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It’s 5pm the Day Before a Holiday – Michigan Public Health Responds to Vaccine-Preventable Diseases
Tiffany Henderson, MPH, Regional Epidemiology Unit Manager
Bethany Reimink, MPH, Region 5 Epidemiologist
Meghan Weinberg, MPH, PhD, Region 1 Epidemiologist
To protect children and their peers from outbreaks of vaccine-preventable diseases at school, Michigan students must receive a minimum of six different immunizations, unless they receive a medical, religious, or philosophical waiver. In 2022, overall Michigan waiver rates rose to 4.8% which is the highest since 2014, leaving many children susceptible to disease.1
When vaccine-preventable disease cases are reported, local health departments (LHDs) investigate and recommend prevention control measures including post-exposure prophylaxis and exclusions of susceptible contacts. Recently, LHDs have been investigating cases of pertussis and chickenpox among students.
In late November, nurses at two LHDs were independently investigating newly referred pertussis cases among their residents. Through detailed public health investigations and strong Regional Epidemiologist connections it was quickly discovered that the children, who lived in different counties, attended the same school and may have even shared classes. As luck (or Murphy's Law) would have it, the connection was made late in the day before the long Thanksgiving Holiday break. Complicating the response further, the school had closed the day prior, leaving only a recorded message that they would re-open the following week. With two identified cases and reports of additional students coughing in the school, there was serious concern about further disease transmission, particularly during gatherings and family visits over the holiday that may include infants who cannot be fully vaccinated and are at higher risk of severe illness. The health department continued to pursue multiple avenues of outreach to the school until they were able to connect, afterhours, with the school’s administration. The school agreed on the importance of notifying the school community so they could take appropriate steps to protect their families and others over the holiday. The health department provided the school with a “ready-to-issue” letter and by 9:00pm that evening, a schoolwide email notification had been sent. Although impossible to quantify, the prompt public health actions taken that day likely prevented transmission to others over the holiday.
Around the same time, another LHD was investigating and responding to a chickenpox outbreak in a school with a high immunization waiver rate. After the first case was reported by the school, the health department encouraged the healthcare provider to confirm the diagnosis with testing. The comprehensive public health case investigation discovered that the case had attended school while infectious. This prompted the health department to contact school officials, who agreed to notifying families of the potential exposure. After the notification letter was sent, additional cases were reported from multiple grades. During chickenpox outbreaks, it is often recommended to exclude exposed persons who cannot provide documentation of varicella immunity. The exclusion period for chickenpox is 21 days after the last identified outbreak case. Because of the number of cases reported from the school and the multiple grades impacted, the health department recommended schoolwide exclusions. The outbreak continues to be monitored and once cases stop being reported, a final exclusion date will be determined.
These two recent responses highlight the importance of getting and staying up to date on all recommended vaccinations to prevent illness and to keep children learning in the classroom. Routine immunization coverage has been negatively impacted by the COVID-19 pandemic. Using the most recent data from the Michigan Care Improvement Registry (MCIR) for children 19-36 months old completion of the primary childhood series is 69% statewide, down from an annual average of 74% in the year before the pandemic. Lower coverage for routine immunizations can place communities at risk of outbreaks of vaccine-preventable diseases like measles, chickenpox, and pertussis (whooping cough). Outbreaks of these diseases can lead to hospitalizations, disruptions of school and childcare, and can place a burden on the health care system. Michigan school immunization data can be found at School Immunization Data (michigan.gov). Annual summaries of vaccine-preventable diseases in Michigan can be found at: Vaccine Preventable Diseases in Michigan - Annual Summaries.
1 Michigan Department of Health and Human Services, Division of Immunizations, Immunization Status of School Children in Michigan, 2022.
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NETEC: New Anthrax Vaccine Added to Arsenal of Defense Against Bioterrorism
Anthrax continues to pose a significant public health concern due to its potential use as a bioterrorism agent and its ability to cause severe illness in humans. However, this summer a new anthrax vaccine was added to the U.S. arsenal of defense against bioterrorism. On July 20, 2023, the United States Food and Drug Administration (FDA) approved Cyfendus for use in adults aged 18 to 65 years exposed to anthrax. Learn more and view resources from NETEC about anthrax preparedness.
Travelers Health Headlines
These are the Travelers Health headlines that are noteworthy from the past month:
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CDC Guidelines for the Prevention and Treatment of Anthrax, 2023
This report updates previous CDC guidelines and recommendations on preferred prevention and treatment regimens regarding naturally occurring anthrax. Also provided are a wide range of alternative regimens to first-line antimicrobial drugs for use if patients have contraindications or intolerances or after a wide-area aerosol release of Bacillus anthracis spores if resources become limited or a multidrug-resistant B. anthracis strain is used. (Hendricks KA, Wright ME, Shadomy SV, et al.; Workgroup on Anthrax Clinical Guidelines. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20:e130687; Meaney-Delman D, Rasmussen SA, Beigi RH, et al. Prophylaxis and treatment of anthrax in pregnant women. Obstet Gynecol 2013;122:885−900; Bradley JS, Peacock G, Krug SE, et al. Pediatric anthrax clinical management. Pediatrics 2014;133:e1411-36). Specifically, this report updates antimicrobial drug and antitoxin use for both postexposure prophylaxis (PEP) and treatment from these previous guidelines best practices and is based on systematic reviews of the literature regarding 1) in vitro antimicrobial drug activity against B. anthracis; 2) in vivo antimicrobial drug efficacy for PEP and treatment; 3) in vivo and human antitoxin efficacy for PEP, treatment, or both; and 4) human survival after antimicrobial drug PEP and treatment of localized anthrax, systemic anthrax, and anthrax meningitis.
Changes from previous CDC guidelines and recommendations include an expanded list of alternative antimicrobial drugs to use when first-line antimicrobial drugs are contraindicated or not tolerated or after a bioterrorism event when first-line antimicrobial drugs are depleted or ineffective against a genetically engineered resistant B. anthracis strain. In addition, these updated guidelines include new recommendations regarding special considerations for the diagnosis and treatment of anthrax meningitis, including comorbid, social, and clinical predictors of anthrax meningitis.
The previously published CDC guidelines and recommendations described potentially beneficial critical care measures and clinical assessment tools and procedures for persons with anthrax, which have not changed and are not addressed in this update. In addition, no changes were made to the Advisory Committee on Immunization Practices recommendations for use of anthrax vaccine (Bower WA, Schiffer J, Atmar RL, et al. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices, 2019. MMWR Recomm Rep 2019;68[No. RR-4]:1–14). The updated guidelines in this report can be used by health care providers to prevent and treat anthrax and guide emergency preparedness officials and planners as they develop and update plans for a wide-area aerosol release of B. anthracis.
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NEW - Weekly Updates on Fall and Winter Virus Season
The CDC and public health partners are working to help people protect themselves this fall and winter virus season, when COVID-19, flu, and RSV are spreading at the same time. You can use CDC's new web tool to find weekly updates on respiratory viral illness activity in the United States or in your area, along with other key data on whether things are getting better or worse, and who is most affected by serious consequences such as hospitalizations or even deaths. Visit our respiratory illness website to learn how to stay safe, find resources and toolkits, and stay updated with the weekly viral respiratory illness snapshot.
PHEP Connects Webinar recording now available
Public Health and Education Collaborations to Support Emergency Preparedness
This webinar discussed the benefits of establishing and maintaining public health and educational agency partnerships and highlights emergency preparedness planning with schools, the intersection between public health and schools, and the logistics of working with schools to improve community preparedness.
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ICS 300 sessions
This course provides training on and resources for personnel who require advanced application of the Incident Command System (ICS). The course expands upon information covered in the ICS-100 and ICS-200 courses. The course objectives are to describe how the National Incident Management System (NIMS) Command and Management component supports the management of expanding incidents and describe the Incident/Event Management process for supervisors and expanding incidents as prescribed by the ICS. Also covered is the implementation of the Incident Management process on a simulated Type 3 incident and development of an Incident Action Plan for a simulated incident.
The target audience for this course are individuals who may assume a supervisory role in expanding incidents or Type 3 incidents. Note: During a Type 3 incident, some or all the command and general staff positions may be activated, as well as division/group supervisor and/or unit leader level positions. These incidents may extend into multiple operational periods.
This course is 21 hours, and the learner must have ICS-100, ICS-200, IS-700, and IS-800 completed to register.
MI-TRAIN Course ID: 1029037
- Jan. 17, 2024: Branch Hillsdale St. Joseph Health Department, Registration Deadline – Jan. 3, 2024
ICS 400 sessions
This course provides training on and resources for personnel who require advanced application of the Incident Command System (ICS). This course expands upon information covered in the ICS-100, ICS-200, and ICS-300 courses. The target audience for this course is senior personnel who are expected to perform in a management capacity in an area command or multi-agency coordination entity.
The course objectives are to explain how major incidents engender special management challenges, describe the circumstances in which an area command is established and describe the circumstances in which multiagency coordination systems are established.
This is a 16 hour course and learners must have completed ICS-100, ICS-200, ICS-300, IS-700, and IS-800 to register.
MI-TRAIN Course ID: 1029045
- Jan. 11, 2024 – Monroe County EMD, Registration Deadline – Dec. 30, 2023
- Jan. 22, 2024 – Macomb Community College, Registration Deadline – Jan. 5, 2024
- Jan. 24, 2024 – MSP Emergency Management and Homeland Security Division, Registration Deadline – Jan. 9, 2024
- Jan. 25, 2024 – Ascencion Borgess Hospital, Registration Deadline – Jan. 10, 2024
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The Guardian of Public Health is a monthly newsletter from the Bureau of Emergency Preparedness, EMS and Systems of Care (BEPESoC), within the Michigan Department of Health and Human Services (MDHHS). The Guardian aims to provide readers with relevant content on topics that affect the public health of Michigan's citizens and communities.
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This publication was supported by Cooperative Agreement number 1NU90TP922062-01-00, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.
Bureau of Emergency Preparedness, EMS and Systems of Care | 1001 Terminal Rd, Lansing, MI 48906 | 517-335-8150
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