A new study has ranked all the states in accordance with how likely they are to get a deadly outbreak of disease.

The top five performing states were Delaware, Kentucky, Maine, New York, and Virginia, which were tops in terms of preventing, diagnosing, and responding to outbreaks of disease based on the study from Trust for America’s Health (TFAH), according to an ABC News report.

TFAH drew on data from the Centers for Disease Control and Prevention to create a scoring system, measuring flu vaccination rates, food safety, and surveillance of HIV and AIDS, and then they ranked each of the states.

An estimated one in 25 people who are hospitalized get a health care related infection, which kills 75,000 people each year — illustrating why the issue is of such importance. Only nine states got that number lower between 2012 and 2013, according to the report.

The states were scored on a 10-point system. The top five all scored an eight. The worst seven states got a three: Idaho, Kansas, Michigan, Ohio, Oklahoma, and Utah.

The outbreak of Ebola in West Africa last year illustrates how important it is to have a strong preventive measures and public health response. It is important to avoid complacency, said Dr. Jeffrey Levi, the executive director of TFAH, according to the report.

States are getting better at food safety, with 39 states achieving national performance targets when it comes to spotting certain strains of E. coli.

But one thing concerns health officials: superbugs. Due to overuse of antibiotics, diseases are becoming more resistant to today’s treatments.

In order to prevent another outbreak, states will need to be proactive and provide the proper funding and support, the organization says.