Abstract
Measles starts with fever, runny nose, and watery eyes, and a rash may develop after a few days. The illness is not serious but can get serious if the infection spread to other parts of the body and spread to the community. The patient can develop a lung infection, ear infection and may even die. There is no medicine as of yet that can kill the measles. What adds to the gravity is that it is a highly communicable disease that can easily spread. The essay discusses the epidemiological determinants of the outbreak of measles and the risk factors involved. It looks into the route of transmission as well as discusses strategies to control an outbreak of measles. There are policies and guidelines from WHO for measles control and prevention. Vaccination and isolation are essential precautions to protect the vulnerable population at home, schools, public places and hospitals. It is essential to keep the non-immunized population segregated from the infected person.
Introduction
With the rising mobility of human populations, it is no surprise to find a rise in the spread of communicable diseases around the world. Moreover, the scientific community of health officials gets aware that those communicable diseases that thought to be under control can still spread and present new problems and give rise to global health issues. Outbreak can extend in a community or may even spread to several countries. Any kind of disease outbreak should be reported immediately to the public health department.
The measles outbreak in the United States real story behind the outbreak did not lie on the West Coast, but a missionary returning from the Philippines (Belluz, 2015). The essay looks at the global communicable disease that seems to have crossed international borders. It traces the route of transmission and the risk factors involved.
2014's massive measles international outbreak An Amish missionary returning from the Philippines led to a massive outbreak of measles in 2014. About four hundred people were taken ill in Ohio's Amish country. and there were 644 more cases of the highly contagious disease across America (Robinson, 2015).
The Amish community refrains from using the conveniences of modern technology. When a member of the local Amish community called the public health nursing director about a potential measles outbreak in the town, there were reasons to panic. Amish community keeps away from the conveniences such as car, computers, internet and other such temptations. It is generally against vaccination, but a measles outbreak was a serious health concern (Belluz, 2015). After all, measles is the most contagious virus known to man, and unvaccinated travelers promote measles outbreaks. The unimmunized travelers may spark outbreaks when they visit geographic clusters of unvaccinated people.
The fear of an epidemic The federal government had declared in 2000 that the United States had eliminated measles. Moreover, now in 2014, there were 288 cases as reported by Belles (Belluz). According to research, nearly all of them had origins from Americans traveling abroad and coming back with the disease. About 97 percent of those cases were associated with ingresses from 18 countries. Many of these travelers came back from the Philippines where there had been a massive outbreak since fall 2013. Thus, the fear of an epidemic of measles still exists from overseas. An unimmunized traveler traveling to a country with a recent outbreak is sure to bring back an infectious disease.
In Ireland, parents are being warned of protecting their children against measles after an outbreak of the infectious disease in southwestern Ireland. Those who have been affected have never received any doses of the measles vaccine (Measles outbreak, 2012). The families are thus urged to take standard doses of the vaccine before traveling within Ireland or to other foreign destinations, especially during the summer vacations.
Another measles outbreak that began in Disneyland, California, went on to affect 170 people in 17 states in 2014. The reason behind the outbreak is attributed to the declining vaccination rates in California. About 50 % of those cases had never been vaccinated for measles. These incidents are prompting the California lawmakers to make it stringent for parents to get those vaccinations for their children. Measles if untreated can lead to disability and death. In 2014, the US saw a record 644 cases of measles which is the highest number in two decades (Measles outbreak, 2015).
Epidemiological determinants of the outbreak Current eruptions of measles in Europe and the US are a reminder of the serious morbidity connected with measles. The cases of measles have risen dramatically according to the World Health Organization report. French outbreak is considered the largest in Europe. The travel has been the main cause of the transmission between countries. However, the global picture is a little more promising, but the mortality remains high. Measles has been eradicated since the 1990s in the United States. However, unvaccinated returning travelers have led to a rise in those cases (Cottrell & Roberts, 2011).
Although, in 2000, US Centers for Disease Control and Prevention declared endemic measles eliminated, the vaccine-preventable diseases are on the rise. This is primarily attributed to parents immunizing their children selectively or delaying the immunization or may even opt out of having their child immunized for measles. CDC reported 121 measles cases in 17 states in 2015 and most cases were unvaccinated (Gostin, 2015).
Measles
Measles may not always be debilitating, but it can bring weeks of fever plus painful, watery eyes. Serious complications such as encephalitis and pneumonia can add on. The virus is very contagious, indestructible and spreads like fire. It can live for hours on exteriors and can easily infect new unimmunized hosts. Because of the declining vaccination rates, measles is on the rise in Europe and ever since 2011, there have been thousands of cases of measles across Europe in 36 countries (Fallis, 2012). In order to laminate the contagious disease, effective outbreak control methods need to be implemented, stricter surveillance methods, and identify the cases in time.
Measles is most common in children but can be caught at any age because of the direct exposure to the aerosol droplets released by the respiratory tract of the infected, especially when they cough or sneeze (Measles outbreak, 2012). Media often blames the parents for not vaccinating their children and thus creating a public health crisis. The vaccine policy is politically divisive, but scientific view consensus sees the childhood vaccines as an effective method to control the vaccine-preventable diseases as asserted by Gostin (2015). Studies suggest that millions of cases of the serious disease were prevented because of childhood vaccinations.
Policies and laws The US Advisory Committee on Immunization Practices recommends a number of childhood vaccines, but the state regulations may vary regarding the types of exemptions (Gostin, 2015). It is observed that families that prefer to out of vaccination often do so because of religious beliefs. Such clustering of herd immunity only encourages disease outbreaks that can easily spread to others. Current WHO guidelines for outbreak response for measles recommend establishing goals for measles control, studying the age distribution, the background of vaccination coverage and measuring the fatality rates (Minetti et al., 2013).
WHO recommends 95% uptake of two doses of measles comprising vaccine for getting rid of the infection in a population (Cottrell & Roberts, 2011). The first dose should be given after the first birthday and the next before the child goes to school. If traveling to an endemic area, the baby six months of age should be given the dose for immediate protection. It is essential to protect unimmunized teenagers so as to eliminate measles. Measles is potentially preventable if there is strict adherence to US vaccine policy recommendations and infection-control guidance as stated by (Chen et al. (2011).
Challenges and strategies Despite advances made in controlling measles worldwide, millions of cases of measles occur globally. Measles is a highly infectious viral disease that spreads easily through airborne transmission. Because of the severity of the diseases, the patients seek care in health care settings and thus pose a strong risk of transmission to other patients. The majority of infected patients with Measles are often unvaccinated or were infected in health care settings. A measles outbreak is both disruptive and costly for the hospitals. Optimal preparedness for measles exposures requires documented immunity records. Thus, there are considerable logistical challenges for the hospital and health department staff in case of a measles outbreak. Rapid serology testing is both costly and disruptive. What adds to the risk factors are unvaccinated contacts, delayed measles diagnosis and improper implementation of infection-control procedures. There are often delays to make diagnosis and laboratory confirmation of measles. Physicians are not well familiar with diagnosing measles (Chen et al., 2011). Substantial challenges remain for the global eradication of Measles, and it will be a couple of years before the targets get achieved. Most people who get infected have never been vaccinated. Measles is highly infectious, and the characteristic rash can appear after seven to 21 days as stated by Cottrell & Roberts (2011).
In order to develop a well-tailored plan, data related to the outbreak should be used along with an implementation of a non-selective mass vaccination campaign. All age groups should be targeted to prevent the spread of the disease to larger numbers. It is sad to see that those guidelines are poorly implemented in actual practice. This is because there is no one-size–fits all strategy to control the infectious disease (Minetti et al., 2013). Depending on the goals of measles elimination or mortality reduction, the right strategies should be devised and implemented.
The only way to get complete protection against measles is vaccination. Several studies show the effectiveness of mass outbreak-response vaccination. The outbreak-response vaccination campaigns may not prevent measles epidemic because of its nature of spreading swiftly, but those campaigns can successfully reduce illness and death (Bonačić Marinović et al., 2012).
Risk factors for measles
Measles is a highly contagious disease and causes more than two million deaths every year. The highest risk factors are for unvaccinated young children and unvaccinated women. Measles deaths occur in countries with weak health infrastructures or those countries recovering from a natural disaster that has interrupted their health services (Measles 2016). Thus, if one is unvaccinated, and travelling internationally, they are at a higher risk of catching the disease.
An outbreak in the community
An outbreak of the measles within a community should never be taken lightly as it places everybody at risk. Within no time, the disease can spread among children and adults, even including those who have been vaccinated. The wildly contagious disease is still common and its virus can easily spread through the air. If one person coughs or sneezes in a crowded area, 90% of those who are non-immune are likely to catch the virus and get infected with measles. Although measles can be serious for all age groups, adults older than 20 years of age and children younger than five years of age are more likely to suffer from measles complications. (Complications of Measles, 2015). Measles during pregnancy can raise the risk of miscarriage, premature labor and low birth-weight babies (Measles, 2015). In the case of an outbreak in the community, immediate action is required without any delay. Measles should be doubted in recent unvaccinated travelers returning from abroad and if they have the fever, cough, and conjunctivitis. Notifications should be made and control measures taken till laboratory confirmation is made. It is essential to collect detailed information about the case and who may have been exposed further so as to provide timely intervention. One needs to identify the sources of infection, get vaccination histories and assess the risk for transmission.
Reporting protocol for measles
Reporting and Surveillance are very essential in case of a measles outbreak in the community. The measles cases should be identified fast and hospitalized to prevent the spread of measles. The Health care providers should be immediately notified, and investigation should start right away. All confirmed, and probable cases, carrying fever, symptoms of measles and rash should be reported. The concerned should complete the measles case report form. WHO Regional Office should be reported about any measles outbreaks and enhance surveillance activities using the Regional Office’s mechanisms. Due to the capacity of measles to spread internationally, the International Health Regulations’ notification and reporting procedures have become stringent and precise. WHO would require data on the affected populations and the measures taken on an outbreak report form where all categories of measles are reported (Guidelines for measles and rubella outbreak 2013).Two essential strategies should be followed right away.
1) Complete isolation of the infected - Any person suspected of measles should be isolated in an examination room right away or kept in a negative–air pressure room. They should wear a size-appropriate mask to prevent transmission (Chen et al., 2011). Patient diagnosed with measles needs to be given severe complications and should get an adequate fluid intake. He has to practice good hand hygiene, use tissues when sneezing and coughing.
2) Notify the Public health authorities – The concerned health care department should be notified as soon as possible about the measles cases. The investigation should not be kept pending till confirmation by laboratory results.
Community and patient education strategies must follow side by side to prevent an outbreak of the disease. Parents often express their concerns related to their right to raise their children as well as their freedom to follow their religion and belief systems. A small fraction of parents are against vaccinations, but they are concerned about the eHealth of their children too. A catch-22 situation develops as these parents do not see any vaccine-preventable childhood diseases and thus don’t feel the need to vaccinate their child (Gostin, 2015). It is essential to talk to them and make them realize the importance of health and life over religion and beliefs.
There is a need to collect data so as to facilitate the public health professionals and one would need to gather demographic information, laboratory details, vaccination and travel history, the source of exposure and occupation. There is a measles case investigation form that can be used to collect the data. Although there is no specific treatment for measles, further spread, and severe complications can be avoided through supportive care. Public Health Authorities can determine the extent of contact tracing based on the data and information collected (Guidelines for the prevention and control of measles outbreaks in Canada, 2013).
Following the above two strategies will lead to a nominal disturbance to healthcare delivery in case of a community measles outbreak. It would be rash to overreact to the situation and place harsh penalties on parents who fail to vaccinate their children, as this may only strengthen public opposition to vaccine policy. A much better options would be to work on the behavioral economics and encourage the parents into compliance. They can be taught about the dangers of measles and the benefits of vaccines (Gostin, 2015).
Conclusion
The community as a whole and even an unvaccinated child benefits if the children in the community are immunized. Unvaccinated children place a wider population at risk and thus violate the basic ethical principle of not harming others. Community measles outbreaks can leave a substantial impact on healthcare delivery and costs. Stress should be given to the pre- assessment of immunity in order to prevent measles transmission in the healthcare setting and public. Travelers going out of the country or coming back in should make their status clear regarding measles vaccination report. Every parent should be encouraged to have an evidence of providing two doses of measles vaccine to their child when he or she turns one year old as a laboratory evidence of immunity.
References
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