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Background: State and local public health agencies collect and use surveillance data to identify outbreaks, track cases, investigate causes, and implement measures to protect the public's health through various surveillance systems and data exchange practices., Purpose: The purpose of this assessment was to better understand current practices at state and local public health agencies for collecting, managing, processing, reporting, and exchanging notifiable disease surveillance information., Methods: Over an 18-month period (January 2014-June 2015), we evaluated the process of data exchange between surveillance systems, reporting burdens, and challenges within 3 states (California, Idaho, and Massachusetts) that were using 3 different reporting systems., Results: All 3 states use a combination of paper-based and electronic information systems for managing and exchanging data on reportable conditions within the state. The flow of data from local jurisdictions to the state health departments varies considerably. When state and local information systems are not interoperable, manual duplicative data entry and other work-arounds are often required. The results of the assessment show the complexity of disease reporting at the state and local levels and the multiple systems, processes, and resources engaged in preparing, processing, and transmitting data that limit interoperability and decrease efficiency., Conclusions: Through this structured assessment, the Centers for Disease Control and Prevention (CDC) has a better understanding of the complexities for surveillance of using commercial off-the-shelf data systems (California and Massachusetts), and CDC-developed National Electronic Disease Surveillance System Base System. More efficient data exchange and use of data will help facilitate interoperability between National Notifiable Diseases Surveillance Systems.

Global climate change has great potential for escalating the number and duration of extreme heat events in California. California accounts for 16% of U.S. crop production, and over 450,000 people are employed in agriculture, with more than two-thirds being of Latino ethnicity. Despite Cal/OSHA regulations which specify that potable water, toilets, shade and rest be provided to agricultural workers, heat related illnesses and deaths still occur. The MICASA Study is a population-based sample of 467 hired farm worker households from Mendota, in California's Central Valley. 474 study participants completing follow-up interview and working in agriculture in the year prior are included in this analysis. Men reported an average of 222 d (SD=69.7) of work compared to 148 d (SD=67.3) for women (p<0.0001). Over 91% of participants reported receiving training on heat-related illness, but level of heat illness knowledge was moderate with 70% responding correctly to 4-5 questions. Knowledge about acclimatization was low, with 44% severely underestimating the time required, and water consumption was low at an average of 10.7 drinks per day. Results suggest important areas to target for heat illness prevention in farm worker populations and that gender specific approaches may be needed for effective heat illness prevention.