100% of Trader Joes employees were either vaccinated, excluded

MDPH Public Health Fact Sheet on Measles
“Measles is more easily spread than almost any other
disease. The virus that causes measles lives in the nose
and throat and is sprayed into the air when an infected
person sneezes, coughs or talks. It can stay in the air
for up to 2 hours. Other people nearby can then inhale the
virus. Touching tissues or sharing a cup used by
someone who has measles can also spread the virus.
People with measles can spread the disease 4 days
before the rash begins until 4 days after rash onset. The
first symptoms appear 10 - 14 days after a person is
exposed.”
TRADITIONAL
National Disease Reporting Pathway
Healthcare
Providers
Institutions
Others
Local Boards of Health
State Health Department
CDC
Labs
Reporting Pathway for Measles
Framingham
Restaurant
Framingham
Corporation
Framingham
Supermarket
Framingham Board of Health
Massachusetts
Department of Public
Health (MDPH)
The Public
Framingham
Restaurant
Framingham
Corporation
MDPH
Framingham
Supermarket
Public
Call case: family, significant others
Framingham BOH
Call from SLI to BOH + PCR for
Pertussis
Arrange for immunization at
worksites (1 x 2, 1 x 1, 1 x 2)
Send sample letters for worksites
Receive confirmation with copy of
lab
Call providers: vaccination history
on high risk
Contact case: ID employers: exclude
Report to worksite on exclusions
Call worksites: identify CC,
exclusions
Complete confidential case report
MMR Clinic at BOH office for public
MMR
5
Basic Measles Timeline: History of Case Definition
Clinic at
Samba.
Period of Infec tivity
Bose
outbreak
Periordof Exclusion
Feb.
15
Feb.
16
Feb.
17
Feb.
18
Feb.
19
Feb.
20
Feb.
21
Feb.
22
Feb.
24
Feb.
23
Feb.
25
Preparations
1st Clinic TJ
Fever onset
Rash onset
Case went to PCP
First call from MDPH
Presumptive
Possitive lab
2nd Clinic TJ
PCR NP (+)
IgM (+)
February 19th (Wednesday)
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First Call from Epidemiologist at DPH Steve Flemming: suspect case.
Review Lab Results (MAVEN) (Probably NOT measles)
Contact suspect case
 Review suspect case history of illness (started feeling ill on Feb. 15)
 Review suspect case history of exposure sites (work and a restaurant)
 Contact employer and obtain list of co-workers (General Manager)
 Communicate with TJ Corporate Office (California)
Reviews TJ History (no float staff, trainings, meetings, corporate events)
Review employee list for high risk co-workers
Have additional vaccine delivered
Screening questionnaire developed (DOB, prior vax history, risk factors, exposure)
February 20th (Thursday)
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Review Lab Results (MAVEN) with Epi: “Strong test result” (it wasn’t until Feb. 24th
that we would know the PCR and NP swab was (+) for measles and serum was IgM
(+) for measles through HSLI.
Identified 57 Co-worker contacts
Identified 1 high risk co-worker (pregnant female; advised to contact ObGYN)
Plan clinic for co-workers within 24 hours. 2 MMR clinics were provided on
Saturday and Monday to capture all exposed employees and recover immunization
validations.
February 21st (Friday)
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Tests and History obtained: strong test result, proceed as a case. confirm rash
onset date and time, where he went prior to rash onset
exclude employees who cannot provide evidence of immunity or vaccination 2/21
(DPH allowed employees until 2/24 to provide it due to weekend)
Exclusion period established as 2/24 through 3/10.
Case travel history: 2/13 , 2/14 worked at Trader Joes 9-5, worked as a musician at
Conquoria Mexicana on Friday (that site was later excluded due to rash onset date)
2/15 Saturday: worked at Trader Joes 9-5,. went to dinner at Sambas on Route 9
Framingham, then home (not feeling well) 2/16 Sunday worked at Trader Joes 9-5
2/17 Monday off, 2/18 Tuesday off, 2-19 Wednesday went to doc because he woke
up with a rash (woke up at 4am), 2-10 Thursday home, wife vaccinated by her PCP
with MMR.
Second case identified at Bose Corporate to Framingham BOH to assist with clinics
February 22nd (Saturday)
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Complete employee list received from Corporate TJ
First of 2 MMR clinics 4-6 pm at the Supermarket
Public Health Fact Sheets distributed at the counters
Exposed employees provided proof of immunity or were vaccinated
(Note: flu shots were also offered to the employees and nearly 30% accepted this
opportunity to be vaccinated against influenza at the same time).
February 23rd (Monday)
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Second of 2 MMR clinics 11-3 pm at the Supermarket
Exposed employees provided proof of immunity or were vaccinated
Vaccine received from DPH for Bose
Additional vaccine requested
Secured supplies from BOH EDS Trailer for clinic
Media on site at BOH, supermarket
Press release distributed to mainstream media
February 24th (Tuesday)
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First of 2 MMR clinics at Bose (approx. 300)
Exposed employees provided proof of immunity, vaccinated or were excluded
Media is providing updates
Media on site at BOH, supermarket
Press release distributed to mainstream media
Single MMR Clinic at restaurant, all but 1 employee vaccinated, showed proof of
immunity. One was excluded.
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February 28th (Friday)
Second of 2 MMR clinics at Bose (approx. 300)
Exposed employees provided proof of immunity, vaccinated or were excluded
Media is providing updates
Another measles case was identified at BOSE on March 1st
His rash onset was 2/13. He was seen at CVS minute clinic in Sudbury on 2/13 so
exposure occurred there. He drove to Rochester NY to visit family from 2/15 to
2/17 (so some exposures may have taken place there) . All family has been
informed.
Hotline Telephone Message
“There is one confirmed case of measles in Framingham. Measles is a highly
contagious disease. If you work or were a patron inside Samba Restaurant on
Saturday February 14th between 5:30 and 9pm or If you work or were a patron
inside Trader Joes in Framingham on Saturday February 15th or Sunday February
16th during the hours of 9am – 5pm you may have been exposed to measles. The
Framingham Board of Health is working closely with the Massachusetts Department
of Public Health authorities to notify those who are at risk. Most people born before
1957 are immune. Most children who attend public schools in Framingham have
received their measles shot in a combination vaccine; MMR. For those who have
NOT been vaccinated or are unsure of their vaccination history, you may ask your
doctor for your vaccine history. If you believe you might be at risk or if you have
questions, it is recommended that you contact your physician or the Framingham
Board of Health 508-532-5472 or the State Department of Public Health 617-9836800 Detailed information about measles is on our website
www.FraminghamMa.gov and on the state Health Department Website. The Board
of Health is providing MMR vaccine to those who may have been exposed during the
clinic hours of 8:30 -= 9:30 and 4-4:45 daily Monday through Friday.”
Measles Alert Messages
This notice was
posted on doors
and windows of
both the Restaurant
and Grocery store.
Media helped deliver the message.
Media helped increase awareness.
 WCVB-TV Channel 5
 Channel 7 Eyewitness News
 Framingham PATCH
 NECN
 Metrowest Daily News
WBZ-Boston
Channel 4
• Trader Joes work site: half the employees at this store are Framingham residents. Half
reside in neighboring communities.
• 27.9% of those vaccinated with MMR also accepted a flu vaccination (CDC
recommends offering to vaccinate with Flu at every patient encounter).
• 100% of Trader Joes employees were either vaccinated, excluded (none) or
provided proof of immunity by 2/25
• 100% of Samba employees were either vaccinated, excluded (1) or provided
proof of immunity by 2/26
Considerations
1. Investigations of infectious disease doesn’t end at the town line; ask
DPH to “Share” MAVEN ID with sister communities impacted.
2. Swift attention to media fosters future health reporting needs.
3. Staff were immediately hi-jacked to attend to control efforts.
4. PHN activities were suspended (consider workforce limits, how
continuity of operations can be maintained).
5. BOH Hotline message had a delay (recent work on telephone lines).
6. Notify community partners (EMS, Emergency Management, Hospitals)
early in the process. (How early?)
7. Culture of employees/shoppers at TJ can be “organic” (some were
less inclined to vaccinate). Increased educational efforts.
8. Culture of restaurant employees may undervalue significance of the
disease or vaccination .
9. Sensitivity to the PR needs of corporate image.
10. Occupational Health and Public Health worked well together.
11. Private vaccinators may not have clinical supplies (depends)
12. EDS supplies of needles/syringes were for IM (flu assumptions)
March 21st, 2014
No new cases identified.