The Ebola outbreak exposed major gaps in the nation’s ability to manage serious infectious disease threats, according to a report from Trust for America’s Health and the Robert Wood Johnson Foundation. Half of states and Washington, D.C., scored five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks. Indicators include public health funding commitment; incident and information management; vaccination rates; public health laboratory capabilities; and food safety. Significant gaps were found in five areas:

1. Preparing for emerging threats. Significant advances have been made in preparing for public health emergencies since Sept. 11, 2001, and the anthrax attacks, but gaps remain and have been exacerbated as resources were cut over time.

2. Vaccinations. More than 2 million preschoolers, 35 percent of seniors and a majority of adults do not receive all recommended vaccinations.

3. Health care-associated infections. While health care-associated infections have declined in recent years due to stronger prevention policies, around one out of every 25 people who are hospitalized each year still contracts an HAI.

4. Sexually transmitted infections and related disease treatment and prevention. The number of new HIV infections grew by 22 percent among young gay men and 48 percent among young Black men between 2008 and 2010; more than one-third of gonorrhea cases are now antibiotic-resistant; and nearly 3 million baby boomers are infected with hepatitis C, the majority of whom do not know they have it.

5. Food safety. Around 48 million Americans suffer from a food-borne illness each year.

In response, the report recommends improvements in three priority areas: core abilities, such as investigative expertise, containment strategies and risk communication capabilities; health care and public health integration, so hospitals and agencies work together better to protect patients, health care workers and the public; and leadership and accountability because stronger leadership is needed for a governmentwide approach to health threats at federal, state and local levels.