According to World Health Organization (WHO), primary prevention entails the approaches and activities aimed at reducing the likelihood that disorder or disease will affect an individual, interrupting or slowing the progress of the disorder or reducing ability” (CDC, 2019). As such, public health looks at strategies such as vaccination, sensitization, urban planning, lifestyle change, et cetera. All these activities in the long-run are cost-effective than actual treatment of disorders and diseases. They also boost life expectancy as well as the quality of life led by the masses. The global immunization rates highlight how the US is retrogressing in primary prevention endeavors, particularly in New York. According to WHO by the end of 2018, “86% of children had been vaccinated against measles by their second birthday” (CDC, 2019). The measles outbreak in New York exposed the weak immunization strategies in place. It also exposed how many parents put their children at risk by not vaccinating them due to philosophical and religious reasons. As such, the measles vaccination rates in the state are 60% is relatively low in comparison to the expected 95% rate that is essential in ensuring “sufficient heard protection.”
As aforementioned, there exist cultural and philosophical elements that characterized the measles outbreak in New York. The cultural implications center on mistrust that is founded on past communal interactions with public health initiative such as the Tuskegee syphilis study (Pelčić et al., 2016). Additionally, some of the residents in New York uphold that the body is sacred and should not receive any modern interventions but instead rely on natural means. Such beliefs lead to vulnerable masses that are easily affected when in contact with an infected individual. The affected that do not believe in vaccination end up not seeking medical aid only to rely on other alternatives that are not effective in the prevention of further outbreak. All these assumptions are not backed by scientific facts but perspectives held by individuals which in turn goes ahead to affect how individuals perceive vaccination and its intended goal.
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The leading causes of the Measles outbreak in New York are the refusal to vaccinate children and lack of a robust public health campaign against Measles. Due to cultural and philosophical reasons, many parents failed to have their children vaccinated hence making them vulnerable to the disease. The other reason is the inefficiency of the public health system in New York. The public health officials failed to advocate for mandatory vaccination for all children in the state. The leadership ought to have been at the forefront in creating laws that make it compulsory for all children to be immunized. This would be fundamental in protecting much of the vulnerable masses, such as school-going children in the state. Moreover, there is a need for a robust screening of patients. This is because the outbreak is linked to travelers who brought the epidemic from countries such as the Philippines, Israel, and Ukraine where similar outbreaks had been reported.
According to the HealthyPeople.gov has set targets for the reduction of Measles in the United States by 2020. The website uses a number of 115 cases for the year 208 as a baseline. The year was arrived at as it recorded the highest of measles cases since the year 1996. Between 2001 and 2008, there have been a total of 325 cases reported which averaged to 41 cases per year. Using the baseline values, the target of infections was set at 30 cases per year (Healthy People, 2019). The 2019 measles cases in the US are above the target standing at 1,234 cases across 31 states from January 1 to August 29, 2019. This is retrogressive and poses a risk for many unvaccinated individuals. The HP 2020 target % for 19 to 35 months-old children for 1-dose of MMR vaccine coverage is 90% (Healthy People, 2019). The vaccination coverage in 2019 for New York is 67.5% relatively lower than the HP 2020 target. This highlights the predominant nature of the communities opposed to vaccination such as Orthodox Jews and other individuals that are suspicious of the immunization efforts by the government. It also pinpoints the ineffective efforts employed by the state in conjunction with the Center for Disease Control and Prevention. Additionally, it denotes that a lot of traveling has occurred in the recent past, which led to the spread of the disease within the New York communities (Healthy People, 2019).
A CDC video on YouTube dubbed “Measles Clinical Features and Diagnosis” is very informative in many ways. It dissects the diseases and how its presentation may be confusing even to clinical officers that might think its Kawasaki’s disease, Roseola, and Dengue disease. It highlights the essence of clinicians querying a patient has been vaccinated against measles before (CDC, 2019). To a layperson, the video succinctly reports that it is prudent for an individual to be vaccinated before traveling to other countries. Additionally, individuals that have recently gone abroad ought to be screened lest they expose others to the diseases. From the video, one gathers that measles incubates in the body for an average of 11 to 12 days where it brings about fever and the three C’s (conjunctivitis, coryza, and coughs) (CDC, 2019). The public is advised that after one contracts the diseases, there might be a stepwise increase in one’s temperature exceeding 39°C or 103°F. A keen observer may notice that an individual has a bad rash with small raised bumps that appear on the skin. The CDC video warns that the rush may not be easily observable in dark-skinned individuals. CDC advocates for isolation of individuals that have the Measles symptoms to avoid its spread.
References
CDC. (2019, July 5). Measles Clinical Features and Diagnosis [Video file]. Retrieved from https://www.youtube.com/watch?v=3HFeQEciDVY
CDC. (2019, September 3). Measles Cases and Outbreaks . Retrieved from https://www.cdc.gov/measles/cases-outbreaks.html
Healthy People. (2019). IID-1.4 Data Details | Healthy People 2020 . Retrieved from https://www.healthypeople.gov/node/4641/data_details
Pelčić, G., Karačić, S., Mikirtichan, G. L., Kubar, O. I., Leavitt, F. J., Cheng-tek Tai, M., … Tomašević, L. (2016). Religious exception for vaccination or religious excuses for avoiding vaccination. Croatian Medical Journal , 57 (5), 516-521. doi:10.3325/cmj.2016.57.516
Appendix A
| Intervention | Definition | Level of Intervention | Example Found in NYC Measles Case |
| Vaccination | A biological preparation that boosts immunity to a particular ailment. The Measles vaccines are differentiated depending on the strain of the disease. | Primary prevention |
On April 9, the Health Commissioner ordered every adult and child who lives, works o resides in the following ZIP codes and has not received the measles mumps and rubella (MMR) vaccine to be vaccinated: 11205 11206 11211 11249 |
| Screening | This is essential in the detection of Measles or its risk factors. | Secondary prevention | People who demonstrate they are immune from measles or have a medical condition that prevents them from receiving the vaccine will not need to get vaccinated. |
| Behavior change | This entails efforts to reach and enhance positive behaviors that eliminate or reduce harmful traits that may lead to contracting of Measles. | Tertiary prevention. | If the Health Department identifies a person with measles or an unvaccinated child exposed to measles in one of the above ZIP codes, that individual or their parent or guardian could be fined. |
