Outbreak Investigation Report Paper
Introduction
The outbreak of epidemics may be extremely dangerous because they may affect a large share of the population and lead to numerous casualties and lethal outcomes, unless the health care system and local authorities come fully prepared for the outbreak. Ideally, the health care system and local authorities should come prepared to the outbreak of epidemics, localize epidemics and minimize negative effects of epidemics. However, the problem of the outbreak of epidemics is the unexpectedness of the outbreak. Otherwise, it would not be the outbreak at all. In this regard, the analysis of cases of outbreaks and their thorough investigation can help to find out effective ways to prevent outbreaks in the future and minimize their negative effects on the population under the impact. At this point, it is possible to refer to the outbreak of measles in Wales which affected children and young adults mainly in 2012-2013. The outbreak affected a large share of the population vulnerable to the epidemics, but the relatively fast response of the local health care system and local authorities allowed preventing the further spread of epidemics and resulted in the successful elimination of the epidemics in the area.Outbreak Investigation Report Paper
Background
The outbreak of measles in Wales occurred unexpectedly and the local health care system failed to prevent the outbreak. However, it is worth mentioning the fact that Wales had the vaccination program and provided MMR vaccines for the target population which was vulnerable to the development of measles. The vaccination failed to enroll all children under the age of 11, although it was supposed that the vaccine will reach all children that will prevent any risk of the emergence of measles in the area. Parents of many children opposed to the vaccination because they considered the vaccine unsafe. As a result, one out of six children under the age of 11 remained unvaccinated that eventually resulted in the outbreak of measles in Wales.Outbreak Investigation Report Paper
In fact, this case has revealed the full extent to which communities were vulnerable to the high risk of the outbreak of epidemics, even though they have all essential means and tools to prevent such outbreaks. In this regard, the case of the outbreak of measles in Wales reveals the unpreparedness or failure of the local health care system to enroll all the target population into the vaccination process and, thus, prevent the outbreak.
Nevertheless, the local health care system and local authorities have managed to respond to the outbreak and localize it. Steadily, the collaboration of health care professionals, local authorities and local community members resulted in the overall decline of the epidemics and the ultimate end of the outbreak of measles in Wales in 2013. At the same time, the outbreak has revealed the vulnerability of Wales to the risk of such outbreaks and proved the importance of vaccination as an effective preventive measure to minimize the risk of such outbreaks in the future.
Investigation of the outbreak
Signs of the outbreak
In fact, first signs of the possible outbreak of measles have started to appear before the outbreak has begun. In fact, There were an estimated 50,887 in Wales requiring one or two doses of MMR – about one in five lived in the Abertawe Bro Morgannwg University (ABMU) Health Board area. Therefore, the need for the vaccination in the area was high but, at this point, it is important to place emphasis on the fact that the local health care system has proved to be ineffective in forecasting the risk and assessment of current needs of the local community since a large share of the risk group remained unvaccinated. As a result, the risk of the outbreak of measles in Wales was actually the question of time since the outbreak had to occur but it was unclear when it would occur.
The measles virus was introduced to the ABMU Health Board area in November 2012 by four children returning from a holiday camp in the South West of England over the autumn half term school holiday. These children were not related and did not attend the same school. Two of these first cases spread the measles virus to 29 other individuals (McCartney, 2013). In fact, this was the first signs of the outbreak of measles in Wales in 2012. The first patients identified were localized but the local health care system failed to prevent the further spread of measles that resulted in the large scale outbreak.Outbreak Investigation Report Paper
In this regard, the major problem the local health care system faced was the outbreak of measles in different parts of Wales. Cases seemed to be irrelevant to each other and the spread of the epidemics in different parts of Wales resulted to its faster spread (Benoff & Grauman, 88). Diverse areas, where measles have started to emerge raised barriers on the way of the local health care system to localization of the epidemics and stopping the outbreak fasts with the minimal number of patients contaminated by the virus.
Key concepts and definitions
Measles is an infection the respiratory system caused by a virus, specifically by a paramyxovirus of the genus Morbillivirus.
Outbreak is the term used to describe the occurrence of disease greater than would be otherwise expected at a particular time and place.
Epidemic is a disease that spreads rapidly among many people in a community at the same time.
Risk groups are groups of people vulnerable to catching the infection/virus, especially during the outbreak.
The target population involves the population that should undergo the specific treatment or vaccination to prevent the outbreak of epidemics.
Vaccination is the administration of antigenic material, a vaccine, to stimulate an individual’s immune system to develop adaptive immunity to a pathogen.Outbreak Investigation Report Paper
Similar cases analysis
The outbreak of smallpox in Yugoslavia in 1972 is, to a certain extent similar to the outbreak of measles in Wales, although the case of the outbreak of smallpox in Yugoslavia in 1972 had graver effects compared to the outbreak of measles in Wales. The outbreak of smallpox in Yugoslavia was provoked by pilgrims returning from Mecca to their local community. Ibrahim Hoti was the clergyman, who actually brought the virus to Yugoslavia, although he had proved to be immune to virus, he had contaminated his community members, who were transferred to hospitals to large cities of Yugoslavia. At that moment, the disease had not been identified that caused the contamination of the personnel of hospitals as well as other patients and further spread of smallpox. However, as the epidemics and its nature became evident and identified, the local health care system and authorities conducted the vaccination of the local population focusing on risk groups and steadily resolved the problem and put the end to the outbreak of smallpox in Yugoslavia in 1972. However, the outbreak resulted in 35 deaths of patients infected during the outbreak which affected 175 people in total.
Hypothesis on the likely source and vehicle associated with outbreak
The poor uptake of the MMR vaccine by children under the age of 11 was one of the main causes of the emergence of the measles outbreak in Wales in 2012-2013.
At the same time, the poor vaccine uptake was the result of emerging parents’ concerns about the safety of the vaccine.
Researchers estimate that it was the second virus strain D8-Swansea (differing from D-Taunton by a single nucleotide base) which was the circulating virus in the ABMU Health Board outbreak from late January to July 2013 (McCartney, 2013). In such a way, the virus outbreak in the Swansea and Neath Port Talbot was a new type of virus that entered the area.
Testing the hypothesis
The drop of the MMR uptake in the Swansea and Neath Port Talbot areas occurred earlier compared to other areas of Wales. Therefore, the outbreak of measles could really be caused by the poor vaccine uptake in the area under the impact of the epidemics.
Relevant information to confirm the hypothesis
The local health care system and authorities focused on the identification of individuals, who have already had the vaccination and those who have not. In such a way, they could identify risk groups, who could be vulnerable to the high risk of catching measles.Outbreak Investigation Report Paper
To inform the target population of the high risk of the development of measles, parents of children, who comprised the risk group, had to be informed (Jennings, 10). This is why the local authorities decided to send letters to parents, letters to health professionals, media and social media engagement and targeted school immunization sessions (McCartney, 122).
In response to the mass vaccination of the population at risk, the outbreak of measles has started to decrease and the spread of the epidemics has slowed down and gradually, mutual efforts of health care professionals and local authorities contributed to the overall decline of the outbreak of measles (Elger & Chevorlet, 18).
Recommendations
In response to the outbreak of measles in Wales, the increased effort was needed to vaccinate those at risk and halt the outbreak. A Senior Response Team (SRT) was established, led by Public Health Wales and with membership from all health agencies involved (McCartney, 13). The establishment of the response team was very important and absolutely right decision (Wiley & Allen, 172). At the same time, the senior response team should and did unite efforts of all health care professionals and authorities that were employed to overcome the outbreak of measles in Wales.
In addition, ABMU Health Board set up a Silver Command group to organize the complicated logistics of delivering very large numbers of MMR vaccinations in the measles outbreak epicenter area, and manage local communications (McCartney, 11). In fact, the development of the effective strategy of the prevention and overcoming the outbreak and its further spread was an essential step that allowed the local health care system and local authorities to tackle the epidemics and eventually end up the outbreak successfully.
As one of the main causes of the outbreak of measles in Wales was the failure of the vaccination with a large share of the risk group population unvaccinated, the local health care system should improve the vaccination program to enroll all of the target population (Alpers, 291). In this regard, two options were available to the local health care system. First, health care professionals should communicate the clear message to parents of children under the age of 11 that the vaccine used in Wales was absolutely safe, while the refusal from vaccination put their children under a threat of the development of measles.Outbreak Investigation Report Paper
Alternatively, the local health care system could introduce the new vaccine that could be safer. At any rate, the point was to persuade the public in the safety of the vaccine (Jennings, 10). If the health care system of Wales was unable to persuade that the existing vaccine was ineffective, it should replace the vaccine by the one, which parents of children could be confident in.
Furthermore, the local health care system should also maintain the close communication with the local community to explain the local population the importance of vaccination and risks associated with the refusal from vaccination (Ghodeswar & Vaidyanathan, 57.
In addition, the monitoring of the vaccination process and enrollment of risk groups into the vaccination, i.e. children under the age of 11, was crucial. Such monitoring would allow the local health care system to identify the large share of the target population being unvaccinated (Abrahams & Geschwind, 350). In response to such problem, the local health care system could act more successfully and effectively following either of the recommendations given above concerning the replacement of the vaccine or persuading parents to vaccinate their children.
Discussion and conclusion
In such a way, the failure of the local health care system of Wales to conduct the vaccination effectively and to enroll the target population and risk groups into the vaccination process resulted in the outbreak of measles in Wales. Nevertheless, the response of health care professionals and local authorities of Wales has proved to be quite successful and effective because the epidemics was eventually localized and ended in 2013. At the same time, the failure of the local health care system to prevent the outbreak reveals the intrinsic problems with the health care system of Wales that can cause outbreaks of other diseases in the future, unless the system of vaccination and public relations are changed.Outbreak Investigation Report Paper
At the same time, the outbreak of measles in Wales in 2012-2013 has revealed the fact that local communities and individuals should also act responsibly. They should not ignore vaccination (Tucker, 148). In this regard, parents should be particularly responsible for their children since they have to secure health of their children through vaccination. On the other hand, health care professionals and local authorities should also encourage people to accept vaccination as an important part of the public health and minimize the risk of safety concerns when the health of children is at stake.
Lessons learned and recommendations
One of the main lessons learned from the outbreak of measles in Wales is the importance of the effective communication of health care professionals, the local authorities, and local community members. Health care professionals should communicate clearly that vaccination is important and necessary, while vaccines are safe, to make sure that the local population agrees to vaccination. In actuality, vaccination is still one of the most effective ways of the outbreak prevention.Outbreak Investigation Report Paper