The Center for Diseases Control and Prevention (CDC) declared measles eliminated in the United States nearly 20 years ago thanks to the widespread vaccine. However, outbreaks sometimes occur when vulnerable people are exposed to infected visitors – and one threatened to quickly take root in Pennsylvania this spring. Thanks to seamless coordination and ongoing communication between Penn Medicine and both federal and state agencies, though, the potential outbreak was stopped in its tracks.
On the evening of May 4, the Pennsylvania Department of Health (DOH) received word of a potential measles exposure at a Wegman’s market in Williamsport and a Weaver’s Farm Market in Port Trevorton. They learned that an infectious tourist was on a bus traveling from Niagara Falls, New York, to Washington D.C., and the bus had made two stops in Pennsylvania along the way, leaving both store employees and any fellow shoppers who had been in the vicinity at risk.
Measles is a highly contagious virus – if one person has it, 90 percent of the people close to them will become infected unless they’re immune. Measles is spread through nose and throat mucus. If an infected person coughs or sneezes, the virus can live in the airspace for two hours, which was why there was such a high risk of exposure at the Wegman’s and Weaver’s locations. While early symptoms include classic cold-like symptoms, within a few days, tiny white spots may appear inside the mouth, followed by a splotchy rash that spreads across the body. For unvaccinated young children and those with compromised immune systems, measles can quickly shift from mildly uncomfortable to potentially fatal.
When unvaccinated individuals and vulnerable communities are exposed to measles, such as by infected travelers, outbreaks tend to spread quickly. Just this summer alone, dozens of outbreaks and exposure scares have occurred in places like Kansas City, Portland, and several counties in New Jersey. Abroad, thousands of cases have been confirmed. Even a remote Amazon tribe, the Yanomami, has been hit with an outbreak that could quite literally wipe out their entire community.
The DOH immediately contacted a number of agencies to coordinate a rapid response, including the Bureau of Epidemiology and the Bureau of Public Health Preparedness (BPHP). While the DOH worked with Wegman’s and Weaver’s to acquire a full list of employees at both locations – “high-risk contacts,” according to BPHP agency director Andrew Pickett – they asked the BPHP to send out a request for assistance by leveraging the mutual aid agreement between the state’s Hospital & Healthsystem Association of Pennsylvania (HAP) coalition partners.
“I received a call from Andy Pickett asking if there was a way we could provide the Immune Globulin [IG, used to prevent disease after exposure] because there was a potentially large measles exposure. The DOH couldn’t purchase it because it’s a specialty medication, and the department doesn’t have contracts set up with the suppliers, so it had to come from a hospital pharmacy,” said Mark R. Ross, vice president of Emergency Preparedness for HAP. “I forwarded that request out to our coalition liaisons throughout the state, and Penn Medicine gave one of the only responses.”
John Wierzbowski, MSc, MPH, and Suzanne Brown, MS, RPh, spearheaded Penn’s efforts to prevent a potential measles outbreak.
IG is not typically kept in stock in American hospitals because more than 90 percent of children receive the measles, mumps, rubella (MMR) vaccine; there’s simply not a large call for it after immunization. However, John Wierzbowski, MSc, MPH, corporate manager of Enterprise Business Continuity and Emergency Operations, has strong working relationships with both Ross at HAP and Suzanne Brown, MS, RPh, director of Pharmacy Services at Pennsylvania Hospital, and felt that even if the health system didn’t have the necessary 113 vials, they could certainly try to round it up. After all, a highly infectious measles outbreak was at stake, and hospital after hospital kept sending back denials. Brown agreed and began calling on her supplier contacts and organizing a wholesale purchase – from her home, car, and a TGI Friday’s parking lot.
“It was a very interesting weekend – a winding tale,” Brown admitted. “After the state determined how many people were exposed at the two locations, I started getting in touch with distributors across the country. I was talking to suppliers in Texas, Kentucky, Nevada... It was no easy task, especially since there was a very short timeline before the IG would no longer be effective. It needed to be ready by Monday, so time was not a luxury we had.”
As Brown sourced out the required amount of IG, placed the order with the DOH’s authorization, and coordinated a quick delivery, Wierzbowski kept the DOH and HAP informed of their progress. Just in time, the medication arrived at the Philadelphia International Airport on Monday, May 7, and Ross – who insisted Penn’s involvement proved “a huge community service” – delivered it personally to the district office in Williamsport. The well-established partnerships between each player ensured that constant communication was kept between Penn Medicine, HAP, the BPHP, and the DOH’s district office. Ultimately, all the Wegman’s and Weaver’s employees who had not been previously immunized, plus a handful of concerned customers, were provided IG in the necessary timeframe. The MMR vaccine was also offered to members of the local Amish community, who tend to vaccinate at a lower rate than the general population.
After this incredibly successful coordination effort, Pickett wrote to Brown, “I want to express my – and our department’s – great gratitude for all of your support during this incident. Without the Sunday order, we would not have been able to accomplish that within the 6-day period. This was a collaborative process and effort, and we likely could not have done this without you. I want you to know how appreciative we are for your efforts.”
Brown, whose above-and-beyond attitude and determination ultimately prevented a possible measles outbreak, agreed. “Without the partnerships we had in place and Penn’s focus on emergency preparedness, I don’t think this could have happened.” Wierzbowski, whose connections allowed him to serve as the linchpin for the process, echoed this. “This was a great example of our line of work in Emergency Management, the mutual aid process, and the strong relationships we have at the regional, state, and federal levels.”