Responding to the Minnesota Measles Outbreak

Rigorous research has repeatedly demonstrated the efficacy and safety of the MMR (Measles, Mumps and Rubella) vaccine. In fact, thanks to the MMR vaccine, measles was declared eliminated in the United States [1]. However, in the wake of a fraudulent and now infamous study conducted by Andrew Wakefield linking the MMR vaccine to autism, some parents have begun resisting the vaccination schedule recommended by doctors and health organizations. As a result, many preventable diseases are making a comeback. For example, there have been multiple outbreaks of measles across the country in the years since its elimination, including the notorious Disneyland outbreak of 2015 and a massive outbreak in an unvaccinated Amish community in Ohio that produced 383 cases of the potentially deadly disease [2]. These are all in addition to the numerous smaller outbreaks that do not receive widespread coverage in the news. But regardless of the size of an outbreak, tracking cases and outcomes for research and analysis can give important insight into how outbreaks develop and the best means of responding to them.

History of the Community

In 2008, the Somali community of Minnesota began experiencing an unexplained and dramatic rise in diagnoses of autism in their community. What’s more, incidents of autism among Somali children were also more severe [3]. The Somali community was, at the time, one of the most widely vaccinated groups in Minnesota [4]. Anti-vaccination groups saw the situation as evidence of the harm they believe vaccinations can cause, and began a highly targeted campaign to convince Minnesotan Somali’s to stop vaccinating their children. This lead to a precipitous decline in vaccination rates, which in turn lead to an outbreak within the community back in 2011 [4]. That outbreak was relatively small, however, and fears of vaccination harm continued to spread; a community that once boasted vaccination rates of over 90% now suffers from a vaccination rate of merely 42% according to the Minnesota Department of Health [4]. It was just a matter of time until the next outbreak.

The Current Situation

Sure enough, measles came roaring back. Starting in late April of 2017, the highly infectious disease began spreading through the now vulnerable unvaccinated Somali population. As of May 18, 2017, the Minnesota Health Department has reported a total of 64 confirmed cases of measles. 61 of those are in confirmed unvaccinated children, and 55 are in Somali children [4]. Fortunately, there has yet to be a fatality from the outbreak, though there have been several hospitalizations. Given the ease with which measles spread (a single case can lead to up to 18 more), it’s impossible to determine what the final outcomes of this most recent outbreak will be.

The Response

Given the severity of the current outbreak, an appropriate and effective response to the situation is necessary. Unfortunately, what used to be a simple matter of education and medical guidance has become a whole lot more difficult. The encroachment of pseudoscience and misinformation, primarily through media and internet distribution, has hindered vaccination efforts in recent years. According to Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research, “The challenge is for scientists to be humble and acknowledge that in this day and age facts will not win the day.” [5].

This has lead Minnesota health officials to take a different approach to the unfolding measles crisis. While education continues to be an important strategy, Minnesota’s health department is combatting misleading information at the personal level by hiring Somali nurses and outreach workers who can better connect with Somali citizens and create a network of trusted personal connections that can help combat anti-vaccination propaganda. They have also enlisted the aid of imams and Somali community leaders to help spread the word. What’s more, the message itself has changed; rather than berating scared parents with facts and figures, they’ve taken to spreading personal stories about the dangers of infection, exposing parents to the real physical and emotional costs of measles rather than presenting them with dry numbers [5]. So far, the response seems to be working; according to some, vaccination rates among Somali children are finally on the rise [6], though it remains to be seen if the incident is going to lead to a higher overall trend or is just a short-term reaction to the current situation.

Going Forward

Finding new means of reaching out to and engaging with parents and patients is an important part of continuing the fight against measles outbreaks, but the effort doesn’t end with convincing parents to vaccinate their children. During outbreaks, accurately recording and easily analyzing medical data and outcomes is of critical importance. While dry numbers and analysis may not prove convincing to fear-stricken parents, they are incredibly important to creating a realistic overview of each outbreak and may even provide insight into the best means of handling the next one. Monitoring the outcomes of these breakouts and being able to find specific answers means maintaining comprehensive medical records whose data is standardized and easily extracted. Electronic synoptic reporting, for example, uses structured report templates to create more complete medical reports than other reporting methods [7]. Improving clinical documentation can help prepare your clinic for measles and other preventable outbreaks.

Recent measles outbreaks across North America demonstrate the ongoing need for comprehensive vaccination programs across North America. However, vocal anti-vaccination groups continue to find an audience in vulnerable communities, not to mention a strong presence on the internet, healthcare providers are required to find new and effective ways to engage with patients and parents to combat the spread of misinformation while building and maintaining comprehensive records for future analysis.

References:

    1. Measles (Ruboela). Centers for Disease Control and Prevention Web site.
      https://www.cdc.gov/measles/about/faqs.html Published October 22, 2010. Updated January 9, 2012. Accessed February 1, 2012.
    2. Measles cases and outbreaks. Centers for Diseas Control and Prevention Web site. https://www.cdc.gov/measles/cases-outbreaks.html Accessed May 19, 2017.
    3. Hewitt A, Hall-Lande J, Hamre K. Autism Spectrum Disorder (ASD) Prevalence in Somali and Non-Somali Children. Journal of Autism and Development Disorders. 2016 Aug;46(8):2599-608 https://www.ncbi.nlm.nih.gov/pubmed/27106569
    4. Measles Disease Statistics. Minnesota Department of Health Web Site. http://www.health.state.mn.us/divs/idepc/diseases/measles/stats.html#Example1 Updated May 17, 2017. Accessed May 19, 2017.
    5. Molteni, M. Anti-vaxxers brought their war to Minnesota–Then came measles. Wired. May 7, 2017. https://www.wired.com/2017/05/anti-vaxxers-brought-war-minnesota-came-measles/ Accessed May 19, 2017.
    6. Howett, G. Minnesota’s ‘incident team’ races to stop measles outbreak. The Star Tribune. Published May 15, 2017. http://www.startribune.com/minnesota-s-incident-team-races-to-stop-measles-outbreak/422215863/#1 Accessed May 19, 2017
    7. Donahoe L, Bennett S, et al. Completeness of dictated operative reports in breast cancer–the case for synoptic reporting. Journal of Surgical Oncology 2012;106(1):79–83.https://www.ncbi.nlm.nih.gov/pubmed/22234931