Public Health Surveillance for Suspected Smallpox in the United States, 2003–2005: Results of a National Survey

In 2005, a Web-based survey of chief epidemiologists of 50 states, the District of Columbia, 9 large cities, and 8 territories examined the status of US smallpox surveillance after the Council of State and Territorial Epidemiologists recommended that smallpox be reportable. Of 55 respondents, 95% reported state or territory laws or regulations governing smallpox reporting; 70% of states required laboratories to report variola virus. All respondents could investigate reported suspected patients; 70%-89% would investigate initially by telephone or fax. In 2004, 11 states reported 33 patients suspected of having smallpox. Reports were more likely in states that provided >/=2 educational and training sessions (67% vs. 21%; prevalence odds ratio, 7.60; 95% confidence interval, 1.07-60.45). The goal is a public health surveillance system in which all states, cities, and territories can detect and manage suspected smallpox cases urgently and in which overall surveillance for other infectious diseases is strengthened.