European Public Health Report: Strategies for Measles Outbreak Control

This report, prepared as a public health consultant for the European Public Health Alliance, analyzes the measles outbreak in Europe, which saw over 41,000 cases in the first six months of 2018. The report delves into the history, background, and epidemiological findings of measles, including mortality, morbidity, trends, and distribution across the European region. A health needs assessment identifies vaccination, vitamin A intake, education, and access to clean water as critical needs for affected populations. The report evaluates public health approaches, highlighting surveillance as a key method for outbreak description. Intervention strategies, such as vaccination, isolation, and quarantine, are recommended to control the spread of measles, alongside a call for increased awareness of symptoms and vaccination protocols for travelers. The report concludes with recommendations for controlling the spread of measles, vaccination of non-immune persons, and vaccination for people traveling or crossing borders to prevent the spread of measles to unaffected people.

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Table of Contents
Executive summary……………………………………………………………………..3
1. Introduction……………………………………………………………………..4
1.1 Brief background information about measles in Europe…………………...4
1.2 History of measles…………………………………………………………..5
2.1Epidemiological findings…………………………………………………………….5
2.2 Health Needs Assessment…………………………………………………………..8
3. Health approaches that describe measles outbreak…………………………………...10
4. Intervention strategies………………………………………………………………...12
4.1 Intervention strategies to control the spread of measles……………………………..12
4.2 Impacts of measles if not controlled…………………………………………….......13
Recommendations………………………………………………………………………13
Conclusion……………………………………………………………………………...14
Bibliography……………………………………………………………………………15
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Executive summary
The purpose of this research is to develop a synopsis to avert along with controlling the
spread of measles infection in European countries since they had adopted the target of
eradicating measles in the whole region by 2015, but their aim was not met. The spread of
Measles infection has been an issue in the European Region because it has had many cases of
disease and deaths of children and adults evident. This research draws attention to the fact that
over 41,000 adults together with children have been affected with measles in the first six months
of 2018 and the overall figure for this time far transcends the twelve-month totals stated for each
other year this decade. As the Public Health Consultant for European Public Health Alliance I
have been appointed as a Principal investigator to develop a research synopsis to avert along
with controlling the spread of measles infection.
After close consideration, it is concluded that some strategies need to be implemented to
control its spread. These strategies include Vaccination of non-immune persons along with
isolating the infected people. Moreover, excluding and quarantining the susceptible people
together with utilizing immunoglobulin is an intervention to control the spread of measles
infection.
It is recommended that unimmunized people should acquire the vaccine within three days
from exposure of measles and people who have obtained only a single dose of the vaccine before
getting the vulnerability could interact with other unaffected or immunized people after receiving
the second vaccination. Moreover, it is recommended for people traveling or crossing borders to
be vaccinated to prevent the spread of measles to unaffected people. Lastly, it is vital to
understand the signs and symptoms of measles so that if the symptoms develop the person
should stay at home.
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1. Introduction
Measles is a viral disease of the respiratory system and is highly contagious (Schneider,
2016). The virus resides to the paramyxovirus family and is also called a systemic disease. The
objective of this research is to develop strategies which will help in preventing the spread of
measles infection. The essay will cover the background information, history and the current
situation of measles infection in the European Region. Furthermore, the health needs of the
affected population, the best approaches to describe measles outbreak and intervention strategies
to prevent the spread of measles infection will be discussed.
1.1 Brief background information about measles infection in the European region
Measles is an acute infection generated by morbillivirus and it is conducted through
airborne respiratory droplets or direct contact with nasal along with throat secretions of affected
people (Kim, Kabir, and Jahan, 2018). Complications from measles infection may entail
diarrhea, pneumonia, otitis media, and laryngotracheobronchitis along with encephalitis.This
disease can be prevented by vaccination which gives lifelong immunity in most recipients
(Haralambieva et al., 2019).
Vaccine intake of at least 95 percent accompanied with two doses of measles-containing
vaccine is necessary to make sure the immunity level in the population is to interrupt the
circulation of the disease and its elimination be accomplished. The greatest yearly overall for
measles incidents so far amidst 2010 and 2017 was 23,927 for 2017, and the lowest was 5,273
for 2016 (Haralambieva et al., 2019). Georgia, the Russian Federation, Ukraine, France, Greece,
Serbia, and Italy have seen over one thousand infections in adults and children in 2018. For
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instance, Ukraine has been the hardest hit with more than 23,000 infected individuals who
account for more than half of the regional total.
1.2 History of measles infection
The initial methodical elucidation of measles and its difference with chickenpox and
smallpox is ascribed to the Persian Physician Rhazes’ (Goodson and Seward, 2015). Measles
came to be demonstrated in 1757 by a Scottish physician called Francis Home that measles was
generated by a contagious factor found in the blood of patients (Edward et al., 2015). Francis
Home tried to develop a measles vaccine, but his vaccine experiments were unsuccessful as the
virus had not yet been isolated.
It was not until an outbreak happened among Boston Massachusetts students in 1954 that
researchers Dr. John F. Enders along with Dr. Thomas C. Peebles were successful in isolating
the virus and the development of the vaccine started soon after the discovery. This same year the
virus causing the infection was secluded from a thirteen-year-old boy from the United States
called David Edmonston and adapted and propagated on chick embryo tissue culture (Lin and
Richardson, 2016).
2. Epidemiological findings
Epidemiology is the study of the disposition and determinants of health associated
conditions along with occurrences in certain populations. Epidemiological data provides
information needed to comprehend the issues in a society to effectively select and provide
prevention programs and to find out if these programs work. Moreover, it provides an
understanding of substance consumption patterns along with consequences. Epidemiological data
helps the public health researchers in directing public health action. With this epidemiological
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data, public health researchers direct public health action by providing Community Health
Assessment, influencing people’s decisions, completing the clinical picture and searching for
causes of the infection.
In the WHO European Region over 41,000 adults together with children have been
affected with measles in the first six months of 2018 and the overall figure for this duration far
transcends the twelve-month overalls announced for each other year this decade (Leong, 2018).
Report to the European Surveillance System by 30 EU/EEA countries to EGDG's monthly
measles, along with rubella monitoring report indicates that amidst 1 February 2017 and 31
January 2018 there are 14,732 incidents of measles. Most of the cases were reported by Romania
with 5,224, Italy with 4,978 and Greece with 1,398 along with Germany having 906 cases
accounting to 35, 34, 9 and 6 percent respectively (Leong, 2018).
According to a report ECDG’S Communication Disease Threat Report (CDTR) shows
that the highest figure of cases of measles in the EU since 1 January 2018 were in Greece with
1,008, Romania with 757, France with 429 together with Italy with 164. From the four countries
seven deaths have been reported. In May 2018 France recorded more than 2,500 cases of measles
including three fatalities and high hospitalization rates of 22 percent and by March 429 cases
were recorded which has increased sharply in the second quarter of 2018. According to monthly
reports, there is an indication that at least thirty-seven individuals have died because of measles
so far in 2018 (Georgakopoulou et al., 2018).
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Using some recent graphs or tables show the current mortality, morbidity in UK and other
countries
Figure 1. Incidence per Million populations
Figure 2. Distribution of measles in European region since 2015 to 2018
Ukraine has had the highest cases of measles of 53,218 in 2018 followed by Kazakhstan
with 49,518, Serbia 5,076, Israel 2,919, France 2,913, Italy 2,517, Russia 2,256, Georgia 2,203,
Greece 2,193, Kyrgyzstan 1,005, France 913, Romania 757, and Italy 168.
Figure3. Distribution of measles in WHO Regions since 2015 to 2018
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2019 data indicate that Africa Region has the maximum number of measles instances of
49,646 in which the lab cases are 736, epidemiological cases are 45,921 and clinical cases are
2,989. It is followed by European region with 18,169 (lab=4,271, epi=608, clin=13,290), South-
East Asia Region with 5,301 (lab=1,528, epi=424, clin=3,301), Western Pacific Region with 670
(lab=340, epi=5, clin=375), Eastern Mediterranean Region with 282 (lab=246, epi=2, clin=34),
and America Region with 270 (lab=270, epi=0, clin=0).
2.2 Health Needs Assessment:
Health Needs Assessment is a logical procedure of recognizing dissatisfied health along
with healthcare needs of a population and making adjustments to meet these unsated needs.
Health Needs Assessment is an approved public health tool to give evidence on a population on
which to plan services and address measles infection. It is undertaken to give a chance to involve
with certain populations and help them to contribute to aimed service planning along with
resource allocation (Pennel et al., 2016). Lastly, Health Needs Assessment for measles in the
community is carried out to provide a chance for cross-sectoral partnership working and
establishing creative and efficacious interventions.
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The first stage is getting started by looking at the population, where it is located and the
reason it is chosen, the aims, people included in the team and the resources needed. Secondly,
identifying health priorities which involve how the population profile was established, the data
available on the population health, how the data was collected, the barriers encountered and how
they were overcome along with the core issues for the population (Pennel et al., 2016). Assessing
a priority for action is another stage which looks at the interventions considered most acceptable
and effective, and how the resource needs were met.
The fourth stage is action planning for change which involves the summary of the action
planning procedure. Finally, project review or moving on stage illustrates how well the action
plan was implemented, what was accomplished, how it contributed to minimizing the infection,
what was learnt via challenges and successes, the needs to occur next, the new priority selected
for the population and the major message from the previous HNA that will be forwarded to the
next (Pennel et al., 2016).
Analyze the health needs of the affected population group in the European region using
relevant epidemiological data (mortality, morbidity, trends,
incidence, prevalence, and distribution, etc.).
Vaccination is a health need for affected European regions with measles (Leong, 2018).
A massive surge in measles cases across Europe has been reported by WHO which claims that
low MMR vaccination rates are to be blamed. This is because over 15,018 cases were
unvaccinated approximating to eighty-two percent of which 2,202 were less one year old, 4,150
between one and four years old, 2,257 between five and nine years old, 1,867 between ten and
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nineteen years old and 4,542 above twenty years old (Leong, 2018). The incidence reported in
2018 was 92 percent of cases reported by six nations.
Diet especially Vitamin A is a health need for people affected with measles in the
European region since low levels or vitamin A deficiency can result in more severe cases of
measles. Vitamin A has been proven as a possible intervention to speed recovery, minimize the
severity along with preventing against following incidents of acute lower respiratory tract
infections (Dabbagh et al., 2017). Romania had the most significant measles outbreak with 5,562
cases which accounted for most of the deaths and whose prevalence was 58 percent among the
hospitalized children.
Education is a health need for health professionals and to people affected with measles.
Individuals already with the disease need to undergo some training on how to prevent this
infection from spreading by either keeping away from uninfected people and also to be aware of
the vaccination (Quaglio et al., 2016).
Housing along with clean water is a basic need for healthy living without which
significant mortality and morbidity will be the result. Related diseases from unclean water
weaken the host and may facilitate infection and comorbidities like diarrhea and pneumonia
which might escalate the opportunity of substantial complications of death from a measles virus
(Prymula et al., 2018).
3. Evaluation of different public health approaches and which approaches are
best to describe Measles Outbreak (e.g., health education, immunization,
screening, surveillance, environmental controls)
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Surveillance is one of the best methods that the public health utilize to describe measles
outbreak. Timely measles surveillance is crucial to infection control. Therefore, identifying along
with validating doubtful measles instances via monitoring permits early recognition of outbreaks
and approximation of the actual underlying prevalence based on the patterns in the stated data.
Also, it will enable the analysis of ongoing spreading to mount more successful immunization
measures (Doherty et al., 2016).
The approach of immunization is vital in describing the outbreak of vaccination in the
European Region (Ravensbergen et al., 2019). A Morbidity and Mortality Weekly Report
indicates that coverage for the initial dose of measles-containing vaccination (MCV1) in Europe
has decreased from 95 percent to 93 percent since 2012 with around half of Euro member states
reporting reduced coverage since 2013 (Datta et al., 2018). The European Centers for Disease
Control (ECDC) shows that up to 80 percent of teenagers together with young adults who
contracted measles in 2017 had not been vaccinated.
Amid concerns about the ongoing transmission of measles infection in many nations of
the World Health Organization European Region, health education is essential in advising
vulnerable contacts of the infection risk and counsels them to watch for signs and symptoms.
Moreover, the purpose of health education is to advise that if symptoms consistent with measles
develop susceptible individuals should self-isolate and visit the hospitals in case they need
medical attention.
On the other hand, health practitioners are engaged in training on vaccine safety along
with contraindication to minimize failures to comply with the childhood immunization schedule
because of contraindications (Ciobanu et al., 2018). Health practitioners are acquainted with
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updated information on the situation of measles, the burden of the disease and surveillance. Also,
they are acquainted with the surveillance standards of measles and the laboratory network along
with prevention and control measures (Ciobanu et al., 2018).
For people with no signs or symptoms and those with no history of measles, no
documented immunity, and no measles vaccination a strategy of screening is utilized to identify
the possible presence of a disease. Once there is an identification of seropositive percentage for
measles antibodies the susceptible persons are vaccinated to prevent its spread.
4.1 Analysis of different intervention strategies to control the infection from
spreading
Excluding the susceptible people from an outbreak is utilized to protect the persons from
potential exposure and to minimize the peril they become affected themselves and eventually
spread the illness. Correspondingly, quarantining is for limiting the transmission via isolating
and limiting the movement of asymptomatic persons who are vulnerable to the illness and are
anticipated to become transmissible (Gastañaduy et al., 2018). The challenge with this strategy is
that the critical task of deciding who is not immune is difficult and verifying compliance along
with monitoring people for symptoms while in quarantine is resource-intensive.
Vaccination of non-immune persons is regarded in moderating measles transmission
since measles vaccine administration within seventy-two hours of initial susceptibility might
modify or prevent the disease (Bica and Clemens, 2017). However, when vaccination is directed
to people known to have been vulnerable the major difficulties are the timely administration of
the vaccine to those vulnerable contacts, because measles incidents can be contagious for four
days before the indicative rash spreads and measles is identified.
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Human immunoglobulin is prepared from plasma pools obtained from thousands of
donors and gives passive protection through antibodies against measles (Späth, Schneider and
von Gunten, 2017). Once it is given to vulnerable individuals within six days of inceptive
subjection, it might offer protection. However, its efficacy fluctuates by the capability of its lot,
with higher antibody levels corresponding with a more significant decline of measles peril.
Finally, the infected people are isolated until they no longer infectious and the period is
based on the duration of transmissibility of the virus (Czumbel et al., 2018). Consequently, this is
complex since the measles virus spread happens before the emergence of the common rash and
habitually needs a high index of intuition for measles among health professionals.
4.2 Impacts/ consequences if not controlled (physical, economic, social, and psychological)
Physically, if measles infection is not controlled it can lead to pneumonia, brain damage,
seizures, ear infection, and even death. In addition to the burden of the infection, hospitalized
measles incidents impose an economic burden to the healthcare system and the community as a
whole. Moreover, measles have a negative social impact if not controlled in the sense that people
with confirmed measles infection spend time off work or school by isolating themselves in fear
of transmitting it to those unaffected.
Recommendation:
What can be recommended is that people who are not immunized or partially vaccinated
and are not willing to acquire the immunization and have been susceptible to measles should not
attend any daycare or school for at least twenty-one days after the last onset of rash (Hall et al.,
2017). Furthermore, it is advisable for people crossing borders to be vaccinated to prevent the
spread of measles. People who have acquired a single dose of the vaccine before getting the
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exposure can go back to childcare or school after receiving the second vaccination. Nonetheless,
it is vital to understand the signs of measles so that if the symptoms develop the person should
stay at home (Hall et al., 2017). Finally, unimmunized people are recommended to acquire the
vaccine within three days from exposure and an immune globulin for pregnant women.
Conclusion
Measles has remained an ongoing global illness which has regulations for reporting any
known outbreaks or cases in societies. Even with measles being proclaimed eradicated
infestations are seen to be pursuing to happen. Every person should be aware of what to look for
in the infectious disease and the proper procedures to be introduced when announcing to the
department of health and the actions to go on with if an outbreak should happen. Luckily, this
contagious disease is avertible by reduced society transmission through good hand hygiene,
following regulations along with vaccination. Moreover, continuing education provision for
families in all populations at high peril will continue being beneficial for reducing exposure and
outbreaks in society. Few people could be not aware or not understand the magnitude of the
disease which is where education continuation will play an essential function for the society.
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