Preventing and Controlling Outbreaks

Reviewed by: Rossana Rosa MD; UnityPoint Health

Two recent articles describe national strategies to control and prevent outbreaks. The first article by Patel et al. presented a national update on measles cases and outbreaks. From January 1, 2019 to October 1, 2019, there have been 1249 measles cases and 22 outbreaks, the highest number of cases since 1992. Ninety-three percent of the cases were unvaccinated or had unknown status. A total of 119 (10%) patients were hospitalized, and 60 (5%) with pneumonia and one (0.1%) had encephalitis. The majority of the cases were associated with two closely related outbreaks in New York City and New York state that affected Orthodox-Jewish communities.  The New York City outbreak began September 30, 2018 with an internationally imported case in a returning US traveler; this outbreak last 9.5 months and affected 702 patients.  The New York State outbreak began October 1, 2018 with an internationally imported case in a foreign visitor; this outbreak lasted 10.5 months and affected 412 patients. The last NY outbreak was declared over on September 3, 2019.

Following the onset of an outbreak of Ebola in the Democratic Republic of Congo (DRC), the government of Uganda started to prepare by assessing their current infection prevention and control practices (IPC).  Biedron et al. described the findings of an assessment of IPC readiness at healthcare facilities in Uganda. The Ebola outbreak in DRC was declared on August 1, 2018 and has since affected 3168 patients, most of them in 2 provinces bordering Uganda.  In August 2018, IPC assessments were conducted at four health care facilities in Uganda, chosen due to their proximity to the focus of the Ebola outbreak in DRC. The following deficiencies were detected and corrected through education:  

• Screening and identification: Screening was made difficult by the use of multiple case definitions, improper use of infrared thermometers, and poor adherence to social distancing measures when screening patients.
• Isolation of suspected cases: This was affected by shortages of IPC consumables such as PPE, training gaps among staff members, absence of a clear case management and referral plan, gaps in patient care, chlorine preparation and waste disposal.
• Reporting to health authorities: Health staff had not been informed of which number to call if a suspected Ebola case was identified and contact numbers for the district health office were not clearly posted.

On June 11, 2019, 3 imported cases were detected in Uganda, yet as of September 27, 2019 no further cases have been identified in Uganda. 

References: 

• Patel M, Lee AD, Clemmons NS, et al. National Update on Measles Cases and Outbreaks — United States, January 1–October 1, 2019. MMWR Morb Mortal Wkly Rep 2019;68:893–896. DOI: http://dx.doi.org/10.15585/mmwr.mm6840e2 
• Biedron C, Lyman M, Stuckey MJ, et al. Evaluation of Infection Prevention and Control Readiness at Frontline Health Care Facilities in High-Risk Districts Bordering Ebola Virus Disease–Affected Areas in the Democratic Republic of the Congo — Uganda, 2018. MMWR Morb Mortal Wkly Rep 2019;68:851–854. DOI: http://dx.doi.org/10.15585/mmwr.mm6839a4