Improving epidemiology, surveillance, and
J. LYLE CONRAD AND JAMES L. PEARSON
In the United States, the first health responder to disease outbreaks, terrorist threats, or terrorist attacks is the local public health authority—and if indicated, the local law authority. This local public health response is based on constitutional law that was first established in 1791. Health and welfare became the responsibility of state governments, which passed laws governing the practice of medicine, the reporting of disease, and the licensing of laboratories and hospitals. By 1925, all states reported some diseases to the U.S. Public Health Service (PHS) in Washington, D.C. In 1961, this reporting and response function was transferred to the then–Center for Disease Control.1 All states and territories have a laboratory designated as the state (or territorial) public health laboratory (PHL). Originally formed to test milk, drinking water, and specimens from patients with suspected venereal diseases or tuberculosis, these laboratories continue to be a vital component of public health surveillance and prevention.
Reporting and investigating disease outbreaks are state functions. Each state health department has delegated these functions to the “state epidemiologist,”