State Activities in Surveillance and Investigation of Non-Infectious Environmental Exposures and Acute Health Effects: Results of a CSTE Survey

BACKGROUND:  The Council of State and Territorial Epidemiologists (CSTE) surveyed states to obtain information about the monitoring and investigation of environmentally related acute health conditions and environmental exposure events. The purpose of this survey was to better understand how jurisdictions collect, share, and use this information; and thus to identify activities that could reasonably be done in most state health departments.

METHODS:  Survey questions addressed eleven acute health conditions (child/adult lead toxicity; mercury, arsenic and cadmium toxicity; acute pesticide illness; acute respiratory diseases from chemical exposures; acute disease cluster; methemoglobinemia; carbon monoxide poisoning; and hyperthermia) and nine environmental exposure types (mold, chemical spills, chemical contamination of food/water, radiation releases, chemically contaminated products, mercury spills, carbon monoxide releases, pesticide accidental exposures, other chemical spills/releases). For each condition/event, respondents were asked to identify the source(s) of the case/event reports, estimated numbers of cases or events annually, numbers and types of follow-up investigations, and types of data analysis and dissemination. Surveys were administered via email in December 2013 to the environmental health directors or CSTE environmental health points of contacts in all States, Washington DC, and the 5 largest US cities.

RESULTS:  Forty-five (80.4%) of the 56 surveyed jurisdictions responded. The number collecting data on health conditions ranged from 43 (96%) for child lead toxicity to 17 (38%) for methemoglobinemia. Except for lead and pesticides, almost all states reported receiving fewer than 50 reports per year per condition. Overall, fewer jurisdictions collected data on environmental exposure events (range of 73% for mold to 22% for carbon monoxide and pesticides exposures). The percent of reported cases and exposure events receiving a follow-up investigation varied widely by condition and state, ranging from 85% down to less than 5%. Generally, with the exception of lead, less than 50% of the states summarized and disseminated case and investigation data on reported conditions and events. Seventy-seven percent of the respondents indicated an interest in expanding these activities if resources were made available, and 58% were willing to share their surveillance and response protocols.

CONCLUSIONS:  There is wide variation across states in the degree to which they collect and respond to environmentally related acute health conditions and exposure events.  In general, fewer states summarize and disseminate the data than collect them.  Resources should be tapped to support states willing to expand these activities, including training and sharing state protocols. A limitation of this survey was that 20% of the jurisdictions did not participate.