The number of users sharing information through a Centers for Disease Control system that tracks disease outbreaks has more than tripled in the last five years, according to an inaugural report on public health preparedness released by the CDC in late February.

In 2006, 4,646 people were using the system, which is known as the Epidemic Information Exchange (Epi-X)--up from 1,366 in 2001. This increase, according to the CDC, is an indication that states have made progress with respect to emergency preparedness. However, observers note that there is still much to be done.

"Communication between the states on potential public health emergencies is very important," says Dr. Joan Pfinsgraff, director of health intelligence at iJet, a risk management consultancy focused on global threats. "It's good that electronic reporting and alerting processes are being put in place and bolstered by the CDC and public health authorities." Now, she says, the CDC needs to make sure it can use the systems in the event of an emergency. "The majority of work going forward will be related to making states' plans operational. For example, if the pandemic plan for the state is to close schools before 1 percent of the population becomes infected, it needs to be sure it can determine when the first cases arrive into the area and that proper communication is in place to carry out the plan."

In addition to increased adoption of the Epi-X system, the report, titled "Public Health Preparedness: Mobilizing State by State," highlights progress in the areas of training, laboratory testing, response plans, and disease detection and investigation--improvements that have been possible, in part, because of US$5 billion the CDC has distributed to states since 2002.

In 1999, only 12 states had the ability to receive urgent reports about diseases 24/7. Now, all state public health departments have that kind of access. In addition, all states have emergency-response plans to address an influenza pandemic, as well as plans to distribute the Strategic National Stockpile's caches of medical supplies in case of emergency. The number of labs that can test and analyze samples has doubled since 2001, and all state public health departments have implemented routine worker training in a range of emergency response areas.

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