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  1. Thiede, Hanne DVM, MPH
  2. Duchin, Jeffrey S. MD
  3. Hartfield, Karen MPH
  4. Fleming, David W. MD


Objective: To assess variability in investigation, prevention, and control of communicable diseases of public health significance among Washington State local health jurisdictions.


Design: Online survey conducted from December 2010 to January 2011.


Setting: Washington State local health jurisdictions.


Participants: Local health officers in the 35 local health jurisdictions in Washington State.


Main Outcome Measures: Variability across local health departments in public health case investigation practices, recommendations, and activities related to animal bites and potential rabies exposures, hepatitis C, meningitis, pertussis, foodborne illness complaints, tuberculosis, reportable animal diseases, provision of health education materials, and use of local disease investigation protocols in addition to statewide case reporting guidelines.


Results: We found differences in approaches to investigation of several notifiable diseases. The most pronounced variations were in investigation of hepatitis C cases and recommendations for rabies postexposure prophylaxis. We also found variability in follow-up of low-risk contacts of pertussis cases, testing for latent tuberculosis infection, organization of response to foodborne illness complaints and avian chlamydiosis, and use of zoonotic disease prevention materials.


Conclusions: Washington State residents receive different public health advice and services for communicable disease issues depending on where they reside in the state. Unnecessary variation is undesirable and may undermine public confidence in the public health system. Additional research is needed to better understand reasons for these differences and to determine whether there are policy, funding, or programmatic changes that could address areas in need of standardization.