Free Epidemiological Problem: Measles In Michigan Research Paper Sample

In January this year, Michigan confirmed reports that measles, a highly-contagious infectious disease, has finally reached Michigan, which was originally determined to have begun in California’s Disneyland. Based on reports, the infected individual is an adult who lives in Oakland, Michigan. According to the U.S. Centers for Disease Control and Prevention (CDC), Michigan joins the ranks of seven other states that reported having at least one infected patient. The CDC further stated that measles is a highly preventable communicable disease because of the availability of a vaccine for the disease. The Michigan Department of Community Health (MDCH) remains vigilant in coordinating with local health officials in monitoring secondary cases who might have been exposed to this case in Oakland County. The CDC reported that in 2014, the United States had an accumulated 644 cases where most of those infected were individuals who did not have a history of measles vaccination. Michigan had five measles cases last year and reported that on the average, Michigan experiences about 60 cases annually from 2001-2012. Currently, more than 50 cases have already been recorded for 2015 (Lites, 2015).
This paper will focus on measles as a communicable disease and will include information such as definition of the disease, description of the disease, signs and symptoms, and prevalence of the disease in Michigan. The paper will also include surveillance methods and means of reporting the disease for healthcare providers. Additionally, information such as who are frequently affected, the attributes of the population, and associated costs when developing a prevention plan will also be reported. Finally, a national screening method will be chosen among currently used test methods and will be reviewed for sensitivity, value, cost, and guidelines for conducting tests on which patients.

All About Measles

The CDC continues to warn individuals that measles is highly contagious and can be prevented through immunization. This applies not only on children but in adults as well. prior to widespread efforts to have people vaccinated against measles, it was estimated to have caused more than 2.6 million deaths in a year.

Definition

Measles is highly contagious and is spread easily. It causes body rash and is sometimes called rubeola or red measles. A common misconception about measles is that it affects children only. However, even adults are predisposed to the infection. It can also be life threatening considering the complications that might arise from it, such as death in patients and pregnancy complications, when it is not treated immediately. The vaccine is part of the vaccine shots given to babies and toddlers, called the MMR or measles, mumps, and rubella. Most babies receive the MMR as part of their standard, regular checkups, which is the reason why the disease is rare both in Canada and the U.S.

Causes of Measles

Measles is caused by a virus and spreads when others touch or breathe in air particles coming from an infected person when the sufferer coughs or sneezes. It can also be transmitted when individuals share foods and drinks and the other one is sick with measles. Typically, the virus is highly contagious from four days prior to the rash appearing on skin until four days after the rashes have disappeared. Because rashes appear when the individual has already caught the virus, most often, they unknowingly spread the virus to people they get in contact with. Those who were born before 1957 have had it, which makes them immune to the measles virus now.

Signs and Symptoms

Measles usually develop after being in contact with a carrier within 10-12 days of exposure. It begins with a bad case of colds or cough accompanied by high fever, sore throat, runny nose, and sneezing. The lymph nodes in the neck may also enlarge and a general feeling of weariness and exhaustion may be felt. In some patients, diarrheal episodes are also evident. After a few days, these symptoms disappear and are replaced with rashes or bumps on the face and the neck areas until small, red, itchy dots appear all over the body. For some, red, sore eyes also manifest including red spots inside the mouth. Incubation period can be between 7-18 days after being around someone with measles (Kutty, Rota, Bellini, Redd, Barskey, Wallace, 2014).
Measles-related deaths are possible and may be caused by complications brought about by the disease. Those at risk of suffering from complications are those belonging to the 5 and under age group and adults who are over 20 years old. Complications include ear infections, diarrhea, blindness, pneumonia, and encephalitis. Additionally, persons who are undernourished and whose body resistance is low due to the presence of other diseases, including HIV/AIDS and those suffering from vitamin A deficiency, may also experience severe cases of measles.
In areas where there is widespread malnutrition and insufficient health care, up to 10% of measles cases result to death. Likewise, pregnant women are highly at risk, which result to hearing loss in baby, miscarriage, or preterm delivery.

Prevalence and Incidence

In the United States, measles is slowly making a comeback when in fact, the country has declared itself clear of the disease since 2000. The U.S. Centers for Disease Control and Prevention (CDC) continues to push people to have them vaccinated since measles appears to be making an unwelcome comeback. The first quarter of 2015 marks the second-worst measles outbreak in the country with over a hundred documented cases in various states, including the state of Michigan. It is a reminder that vaccinations are not just for kids but for adults as well, especially now that measles is becoming rampant once again (Durrheim & Dahl-Regis, 2013, p. 183). In Michigan, there is only one confirmed documented case of an adult suffering from measles. Based on reports, the individual has already fully recovered and there is no proof yet that the issue can be tied up to the outbreak that occurred in California (Stateside Staff).
The following image shows the prevalence and incidence of measles in the U.S. (all states) for first quarter of 2015.
The following image shows the prevalence and incidence of measles in the United States of America and how many of the population is affected.

Current Surveillance Methods

An important aspect of controlling the spread of measles is laboratory-based surveillance, which aids in the confirmation of various measles cases. Another significant phase of checking the presence of measles is through genetic characterization of different types of measles (Rota, Brown, Hubschen, Muller, Icenogle, Chen, Bankamp, Kessler, Brown, Bellini, & Featherstone, 2011). Typically, these methods require that measles specimens are obtained from national surveillance activities. The collected serum samples are tested against representative samples, which should be done within a few days after the appearance of the rashes. Otherwise, test results will vary depending on the day the specimen is collected, as the “sensitivity of the virus detection will be excellent on the day of rash and decline during the first 2 weeks following rash onset” (Rota, 2011). In the same manner, results of surveillance methods can be affected tremendously and compromise its effectivity in coming up with the result if “virologic specimens are not routinely obtained, are collected only after a positive serum result has been found, or if they are improperly stored or transferred” (Rota et al., 2011).
Worldwide surveillance guidelines recommend that countries collect the proper specimens in order to isolate the virus from every chain of transmission, while those countries that are responsible in controlling measles outbreak and mortality reduction obtain specimens from locations with measles outbreak (Rota et al., 2011). Obtaining these samples is very crucial because these will help determine the control measures to be applied in such outbreaks as well as aiding in the study of various patterns of genotypes during and after immunization campaigns. The best specimens are those from nasopharyngeal swab sediments, which are a rich “source of viral RNA for RT-PCR” (Rota et al., 2011) that can be used as excellent resources for molecular detection of measles and other similar diseases, such as rubella. Other types of virus isolation methods and molecular techniques include restriction fragment length polymorphism and heteroduplex mobility assays.
Because some laboratory testing happens in different countries, it is important that rapid exchange of information about measles strains is reported. Thus, real-time monitoring of measles transmission chains, sequence, and genotype information are sent to a centralized database developed by the World Health Organization (WHO) in Switzerland. In order to guarantee the accurateness of virus and genotype information, all are required to timely report the information to the WHO databases to gain accreditation of all Regional Reference Laboratories.

Descriptive Epidemiology of the Measles Disease

Measles is not a disease that affects children only because it can also affect adults, which is why the CDC continues to remind everyone to have them vaccinated against the disease. In the U.S., 50 of the states allow immunization against measles, but 48 of these states also allow religious and other medical exemptions to determine whether an individual will have the vaccine or not (Dalbey, 2015). Children are required to have measles vaccine from childhood in order to curb the possibilities of contracting the disease. For instance, in the state of Michigan, some parents are adamant in having their children immunized against measles, which even resulted to a courtroom battle between the state and the parents who were said to be protecting the rights of their children against immunization.
For adults, the CDC recommends that they receive immunization for “annual flu shots and regular tetanus boosters vaccinations against shingles, pneumonia, and HPV” (Dalbey, 2015). Apart from these, the CDC also recommends that those who were born in 1957 or later be immunized against measles because the vaccine was not available yet during that period. Even those who intend to travel abroad are encouraged to check their immunization records to ensure they do not contract whatever diseases there are in the country they intend to visit.

Who are at Risk

People who were born after 1957 and only received one dose of the MMR vaccine are encouraged to talk to their healthcare providers to determine whether they should get another round of measles shots or not. Infants who are less than a year old and are too young to receive the vaccine are also at risk because they need to be at least 12-15 months for them to receive the vaccine. While the government has been pushing for people to have themselves vaccinated, still there are people who are adamant about receiving vaccination, thus, putting themselves at risk for measles disease in case of an outbreak. Additionally, there are certain parts of the world with low vaccination rates. Those living in these areas are at high risk of contracting the disease in case of a measles outbreak (Kutty et al., 2014).

Characteristic of the Population Typically at Risk

The United States was declared measles-free in 2000, but incidences of measles outbreak have been reported in recent months because there are still some parts of the world where measles is present, including countries Asia, Africa, and Europe, among others. According to WHO reports, about 20 million people become infected with the disease every year. Of this number, about 146,000 people die yearly (Centers for Disease Control and Prevention).
Typically, those who contract the disease now are those who have no vaccination against measles. These occurrences are usually because of non-Americans who enter the United States and who are originally from countries where measles is rampant. In some cases, Americans may also bring the disease to the U.S. after they visit a country where there are recorded incidences of the disease. In recent years, outbreaks in countries where some Americans visit contribute to the increase in measles cases in the America. These countries include France, India, Germany, the Philippines, and England, among others (CDC).

Costs Associated with the Disease

The costs of maintaining or treating a measles patient in the United States can put a heavy dent on the country’s health budget. For instance, in 2011, the country experienced about 16 outbreaks where a total of 107 cases were confirmed reported. Based on reports, health departments back then spent $4,000 - $10,200 per day. Still, this is a conservative amount because the basis was a median of 17.5 days treatment only (Maron, 2015). Based on another study consisting of a joint effort in 11 industrialized countries, the report came up with more than US$151 million for treatment and control of the measles disease (Carabin, Edmunds, Gyldmark, Beutels, Levy-Bruhl, Salo, & Griffiths, 2003).

Current National Standards for Screening

In America, there are various ways on how to diagnose whether an individual has measles or not. Lab tests confirm through serum samples or throat swabs if a patient is positive of measles. Detection of “measles-specific IgM antibody and measles RNA by real-time RT-PCR are the most common methods” (Kutty et al., 2014). Apart from throat swab, respiratory and urine samples may also be used to detect the presence of the virus.
Serology or antibody testing is another way to confirm measles immunity or case. Testing the antibodies, IgM and IgG will reveal if one is suffering from measles. IgM is the first antibody to appear and increases in level then taper off after a couple of weeks. IgG antibodies take a while to develop but once they do, they remain positive all throughout and serves as protection against re-infection (Measles and Mumps Test, 2015).
Another way is through direct detection of the virus, which involves culturing the virus using molecular methods such as PCR. The limitation of this method is that it only identifies active infections but cannot confirm or guarantee the patient’s immunity to the virus. This method is typically done on severe cases of measles.
Of the above methods, I think lab tests using serums is the best and easiest method to use in order to determine an individual’s immunity against or vulnerability to the disease because it only requires swab or serum for testing. This could be a relatively cheap method to determine measles outbreak and a faster method than the rest. Additionally, it does not require extraction of blood, which could be against some people’s religion when it comes to treating diseases. These antibody tests are usually required when a health practitioner wants to know of the patient is immune to whichever type of virus, which could have resulted to a previous infection or as a result of immunization (Measles and Mumps Test, 2015).

My Plan

When I finish school, I will address the measles disease by ensuring that:
People are educated about measles as a disease, including the effects it has on an individual’s health, how it can be transmitted to other people, the costs involved in treating the disease, and how measles could lead to death of the patient or result to birth defects for babies whose mothers contracted measles during pregnancy. To ensure the success of this endeavor, I will be more active in our community when it comes to education
Babies, children, and adults are immunized against measles. To ensure my success, I will study more about the disease so I can support our hospitals and health practitioners in espousing the benefits of measles vaccine
I will volunteer in our local health community and work in health centers to help in providing more knowledge about the disease and help in establishing protocols for sick people.

Conclusion

Measles is one of the most contagious, preventable diseases known to man. It is highly lethal because it can lead to death of the patient or birth defects of babies whose mothers suffered from measles during pregnancy. Through vaccination, the spread and acquisition of the disease can be prevented that is why it is a mandatory immunization for babies. However, due to varying religious and ethical beliefs, not everyone is open to the idea of having the children immunized against the disease. As such, there are still a great number of people suffering from measles outbreaks. Because of this, it is important that people who intend to visit locations where measles outbreaks are common are immunized against the disease. Likewise, if signs and symptoms of measles are already evident, people should not self-medicate. Instead, they should go straight to the hospital or have themselves checked by a health practitioner to avoid further complications.

References

Carabin, H., Edmunds, W.J., Gyldmark, M., Beutels, P., Levy-Bruhl, D., Salo, H., & Griffiths, U.K. (2003). The cost of measles in industrialized countries. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14505896
Centers for Disease Control and Prevention [CDC]. (n.d.). Measles (Rubeola). Retrieved from http://www.cdc.gov/measles/hcp/
Dalbey, Beth. (2015). Measles in Michigan: Local case status, court action, and what vaccines CDC recommends for adults. Retrieved from http://patch.com/michigan/northville/measles-michigan-local-case-status-court-action-and-what-vaccines-cdc-recommends-adults
Durrheim, DN., & Dahl-Regis, M. (2013). The ethical imperative to eradicate measles. J Clinic Res Bioeth 5 (3). Retrieved from http://omicsonline.org/open-access/the-ethical-imperative-to-eradicate-measles-2155-9627.1000183.pdf
Kutty, P., Rota, J., Bellini, W., Redd, S.B., Barskey, A., Wallace, G. (2014). Manual for surveillance of vaccine-preventable diseases. Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html
Lites, D. (2015). Measles confirmed in Oakland County – Adult: first Michigan case of 2015. CBS Detroit. Retrieved from http://detroit.cbslocal.com/2015/01/23/measles-confirmed-in-oakland-county-adult-first-michigan-case-of-2015/
Maron, D.F. (2015). Spreading the measles outbreak also takes a heavy economic toll. Retrieved from http://www.scientificamerican.com/article/spreading-measles-outbreak-also-takes-heavy-economic-toll/
Measles and mumps test. (2015). Retrieved from http://labtestsonline.org/understanding/analytes/measles/tab/test/
Rota, P.A., Brown, K.E., Hubschen, J.M., Muller, C., Icenogle, J., Chen, M., Bankamp, B., Kessler, J., Brown, D.W., Bellini, W.J., & Featherstone, D. (2011). Improving global virologic surveillance for measles and rubella. The Journal of Infectious Diseases. 204 (suppl 1): S506-S513. doi: 10.1093/infdis/jir117 Retrieved from http://jid.oxfordjournals.org/content/204/suppl_1/S506.full
Stateside Staff. (2015). The measles outbreak has made it to Michigan. Michigan Radio. Retrieved from http://michiganradio.org/post/measles-outbreak-has-made-it-michigan