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MEASELS OUTBREAK

Lily (Bertha) Gonzalez

Concordia University Nebraska

12/08/15

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MEASLES OUTBREAK

Measles is a respiratory and acute viral disease that can lead to complications such as

pneumonia, encephalitis and death. Measles is highly contagious, as it is a virus that naturally

lives in the nose and throat mucus of an infected person, it can spread to others through coughing

and sneezing. This virus can live for up to two hours in an airspace where the infected person

coughed or sneezed. If other people breathe the contaminated air or touch the infected surface,

then touches their eyes, nose or mouth, they can become infected. (CDC 2015).

In 1954, John F. Enders and Dr. Thomas C. Pebbles collected and isolated the measles

virus in a 13 year old boy named David Edmonston. Later in 1963, they transformed the B-strain

of measles into a vaccine and licensed it in United States the same year. In 1968, the vaccine was

improved by Dr. Maurice Hilleman and began to be distributed the same year. This has been the

only measles vaccine used in the United States since 1968. Before the vaccine was available, the

number of people infected with the measles was probably about 3.5 million cases per year.

However, the CDC admits that there was a massive underreporting of measles cases, as virtually

all children acquired measles. (CDC 2014)

Measles was declared ‘eradicated’ (absence of continued disease transmission for greater

than 12 months) from the United States in 2000, thanks to the highly effective vaccination

program and better measles control in the Americas region. (CDC 2014). But, from the year

2007 to present, there have been more and more measles cases reported, including the major

outbreak from California in January of 2015. (National Vaccine Information Center N. D). This

happens in people who are not immunized, especially children. The best weapon against the

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disease is the vaccine. Therefore the CDC and other health officials are asking the general

public, especially children, to get immunized.

Measles Outbreak

According to the CDC, from January 1st to November 13 of 2015 there have being 189

cases of measles in 24 states and the District of Columbia. Most of these cases (113 cases 60%)

were part of a large outbreak in an amusement park in California. They believe that the outbreak

started from an infected traveler who visited the park. (CDC 2015). Considering that the major

outbreak happened in a recreational park where hundreds or maybe thousands of families,

especially children, come from different parts of the nation and of the world, the first thing that I

will recommend is to close the park temporarily. The measles virus is highly contagious and can

live in the air for up to two hours. 90% of the people who are not immunized and are close to an

infected person will become infected (CDC 2015). This park receives approximately 24 million

people per year, including many international visitors from countries where measles is endemic.

(CDC 2015) Leaving this park open after the exposure increased the risk for an outbreak; and

this was exactly what happened.

After closing the center I would create a national/ international press release in different

languages to inform the entire nation about the outbreak. Grantmakers in health recommend the

following to structure the message in a clear and concise manner. Three questions should be

asked and answered: 1) What is wrong? 2) Why does it matter? and 3) What should be done

about? Let’s analyze this press release from the CDC 2015.

In January of 2015, the California Department of Health (CDPH) was informed about a

suspected measles cases. The patient was an 11 year old child, unvaccinated, with rash onset on

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December 28. The patient was hospitalized. During the exposure period the child visited the

Disney Park located in Orange County. On the same day, CDPH received reports of four

additional suspected measles cases: two California residents and two Utah residents, and all the

cases visited one or both Disney parks during the time frame of December 17 to 20. There had

been seven confirmed cases of measles in California by January 7. (CDC 2015). This

information answers the first question: Measles outbreak is the problem. Now, what is the

message for the families? Why do they need to worry about it? What does it matter? According

to Morrow 2009, people need to perceive the nature of the risk and need to understand the

probability of being affected. Therefore, I would add this to the message: “Measles is a highly

contagious disease and is very easily transmitted, because the virus spreads through the air when

an infected person coughs or sneezes and the droplets of saliva remain contagious for up to 2

hours afterward. The rash of measles may not appear for several days and people with measles

may not realize they are sick until they have contaminated others. Measles can be very

dangerous, especially for babies and young children. Measles can also cause serious

complications including brain damage. 1 or 2 out of 1000 people with measles will die, even

with the best care. Now the families would know why they need worry about it. The last

question we need to answer is: what can be done about the problem? In this particular situation

the outbreak was in California, but residents from the entire country could have been exposed to

measles, since the person infected with the virus could travel throughout the country through

airports, busses, trains and other public places where they could ostensibly come into contact

with hundreds of others who would then also be exposed to the virus. Here is the message for the

measles of what they can do about it: Unvaccinated children are at higher risk to be infected with

the measles virus. Health officials and the Center for Disease Control and Prevention urge the

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entire community to get vaccinated; parents have the power to provide to their children long-

lasting protection with the vaccine. (CDC N.D). Based on the philosophy of Morrow 2009, now

the families can perceive the nature of the risk and can understand that there is a strong

possibility to be infected. After understanding the problem, they are able to make an educated

decision on vaccinating their family to prevent infection.

To promote the press release and other important message related to the outbreak, I

would use the most wide spread media sources, to make sure that I reach all the different

demographics in my community. I would include television news (through the most popular

morning and evening shows), radio (morning and evening news and other popular shows). These

two media vehicles can reach several rural areas, particularly the radio. I know this from my own

experience. I’m the host from a local radio health show, and we have received phone calls from

very isolated areas. I would also include other modern media tools like Tune-in radio, Facebook,

Twitter and Instagram. These media vehicles have national and intentional broadcasting

potential, and are very popular, especially with young and middle-age groups. If possible, I

would also include magazines and handouts that are distributed in airports, busses, trains, and

maritime terminals, to include potential emigration terminals. By doing this, I would create

awareness of the measles virus and the possibility to get infected as a traveler. In Yakima, for

instance, farm workers migrate from California and Oregon to Washington following the

agricultural season. After they finish the work season in Washington, some of them move to

Alaska for fishing, therefore it is critical to cover the borders. I would also include the

newspaper, which is a traditional media tool within the senior community here in Yakima.

Lastly, I would include non-traditional publicity, such as church and school bulletins or notices,

announcements in grocery stores, bakeries, laundromats, warehouses and other agricultural areas.

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From a marketing assessment that Memorial hospital did few years ago, we learned that these

non-traditional media vehicles are some of the most effective for the Latino population. Finally,

to make sure that I reached all of the different groups in the community, I would send the press

release or message to public and private clinics and hospitals and to public and private early

learning centers.

To ensure the understanding and compliance with the message, I would research my

target community first; besides cultural expectations and beliefs, I would like to know their

demographics, language preferences and ages in order to tailor the message to the specific

community. I might need to create a different version of the message and in different languages.

For example, in Yakima, WA (my hometown), almost 41% of the community are Latinos, and

many of them (especially the seniors) have numeracy and literacy barriers. We also have

American Indian and Alaska Native (1.9 %), Black or African American (1.7 %), Asian (1.5%)

and Caucasian or white (67.1 %) according to the United States Census Bureau 2015. Based on

this data for the Yakima Valley, I would develop the messages in at least English and Spanish,

and I would choose different voices and faces to deliver the message. Morrow 2009 recommends

using trusted messengers to be more successful with the message. Grantmakers in health

recommends utilizing authentic voices for the message to gain power. Including people from

different ethnicities to be the messengers, this strategy would help to make the message

perceived as welcome, accepted and safe from the receiving population. Another important thing

that I would consider when developing the message is the level of education of the different

ethnicities. In Yakima, 72.3 % have a high school diploma only, and 17 % have a bachelor

degree or higher education (United States Census Bureau 2015). Therefore I would write the

message in clear, simple and concise language, and if possible I would use pictures or symbols to

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make the message easy to understand. An example of what I would do can be found at this link

from the Center for Disease Control and Prevention.

http://www.cdc.gov/measles/downloads/measles-infographic.pdf

To ensure the compliance for the Latino community, I would make sure that the Latino

families have access to primary healthcare providers to get their vaccinations. Some families

may be new residents in the community; therefore I would partner with the school district to

include the message within the information they send home with the students. I would also attend

some school community meetings to ask the people directly for possible barriers and to address

some questions or concerns. According to Morrow 2009, there are many cultures that need to be

studied and understood in todays’ communities. Every one of these cultures has their own

beliefs and expectations about health. Keeping this in mind, I would ask for the collaboration of

community leaders from different ethnic groups to ensure culturally and linguistically sensitive

messages. These leaders or collaborators could help me to ensure the compliance of the message

as well.

One last recommendation to ensure compliance would be to utilize the rule of three; if

they hear it once, they might ignore it, if they hear about it from another source, they may stop

and think, if they hear about it a third time, they may take action. (Fenton 2001)

To avoid panic, I would develop a sensitive message to the audience which would be

personal, concise, and appeals to emotions without inducing fear, and which also recognizes their

socio economic or language barriers, stresses the benefits of obtaining the vaccine, and uses

trusted messengers. Morrow 2009 stated that “Trust and credibility can be particularly important

and difficult in poor and minority communities. Some of the tendency to distrust arises from

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their knowledge that they probably bear more risk than others.” A strategy that we have been

using with the Latino Community in our area is a community based approach, this help as to

build the bridge and break the fear. I have also worked with some community leaders like

priests/pastors of local churches, teachers, and other community centers delivering important

health screenings and critical health messages. I have found this to be a very efficient method of

information delivery and education and a good way to interact with the families, to know them

better and to answer any possible questions or concerns. Morrow 2009 stated that “An effective

way to change risk behavior is by facilitating community interactions to address the issue” he

also say that effectiveness depends on development or arguments based on the values, interests

and needs of the targeted audience.

The communication for persuasion model was developed by McGuire and can be used to

examine the behaviors of the consumer in response to the message. McGuire developed the

Information Persuasion model (IPM) as well; this proposes three factors that can influence a

persons’ choice: 1) an external factor-- for example: price and location, 2) an internal directive

factor--for example: individual attitudes or beliefs, and 3) internal dynamic factors--for example:

demographic characteristics such as age or ethnicity. McGuire argues that the internal factors

influence or change the message as it moves through the communication-persuasion model. The

communication persuasion model can be characterized as an input-output matrix that can be

manipulated and measured to achieve a change. This theory is relevant to my case, because it

helps me to understand that if I guide my health message according to the internal directive

factors of the individual (attitudes, beliefs, demographic, age and ethnicity), I could then

persuade the individual to make a change, and I could build a sensitive message to them. For

example, many Latino families focus on family values and traditions, and say that they would

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like their children to have what they were never able to have. Keeping that in mind, I would

craft my message as written below:

“Children are our most precious treasures.

We have the best gift for them for this season:

long lasting love and protection against harmful illness.

Please, immunize your child.”

The Cultivation Theory states that those individuals that watch TV for longer periods of

times are more susceptible to media messages; they believe that these messages are real and

valid. Heavy viewers are exposed to more violence and they are affected for the Mean World

Syndrome, which is the belief that the world is far worse and dangerous than it actually is. This

theory suggests that television and media have a small but significant influence on the attitudes

and beliefs of the society about the society. (Mass communication theory N.D.). In general, Mass

Media and Cultivation Theory are very relevant to my message because it shows me the

powerful value of television and the influence of the content of my messages. Based on this

information I would be very strategic of developing the message for television (short, clear,

personal, cultural and linguistically sensitive to the vulnerability of the specific community).

The collaboration of different agencies is fundamental to achieve a mega

campaign and control the cases of measles. Also, it is crucial for health providers and the

general public to be updated on the outbreaks, as well as to find practical information to control

and prevent measles. Some of these agencies are: the Center for Disease Control and Prevention,

the American Academy of Pediatrics, the American Academy of Family Physicians, The

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Washington State Department of Health, the National Institute of Health, other local agencies

include the Yakima Health District, the Department of Health and Social Services, the National

Vaccines information Center, the Food and Drug Administration and the Vaccine Adverse Event

Reporting System.

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Recommendations

When communicating important health messages to the public, it is fundamental to know

the target population. Knowledge of the cultural expectations, beliefs, age and other important

demographic characteristics of the individuals will be fundamental for developing a culturally

and linguistically sensitive message. Finally, to ensure that people are compliant in getting the

vaccination; I would recommend that a system of data gathering is put into place; so that the

numbers of people who are vaccinated after the message has been released are recorded and put

into a data base. This would further inform the efforts to get as many people vaccinated as

possible to prevent serious outbreak problems. When developing a plan for communication of

this type of crucial health-related message, it is essential to implement some of the theories and

models of communication I have discussed in this paper.

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Conclusion

In order to create health messages that ensure the positive response of individuals in the

community, it is critical to know the target population. The acknowledgment of their cultural

expectations, values, interests and needs will help health officials to tailor a safe and well

received message for the specific community it is targeting.

This paper explained essential points to communicate a critical messages like to measles

outbreak to different communities, it also include examples of personal experiences/community

intervention used in the Yakima Valley.

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Reference

Center for Disease Control and Prevention. (2014). Pre-Vaccine Era. Retrieved from

http://www.cdc.gov/measles/about/history.html

National Vaccine Information Center. (N.D.). What is the History of Measles in America and

Other Countries? Retrieved from

http://www.nvic.org/vaccines-and-diseases/measles/measles-history-in-america.aspx

Center for Disease Control and Prevention. (CDC). (2015). Morbidity and Mortality Weekly

Report (MMWR). Retrieved from

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6414a1.htm

Center for Disease Control and Prevention. (2015). Measles Cases and Outbreaks.

http://www.cdc.gov/measles/cases-outbreaks.html

Grantmakers in Health. Communicating for Policy Change. (2007). No. 29

United States Census Bureau. (2015). State and County QuickFacts. Retrieved from

http://quickfacts.census.gov/qfd/states/53/5380010.html

Center for Disease Control and Prevention. (2015). Measles Outbreak – California, December

2014 – February 2015. Retrieved from

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm#Fig

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Center for Disease Control and Prevention. (N.D). Measles it isn’t Just a Little Rash. Retrieved

from

http://www.cdc.gov/measles/downloads/measles-infographic.pdf

Morrow, B.H. (2009). Risk Behavior and Risk Communication Synthesis and Expert Interviews.

Retrieved from

https://coast.noaa.gov/digitalcoast/_/pdf/risk-behavior-communication-report.pdf

Corcoran, Nova. (N.D.). Theories and models in communicating health messages. Retrieved

from

http://www.corwin.com/upm-data/13975_Corcoran___Chapter_1.pdf

Mass Communication Theory (N.D.). Retrieved from

http://masscommtheory.com/theory-overviews/cultivation-theory/

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