Public health surveillance of communicable diseases relies on reports from health care workers and laboratories in the community. The attacks with anthrax in 2001 and outbreaks of new infectious diseases in Asia raised concerns about public health agencies' ability to respond rapidly and effectively to new disease outbreaks, prompting the Centers for Disease Control and Prevention (CDC) to issue guidelines to local public health agencies. The CDC recommended that local agencies provide a single, well-publicized telephone number and institute a telephone triage system for receiving urgent reports and have a trained public health professional available to respond to urgent case reports within 30 minutes of a call; the CDC also recommended that the service be available 24 hours a day, seven days a week.

To test whether such systems were working across the country, researchers at the RAND Center for Domestic and International Health Security, with support from the U.S. Department of Health and Human Services, used trained callers to pose as physicians or nurses from local health care facilities and contact 19 local agencies, pretending to be health care workers with urgent cases to report-describing, for example, symptoms consistent with smallpox, anthrax, or bubonic plague. (After the caller received a response, the responder was told the call was a test and was asked not to tell coworkers.) The researchers found that performance varied widely among the 19 local agencies.

FIGURE. In 2001 Margarita Chierico tried on a laminated Saranex suit as Maurice Baum showed the correct way to wear it during a decontamination class at University Hospital and Medical Center in Tamarac, Florida. The class was designed to help hospital workers respond to nuclear, biological, and chemical attacks. A recent study found that many public health agencies are not prepared for such events.

Only 10 of the agencies provided a single phone number for reporting urgent cases 24 hours a day, seven days a week; eight responded to calls within 30 minutes. Alarmingly, three did not respond at all to five consecutive calls. The response time also varied widely, from one minute to more than 11 hours. The longer response times (more than an hour) were seen at the ends of business days and during evenings and weekends.

During some calls, officers told callers "not to worry" about the "cases" of botulism and bubonic plague described, or they failed to advise that a patient with signs consistent with smallpox be isolated.

What's clear is the need to improve urgent case reporting systems, including response times and the quality of response, throughout many regions of the country. The authors of the study have developed a manual that local public health agencies can use as a guide for testing their own performance. It's available for download at http://www.rand.org/publications/TR/TR260.

Dausey DJ, et al. Health Aff (Millwood) [Web Exclusive]. 30 August 2005; W5: 412-9.