C228 Task 2
C228 Task 2
C228 Task 2
C228 Task 2
Nikkea Ferrin
9/21/2020
2
I have chosen to analyze the 2014 international Measles outbreak that occurred
between the Philippines and the state of Ohio in the United States of America. The
Philippines experienced a large outbreak of Measles starting in October 2013 and lasted
most of 2014 with 21,420 confirmed cases and an additional 60,000 suspected cases
(Glover et al., 2015). The virus originated in the Philippines and was brought to Ohio by
two Amish men returning home from a humanitarian aid mission. The outbreak in Ohio
was declared in March 2014 and lasted about four months. There were 383 confirmed
Measles is a highly contagious virus that can cause high fevers, cough, runny nose, and a
rash. According to the Centers for Disease Control and Prevention (CDC), up to 90% of people
who encounter a contagious person will become infected if they are not immune. It is spread
person to person by the droplets produced when an infected person coughs or sneezes.
Additionally, these droplets can stay in the air and on surfaces for up to two hours. An infected
person can spread the disease before they know that they are sick. They are contagious for about
four days before the rash appears and for an additional four days afterwards. Most people recover
without lasting effects; however, measles can cause serious complications, especially in children
under 5 years old. The CDC also states that before a vaccine was developed, there was an
estimated 3-4 million measles cases per year with about 400-500 people dying, 48,000 people
hospitalized, and about 1,000 people suffering from measles-induced encephalitis. Finally, the
infection rate drops from 90% to about 3% when a person has received two doses of the measles
The main risk factor associated with this specific outbreak was the vaccination status of
the people infected. Almost all the people infected were part of the Amish community. This is
important as the rate of measles vaccination in the Amish community at the time was estimated
to be about 14% versus 88% in the non-Amish population of Ohio. Of the 383 people involved in
this outbreak, 340 of them were unvaccinated (Gastañaduy et al., 2016). Another risk factor in
this outbreak was a lack vaccine and travel information. The two Amish men who brought the
virus back from the Philippines stated that they would have received the vaccine if it had been
recommended by a physician before traveling (Glover et al., 2015). The final risk factor
identified was delayed reporting due to a misdiagnosis. When the two men first showed
symptoms, they were misdiagnosed with Dengue fever (Gastañaduy et al., 2016). It was not until
other members of the Amish community started showing symptoms that the diagnosis was
determined to be measles. This delay in reporting to the Ohio Health Department meant that the
virus had more time to spread before containment measures could be put into place.
The international route of transmission was air travel between countries. Measles was
officially declared eradicated from the United States in 2000 (Gastañaduy et al., 2019). Since
that time, the main sources of outbreaks have been infected travelers from outside the United
States. In this instance, two unvaccinated men flew to the Philippines, contracted the virus, and
then flew back to Ohio. The route of transmission in Ohio was droplets spread from person to
person. Once back home, the men spread the virus to other members of their community by
coming into close contact with family and friends. The virus was able to spread quickly through
effects felt throughout. Immediate social distancing would take effect to reduce the spread from
person to person. This means that community members would need to stay home and reduce all
unnecessary contact with other people outside their household. When they do have to leave their
homes for essential tasks, then they would have to wear masks and stay at a distance from others.
Due to this need for social distance, the government would be functioning at a reduced capacity
as non-essential workers would need to stay home. The government could still function using
technology to communicate; however, all processes would be delayed. The economy would
significantly decrease as members of the community would not be out spending money at local
stores. Small businesses would suffer and may need to close. Businesses that could operate
online may see an increase in orders due to community members utilizing the internet in order to
stay at home. Public transportation would still need to function in order to allow essential
workers to get to and from work but may be offered at a reduced capacity. Schools would likely
need to be shut down until the outbreak resolves. Online learning may be implemented if the
outbreak cannot be controlled. Hospitals in the community would be overrun with patients
seeking medical attention. This would lead to inadequate staffing levels and patient care times
would increase. A triage area would have to be designated to keep the potential measles cases
separate from people coming to the hospital for other concerns. Staff at the hospital would have
to use personal protective equipment such as masks, face shields, gowns, and gloves to keep
themselves and their patients safe. The supply of this equipment would quickly diminish and
Health District. It is required to report immediately upon suspicion, even if it is not yet
confirmed. You must speak to a live person at the Snohomish Health District in order to report
the case, there is an after-hours emergency number to call outside of business hours. The
Snohomish Health District is then required to report the case immediately to the state level at the
Washington State Department of Health. The Department of Health is then required to report the
case immediately to the nation level at the Centers for Disease Control (Snohomish Health
District, 2018).
The first strategy I would use to prevent an outbreak in my community is to increase the
vaccination compliance rate in my area. I can use county data to identify specific groups of
people who have lower vaccination rates and then create an educational outreach program to
discover why these groups choose not to vaccinate and then provide education and access to free
vaccines. The second strategy I would use would be to create an educational campaign targeting
international travelers. Since the United States officially declared measles eradicated, the
primary source of outbreaks has been international travelers bringing the disease into the
country. Not all travelers consider the diseases they may be exposed to abroad. Encouraging
travelers to check their titer levels and get vaccinated before their travels will help reduce the
References
Gastañaduy, P. A., Budd, J., Fisher, N., Redd, S. B., Fletcher, J., Miller, J., McFadden, D. J.,
Rota, J., Rota, P. A., Hickman, C., Fowler, B., Tatham, L., Wallace, G. S., Fijter, S.,
doi:10.1056/nejmoa1602295
Gastañaduy, P. A., Redd, S. B., Clemmons, N. S., Lee, A. D., Hickman, C. J., Rota, P. A., &
https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html
Glover, C. (2015). A Mathematical Model of the 2014 Ohio Measles Outbreak to Assess the
Snohomish Health District (2018). Disease Reporting. Retrieved September 19, 2020, from
https://snohd.org/296/Disease-Reporting