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Discussion: Investigating Pandemics and Epidemics

NURS 8310 Discussion: Investigating Pandemics and Epidemics

Discussion: Investigating Pandemics and Epidemics

Emerging Infection

Measles has re-emerged in the US for a variety of reasons, including misinformation spread by  antivaccination advocates and imported cases from countries where infected children may be too young for immunization (Stinchfield, 2020).

The CDC confirmed 1,249 cases of measles between January 1 and October 4, 2019. This year marks the greatest number of measles cases in the country since 1992. While cases have been reported in 31 states, 75% of measles cases were linked to outbreaks in New York City and New York state, most of which were among unvaccinated children in Orthodox Jewish communities. These outbreaks have been traced to unvaccinated travelers who brought measles back from other countries at the beginning of October 2018 (HHS.gov, 2019).

Before the record high in 2019, the US saw a spike in 2014. the virus spreads mostly to children too young to receive the MMR vaccine, those unvaccinated and the immunocompromised.

Investigative Process

When an outbreak of measles is suspected it is critical to rapidly determine if the suspected outbreak is indeed a real outbreak by verifying that the reported suspected cases comply with the recommended clinical case definition, and that the increase in the number of reported cases meets the definition of an outbreak (5/100,000 in one month in a geographical area) (WHO.org, 2009).  The Outbreak Coordination Committee which is a multidisciplinary group (preferably formed before an outbreak) ensures laboratory confirmation, adequate clinical management, surveillance and notifications of suspected cases, assess risk, implement control and preventive measures and ensure effective community involvement (WHO, 2009).

Epidemiologic Triangle/Vector Theory

The epidemiological triangle is a model used to study diseases and consists of 3 vertices; the agent, the host and the environment. The agent is what causes the disease. The host is the exposed person. The environment is the conditions surrounding the host that makes the conditions favorable for the agent.  Within the triangle is time; time of incubation, duration of illness and/or time to the brink of an epidemic.  Measles is caused by a virus in the paramyxovirus family and it is normally passed through direct contact and through the air to humans.  The World Health Organization (WHO) (2019) reported that measles is one of the world’s most contagious diseases by remaining active and contagious in the air or on infected surfaces for up to 2 hours.

Healthcare interventions

When measles is in a community, two primary interventions will help stop the outbreak. One is to increase community immunity by vaccinating all eligible members of that community. The other is to reduce transmission in healthcare settings such as clinics and EDs, as well as schools, daycare centers, and other public places. Patients with suspected measles cases should be roomed farthest away from other patients with a portable air filtration system placed outside the room when airborne infectious isolation is unavailable.

Communicate clearly that the MMR vaccine is safe, does not cause autism, it protects against a deadly disease, and is the best protection against severe adverse reactions, such as blindness, deafness, or other neurologic or immunologic impairments. With the recent measles outbreaks that occurred in 2018, 8 states are considering removing personal exemptions for the measles vaccine. According to the Association of State and Territorial Health Officials (ASTHO, 2018) bills to restrict exemptions are now pending in a growing number of states.

Could it have been avoided?

One dose of MMR vaccine given at 12 to 15 months confers 93% coverage to prevent measles (Stinchfield, 2020).  In recent years, many of significant influence have spoken out against vaccination. The anti-vaccination sentiments in recent decades were also fomented by the 1998 publication of a series of articles in The Lancet by a former British doctor, Andrew Wakefield (Bekecke & DeYoung, 2019). Wakefield suggested a connection between the measles, mumps, and rubella (MMR) vaccine and development of autism in young children (Bekecke & DeYoung, 2019). Reich (2014) points out, ideas about neoliberalism and skewed perceptions of feminist concepts of bodily autonomy and parental decision-making trumps medical expertise.

Effectively countering the anti-vaccine movement should be addressed through understanding mechanisms for increasing trust between the medical community and parents (Bekecke & DeYoung, 2019). Eroded trust can still be a factor today in medical decision-making, and this historical context should be considered when working with communities for vaccination promotion (Bekecke & DeYoung, 2019). Understanding these social and behavioral factors can prevent these behavioral trends from gaining additional traction throughout the United States and beyond, protecting an increasingly connected world from preventable illnesses (Bekecke & DeYoung, 2019).

Resources

ASTHO.org. (2018). State legislation surrounding vaccine exemptions. Retrieved 25 January

2022 from https://www.astho.org/StatePublicHealth/State-Legislation-Surrounding-Vaccine-Exemptions/03-01-18/?terms=measles

Benecke, O. & DeYoung, S. (2019). Anti-vaccine decision-making and measles resurgence in

the United States. Retrieved 25 January 2022 from https://journals.sagepub.com/doi/10.1177/2333794X19862949

CDC.gov. (2014). Measles cases in the United States reach 20-year high: CDC urges vaccination

as summer travel season approaches. Retrieved 25 January 2022

HHS.gov. (2019). With end of New York outbreak, United States keeps measles elimination

status. Retrieved 25 January 2022 from https://public3.pagefreezer.com/browse/HHS.gov/31-12-2020T08:51/https://www.hhs.gov/about/news/2019/10/04/end-new-york-outbreak-united-states-keeps-measles-elimination-status.html

Martin, E. K., Shearer, M. P., Trotochaud, M., & Nuzzo, J. B. (2021). Outbreak response

operations during the US measles epidemic, 2017-19. BMC Public Health, 21(1), 620. https://doi.org/10.1186/s12889-021-10652-9

Reich, J. (2014) Neoliberal mothering and vaccine refusal: imagined gated communities and the

privilege of choice. Gender & Society 28:679-704.

Stinchfield, P. A. (2020). Measles: A clinician’s guide to a reemerging disease.  (1), 39–43.

https://doi.org/10.1097/01.NURSE.0000615088.55221.bb

WHO. (2009). Response to measles outbreaks in measles mortality reduction settings:

Immunization, vaccines and biologicals. Retrieved 25 January 2022 from https://www.ncbi.nlm.nih.gov/books/NBK143959/

WHO. (2019). Measles. Retrieved 25 January 2022 from https://www.who.int/news-room/fact-

sheets/detail/measles

The reemerging infectious disease selected in this discussion is the H1N1 influenza virus.H1N1 swine flu is an acute disease that affects the upper respiratory system and can cause inflammation of the upper respiratory passages, trachea, and sometimes the lower respiratory tract. It is caused by an infection of the upper respiratory tract. According to current knowledge, the incubation time for H1N1 swine flu spans from 1 to 4 days, with the average being around 2 days in most persons, although it can last as long as 7 days in certain individuals. The contagious period for adults begins around one day before symptoms appear and lasts approximately five to seven days after the person exhibits symptoms (Jilani, Jamil, & Siddiqui, 2020).

It is estimated that around 500 million individuals throughout the world were infected by the 1918 lethal influenza pandemic produced by the H1N1 influenza virus, which resulted in the deaths of approximately fifty to one hundred million people. After human influenza virus strains have been eliminated from the population, the potential for swine influenza virus strains to remain in the animal population creates a reservoir where swine influenza viruses could persist and later emerge to infect humans once their immunity to these strains has subsided (Jilani, et al., 2020).

Individuals with lower immune systems, as well as youngsters, may be infectious for a longer amount of time. The most effective management method for influenza A infection in people is to prevent it in the first place. A quantum dot (QD) fluorescent dye-based on CdSe/CdS/ZnS is used for the quick and sensitive detection of two prevalent influenza subtypes (H1N1 and H3N2) has been developed (Nguyen et al., 2020).

A type of swine flu known as H1N1 is a descendant of the strain that was responsible for the 1918 swine flu pandemic. Despite the fact that the 1918 virus has survived in pigs, descendent forms of the virus have been found to infect humans, leading to the regular seasonal outbreaks of influenza. With just 12 recorded occurrences in the United States since 2005, direct transfer of the virus from pigs to people is an extremely unusual event (Jilani, et al., 2020).

References

Nguyen, A. V. T., Dao, T. D., Trinh, T. T. T., Choi, D. Y., Yu, S. T., Park, H., & Yeo, S. J. (2020). Sensitive detection of influenza a virus based on a CdSe/CdS/ZnS quantum dot-linked rapid fluorescent immunochromatographic test. Biosensors and Bioelectronics155, 112090.

Jilani, T. N., Jamil, R. T., & Siddiqui, A. H. (2020). H1N1 Influenza (Swine Flu). StatPearls.

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Emerging Infection
Measles has re-emerged in the US for a variety of reasons, including misinformation spread by  antivaccination advocates and imported cases from countries where infected children may be too young for immunization (Stinchfield, 2020).

The CDC confirmed 1,249 cases of measles between January 1 and October 4, 2019. This year marks the greatest number of measles cases in the country since 1992. While cases have been reported in 31 states, 75% of measles cases were linked to outbreaks in New York City and New York state, most of which were among unvaccinated children in Orthodox Jewish communities. These outbreaks have been traced to unvaccinated travelers who brought measles back from other countries at the beginning of October 2018 (HHS.gov, 2019).
Before the record high in 2019, the US saw a spike in 2014. the virus spreads mostly to children too young to receive the MMR vaccine, those unvaccinated and the immunocompromised.
Investigative Process
When an outbreak of measles is suspected it is critical to rapidly determine if the suspected outbreak is indeed a real outbreak by verifying that the reported suspected cases comply with the recommended clinical case definition, and that the increase in the number of reported cases meets the definition of an outbreak (5/100,000 in one month in a geographical area) (WHO.org, 2009).  The Outbreak Coordination Committee which is a multidisciplinary group (preferably formed before an outbreak) ensures laboratory confirmation, adequate clinical management, surveillance and notifications of suspected cases, assess risk, implement control and preventive measures and ensure effective community involvement (WHO, 2009).
Epidemiologic Triangle/Vector Theory
The epidemiological triangle is a model used to study diseases and consists of 3 vertices; the agent, the host and the environment. The agent is what causes the disease. The host is the exposed person. The environment is the conditions surrounding the host that makes the conditions favorable for the agent.  Within the triangle is time; time of incubation, duration of illness and/or time to the brink of an epidemic.  Measles is caused by a virus in the paramyxovirus family and it is normally passed through direct contact and through the air to humans.  The World Health Organization (WHO) (2019) reported that measles is one of the world’s most contagious diseases by remaining active and contagious in the air or on infected surfaces for up to 2 hours.
Healthcare interventions
When measles is in a community, two primary interventions will help stop the outbreak. One is to increase community immunity by vaccinating all eligible members of that community. The other is to reduce transmission in healthcare settings such as clinics and EDs, as well as schools, daycare centers, and other public places. Patients with suspected measles cases should be roomed farthest away from other patients with a portable air filtration system placed outside the room when airborne infectious isolation is unavailable.
Communicate clearly that the MMR vaccine is safe, does not cause autism, it protects against a deadly disease, and is the best protection against severe adverse reactions, such as blindness, deafness, or other neurologic or immunologic impairments. With the recent measles outbreaks that occurred in 2018, 8 states are considering removing personal exemptions for the measles vaccine. According to the Association of State and Territorial Health Officials (ASTHO, 2018) bills to restrict exemptions are now pending in a growing number of states.
Could it have been avoided?
One dose of MMR vaccine given at 12 to 15 months confers 93% coverage to prevent measles (Stinchfield, 2020).  In recent years, many of significant influence have spoken out against vaccination. The anti-vaccination sentiments in recent decades were also fomented by the 1998 publication of a series of articles in The Lancet by a former British doctor, Andrew Wakefield (Bekecke & DeYoung, 2019). Wakefield suggested a connection between the measles, mumps, and rubella (MMR) vaccine and development of autism in young children (Bekecke & DeYoung, 2019). Reich (2014) points out, ideas about neoliberalism and skewed perceptions of feminist concepts of bodily autonomy and parental decision-making trumps medical expertise.
Effectively countering the anti-vaccine movement should be addressed through understanding mechanisms for increasing trust between the medical community and parents (Bekecke & DeYoung, 2019). Eroded trust can still be a factor today in medical decision-making, and this historical context should be considered when working with communities for vaccination promotion (Bekecke & DeYoung, 2019). Understanding these social and behavioral factors can prevent these behavioral trends from gaining additional traction throughout the United States and beyond, protecting an increasingly connected world from preventable illnesses (Bekecke & DeYoung, 2019).

Resources
ASTHO.org. (2018). State legislation surrounding vaccine exemptions. Retrieved 25 January
2022 from https://www.astho.org/StatePublicHealth/State-Legislation-Surrounding-Vaccine-Exemptions/03-01-18/?terms=measles
Benecke, O. & DeYoung, S. (2019). Anti-vaccine decision-making and measles resurgence in
the United States. Retrieved 25 January 2022 from https://journals.sagepub.com/doi/10.1177/2333794X19862949
CDC.gov. (2014). Measles cases in the United States reach 20-year high: CDC urges vaccination
as summer travel season approaches. Retrieved 25 January 2022
HHS.gov. (2019). With end of New York outbreak, United States keeps measles elimination
status. Retrieved 25 January 2022 from https://public3.pagefreezer.com/browse/HHS.gov/31-12-2020T08:51/https://www.hhs.gov/about/news/2019/10/04/end-new-york-outbreak-united-states-keeps-measles-elimination-status.html
Martin, E. K., Shearer, M. P., Trotochaud, M., & Nuzzo, J. B. (2021). Outbreak response
operations during the US measles epidemic, 2017-19. BMC Public Health, 21(1), 620. https://doi.org/10.1186/s12889-021-10652-9
Reich, J. (2014) Neoliberal mothering and vaccine refusal: imagined gated communities and the
privilege of choice. Gender & Society 28:679-704.
Stinchfield, P. A. (2020). Measles: A clinician’s guide to a reemerging disease.  (1), 39–43.
https://doi.org/10.1097/01.NURSE.0000615088.55221.bb
WHO. (2009). Response to measles outbreaks in measles mortality reduction settings:
Immunization, vaccines and biologicals. Retrieved 25 January 2022 from https://www.ncbi.nlm.nih.gov/books/NBK143959/
WHO. (2019). Measles. Retrieved 25 January 2022 from https://www.who.int/news-room/fact-
sheets/detail/measles

This is an outstanding work. The identified Monkeypox as the reemerging infectious disease is well detailed and well done. Currently, there are no proven specific drugs available for safe treatment of Monkeypox (Moore & Zahra, 2021). Therefore, for purposes of mitigating the outbreak of Monkeypox in the US, antivirals, vaccines, and vaccinia immune globulin (VIG) can be utilized (Petersen et al., 2019). However, the utilization of vaccines for mitigation is restricted because of safety concerns. Although you have suggested that the best prevention measure is to avoid contact with the infected animals because it is the major mode of transmission, there are also incidences of human-to-human spread. As such, other advisable mitigation measures include isolation of infected individuals from others who are at risk of infection, avoid contact with materials that have been in contact with the infected animals or individuals, utilization of protective equipment (PPE) when handling patients, and ensuring effective hand hygiene after contacting the infected people or animals (Reynolds et al., 2019). Moreover, community interventions such as the ability to identify Monkeypox and readiness to take sick people to health care facilities are crucial in mitigating the disease. It is also important to avoid high-risk behaviors such as eating wild animal carcasses.

References

Moore, M., & Zahra, F. (2021). Monkeypox. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK574519/

Petersen, B. W., Kabamba, J., McCollum, A. M., Lushima, R. S., Wemakoy, E. O., Tamfum, J. J. M., … & Reynolds, M. G. (2019). Vaccinating against monkeypox in the Democratic Republic of the Congo. Antiviral research, 162, 171-177. https://doi.org/10.1016/j.antiviral.2018.11.004

Reynolds, M. G., Doty, J. B., McCollum, A. M., Olson, V. A., & Nakazawa, Y. (2019). Monkeypox re-emergence in Africa: a call to expand the concept and practice of One Health. Expert review of anti-infective therapy, 17(2), 129-139. https://doi.org/10.1080/14787210.2019.1567330