Measles: Eliminated or Epidemic?

Eliminated or Epidemic?

Measles: Eliminated or Epidemic?

Tonya M. Cavallo

Western Governors University

Measles Outbreak

Often you will hear of an outbreak in the media. Just what is an outbreak? According to the CDC article Tranmission of measles, an outbreak is the occurrence of more cases of a disease than normally expected within a specific place or group of people over a given period of time. There are all sorts of outbreaks that occur. These can range from stomach viruses, to Ebola, or even Influenza (March 31, 2015). I am going to focus on the disease called Measles and an outbreak that occurred from a disease that we thought had been eliminated.

Measles is a very contagious virus that can result in serious complications sometimes even death. Elimination of this disease was declared in 2000, however secondary measles outbreaks still occur in the United States primarily from the virus being brought into the United States by unvaccinated travelers from endemic areas of the world. According to the CDC total of 288 confirmed measles cases were reported to them from January 1 through May 23, 2014, this being single the highest reported yearly total of measles cases since elimination. Fifteen outbreaks were responsible for 79% of cases reported, This includes the largest outbreak reported in the United States since elimination. (Gastañaduy,et al., 2014). This largest measles outbreak reached a devastating total of 382 cases and was linked to a group of Amish missionaries located in Ohio . The outbreak is said to have began in early spring 2014 after an unvaccinated Amish missionary returned from the Philippines. The Philippines had been experiencing a large, ongoing measles outbreak since the fall of 2013 with more than 26,000 cases reported (Painter, 2014).

A call came to Jacqueline Fletcher, the public health nursing director for Ohio's Knox County, in April of 2014 from a member of the local Amish community telling her that there was possibly an outbreak of measles in the town and she thought that the public health department should know about it (Belluz, 2015). This outbreak was indeed real and Fletcher spent months working to get control of the situation that in the end infected 382 Amish from Ohio by the time it was said to be over in August of 2014. Nobody died during the outbreak but nine of the victims were hospitalized with complications.

This is by far not the only case of measles outbreaks in the United States. According to the Center for Disease Control Since 2011, six confirmed measles cases have been reported to California Department of Public Health (CDPH) alone. These cases seem to primarily be related to large theme parks that bring in many international tourists. International travel to and from countries where measles is endemic is a well-known risk factor for the transmission of measles (Zipprich, et al., 2015). International travel is not the only way that U.S. residents can be exposed to measles, venues with large numbers of international visitors, such as other tourist attractions and airports also pose a great risk. Another example of an outbreak occurred on January 5, 2015, when the CDPH was notified of a possible measles case. According to the CDC article Outbreak — California, December Measles 2014–February 2015 the California Department of Public Health (CDPH) was notified about a suspected measles case. The patient was an unvaccinated 11 year old child in the hospital that reported rash on December 28. The child had no international travel history only a visit to one of two adjacent Disney theme parks in Orange County, California. On the same day, CDPH received reports of six other possible measles cases four were California residents and two were Utah residents, all of these individuals had visited one or both Disney theme parks between December 17–20. As of February 11, 2015. A total of 125 measles cases with rash occurring during December 28, 2014–February 8, 2015, had been confirmed and connected with this outbreak before it was over, yet the source of the outbreak was never discovered (Zipprich, et al., 2015). In my opinion this is an example not of international travel from an unvaccinated American to another country bringing back the virus, yet a case of someone from another country bringing the virus into the United States and infecting unvaccinated Americans. This example basically has the same outcome as the prior example yet opposite primary sources of transmission only solidifying the importance of vaccination in the United States.

Epidemiological Determinants of the Outbreak

According to the CDC Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing (2015). Possibly the worst part of the measles virus is just how resilient it is. A person with measles can cough in a room, leave, and as long as 2 hours later still infect an unvaccinated person from droplets left behind in the air . No other virus can do that. It also lives on surfaces for hours, therefore If other people touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. The CDC also mentions that Measles is so contagious that if just one person has it, 90% of the people close to that person who are not immune will become infected. Those infected can spread measles from four days before the rash appears until four days after the rash appears and the disease is spread only by humans (2015).

In the Ohio case, the unvaccinated Amish man had traveled by plane to the Philippines on a missionary trip. At the time of his travels the Philippines were in the middle of a large Measles epidemic themselves. So here you have an unprotected man placed in the middle of an epidemic and there you have it, a prime target for future transmission. When he returned home and became symptomatic a doctor misdiagnosed him with Dengue fever therefore he continued to pass one of the most contagious viruses ever found easily on to family, friends and neighbors as most of his contacts had never received the vaccination themselves. It is without a doubt a recipe for disaster any time an infected individual brings an illness back to an unprotected community.

There were additional risk factors involved in the Ohio outbreak as the Amish people involved did not have phones which made trying to reach everyone who might have been exposed to the disease and get them into quarantine as to not spread the