Application of Community Health and Population Focused Nursing C228 Task 2: Measles Outbreak
Community Outbreak
Description of the Outbreak
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Despite a declaration of elimination in the year 2000 by the United States, 2014 was a landmark year for measles outbreaks. 594 cases of the highly contagious virus were reported in the US between January 1st and August 22nd that year. (Wendorf, 2014) One outbreak of interest occurred in King County, Washington. This particular outbreak, though small, illustrates how easily transmission can occur between countries. Over the course of 5 weeks, 15 people in King County were infected with the measles virus, 12 of whom were a part of the close-knit Micronesian community. (Wendorf, 2014)
The start of this outbreak in the US can be traced to an unvaccinated Micronesian child who had recently returned from an extended visit to the Federated States of Micronesia (FSM). Her symptoms were noticed on May 30th, 2014; four days after her return to the United States. (Wendorf, 2014) According to Breakwell, et al., FSM had been without a case of measles for 20 years before the start of the outbreak on the islands, which was first confirmed on May 15th, 2014. It is now thought to have started in February of that year, but measles was overlooked as a diagnosis because of its rarity on the fairly well vaccinated islands. It was allowed to proliferate for months without public health interventions. This lead to 393 cases of measles and 1 death on the main FSM islands. (2015)
Epidemiological Determinants and Risk Factors
The primary epidemiological determinant responsible for this outbreak was a lack of vaccination within the King County Micronesian community. An unvaccinated child visiting FSM during a measles outbreak brought home an unwanted, and quite contagious souvenir. It was discovered at vaccination clinics during the outbreak, that most community members had no records or recollection of prior vaccination. (Wendorf, 2014) Measles is easily spread through the air and on surfaces from the copious secretions of those infected to those without immunity. Lack of immunity is the primary risk factor for acquiring the illness. Close contact at home and in public spaces is another contributing factor. The CDC states in the Transmission subsection of it’s Measles webpage that “Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.” (2017).
Vaccine failure also played a major role in the proliferation of this outbreak. 123 infected adults during the FSM outbreak had records verifying that they received 2 doses of measles containing vaccine. This issue is explained well in the CDC’s Morbidity and Mortality Weekly Report from Breakwell, et al., “Vaccine failure can result from improper vaccine storage and handling, leading to decreased vaccine potency. FSM is a tropical country with multiple vaccine storage challenges, including high ambient temperatures, frequent power outages, and inter-island shipping issues.” (2015) [Show Less]