Background: State laws regarding disease intervention activities have not been described systematically. The purpose of this study was to examine state disease intervention laws, overall and by US census region and state syphilis morbidity.
Methods: State laws authorizing and requiring disease intervention activities were compiled and coded; a disease intervention activity legal “cascade” was developed to classify the scope of these laws. Additionally, states were categorized by US census region (West, Midwest, South, Northeast) and being above or at/below the overall US primary and secondary (P&S) syphilis rate (4.5 per 100,000) in 2011. The legal cascade was analyzed by census region and P&S syphilis rate using chi-squares.
Results: Based on the disease intervention activity legal cascade, we found: 1) all 50 states have laws addressing communicable disease intervention, 2) 76% of states (n=38) have disease intervention laws that reference sexually transmitted diseases (STDs), 3) 64% of states (n=32) require disease intervention for STDs (e.g., DIS activities), 4) 10% of states (n=5) require DIS notification of sexual contacts for STDs, and 5) 6% of states (n=3) require DIS notification, testing, and treatment of sexual contacts for STDs. Cascade levels did not vary significantly by region (p values ranged from 0.65 to 0.98) or by syphilis rate (p-values ranged from 0.27 to 0.80). States that required notification, testing and treatment of sexual contacts for STDs (cascade level 5) were in all regions except the West, and had P&S syphilis rates at/below the US rate.
Conclusions: All states have laws concerning communicable disease intervention; significant legal variation exists across jurisdictions in how these laws relate to STDs. Jurisdictions with the highest P&S syphilis rates did not have legal environments that require disease intervention activity for STDs. Future research should examine the relationships between the legal cascade, DIS practice, and STD burden.