Measles, Mumps, and Pertussis. UALBH Annual Symposium September 8, 2017 Gary Edwards, Executive Director

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1 Measles, Mumps, and Pertussis UALBH Annual Symposium September 8, 2017 Gary Edwards, Executive Director

2 Measles, Mumps, and Pertussis Oh My!!!

3

4 When you come to a fork in the road,... take it. Don t be afraid to change course. Travel the road less travelled.

5 Public Health s Responsibility 26A health departments provide communicable disease control, surveillance, epidemiology 26A shall enforce state health laws, rules, regulations, etc. 26A-1-114(1)(b) establish, maintain, enforce isolation and quarantine 26A-1-114(1)(d) operate programs necessary to control disease 26A-1-114(1)(j) investigate causes of morbidity R (2)(e) direct the investigation and control of diseases R (2) provide evidence-based communicable disease prevention and control using State disease plans

6 Public Health Priority Depends on the disease, the number of cases, the prescribed response

7 Measles Caused By: RNA virus Is one of the most contagious of all infectious diseases Over 90% of contacts, if not immunized, will become ill Transmitted By: Droplets or by airborne spread when an infected person breathes, coughs, sneezes, even talking and singing Incubation Period: Ranges from 7 to 21 days after a person is exposed Infectious Period: 4 days before to 4 days after the rash appears

8 Symptoms: Measles typically begins with: The 3 C s cough runny nose (coryza), and red, watery eyes (conjunctivitis) High fever Rash 3-5 days later

9 Measles, cont. No specific treatment Post exposure prophylaxis MMR within 3 days Immunoglobulin within 6 days Vaccination 1 st months old 2 nd 4 6 years old All need 2 MMRs if born in 1957 or after

10 People don t care how much you know until they know how much you care.

11 Count Measles, cont. Confirmed Cases- 3 Not a Case Measles Outbreak by Onset Date Not a Case Confirmed Case 0 Onset Date

12 Measles, cont. Each case can have from tens to hundreds of contacts. The most common contacts are: Family Health care Church Day care/school Work Travel Weddings/family functions

13 Measles, cont. Case Fever 3 C s Rash Day: Infectious Period Clinic Visit Clinical Case Labs Back- Confirmed Case Contacts Person Exposed Call Educate Check vaccine documentation Give MMR Quarantine for 21 days

14 Isolation, Quarantine, Exclusion Fear of a name increases fear of the thing itself.

15 Measles, cont. Contacts: Total- 400 Quarantine/monitoring- 80 Contact Vaccinations: Total- 210 MMR- 180 IG- 30 Cost: Total- $97, Personnel and Administrative- $83,600 Medical Supplies- $14,170

16

17 Mumps Caused by: Paramyxovirus Transmitted by: Coughing, sneezing, or talking Sharing items, such as cups or eating utensils Touching objects or surfaces Infectious Period: 2 days before the salivary glands begin to swell up and up to 5 days after Incubation Period: days after infection

18 Mumps, cont. Symptoms: Fever Headache Muscle aches Tiredness Loss of appetite Swollen and tender salivary glands under the ears on one or both sides (parotitis)

19 Mumps, cont. Total cases- 45 Confirmed- 39 Not a case- 6 Average number of contacts per case: 95 Total contacts accessed: individuals given PEP

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24 It is important to fight, and fight again, and keep fighting, for only then could evil be kept at bay, though never quite eradicated.

25 LHDs must remain knowledgeable. LHDs must work with compassion. LHDs must have courage to address the tough issues. We will reach the end of the road and be able to go home again.

26

27 An analysis of Pertussis Cases and Exemptions in Salt Lake County

28 Background Pertussis outbreaks typically occur every 3-4 years, with Salt Lake County s most recent peak years occurring in 2006 and 2012 Utah regulations allow exemptions for medical, religious, or personal reasons Pertussis outbreaks in schools in Utah are defined as two or more cases from the same school that occur within 20 days by onset or diagnosis date, and exclusion of unimmunized students and staff is recommended if the school s exemption rate is > 15% 1 Herd immunity thresholds for pertussis range from 92-94% 2, and vaccine efficacy for fully vaccinated children is ~98% the first year 3 1 Utah Pertussis Outbreak Recommendations in Child Care Settings and Schools. UDOH Fine PE. Herd immunity: history, theory, practice. Epidemiol Rev. 1993;15(2): CDC.gov. Effectiveness of Whooping Cough Vaccines

29 Background (cont.) While very effective in the first year, the Pertussis vaccination efficacy wanes The public questions exemption of unimmunized students when they see cases in the immunized population

30 Conclusions Schools with higher exemption rates had higher pertussis rates Schools with vaccine coverage below the herd immunity threshold had pertussis rates twice as high as those of schools with higher vaccine coverage Among census tracts, having a low percentage of minorities was the most significant predictor of pertussis rates/clusters and may partially explain the association with exemptions rates/clusters

31 Potential Interventions A. Reduce the threshold for exclusion of unvaccinated students andstaff during outbreaks from > 15% exemptions to > 4% exemptions B. Provide education to a school with > 4% pertussis vaccine exemptions when a single pertussis case is reported in the school and inform them of their increased risk of having multiple cases of pertussis C. Provide education to all schools with > 4% pertussis vaccine exemptions and inform them of their increased risk of having multiple cases of pertussis if they have a single case of pertussis D. Consider single cases of pertussis reported in schools with > 4% pertussis vaccine exemptions to be probable outbreaks and respond according to routine outbreak response guidelines (letter to parents, exclusion of unvaccinated students and staff, etc.)

32 Impacts Only 3 schools with outbreaks during had exemptions > 4% and would potentially be impacted by lowering the exclusion threshold from > 15% ~60-70 schools might be expected to have exemptions > 4% per year, of which ~10-20 schools would have exemptions > 4% together with one or more pertussis cases Up to ~5-10 cases of pertussis (up to ~10-20% annually) could potentially be prevented by the proposed or other interventions (includes outbreak cases since initial cases in the 3 outbreaks were reported at least a week before subsequent cases)

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