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Epidemiology Surveillance and Capacity Improvement: A Characterization of Texas, 2017

Published online by Cambridge University Press:  17 March 2021

Kahler W. Stone*
Department of Health and Human Performance, Middle Tennessee State University, Murfreesboro, TN, USA
Marilyn Felkner
Department of Public Health, University of Texas, School of Human Ecology, Austin, TX, USA
Eric Garza
Emerging and Acute Infectious Disease Branch, Texas Department of State Health Services, Austin, TX, USA
Maria Perez-Patron
Department of Epidemiology and Biostatistics, Texas A&M School of Public Health, College Station, TX, USA
Cason Schmit
Department of Health Policy and Management, Texas A&M School of Public Health, College Station, TX, USA
Thomas J. McDonald
Department of Environmental and Occupational Health, Health, Texas A&M School of Public Health, College Station, TX, USA
Jennifer A. Horney
Department of Epidemiology, University of Delaware, Newark, DE, USA
Corresponding author: Kahler W. Stone, Email:



In response to increasing caseloads of foodborne illnesses and high consequence infectious disease investigations, the Texas Department of State Health Services (DSHS) requested funding from the Texas Legislature in 2013 and 2015 for a new state-funded epidemiologist (SFE) program.


Primary cross-sectional survey data were collected from 32 of 40 local health departments (LHDs) via an online instrument and analyzed to quantify roles, responsibilities, and training of epidemiologists in Texas in 2017 and compared to similar state health department assessments.


Sixty-six percent of SFEs had epidemiology-specific training (eg, master’s in public health) compared to 45% in state health department estimates. For LHDs included in this study, the mean number of epidemiologists per 100 000 was 0.73 in medium LHDs and 0.46 in large LHDs. SFE positions make up approximately 40% of the LHD epidemiology workforce of all sizes and 56% of medium-sized LHD epidemiology staff in Texas specifically.


Through this program, DSHS increased epidemiology capacity almost twofold from 0.28 to 0.47 epidemiologists per 100 000 people. These findings suggest that capacity funding programs like this improve epidemiology capacity in local jurisdictions and should be considered in other regions to improve general public health preparedness and epidemiology capacity.

Original Research
© Society for Disaster Medicine and Public Health, Inc. 2021

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Centers for Disease Control and Prevention. Public Health Emergency Preparedness and Response Capabilities: national standards for state, local, tribal, and territorial public health. U.S. Department of Health and Human Services. 2018. Accessed June 23, 2020.Google Scholar
Boulton, M, Abellera, J, Lemmings, J, Robinson, L. Assessment of epidemiologic capacity in state and territorial health departments – United States, 2004. Morb Mortal Wkly Rep. 2005;54(18):457459.Google Scholar
Boulton, ML, Hadler, J, Beck, AJ, et al. Assessment of epidemiology capacity in state health departments, 2004–2009. Public Health Rep. 2011;126(1):8493.CrossRefGoogle ScholarPubMed
Hadler, JL, Lampkins, R, Lemmings, J, et al. Assessment of epidemiology capacity in state health departments – United States, 2013. Morb Mortal Wkly Rep. 2015;64(14):394398.Google Scholar
Council for State and Territorial Epidemiologists. 2017 Local Epidemiology Capacity Assessment. CSTE. 2017. Accessed August 12, 2018.Google Scholar
Council for State and Territorial Epidemiologists. 2013 National assessment of epidemiology capacity: findings and recommendations. CSTE, Atlanta (GA). 2014. Accessed October 7, 2016.Google Scholar
NACCHO. NACCHO profile study. 2016. Accessed November 7, 2017.Google Scholar
McGinty, MD, Binkin, N, Arrazola, J, et al. Epidemiology workforce capacity in 27 large urban health departments in the United States, 2017. Public Health Rep. 2019;134(4):386394.Google ScholarPubMed
Joseph, A. Contact tracing may help avoid another lockdown. Can it work in the U.S.? State News. 2020. Accessed June 23, 2020.Google Scholar
Simmons-Duffin, S. As states reopen, do they have the workforce they need to stop coronavirus outbreaks? NPR. 2020. Accessed June 23, 2020.Google Scholar
Okeson-Haberman, A. Health officials worry not enough contact tracers in Kansas. US News & World Report. 2020. Accessed June 23, 2020.Google Scholar
Soltys, SM. Not enough contact tracers, and other reasons it’s too soon to reopen. Illinois Times. 2020. Accessed June 23, 2020.Google Scholar
Association of State and Territorial Health Officials. ASTHO profile of state public health: volume three (p. 142). 2012. Accessed April 17, 2019.Google Scholar
Beck, AJ, Boulton, ML, Coronado, F. Enumeration of the governmental public health workforce, 2014. Am J Prev Med. 2014;47(5):S306313.CrossRefGoogle ScholarPubMed
Beck, AJ, Meit, M, Heffernan, M, Boulton, ML. Application of a taxonomy to characterize the public health workforce. J Public Health Manag Pract. 2015;21:S3645.CrossRefGoogle ScholarPubMed
Chapple-McGruder, T, Leider, JP, Beck, AJ, et al. Examining state health agency epidemiologists and their training needs. Ann Epidemiol. 2017;27(2):8388.Google ScholarPubMed
CDC, CSTE. Applied epidemiology competencies: competencies for applied epidemiologists in governmental public health agencies (AECs). 2008. Accessed August 14, 2017.Google Scholar
O’Keefe, KA, Shafir, SC, Shoaf, KI. Local health department epidemiologic capacity: a stratified cross-sectional assessment describing the quantity, education, training, and perceived competencies of epidemiologic staff. Front Public Health. 2013;1:64.CrossRefGoogle ScholarPubMed
Thompson, D. What is “contact tracing” and how does it work? WebMD. 2020. Accessed June 23, 2020.Google Scholar
Yan, H. Contact tracing 101: how it works, who could get hired, and why it’s so critical in fighting coronavirus. CNN. 2020. Accessed June 23, 2020.Google Scholar
Watson, C, Cicero, A, Blumenstock, J, Fraser, M; Contributors. A national plan to enable comprehensive COVID-19 case finding and contact tracing in the US (p. 1-16). Johns Hopkins Bloomberg School of Public Health Center for Health Security, Johns Hopkins University. April 10, 2020. Accessed June 23, 2020.Google Scholar
Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University. Contact tracing workforce estimator. 2020. Accessed June 23, 2020.Google Scholar
Moser, M, Ramiah, K, Ibrahim, M. Epidemiology core competencies for master of public health students. Public Health Rep. 2008;123(Suppl 1):5966.CrossRefGoogle ScholarPubMed
MacDowell, M, Glasser, M, Fitts, M, et al. A national view of rural health workforce issues in the USA. Rural Remote Health. 2010;10(3):1531.Google ScholarPubMed
Hoffmann, T. The meanings of competency. J Eur Ind Train. 1999;23(6):275286.CrossRefGoogle Scholar
Hoogveld, AWM, Paas, F, Jochems, WMG. Training higher education teachers for instructional design of competency-based education: product-oriented versus process-oriented worked examples. Teach Teach Educ. 2005;21(3):287297.CrossRefGoogle Scholar
Enanoria, WT, Crawley, AW, Hunter, JC, et al. The epidemiology and surveillance workforce among local health departments in California: mutual aid and surge capacity for routine and emergency infectious disease situations. Public Health Rep. 2014;129(Suppl 4):114122.CrossRefGoogle ScholarPubMed
Moehrle, C. Who conducts epidemiology activities in local public health departments? Public Health Rep. 2008;123(Suppl 1):67.CrossRefGoogle ScholarPubMed
Healthy People 2020. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. 2017. Accessed January 5, 2018.Google Scholar