1. Lilian Peake, M.D., M.P.H. District Health Director Thomas Jefferson Health District Virginia Department of Health

2. Health Department’s Role in an Outbreak Is this an outbreak of a communicable disease ? What is the potential impact? Epidemiological investigation & on-going surveillance for cases What controls can be placed to prevent spread of disease? Quarantine & monitor exposed Provide preventive treatment Isolate ill persons Inform, educate & coordinate with healthcare community, first responders, officials & public Assistance with sheltering; mortuary support; mass care Environmental health monitoring & controls Could this be bioterrorism?

4.  Identify community partners  Establish communication systems  Routine coordination and collaboration

5.  Letters  E-mail  Blast Fax  Website  Facebook  Conference Calls  Post signs  Call centers  Web-based systems  Others?

6.  Disease Reporting Epi-1  Infection Control Committee  Emergency Planning Committee LEPC  Communications

7. A public health message from www.vdh.virginia/LHD/ThomasJefferson Un mensaje de salud publica de www.vdh.virginia/LHD/ThomasJefferson Vital Signs is a community health promotion column sponsored by Martha Jefferson Hospital, Region Ten, Thomas Jefferson Health District and the University of Virginia Health System. Dear Dr. Hoke:

8.  Health Department  Hospitals  Local governments  University & colleges  Schools

9. www.communityemergency.org

11.  Identify partners  Establish communication systems  Develop shared guidelines, communications  Share data

12.  In-person meeting(s) with partners  Agree on system for regular communication throughout outbreak

13.  Private provider reports suspected case of measles in an elementary school student  Places where contact may have occurred  Media  VDH Office of Epidemiology  DCLS – state public health laboratory  Neighboring local health departments  CDC  Community physicians Urgent Care  Hospitals Hospital Epidemiology & Infection Control Lab Emergency Department  School Students & Families Staff Administration School Board

14. HEALTH ALERT To: Providers in Thomas Jefferson Health District From: Lilian Peake, M.D., M.P.H, District Health Director Date: May 25, 2011 Re: Additional Measles Cases Two cases of measles…

15. PVCC Anita Showers Mary Jane King UVA Peter Jump Costi Sifri, MD Kyle Enfield, MD Beth Mehring TJHD Lilian Peake, MD Peggy Brown Paviour VDH Suzi Silverstein Cheryle Rodriguez Maribeth Brewster PVCC TB Investigation Communications Conference Call 9/29/10 Decisions:

16. Attention Valued Customers IMPORTANT MEASLES HEALTH ALERT NOTICE If you were outside of the Paramount Theater MAY 20, 2011 BETWEEN 4:30 PM AND 8:30 PM Please call Virginia Department of Health Hotline at 2-1-1

17. You may receive free testing at the Charlottesville-Albemarle Health Department during a special clinic just for PVCC students. To make an appointment, please go on-line at www.vdh.virginia.gov/AppointmentCenter. www.vdh.virginia.gov/AppointmentCenter

18. Instructions for Collecting Suspected Measles Specimens – Updated 6/3/11 *Use airborne and droplet precautions while collecting specimens* Adult Serum Testing: Exclusion Assessment Tool for Health Care Workers Exposed to Measles The purpose of this assessment tool is to assist public health, infection control practitioners, and doctor’s office/ clinic staff in evaluating the exposure of workers in a healthcare setting. These are general rules and may be updated as additional information becomes available.

19. Isolation for Suspected or Confirmed Measles Immediately place a mask on the patient. Do not allow the patient to remain in the waiting room… Immediately call Infection Prevention and Control at PIC 1243 from 8:00 AM – 5:00 PM and PIC 9204 at other hours. IP&C will communicate with the health department and coordinate transfers if needed. For any questions or concerns, please call Infection Prevention & Control Phone 924-0260 PIC 1243 (8 AM – 5 PM) Costi Sifri, MD Hospital Epidemiologist

20. Thomas Jefferson Health District H1N1 Update - 7/27/09 Novel Influenza A (H1N1) continues to circulate in our community and throughout Virginia… Thomas Jefferson Measles Investigation – Talking Points May 16, 2011 The Virginia Department of Health is currently investigating a suspected case of measles in a resident of the Thomas Jefferson Health District…

21.  Designated spokespersons  Joint interviews  Joint PSAs

22. K EY M ESSAGE 1K EY M ESSAGE 2K EY M ESSAGE 3 The Charlottesville/Al bemarle HD confirmed four cases of measles. The outbreak highlighted the importance of vaccination against measles. Because measles still occurs in other countries and there some large outbreaks are occurring in Europe, there is an ongoing risk of imported cases in our community. Scenario: Measles Update Stakeholder: General Public Concern: Misinformation

23. VDH Measles Frequently Asked Questions and Answers Updated 5/26/2011 FOR CALL CENTER USE ONLY – NOT FOR PUBLIC DISTRIBUTION 1.What is measles? Measles is a very contagious, vaccine-preventable viral disease with an incubation period of approximately 10 days (range 7– 21 days) from exposure to rash onset.

24. October 4, 2010 (First Name, Last Name) (Address 1, Address 2) (City, State Zip) Dear (First name): As a student at Piedmont Virginia Community College your health and safety is a primary concern to us. We have identified you as someone who may have been exposed to tuberculosis (TB)…

25. Thomas Jefferson Health District Epidemiology of Cases* Related to 2006-07 Mumps Investigation Last Updated:3/15/07 Table I. Total Number of Mumps Cases by Case Status Number of Cases Confirmed19 Probable45 Total64 Table IV. Cases by Status Number of Cases Undergraduate students 51 Graduate and professional students3 Non-medical faculty and staff0 Medical faculty and staff1 Other0 Total55 Please note that numbers are subject to change as additional information is received about the cases. *Case definitions: Clinical Case Definition - An illness with acute onset of unilateral or bilateral tender, self-limited swelling of the parotid or other salivary gland, lasting two or more days, and without other apparent cause.

27. THOMAS JEFFERSON HEALTH DISTRICT MEASLES OUTBREAK INVESTIGATION AFTER ACTION REPORT/IMPROVEMENT PLAN JUNE 15, 2011