The 2019 measles outbreak in Clark County, Washington

2021 ◽  
pp. 41-59
Author(s):  
Michael A. Stoto ◽  
Rachael Piltch-Loeb ◽  
Roxanne Wolfe ◽  
Robin Albrandt ◽  
Alan Melnick
2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Stoto ◽  
R Piltch-Loeb ◽  
R Wolfe ◽  
R Albrandt ◽  
A Melnick

Abstract Issue Clark County experienced a measles outbreak that challenged public health authorities. Description of the practice: We conducted a formal After Action Review with state and local health officials, school officials, and others to identify lessons for public health practitioners facing future outbreaks. Results Following the early identification of measles in a child who had recently arrived from Ukraine, active surveillance identified 71 confirmed cases, most in unvaccinated persons under 18 years of age. 4,138 contacts were traced and public health personnel made daily monitoring calls to 816. 53 potential exposure sites in healthcare facilities, schools and other public places were identified and communicated to the public. As a social distancing measure, unvaccinated students, teachers, and staff were excluded from schools in which exposure had occurred. Ascertaining susceptibility status was challenging. The national anti-vaccination sentiment and a parallel outbreak in a New York religious community created challenges in representing community risk while avoiding stigmatization of a community in which the first reported case was identified. Rather than respond to every false claim on social media, the health department developed talking points about emerging issues and engaged the community in dialogue. Lessons Responding to the measles outbreak required innovative approaches to surveillance and contact tracing, social distancing (school exclusions), and emergency risk communication. The response required extensive coordinated efforts of the county and state health departments, school systems, and many other organizations. Mutual aid enabled an influx of resources but managing the surge of responders proved challenging. Key messages Public health emergencies require effective emergency management practices. Carefully conducted After Action Reviews of health emergencies can help public health practitioners identify challenges and innovative practices.


2010 ◽  
Vol 96 (1) ◽  
pp. 20-29
Author(s):  
Jerry C. Calvanese

ABSTRACT Study Objective: The purpose of this study was to obtain data on various characteristics of peer reviews. These reviews were performed for the Nevada State Board of Medical Examiners (NSBME) to assess physician licensees' negligence and/or incompetence. It was hoped that this data could help identify and define certain characteristics of peer reviews. Methods: This study examined two years of data collected on peer reviews. The complaints were initially screened by a medical reviewer and/or a committee composed of Board members to assess the need for a peer review. Data was then collected from the peer reviews performed. The data included costs, specialty of the peer reviewer, location of the peer reviewer, and timeliness of the peer reviews. Results: During the two-year study, 102 peer reviews were evaluated. Sixty-nine percent of the peer-reviewed complaints originated from civil malpractice cases and 15% originated from complaints made by patients. Eighty percent of the complaint physicians were located in Clark County and 12% were located in Washoe County. Sixty-one percent of the physicians who performed the peer reviews were located in Washoe County and 24% were located in Clark County. Twelve percent of the complaint physicians were in practice in the state for 5 years or less, 40% from 6 to 10 years, 20% from 11 to 15 years, 16% from 16 to 20 years, and 13% were in practice 21 years or more. Forty-seven percent of the complaint physicians had three or less total complaints filed with the Board, 10% had four to six complaints, 17% had 7 to 10 complaints, and 26% had 11 or more complaints. The overall quality of peer reviews was judged to be good or excellent in 96% of the reviews. A finding of malpractice was found in 42% of the reviews ordered by the medical reviewer and in 15% ordered by the Investigative Committees. There was a finding of malpractice in 38% of the overall total of peer reviews. The total average cost of a peer review was $791. In 47% of the peer reviews requested, materials were sent from the Board to the peer reviewer within 60 days of the original request and 33% took more than 120 days for the request to be sent. In 48% of the reviews, the total time for the peer review to be performed by the peer reviewer was less than 60 days. Twenty seven percent of the peer reviews took more than 120 days to be returned. Conclusion: Further data is needed to draw meaningful conclusions from certain peer review characteristics reported in this study. However, useful data was obtained regarding timeliness in sending out peer review materials, total times for the peer reviews, and costs.


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