Preface

A E Cs

Applied Epidemiology

Competencies

Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs)

Partner organizations participating in the development of these competencies:
 Executive Summary
The Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial
Epidemiologists (CSTE) developed the Competencies for Applied Epidemiologists in Governmental
Public Health Agencies (Applied Epidemiology Competencies or AECs for short) to improve the practice
of epidemiology within the public health system. The document
• Defines the discipline of applied epidemiology and
• Describes what skills four different levels of practicing epidemiologists working in government
public health agencies should have to accomplish required tasks.

The AECs were developed within the framework of the Core Competencies for Public Health
Professionals—a product of the Council on Linkages Between Academia and Public Health
Practice—and thus are consistent with the larger field of public health practice. The AECs resulted
from 2 years of highly collaborative work by an expert panel representing local, state, and federal
public health agencies and schools and graduate programs of public health. Epidemiologists at all
levels of public health practice from throughout the country and from academia provided
substantial input into the AECs.

The target audience and intended uses of the AEC are as follows:
• Practitioners: to assess current skills, create career development plans, and plan specific training;
• Employers: to create career ladders for employees, develop position descriptions and job
qualifications, develop training plans for employees, determine compensation, and assess
epidemiologic capacity of the organization;
• Educators: to design programs that train the next generation of epidemiologists to meet the needs
of public health agencies, incorporate critical elements of epidemiologic practice into existing
coursework, and provide continuing education to the current workforce.

The document defines competencies for four tiers of practicing epidemiologists categorized on the basis
of level of responsibility, experience, and education: entry-level or basic, mid-level, supervisory, and
senior scientist/researcher. The expert panel intended that all persons practicing applied epidemiology
gain minimal competency in all of the defined skill domains within the tier that most closely matches
their level of responsibility. However, every applied epidemiologist is not expected to be equally
competent in all areas. Different public health programs that use applied epidemiology may emphasize
different competency areas, and a government agency’s responsibilities, needs, and resources may require
persons in individual epidemiologic positions to focus on particular competencies.

CDC and CSTE seek to generate awareness throughout the public health system of the availability of this
new tool. We encourage individual epidemiologists, public health agencies, and academic centers to use
the competencies and to move with us toward a common goal of improving epidemiologic practice. We
will publish information about the competencies, including tools and documentation to support their use,
on the CDC (www.cdc.gov/od/owcd/cdd/aec/) and CSTE (www.cste.org/competencies.asp) Web sites.
 Preface

Introduction

Epidemiology, one of the core sciences of public health, is “the study of the distribution and determinants
of health-related states and events in specific populations, and the application of this study to control of
health problems.”1 Epidemiologists produce data for decision-making and for understanding disease in
the population. Public heath epidemiologists who work in local, state, and federal health agencies are
critical for the detection, control, and prevention of major health problems.

The Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial
Epidemiologists (CSTE) recognize the vital role of applied epidemiologists working at all levels of
government public health practice. However, recent studies demonstrated a significant shortage of
epidemiologists needed by local and state public health agencies.2,3,4. In addition, epidemiologists
practicing in public health agencies often do not have sufficient training to carry out their responsibilities.
In a CSTE survey,2 29% of epidemiologists had no formal training or academic coursework in
epidemiology. The assessment indicated a need for additional training in several key areas, particularly
design of epidemiologic studies, design of data-collection tools, data management, evaluation of public
health interventions, and leadership and management.

In January 2004, CDC and CSTE hosted a summit to address issues affecting public health
epidemiologists. Leaders in applied epidemiology were invited to discuss the key workforce issues.
Participants strongly supported the need to establish core competencies for applied epidemiologists. This
competency development process since has been identified as a priority for CDC and CSTE.

In October 2004, CDC and CSTE convened an expert panel to define applied epidemiology competencies
(AECs) for local, state, and federal public health epidemiologists. This panel comprised representatives
from state and local health agencies, schools of public health, and private industry and from throughout
CDC (Appendix A). Led by experts in competency development, the panel worked through a structured
process, which included ample opportunity for input from practicing and academic epidemiologists, to
define the AECs (Appendix B).

1
Last JM. A Dictionary of Epidemiology. 4th edition. New York: Oxford University Press, 2001:62.
2
Council of State and Territorial Epidemiologists. 2004 National Assessment of Epidemiologic Capacity: Findings
and Recommendations. Atlanta: Council of State and Territorial Epidemiologists, 2004. Available at
http://www.cste.org//Assessment/ECA/pdffiles/ECAfinal05.pdf. Accessed May 31, 2006.
3
Association of State and Territorial Health Officials. State Public Health Employee Worker Shortage Report: A Civil
Service Recruitment and Retention Crisis. Washington, DC: Association of State and Territorial Health Officials,
2004. Available at http://www.astho.org/pubs/Workforce-Survey-Report-2.pdf. Accessed May 31, 2006.
4
Bureau of Health Professions, Health Resources and Services Administration. Public Health Workforce Study.
Rockville, MD: U.S. Department of Health and Human Services, Health Resources and Services Administration,
2005. Available at http://bhpr.hrsa.gov/healthworkforce/reports/publichealth/default.htm. Accessed May 31, 2006.

November 2008 version 2.0 2

Goal and Objectives

The goal of the AECs is to improve the practice of epidemiology in public health agencies. The objectives
are to create a comprehensive list of competencies that
• Define the discipline of applied epidemiology and
• Describe what skills four different levels of practicing epidemiologists working in government
public health agencies should have to accomplish required tasks.

Target Audience
The AECs focus on the knowledge, skills, and abilities needed to practice epidemiology in government
public health agencies. The AECs target primarily persons who currently practice epidemiology and
persons who seek to become epidemiologists in government public health agencies. However, many of
the competencies apply to epidemiologists practicing in other venues, including research and private
industry. In addition, many apply to people in public health agencies who use epidemiologic methods in
their jobs—such as public health nurses and environmental health specialists—but who do not classify
themselves as epidemiologists. Any person, regardless of job title, should meet the recommended level of
competency for any tasks he or she performs that require epidemiologic methods.

Framework
Definition of competencies

Competencies are action-oriented statements that delineate the essential knowledge, skills, and abilities in
the performance of work responsibilities.5 Competencies are describable and observable.

Guiding principles for AECs

• Base them on the Core Competencies of the Council on Linkages for Core Competencies for
Public Health Professionals.
The AECs were created within the framework of the Core Competencies for Public Health
Professionals, developed by the Council on Linkages Between Academia and Public Health
Practice (COL).6 The COL framework defines eight skill domains that encompass the entire field of
public health practice. By incorporating the AECs into the eight skill domains of the COL, the
expert panel recognized the practice of epidemiology as a subfield of public health and
acknowledged that people practicing epidemiology in a public health setting should develop
competency as public health practitioners.

• Seek broad input.

The expert panel solicited input from the local, state, and federal practitioners and from schools of
public health to ensure the AECs truly reflected the practice of epidemiology in public health
agencies and could be used in the practice setting and in schools of public health. Furthermore, the
broad input process provided a mechanism for educating individual epidemiologists, public health
agencies, academic centers, and professional organizations about the AECs.

5
Nelson JC. Essien JDK., Loudermilk R. Cohen D. The Public Health Competency Handbook: Optimizing Individual
& Organization Performance for the Public’s Health. Atlanta, GA: Center for Public Health Practice of the Rollins
School of Public Health, 2002.
6
Public Health Foundation. Council on Linkages Between Academia and Public Health Practice. Available at
http://www.phf.org/Link.htm. Accessed May 31, 2006.
3 CDC/CSTE
 • Create a broad scope of competencies.
The expert panel intentionally created broad competencies that would cover the discipline of
applied epidemiology, which itself is broad and diverse. CDC and CSTE intend that all persons
practicing applied epidemiology—including persons who may not have the title of epidemiologist
but whose job requires the use of epidemiologic methods—gain minimal competency in all of the
defined skill domains. However, every applied epidemiologist is not expected to be equally
competent in all areas. Different content areas of applied epidemiology (e.g., infectious disease,
chronic disease, environmental health) may emphasize different competency areas. In addition, job
descriptions among public health agencies vary by the needs and resources of the agency, the
setting (rural or urban), and the scope of the agency’s responsibilities (local, state, or federal).

• Guide careers in applied epidemiology.

The competencies represent a continuum of applied epidemiologic practice, not a single point in
time in a person’s career. In other words, a person may not start with knowledge and skills in all
areas but would be expected to gain knowledge within each tier and potentially move through tiers
over time.

Structure of the AECs

• Identification of tiers of epidemiologic practice.
During development of the AECs, the expert panel recognized that people practicing epidemiology
represent a broad range of experience, knowledge, and job responsibilities for which no one set of
competencies would be appropriate. Therefore, the panel defined four tiers of epidemiologic
practice differentiated on the basis of level of responsibility, experience, and education (Appendix
B) and created competencies appropriate for each tier. The four tiers are
o Entry-level or basic
o Mid-level
o Supervisory
o Senior scientist/Researcher

• Skill domains, competencies, and subcompetencies.

The AECs are organized according to the eight skill domains defined by the COL. Within each
skill domain is a high-level competency statement, followed by subcompetency and, in some cases,
sub-subcompetency statements that detail the specific knowledge, skills, and abilities necessary to
meet the required competency. Many of the AECs originated in the COL competency set but have
been modified to reflect the particular needs of epidemiologic practice. Additional competencies
have been added throughout all of the skill domains to capture specific skills and knowledge
necessary for epidemiologists in public health agencies. The Analytic/Assessment and Basic Public
Health Sciences skill domains are the most closely linked to applied epidemiologic practice and
therefore have received the greatest number of new, epidemiology-specific competencies.

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Intended Use
The AECs define the discipline of applied epidemiology as practiced in government agencies. The
intended uses vary by category of user and include the following:
• Practitioners
o Assessing current skills
o Creating career development plans
o Planning specific training and educational needs
• Employers
o Creating career ladders for employees
o Developing position descriptions and job qualifications
o Developing training plans for employees
o Assessing epidemiologic capacity of an organization
• Educators
o Designing education programs that meet the needs of public health agencies
o Incorporating critical elements of epidemiologic practice into existing coursework

Dissemination
CDC and CSTE intend to disseminate the AEC document broadly throughout the epidemiology and
public health communities. The final competency set will be presented at multiple state, regional, and
national public health and epidemiology meetings that focus on educating the target audiences about the
development and use of the AECs. Detailed information about the development process, as well as
examples of the intended use of the AECs and case studies from sites where they are used, will be
published in major public health journals. Finally, complete information about the AECs will be available
on the CDC (www.cdc.gov/od/owcd/cdd/aec/) and CSTE (www.cste.org/competencies.asp) Web sites.
CDC and CSTE also intend to develop a tool kit to support adoption and use of the AECs, which also will
be available on the CDC and CSTE Web sites.

Conclusion
CDC and CSTE anticipate the AECs will be used as the basis of instructional competencies for training
government epidemiologists and as the framework for developing position descriptions, work
expectations, and job announcements for epidemiologists practicing in public health agencies. Once
public health agencies have used them for a period of time, CDC and CSTE will evaluate their utility and
effectiveness as part of an ongoing process to update and improve them.

Acknowledgement
CDC and CSTE sincerely appreciate the extensive effort by the members of the expert panel in
developing the AECs. We also greatly appreciate the interest of the public health and epidemiology
communities across the country and the many individuals who reviewed and commented on the draft
AECs. We look forward to their continuing engagement and support in using these competencies to
improve the practice of applied epidemiology.

5 CDC/CSTE
 Appendix A: Panel Members
Convened by the Centers for Disease Control and Prevention (CDC) and the
Council of State and Territorial Epidemiologists (CSTE)

Conveners
Denise Koo, MD, MPH
CAPT, USPHS
Director, Career Development Division
Office of Workforce and Career Development
Centers for Disease Control and Prevention

Matthew Boulton, MD, MPH

Associate Professor of Epidemiology
Associate Dean for Practice
University of Michigan School of Public Health
(Former State Epidemiologist, Michigan)

Chairs
Guthrie Birkhead, MD, MPH
Deputy Commissioner
Office of Public Health
New York State Department of Health

Kathleen Miner, PhD, MPH, CHES

Associate Professor and Associate Dean for Applied Public Health
Rollins School of Public Health
Emory University

Editor and Consultant

Jac Davies, MS, MPH
CSTE Consultant and Editor

Expert Panel Members

Kaye Bender, RN, PhD, FAAN
Dean and Professor
University of Mississippi Medical Center School of Nursing

Roger Bernier, PhD, MPH

Senior Advisor for Scientific Strategy and Innovation
National Center for Immunization and Respiratory Disease
Centers for Disease Control and Prevention

Mike Crutcher, MD, MPH

Commissioner of Health
Oklahoma State Department of Health

November 2008 version 2.0 6

Richard Dicker, MD, MSc
Office of Workforce and Career Development, Retired
Centers for Disease Control and Prevention

James Gale*, MD, MS

Professor Emeritus Epidemiology
School of Public Health and Community Medicine
University of Washington

Kristine Gebbie*, DrPH, RN

Acting Dean, Hunter-Bellevue School of Nursing
Former Director, Center for Health Policy, Columbia University School of Nursing

Gail Hansen, DVM, MPH

American Veterinary Medical Association, Congressional Fellow
Former State Epidemiologist, Kansas Department of Health and Environment

Richard Hopkins, MD, MSPH

Acting State Epidemiologist
Florida Department of Health
(formerly with Division of Public Health Surveillance and informatics, CDC)

Sara L. Huston, PhD

Cardiovascular Epidemiologist, Heart Disease & Stroke Prevention Branch
North Carolina Division of Public Health Research Assistant Professor
Department of Epidemiology, University of North Carolina at Chapel Hill

Maureen Lichtveld*, MD, MPH

Professor and Chair
Freeport McMoRan Chair of Environmental Policy
Tulane University School of Public Health and Tropical Medicine

Miriam Link-Mullison, MS, RD

Public Health Administrator
Jackson County Health Department, Murphysboro, Illinois

Kristine Moore*, MD, MPH

Medical Director
Center for Infectious Disease Research and Policy (CIDRAP)
University of Minnesota

Hal Morgenstern, PhD

Professor, Epidemiology
Director, Graduate Summer Session in Epidemiology
Professor, Environmental Health Sciences
University of Michigan School of Public Health

Lloyd Novick, MD, MPH

MPH Program Director
East Carolina University
Director of the Brody School of Medicine Division of Community Health and Preventive Medicine

7 CDC/CSTE
Len Paulozzi, MD, MPH
Medical Epidemiologist
Division of Unintentional Injury Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention

Arthur Reingold*, MD
Professor and Head of Epidemiology
Associate Dean for Research
School of Public Health
University of California at Berkeley

William M. Sappenfield, MD, MPH

State MCH Epidemiologist
Division of Family Health Services
Florida Department of Health
(formerly with the National Center for Chronic Disease Prevention and Health Promotion, CDC)

Gregory Steele, DrPH, MPH

Associate Professor
Epidemiology Concentration Advisor
Indiana University School of Medicine
Department of Public Health

Lou Turner, DrPH, MPH

Deputy Section Chief, Epidemiology Section
North Carolina Division of Public Health
(Former State Lab Director)

Mark E. White, MD
Associate Director for Science and Strategy
Coordinating Office for Global Health/Office of Capacity Development and Program Coordination
Centers for Disease Control and Prevention

*Review Panelist

Council of State and Territorial Epidemiologists

Pat McConnon, MPH
Executive Director
CSTE National Office

Jennifer Lemmings, MPH

Deputy Director of Programs
CSTE National Office

LaKesha Robinson, MPH

Director of Programs
CSTE National Office

November 2008 version 2.0 8

 Appendix B: Competency Development Process
The expert panel began by examining and refining existing public health and epidemiologic
competencies. Next, the panel mapped the existing competencies to the skill domains within the Core
Competencies for Public Health Professionals,7 a competency framework developed by the Council on
Linkages Between Academia and Public Health Practice (COL) through an extensive process. The COL
defined eight skill domains for public health practitioners:

• Analytic/Assessment Skills
• Policy Development/Program Planning Skills
• Communication Skills
• Cultural Competency Skills
• Community Dimensions of Practice Skills
• Basic Public Health Sciences Skills
• Financial Planning and Management Skills
• Leadership and Systems Thinking Skills

The expert panel determined that expectations for all epidemiologists should be based on the general
skills outlined in the COL core competencies, and individuals and organizations should reference the
COL core competencies as part of any career development activity.

Although the COL core competencies were deemed appropriate for all epidemiologists, the expert panel
recognized that the COL document did not adequately address the unique elements of epidemiologic
practice. Therefore, the panel focused on articulating the particular knowledge, skills, and abilities
required to carry out epidemiologic activities. The AEC document used the COL domains, but lists them
in a different order.

In the resulting competency set, each skill domain includes multiple competency statements. The expert
panel added subcompetency statements and additional detail to clarify the intent and scope of many of the
AECs. Although many of the competencies may be appropriate for epidemiologists in a wide variety of
public- and private-sector settings, the document focuses on the knowledge, skills, and abilities that
pertain to the practice of applied epidemiology in a government public health agency.

The expert panel developed the AECs in four tiers, each focusing on epidemiologists whose levels of
experience and responsibilities differ from those in the other tiers:

7
Public Health Foundation. Council on Linkages Between Academia and Public Health Practice. Available at
http://www.phf.org/Link.htm. Accessed May 31, 2006.
9 CDC/CSTE
 Examples of Functional Examples of Educational
Level Responsibility and Experiential Criteria
Tier 1—Entry- Carries out simple data • Newly graduated Master’s degree with
level or basic collection, analysis, and minimal experience but from a Master’s
epidemiologist8 reporting in support of program with a focus on epidemiology
surveillance and epidemiologic and/or analysis and assessment; or
investigations.
• Bachelor’s or other nonepidemiology
professional degree or certification (e.g.,
RN, MD/DO, DDS/DMD, DVM, PhD, RS)
without formal academic epidemiology
training and with at least 2 years’
experience performing epidemiology work
under the guidance9 of a Tier 2 or Tier 3
epidemiologist.
Tier 2—Mid-level Carries out simple and more • Master’s degree with a focus in
epidemiologist complex and nonroutine data epidemiology with 2 or more years’ work
collection, analysis, and experience in epidemiology in a public
interpretation task and can work health agency; or
independently; or may supervise
• Doctoral level epidemiologist; or
a unit or serve as a project
leader or surveillance • Other nonepidemiology professional
coordinator. degree or certification (e.g., RN, MD/DO,
DDS/DMD, DVM, PhD, RS) with specific
epidemiology training (e.g., MPH degree,
CDC Epidemic Intelligence Service
program) or at least 4 years’ experience
performing epidemiologic work under the
guidance of a Tier 3 epidemiologist.
Tier 3 a & b— 3a: supervisor and/or manager, • A master’s degree with a focus in
Senior-level director of a major section, epidemiology and ≥ 4 years’ work
epidemiologist program, or bureau in a experience in epidemiology in a public
public health agency. health agency; or

3b: senior scientist/subject area • A doctoral-level degree in epidemiology,

expert in an epidemiologic supplemented with ≥ 2 years’ work
focus area. experience at a Tier 2 Epidemiologist
level; or
• Other non epidemiology professional
degree or certification (e.g., RN, MD/DO,
DDS/DMD, DVM, PhD, RS) with specific
epidemiology training (e.g., MPH degree,
CDC Epidemic Intelligence Service
program) and ≥ 4 years’ work experience
at a Tier 2 epidemiologist level.

8
Entry-level or basic epidemiologists include persons who may not be titled an epidemiologist but who perform
epidemiology functions at least part-time.
9
Guidance can be received from an epidemiologist in the same agency or in other organizations.

November 2008 version 2.0 10

CDC and CSTE do not intend these tiers to be rigid categories for practicing epidemiologists but rather to
guide epidemiologists and public health agencies in understanding typical expectations for persons who
perform the kinds of epidemiologic activities described in each tier. Similarly, the descriptions of the tiers
are intended to provide general guidance, not to prescribe how a given person qualifies for a specific tier.

The expert panel initially focused on Tier 2 epidemiologists. The panel developed and modified
competencies to define expectations appropriate for persons practicing at the Tier 2 level. The panel then
used the Tier 2 competencies as a base to create competencies appropriate for Tier 1 and Tier 3a and 3b
epidemiologists.

7
Public Health Foundation. Council on Linkages Between Academia and Public Health Practice. Available at
http://www.phf.org/Link.htm. Accessed May 31, 2006.
11 CDC/CSTE
Validation Process
After creating the first draft of Tier 2 competencies, the expert panel developed a survey to collect
feedback from the practice community on the appropriateness and validity of the proposed competency
statements. The survey presented all of the high-level competency statements within each skill domain
and for each competency asked
• Do you do this, and if so, how often do you perform this task?
• Is this competency appropriate for a Tier 2 epidemiologist?

At the end of each skill domain, the survey also asked whether any competencies were missing and
whether the respondent suggested any changes. Each respondent also was asked to self-identify as a Tier
1, 2, 3a, or 3b epidemiologist on the basis of the tier definitions provided by the expert panel.

The draft Tier 2 competencies were first presented to the public in June 2005 at CSTE’s annual meeting.
All attendees were asked to complete the survey; 259 persons responded. In addition, a notice asking for
others to respond was sent to 14 professional organizations: Association of State and Territorial Health
Officials; National Association of County and City Health Officials; American College of Epidemiology;
Society for Epidemiologic Research; Association of American Medical Colleges; Association of Teachers
of Preventive Medicine; Association of Schools of Public Health; Association of Maternal and Child
Health Programs; National Environmental Health Association; National Association of Local Boards of
Health; Association of State and Territorial Directors of Nursing; State and Territorial Injury Prevention
Directors Association; American Public Health Association; and National Association of Chronic Disease
Directors. To facilitate responses from this broader audience, the survey was placed on the CSTE Web
site, resulting in 121 additional responses.

After developing the draft Tier 2 competencies, the expert panel developed draft competency statements
for Tiers 1, 3a, and 3b. These draft statements, along with the original form of the Tier 2 competencies,
were used in the final validation process.

The complete draft of all competency statements was posted to CSTE’s Web site, along with a revised
Web-based survey that included separate sections for each tier. The survey instructions asked respondents
to focus on the tier with which they self-identified and, if appropriate, to comment on other tiers on which
they felt qualified. The survey also collected respondents’ basic demographic information and self-
identified tier.

As in the first round, professional organizations were asked to encourage their members to respond to the
survey, with the National Association of Health Data Organizations and the American College of
Preventive Medicine added to the list. Information also was published in the MMWR and featured
prominently on the CSTE Web site.

In addition to the general requests for response, CDC and CSTE asked state epidemiologists to volunteer
to solicit more comprehensive response in their own states. Three states volunteered—Kentucky,
Connecticut, and Tennessee—and in each, the state epidemiologist encouraged all epidemiologists
employed by the state to respond to the survey. The three state epidemiologists also encouraged any
epidemiologists employed by local health departments to respond. Because of this outreach effort,
response in these three states was particularly high, averaging 96%.10

CSTE received 420 responses to the survey regarding the four tiers.

8
Entry-level or basic epidemiologists include persons who may not be titled an epidemiologist but who perform
epidemiology functions at least part-time.
9
Guidance can be received from an epidemiologist in the same agency or in other organizations.

November 2008 version 2.0 12

 Domain of Practice
Tier Academic Federal Local Other State Unknown TOTAL
1 7 22 71 9 74 0 183
2 8 17 50 8 81 2 166
3a 0 8 13 0 22 1 44
3b 3 8 3 1 10 2 27
TOTAL (%) 18 (4) 55 (13) 137 (33) 18 (4) 187 (45%) 5 (1) 420

Final Editing and Review Process

For the final editing process, the consultant/editor, the conveners, and co-chairs reviewed all comments
from all survey respondents in the first round (Tier 2 only) and the second round (all tiers). The comments
were categorized according to whether they proposed a new competency, suggested a rewrite or found a
statement confusing, stated the competency was not appropriate, or provided a general comment.

For the first two categories, the expert panel reviewed the proposed changes and determined whether to
accept the change, accept the change with modifications, or not accept the change. For the second two
categories, the expert panel identified major trends or concerns and addressed them either by changing the
competency statements or clarifying statements in the Preface to the competency document. Many of the
suggested changes focused on the tier definitions, and the expert panel reviewed and revised these as well.

In addition to analyzing the qualitative data, the expert panel reviewed the quantitative data from the
surveys. The panel discussed any competency statement for which overall agreement with the question
“Is this an appropriate competency?” fell below 75% and decided whether to retain or to change the
competency. The acceptance level for the draft competency statements was very high, and fewer than 8%
fell below that threshold.

After final discussion, review, and editing, the expert panel agreed the AECs were complete.

10
The response rate for these three states was estimated on the basis of the number of respondents participating on
behalf of the volunteer states compared with the total number of epidemiologists in each state as identified in
CSTE’s 2004 Epidemiology Capacity Assessment.

13 CDC/CSTE