How Children’s Minnesota Successfully Managed a Measles Outbreak

Health providers across the country must react quickly and proactively if an outbreak occurs in their area, but it’s not an easy undertaking.

Although measles was declared eliminated in the United States in 2000, measles is still endemic in many areas of the world. Public health officials and healthcare providers know that a new measles outbreak in the U.S. could ignite at any moment when communities of susceptible individuals combine with easily accessible, rapid international travel. This is the situation in several jurisdictions, where recent outbreaks have resulted in the largest number of confirmed measles cases the U.S. has seen in 25 years, according to the CDC.

Clinics, hospitals, and healthcare systems across the country must be prepared to act quickly if an outbreak occurs in their area, but it’s not an easy undertaking.

At the 2019 APIC conference in Philadelphia, attendees had the chance to hear from Jennifer Boe, BSN, RN, PHN, CIC, an infection preventionist at Children’s Minnesota, and Joe Kurland, MPH, CIC, an infection preventionist and vaccine specialist at Children’s Minnesota, who helped quell a measles outbreak in their community in 2017.

Just before the conference, we caught up with them to learn more about what they would be presenting during their session.

VigiLanz: How did the measles outbreak develop in your community? What type of situation was your hospital facing?

Boe and Kurland: We have a large, vibrant Somali community here in Minnesota, centered in the Twin Cities metro area, and they frequently travel to places where measles is endemic. Back in 2004, the MMR vaccination rate for the Somali-Minnesotan community was about 92 percent. Around 2006, and in response to the Somali community’s perception of increased and disproportionate rates of autism without a known cause, the community was subjected to targeted anti-vaccine messaging. As a result, the MMR rate among Somali-Minnesotan children plummeted to a low of 42 percent. With low community immunity and frequent international travel, it was only a matter of time until we had an outbreak. Our first measles case occurred in March 2017 in a Somali-Minnesotan child, and we knew immediately that we would be seeing many more cases. At Children’s Minnesota, we ended up testing 275 patients for measles between April and August. At the end of the outbreak, Minnesota had 75 confirmed cases, and Children’s had cared for 52 of them, including 22 inpatient hospitalizations.

“With low community immunity and frequent international travel, it was only a matter of time until we had an outbreak.”

VigiLanz: What were some of the first things you did to address the problem?

Boe and Kurland: Because of the low community immunity, we knew this was a public health emergency. We activated our hospital incident command system (HICS), and it was “all hands on deck.” We collaborated with our state health department, developed phone banks and a measles hotline, and prepared the emergency departments and clinics to rapidly identify and isolate suspect cases. Our infection prevention team had to reprioritize our normal work and resources in order to accommodate this outbreak response. This included rotating call every 24 hours and assigning one team member to other high-priority daily work. 

VigiLanz: What role did VigiLanz play in supporting your efforts?

Boe and Kurland: VigiLanz helped ensure that no suspect cases being tested for measles slipped through the cracks. For example, we ask providers to contact us whenever they consider ordering a measles test for a patient. At the height of the outbreak when we were testing so many patients, we found that we weren’t being notified 100 percent of the time. We worked with our VigiLanz support team member to create a new rule, which alerted us whenever a measles test was ordered. VigiLanz was able to implement this new alert for us within one day of us requesting it. Knowing about suspect cases ahead of time ensured we were in the loop, and it allowed us to identify potential exposures so we could rapidly respond if the measles test was positive. Another VigiLanz rule alerted us if a known case or exposed patient returned to our organization for care.

VigiLanz: What is one thing you will discuss during your session that you think health systems would really benefit from hearing more about?

Boe and Kurland: During our session, we’ll also discuss our exposure reduction interventions that were implemented during the outbreak, as well as our post-exposure response plan, including prophylaxis and prioritization of exposed individuals. We will also share a checklist to help organizations improve their preparedness and plan their response to a measles outbreak. Finally, we will hold a Q&A after the session, and we are excited to talk to other infection preventionists and providers about unique challenges at their health systems and share thoughts on how they might be addressed.