{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T00:29:22Z","timestamp":1777681762861,"version":"3.51.4"},"reference-count":28,"publisher":"SAGE Publications","issue":"1_suppl","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Security"],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:p>The COVID-19 pandemic illuminated the lack of resources available to US state and local public health agencies to respond to large-scale health events. Two response activities that were notably underresourced are case investigation and contact tracing (CI\/CT), which health agencies routinely employ to control and prevent the transmission of infectious diseases. However, the scale of contact tracing required during the COVID-19 pandemic exceeded available resources, even in high-capacity public health agencies. For both routine outbreak response and epidemic preparedness, health agencies must have CI\/CT program capacities in place prior to the detection of an outbreak to be ready to respond. Our research builds on previous work to identify the baseline CI\/CT capacities needed in US state and local public health agencies to respond to any type of outbreak. Fifteen public health officials representing 10 public health agencies and 4 experts in CI\/CT were interviewed about various aspects of their CI\/CT program during the COVID-19 pandemic. The interviews coincided with the beginning of the 2022 mpox epidemic. Discussions on CI\/CT during that response were collected to augment the interviews, where possible. Findings revealed that CI\/CT capacities were underresourced prior to and during the pandemic, as well as during the mpox outbreak, even after substantial additional resourcing and efforts to scale up. Moreover, state and local health agencies encountered challenges in pivoting their COVID-19 CI\/CT capacities for the mpox response, suggesting that CI\/CT programs should either be designed with flexibility in mind, or should allow for specialization based on the pathogen's mode of transmission and the population at risk. Federal, state, and local health agency staff and officials should consider lessons learned from this research to plan for readily scalable and sustainable CI\/CT programs to ensure readiness for future outbreaks.<\/jats:p>","DOI":"10.1089\/hs.2023.0011","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T09:44:24Z","timestamp":1692870264000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Case Investigation and Contact Tracing in US State and Local Public Health Agencies: Sustaining Capacities and Applying Lessons Learned From the COVID-19 Pandemic and 2022 Mpox Outbreak"],"prefix":"10.1177","volume":"21","author":[{"given":"Alexandra","family":"Woodward","sequence":"first","affiliation":[{"name":"Alexandra Woodward, DrPH, MPH, is a DrPH Researcher, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Center for Health Security, Baltimore, MD."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caitlin","family":"Rivers","sequence":"additional","affiliation":[{"name":"Caitlin Rivers, PhD, is an Assistant Professor, Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, and a Senior Scholar, Johns Hopkins Center for Health Security, Baltimore, MD."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,9,27]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"US Centers for Disease Control and Prevention. Prioritizing case investigation and contact tracing for COVID-19. Updated February 28 2022. Accessed July7 2023. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/php\/contact-tracing\/contact-tracing-plan\/prioritization.html"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/PHH.0000000000001290"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0006762"},{"key":"e_1_3_2_5_2","unstructured":"US Centers for Disease Control and Prevention. Case investigation and contact tracing: part of a multipronged approach to fight the COVID-19 pandemic. Updated February 28 2022. Accessed November26 2022. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/php\/principles-contact-tracing.html"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","unstructured":"Woodward A Rivers C. Building case investigation and contact tracing programs in U.S. state and local health departments: a conceptual framework. Preprint. medRxiv. Posted January 11 2023. Accessed July7 2023. https:\/\/doi.org\/10.1101\/2023.01.07.23284294","DOI":"10.1101\/2023.01.07.23284294"},{"key":"e_1_3_2_7_2","unstructured":"Wogan JB. Charting a course for public health based on lessons from contact tracing during the pandemic. Mathematica blog. Published October 5 2022. Accessed October20 2022. https:\/\/www.mathematica.org\/blogs\/charting-a-course-for-public-health-based-on-lessons-from-contact-tracing-during-the-pandemic"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.706697"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-12790-0"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3233\/SJI-200763"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1057\/s41271-021-00285-y"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/PHH.0000000000001488"},{"key":"e_1_3_2_13_2","unstructured":"National Association of County and City Health Officials (NACCHO). Building COVID-19 contact tracing capacity in health departments to support reopening American society safely. NACCHO position statement. Published April 16 2020. Accessed July7 2023. https:\/\/www.naccho.org\/uploads\/full-width-images\/Contact-Tracing-Statement-4-16-2020.pdf"},{"key":"e_1_3_2_14_2","unstructured":"National Academy for State Health Policy. State approaches to contact tracing during the COVID-19 pandemic. Updated September 23 2022. Accessed July7 2023. https:\/\/www.nashp.org\/state-approaches-to-contact-tracing-covid-19\/#tab-id-1"},{"key":"e_1_3_2_15_2","unstructured":"National Association of County and City Health Officials (NACCHO). Keep communities healthy by investing in the public health workforce. Accessed August1 2023. https:\/\/www.naccho.org\/uploads\/downloadable-resources\/Workforce-COALITION-2021.pdf"},{"key":"e_1_3_2_16_2","unstructured":"Johns Hopkins Center for Health Security National Public Radio (NPR). Center for Health Security\/NPR state survey. Johns Hopkins Coronavirus Resource Center. Updated March 10 2023. Accessed July10 2023. https:\/\/coronavirus.jhu.edu\/contact-tracing\/state-survey-results"},{"key":"e_1_3_2_17_2","unstructured":"US Census Bureau. Census regions and divisions of the United States. Accessed August1 2023. https:\/\/www2.census.gov\/geo\/pdfs\/maps-data\/maps\/reference\/us_regdiv.pdf"},{"key":"e_1_3_2_18_2","unstructured":"World Population Review. United States by density. Updated March 2023. Accessed July7 2023. https:\/\/worldpopulationreview.com\/state-rankings\/state-densities"},{"key":"e_1_3_2_19_2","unstructured":"Coronavirus Aid Relief and Economic Security (CARES Act) HR 748 116th Cong (2020). Pub L No. 116-136 134 Stat 281. Accessed July13 2023. https:\/\/www.congress.gov\/116\/plaws\/publ136\/PLAW-116publ136.htm"},{"key":"e_1_3_2_20_2","unstructured":"American Rescue Plan Act HR1319 117th Cong (2021). Pub L No. 117-2 135 Stat 4. Accessed July13 2023. https:\/\/www.congress.gov\/bill\/117th-congress\/house-bill\/1319\/text"},{"key":"e_1_3_2_21_2","unstructured":"Health Insurance Portability and Accountability Act HR3103 104th Cong (1995-1996). Pub L No. 104-191 110 Stat 1936. Accessed July13 2023. https:\/\/www.congress.gov\/bill\/104th-congress\/house-bill\/3103"},{"key":"e_1_3_2_22_2","unstructured":"Henry TA. What physicians can do to boost COVID-19 contact-tracing efforts. American Medical Association. Published June 17 2020. Accessed November15 2022. https:\/\/www.ama-assn.org\/delivering-care\/public-health\/what-physicians-can-do-boost-covid-19-contact-tracing-efforts"},{"key":"e_1_3_2_23_2","unstructured":"Resolve to Save Lives. Measures to Improve COVID-19 Response: End-to-End Quality Improvement of COVID-19 Testing Case Investigation and Contact Tracing. New York: Resolve to Save Lives; 2021. 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