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August 7, 2019

'Nothing short of epic': The new ways local officials and providers are fighting measles

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    As the number of U.S. measles cases continues to grow, state and local officials and health care providers are using new approaches to get communities vaccinated and combat misinformation.

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    Background: US measles cases continue to rise

    CDC on Monday announced that local health officials reported eight new measles cases last week, bringing the total number of measles cases reported in the United States to 1,172 cases as of Aug. 1.

    The number of measles cases reported so far this year has surpassed the previous 25-year high, when 963 cases were reported in 1994:

    While the spread of measles in the country appears to have slowed, health officials are concerned the rate of new measles cases could accelerate as children attend summer camps and return to school, and as individuals travel for holidays. According to the latest CDC data, 30 states have reported measles cases as of Aug. 1. CDC researchers noted there currently are measles outbreaks in California, New York, Texas, and Washington:

    Measles largely is preventable with the measles, mumps, and rubella (MMR) vaccine. One dose of the vaccine is 93% effective at preventing measles, and two doses are 97% effective against the disease. But the disease is highly contagious and requires communities to maintain measles vaccination levels between 93% and 95% to prevent the disease's spread.

    CDC researchers have attributed the high number of measles cases in 2019 to a few large outbreaks in the United States, including one in Washington and two in New York. A large number of the measles outbreaks reported so far in 2019 were associated with close-knit communities where individuals are underimmunized. CDC officials said misinformation about the risks of vaccinations has led to lower vaccination rates in the communities facing outbreaks.

    CDC officials said the United States could be at risk of losing its World Health Organization designation as a country that has eliminated the disease if the ongoing measles outbreak continues until October of this year. A country is considered to have eliminated measles after an absence of continuous spread of the disease for more than a year, and the United States in 2000 largely eliminated person-to-person transmission of the measles.

    Local officials turn to new methods for combatting measles

    To prevent new cases of the measles, state and local officials and health care providers are relying on new strategies to fully vaccinate communities and debunk misinformation about vaccines.

    For example, New York City's Health Department launched a 24-hour response team at the department's headquarters in Long Island City, Queens. Some members of the team are responsible for receiving information from health care providers about suspected measles cases, while others are responsible for investigating the suspected cases and determining where individuals with suspected cases of measles traveled when they were contagious. Another group keeps track of individuals with known exposure to the measles.

    Jennifer Rosen, a senior official on the response team, said, "We can pinpoint exactly who spread the measles to whom." However, Rosen noted some individuals are reluctant to speak to local officials about their measles exposure. "Either they're scared and don't want to answer the phone, or even if they will talk, they're not necessarily forthcoming about where they went and who they were with while they were infectious. So that's a big challenge," Rosen said.

    New York City Health Commissioner Oxiris Barbot said the city's efforts to address its longest and largest measles outbreak in nearly three decades have been "nothing short of epic." New York City had spent at least $2.3 million through mid-May to address the measles outbreak by purchasing vaccines, supplies, and outreach materials and paying health officials overtime pay.

    Michael Fraser, executive director of the Association of State and Territorial Health Officials, said the number of measles cases that emerged this year has created a "new normal," with states "getting more nuanced in [thei]r communication and [gaining a] better understanding [of] the … communities that are vaccine-hesitant." For instance, Fraser noted health officials in a few states are examining immunization data "down to the school and practice level" to identify areas where residents are vulnerable to contracting the measles.

    In Vermont, Health Commissioner Mark Levine said state officials found vaccination levels varied widely among schools, "creating significant pockets of vulnerability." Vermont officials have sent memos containing the vaccination data to school headmasters, principals, and superintendents, and have asked the school officials to follow up with the families of children who are not satisfying the state's school immunization requirements. State officials also said they will strongly enforce the school immunization requirements in the fall.

    In Colorado, where children's vaccination rates are among the lowest in the United States, Gov. Jared Polis (D) signed an executive order intended to promote vaccination education. The executive order directs Colorado's Health Department to conduct research on the causes of low immunization rates and determine ways to increase vaccination rates in the state.

    Providers turn to new methods for combatting measles

    Hospitals also have had to quickly adapt to the surge in measles cases. For instance, hospital officials at NYU Langone Health—which admitted 50 measles patients, including 18 children who required intensive care, and treated the majority of measles cases that were reported in New York City—said the hospital retrained its ED staff to help them recognize measles, because most of the staff had not encountered a measles case in real life.

    The hospital also had to find ways to contain the measles virus, which is highly contagious and can remain in the air for up to two hours after an infected individual leaves a room. For example, hospital officials developed new screening procedures for visitors after the father of an infant in the neonatal intensive care unit was diagnosed with measles. In addition, NYU Langone Health isolated measles patients by purchasing three special tents, which cost $9,000 each, to transport sick children from the ED to hospital rooms. The hospital also converted about 80 of its about 350 hospital rooms into negative-pressure isolation rooms to prevent contaminated air from escaping the rooms.

    Further, NYU Langone Health deployed a Spanish-speaking health team to a Brooklyn soccer field to offer Latino soccer players and their fans no-cost MMR vaccines. The move came after a measles outbreak spread from outside of New York's predominantly Orthodox Jewish communities and sickened a few Latino adults.

    Paulo Pina, a doctor from NYU Langone Health, said, "We know there's a lot of adults who are unvaccinated. It's important that we vaccinate them, too, because this is New York: Everybody interacts with everybody" (Mathias, Reuters, 8/5; Sun, Washington Post, 8/2).

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