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Feature Article: Outbreaks can occur anywhere
February 2015
By late January 2015, a measles outbreak that originated when an infected person visited
Disneyland in southern California, had spread to more than 67 people in six states and
Mexico. So far, more than 20 people had been hospitalized and public health officials
were scrambling to halt further spread.
The overwhelming majority of those infected were unvaccinated either by choice or
because they were too young to receive the vaccine. Typically, children receive the first
dose of measles vaccine between 12 and 18 months of age and the second dose
between 4 and 6 years of age.
The story has refocused attention on the importance of vaccination to avert vaccinepreventable disease (VPD) outbreaks. The likelihood of a VPD thriving is greater in
locations with a large number of unprotected people. It’s based on this principle that
states require children to be vaccinated before entering school systems. And, although
other gathering places do not require immunizations, tourist attractions, like amusement
parks, that draw large groups of visitors from around the world, are prime locations for
outbreaks to originate.
Just the Vax Trivia
Corner
Low immunization
rates in the U.S.
during the late
1980s and early
1990s led to an
outbreak of what
vaccinepreventable
disease?
The decision not to vaccinate, or even to delay vaccination, does not occur in a vacuum, nor is it
inconsequential. Last year, California parents claimed a record number of personal belief exemptions to
mandatory school vaccinations. That was the same year that state health officials reported the most measles
cases since 1995 and the most whooping cough cases since 1947. Indeed, more than 80 percent of those
infected in the current outbreak are from California. Of interest, on Feb. 5, 2015 two California state
legislators have stated they will submit a bill asking for the elimination of California’s personal belief
exemption to vaccines.
Although this particular outbreak makes for a compelling news story, it’s important to remember that VPD
outbreaks don’t have to happen on such a grand scale, or originate at such a well-known location, to have an
impact. Any outbreak, anywhere affects not only the infected individuals, but also their families and friends.
For example, a hepatitis A outbreak sickened more than 600 and killed three people in western Pennsylvania
in 2003. The people affected by this outbreak had simply gone out to a local restaurant for some Mexican
food. Unfortunately, the scallions being served were contaminated with hepatitis A. Nearly 2,000 people had
dined at that restaurant during the four days of peak exposure.
Even a small-scale outbreak of a VPD like measles can cause significant and unforeseen inconveniences. In
an account from the Parents PACK personal stories collection, a small measles outbreak at a Pennsylvania
high school led to unanticipated, and unappreciated, quarantines, when some students had to miss important
activities like the prom, graduation, and final exams. As recently as December 2014, an outbreak of mumps
affected the National Hockey League infecting 16 players across several teams. Luckily, in most cases, the
public did not need to worry about the virus spreading from players on the ice. However, it was around the
holidays and these players did likely visit family and friends and travel. One group of unknowingly exposed
players even visited a children’s hospital while potentially contagious.
Exposure to a transmissible disease can occur anywhere people gather. It can be at a church gathering,
sporting events or even supermarkets — all of which have been documented. As the above examples
demonstrate, VPDs can occur when you go on vacation, when you go out to eat, or when you go to school.
For better or worse, these examples also serve as a reminder that while vaccinations may be a choice,
exposures are not.
Ask the VEC: Too young to get vaccines
Q. We have a newborn, and he is too young to receive the seasonal influenza vaccine
as well as the first does of the measles, mumps and rubella vaccine. Given all the reports
about measles, what can we do to protect him from vaccine-preventable diseases?
A. Unfortunately, when our babies are too young to be vaccinated, our best recourse is
to keep them away from situations in which they may be exposed to infectious diseases
— and even our best attempts are not always sufficient. When we go to work or have
young children in school, diseases may come home. However, here are few tips to help
avoid spreading illness to your newborn:
¾ Limit visitors, especially if someone is ill.
¾ Rinse baby’s hands with gentle baby soap and lukewarm water after an outing or
being exposed to visitors.
¾ Limit outings for the baby, especially to places with large crowds.
¾ Promote proper and frequent hand washing.
¾ Cover coughs correctly. Cough or sneeze into your elbow and not your hands and
teach young siblings to do the same.
¾ Discourage others from kissing your baby on the face or hands.
Did You Know? … Five states tie for top score in infectious disease
outbreak readiness; 25 score below average
The non-profit, non-government group Trust for America’s Health recently released the
report “Outbreaks: Protecting Americans from Infectious Diseases,” which evaluated
each state’s ability to manage a severe infectious disease outbreak in light of the recent
Ebola crisis. The group identified 10 key indicators of preparedness, worth one point
each, and assigned each state a grade on a 10-point scale. The report is available at:
http://healthyamericans.org/reports/outbreaks2014/
Just the Vax
Trivia Answer:
The correct answer
is measles. Low
immunization rates
in the U.S. led to a
measles outbreak
during the late
1980s and early
1990s. In California
alone, 16,400
people were
infected, almost
4,000 were
hospitalized and 75
died. Measles was
declared eliminated
from the U.S. in
2000.
Go to
vaccine.chop.edu/
trivia to play Just
the Vax , the
Vaccine Education
Center’s trivia
game, where you
can find this
question and others
like it.
Maryland, Massachusetts, Tennessee, Vermont and Virginia tied for the highest score
with an 8, while half of U.S. states and the District of Columbia scored five or lower. The
key indicators were related to a state’s prevention, detection, diagnosis and response
capabilities in the event of an outbreak. The report’s website includes an interactive map that provides a
breakdown of each state’s performance as well as the text of the full report.
Around the World: Any outbreak has potential for global spread
Disneyland’s role as the epicenter of the current measles outbreak has served to punctuate the pervasiveness
of infectious diseases. Because many travelers from around the world congregate in this and other popular
tourist attractions, infectious diseases can easily spread. Then once the newly infected person or people go
home, they further spread the disease. This type of situation highlights how globally interconnected our
society has become.
Fortunately, the World Health Organization created the Global Outbreak Alert and Response Network
(GOARN) to update the public regarding current outbreaks around the world. GOARN has several interactive
features including a database of outbreaks organized by both disease and country. Users can choose a
country and view data about current and past outbreaks as well as health information relevant to the country.
The system also features a Global Outbreak News platform that publishes up-to-date reports of infectious
diseases occurring around the world. To learn more about GOARN and its features, visit its website
(http://www.who.int/csr/outbreaknetwork/en/).
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