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The Role of Vaccine Adherence in an Outbreak
Read the overview below and complete the activities that follow.
The Ohio State Department of Health confirmed a diagnosis of measles in a 6-year-old girl who was hospitalized in Cincinnati while visiting relatives in May 2005. Because the patient was a resident of Indiana, the Indiana State Department of Health initiated an investigation that eventually identified a total of 34 cases of measles occurring between May 16 and June 24. Of the 34 infected persons, 33 had participated in a church gathering in northwestern Indiana on May 15, or were family members of a participant. The final case occurred in a phlebotomist who worked at a hospital where one of the measles patients had been admitted; childhood school records indicated that he had received only one of two recommended doses of measles vaccine. Three of the 34 patients were hospitalized, two with dehydration and one with pneumonia requiring 6 days of mechanical respiratory support. Complications seen in the 31 non-hospitalized patients included 16 cases of diarrhea and 2 cases of otitis media (ear infection). State and local health departments in Ohio, Indiana, and Illinois (where one patient lived) immediately began tracing the contacts of all 34 patients to determine the outbreak's epidemiology. One of the people present at the church gathering on May 15 was a 17-year-old girl who had never been immunized for measles and who had worked from May 4 through 14 as a missionary in Bucharest, Romania, where a large measles outbreak was later reported. The day before the gathering, the girl had returned to the United States, traveling on both international and domestic commercial airliners. When she arrived, she was experiencing fever, cough, conjunctivitis, and cold-like symptoms; family members later recalled that she had exhibited a rash the next day. At the time, this propagated measles outbreak was the largest in the United States since 1996. Its severity was due almost entirely to the fact that only one of the 33 people infected had been adequately vaccinated against measles. State and local health departments in Indiana, Ohio, and Illinois worked to control the outbreak through multiple measures, including voluntary isolation of patients, administration of vaccine and immunoglobulin to susceptible contacts, voluntary home quarantine of susceptible individuals who refused vaccination, and alerting hospitals and the media to the measles outbreak.
Locate this article using an online search engine: CDC. October 28, 2005. Morbidity Mortality Weekly Report 54(42): 1073–75. Then, locate the following journal article in a similar manner: Berger BE et al. 2010. Could the United States experience rubella outbreaks as a result of vaccine refusal and disease importation? Human Vaccines 6(12): 1016-20. Read both articles thoroughly, and then answer the questions that follow here.
1. What is an index patient? Who was the index patient in this case?
2. How did scientists positively determine measles infection in the patients?
3. Based upon the data collected in this case, could this measles outbreak have been completely avoided? If so, explain how.
4. What is herd immunity, and does it exist in the U.S. today?
5. Based upon the actions of the Advisory Committee on Immunization Practices (ACIP): (1) Who is recommended to be fully vaccinated against measles and why?; (2) At what age should vaccination against measles begin and why?; and (3) How is one determined to be sufficiently immune to measles virus?
6. Conduct additional research, and discuss whether mandatory quarantine would be useful in prohibiting the spread of an infectious disease outbreak.
7. Conduct additional research, and then develop your position on the efficacy of the current vaccination program in the United States.
