C228 Task 2

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C228 Task 2

Nikkea Ferrin

Western Governors University

9/21/2020
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Sections A and B: Outbreak Description

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 cases during this time (Glover et al., 2015).

Section B1: Epidemiological Determinants and Risk Factors

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

vaccine (Gastañaduy et al., 2019).


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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.

Section B2: Route of Transmission

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

the Amish community due to low rates of vaccination.


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Section B3: Impact in My Community at a Systems Level

If there was a massive outbreak of measles in my community, there would be major

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

may be hard to resupply from manufactures if the outbreak is widespread.


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Section B4: Reporting Protocol for an Outbreak in My Community

I live and work in Snohomish county in Washington State. If there is a confirmed or

suspected case of measles in my county it needs to be reported immediately to the Snohomish

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).

Section B5: Two Strategies to Prevent an Outbreak in My Community

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

possibility of an outbreak in my community.

Section C: Bentonville Activities Completion

Please see attached file named “Bentonville Completion Certificate.”


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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.,

Fiebelkorn, A. P., & Diorio, M. (2016). A Measles Outbreak in an Underimmunized

Amish Community in Ohio. New England Journal of Medicine, 375(14), 1343-1354.

doi:10.1056/nejmoa1602295

Gastañaduy, P. A., Redd, S. B., Clemmons, N. S., Lee, A. D., Hickman, C. J., Rota, P. A., &

Patel, M. (2019). Surveillance Manual. Retrieved September 19, 2020, from

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

Effectiveness of the Public Health Response. (Electronic Thesis or Dissertation).

Retrieved from https://etd.ohiolink.edu/

Snohomish Health District (2018). Disease Reporting. Retrieved September 19, 2020, from

https://snohd.org/296/Disease-Reporting

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