Epi Teams Case Study

Case Study: Possible Measles Outbreak

PARTICIPANT VERSION

Objectives

·  List three (3) strategies for active case finding

·  Describe outbreak control measures

·  Prepare a statement for media during an outbreak situation

·  Identify critical components of an outbreak investigation report

Instructions

Read each update aloud and, as a team, discuss the questions that follow.

Time Allotted: 1.5 hours

Background Material

The following trainings, found at the North Carolina Center for Public Health Preparedness Training Web Site (http://nccphp.sph.unc.edu/training/), are recommended for Epi Team members without prior outbreak investigation experience. They can be viewed prior to completing the case study.

1.  Embarking on an Outbreak Investigation (FOCUS on Field Epidemiology Volume 1, Issue 3)

2.  Writing an Outbreak Report (I is for Investigation Session VI)

3.  Risk and Crisis Communication (I is for Investigation Session VII)

Resources

CDC. Prevention of Specific Infectious Diseases: Measles. In CDC Health Information for International Travel 2008. Available at http://wwwn.cdc.gov/travel/yellowBookCh4-Measles.aspx. Accessed on September 10, 2007.

WHO. Measles Fact Sheet. 2007. Available at http://www.who.int/mediacentre/factsheets/fs286/en/. Accessed on September 10, 2007.

Question 1: What questions do you have for the nurse?

Question 2: Would you recommend that any laboratory tests be conducted at this point? If so, describe the test and the type of specimen that should be taken.

Question 3: Given the timeline of events, do you believe Pina contracted the disease in North Carolina or in India?

Question 4: Is it possible that Pina exposed others to measles? Consider the incubation period of measles, and the date of onset of her symptoms.

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Question 5: Would you activate your Epi Team at this point? Why or why not? If so, which members of your Epi Team would be involved in this investigation?

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Question 6: What public health agencies would you contact now?

Question 7: You realize that Pina’s 5 month-old infant is at risk for contracting the disease, since the Measles, Mumps, and Rubella (MMR) vaccine is not usually given until 12 months of age. Should you provide the MMR vaccine to the infant?

Question 8: What methods could you use to find additional cases?

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Question 9: What information should you collect when speaking with asymptomatic exposed individuals?

Group Activity

Draft a message to share with the public based on what you know so far about the measles case and the potential for a larger outbreak. Keep in mind that you want the media to help you locate potential case-patients and provide information about the outbreak to the public in a way that does not cause alarm or fear.

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Question 10: What other media communication might be appropriate?

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Question 11: Should you offer Measles, Mumps, and Rubella (MMR) vaccine to exposed people?

Question 12: If you choose to offer MMR vaccine, describe how vaccine should be delivered. For example, will you hold a mass vaccination clinic? Do you have enough vaccine available at your health department, or will you need to order additional doses?

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Question 13: What kind of protection do you need to provide for your team members who are interviewing potentially exposed individuals? What about the community hospital staff who vaccinate potentially exposed individuals?

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Question 14: Since the outbreak appears to be under control, your health director suggests that the Epi Team write an outbreak report. What are some reasons for writing an outbreak report?

Activity

In small groups, draft an outline of an outbreak report listing all of the topics that should be included. Make sure to note the intended audience – your group should decide whether the outbreak report will be shared with 1) colleagues and superiors within your local health department, 2) other partners in the community, including the hospital, 3) the state health department, state laboratory, and public health regional surveillance team, and CDC, 4) the general public, and/or 5) other groups.

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Group Brainstorm

Choose one member of the epi team to record responses on a flip chart. As a group, discuss one or more of the following questions.

·  What aspects of the investigation were successful?

·  All outbreaks present unique challenges. What characteristics of this outbreak made it challenging?

·  What areas of the investigation could have been improved?

·  If a similar outbreak occurred in your county, do you think that your epi team would be prepared to handle it?

·  Did your Epi Team communicate effectively with a) the general public/media, b) hospital, c) state health department, and d) CDC?

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