MDPH Public Health Fact Sheet on Measles

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2 MDPH Public Health Fact Sheet on Measles Measles is more easily spread than almost any other disease. The virus that causes measles lives in the nose and throat and is sprayed into the air when an infected person sneezes, coughs or talks. It can stay in the air for up to 2 hours. Other people nearby can then inhale the virus. Touching tissues or sharing a cup used by someone who has measles can also spread the virus. People with measles can spread the disease 4 days before the rash begins until 4 days after rash onset. The first symptoms appear days after a person is exposed.

3 TRADITIONAL National Disease Reporting Pathway Healthcare Providers Institutions Others Labs Local Boards of Health State Health Department CDC

4 Reporting Pathway for Measles Framingham Restaurant Framingham Corporation Framingham Supermarket The Public Framingham Board of Health Massachusetts Department of Public Health (MDPH)

5 Framingham Restaurant Framingham Corporation Framingham Supermarket Public MDPH Framingham BOH Call from SLI to BOH + PCR for Pertussis Receive confirmation with copy of lab Contact case: ID employers: exclude Call worksites: identify CC, exclusions Call case: family, significant others Arrange for immunization at worksites (1 x 2, 1 x 1, 1 x 2) Send sample letters for worksites Call providers: vaccination history on high risk Report to worksite on exclusions Complete confidential case report MMR MMR Clinic at BOH office for public 5

6 Basic Measles Timeline: History of Case Definition Period of Infec tivity Periordof Exclusion Clinic at Samba. Bose outbreak Fever onset Rash onset Case went to PCP Preparations First call from MDPH Presumptive Possitive lab 1 st Clinic TJ 2 nd Clinic TJ PCR NP (+) IgM (+)

7 February 19 th (Wednesday) First Call from Epidemiologist at DPH Steve Flemming: suspect case. Review Lab Results (MAVEN) (Probably NOT measles) Contact suspect case Review suspect case history of illness (started feeling ill on 15) Review suspect case history of exposure sites (work and a restaurant) Contact employer and obtain list of co-workers (General Manager) Communicate with TJ Corporate Office (California) Reviews TJ History (no float staff, trainings, meetings, corporate events) Review employee list for high risk co-workers Have additional vaccine delivered Screening questionnaire developed (DOB, prior vax history, risk factors, exposure)

8 February 20 th (Thursday) Review Lab Results (MAVEN) with Epi: Strong test result (it wasn t until 24 th that we would know the PCR and NP swab was (+) for measles and serum was IgM (+) for measles through HSLI. Identified 57 Co-worker contacts Identified 1 high risk co-worker (pregnant female; advised to contact ObGYN) Plan clinic for co-workers within 24 hours. 2 MMR clinics were provided on Saturday and Monday to capture all exposed employees and recover immunization validations.

9 February 21 st (Friday) Tests and History obtained: strong test result, proceed as a case. confirm rash onset date and time, where he went prior to rash onset exclude employees who cannot provide evidence of immunity or vaccination 2/21 (DPH allowed employees until 2/24 to provide it due to weekend) Exclusion period established as 2/24 through 3/10. Case travel history: 2/13, 2/14 worked at Trader Joes 9-5, worked as a musician at Conquoria Mexicana on Friday (that site was later excluded due to rash onset date) 2/15 Saturday: worked at Trader Joes 9-5,. went to dinner at Sambas on Route 9 Framingham, then home (not feeling well) 2/16 Sunday worked at Trader Joes 9-5 2/17 Monday off, 2/18 Tuesday off, 2-19 Wednesday went to doc because he woke up with a rash (woke up at 4am), 2-10 Thursday home, wife vaccinated by her PCP with MMR. Second case identified at Bose Corporate to Framingham BOH to assist with clinics

10 February 22 nd (Saturday) Complete employee list received from Corporate TJ First of 2 MMR clinics 4-6 pm at the Supermarket Public Health Fact Sheets distributed at the counters Exposed employees provided proof of immunity or were vaccinated (Note: flu shots were also offered to the employees and nearly 30% accepted this opportunity to be vaccinated against influenza at the same time).

11 February 23 rd (Monday) Second of 2 MMR clinics 11-3 pm at the Supermarket Exposed employees provided proof of immunity or were vaccinated Vaccine received from DPH for Bose Additional vaccine requested Secured supplies from BOH EDS Trailer for clinic Media on site at BOH, supermarket Press release distributed to mainstream media

12 February 24 th (Tuesday) First of 2 MMR clinics at Bose (approx. 300) Exposed employees provided proof of immunity, vaccinated or were excluded Media is providing updates Media on site at BOH, supermarket Press release distributed to mainstream media Single MMR Clinic at restaurant, all but 1 employee vaccinated, showed proof of immunity. One was excluded.

13 February 28 th (Friday) Second of 2 MMR clinics at Bose (approx. 300) Exposed employees provided proof of immunity, vaccinated or were excluded Media is providing updates Another measles case was identified at BOSE on March 1 st His rash onset was 2/13. He was seen at CVS minute clinic in Sudbury on 2/13 so exposure occurred there. He drove to Rochester NY to visit family from 2/15 to 2/17 (so some exposures may have taken place there). All family has been informed.

14 Hotline Telephone Message There is one confirmed case of measles in Framingham. Measles is a highly contagious disease. If you work or were a patron inside Samba Restaurant on Saturday February 14 th between 5:30 and 9pm or If you work or were a patron inside Trader Joes in Framingham on Saturday February 15th or Sunday February 16th during the hours of 9am 5pm you may have been exposed to measles. The Framingham Board of Health is working closely with the Massachusetts Department of Public Health authorities to notify those who are at risk. Most people born before 1957 are immune. Most children who attend public schools in Framingham have received their measles shot in a combination vaccine; MMR. For those who have NOT been vaccinated or are unsure of their vaccination history, you may ask your doctor for your vaccine history. If you believe you might be at risk or if you have questions, it is recommended that you contact your physician or the Framingham Board of Health or the State Department of Public Health Detailed information about measles is on our website and on the state Health Department Website. The Board of Health is providing MMR vaccine to those who may have been exposed during the clinic hours of 8:30 -= 9:30 and 4-4:45 daily Monday through Friday.

15 Measles Alert Messages This notice was posted on doors and windows of both the Restaurant and Grocery store.

16 Media helped deliver the message. Media helped increase awareness. WCVB-TV Channel 5 Channel 7 Eyewitness News Framingham PATCH NECN Metrowest Daily News WBZ-Boston Channel 4

17 Trader Joes work site: half the employees at this store are Framingham residents. Half reside in neighboring communities. 27.9% of those vaccinated with MMR also accepted a flu vaccination (CDC recommends offering to vaccinate with Flu at every patient encounter). 100% of Trader Joes employees were either vaccinated, excluded (none) or provided proof of immunity by 2/25 100% of Samba employees were either vaccinated, excluded (1) or provided proof of immunity by 2/26

18 Considerations 1. Investigations of infectious disease doesn t end at the town line; ask DPH to Share MAVEN ID with sister communities impacted. 2. Swift attention to media fosters future health reporting needs. 3. Staff were immediately hi-jacked to attend to control efforts. 4. PHN activities were suspended (consider workforce limits, how continuity of operations can be maintained). 5. BOH Hotline message had a delay (recent work on telephone lines). 6. Notify community partners (EMS, Emergency Management, Hospitals) early in the process. (How early?) 7. Culture of employees/shoppers at TJ can be organic (some were less inclined to vaccinate). Increased educational efforts. 8. Culture of restaurant employees may undervalue significance of the disease or vaccination. 9. Sensitivity to the PR needs of corporate image. 10.Occupational Health and Public Health worked well together. 11.Private vaccinators may not have clinical supplies (depends) 12.EDS supplies of needles/syringes were for IM (flu assumptions)

19 March 21 st, 2014 No new cases identified.