Analysis of Outbreaks and Epidemics

This assignment provides a collection of references to various epidemiological studies, including the analysis of measles outbreaks linked to Disney theme parks, a mumps outbreak in Guam, and strategies for preventing cholera introduction during international personnel deployments. The references also cover economic burden assessments and potential infection transmission routes in hospital wards. This compilation aims to assist students and researchers in understanding different aspects of epidemiology and outbreak management.

Running head: NURSING ASSIGNMENT
INTERNATIONAL OUTBREAK OF MEASLES IN DISNEYLAND, CALIFORNIA
Name of the Student
Name of the University
Author note

1NURSING ASSIGNMENT
Description of the chosen international outbreak
In this assignment, Measles outbreak in the Disneyland, California in the year 2014/15
has been selected for discussion. After the declaration of eradication of measles from the United
States of America, this outbreak occurred during the timeline of December 2014 to February
2015. According to WHO (2015), the first official information about the outbreak arrived in the
Californian Department of Public Health (CDPH) on 5th january 2015 and up to 11 February
2015, more than 120 patients were admitted to the hospitals having measles infection. This
outbreak was determined as international outbreak, as more than 3 countries were affected with
the disease such United States of America, Canada, Brazil and Mexico. Within these, more than
16 states of USA had more than 150 of the patients were admitted to different hospital
throughout the nation (Majumder et al., 2015).
The dates at which all these countries reported the arrival of the measles varied. The
United States of America’s Centers for Disease Control and Prevention determined the presence
of measles and officially registered it from 1st to 6th January 2015 in 16 of the states and in
Washington D.C. on the other hand, the Canadian Healthcare System reported the presence of
measles in two sections as two different outbreak patterns were observed in Canada (WHO,
2015). The first outbreak occurred on 3rd February in Quebec province where the Lanaudiere
Public Health Department determined the presence of the disease from the beginning of 2015.
Whereas, the second outbreak reported on 2nd February in the Ontario province by the Toronto
Public Health. Similarly the health department of Mexico, the Mexican IHR National Focal
determined the presence of measles on 30th December and the rashes were developed on people
who went to travel Disneyland between 16th to 18th December (WHO, 2015). Whereas in Brazil,

2NURSING ASSIGNMENT
in the northern states of Ceará and Pernambuco, measles outbreak was reported from 14th to 19th
March, 2015 and determined that due to transmission and transfusion, more than 224 people
acquired measles in the region (Broniatowski, Hilyard & Dredze, 2016).
Epidemiological Determinants and Risk Factors
Measles is one of the most contagious viral infection and according to the data of World
Health Organization, causes the fifth highest number of deaths in children less than 5 years of
age (Dhillon et al., 2012). The world distribution of this disease has been reduced in the past few
decades due to the invention of vaccines and booster doses that made people immune to this
disease, however the low rate of vaccines in developing countries made this infection
predominant in those regions (Antó, 2012). This virus spreads through the respiratory tract by
droplet aerosols, sneezing droplets, and respiratory secretions and has the ability to remain viable
for longer time within them. According to Malik (2015), the occurrence in the western world of
this disease generally occurs during winters and infection is acquired through the conjunctiva or
upper respiratory tract.
The associated risk factors for measles are linked to vaccination, deficiency of vitamin A
and travelling through different continents. In this case of measles outbreak in Disneyland, these
three risk factors are linked to the epidemiological factors of measles. Disneyland is one of the
most famous tourist place of California where travelers from each continent of world and of
every age gathers (McCarthy, 2015). Therefore, according to Malik (2015), in such public
gatherings of people from different nationality, risk of disease outbreak is always high. Hence, if
a single person in that public gathering had not received vaccination against measles then
through that individual, there is a high risk of disease distribution in the entire region. Further,

3NURSING ASSIGNMENT
vitamin A deficiency helps the infection to resist the immune system and develop severe
symptoms. Therefore, from this discussion, the linkage of measles outbreak in Disneyland has
been linked with the risk factors and epidemiology of it (Antó, 2012).
Route of Transmission
The primary route of transmission for measles is the airborne droplets, as this highly
infected virus is populated in the throat and nose mucus of the infected individual. According to
Gardi et al., (2015), the measles virus has the ability to live in the airspace for 3 hours in the
sneezing or coughing droplets of the infected person that determines its severity in the process of
transmission. Further, if someone comes into the contact with the person infected with the
disease, the measles virus can transfer to the non-infected person though his conjunctiva or upper
respiratory tract and can also spread through touch nose, mouth and eyes with hands having
infected droplets (Vanhems et al., 2013). As the Disneyland is a famous tourist park, the chances
of transmission of measles become high, as due to high crowd and gathering, possibility of
people being infected due to coughing or sneezing droplets and through hand or conjunctiva
increases. The Center for Disease Control and Prevention of the United States of America
determines that if a person having measles infection is present in a public gathering, then the
chances of the individuals around that person to acquire measles becomes 90% (Gardi et al.,
2015).
Impact of this disease outbreak in Danville, Virginia at a Systems Level
The outbreak of measles in Disneyland, after the declaration of USA measles free, led
each healthcare expert think deeper about the state and system level of impact of this outbreak.
In each of the state and countries, such as California, USA, Mexico, Brazil the amount of human

4NURSING ASSIGNMENT
and financial efforts put for the eradication of the disease failed due to the sudden outbreak of the
disease (Ortega-Sanchez et al., 2014). According to the Center for Disease Control and
Prevention of USA, Virginia the disease outbreak affected the Virginian system for measles
control and prevention. As per Ortega-Sanchez et al., (2014), the controlled rate of measles were
provided the healthcare facilities within the Virginia to provide all the children below the age of
5 with vaccination to measles and booster doses were also provided to them to prevent future
occurrence (Nelson et al., 2013). However, due to the Disneyland incident, the virus generated
resistance against the vaccine and the rate of outbreaks increased in Virginia. This hampered the
healthcare system of the community and the rate of people affected with measles increased.
Reporting Protocol for an Outbreak in Danville, Virginia
The reporting protocol of disease outbreaks are means through which one nation can take
necessary steps to control the outbreak within the country. The Virginian state has also
developed and updated the disease control and reporting protocol related to measles after the
outbreak of the disease in Disneyland. According to the reporting guidelines, outbreak of disease
is referred to a situation, when a cluster of people becomes affected to a single disease (Virginia
Department of Health, 2016). This disease can be a public health concern or a disease with newer
symptoms against which proper action needs to be taken (Virginia Department of Health, 2016).
Therefore, according to the law of disease reporting, the test reports from the laboratory and
prescription of the physician is necessary for the determination of disease outbreaks. The
government directed the laboratories and physicians that they should they should provide priority
to the patients who are having symptoms of measles and take preventive measures to control the
disease (Virginia Department of Health, 2016).

5NURSING ASSIGNMENT
Further after the confirmation of disease outbreak, the regulatory guidelines suggests
isolation of the people affected with measles or other contagious disease so that further
dispersion of the disease within the community can be stopped. This regulation is strictly applied
to the healthcare facilities of Virginia that non-compliance with the guidelines can hamper those
healthcare facilities (Virginia Department of Health, 2016). Further, the isolated individual or
group of individuals should be provided with proper healthcare interventions and the nurse and
healthcare workers, determined to serve the infected person should be vaccine and immune with
medicine so that the transmission of measles from the healthcare worker to other communities
can be prevented (Virginia Department of Health, 2016).
Two Strategies to Prevent an Outbreak in Virginia
The two prime strategies for prevention of disease outbreak in Virginia are-
1. As the Virginian law interferes with the freedom of movement, personal rights to
protect one’s mind and body, property and other human rights, the government
should focus on the balance between private and personal system so that an
ethical and transparent way for can be utilized for the implementation of public
health distribution. Further, in this aspect the government should help the
healthcare authorities to reach to difficult and outskirt areas so that the reach of
vaccination and immunization to different infectious diseases can be increased.
This will help the authorities by controlling the reach of disease outbreak and the
contact of infected people with normal individuals can be limited (Lewnard et al.,
2016).

6NURSING ASSIGNMENT
2. Secondly, the Virginian government should focus on amending the healthcare
laws so that arranging a healthcare program within the community becomes easier
for the private healthcare organizations. This will increase the numbers healthcare
campaigns, where the local community can be provided with opportunity to
determine their health status. This free clinical checkup and infectious disease
testing will help the individual as well as the community to understand the
dominance of the disease and necessary preventable steps they need to take for
successful limitation of the disease (Leung et al., 2015).

7NURSING ASSIGNMENT
References
Antó, J. M. (2012). Recent advances in the epidemiologic investigation of risk factors for
asthma: a review of the 2011 literature. Current allergy and asthma reports, 12(3), 192-
200. Retrieved from: https://link.springer.com/article/10.1007/s11882-012-0254-7
Broniatowski, D. A., Hilyard, K. M., & Dredze, M. (2016). Effective vaccine communication
during the disneyland measles outbreak. Vaccine, 34(28), 3225-3228. Retrieved from:
https://www.sciencedirect.com/science/article/pii/S0264410X16301980
Dhillon, P. K., Jeemon, P., Arora, N. K., Mathur, P., Maskey, M., Sukirna, R. D., &
Prabhakaran, D. (2012). Status of epidemiology in the WHO South-East Asia region:
burden of disease, determinants of health and epidemiological research, workforce and
training capacity. International journal of epidemiology, 41(3), 847-860. Retrieved from:
https://academic.oup.com/ije/article/41/3/847/835633
Gardy, J. L., Naus, M., Amlani, A., Chung, W., Kim, H., Tan, M., ... & Hayden, A. S. (2015).
Whole-genome sequencing of measles virus genotypes H1 and D8 during outbreaks of
infection following the 2010 Olympic Winter Games reveals viral transmission
routes. The Journal of infectious diseases, 212(10), 1574-1578. Retrieved from:
https://academic.oup.com/jid/article/212/10/1574/2459180
Leung, J., Lopez, A. S., Blostein, J., Thayer, N., Zipprich, J., Clayton, A., ... & Seetoo, K.
(2015). Impact of the US Two-Dose Varicella Vaccination Program on the Epidemiology
of Varicella Outbreaks: Data from 9 States, 2005–2012. The Pediatric infectious disease

8NURSING ASSIGNMENT
journal, 34(10), 1105. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606850/
Lewnard, J. A., Antillón, M., Gonsalves, G., Miller, A. M., Ko, A. I., & Pitzer, V. E. (2016).
Strategies to prevent cholera introduction during international personnel deployments: a
computational modeling analysis based on the 2010 Haiti outbreak. PLoS
medicine, 13(1), e1001947. Retrieved from: http://journals.plos.org/plosmedicine/article?
id=10.1371/journal.pmed.1001947
Majumder, M. S., Cohn, E. L., Mekaru, S. R., Huston, J. E., & Brownstein, J. S. (2015).
Substandard vaccination compliance and the 2015 measles outbreak. JAMA
pediatrics, 169(5), 494-495. Retrieved from:
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2203906?
utm_source=tech.mazavr.tk&utm_medium=link&utm_compaign=article
Malik, T. A. (2015). Inflammatory bowel disease: historical perspective, epidemiology, and risk
factors. Surgical Clinics, 95(6), 1105-1122. Retrieved from:
http://www.surgical.theclinics.com/article/S0039-6109(15)00140-1/abstract
McCarthy, M. (2015). Measles outbreak linked to Disney theme parks reaches five states and
Mexico. BMJ: British Medical Journal (Online), 350. Retrieved from:
https://search.proquest.com/openview/327eadcd1b2a9ea320b15e039920e624/1?pq-
origsite=gscholar&cbl=2043523
Nelson, G. E., Aguon, A., Valencia, E., Oliva, R., Guerrero, M. L., Reyes, R., ... & Monforte, M.
N. (2013). Epidemiology of a mumps outbreak in a highly vaccinated island population

9NURSING ASSIGNMENT
and use of a third dose of measles–mumps–rubella vaccine for outbreak control—Guam
2009 to 2010. The Pediatric infectious disease journal, 32(4), 374-380. Retrieved from:
https://journals.lww.com/pidj/Fulltext/2013/04000/Epidemiology_of_a_Mumps_Outbrea
k_in_a_Highly.26.aspx
Ortega-Sanchez, I. R., Vijayaraghavan, M., Barskey, A. E., & Wallace, G. S. (2014). The
economic burden of sixteen measles outbreaks on United States public health
departments in 2011. Vaccine, 32(11), 1311-1317. Retrieved from:
https://www.sciencedirect.com/science/article/pii/S0264410X13013649
Vanhems, P., Barrat, A., Cattuto, C., Pinton, J. F., Khanafer, N., Régis, C., ... & Voirin, N.
(2013). Estimating potential infection transmission routes in hospital wards using
wearable proximity sensors. PloS one, 8(9), e73970. Retrieved from:
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0073970
Virginia Department of Health. (2016). Rules and Regulations of the Board of Health –
Commonwealth of Virginia. Vdh.virginia.gov. Retrieved 15 March 2018, from
http://www.vdh.virginia.gov/content/uploads/sites/13/2016/03/Regulations-for-Disease-
Reporting-and-Control-October-2016.pdf
WHO. (2015). WHO | Measles – The Americas. Who.int. Retrieved 15 March 2018, from
http://www.who.int/csr/don/13-february-2015-measles/en/