Health
Florida’s Measles Outbreak: Transparency Lacking, Health Concerns Rising
The scarcity of information regarding measles cases in Florida has raised concerns among health experts, especially for those planning vacations to the state who wish to avoid exposure to the virus. This lack of transparency contrasts with the standard public health practice during measles outbreaks, where alerts are issued to warn the public of potential exposure.
For instance, health officials in two Michigan counties recently warned residents of potential exposure to measles. These alerts were issued following the discovery of two adults who had contracted the virus abroad and had been in health-related settings in the area. The counties urged unvaccinated individuals who had been in the listed locations at the listed times to contact public health or their health care provider, warning them to phone ahead if they needed to seek in-person care.
In Florida, however, the Department of Health has released limited information about the 10 residents and at least four non-residents diagnosed with measles in the past month. This lack of transparency leaves the public in the dark about potential exposure.
“Very little information is available,” Scott Rivkees, Florida’s former surgeon general, told STAT by email, adding it is “very unusual to have such sparse information for the public, especially when the onus is being put on parents to make decisions.”
This lack of information is particularly concerning as measles activity has been reported in at least three Florida counties — Broward, Polk, and Orange — in the past month. The state Department of Health’s website homepage has a single measles alert, which does not provide specific details about the cases.
Michael Mina, an infectious diseases epidemiologist, said the state’s approach defies common sense. “What’s happening in Florida is sort of breaking all the global conventions around measles,” said Mina. “One of the first things that anyone would normally do, whether it be in Europe or the United States, is be extremely — almost overly — transparent.”
The primary cost of not containing measles transmission is unnecessary illness. Measles is a very unpleasant experience and can be fatal. Knowing that measles poses a present risk can change thinking about vaccination, said Jane Zucker, who retired from the New York City Department of Health last July.
William Moss, executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health, emphasized the importance of public health officials promoting vaccination and alerting the public of potential exposures.
Informing the public of sites where measles exposures could have taken place is especially critical in health care settings, which can significantly increase the size of an outbreak and the work required to contain it.
One of the reasons measles spreads so well is that infected people are contagious in the four days before the telltale measles rash develops. During that period they can become quite sick, so they may seek medical care. But their symptoms could be caused by a range of conditions.
“Unless you really know something’s going on with measles, or you have some reason to suspect measles, those are just not going to be recognized very often, and that often leads to lots of exposures in health care facilities,” said Kathleen Harriman, who retired from the California Department of Public Health.
Telling the public of possible measles exposure events can get parents of unvaccinated children or adults who are unvaccinated to think “Maybe this is measles” if their children or they themselves become ill.
It also alerts medical providers that they should think about measles and to be on the lookout for the triad of symptoms known as the three C’s — cough, coryza (a stuffed up or runny nose) and conjunctivitis or pink eye — which along with fever can signal measles.
In addition to preventing unnecessary illness, this transparency can also save a great deal of money. The health department costs of containing the Disneyland outbreak were between $1.5 million and $4 million, Harriman has said.
In an account of New York City’s efforts to stop the 2018-2019 outbreak that was published in the New England Journal of Medicine, Zucker and colleagues estimated that the cost to their department alone of responding to that outbreak was $8.4 million.
“You need to stop transmission. You just have to stop transmission,” Zucker said. But “it’s very labor intensive.”
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