Containing a measles outbreak in Minnesota, 2017: methods and challenges

Abstract

Aims: We report on a measles outbreak largely occurring in Minnesota’s under-vaccinated Somali community in the spring of 2017. The outbreak was already into its third generation when the first two cases were confirmed, and rapid public health actions were needed. The aim of our response was to quickly end transmission and contain the outbreak. Methods: The state public health department performed laboratory testing on suspect cases and activated an Incident Command staffed by subject matter experts that was operational within 2 h of case confirmation. Epidemiologic interviews identified exposures in settings where risk of transmission was high, that is, healthcare, childcare, and school settings. Vaccination status of exposed persons was assessed, and postexposure prophylaxis (PEP) was offered, if applicable. Exposed persons who did not receive PEP were excluded from childcare centers or schools for 21 days. An accelerated statewide measles, mumps, and rubella (MMR) recommendation was made for Somali Minnesota children and children in affected outbreak counties. Partnerships with the Somali Minnesota community were deepened, building off outreach work done with the community since 2008. Results: Public health identified 75 measles cases from 30 March to 25 August 2017: 43% were female, 81% Somali Minnesotan, 91% unvaccinated, and 28% hospitalized. The median age of cases was 2 years (range: 3 months–57 years). Most transmission (78%) occurred in childcare centers and households. A secondary attack rate of 91% was calculated for unvaccinated household contacts. Over 51,000 doses of MMR were administered during the outbreak above expected baseline. At least 8490 individuals were exposed to measles; 155 individuals received PEP; and over 500 persons were excluded from childcare and school. State and key public health partners spent an estimated $2.3 million on response. Conclusion: This outbreak demonstrates the necessity of immediate, targeted disease control actions and strong public health, healthcare, and community partnerships to end a measles outbreak.

The Vaccine Uptake Continuum: Applying Social Science Theory to Shift Vaccine Hesitancy

“…While clearly presenting as a medical problem, vaccine hesitancy is, at its root, a socio-behavioral and cultural phenomenon as evidenced by initial outbreaks in particular population subgroups including the Orthodox Jewish community in parts of New York, Somali-Americans in Minnesota, or the Slavic community and surrounding neighbors in southwest Washington. Shared vaccine hesitancy beliefs may be rooted in religious dogma, parental-choice belief systems, or simply community norms, depending on the geographic location and people [1,4,5].…”

National Update on Measles Cases and Outbreaks — United States, January 1–October 1, 2019

“…This represents the most U.S. cases reported in a single year since 1992 ( 1 ), and the second highest number of reported outbreaks annually since measles was declared eliminated* in the United States in 2000 ( 2 ). Measles is an acute febrile rash illness with an attack rate of approximately 90% in susceptible household contacts ( 3 ). Domestic outbreaks can occur when travelers contract measles outside the United States and subsequently transmit infection to unvaccinated persons they expose in the United States.…”

How To Prepare for the Unexpected: a Public Health Laboratory Response

“…MDH worked with Hennepin County Human Services and their local public health department to issue health alerts with recommendations to health care providers for measles laboratory testing (including specimen and epidemiological requirements) and strategies to minimize transmission in health care settings. Updated guidance regarding vaccination recommendations, including an accelerated MMR vaccination schedule was communicated through health alerts in multiple languages ( 18 ).…”