K-899. Nosocomial Measles Outbreak, Arizona, February 19 - April 30, 2008
Session: Slide Session: Outbreaks and Pseudo-Outbreaks
Sunday, October 26, 2008: 12:00 AM
Room: Constitution B (Grand Hyatt)
Background: Measles can result in hospitalizations and death. U.S. Measles elimination was declared in 2000, however outbreaks linked to importations have occurred, mainly in community settings. On 19 February, the Arizona Dept. of Health Services was notified of measles in a Swiss National. Through April 30, 18 additional cases were identified, many in healthcare settings. We reviewed the outbreak epidemiology to determine contributing factors to nosocomial transmission. Methods: Epidemiological data were obtained by case investigation. We defined healthcare settings (HS) as locations where medical care was provided and healthcare personnel (HCP) as persons who worked in HS. Results: Nineteen measles case-patients, including two HCP, were identified at three hospitals and in the community; 11 (58%) acquired measles in HS; six (32%) were hospitalized; 17 (89%) did not have documented immunity at time of exposure. Fourteen case-patients accessed acute medical care, either at pediatricians’ offices (3), or emergency department/urgent care facilities (11). Of 7764 measles exposures, 5183 (67%) occurred in HS. During the first health encounter, measles was not considered, and appropriate infection control measures were not implemented for all 19 case-patients. In one hospital, 404 (22%) of 1872 HCPs lacked documentation of immunity, necessitating HCP vaccination and voluntary quarantine. Conclusions: Delays in diagnosis and implementation of airborne precautions combined with susceptible HCPs contributed to this nosocomial outbreak, the largest in the US in a decade. Since measles cases are likely to present in HS, suspecting measles as a diagnosis, instituting immediate airborne isolation, and ensuring all HCPs have evidence of measles immunity is paramount in preventing further spread.
Francelli Lugo1, Jane Seward, MBBS, MPH2, Jennifer Rosen, MD3, Jessica Leung, MPH2, Karen Lewis4, Ken Komatsu, MPH5, Lisa Hulette1, Babs Johnson1, Derek Ehrhardt, RN, MSN/MPH2, Michelle McDonald1, Philip Gould, MD MPH2, Preeta Kutty, MD2, Rebecca Sunenshine, MD2, Rod Norrish1, Sanny Chen, PhD6, Sherry Daniels1, Shoana Anderson, MPH7, Susan Goodykoontz4 and  S. Y. Chen, None., (1)Pima County Health Department, (2)CDC, Atlanta, GA, (3)CDC, (4)Arizona Dept. of Health Services, (5)Arizona Department of Health Services, Phoenix, AZ, (6)CDC, Phoenix, AZ, (7)AZ Dept of Hlth Svcs

CURRICULUM VITAE
Jane Frances Seward, M.B.,B.S., M.P.H. (Epid)
Education
1974
University of Western Australia, School of Medicine - M.B.,B.S.
1983
Emory University School of Medicine, Atlanta, Georgia - M.P.H. (Epidemiology)
Medical training and licensure
1974-77 Pediatrics internship and residency, Lenox Hill hospital, NYC and Tulane University, Charity Hospital, New Orleans, La
Licensed: Western Australia and GA, USA
Board certification
Board Certified in Pediatrics, November 1981
Fellow of the American Academy of Pediatrics
Current position
Since 2006: Deputy Director, Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, CDC. Duties: serves as the deputy director and principal scientific and technical advisor to the Director, Division of Viral Diseases (DVD) to plan, direct, coordinate and provide national leadership to identify, investigate, diagnose, treat and prevent disease, disability and death from viral vaccine-preventable diseases, other respiratory and enteric viral diseases, and unknown (presumably viral) agents.
2006-2008:
CDC lead for national investigations and response for multistate mumps outbreak in the U.S. 2006
CDC senior spokesperson for measles investigations and response, 2008
Steering committee member for CDC’s Advisory Committee on Immunization Practices
1996-2005
Joined CDC in 1996 as medical epidemiologist in varicella. In 2000, assumed duties as Chief, Viral Vaccine Preventable Diseases Branch, NIP, CDC with lead responsibility for providing national and international medical leadership, direction and management of surveillance, epidemiologic and scientific medical research and policy development for viral diseases that are vaccine preventable in the United States.
Specific expertise:
Varicella and Herpes Zoster
Recognized international expert on varicella; work has included documentation of the impact of varicella vaccine in the United States on cases, hospitalizations and deaths and vaccine policy changes to improve varicella control; co-author of > 80 peer review and MMWR articles related to varicella in the United States including varicella outbreak investigations, epidemiological studies related to varicella disease burden, vaccine policy, impact and effectiveness; and overseeing disease burden, cost effectiveness, other studies and vaccine policy development for anticipated zoster vaccine.
Polio, Measles, Rubella, CRS
Key publication on the epidemiology of polio in the US; NVAC-ACIP report on “needs and recommendations for the US poliovirus vaccine stockpile”; investigation of VDPV polio infections in MN; documentation of an imported VAPP case; documentation of elimination of measles in the US (JID supplement, 2004 including key article on epidemiology of measles in the US); investigation and control of a large measles outbreak in the Marshall Islands, 2004; investigation of the largest measles outbreak in the Americas in Indiana in 2005; national measles surveillance that documents importations; documentation of the elimination of rubella and CRS in the U.S.; documentation of CRS disease burden in Morocco; national surveillance for CRS and rubella.
Smallpox: Developed subject matter expertise in smallpox and smallpox vaccine, assisted in development of the CDC and global strategy for evaluating suspected smallpox cases; key trainer on smallpox surveillance and outbreak investigation for CDC and WHO training courses, established smallpox vaccine in pregnancy registry with the Department of Defense and provided consultation to state/local health departments on suspected smallpox cases.
Surveillance for Vaccine Preventable Diseases: recognized national expert in vaccine preventable disease surveillance and outbreak investigation and control m

Philip L Gould
degree(s)
MD, MPH
EIS Officer
Division of Viral Diseases, NCIRD
CDC
MS A-47
1600 Clifton Road, Atlanta GA 30333
telephone number:
404-639-3972
fax number: 404-639-6885
e-mail address:
ffa9@cdc.gov

Educational History:
Residency/2000-2002, Uniformed Services University of the Health Sciences, Preventive Med.
Residency/1993-1996, University of Nebraska Medical Center/Offutt AFB
Family Practice, Family Practice
MD/1993, Tulane University School of Medicine, Medicine
MPH/2001, Uniformed Services University of the Health Sciences, Epidemiology/Tropical Medicine
MPH&TM/1993, Tulane University School of Public Health and Tropical Medicine, Tropical Medicine
BA/1989, University of Virginia, HIstory
Professional Experience
Current: EIS 2006, Centers for Disease Control and Prevention, in Division of Viral Diseases, NCIRD
2002-2006, Preventive Medicine consultant, Air Force Institute for Operational Health
Surveillance chief, Epidemiology Services, Air Force Institute for Operational Health, Brooks City-Base, TX 78235.
Chief epidemiologist with the DoD Influenza Surveillance Program
27 Sentinel and 62 non-sentinel bases participate in this program which involves an average of over 4000 specimens annually. Supervisory editor of the weekly DoD Influenza and Respiratory Virus Surveillance Report.
DoD CENTCOM Disease Non-Battle Injury Surveillance
Senior epidemiologist during critical phase of Operation Iraqi Freedom, March 15 2003 to July 2003, with the end of the conflict declared. Developed multiple graphing and innovative methods of reporting data from a vast array of different Army, Navy, Air Force, Marine, and Coast Guard information. Member of select DoD panel to categorize all available ICD-9s into one and only one DNBI category.
AF representative to the Joint Technology Coordinating Group for Military Infectious Disease (JTCG-2). By-name appointment by Commander, 311th Human Systems Wing (yearly appointment, 2 years, 2004-2006)
AF representative to the Joint Readiness Clinical Advisory Board panel on Pandemic Diseases. (2004-2006)
Papers:
Marsden-Haug N, Foster VB, Gould PL, Elbert E, Wang H, and Pavlin J, “Evaluation of ICD-9 Code Based Syndromic Surveillance for Influenza-like Illness”, Emerg Infect Dis J, Feb 2007.
Daum LT, Shaw MW, Klimov AI, Canas LC, Macias EA, Niemeyer D, Chambers JP, Renthal R, Shrestha SK, Acharya RP, Huzdar SP, Rimal N, Myint KS, and Gould P, “Hemagglutinin Analysis of Isolates from an Influenza A (H3N2) Outbreak in Southeast Nepal”, Emerging Infectious Diseases, 11(8), Aug 2005. Available at http://www.cdc.gov/ncidod/EID/vol11no08/05-0302.htm
Sanders JW, Putnam SD, Gould P, et al, “Diarrheal illness among deployed U.S. military personnel during Operation Bright Star 2001_Egypt”, Diagnostic Microbiology and Infectious Disease, 52(2):85-90, Jun 2005.
Grayson JK, Gould PL, “New Twist on Old Methods--Simple Schemas for Disease and Non-Battle Injury Surveillance in Deployment Settings”, MMWR, 53 (Suppl): 231 (abstract only).
Moore M, Gould PL, Keary BS, “Global urbanization and impact on health”, International Journal of Hygiene and Environmental Health, (206) 269-278, Aug 2003.

Minal Patel, MD - Dr. Patel is currently an Epidemic Intelligence Service Officer with the Enteric Diseases Epidemiology Branch at the Centers for Disease Control and Prevention in Atlanta, GA. Her work includes investigation of foodborne disease outbreaks and evaluation of the impact of safe drinking water on illness as well as community implementation of safe drinking water in Kenya. She has also worked on the initial investigations into novel H1N1 in California. Dr. Patel completed her MD at Weill Medical College of Cornell University and residency training in Pediatrics at New York Presbyterian Hospital-Cornell. She obtained a BA in Molecular Biology and Biochemistry from Rutgers Univeresity.

Derek Ehrhardt graduated from Marquette University School of Nursing and specialized in emergency medicine. After completing Master’s of Public Health and Master’s of Nursing degrees from Johns Hopkins University, he joined the faculty at the Johns Hopkins University Bloomberg School of Public Health, Center for Refugee and Disaster Response. While there, he managed international emergency medicine development programs and contributed to nutritional research and livelihood indicator surveillance in developing countries. Derek is now an Epidemic Intelligence Service Officer for the Center’s for Disease Control and Prevention assigned to the Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. He has worked on public health issues in international populations in the Balkans, the Palestinian Territories, Tanzania, and recently with the American Red Cross on the response to hurricanes Katrina and Rita.

Biography:
Philip L Gould

MD, MPH
EIS Officer
Division of Viral Diseases, NCIRD
CDC
MS A-47
1600 Clifton Road, Atlanta GA 30333
telephone number:
404-639-3972
fax number: 404-639-6885
e-mail address:
ffa9@cdc.gov

Educational History:
Residency/2000-2002, Uniformed Services University of the Health Sciences, Preventive Med.
Residency/1993-1996, University of Nebraska Medical Center/Offutt AFB
Family Practice, Family Practice
MD/1993, Tulane University School of Medicine, Medicine
MPH/2001, Uniformed Services University of the Health Sciences, Epidemiology/Tropical Medicine
MPH&TM/1993, Tulane University School of Public Health and Tropical Medicine, Tropical Medicine
BA/1989, University of Virginia, HIstory
Professional Experience
Current: EIS 2006, Centers for Disease Control and Prevention, in Division of Viral Diseases, NCIRD
2002-2006, Preventive Medicine consultant, Air Force Institute for Operational Health
Surveillance chief, Epidemiology Services, Air Force Institute for Operational Health, Brooks City-Base, TX 78235.
Chief epidemiologist with the DoD Influenza Surveillance Program
27 Sentinel and 62 non-sentinel bases participate in this program which involves an average of over 4000 specimens annually. Supervisory editor of the weekly DoD Influenza and Respiratory Virus Surveillance Report.
DoD CENTCOM Disease Non-Battle Injury Surveillance
Senior epidemiologist during critical phase of Operation Iraqi Freedom, March 15 2003 to July 2003, with the end of the conflict declared. Developed multiple graphing and innovative methods of reporting data from a vast array of different Army, Navy, Air Force, Marine, and Coast Guard information. Member of select DoD panel to categorize all available ICD-9s into one and only one DNBI category.
AF representative to the Joint Technology Coordinating Group for Military Infectious Disease (JTCG-2). By-name appointment by Commander, 311th Human Systems Wing (yearly appointment, 2 years, 2004-2006)
AF representative to the Joint Readiness Clinical Advisory Board panel on Pandemic Diseases. (2004-2006)
Papers:
Marsden-Haug N, Foster VB, Gould PL, Elbert E, Wang H, and Pavlin J, “Evaluation of ICD-9 Code Based Syndromic Surveillance for Influenza-like Illness”, Emerg Infect Dis J, Feb 2007.
Daum LT, Shaw MW, Klimov AI, Canas LC, Macias EA, Niemeyer D, Chambers JP, Renthal R, Shrestha SK, Acharya RP, Huzdar SP, Rimal N, Myint KS, and Gould P, “Hemagglutinin Analysis of Isolates from an Influenza A (H3N2) Outbreak in Southeast Nepal”, Emerging Infectious Diseases, 11(8), Aug 2005. Available at http://www.cdc.gov/ncidod/EID/vol11no08/05-0302.htm
Sanders JW, Putnam SD, Gould P, et al, “Diarrheal illness among deployed U.S. military personnel during Operation Bright Star 2001_Egypt”, Diagnostic Microbiology and Infectious Disease, 52(2):85-90, Jun 2005.
Grayson JK, Gould PL, “New Twist on Old Methods--Simple Schemas for Disease and Non-Battle Injury Surveillance in Deployment Settings”, MMWR, 53 (Suppl): 231 (abstract only).
Moore M, Gould PL, Keary BS, “Global urbanization and impact on health”, International Journal of Hygiene and Environmental Health, (206) 269-278, Aug 2003.

Jeffrey Hageman is an epidemiologist in the Division of Healthcare Quality Promotion, National Center for Infectious Diseases, at the Centers for Disease Control and Prevention (CDC). Mr. Hageman completed his undergraduate degree in microbiology at Miami University and Master of Health Science in infectious disease epidemiology from Johns Hopkins School of Hygiene and Public Health. Mr. Hageman joined CDC in 1998 and has been with the Division of Healthcare Quality Promotion, formerly the Hospital Infections Program, since then. Mr. Hageman has published peer-reviewed articles on various infectious diseases topics and has conducted and assisted with outbreak investigations associated with emerging and antimicrobial-resistant pathogens. In his current position, he is responsible for coordinating and conducting activities related to antimicrobial-resistant Staphylococcus aureus. These activities include surveillance, field investigations, epidemiologic studies, laboratory testing, and public health management (e.g., outbreak response and control) of both vancomycin-resistant S. aureus and methicillin-resistant S. aureus (MRSA) in the community and healthcare settings. During the past few years he was also responsible for assisting with investigations of allograft-associated infections which have included transmission of Clostridium and Group A Streptococcus from cadaveric musculoskeletal tissues.

Minal Patel, MD - Dr. Patel is currently an Epidemic Intelligence Service Officer with the Enteric Diseases Epidemiology Branch at the Centers for Disease Control and Prevention in Atlanta, GA. Her work includes investigation of foodborne disease outbreaks and evaluation of the impact of safe drinking water on illness as well as community implementation of safe drinking water in Kenya. She has also worked on the initial investigations into novel H1N1 in California. Dr. Patel completed her MD at Weill Medical College of Cornell University and residency training in Pediatrics at New York Presbyterian Hospital-Cornell. She obtained a BA in Molecular Biology and Biochemistry from Rutgers Univeresity.

Minal Patel, MD - Dr. Patel is currently an Epidemic Intelligence Service Officer with the Enteric Diseases Epidemiology Branch at the Centers for Disease Control and Prevention in Atlanta, GA. Her work includes investigation of foodborne disease outbreaks and evaluation of the impact of safe drinking water on illness as well as community implementation of safe drinking water in Kenya. She has also worked on the initial investigations into novel H1N1 in California. Dr. Patel completed her MD at Weill Medical College of Cornell University and residency training in Pediatrics at New York Presbyterian Hospital-Cornell. She obtained a BA in Molecular Biology and Biochemistry from Rutgers Univeresity.



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