Commentary: Public Health Response to Disease Outbreaks

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There has been much recent media coverage in The Chronicle and other sources about the measles outbreak in Washington costing more than $1 million to Clark and King Counties and the State so far. That does not include costs associated with other counties, like Lewis, that are providing education and support or following up on exposed and potential cases.

You may be wondering what all that money is being spent on and what the public is getting for its tax dollars. Limiting the spread of the disease is arguably the number one public value received. As of this writing, Lewis County has NO confirmed measles cases.

When any outbreak occurs, public health departments immediately focus on containment measures designed to:

• Limit exposure to susceptible people;

• Identify who has been exposed;

• Monitor for additional cases;

• Establish diagnostic testing;

• Assist with treatment as needed;

• Alert healthcare providers and schools; and

• Alert the public.

Measles is one of the more than 100 diseases that the Washington State Department of Health (DOH) designates a “notifiable condition.” That means it is capable of causing harm to the public’s health. Measles is incredibly contagious, so one of the first duties of local public health departments is to help healthcare providers throughout the county report suspected measles to the department. Public health staff also coordinate submitting specimens for laboratory confirmation whenever providers suspect a patient may have measles.



Public health staff also send up-to-date measles recognition and reporting information to school districts throughout the county.

Even before laboratory testing results are known, patients are interviewed by public health staff asking about the possible source of their potential measles, recent travel, vaccination status, potential for the illness having been spread to family, co-workers, schoolmates, or other close contacts, along with other data.

People with measles are usually contagious up to nine days. They are contagious for up to four days before they even know they are sick. After the patient interview, public health staff begin to investigate places where the patient could have unknowingly shared the disease. This includes public places like workplaces, stores, healthcare facilities, restaurants, schools, and other facilities open to the general public. This is because a contagious person can leave measles virus in the air for up to two hours, anywhere they have been.

Unimmunized people who shared a public place with someone who had measles while contagious are at risk of getting measles. The risk of getting measles is significantly reduced for people who have been immunized with the MMR vaccine. The current outbreak in Clark County alone involves multiple locations over the past 10 weeks. These include 15 schools, one child daycare center, 13 healthcare facilities, and 26 other locations including stores, churches, and the Portland airport. These investigations require highly trained people and take time.

Fast investigations and widespread notifications of at-risk locations are key to limiting disease spread. Once test results confirm measles, locations and at-risk times are shared as widely as possible to reach anyone who may be susceptible to the disease. Unvaccinated people who were in close contact with the contagious person have a greater than 90 percent chance of coming down with measles. Exposure location and time information helps people determine if they may have been exposed to measles.

So, let’s go back to the question of why this all costs extra money. Thanks to widespread vaccination for decades, outbreaks of diseases as highly contagious as measles are not an everyday occurrence. Therefore county public health departments are not adequately staffed to deal with such crises. Staff members get reassigned from regular duties to assist, causing extra hours to do the regular work.

The sheer number of location investigations and patient interviews requires additional staff to be brought in from neighboring counties, the state, and even out-of-state. Every participating departments’ ability to do their daily duties is impacted. People with special expertise who are not available locally are required. Help brought in from out of the local area have travel expenses and must be housed and fed while serving in the affected community.

All this adds up to significant disruption of normal operations and additional costs. The value for these dollars spent is measured in limiting the disease spread, having a well-informed public who know if they are at risk, educating individuals on how to decrease their risk after exposure, and ultimately increasing vaccination rates to make the next outbreak unlikely and less impactful.

For more information on measles from trusted sources, go to: http://bit.ly/2GLBG2W. For updated on conditions in Lewis County, follow Public Health on Twitter: @LCPHSS.