The Workings of Outbreak Response in Refugee Communities

Transcription

1 The Workings of Outbreak Response in Refugee Communities ABC News Victoria Hall Epidemic Intelligence Service Officer 11 th Annual Local Public Health and Resettlement Agency Forum January 25, 2018

2 If I can stop one heart from breaking, I shall not live in vain; If I can ease one life the aching, Or cool one pain, Or help one fainting robin Unto his nest again, I shall not live in vain. - Emily Dickinson

3 OUTBREAK

4

5 3/2/2018 5

6 3/2/2018 6

7 What is an outbreak? An occurrence of more cases of disease than expected in a given area or among a specific group over a particular period of time

8 Seeing Something Expected

9 More Cases than Expected

10 Seeing Something Unexpected

11 Cycle of Public Health Prevention and Control Surveillance

12 Cycle of Public Health Prevention and Control Surveillance Epidemiological investigation (e.g., outbreak investigation)

13 Cycle of Public Health Prevention and Control Surveillance Control measures Epidemiological investigation (e.g., outbreak investigation)

14 Cycle of Public Health Prevention and Control Surveillance Control measures Epidemiological investigation (e.g., outbreak investigation)

15 Why investigate? Prevent additional illnesses Identify infection control gaps Learn more about a disease Study effectiveness of prevention strategies Address public concern about the outbreak

16 Challenges of Outbreak Response Need to fast Need to be right Need to work across many agencies Need to still do regular work

17 Challenges to MDH in Outbreak Responses Language Fear Cultural context Traditional practices Tracking individuals

18 Measles Outbreak in Minnesota, 2017

19 Measles (rubeola) Airborne or direct contact transmission Fever, cough, runny nose, red, watery eyes followed by rash Measles, Mumps, Rubella (MMR) vaccine :1 dose 93% effective, 2 doses 97% Pictures: 19

20 10 Million Cases

21 10 Million Cases Cases

22 10 Million Cases Cases 1 2 Cases

23 April 10, 2017

24 April 10, 2017 Somali Minnesotan Same Daycare No Travel Unimmunized

25 April 10, 2017 Sibling Previously Ill

26 100% 90% 80% 70% 60% 92% Comparison of MMR Rates at 2 Years Old in Minnesota-born Children of Somali Descent versus Non Somali, , Minnesota 88% 89% 68% 50% 40% 30% 20% 10% MMR1 Somali-descent MMR1 Non-Somali 42% 0% Year of birth Data derived from Minnesota Immunization Information Connection (MIIC), March 2017 Minnesota Department of Health

27 79 Cases

28 81% Somali Minnesotan Community

29 90% Unvaccinated

30 Cultural Context 30

31 Previous Work Recognized the trend

32 Previous Work Recognized the trend Limited resources Competing priorities

33 Building trust during an outbreak What relationships have you already built? Where does the community go for information? Who are the trusted leaders and advisors? Who can advocate from inside community?

34 Community and Health Care Outreach Efforts

35 Multidrug-Resistant Tuberculosis Outbreak,

36 Tuberculosis Bacteria, caused by Mycobacterium tuberculosis Spread by airborne droplet nuclei generated by Talking, yelling, singing, coughing, sneezing Two phases: Latent TB infection (LTBI) and Active TB disease Most commonly found in lungs, but can be anywhere in the body Treatable with antibiotics

37 Optional Tagline Goes Here mn.gov/websiteurl

38 The Hmong Community

39 TB and the Hmong Community

40 10 8 Hmong Non-Hmong Number of confirmed cases Year

41 WGS map of Hmong MDR TB cases, to date Father of patient 3 (2011 case) Patient MRCA Patient 10 Patient 5 Patient 4 Patient 9 Patient 8 Patient Patient 6 Patient 7 Patient 2

42 WGS map of Hmong MDR TB cases, to date Father of patient 3 (2011 case) Patient MRCA Patient Patient 4 Patient 9 Patient 8 Patient 1 Patient 10 2 Outbreak 2 Patient Patient 7 cases Patient 2

43 Community engagement What community practices need to be addressed? What community members or organizations are well trusted? Where does the community go for information? What context and stigma must be recognized to successfully respond?

44 Community engagement Adult Senior Centers Hmong radio, videos, and TV Messaging that appeals to community values Address stigma Community, medical, and political leaders 3/2/2018

45 Provider education

46 What Next?

47 Thank you! Victoria Hall