COEUR d'ALENE — In a new report, Idaho scored three out of 10 on key indicators related to infectious disease prevention, detection and response. The state tied with six others for the lowest score.

The report, "Outbreaks: Protecting Americans from Infectious Diseases," was produced by the Robert Wood Johnson Foundation and the Trust for America's Health.

"The overuse of antibiotics and underuse of vaccinations along with unstable and insufficient funding have left major gaps in our country's ability to prepare for infectious disease threats," Dr. Jeffrey Levi, executive director of Trust for America's Health, said in a statement. "We cannot afford to continue to be complacent. Infectious diseases — which are largely preventable — disrupt the lives of millions of Americans and contribute to billions of dollars in unnecessary health care costs each year."

"America's investments in infectious disease prevention ebb and flow, leaving our nation challenged to sufficiently address persistent problems," said Paul Kuehnert, a Robert Wood Johnson Foundation director. "We need to reboot our approach so we support the health of every community by being ready when new infectious threats emerge."

The report's recommendations said antibiotic overuse must decrease and vaccination rates must increase.

Flu vaccination rates and school requirement policies for childhood immunization were two of the 10 indicators states were scored on, and Idaho didn't pass in either category. Some of the other indicators included syringe-exchange programs, HIV/AIDS surveillance, food safety and public-health funding.

In the flu vaccination category, states received a passing grade if half of the population — ages 6 months and older — was vaccinated.

Dr. Walt Fairfax, chief medical officer at Kootenai Health, said that standard sets a fairly low mark for states to achieve.

"Flu is a very dangerous disease," Fairfax said Monday.

The flu vaccination rate in Idaho was 42.2 percent, below the national average of 47.1 percent.

Getting the flu shot is critical for people who spend time in "mixing spots" like schools and hospitals, Fairfax said.

"At this point we don't have the perfect flu vaccination," he said. "But it works."

Everyone should get a flu vaccination and parents must make sure children receive all their immunizations, said Tom Shanahan, a spokesman for the Idaho Department of Health and Welfare.

"It not only protects them, it protects other people in the community," Shanahan said Monday.

The report graded states on how challenging they make opting out of mandated childhood vaccination requirements for school attendance for non-medical reasons.

Fairfax said doctors must be persistent and gentle in conversations with parents who might object to immunizations for their kids.

Children foregoing vaccinations can threaten "herd immunity," the report said.

"In recent years, there have been a number of outbreaks in community clusters, including in some communities with high levels of religious-based vaccine exemptions in Texas, Florida and Brooklyn, N.Y.," the report said.

There is a bit of a resurgence of measles because too many kids didn't get immunizations, Fairfax said.

"Measles can cause significant harm to children," he said.

The full report can be read at www.healthyamericans.org by clicking on "Reports" at the top of the homepage. Trust for America's Health is a nonprofit, nonpartisan organization.