Beruflich Dokumente
Kultur Dokumente
Objectives
Outbreak #1 Outbreak #2
• January – April, 2019 • May 2019 – present
• 72 Cases in WA • 13 Cases as of July 18
• Clark (71) and King • King (10), Pierce (2) ,
County (1) and Snohomish (1)
counties
• In addition: Oregon (2)
and Georgia (2) had • In addition: California
measles cases (1), Oklahoma (1),
associated with WA Illinois (1) associated
outbreak with SeaTac outbreak
2014 2018
• Central WA wildfires • Healthcare Acquired
• Ebola Infections
• Oso landslide • Hep C Exposure
2016 2019
• October storms • Measles x 2
• Seattle Pain Clinic surge
• Zika
2017
• Hanford PUREX
• Influenza surge
• Mumps
• September fires
Personal/philosophical
exemptions: 3.7%
Healthcare provider
signature required on Medical exemptions
Certificate of Exemption 0.9% (decrease from the
Separate Certificate of 1.2% reported last year.)
Exemption required
Religious
exemptions*: 0.4%
: 85.7%
: 8.0%
: 4.7%
: 1.6%
Complete Required Immunizations
Hepatitis B
Pertussis MMR
Polio
Varicella
All vaccines
*HP2020: Healthy People 2020, ten-year national goal for kindergarten immunization completeness.
School Immunization Exemptions
Washington State School Immunization Slide Set, 2017-2018 School Year. Washington State
Department of Health, 2018. Updated March 2018.
Jan 4, 2019
Lab confirms measles in a child
1–10 years old with unknown
immunization history
Suspect Case
Meets the clinical case definition, but no labs and no epi link
Confirmed Case
An acute febrile rash illness with:
Isolation of measles virus from a clinical specimen or
Positive PCR or
IgG seroconversion or a significant rise in measles IgG or
A positive serologic test for measles IgM or
Epi link to a confirmed case
Healthcare Provider Advisories &
Governor Emergency Proclamation
Jan 17
Measles Feb 3
Regional Measles
Alert Regional
Alert
Jan 15 Jan 25
Measles Measles Feb 13
Regional Regional Measles
Alert Alert & Regional Mar 5
Governor Alert Measles
Emergency Regional
Jan 4 Proclamation Alert
Measles
Alert
Clinical presentation
Infection control recommendations
Exposure locations
Suspect measles worksheet
Determination whether case is highly suspect
based on clinical presentation, immunization
status, exposure and travel history
Lab recommendations: specimen
collection/storage, lab testing
Specimen collection guidelines
Instructions for arranging specimen shipping
to public health lab
Post Exposure:
MMR to eligible unvaccinated if within 72 hours of exposure
Do not give MMR post 72 hours to unimmunized individuals
IG within 6 days for:
― Unvaccinated pregnant women
― Infants
― Severely immunocompromised and ineligible for vaccine
Routine Vaccination:
Do not extend to infants 6-11 months
Governor Proclaimed Public Health Emergency
Obtain list and contact information of exposed patients and contact them
Identify those who are susceptible and actively monitor for 21 days (home
quarantine, daily calls)
Recommendations on PEP
Identify whether anyone else was present/exposed and contact them
Case Contacts Investigated
96 Exposures:
30 General Public
29 Healthcare Facility
31 School
2 Daycare
4 Workplace
Summary: 71 Cases
52 One MMR 3
50
Unverified 7
40
Unvaccinated 61
30
0 20 40 60 80
20 Confirmation Type
14
10
Epi-linked 30
4
1
0
1-10 11-18 19-29 30-39
Years Years Years Years Lab Confirmed 41
0 10 20 30 40 50
71 Cases in Time
Days in response: 58
Total responders: 237
Daily average: 40 to 50
Clark County Public Health: 89
Washington Department of Health: 57
Centers for Disease Control and
Prevention: 3
Medical Reserve Corps: 50
Mutual aide, local volunteers,
Emergency Management Assistance
Compact, Interpreters, others: 38
Cost: $864,678.73
Activation Jan-Mar 2019 May 2019 2019
Totals Response* Response Cumulative Total
*Costs verified as of 5/20/19. Could change as actuals are still being reconciled.
What Else Was Going On
Legislation
House Bill 1638/Senate Bill 5841
Removes personal and philosophical exemption for MMR
Religious and medical exemption still allowed
Effective July 28, 2019
U.S. Senate
March 5: HELP Full Committee Hearing—Vaccines Save Lives:
What Is Driving Preventable Disease Outbreaks?
Lots of Media
Common
4/29/2019
SeaTac Airport
exposure date at
5/1/2019
5/3/2019
5/5/2019
5/7/2019
5/9/2019
5/11/2019
Airport, WA Resident
5/13/2019
21-day incubation period
5/15/2019
5/17/2019
5/19/2019
5/21/2019
5/23/2019
5/25/2019
5/27/2019
5/29/2019
5/31/2019
6/16/2019
6/18/2019
6/20/2019
Non-Airport Public Setting
6/22/2019
6/24/2019
6/26/2019
Washington State Department of Health | 42
6/28/2019
6/30/2019
Household
7/2/2019
7/4/2019
Measles Cases by Exposure Setting (n=16)
7/6/2019
7/8/2019
Unknown
7/10/2019
7/12/2019
7/14/2019
Confirmed Cases (current outbreak) as of 7/15/19
Jurisdiction Number
Washington State 13
King (10)
Pierce (2)
Snohomish (1)
Out-of-State 3
Oklahoma (1)
California (1)
Illinois (1)
TOTAL 16
Age Number
<1 year 2
1 to 10 years 0
11 to 18 years 3
19 to 29 years 1
30 to 39 years 3
40 to 49 years 5
50 to 59 years 2
MMR Number
0 doses 7
1 dose 3
2 or more doses 2
Other evidence of immunity 0
Unknown 4
TOTAL 16
@WADeptHealth
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