Question

Based on the information given, what do you anticipate the challenges will be for an outbreak that has occurred across state lines? What plan of action would you take in order to address the outbreak from an Interprofessional standpoint?

The following are excerpts from the original case study:

Part I

On Tuesday, November 3, 1970, the Center for Disease Control (CDC) in Atlanta received the weekly telegram of surveillance data from the Texas State Health Department. The telegram reported 319 cases of measles in the state during the previous week. In contrast, Texas had reported an average of 26 cases per week during the previous four weeks. In follow-up telephone calls, CDC learned from State health officials that 295 cases of measles had been diagnosed in the city of Texarkana, including 25 in children reported to have been previously immunized. An invitation to investigate the situation was extended to the CDC on November 4, 1970. An EIS officer departed for Texarkana early on November 5.

Background

Texarkana is a city of roughly 50,000 that straddles the Texas-Arkansas state line. Texarkana, Texas (Bowie County), had a population of 29,393 in the 1960 census; the population had been stable during the 1960s. Texarkana, Arkansas (Miller County), had a 1960 population of 21,088. Although Texarkana is divided by the state line, it is a single town economically and socially. Persons of all ages on both sides of town have frequent contact. Churches, physicians, offices, movie theatres, and stores draw people from both the Arkansas and Texas sides of town. People cross the state line to attend social functions such as football games and school dances. Many families have friends and relatives who visit back and forth on both sides of town. Private nurseries and kindergartens receive children from both sides of town. The two sides of Texarkana, however, do have separate public school systems and separate public health departments.

Part III

Before this outbreak, the proportion of children vaccinated against measles on the Arkansas side was substantially higher than the proportion vaccinated on the Texas side. The Texas side had never had a community or school vaccination campaign for measles. In contrast, the Arkansas side had held mass community programs against measles for school and pre-school children in 1968 and 1969. Based on health department and physician records, investigators estimated that over 99% of children aged 1-9 years in Miller County, Arkansas had received measles vaccine prior to the outbreak. The overall vaccination level in Bowie County, Texas, was estimated to be 57%

Answer 1

summary of texaskana are :The texas had a population of 29.393 whereas the miller had a population of 21,088 and combined together population around both country are 50,000. both have separte public health system and public school system. but many people in both side communicated each other by visiting relatives and families. churches, movie, offices, stores draw all ages from both side. people of both side attended attended social function like school dances and foot ball games. both side of preschool school children attended nurseries and kindergardens. arkanas received measels vaccine prior to outbreak.

Measels tend to spread via respiratory droplet and spread 4 days before onset of rash and 5 days after onset of rash.and incubation period of mealses is 10 days from exposure and 14 days after apperence of rash.

Challenges of out break are 1.measels mainly affect children from age of 1 to 3 years old and may extend up to 14 years old and it affect old age group.

2. children who previousely vaccinated, chances to have less percentage of measels infection.

3. people of all age attended movie, churches, stores, physician, eventhough they have separtae public health systems and separate school system, chances is higher for transmission.

4.we must remember that reaction of measels vaccine may cause measels illness due to attenuated virus multiplication in 5-10 days after immunization.

5.people of Texa side never immunized against measels.

6. texakanas have common kindergarden and nurseries for preschool children. they chances of transmission is higher in texas than miller.

7. incubation of period and way of transmission could pose a risk to children and old age group.

Plan of action. measels vaccine was under trial in 1958 and in 1963, live measels vaccine was licensed for administration.

• collect history of contact children and old age group and visting places.
• advise to close kidergarders and nurseries and keep children indoors, avoid soical gathering.
• educate signs and symptoms of infection to all parents.
• isolate all children and oldage group afterr onset of rash
• educate the people to wear mask because it transmits through respiratory droplet and conjunctiva. expalin about wash hands using sanitizer
• protect contacts children 9-12 months with measels vaccine or immunoglobin (0.25ml per kg of body weight) within 3 days of exposure or early in the incubation period against measles
• educate all common visting places of all age group should be sanitized
• it is better to monitor all children in both side because effcetivenessof measels vaccine is 85%
• protect all immunocompromised children and malnourished and old age group.
• vigilance on the children of texas side. because they have had no immunization
• education all parents to give immunization to infants aginst measels infection irrespective measle exposure
• instruct parent and children about  hygeine technique.
• children should treated with vitamin A . because all measels children is prone to have keratomalcia and blindness due to vitamin A deficiency