Guest column by Washington State Secretary of Health John Wiesman
Containing a measles outbreak takes a whole community response, led by governmental public health. It usually starts with an attentive health care provider quickly identifying and reporting a suspected measles case to their local health department.
The moment a suspected case is reported, public health must catapult into action. The race against the clock has already began, and we must play catch up. That first person is quickly interviewed by public health to find out when they were infectious (4 days before and after the onset of the rash), who they were in close contact with during that time and what public spaces they may have visited while contagious. If still infectious, the health officer orders them to isolate themselves so they don’t infect others.
Public health then notifies all the public places the individual visited while infectious. Measles is highly transmittable. Someone can become infected up to 2 hours after someone with measles left the public space. Public health must then staff a call center to handle questions from the public and those who may have been exposed. In Washington, we partner with the Washington Poison Center when a local health department doesn’t have the capacity to staff that call center on their own.
For each close contact identified in the interview of the case, public health reaches out to them. Our job is to let them know they may have been exposed to measles, find out their vaccination history and do a symptom check. If they are unvaccinated and without symptoms, we ask them to quarantine themselves for up to 21 days (that’s how long it can take to develop symptoms). If they show symptoms, we get them to a health care provider and obtain samples for the state public health lab to test for measles. If they have measles, they now become a case and we start the process all over with them.
If the close contact individual wasn’t immunized and they don’t currently have symptoms, we monitor their health for up to 21 days to quickly identify if they develop measles. In the current outbreak, over 1,670 contacts have been identified and 172 are being actively monitored in this outbreak.
For every case, we work with the health care facilities, schools, places of worship and workplaces where the person may have been to identify any susceptible contacts. These entities, in coordination with the local health officer, may exclude unvaccinated folks from those environments during the incubation period as a mechanism to help limit the spread. And when there is large community spread, health care and long-term facilities may limit visitors to protect their patients/residents.
As you can see, this is a staff- and time- intensive activity. It is highly disruptive to people’s lives and causes needless suffering and disease. Currently the department of health has had over 100 staff and Clark County Public Health has had 192 staff working to contain the outbreak. Total costs during the first three weeks of the response have exceeded $699,000 (across Clark County, King County and DOH).
And all of this is preventable, if only we could achieve a vaccination level where 95 percent of the population was vaccinated. This preventive work is the work we would like to be doing in public health. But the most basic public health services have been deteriorating for years, and we are running from fire to fire. Adequately funding the governmental public health system will take a multi-biennium effort and is what we call foundational public health services. Governor Inslee’s budget adds $22 million for this effort, while the full gap is estimated at $450 million.
Washington State Secretary of Health