Containing a measles outbreak in Minnesota, 2017: methods and challenges

AIMS

We report on a measles outbreak largely occurring in Minnesota's under-vaccinated Somali community in the spring of 2017. The outbreak was already into its third generation when the first two cases were confirmed, and rapid public health actions were needed. The aim of our response was to quickly end transmission and contain the outbreak.

METHODS

The state public health department performed laboratory testing on suspect cases and activated an Incident Command staffed by subject matter experts that was operational within 2 h of case confirmation. Epidemiologic interviews identified exposures in settings where risk of transmission was high, that is, healthcare, childcare, and school settings. Vaccination status of exposed persons was assessed, and postexposure prophylaxis (PEP) was offered, if applicable. Exposed persons who did not receive PEP were excluded from childcare centers or schools for 21 days. An accelerated statewide measles, mumps, and rubella (MMR) recommendation was made for Somali Minnesota children and children in affected outbreak counties. Partnerships with the Somali Minnesota community were deepened, building off outreach work done with the community since 2008.

RESULTS

Public health identified 75 measles cases from 30 March to 25 August 2017: 43% were female, 81% Somali Minnesotan, 91% unvaccinated, and 28% hospitalized. The median age of cases was 2 years (range: 3 months-57 years). Most transmission (78%) occurred in childcare centers and households. A secondary attack rate of 91% was calculated for unvaccinated household contacts. Over 51,000 doses of MMR were administered during the outbreak above expected baseline. At least 8490 individuals were exposed to measles; 155 individuals received PEP; and over 500 persons were excluded from childcare and school. State and key public health partners spent an estimated $2.3 million on response.

CONCLUSION

This outbreak demonstrates the necessity of immediate, targeted disease control actions and strong public health, healthcare, and community partnerships to end a measles outbreak.

A chromosomal reciprocal translocation (1q+; 14q−) in a boar siring reduced litter sizes

In our initial cytogenetic surveillance of boars one of 15 was found to be hypoprolific. It averaged 7.1 piglets per litter in over 51 monospermic matings with sows which, with other boars averaged 10.8 piglets per litter. Cytogenetic evaluations revealed only the hypoprolific boar to have an abnormal karyotype, namely {38XY, t(1;14) (q2.12, q2.2)}. This represents a new type of 1;14 reciprocal translocation, and also the first report of a reciprocal translocation for swine in the United States.

Potential predictors of information-seeking behavior by homosexual/bisexual (gay) men with a human immunodeficiency virus seropositive health status

Seeking ways to improve their health, gay men with human immunodeficiency virus (HIV) infections living in San Francisco are developing information networks and patterns of self-care behavior. Drawing from a set of explanatory theories, this cross-sectional survey with retrospective elements examined patterns and potential predictors of information-seeking activity in a cohort or 162 HIV seropositive (HIV+) men, 60 of whom provided complete data sets. The study suggests that 1 year after becoming aware of an HIV+ health status, most patients have developed multifaceted information networks. The amount of tangible aid acquired from these networks and frequency of consultation is positively related to patterns of HIV self-care behaviors and "feeling calm" (p less than 0.01), suggesting that these variables may be important markers for the need of supportive-educative nursing care. Suggestions for nursing practice and research are also described.

Potential correlates of self-care and symptom distress in homosexual/bisexual men who are HIV seropositive

Although treatment of HIV infections is possible, anecdotal data and research suggest that infected homosexual and bisexual men are developing sets of HIV-specific self-care behaviors that they believe will maintain their health or delay progressive disease. However, little is known about frequent use of HIV self-care in relationship to symptom distress or other factors commonly assessed by nurses. These deficits limit the ability of healthcare providers to intervene appropriately. Consequently, the following repeated-measures study retrospectively examined correlates of HIV self-care in 162 outpatients who were attending a major healthcare facility in San Francisco, CA. Standard and HIV-specific instruments created for the study were used in data collection. Results suggest that the men increased their use of 35 of 81 HIV self-care behaviors once they became aware of being HIV seropositive (p less than 0.001). Frequent use of HIV self-care behaviors was related to several variables, including previous patterns of self-care (p less than 0.001), and AIDS diagnosis (p less than 0.01), and a locus of control (LOC) indicator (e.g., the statement "What happens to me is beyond my control") (p less than 0.001). Symptom distress also was related to several variables, including selected LOC and quality-of-life (QOL) indicators, mood states, and recent diagnosis of selected AIDS-related diseases (p less than 0.01). Collectively, these results suggest that taking self-care and selected psychosocial histories will allow nurses to identify ambulatory patients with HIV infections who need intensive care.