Operational response to measles outbreaks in the United States, 2017-19

A study published today in BMC Public Health draws on the first-hand experience of frontline responders to address the operational components of the measles epidemic response, with a focus on resource needs, barriers to implementing activities intervention, and lessons and recommendations to inform public health practitioners about preparing for future epidemics. Authors Elena Martin and Matthew Shearer discuss their work in this blog.

Despite widespread coverage with a highly effective vaccine, pockets of under-vaccinated populations and imported cases can lead to large measles outbreaks. And even though measles has been declared eliminated in the United States over 20 years ago, the country faced a series of large measles outbreaks in the years since, especially in the last decade.

In our study just posted in BMC Public Health, we interviewed people from state and local health departments and health systems across the country that responded to measles outbreaks in 2017-2019, representing outbreaks that account for over 75% of all cases of measles in the United States during this period. Our main goal was to capture first-hand operational experiences in order to generate evidence-based lessons that can inform preparedness activities for future outbreaks of measles and other highly communicable diseases.

This study was carried out under the aegis of a larger initiative, Epidemics Observatory, which aims to address operational challenges and obstacles encountered in outbreak responses and disseminate lessons to facilitate future preparedness and response efforts. Outbreak responses tend to be busy times and do not lend themselves to documenting operational knowledge gained during the response. The Outbreak Observatory aims to provide a forum to consolidate these lessons so that other jurisdictions can put them into practice without having to learn them firsthand. Previous studies by the Epidemics Observatory, including Hepatitis A epidemic in the United States 2017-2018 and the impact of Candida auris and the 2017-2018 influenza season on U.S. Health Systems – identified lessons that go beyond these individual responses to inform broader preparedness for outbreaks and epidemics. As the complexities of the COVID-19 pandemic response underscore, sharing the wealth of operational experience held by frontline responders is critical to improving epidemic preparedness and response capacity. before future communicable diseases.

Even for small outbreaks, health services faced considerable challenges in carrying out routine response activities, such as contact tracing.

Participants in our study of the measles outbreaks in the United States drew attention to a number of resource and operational gaps during their response operations that directly apply to the COVID pandemic. -19. While some of these outbreaks have been quite large, none, even by far, compared to the scale of the US COVID-19 outbreak. Even for the smallest outbreaks, health services faced considerable challenges in carrying out routine outbreak response activities, such as contact tracing. These shortcomings became headlines with COVID-19, as the country’s health services struggled to implement trial, contact search, and other surveillance operations during the pandemic. In addition, most health services interviewed for this study indicated that they did not have the resources to conduct mass vaccination operations in response to the epidemic. Rather, they relied heavily on health care providers and community pharmacists to administer vaccinations.

Funding for public health preparedness has declined steadily over the past decade or more, and health departments are unable to maintain the programs and staff needed to respond to even minor outbreaks, let alone epidemics or epidemics. major pandemics.

As we observed during the response to COVID-19 – first with mass testing clinics and currently with vaccinations—Health services require considerable external resources to provide large-scale responses to major epidemics. Funding for public health preparedness has declined steadily over the past decade or more, and health departments have been unable to maintain the programs and staff needed to respond to even minor outbreaks, let alone major epidemics or pandemics.

As with the epidemics included in this study, many of which occurred largely in island communities – for example, racial / ethnic minorities, immigrants, Orthodox religious communities – COVID-19 has had a disproportionate impact on vulnerable racial and ethnic minority communities. Public health and healthcare organizations have faced significant barriers to encouraging vaccination among affected communities, and we are currently seeing similar challenges as the availability of SARS-CoV-2 vaccines increases and eligibility groups are growing. During measles outbreaks, health officials have often relied on community health care providers, especially those serving vulnerable and island communities, to engage with the affected community. In addition, trusted community leaders – including religious leaders, business leaders, and community organizations – have played a critical role as trusted voices to disseminate accurate information on protective measures, including protection. vaccination. However, it takes a lot of time and resources to develop these relationships, and it can be very difficult to do so in the midst of an outbreak or epidemic response. Health services that had already established relationships (for example, from previous outbreaks) found it easier to leverage these community leaders to have a positive impact.

Historically, most outbreak research has focused on the epidemiology of the disease or clinical care or is limited to after-action reports that focus on organizational challenges and may never be publicly released.

Historically, most research on outbreaks has focused on the disease epidemiology or clinical care or is limited to after action reports that focus on organizational challenges and can never be released publicly. Understanding the operational experiences of frontline responders, including public health and healthcare organizations, and translating these experiences into evidence-based lessons that can inform further preparedness efforts is critical. Without these lessons, jurisdictions repeat the same mistakes and must learn from them firsthand. And the challenges, obstacles and gaps identified in small outbreaks will only be exacerbated during larger events.

Efforts to document and disseminate these operational experiences, such as the Epidemics Observatory and others, support the development of programs and policies that can enable a sustainable public health preparedness capacity that is required for a range of health events. communicable diseases, from the smallest epidemics to the largest health emergencies like COVID. -19.

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