Measles Outbreak In Disneyland, California (2014/15)

Outbreak Details

In this assignment, Measles outbreak in the Disneyland, California in the year 2014/15 has been selected for discussion. After the declaration of eradication of measles from the United States of America, this outbreak occurred during the timeline of December 2014 to February 2015. According to WHO (2015), the first official information about the outbreak arrived in the Californian Department of Public Health (CDPH) on 5^th january 2015 and up to 11 February 2015, more than 120 patients were admitted to the hospitals having measles infection. This outbreak was determined as international outbreak, as more than 3 countries were affected with the disease such United States of America, Canada, Brazil and Mexico. Within these, more than 16 states of USA had more than 150 of the patients were admitted to different hospital throughout the nation (Majumder et al., 2015).

The dates at which all these countries reported the arrival of the measles varied. The United States of America’s Centers for Disease Control and Prevention determined the presence of measles and officially registered it from 1^st to 6^th January 2015 in 16 of the states and in Washington D.C. on the other hand, the Canadian Healthcare System reported the presence of measles in two sections as two different outbreak patterns were observed in Canada (WHO, 2015). The first outbreak occurred on 3^rd February in Quebec province where the Lanaudiere Public Health Department determined the presence of the disease from the beginning of 2015. Whereas, the second outbreak reported on 2^nd February in the Ontario province by the Toronto Public Health. Similarly the health department of Mexico, the Mexican IHR National Focal determined the presence of measles on 30^th December and the rashes were developed on people who went to travel Disneyland between 16^th to 18^th December (WHO, 2015). Whereas in Brazil, in the northern states of Ceará and Pernambuco, measles outbreak was reported from 14^th to 19^th March, 2015 and determined that due to transmission and transfusion, more than 224 people acquired measles in the region (Broniatowski, Hilyard & Dredze, 2016).  Measles Outbreak In Disneyland Discussion Paper

Measles is one of the most contagious viral infection and according to the data of World Health Organization, causes the fifth highest number of deaths in children less than 5 years of age (Dhillon et al., 2012). The world distribution of this disease has been reduced in the past few decades due to the invention of vaccines and booster doses that made people immune to this disease, however the low rate of vaccines in developing countries made this infection predominant in those regions (Antó, 2012). This virus spreads through the respiratory tract by droplet aerosols, sneezing droplets, and respiratory secretions and has the ability to remain viable for longer time within them. According to Malik (2015), the occurrence in the western world of this disease generally occurs during winters and infection is acquired through the conjunctiva or upper respiratory tract.

Measles Epidemiology

The associated risk factors for measles are linked to vaccination, deficiency of vitamin A and travelling through different continents. In this case of measles outbreak in Disneyland, these three risk factors are linked to the epidemiological factors of measles. Disneyland is one of the most famous tourist place of California where travelers from each continent of world and of every age gathers (McCarthy, 2015). Therefore, according to Malik (2015), in such public gatherings of people from different nationality, risk of disease outbreak is always high. Hence, if a single person in that public gathering had not received vaccination against measles then through that individual, there is a high risk of disease distribution in the entire region. Further, vitamin A deficiency helps the infection to resist the immune system and develop severe symptoms. Therefore, from this discussion, the linkage of measles outbreak in Disneyland has been linked with the risk factors and epidemiology of it (Antó, 2012).

The primary route of transmission for measles is the airborne droplets, as this highly infected virus is populated in the throat and nose mucus of the infected individual. According to Gardi et al., (2015), the measles virus has the ability to live in the airspace for 3 hours in the sneezing or coughing droplets of the infected person that determines its severity in the process of transmission. Further, if someone comes into the contact with the person infected with the disease, the measles virus can transfer to the non-infected person though his conjunctiva or upper respiratory tract and can also spread through touch nose, mouth and eyes with hands having infected droplets (Vanhems et al., 2013). As the Disneyland is a famous tourist park, the chances of transmission of measles become high, as due to high crowd and gathering, possibility of people being infected due to coughing or sneezing droplets and through hand or conjunctiva increases. The Center for Disease Control and Prevention of the United States of America determines that if a person having measles infection is present in a public gathering, then the chances of the individuals around that person to acquire measles becomes 90% (Gardi et al., 2015).

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The outbreak of measles in Disneyland, after the declaration of USA measles free, led each healthcare expert think deeper about the state and system level of impact of this outbreak. In each of the state and countries, such as California, USA, Mexico, Brazil the amount of human and financial efforts put for the eradication of the disease failed due to the sudden outbreak of the disease (Ortega-Sanchez et al., 2014). According to the Center for Disease Control and Prevention of USA, Virginia the disease outbreak affected the Virginian system for measles control and prevention. As per Ortega-Sanchez et al., (2014), the controlled rate of measles were provided the healthcare facilities within the Virginia to provide all the children below the age of 5 with vaccination to measles and booster doses were also provided to them to prevent future occurrence (Nelson et al., 2013). However, due to the Disneyland incident, the virus generated resistance against the vaccine and the rate of outbreaks increased in Virginia. This hampered the healthcare system of the community and the rate of people affected with measles increased.

Risk Factors For Measles

The reporting protocol of disease outbreaks are means through which one nation can take necessary steps to control the outbreak within the country. The Virginian state has also developed and updated the disease control and reporting protocol related to measles after the outbreak of the disease in Disneyland. According to the reporting guidelines, outbreak of disease is referred to a situation, when a cluster of people becomes affected to a single disease (Virginia Department of Health, 2016). This disease can be a public health concern or a disease with newer symptoms against which proper action needs to be taken (Virginia Department of Health, 2016). Therefore, according to the law of disease reporting, the test reports from the laboratory and prescription of the physician is necessary for the determination of disease outbreaks. The government directed the laboratories and physicians that they should they should provide priority to the patients who are having symptoms of measles and take preventive measures to control the disease (Virginia Department of Health, 2016).

Further after the confirmation of disease outbreak, the regulatory guidelines suggests isolation of the people affected with measles or other contagious disease so that further dispersion of the disease within the community can be stopped. This regulation is strictly applied to the healthcare facilities of Virginia that non-compliance with the guidelines can hamper those healthcare facilities (Virginia Department of Health, 2016). Further, the isolated individual or group of individuals should be provided with proper healthcare interventions and the nurse and healthcare workers, determined to serve the infected person should be vaccine and immune with medicine so that the transmission of measles from the healthcare worker to other communities can be prevented (Virginia Department of Health, 2016).

The two prime strategies for prevention of disease outbreak in Virginia are-

1. As the Virginian law interferes with the freedom of movement, personal rights to protect one’s mind and body, property and other human rights, the government should focus on the balance between private and personal system so that an ethical and transparent way for can be utilized for the implementation of public health distribution. Further, in this aspect the government should help the healthcare authorities to reach to difficult and outskirt areas so that the reach of vaccination and immunization to different infectious diseases can be increased. This will help the authorities by controlling the reach of disease outbreak and the contact of infected people with normal individuals can be limited (Lewnard et al., 2016).
2. Secondly, the Virginian government should focus on amending the healthcare laws so that arranging a healthcare program within the community becomes easier for the private healthcare organizations. This will increase the numbers healthcare campaigns, where the local community can be provided with opportunity to determine their health status. This free clinical checkup and infectious disease testing will help the individual as well as the community to understand the dominance of the disease and necessary preventable steps they need to take for successful limitation of the disease (Leung et al., 2015).

References

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Broniatowski, D. A., Hilyard, K. M., & Dredze, M. (2016). Effective vaccine communication during the disneyland measles outbreak. Vaccine, 34(28), 3225-3228. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0264410X16301980

Dhillon, P. K., Jeemon, P., Arora, N. K., Mathur, P., Maskey, M., Sukirna, R. D., & Prabhakaran, D. (2012). Status of epidemiology in the WHO South-East Asia region: burden of disease, determinants of health and epidemiological research, workforce and training capacity. International journal of epidemiology, 41(3), 847-860. Retrieved from: https://academic.oup.com/ije/article/41/3/847/835633

Gardy, J. L., Naus, M., Amlani, A., Chung, W., Kim, H., Tan, M., … & Hayden, A. S. (2015). Whole-genome sequencing of measles virus genotypes H1 and D8 during outbreaks of infection following the 2010 Olympic Winter Games reveals viral transmission routes. The Journal of infectious diseases, 212(10), 1574-1578. Retrieved from: https://academic.oup.com/jid/article/212/10/1574/2459180

Leung, J., Lopez, A. S., Blostein, J., Thayer, N., Zipprich, J., Clayton, A., … & Seetoo, K. (2015). Impact of the US Two-Dose Varicella Vaccination Program on the Epidemiology of Varicella Outbreaks: Data from 9 States, 2005–2012. The Pediatric infectious disease journal, 34(10), 1105. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606850/

Lewnard, J. A., Antillón, M., Gonsalves, G., Miller, A. M., Ko, A. I., & Pitzer, V. E. (2016). Strategies to prevent cholera introduction during international personnel deployments: a computational modeling analysis based on the 2010 Haiti outbreak. PLoS medicine, 13(1), e1001947. Retrieved from: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001947

Majumder, M. S., Cohn, E. L., Mekaru, S. R., Huston, J. E., & Brownstein, J. S. (2015). Substandard vaccination compliance and the 2015 measles outbreak. JAMA pediatrics, 169(5), 494-495. Retrieved from: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2203906?utm_source=tech.mazavr.tk&utm_medium=link&utm_compaign=article

Malik, T. A. (2015). Inflammatory bowel disease: historical perspective, epidemiology, and risk factors. Surgical Clinics, 95(6), 1105-1122. Retrieved from: https://www.surgical.theclinics.com/article/S0039-6109(15)00140-1/abstract

McCarthy, M. (2015). Measles outbreak linked to Disney theme parks reaches five states and Mexico. BMJ: British Medical Journal (Online), 350. Retrieved from: https://search.proquest.com/openview/327eadcd1b2a9ea320b15e039920e624/1?pq-origsite=gscholar&cbl=2043523

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Ortega-Sanchez, I. R., Vijayaraghavan, M., Barskey, A. E., & Wallace, G. S. (2014). The economic burden of sixteen measles outbreaks on United States public health departments in 2011. Vaccine, 32(11), 1311-1317. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0264410X13013649

Vanhems, P., Barrat, A., Cattuto, C., Pinton, J. F., Khanafer, N., Régis, C., … & Voirin, N. (2013). Estimating potential infection transmission routes in hospital wards using wearable proximity sensors. PloS one, 8(9), e73970. Retrieved from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0073970

Virginia Department of Health. (2016). Rules and Regulations of the Board of Health – Commonwealth of Virginia. Vdh.virginia.gov. Retrieved 15 March 2018, from https://www.vdh.virginia.gov/content/uploads/sites/13/2016/03/Regulations-for-Disease-Reporting-and-Control-October-2016.pdf  . Measles Outbreak In Disneyland Discussion Paper