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N.D. ranks low, Minnesota ranks high in readiness for infectious diseases

A nurse prepares to administer an influenza vaccine at Boston Children's Hospital in Boston, Massachusetts January 10, 2013. REUTERS/Brian Snyder

When it comes to infectious diseases, North Dakota and Minnesota vary in preparedness in the case of an outbreak, a new study shows.

In a report released Tuesday by Trust for America's Health and the Robert Wood Johnson Foundation, North Dakota was ranked in the bottom half of outbreak-ready states and Minnesota ranked in the top half.

Out of the 10 "key indicators" used to score states, North Dakota met four and Minnesota met seven.

The indicators ranged from not decreasing public health funding, to having certain vaccines, to having labs prepared for increased testing in the instance of a disease outbreak.

Although neither Minnesota nor North Dakota scored a perfect 10 -- the highest-scoring state was New Hampshire with eight -- representatives from state health departments on both sides of the Red River agreed that they should always work on being prepared for outbreaks.

"We have to be prepared for outbreaks," said Kirby Kruger, director of the Division for Disease Control at the North Dakota Department of Health.

North Dakota

Kruger pointed to two recent instances where North Dakota faced outbreaks: hepatitis C in Ward County and a tuberculosis outbreak in Grand Forks this past year.

"We've been able to amp up for this," he said.

The Grand Forks TB outbreak gave North Dakota a chance to "learn some lessons along the way," including helping patients in isolation, which is rarely needed in this day in age, Kruger said.

"I think we did well considering the specific challenges," he said, adding that partnerships between the state health department and local health care functioned well during the TB outbreak.

As far as the study goes, Kruger said it's difficult to compare all 50 states by only 10 indicators.

North Dakota's goal is to have a 100 percent vaccination rate, but it failed the report's whooping cough and flu vaccine indicators.

The report asked for 90 percent of 19- to 35-month-olds to be vaccinated for whooping cough and at least 50 percent of the population vaccinated during the 2012-13 flu season.

Kruger said North Dakota is about 85 percent vaccinated for whooping cough and in the mid- to upper-40 percent level vaccinated for the flu.

"Anytime we fall below 100 percent, we know we have some work to do," he said.

North Dakota did meet the report's human papillomavirus vaccination requirement for educating teenagers, according to the report.

When it comes to vaccines, the main thing the Department of Health can do is educate, Kruger said, and it aims to do that by working with local public health systems and private health care providers, as well as reaching out through the media.

"Our goal is to continue to educate," he said.

North Dakota also failed the study's indicator of mandating that health care facilities report health care-associated infections, but Kruger said the report is missing the state's encouragement of reporting infections to the National Healthcare Safety Network, which goes directly to the Centers for Disease Control and Prevention.

He added that there are specific infections that are required to be reported to the state Department of Health.


Representatives from the Minnesota Department of Health also said it's difficult to measure states by only 10 indicators.

"We believe Minnesota is well-prepared to respond to infectious disease outbreaks of almost any kind," said Doug Schultz, a spokesman for the Minnesota Department of Health, in an email.

Like North Dakota, Minnesota only narrowly failed some of the report's indicators, Schultz said. For example, it had 84.2 percent of people vaccinated for whooping cough where the report asks for 90 percent.

Seven other states scored seven like Minnesota, and only New Hampshire scored higher. Nine states scored the same as North Dakota, and nine ranked lower, with scores of three or two. The lowest-scoring states in the study, at two, were Georgia, Nebraska and New Jersey.

North Dakota scored 4/10 in outbreak readiness

• Pluses: Strong funding for public health. Requires teens to be vaccinated for HPV, a virus associated with cancer.

• Minuses: No plan to triple capacity for testing for diseases during outbreaks. No requirement for health care facilities to report infections at the facilities.

Minnesota scored 7/10 in outbreak readiness

• Pluses: More than half of population vaccinated for flu. Labs conducted exercises to ensure operations will continue despite outbreaks.

• Minuses: Decreased funding for public health. Less than 90 percent of infants vaccinated for whooping cough.

On the Web: To view the entire study, visit

Call Haley at (701) 780-1102; (800) 477-6572, ext. 1102; or send email to