ADDRESSING MEASLES IN MINNESOTA: AN ONGOING NEED
On April 10, 2017, the Minnesota Department of Health (MDH) was notified about a suspected measles case. What would come in the months to follow was the largest measles outbreak Minnesota had seen in almost 30 years. By May 31, 2017 the number of confirmed measles cases had jumped to 65 and was continuing to increase.
The majority of the cases were centered in the Minnesota Somali-American community, where MMR vaccination rates had been steadily declining since 2008. Because the outbreak occurred in a community with low MMR vaccination coverage, measles spread rapidly, resulting in thousands of exposures in child care centers, schools, and health care facilities. At the end, 75 cases of measles occurred in Minnesota, with Hennepin County experiencing the most cases.
The vaccination rate for MMR in the Somali-American community was already low due to the influence of anti-vaccination campaigners. In Minnesota in 2014, the percent of two-year-olds of Somali descent who had received the MMR vaccination was at 42 percent, which was 47 percent below those of non-Somali descent. Low vaccination rates required both medical and non-medical interventions to combat the disease itself.
PHEP-funded epidemiologists investigated potential cases and worked to determine the severity of the cases, potential contacts, and vaccination needs. Staff collaborated at both the state and local levels with child care centers, schools, and health care facilities to implement effective disease control measures. These control measures spanned everything from post-exposure prophylaxis, to recommendations for exclusion from high-risk settings, to increased outreach to the community.
As cases were identified, state and local public health partners worked with childcare centers, schools, and health care providers to ensure that individuals received appropriate post-exposure prophylaxis. This intervention helped to prevent further cases from occurring and allowed individuals to continue to go to work, school, and childcare. For example, after a child in a local school became infected and potentially exposed many other children, MDH partnered with Hennepin County Public Health to set up a clinic to provide measles antibody injections. Hennepin County used its point of dispensing (POD) expertise to set up a clinic in less than 24 hours.
Additionally, exclusion was used in situations where post-exposure measures were not able to be implemented. MDH recommended the exclusion of susceptible children from childcare and school, which proved to be a very effective way to prevent further transmission, especially in settings where vaccination rates for MMR were low.
Another intervention tool found to be important both before and during the outbreak was to have culturally appropriate community outreach and public health staff that were part of the Minnesota Somali community. Using existing partnerships, state and local public health officials worked with MDH Somali public health advisors, Somali medical professionals, faith leaders, elected officials, and other community leaders to disseminate educational materials, attend community events, and create opportunities for open dialogue and education about measles and concerns about MMR vaccine. The majority of community outreach focused on oral communication, because it is preferred by the Somali community. Public health used radio and television messaging and telephone call-in lines to distribute the message of vaccine safety.
MDH officials declared that the 2017 measles outbreak was “over” on August 25, 2017. However, state and local public health staff, supported by PHEP funding, continue to conduct outreach to affected populations to address the concerns around MMR vaccine. Because immunization rates are still low in these populations, promoting vaccination and working with the community to address their concerns is an important tool in our efforts to stop measles.