and Mex24 ico on a daily basis, and this transmobility of popu25 lation presents actual cases and the potential risk of 


rfrederick on PROD1PC67 with BILLS
17 

•S 3476 IS

1 transmission of infectious diseases and disease 

2 agents between these countries. 

3 ‘‘(2) Numerous infectious disease cases in the 

4 United States are binational in origin, thus requir5 ing improved epidemiology, surveillance, follow-up 

6 investigations, and disease case management along 

7 the United States and Mexico border. 

8 ‘‘(b) GUIDELINES FOR BINATIONAL COOPERA9 TION.—Not later than 1 year after the date of the enact10 ment of this subtitle, the Director of the Centers for Dis11 ease Control and Prevention shall— 

12 ‘‘(1) develop an expedited review and approval 

13 process and adopt the resultant version of the 

14 ‘Guidelines for US–Mexico Coordination on Epide15 miological Events of Mutual Interest’, which have 

16 been developed with input from United States and 

17 Mexican State health agencies, including the Mexi18 can Federal Health Secretariat, the United States 

19 Department of Health and Human Services, and the 

20 Centers for Disease Control and Prevention; and 

21 ‘‘(2) use these guidelines as the basis for devel22 oping improved standards and protocols for bina23 tional epidemiology, surveillance, laboratory anal24 yses, and control of infectious diseases between the 

25 United States and Mexico. 


rfrederick on PROD1PC67 with BILLS
18 

•S 3476 IS

1 ‘‘(c) DEFINITION.—In this section, the term ‘bina2 tional’ refers to both sides of the United States-Mexico 

3 border, whether collectively, such as an activity or pro4 gram being carried out concurrently by or in both coun5 tries, a phenomenon (for example, a disease outbreak or 

6 health emergency) affecting a population or geographic 

7 area in both countries, or a disease case that originated 

8 on one side of the border and was transmitted to the other. 

9 ‘‘SEC. 2825. EVALUATION OF BEST PRACTICES IN PUBLIC 

10 HEALTH SURVEILLANCE. 

11 ‘‘(a) IN GENERAL.—The Secretary, acting through 

12 the Director of the Centers for Disease Control and Pre13 vention, shall establish a committee— 

14 ‘‘(1) to evaluate best practices in public health 

15 surveillance, including human and animal disease 

16 surveillance and environmental health monitoring of 

17 harmful exposures through air, water, soil, or other 

18 means; and 

19 ‘‘(2) to assess systems needed for improving co20 ordination among public health surveillance and 

21 monitoring systems. 

22 ‘‘(b) COMPOSITION.—The committee established 

23 under subsection (a) shall be composed of— 


rfrederick on PROD1PC67 with BILLS
19 

•S 3476 IS

1 ‘‘(1) an epidemiologist employed and designated 

2 by the Director of the Centers for Disease Control 

3 and Prevention; 

4 ‘‘(2) an informatics specialist designated by the 

5 Director of the Centers for Disease Control and Pre6 vention; 

7 ‘‘(3) an epidemiologist designated by the Direc8 tor of the Centers for Disease Control and Preven9 tion to represent the National Center for Environ10 mental Health and the Agency for Toxic Substances 

11 and Disease Registry; 

12 ‘‘(4) a representative of an academic center or 

13 professional, scientific association designated by the 

14 American Society for Microbiology; 

15 ‘‘(5) a food scientist designated by the Commis16 sioner of Food and Drugs; 

17 ‘‘(6) an individual designated by the Secretary 

18 of Agriculture from the Division of Veterinary Serv19 ices; 

20 ‘‘(7) a wildlife disease specialist designated by 

21 the Secretary of Agriculture; 

22 ‘‘(8) an epidemiologist employed by a State and 

23 designated by the Council of State and Territorial 

24 Epidemiologists; 


rfrederick on PROD1PC67 with BILLS
20 

•S 3476 IS

1 ‘‘(9) a public health laboratorian employed by a 

2 State and designated by the Association of Public 

3 Health Laboratories; 

4 ‘‘(10) a public health veterinarian employed by 

5 a State and designated by the National Association 

6 of State Public Health Veterinarians; 

7 ‘‘(11) a laboratorian designated by the Amer8 ican Association of Veterinary Laboratory Diagnosti9 cians; 

10 ‘‘(12) a State health official designated by the 

11 Association of State and Territorial Health Officials; 

12 ‘‘(13) a local health official designated by the 

13 National Association of County and City Health Of14 ficials; 

15 ‘‘(14) an environmental health scientist em16 ployed and designated by the Administrator of the 

17 Environmental Protection Agency; and 

18 ‘‘(15) a representative with expertise in the De19 partment of Veterans Affairs’ disease monitoring 

20 systems. 

21 ‘‘(c) FUNCTIONS.—The committee established under 

22 subsection (a) shall— 

23 ‘‘(1) review innovative approaches adopted by 

24 State and local agencies to improve disease detec25 tion; 


rfrederick on PROD1PC67 with BILLS
21 

•S 3476 IS

1 ‘‘(2) evaluate best practices in public health 

2 surveillance; 

3 ‘‘(3) develop model data sharing agreements 

4 among local, State, and Federal health agencies; 

5 ‘‘(4) assess systems needed for coordinated ani6 mal and human disease surveillance and develop rec7 ommendations for the improvement of such surveil8 lance; and 

9 ‘‘(5) disseminate findings and recommendations 

10 to relevant local, State and Federal agencies. 

11 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

12 is authorized to be appropriated to carry out this section, 

13 $750,000 for each of fiscal years 2009 through 2010.’’. 

Æ 


rfrederick on PROD1PC67 with BILLS