Measles has re-emerged in the US for a variety of reasons, including misinformation spread by antivaccination advocates and imported cases from countries where infected children may be too young for immunization (Stinchfield, 2020).
The CDC confirmed 1,249 cases of measles between January 1 and October 4, 2019. This year marks the greatest number of measles cases in the country since 1992. While cases have been reported in 31 states, 75% of measles cases were linked to outbreaks in New York City and New York state, most of which were among unvaccinated children in Orthodox Jewish communities. These outbreaks have been traced to unvaccinated travelers who brought measles back from other countries at the beginning of October 2018 (HHS.gov, 2019).
Before the record high in 2019, the US saw a spike in 2014. the virus spreads mostly to children too young to receive the MMR vaccine, those unvaccinated and the immunocompromised.
Investigative Process
When an outbreak of measles is suspected it is critical to rapidly determine if the suspected outbreak is indeed a real outbreak by verifying that the reported suspected cases comply with the recommended clinical case definition, and that the increase in the number of reported cases meets the definition of an outbreak (5/100,000 in one month in a geographical area) (WHO.org, 2009). The Outbreak Coordination Committee which is a multidisciplinary group (preferably formed before an outbreak) ensures laboratory confirmation, adequate clinical management, surveillance and notifications of suspected cases, assess risk, implement control and preventive measures and ensure effective community involvement (WHO, 2009).
Epidemiologic Triangle/Vector Theory
The epidemiological triangle is a model used to study diseases and consists of 3 vertices; the agent, the host and the environment. The agent is what causes the disease. The host is the exposed person. The environment is the conditions surrounding the host that makes the conditions favorable for the agent. Within the triangle is time; time of incubation, duration of illness and/or time to the brink of an epidemic. Measles is caused by a virus in the paramyxovirus family and it is normally passed through direct contact and through the air to humans. The World Health Organization (WHO) (2019) reported that measles is one of the world’s most contagious diseases by remaining active and contagious in the air or on infected surfaces for up to 2 hours.
Healthcare interventions
When measles is in a community, two primary interventions will help stop the outbreak. One is to increase community immunity by vaccinating all eligible members of that community. The other is to reduce transmission in healthcare settings such as clinics and EDs, as well as schools, daycare centers, and other public places. Patients with suspected measles cases should be roomed farthest away from other patients with a portable air filtration system placed outside the room when airborne infectious isolation is unavailable.
Communicate clearly that the MMR vaccine is safe, does not cause autism, it protects against a deadly disease, and is the best protection against severe adverse reactions, such as blindness, deafness, or other neurologic or immunologic impairments. With the recent measles outbreaks that occurred in 2018, 8 states are considering removing personal exemptions for the measles vaccine. According to the Association of State and Territorial Health Officials (ASTHO, 2018) bills to restrict exemptions are now pending in a growing number of states.
Could it have been avoided?
One dose of MMR vaccine given at 12 to 15 months confers 93% coverage to prevent measles (Stinchfield, 2020). In recent years, many of significant influence have spoken out against vaccination. The anti-vaccination sentiments in recent decades were also fomented by the 1998 publication of a series of articles in The Lancet by a former British doctor, Andrew Wakefield (Bekecke & DeYoung, 2019). Wakefield suggested a connection between the measles, mumps, and rubella (MMR) vaccine and development of autism in young children (Bekecke & DeYoung, 2019). Reich (2014) points out, ideas about neoliberalism and skewed perceptions of feminist concepts of bodily autonomy and parental decision-making trumps medical expertise.
Effectively countering the anti-vaccine movement should be addressed through understanding mechanisms for increasing trust between the medical community and parents (Bekecke & DeYoung, 2019). Eroded trust can still be a factor today in medical decision-making, and this historical context should be considered when working with communities for vaccination promotion
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