Arkansas is the state least prepared for an infectious disease outbreak, according to a new analysis.

But no state is perfect: none scored higher than an eight on the 10-point scale used in “Outbreaks: Protecting Americans from Infectious Disease,” a new report assessing readiness for infectious threats and conducted by the Trust for America’s Health and the Robert Wood Johnson Foundation.

“It is not a comprehensive review; but collectively, it provides a snapshot of efforts to prevent and control infectious diseases in states and within the healthcare system,” the report’s authors write of their scoring system, based on 10 indicators of preparedness. The states that scored highest—8 points each—were Maryland, Massachusetts, Tennessee, Vermont and Virginia. Half the states scored a six, seven or eight. Arkansas alone scored two. D.C. earned a score of five.


Infectious disease preparedness. (Trust for America’s Health/Robert Wood Johnson Foundation)

The scores were determined by how states ranked along 10 indicators chosen by consulting with leading public health officials. Together, they “offer a composite snapshot of strengths and vulnerabilities across the health system,” the authors write. But the scores should not be taken as a reflection on state health departments or systems. Some are attributable to broader factors, such as resources, policies, community health status and attitudes.

The indicators evaluated such things as public health funding, information management, childhood and flu vaccination rates, preparedness for the public health impacts of climate change and food safety.

The indicator on which states were most successful measured the capabilities of public health laboratories during emergencies or drills. Between July 2013 and July 2014, 47 states and D.C. conducted an exercise or used a real event to test how long it took for urgent information to travel between labs.

The indicator on which the fewest states succeeded measured efforts to minimize health care-associated infections, in which patients contract an infection while receiving medical treatment. The study evaluated two such types, but the one on which states scored worst evaluated those in which infections were spread by the insertion of a central line, a tube often placed in a large vein, often in the neck, chest, arm or groin, to provide medical treatment. Only 10 states saw such infections fall from 2011 to 2012.

35 states met child vaccination goals

(Note: Hover over a state to see its rate. Darker shading indicates higher rates.)

Thirty-five states and D.C. have already met a federally-set child vaccination goal as part of the Healthy People 2020 initiative to improve the nation’s health by that year. The goal is to ensure that at least 90 percent of children aged 19 months to 35 months get at least three doses of the Hepatitus B vaccine.

The CDC estimates that anywhere from 700,000 to 1.4 million people are infected with Hepatitus B and nearly two in three of them don’t know it. It is typically transferred from mother to child during birth and the vaccine has been available since 1982.

14 states met flu vaccination goals


(Note: Hover over a state to see its rate. Darker shading indicates higher rates.)

Just 14 states vaccinated at least half their population aged six months or older for the seasonal flu during last year’s flu season, according to the study. South Dakota had the highest vaccination rate, of 57.4 percent. Wyoming’s was lowest, at 37.6 percent. Historically, children and seniors have been encouraged to get vaccinated but there are benefits to everyone getting the vaccination.

“Experts note that vaccination rates need to generally be above 70 percent for ‘herd immunity’ effects — which limit the spread and protect those without immunity — to become apparent,” the report’s authors write.

38 states met food safety goals


(Note: Hover over a state to see its rate. Darker shading indicates higher rates.)

The majority of states scored well on food safety, with 38 meeting national goals of testing reported cases of the common food-borne illness E. coli (Escherichia coli O157, to be precise). The national goal is to test 90 percent of reported cases within four days. Sixteen states achieved that goal 100 percent of the time.