Lehigh County Health & Medicine Spring 2020 - 20

FEATURE

As details and travel history of the case your movement for the next 21 days. We
became clear, the diagnosis seemed more learned that thanks to technology - many
and more plausible. Unvaccinated individual, of our movements have a time stamp.
recent travel to an area with Measles, symp- Many cellphones showed a message that
toms perfectly matching the presentation you "checked in" at a particular time or a
for Measles, it was all falling into place and receipt showed the time you checked out.
then just as the Phantoms were charging Despite many folks knowing exactly when
towards the goal, my cell rang and I heard they came and went, their receipts or logs
the words I dreaded, "we have blood test said differently, putting them in or out of
confirmed measles."
the exposed group.

could have paid the price. The public health
system in Pennsylvania would have been
ill prepared to handle even dozens of cases
if each case had travel history and moved
freely through crowded places.
Many Understand
The courts as well as many exposed
individuals understood the importance of
limiting the possible spread. Older individuals could recall people becoming very ill
from Measles. Many even shared stories of
serious complications from the disease in
their own families. To those exposed it wasn't
just a childhood illness like the common
cold. Many made personal sacrifices to
protect others and encouraged others to get
vaccinated and maintain up to date records.

Good Record Keeping Matters
Although many had vivid memories of
childhood vaccinations, they couldn't prove
it and if their titers showed a lack of immunity, they needed to isolate for 21 days. Most
could remember their parents having a strong
box or a shoe box with everyone's important
papers, but few knew what happened to those
papers when a parent passed or downsized.
It is my hope that the availability of
Thanks to the very quick action of a physi- Since few doctors' offices were computerized electronic medical records and personal
cian assistant, the case was isolated from other many years ago, few doctors could produce health portals will make future communipatients very quickly, minimizing the number records for patients over the age of 20 years. cable disease investigations easier. Finding
of those directly exposed. In the absence of Each person exposed and born after 1957 immunization records in the future should be
hard facts regarding air exchanges and HVAC needed to produce a vaccination record far quicker and patients now have an active
systems, in discussion with the Pennsylvania or show immunity by blood test. If they role in accessing their own documentation.
Department of Health it was decided that the couldn't, they were asked to isolate for 21 The issue of thorough and timely vaccination
definition of exposed included anyone who days in case they were incubating Measles. though remains a challenge. Despite the
came into airspace up to two hours after the
widespread availability of sound research
index case. That significantly increased the Media - Friend or Foe?
on vaccine safety, myths continue to thrive,
numbers of potentially exposed considering
The coverage by local media helped folks and folks continue to decline vaccinating
time was spent locally at two outpatient self-identify if they were part of the exposure. children at way too high a rate. We saw
laboratories, an employment site and the When the message went out regarding firsthand in Allentown how many can be
hospital waiting room.
airspace and waiting room exposures, folks impacted by one unvaccinated individual.
were easily able to gather information about We need the help of all clinicians, employers
Quick and efficient response by hos- relevant exposure times and the availability of and individuals to stress the importance
pital employee health, hospital infection testing/immunization. The media, however, of vaccinations and to encourage those
control, state public health staff and local failed to use its reach to drive home the point vaccinations through policy and education.
public health staff resulted in rapid citizen of the importance of immunizations. One Every one of these cases of disease which
notification which ultimately resulted in unvaccinated person contracting Measles could have serious complications is premany receiving vaccination and/or titers for resulted in hundreds of known and probably ventable and vaccination is the answer.
immunity. Almost from the start we learned hundreds more unknown exposures. People
many valuable lessons.
isolated for 21 days as a result of shared Vicky Kistler, MEd, has been the Health Director for
the City of Allentown for the past 12 years. Previously
airspace and the inability to find records.
she was the Communicable Disease Manager for 14
Stories Change
years. The Allentown Health Bureau has 37 staff and
It is very difficult to remember exactly
Luckily, there were no known secondary provides services to over 122,000 Allentown residents.
where you were several days before, not cases of Measles from this index case. Most Some programs extend into Lehigh and other counties
to mention exactly where you were at a of the closest contacts were fully vaccinated, as well.
point in time - and the time made all the helping to limit the spread. Swift post-exdifference in the world. Did you enter the posure work took the necessary precautions
lab at 2:00 pm or at 2:15 pm? The answer since the numbers were in the hundreds but
to that question could put you in or out had there been many cases, the youngest and
of the exposed category and could alter the oldest or the sickest in our community

In my 27 years of working in public health
I had not had a case of Measles in the city of
Allentown, much less a case that had traveled
and spent time in a busy emergency room.
Measles being the highly contagious disease
that it is was going to prove very interesting
to contain, especially since there was still time
to protect some of those who were exposed.

20 Lehigh County Health & Medicine | SPRING 2020

Lehigh County Health & Medicine Spring 2020

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