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Running head: TASK 2 1 International Outbreak Task 2 Western Governors University International Outbreak A. Measles Measles is one of the most contagious infectious diseases known in history. Measles is a virus commonly occurring during childhood. Previously infecting 3,000 to 4,000 U.S. children and causing 400 to 500 deaths, measles steadily declined after the 1968 introduction of a safe, highly effective vaccine to the point of declared national elimination (Koh and Gellin, 2020). However, there has been a resurgence in the past 40 years within the U.S., mainly due to unvaccinated children. In other countries, many international travelers continue to introduce the disease into unvaccinated U.S. communities. The U.S. was prompted to develop the Vaccines for Children Program, a low-income program allowing children to take part of the vaccine for free (Koh and Gellin, 2020). The recommended measles vaccination series is a two-part immunization process in which the first dose is recommended starting with the first dose at age 12 through 15 months and the second dose at age 4 through 6 years before school entry. B. International outbreak The two countries involved in a recent measles outbreak are the United States and Israel. A recent outbreak occurred October 1, 2018, when the New York Department of Health received a report of an unvaccinated teenage traveler diagnosed with measles. Over the next two weeks, six additional cases of measles were received by the New York Department of Health. On
October 24, 2018, the New Jersey Department of Health received a report of an international traveler infected with measles. After further investigation, it was discovered that the unvaccinated travelers had recently traveled to Israel, where an outbreak of 3,150 cases of measles was ongoing. During the investigation between October 1, 2018-April 30, 2019, New York had a reported 242 confirmed cases and from October 17, 2018-November 30, 2018, New Jersey had a reported 33 confirmed cases (McDonald, Ruppert, Soulo, et al, 2019). B1. Epidemiological Determinants and Risk Factors An epidemiological determinant that influenced this outbreak were both unvaccinated travelers traveling to a country where vaccination rates are extremely low and widespread infection is ongoing. Both travelers were identified to belong to an Orthodox Jewish community. Andrews (2019) reported that measles cases in New York were concentrated among children from Orthodox Jewish families, many of whom attended religious schools where vaccination rates may have been below the 95 percent threshold considered to maintain immunity. When there is a higher vaccination rate there is an increased likelihood that individuals in a community will be protected, this is called herd immunity or community immunity. When more individuals are vaccinated, there is a decreased chance that germs will spread and cause infection. Vaccinated individuals not only protect themselves, but others that are unable to receive vaccination due to an immunocompromised condition or may be too young to receive the vaccine. However, one should not rely on herd immunity alone when there is evidence-based research that shows the efficacy of the protection offered when adhering to recommended schedule for the measles vaccine. Another risk factor potentially contributing to the decreased vaccination rate is the exemption from vaccination requirements based on religious or medical reasons. Some states
ear infections and the most severe complications being respiratory and neurologic complications that may result in death. B3. Impact in My Community at a Systems Level An outbreak would significantly impact the functioning of the community. Identifying the source and when the individual became infected would be of utmost importance. Tracing the infected individual’s whereabouts would be a necessary part of identifying the potential spread of the disease. Local schools or facilities would need to close to ascertain whether the students, faculty, and staff or unprotected individuals had documented receipt of proper immunization status. The community would need to be informed of the signs and symptoms to monitor as well as who to report to should the person display signs or symptoms. Hospitals and clinics would be on alert for the potential influx of patients they would need to provide care or treatment. The local health department must work together with local partners to increase the vaccination rate within the community. A swift response to the reported outbreak would necessitate the local health department to investigate and provide surveillance for any individual infected or potentially infected within the community. An effort to administer the vaccine would take time and resources to increase the vaccination rate and prevent further spread of the infectivity of measles. B4. Reporting Protocol within the Community In Virginia, the state has a protocol in place for reporting an outbreak occurring within the community. When an individual becomes infected from measles, it is the providers responsibility to report such an occurrence to the local health department in which the jurisdiction is assigned. The Virginia Department of Health has available a list of communicable diseases and illnesses that are required to be reported by a list of those required to report. The
list of those required to report are the following: (1) physicians, (2) directors of laboratories, (3) persons in charge of a medical care facility, (4) persons in charge of a residential or day program, service, or facility licensed or operated by any agency of the Commonwealth, or a school, child care center, or summer camp, (5) local health directors, (6) persons in charge of hospitals, nursing facilities or nursing homes, assisted living facilities, and correctional facilities, and (7) employees, applicants, and persons in charge of food establishments (Virginia Department of Health, 2018). Once reported, the local health department is responsible for the surveillance and investigation of such diseases. Furthermore, the local health department is responsible for providing all findings related to the surveillance and investigation to the Office of Epidemiology. The Office of Epidemiology, on behalf of the commissioner, is responsible for the statewide surveillance of the disease and works to coordinate and support the local health department during its investigation. Finally, the director of the Office of Epidemiology acts as the commissioner’s designee in overseeing the efforts of the local health department. B5. Two Strategies to Prevent an Outbreak in My Community Education is key in preventing a disease outbreak within the community. Pediatricians and primary care physicians are the key providers that parents rely on for information regarding health education. Koh and Gellin (2020) reported that 80% of parents identified physicians and nurses as trusted sources of information when making vaccination decisions. When a physician can emphasize the importance of receiving vaccines as the standard of care, the parent can make a better-informed decision for their child. A second strategy to prevent an outbreak in the community would be partnering with leadership within the community. As seen in the outbreak that occurred in the Orthodox Jewish community in 2018 to 2019, religious leaders such as rabbis can provide clear, scientific
