I have chosen a breakout of Measles in May-June 2016. The outbreak took place in an Arizona ICE detention center on May 25, 2016. Patient A, a detainee, had been hospitalized with a fever and generalized maculopapular rash, which was confirmed by real-time polymerase chain reaction (rPCR). The second case of measles in a staff member was confirmed the next day by rPCR the next day. The detainee probably incurred this disease in Mexico before crossing the border. The disease takes 7 to 21 days after the exposure to the infection for symptoms to appear. This person who transmitted the disease outbreak, resulted in “31 total cases, 22 were detainees, and nine were staff members with rash onsets occurring May 6- June 26” (Venkat H, Kassem AM, Su C, et al. (2017, May 26).
Most of these were in an unknown vaccinated immigrant population, and staff members vaccination records were not available during the breakout was recognized. This outbreak ranged in ages from 19-52. “Seven out of the nine staff members reported at lease one dose of the measle vaccine. Three of the nine staff members received one dose of the vaccine 7-13 days before becoming ill. Initial reports of rash illness among a few detainees were thought to be varicella, based on clinical presentation. Some detainees did not initally seek medical attention when they became ill, leading to a delay in diagnosising the first few cases of measles” (Venkat H, Kassem AM, Su C, et al. (2017, May 26).
Measles is a highly contagious airborne virus. It lives in the nose and throat of those infected, when an infected person sneezes or coughs the virus remains active for 2 hours even after the person has left the area. A person with no immunity only has to breathe the contaminated air or touch the contaminated surface, and then touch their eyes, nose, or mouth to become infected. As many as 90% of the people who are not immune that come in contact with the virus will become infected. Exposure to the measle virus will happen within 4 days prior and 4 days after the rash appears. (Transmission of Measles. (2017, March 03).This virus can lead to complications and death. (Wallace, G., MD. (2013, September 13).
The population most at risk for infection from the measle virus would be the unvaccinated population. The people who are not immune, 9 out of 10 exposed to the virus will become infected. With many of the population not vaccinated it puts vulnerable people at higher risk for complications. These groups of the population would be infants and children under 5, people with immune deficiencies, such as HIV or leukemia, pregnant women. Complications can include otitis media, pneumonia, bronchitis, and diarrhea. The at risk population infected with the measles virus may be hospitalized and die with respiratory distress from bronchitis or pneumonia, and have possible complications of acute encephalitis, which may cause permanent brain damage (Wallace, G., MD. (2013, September 13).
If an outbreak of measles were to occur in my community, an epidemiologic investigation would be conducted for each case. Currently, measles epidemiology in my community would be determined by characteristics of the suspected imported case, and contact with the unvaccinated or susceptible population. In other words, each case would have to be addressed by where the individual had been, where they may have acquired the virus ,and what population has already been exposed (AZDHS | Epidemiology & Disease Control – Measles. (n.d.). Any suspected outbreak first and foremost would have to be reported. An outbreak could affect schools, health care facilities, and community events (Disease Reporting | Maricopa County, AZ. (n.d.).
All staff should make sure they are protected against measles, either by a history of having the measles or by two doses of the vaccine. Children and pregnant women who are not immune and have been exposed, should contact their physicians immediately to ensure proper health care (Management of Specific Infectious Diseases. (2014, October). In my county, Maricopa, there are around 5% of all kindergarteners whose parents have opted out for personal reasons on having their children vaccinated (Measles in Arizona: What you need to know. (2015, January 29). Arizona children 19 to 35 months are only at 84.1 percent coverage for the MMR vaccine. Arizona is the lowest coverage for children in this age group which is reflective of the vulnerability of our children (Hill, H. A., M.D., PhD, & Elam-Evans, L. D., PhD. (2015, August 28). There are adults working in the schools that may also not be vaccinated (Wallace, G., MD. (2013, September 13).
The Department of Public Health will make recommendations on excluding persons at risk, this would include indiviuals that have not been vaccinated. Recommendations are to keep persons during the infectious stage of Measles, isolated from others who are suseptible. Measles are so contatious that there is nearly a 100% chance of contracting the Measles if you have no immunity and are exposed (Measles in Arizona: What you need to know. (2015, January 29). The infectious period for the Measles would be 4 days before the rash appears to 4 days after the rash appears. All individuals with the Measles would be asked to stay home during this time. These people generally are to ill to attend school during this period anyway. Managing the outbreak is by isolating the exposure and good personal hygiene. People would also be asked to contact their health care facility or physicians office to facilatate keeping them away from other suseptible population. This will help prevent spread of the virus (Management of Specific Infectious Diseases. (2014, October).
When an individual in school or any medical facility is suspected to have measles, the administrator of a Health Care Institution or Correctional Facility, administrator of a School, Child Care Establishment, or Shelter, and Clinical Laboratories are mandated to reporting the virus within 24 hours. This will be reported to the County Health Department. The Maricopa County Health Department has epidemiologists, nurses, and other investigative staff keep track of the number of cases of each disease we have in our county and to investigate the epidemiology of the disease. They will also provide recommendations for controlling exposure or spread of the disease. They will monitor patterns to help stop transmission (AZDHS | Epidemiology & Disease Control – Measles. (n.d.).
The county must report the outbreak to the State of Arizona Health Department. Laboratories confirming the Measles specimens are also mandated to report results to the Arizona State Public Health Laboratory within 24 hours after they obtain the positive result (AZDHS | Epidemiology & Disease Control – Measles. (n.d.). The State also has their own team of nurses, epidemiologists and other investigative staff to track the number of cases in the state. The head of the Arizona State Department of Public Health would be the incident commander in event of a major outbreak of any threat to the health of the people of Arizona. The state will then report the event or in this case the outbreak of Measles to the National Notifiable Diseases Surveillance System (NNDSS) through the Center for Disease Control and Prevention (CDC). The NNDSS is a system that is nationwide. It allows all levels of Public Health to share disease related health care information (National Notifiable Diseases Surveillance System (NNDSS). (2018, February 16). The CDC also have epidemiologists and investigative staff to investigate outbreaks and support state and local health departments. Once it is reported to the national level it will be reported to the World Health Organization (WHO) to be reported globally. WHO works with countries to develop early detection systems, also tracking disease in the world (From the ground up: Rebuilding health systems in the wake of Ebola. (2016, February).
Two strategies that I would recommend preventing measles would first be to educate the citizens in Phoenix, Arizona about measles and the risks involved in the disease. I would describe the symptoms, and what effects they may expierance with the dieseae. I would include the risk and the population most at risk, this would be done through educational programs for citizens in the community, also have information sent home with children from schools. The next step, would be to education on the importance of vaccination. People need to know that vaccines for measles contain the same virus in a killed or weakened form that causes measles. This form will not cause the disease but will make the immune system produce antibodies that lead to immunity. This is a safer way for the individual to get the protection to avoid the measles than having to go through the sickness and risks involve with the sickness (Vaccines & Immunizations. (2017, August 18). People have many reasons to not vaccinate including personal belief and religion, but maybe with more education some of these people may change their opinions on vaccinating. Education for the public could be done by having an information booth with pamphlets included at community fairs or events. It could also be accomplished by giving presentations to schools, clubs, churches and business organizations. I have found education often dispels inaccurate beliefs. Hopefully, through education, we could have a healthier community protected from measles through immunization.
Finally, the best way to prevent an outbreak from happening, would be from frequent handwashing. Covering your mouth and nose while coughing or sneezing then washing your hands after contact with the nose and/or throat secretions will provide effectiveness in reducing transmission of the measles virus. Alcohol-based hand sanitizers that are at least 60% alcohol can be effective on some germs, but not all. Washing your hands with soap and water is your best protection (Handwashing: Clean Hands Save Lives. (2016, March 07). These are just a few and simples ways to eliminate, and contain the measles virus.