<i>Notes from the Field</i>: Measles Outbreak of Unknown Source — Shelby County, Tennessee, April–May 2016

Fill, Mary-Margaret A.; Sweat, David; Morrow, Helen; Haushalter, Alisa; Martin, Judy C.; Zerwekh, Tyler; Chakraverty, Tamal; Kmet, Jennifer; Morris, Kevin N.; Moore, Kelly L.; Kainer, Marion A.; Murphree, R. L.; Dunn, John R.; Schaffner, William; Jones, Timothy F.

doi:10.15585/mmwr.mm6538a3

Cited by 7 publications

(8 citation statements)

References 2 publications

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“…According to the Centers for Disease Control and Prevention, there were two measles outbreaks between January 2016 and January 2017 (the start of our survey). The first one occurred in Shelby County, TN between April and May [36]. The second one followed in Eloy, AZ between May and June [37].…”

Section: Methodsmentioning

confidence: 99%

The effect of trust and proximity on vaccine propensity

et al. 2019

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The main goal of this paper is to study the effects of (1) trust in government medical experts and (2) proximity to a recent disease outbreak on vaccine propensity. More specifically, we explore how these variables affect attitudes with regards to measles. Using original survey data, collected in January/February 2017, we obtain three main empirical findings. First , contrary to our expectations, an individual’s proximity to a recent measles outbreak has no independent effect on vaccination attitudes. Second , corroborating previous studies in the field, we find that trust in institutions such as the CDC has a positive effect on our dependent variable. Third , there is a significant interactive relationship between proximity and trust in governmental medical experts. While distance from a previous measles outbreak has no effect on vaccination attitudes for respondents with medium or high levels of trust, the variable exerts a negative effect for subjects with little confidence in government medical experts. In other words: low-trust individuals who live farther away from a recent measles outbreak harbor less favorable views about vaccination for this particular disease than low-trust respondents who live close to an affected area. This implies that citizens who are skeptical of the CDC and similar institutions base their vaccination decision-making to some degree on whether or not a given disease occurs in close vicinity to their community.

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Section: Methodsmentioning

confidence: 99%

The effect of trust and proximity on vaccine propensity

et al. 2019

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“…We were unable to identify whether the source was a detainee, a staff member, or a facility visitor. Importantly, when the introduction of measles is not identified, the length of transmission before the recognition of the first case-patients is unknown [17][18][19]. Because documenting the lack of sustained transmission is a key criteria for determining elimination, every effort should be made to determine the source of outbreaks.…”

Section: Discussionmentioning

confidence: 99%

Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016

Venkat

Briggs²,

Brady

et al. 2018

Clinical Infectious Diseases

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Background.-We describe a measles outbreak and control measures implemented at a privately operated detention facility housing US Immigration and Customs Enforcement detainees in 2016. Methods.-Case-patients reported fever and rash and were either laboratory-confirmed or had an epidemiological link to a laboratory-confirmed case-patient. Immunoglobulin G (IgG) avidity and plaque reduction neutralization tests distinguished between primary acute and reinfection casepatients. Measles-specific IgG was measured to assess detainee immunity levels. We compared

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“…PHE offered excellent value to prevent large measles outbreaks [28,29], and even smaller outbreaks [26], if the risk of measles exposure was high. For travelers to specific hot spots in certain years, PHE could offer good value to prevent even relatively small outbreaks [27]. Improving MMR vaccination among travelers returning to US communities with heterogeneous vaccination coverage should be prioritized, with focused interventions that highlight the benefits of MMR vaccination, such as the intervention that occurred after the 2015 Disneyland outbreak [36].…”

Section: Discussionmentioning

confidence: 99%

“…Fewer contacts (200 contacts) result from travelers vaccinated twice, given that contacts result only from the importation in the absence of US-acquired cases. Given the broad range in the number of contacts per importation and/or outbreak [4,23,[25][26][27][28][29], we varied these estimates widely in sensitivity analyses.…”

Section: Contactsmentioning

confidence: 99%

“…PHE could be cost-saving when each importation resulted in more US-acquired cases or extensive contact tracing, which can occur when travelers return to US communities with heterogeneous MMR coverage (Figure 3). For travelers with lower Risk exposure itineraries (eg, Europe, Figure 3A), PHE resulted in ICERs ≥$100 000/measles case averted if small or moderate-sized outbreaks resulted from an importation, such as were reported in Tennessee (Figure 3, star) or Arizona (Figure 3, square), respectively [26,27]. PHE resulted in an ICER <$50 000/measles case averted only if a large outbreak resulted from the importation, such as occurred in an Ohio Amish community (Figure 3, circle) [28].…”

Section: Multi-way Sensitivity Analyses: Heterogeneous Vaccination Communitiesmentioning

confidence: 99%

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The Clinical Impact and Cost-effectiveness of Measles-Mumps-Rubella Vaccination to Prevent Measles Importations Among International Travelers From the United States

Hyle

Fields²,

Fiebelkorn

et al. 2018

Clinical Infectious Diseases

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Background Measles importations and the subsequent spread from US travelers returning from abroad are responsible for most measles cases in the United States. Increasing measles-mumps-rubella (MMR) vaccination among departing US travelers could reduce the clinical impact and costs of measles in the United States. Methods We designed a decision tree to evaluate MMR vaccination at a pretravel health encounter (PHE), compared with no encounter. We derived input parameters from Global TravEpiNet data and literature. We quantified Riskexposure to measles while traveling and the average number of US-acquired cases and contacts due to a measles importation. In sensitivity analyses, we examined the impact of destination-specific Riskexposure, including hot spots with active measles outbreaks; the percentage of previously-unvaccinated travelers; and the percentage of travelers returning to US communities with heterogeneous MMR coverage. Results The no-encounter strategy projected 22 imported and 66 US-acquired measles cases, costing $14.8M per 10M travelers. The PHE strategy projected 15 imported and 35 US-acquired cases at $190.3M per 10M travelers. PHE was not cost effective for all international travelers (incremental cost-effectiveness ratio [ICER] $4.6M/measles case averted), but offered better value (ICER <$100 000/measles case averted) or was even cost saving for travelers to hot spots, especially if travelers were previously unvaccinated or returning to US communities with heterogeneous MMR coverage. Conclusions PHEs that improve MMR vaccination among US international travelers could reduce measles cases, but are costly. The best value is for travelers with a high likelihood of measles exposure, especially if the travelers are previously unvaccinated or will return to US communities with heterogeneous MMR coverage.

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Notes from the Field: Measles Outbreak of Unknown Source — Shelby County, Tennessee, April–May 2016

Cited by 7 publications

References 2 publications

The effect of trust and proximity on vaccine propensity

The effect of trust and proximity on vaccine propensity

Measles Outbreak at a Privately Operated Detention Facility: Arizona, 2016

The Clinical Impact and Cost-effectiveness of Measles-Mumps-Rubella Vaccination to Prevent Measles Importations Among International Travelers From the United States

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