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The Council of State and Territorial Epidemiologists (CSTE) is the professional non-profit organization representing applied public health epidemiologists across United States states, territories, and freely associated states. Working in formal partnership with the Centers for Disease Control and Prevention (CDC), CSTE establishes standardized surveillance case definitions, coordinates national notifiable condition reporting, and advocates for epidemiological workforce capacity. For investigators working in applied epidemiological research, CSTE position statements provide the official technical criteria that govern population-level disease surveillance across public health jurisdictions.
What it is
Founded in 1951, the Council of State and Territorial Epidemiologists functions as the collective technical and policy voice for applied epidemiology in the United States. Unlike academic professional societies centered on theoretical methods, CSTE is directly anchored in state and territorial health departments. Its primary operational role is standardizing how health agencies identify, classify, and track infectious, chronic, environmental, and occupational conditions across state borders, bridging the gap between local field practice and national health initiatives alongside organizations like ASTHO (Association of State and Territorial Health Officials).
The cornerstone of CSTE’s technical authority is the annual Position Statement process. Through this mechanism, practicing epidemiologists formulate and vote on formal resolutions that determine which conditions should be designated as Nationally Notifiable Conditions and specify uniform surveillance case definitions. Researchers analyzing population health dynamics frequently examine these standardized reporting channels to assess jurisdictional coordination across epidemiology and public health systems.
Who runs it and what it covers
CSTE is governed by an Executive Board composed of elected state and territorial epidemiologists, regional representatives, and committee chairs. The organization’s membership includes practicing epidemiologists from state, local, tribal, and territorial (STLT) health departments, federal liaisons from the CDC, and academic partners.
The substantive work of CSTE is organized into permanent steering committees and specialized subcommittees:
- Infectious Disease Steering Committee: Establishes surveillance case definitions and surveillance protocols for healthcare-associated infections, vector-borne pathogens, respiratory illnesses, vaccine-preventable diseases, and emerging antimicrobial resistance (AMR).
- Chronic Disease, Maternal & Child Health, and Oral Health Committee: Develops surveillance indicators for cardiovascular conditions, diabetes, cancer registries, and maternal morbidity.
- Environmental Health / Occupational Health / Injury Committee: Standardizes reporting for occupational injuries, chemical exposures, lead poisoning, and climate-related health outcomes.
- Surveillance and Informatics Steering Committee: Leads the development of public health data standards, electronic laboratory reporting (ELR), electronic case reporting (eCR), and cloud-based data architecture in partnership with CDC’s National Notifiable Diseases Surveillance System (NNDSS).
In addition to regulatory standards, CSTE oversees applied workforce training initiatives, most notably the CSTE Applied Epidemiology Fellowship (AEF)—a competitive two-year training program operated in collaboration with CDC that places master’s- and doctoral-level epidemiologists in state and local health agencies—and the Data Science Team Training (DSTT) program for public health informaticians. Biological safety practices in field outbreak investigations supported by CSTE align with established biosafety containment protocols.
How to search or use it
Researchers, public health analysts, and clinical epidemiologists utilize CSTE data products and resources primarily through official surveillance repositories and technical working groups. The following workflow outlines practical access to CSTE outputs:
- Access Official Case Definitions via CDC NDC: While position statements are authored and adopted by CSTE, the official codified surveillance case definitions are publicly hosted in the CDC National Notifiable Diseases Surveillance System (NNDSS) portal at ndc.services.cdc.gov. Researchers query this portal by condition, year, or pathogen to review precise clinical criteria, laboratory evidence thresholds, and epidemiological linkage standards.
- Review CSTE Position Statements: Investigators consult individual position statements (indexed by year and committee, such as 24-ID-01) to trace the historical evolution of disease classifications. Position statements provide the rationale, literature review, and consensus debates that justify revisions to case definitions.
- Interpret Case Classification Tiers: When evaluating surveillance datasets, researchers must differentiate between reporting tiers:
- Suspect Case: Meets presumptive clinical or preliminary screening criteria without confirmatory laboratory or epidemiological linkage.
- Probable Case: Meets clinical criteria and supportive (non-confirmatory) laboratory evidence or verified epidemiological linkage to a confirmed case.
- Confirmed Case: Meets definitive laboratory criteria (e.g., pathogen isolation, genomic sequencing, or diagnostic PCR/culture) regardless of clinical severity.
- Engage with CSTE Working Groups and Webinars: Applied researchers join disease-specific subcommittees and access technical training webinars, toolkits, and data evaluation templates distributed through CSTE’s professional development library.
- Apply for Fellowships and Research Opportunities: Early-career researchers review eligibility guidelines on cstefellows.org to apply for the Applied Epidemiology Fellowship, which matches postgraduates with state health department mentors.
Strengths and limits
Understanding CSTE’s institutional strengths and jurisdictional constraints ensures appropriate interpretation of its technical outputs.
Strengths
- Authoritative Consensus Standard: CSTE position statements represent the definitive, legally recognized standard for public health disease classification in the United States, providing uniform national consistency.
- Direct Connection to Field Practice: Governed by active state epidemiologists rather than external theoretical panels, ensuring case definitions reflect operational laboratory capabilities and field realities.
- Robust Workforce Capacity Building: The CSTE Applied Epidemiology Fellowship has trained thousands of applied field epidemiologists, serving as a critical pipeline for state and federal public health leadership.
Limits
- Not Intended for Clinical Diagnosis: CSTE surveillance case definitions are designed exclusively for population-level public health counting and trend analysis; they are deliberately distinct from clinical diagnostic criteria and must not be used to direct individual patient treatment.
- Voluntary State Implementation: The United States Constitution delegates public health authority to individual states. While CSTE votes establish national recommendations, individual state legislatures and health departments retain sovereign discretion over which conditions are legally reportable within their state borders.
- Reporting Lag and Revision Intervals: Updating a national case definition requires a multi-month review and voting process at the annual conference, which can create temporary reporting discrepancies during the emergence of novel pathogen variants.
Alternatives
Epidemiologists, researchers, and public health officials interact with several complementary organizations that serve distinct governance, policy, and research roles.
| Organization | Primary Membership | Core Focus & Mission | Relationship to Disease Reporting | Key Outputs |
|---|---|---|---|---|
| CSTE (Council of State and Territorial Epidemiologists) | State, local, and territorial applied epidemiologists | Standardized surveillance case definitions, applied epidemiological methods, and workforce training | Drafts and approves Nationally Notifiable Condition criteria and case definitions | Position statements, case definitions, Applied Epidemiology Fellowship (AEF) |
| ASTHO (Association of State and Territorial Health Officials) | Chief state and territorial health officers and executive agency leaders | Public health executive leadership, state health policy, legislative advocacy, and agency governance | Coordinates state-level executive health policy and administrative rulemaking | State health policy briefs, executive toolkits, legislative testimony |
| NACCHO (National Association of County and City Health Officials) | Local health department officials and county/municipal leaders | Local public health capacity, municipal disease control, and community health assessment | Implements local surveillance reporting feeding into state health departments | Local health department profiling, community health toolkits, municipal policy guidance |
| CDC (Centers for Disease Control and Prevention) | Federal scientific agency personnel and researchers | Federal health protection, biomedical research, outbreak response, and national surveillance management | Hosts and manages the NNDSS platform, adopting approved CSTE position statements | MMWR reports, CDC surveillance data portals, laboratory guidance, national guidelines |
Frequently Asked Questions
Who is CSTE?
CSTE stands for the Council of State and Territorial Epidemiologists, a non-profit professional association founded in 1951 that represents applied public health epidemiologists working in United States state, local, tribal, and territorial health departments.
What is the meaning of CSTE?
In public health and epidemiology, CSTE stands for the Council of State and Territorial Epidemiologists. The organization is responsible for voting on position statements that define Nationally Notifiable Conditions and establishing uniform public health surveillance case definitions across jurisdictions.
What is the Certified Software Test Engineer (CSTE) certification?
In the software quality assurance industry, CSTE refers to the Certified Software Test Engineer credential administered by the QAI Global Institute (formerly Quality Assurance Institute). This professional certification tests proficiency in software testing methodologies, verification, and quality control, and is completely unrelated to the Council of State and Territorial Epidemiologists in public health.
What is a CSTE electrical?
In electrical and power systems engineering, CSTE typically stands for Customer Service Termination Enclosure, a standardized utility metering cabinet or service termination box used in electrical utility infrastructure to house service entrance conductors and metering equipment. It is entirely unrelated to public health epidemiology.
How does a condition become nationally notifiable through CSTE?
A disease becomes nationally notifiable through the CSTE position statement process. A working committee drafts a proposed position statement detailing clinical criteria, laboratory tests, and reporting urgency. During the annual CSTE meeting, eligible state and territorial epidemiologists vote on the resolution. Once approved, CSTE recommends the condition to the CDC for inclusion in the National Notifiable Diseases Surveillance System (NNDSS).
Sources
- Centers for Disease Control and Prevention (CDC) National Notifiable Diseases Surveillance System (NNDSS), “Surveillance Case Definitions and CSTE Position Statements,” https://ndc.services.cdc.gov/ (accessed 2026-11-07).
- Public Health Reports, “Impact of the 2024 Council of State and Territorial Epidemiologists’ Varicella Case Definition and Classification on Varicella Cases Reported in Minnesota,” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438851/ (accessed 2026-11-07).
- MMWR Surveillance Summaries, “Brucellosis Surveillance – United States, 2010-2024,” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13229130/ (accessed 2026-11-07).
- American Journal of Tropical Medicine and Hygiene, “Analysis of Confirmed Leptospirosis Cases in Hawai’i Identifies Spatial and Environmental Patterns of Incidence,” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12590966/ (accessed 2026-11-07).
