In 2000, the United officials sent out emails and posted on States declared the Facebook, Twitter and Instagram to ask measles eliminated, anyone who may have been at the library to thanks to widespread come forward. use of vaccines. But the Working together, Cal State and county virulent disease is back, health officials came up with a list of 1,094 with more than 1,000 cases confirmed people who were exposed; all were required nationwide this year through to present proof they had been vacciJune 3—the greatest number nated or had immunity. “We shouldn’t since 1992. For every At one point during the thousand cases, 1 to 3 investigation, 887 people have to be using people with measles were under a blanket these ancient techniques. will die, even with quarantine order from We should have everybody the best of care, the Los Angeles according to the immunized. That’s what keeps me County Department U.S. Centers for of Public Health until up at night. If we stop vaccinating, they could establish Disease Control we can turn the clock back to the their immunity and Prevention. So public health status. Middle Ages.” departments are Public health Alan Melnick, redirecting scarce departments regularly resources to try to employ this sort of shoedirector of public health in Clark control the spread. leather detective work to County, Wash. Using basic techniques track and control outbreaks in place for over 100 years, of sexually transmitted diseases public health investigators work and foodborne illnesses like salmonella. to control an outbreak before it balloons. But there is a palpable sense of frustration Such investigations have evolved with that sets the measles apart: It is easily new technologies but remain among the preventable. best defenses against infectious disease “We shouldn’t have to be using these outbreaks—and among the great untold ancient techniques. We should have everycosts of an epidemic. body immunized,” said Alan Melnick, direcThe New York City Department tor of public health in Clark County, Wash., of Health and Mental Hygiene, which which logged 71 measles cases during a has confirmed 566 measles cases since two-month outbreak that ended in February. September, has spent more than $2.3 million “That’s what keeps me up at night. If we on related investigations. The Los Angeles stop vaccinating, we can turn the clock back County Department of Public Health to the Middle Ages.” estimates spending as much as $2,000 to track down each contact of a confirmed patient—and it has made hundreds of such efforts in recent months. “Public health departments across the In the course of Clark County’s outbreak, country have had their budgets tightened in 237 people spent 19,071 hours doing a sustained fashion over the past 15 years,” outreach, investigation and monitoring said William Schaffner, an infectiousthe health of people exposed, at a cost of disease specialist at Vanderbilt University. more than $864,000. They investigated 53 “There are no public health departments that exposure sites, including 15 schools and the are like firemen playing pinochle and waitarena where the Portland Trail Blazers play ing for an outbreak. They have other things just across the state line in Oregon. to do, and they have to put aside those tasks All this work meant delays in other to deal with an outbreak.” programs, including restaurant health At Cal State LA, public health officials inspections and a home-visit program for visited the library and tried to figure out high-risk pregnant women and infants. exactly where the infected student had “Just because the measles outbreak is gone—the photocopy area, for example—to going on, it doesn’t mean other commudetermine who might have been nicable diseases are taking a holiday,” exposed. They worked with the Melnick said. school to identify which library There was a time public health officials employees were present. They wouldn’t have bothered. Before the scoured library records to find late 19th century, officials “were busy anyone who had checked out trying to control diseases like typhoid, books or logged onto a library
Costly and distracting
computer during the specified time period. But they realized they were missing others who may have come in to browse, work or eat at a library cafe. So school
“the measles detectives ” continued on page 18
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