Impacts of infectious disease outbreaks in U.S. Jurisdictions

National and state-level health and economic indicators for jobs, trade, agriculture, and travel illustrate U.S. global interconnectivity. While these connections benefit Americans across all states through jobs and economic revenue, they also make Americans vulnerable to the economic and health impacts of global health threats. Recent global health threats, like Ebola and Zika, demonstrate this. In 2018, the CDC funded the Council of State and Territorial Epidemiologists (CSTE) to identify and assess impacts and vulnerabilities of state and local jurisdictions associated with these global health threats. SGNL Solutions was asked to conduct case studies to assess impacts of global health security threats (such as Ebola or Zika) in up to nine local jurisdictions where impacts of these threats can be documented. 


In this project, SGNL Solutions:

  • Conducted a literature review;

  • Interviewed key informants from selected jurisdictions;

  • Interviewed stakeholders from CSTE, CDC, and other public health partners;

  • Compiled data from all available sources;

  • Performed an analysis of the results; and

  • Completed a scientific summary report of the example impacts of global health threats in the case study jurisdictions.

SGNL Solutions began by conducting a review of the literature pertaining to imported infectious diseases and the impacts of these threats in the United States. Following and informed by the literature review, SGNL Solutions selected seven infectious disease events for further exploration that occurred in the United States in the last 10 years. Those selected were:

  1. caused by introduction of a pathogen from outside the United States (i.e., imported),

  2. associated with a declared public health emergency of international concern from the World Health Organization

  3. associated with CDC Bio-Terrorism Agents, and/or

  4. associated with pathogens that are well controlled or eradicated in the United States.


Key informant interviews were scheduled with 22 stakeholders (21 conducted) from 7 jurisdictions to hear first-hand accounts of local impacts. Based on the response rate of the key informants and availability of data, 5 final jurisdictions were selected as case studies, which were documented separately. The lessons gleaned from all the case studies and interviews are synthesized in a final report with findings from past events and recommendations for improved response to future global health security threats to protect U.S. communities.

The findings were categorized to answer 3 key questions regarding global health security threats:

  1. What are the impacts of imported infectious diseases on public health systems and the communities they serve?

  2. What are the barriers and enabling factors encountered by state and local jurisdictions that could be modified to prevent or mitigate impacts of future outbreaks? (e.g. through policy or practice changes at the federal, state, and/or local level)?

  3. What are the roles of all levels of domestic and international governments in global health security?

The final products from this project, our findings, and recommendations were submitted to CDC and currently under clearance review.

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