News From Terre Haute, Indiana

Flashpoint

August 25, 2011

FLASHPOINT: Measles outbreak demonstrates the need for up-to-date vaccinations

INDIANAPOLIS — Details of individuals below have been changed to protect the privacy of those involved.

Real incidents that engage national, state and local health professionals can be far more fascinating than television investigative dramas and are clearly more important.

This summer, Indiana experienced a health emergency which triggered a massive and urgent response. The swift response and integrated coordination of dozens of public and private health care professionals and organizations was exemplary. I want to take this opportunity to let Hoosiers know about the resources required and the excellence in the teamwork demonstrated by Indiana public health organizations in order to protect all of our health.

On June 3, 2011, a man flew into O’Hare International Airport in Chicago, headed back to his Indiana home after spending a year overseas. The man had a fever, a rash, and unbeknownst to him, the measles virus. Although perhaps his intention was to share his memories of travel, it was his infection that would impact over 700 Hoosiers in an outbreak investigation which affected an entire region of the state.   

The measles virus causes a highly contagious respiratory disease that can lead to permanent disabilities and even death. Because measles is so contagious, even one case is considered an outbreak. Luckily, the number of cases in the United States remains small due to the widespread availability of the Measles, Mumps, and Rubella (MMR) vaccine which was introduced in the 1960s. (The MMR vaccine is safe and 99 percent effective with two doses.) However, visitors from other countries or unvaccinated U.S. citizens traveling abroad, can become infected while traveling and bring it home. The recent measles outbreak in Indiana, which infected 14 Hoosiers, exemplifies how one individual’s choice not to get vaccinated has the potential to impact hundreds of lives. 

When the initial carrier arrived back in Indiana, he visited a physician, but was misdiagnosed. During the days that followed, multiple friends and family members were exposed, many of whom were unvaccinated. On June 20, five highly infectious family members, ill with fever and rash, visited a hospital emergency room and were correctly diagnosed with measles. The Indiana State Department of Health (ISDH) instigated a complex response to contain the outbreak. 

Following diagnosis, the infected individuals were instructed to “self-quarantine” for five days after rash onset, and although most were cooperative, one required a legal order to comply. Unfortunately, the infected individuals had been going about life as usual up until the diagnosis — working, going to church, babysitting, participating in Little League, even taking a bus trip to an amusement park — all without knowing they were infected with a highly contagious and potentially deadly disease. None of the individuals who were infected during the measles outbreak were fully immunized; most were not vaccinated at all. 

The ISDH activated an emergency alert message through the Indiana Health Alert Network, notifying physicians and hospitals statewide of the outbreak and brought the CDC in to assist. The very next day, ISDH teams of nurses and epidemiologists were deployed to the area to help identify additional cases and contain the outbreak. Hundreds of residents had to be interviewed and their immunity to measles verified. One organization’s production line even had to be closed down while the entire workforce was screened by ISDH and local health departments and vaccinated, if necessary. 

The Indiana immunization registry, CHIRP, allowed physicians and nurses to quickly verify the vaccination status of exposed individuals. CHIRP serves as a valuable tool to encourage and record needed immunizations.

It is due to the diligence of the physician who properly diagnosed the first patient; the swift engagement and “boots on the ground” of the ISDH, CDC, and local health departments; the successful community-wide identification of those who needed to be quarantined or vaccinated; and the use of the CHIRP database, that a potentially devastating epidemic was remarkably contained to only 14 cases. Although the resources employed to confront and contain this outbreak were significant, an uncontained outbreak could incur costs and response on a massive scale due to avoidable illness, disabilities, and even deaths, as well as the potential collapse of a community’s productivity.

It is an individual or guardian’s right to choose safe vaccinations for household members, but as this case demonstrates, failure to be immunized can pose a serious threat to family, friends and coworkers. While parents prepare to send Indiana’s children to school this year, I urge them and all Hoosiers, to make sure their vaccinations are up-to-date. A fully vaccinated population is the only protection against unnecessary, costly, and dangerous outbreaks like the one Indiana just experienced. 

To learn more about  immunizations and public health preparedness, please visit www.statehealth.IN.gov.

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