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A US metropolitan county health department’s response to a measles outbreak in a childcare facility – challenges faced and lessons learned

Diane Meyer, Marc Trotochaud, Lisa Ferguson, Jennifer Vines, Russell Barlow, Jennifer B Nuzzo
Date posted:
November 17, 2020
Publication type:
Perspectives in Public Health
SAGE Journals
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In 2019, the US Centers for Disease Control and Prevention (CDC) reported the largest number of measles cases since 1992. Thirty-one states reported a total of 1282 cases.1 Rising measles incidence increases the likelihood that state and local health departments across the US will have to respond to an outbreak of this disease in the future.

Reports describing US measles outbreaks have highlighted the difficulties that local public health authorities may encounter in trying to contain the spread of measles. Relatively few studies have highlighted considerations necessary for a rapid and effective public health response to measles at the operational level. Those that have been published detail a variety of challenges, including vaccine hesitancy, delay of vaccination, delays in the timely recognition of outbreaks and implementation of mitigation measures, and the high costs associated with the response.27 Additional analyses that highlight the operational challenges and lessons learned associated with responding to outbreaks may help other public health departments plan for future introductions of measles and other communicable diseases.

In late June 2018, the Multnomah County Health Department (‘health department’) located in Portland, Oregon, US, responded to a small measles outbreak at a local childcare facility. During their infectious period, the index case spent time at the facility and exposed staff and children, including unvaccinated infants. While only three individuals ended up getting infected with measles, an estimated 500 people were exposed. Public health interventions included identifying and following up with potentially exposed individuals, determining which children should be excluded from the childcare facility and administration of immunoglobulin (IG).

Congregate settings like childcare facilities are at high risk for measles transmission and severe illness. Infants are particularly vulnerable to measles infection because they generally do not receive their first dose of measles-containing vaccine (MMR) until 1 year of age. Furthermore, the risk of serious measles-related complications is greatest among children under age 5 and adults over age 20.8 Luckily, no infants developed measles during this outbreak.

This analysis aims to describe the challenges encountered and lessons learned during the Multnomah County Health Department’s response to this measles outbreak in a childcare facility setting, distilled through qualitative interviews with health department staff involved in the response. Although this outbreak was small, these challenges and lessons learned may inform public health policy and help other local public health authorities prepare for measles outbreaks. These lessons will become increasingly important as measles cases continue to increase in both the US and abroad.



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