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Infectious Disease Guiding Principles

Sound public health infectious disease control programs require science-based policies, programs, and infrastructure be in place to prevent infectious disease morbidity and mortality, rapidly identify and control outbreaks, support disease elimination, and prevent and respond to re-emerging and emerging infectious disease threats. Evolving risk factors associated with external drivers such as globalization, displacement of people, and climate change reinforce the need for robust and sound public health infectious disease programs.

Surveillance and Reporting

States, tribes, territories, and their local and federal partners are primarily responsible for infectious disease surveillance and reporting. State and territorial public health agencies work with public health professionals, hospitals and other facilities, healthcare providers, laboratories, and schools to help them understand and carry out their responsibility to diagnose and report all relevant infectious diseases in an accurate, complete, and timely manner. This essential function is further elevated by the obligations of our public health system to comply with the provisions of the International Health Regulations as administered by the World Health Organization, of which, the United States is a signatory member. ASTHO supports the following measures for enhanced infectious disease surveillance and reporting:

  • Developing infectious disease case definitions and a list of nationally notifiable diseases in collaboration with CDC and the Council of State and Territorial Epidemiologists.
  • Defining outbreak thresholds for reportable diseases.
  • Working to create surveillance data standards that will allow electronic health records and health information exchanges to be leveraged to collect infectious disease surveillance data.
  • Reporting disease data from states and territories to CDC.
  • Including state and territorial health agency perspectives when developing national surveillance strategies and systems for reporting existing and emerging infectious diseases to federal agencies.
  • Creating or enhancing surveillance systems and case information collection tools to allow for simultaneous or sequential reporting of time-sensitive health data coordinated among local, state, territorial, tribal, and federal public health authorities.
  • Appropriating federal funding to support the technology and infrastructure needed to efficiently collect, analyze, and disseminate infectious disease surveillance and reporting information and allow for transmission among local, state, territorial, and federal health authorities.
  • Collecting legitimate survey and surveillance data to detect trends and risk behaviors and aid in the design of effective interventions to prevent or control infectious disease threats. Federal law (i.e., the Family Educational Rights and Privacy Act) should not inhibit state, territorial, or local public health surveillance, investigatory, and control activities. Public health laws are exempt from protected health information confidentiality.

Legal Authorities and Public Health Law

The authority to evaluate the contributing factors to infectious disease transmission, prevention, and impacts on morbidity and mortality in all settings is critical to the states’ and territories’ ability to prevent and control infectious diseases. This may entail using a variety of sources, including case investigations, patient interviews, population surveys, medical record reviews, state registry data, detailed laboratory analyses, and vital statistics data. ASTHO supports:

  • States and territories holding appropriate statutory and regulatory authority to rapidly mandate reporting of emerging infectious diseases or syndromes to efficiently identify and appropriately respond to new infectious disease threats.
  • States and territories holding appropriate statutory and regulatory authority to enforce quarantine, isolation, and other non-pharmaceutical, community-based interventions such as school dismissal, business closures, and large event cancellations, as appropriate, to control certain infectious diseases.
  • Continuing assessment of public health laws and policies to determine best practices for preventing and reducing the spread of infectious diseases.
  • Periodically re-examining federal, state, and local laws and statutes relative to emerging infections to ensure public health agencies have the powers to respond appropriately to emerging diseases and public health emergencies.

Infectious Disease Prevention

Effective infectious disease control and response efforts include prevention components, such as routine and outbreak response, vaccination programs, and educational programs to encourage changes in unhealthy human behaviors and public acceptance of prevention strategies. ASTHO supports:

  • State and territorial public health agencies collaborating with local health entities and the clinical sector to promote basic hygiene and infection control principles and prevent transmission of existing and emerging infectious diseases.
  • Partnering with clinical providers to develop policies and programs to support evidence-based strategies for screening and linkage to care for clinically latent infectious diseases, such as HIV, tuberculosis, viral hepatitis, and other selected sexually transmitted infections.
  • Enhancing surveillance of infectious diseases, including those originating in other countries.
  • Promoting appropriate and responsible use of antibiotics among the clinical sector, agricultural partners, and the public as an important part of infectious disease prevention and control programs.
  • Building surveillance for and mitigation of opportunities for the emergence of new vector-borne diseases like Zika, as well as controlling those diseases that have emerged, such as West Nile virus, through vector control programs. ASTHO maintains that the need for such programs in particular localities is best assessed and developed in consultation with state and territorial public health agencies.
  • Creating collaborative partnerships among state and territorial public health agencies and veterinary and agricultural organizations to prevent the spread of existing zoonoses and the emergence of new zoonoses, and to control and prevent water- and food-borne illnesses.
  • Enforcing state vaccine mandates and adoption of new mandates, as appropriate, to protect the population from vaccine-preventable diseases.
  • Working to reduce healthcare-associated transmission of infectious disease by promoting education and compliance with transmission-reducing strategies and using policy to advance prevention efforts.
  • Collaborating with schools, worksites, and representatives of racial and ethnic minority populations and tribal governments to implement targeted interventions for disease prevention among high-risk populations.

Preparedness

State and territorial health agency consultation and input into national preparedness plans is critical to effectively detect, respond to, and recover from emerging infectious disease threats. Activities to bolster our nation’s readiness to protect the public’s health from infectious diseases such as pandemic influenza require a sustained commitment to collaboration, service integration, and investments in resources, including adequate federal funding. ASTHO supports:

  • Enhancing the nation’s collective capability to respond to naturally occurring infectious disease outbreaks and to prepare for bioterrorism.
  • Collaborating with state and territorial health agencies, the federal government, local agencies, other state and territorial agencies, tribal partners, the private sector, and representatives of high-risk populations to conduct preparedness activities.
  • Sharing and integrating surveillance and reportable disease data and other sources of public health intelligence to maintain situational awareness of disease incidence, disease syndromes, or unusual events for the near-real-time or real-time detection of unusual infectious disease occurrences.
  • Continuing efforts to improve surveillance and laboratory capabilities to ensure robust and timely monitoring of disease threats.
  • Continuing and enhancing funding for public health preparedness activities to improve public health readiness and ensure ongoing commitment to preventing bioterrorism and major infectious disease threats.

Communication and Collaboration

Providing accurate and timely health information about disease outbreaks and emerging infections to private citizens, healthcare providers, and other state and territorial response agencies in the United States and internationally is integral to an infectious disease outbreak response. Coordination of federal, state, and local health agency messages ensures that providers and the public receive clear and consistent information. ASTHO supports:

  • Expanding collaborations beyond traditional state and territorial public health partners to include others who may be involved in surveillance and response to an emerging infection, such as agricultural agencies, veterinarians, law enforcement, customs and border protection officials at ports of entry, transportation agencies, border control, and neighboring countries.
  • Integrating public health and clinical sector health information exchanges and other data sharing platforms to promote system interface for rapid detection of disease spread, identification of adequately protected populations, and appropriate and effective treatment during infectious disease outbreaks.

Infectious Disease Workforce

Ensuring a skilled workforce is the most difficult challenge state and territorial health agencies face in responding to public health threats and emergencies. Enhanced coordination among public health, clinical, laboratory, and academic programs is integral to developing a robust, active community of epidemiologists, laboratorians, clinical investigators, health educators, occupational health specialists, bioinformatics practitioners, and research scientists who are ready to respond to disease outbreaks and seek solutions to new infectious disease threats. ASTHO supports:

  • Sustaining federal funding for public health training programs to support the current public health workforce.
  • Ensuring adequate and ongoing training of new and existing public health staff in the ever-changing technologies and systems for surveillance, disease detection, and analysis.

Laboratory

The state and territorial public health laboratory has a fundamental role in detecting and identifying infectious diseases. Links to clinical, veterinary, agricultural, and academic laboratories are also critical for shared expertise and to identify laboratory surge capacity for an infectious disease emergency. ASTHO supports:

  • Sustaining federal funding to support state and territorial public health laboratory operations and improvements and regional public health laboratory referral centers.
  • Ensuring public health laboratory access to appropriate, state-of-the-art laboratory tests and reagents to detect and identify infectious diseases.
  • Ensuring public health laboratory access to ongoing technological and training support for new and classic methods of infectious disease detection and identification.
  • Supporting a national laboratory system to integrate reporting between public and private sector laboratories at the state and national levels and provide the communication, coordination, and testing capacity required to effectively detect and report outbreaks and exposures.

Research

State and territorial health agencies contribute critical information to understanding infectious diseases by exploring the causes, transmission, and prevention of diseases in the course of their public health practice through analysis of existing data and by research protocols as necessary. Ongoing research and monitoring of emerging infectious diseases such as pandemic influenza, antimicrobial-resistant infections, and food-borne pathogens are important aspects of protecting the public’s health. ASTHO supports:

  • Using federal policies and funding streams to create incentives for the public and private sectors to develop improved tests to diagnose certain existing infectious diseases and reliable and accurate rapid screening field methods.
  • Developing incentives that encourage development and research for vaccine efficacy and adverse events, antiviral efficacy and side effects, new antimicrobials, and diagnostic tests for emerging infectious diseases.

Approval History:

Infectious Disease Policy Committee Review and Approval: July 11, 2017
Board of Directors Review and Approval: August 23, 2017
Ratified by the ASTHO Assembly of Members: September 20, 2017
Policy Expires: September 30, 2020
Expiration Date Extension due to COVID-19: September 2022

ASTHO policies are broad statements of enduring principles related to particular policy areas that are used to guide ASTHO’s actions and external communications.