Full Text
April 18, 2019 Dear Children’s Camp Operator: The New York State Department of Health (NYSDOH) would like to alert you to the continuing measles outbreak in New York State (NYS) and how it affects your camps. New York State is experiencing the largest outbreak in more than two decades. Since October 2018, over 500 individuals have been infected in multiple areas of NYS, including New York City, Rockland, Orange and Sullivan Counties. Measles was introduced by several individuals who were exposed while traveling abroad. There are several large outbreaks going on in different countries around the world. Imported cases among international travelers can rapidly spread measles in communities with high numbers of unvaccinated individuals. Ongoing transmission continues in the current outbreak areas and it may spread throughout communities this summer affecting your campers and staff. Measles is a highly infectious disease that can be spread rapidly, especially in a camp setting where groups of children congregate. It is important to monitor for measles cases, and identify and report any suspect measles cases among campers and staff to your local health department, in order to rapidly contain an outbreak. Delays in reporting can allow measles to spread, disrupt the camp season, and result in further transmission to additional communities once campers and staff return home. An outbreak at your camp could result in campers who are unimmunized being sent home, or even in your camp having to be closed early for the season. This letter is to provide you with guidance on the recommended vaccines for both campers and staff, how to monitor campers and staff for signs and of measles, recognize and report measles to the local health department, and includes steps you can take to help minimize disruptions at camp if a case of measles is identified. PREVENTING MEASLES The best protection against measles is broad vaccination coverage. Therefore, vaccination of all individuals who will be working in or attending summer camps is strongly recommended. Individual camps may also choose to recommend or require specific immunizations of their campers and staff. NYSDOH recommends two doses of measles vaccine for all campers and camp staff born on or after January 1, 1957. Experience with outbreaks has shown two doses of measles vaccine is more effective at preventing infection and spread of disease than one dose. Two doses of the measles vaccine are about 97% effective at protecting against measles. Most U.S. residents receive two doses of measles vaccine in the form of the combined measles, mumps, and rubella vaccine (MMR) with the first dose at age 12-15 months, and a second dose upon school entrance at ages 4-6 years. However, international camp employees and some campers may have received only one dose, or no doses, of the measles vaccine. To ensure maximum protection against measles, the NYSDOH recommends two doses of MMR vaccine as soon as possible for all campers and camp staff who: ---PAGE BREAK--- • Were born on or after January 1, 1957; • Have had fewer than two doses of MMR; and • Have no history of measles. ADDITIONAL IMMUNIZATION RECOMMENDATIONS FOR CAMPERS There has been an increase in the number of cases of vaccine-preventable diseases (VPDs) in the United States over the past several years. The best protection against vaccine- preventable diseases is broad vaccination coverage. • The part of the State Sanitary Code that applies to campers is Subpart 7-2, which requires that the camp maintain immunization records for all campers. It does not, however, specify which vaccines are required for camp attendance. • Individual camp policy may choose to recommend or require specific immunizations of their campers. For the optimal health and safety of all campers and camp staff, the NYSDOH strongly recommends that all campers meet the age appropriate immunization schedule as set forth by the Advisory Committee on Immunization Practices (ACIP): http://www.cdc.gov/vaccines/schedules/index.html • At a minimum, campers should meet the same immunization requirements as school-aged children as indicated in Public Health Law (PHL) Article 21, Title 6, Section 2164. Refer to New York State Immunization Requirements for School Entrance/Attendance, available at: • In New York State, PHL Article 21, Title 6, Section 2167 also requires the notification of campers and parents about recommendations for and the availability of meningococcal vaccine for all campers attending overnight camps for a period of 7 or more consecutive nights. Meningococcal ACWY (MenACWY) vaccine is recommended at age 11 or 12 years, with a booster dose at age 16 years. In New York State, meningococcal vaccination at the recommended ages is required for school attendance. Please note that the NYSDOH does not recommend that campers receive either dose of MenACWY vaccine before the recommended ages. Students who are vaccinated before the recommended ages may need to have the doses repeated in order to attend school. ADDITIONAL IMMUNIZATION RECOMMENDATIONS FOR STAFF • Individual camp policy may choose to recommend or require specific immunizations of their staff. For the optimal health and safety of all camp staff, including international staff, the NYSDOH strongly recommends that all staff meet the age appropriate immunization schedule as set forth by the Advisory Committee on Immunization Practices (ACIP): http://www.cdc.gov/vaccines/schedules/index.html • At a minimum, immunizations that are routinely recommended (if not already administered, a history of disease does not exist, or serology has not proven immunity) include: o 2 measles, mumps, and rubella (MMR) vaccine doses, o 1 tetanus, diphtheria, and acellular pertussis (Tdap) vaccine booster dose within the last 10 years, and o 2 varicella vaccine doses. • Hepatitis B vaccine is recommended for staff with reasonably anticipated risk for exposure to blood or body fluids (e.g. health care workers, lifeguards). ---PAGE BREAK--- MAINTAINING VACCINATION RECORDS Subpart 7-2 of the New York State Sanitary Code requires camps to maintain immunization records for all campers which includes dates for all immunizations against diphtheria, haemophilus influenza type b, hepatitis b, measles, mumps, rubella, poliomyelitis, tetanus and varicella (chickenpox). The record must be kept on file for every camper and updated annually. Camps should also maintain current, complete immunization records for all camp staff. To facilitate a timely and appropriate public health response and minimize any disruptions at summer camp in the event a suspect measles case or other VPDs case is identified, camps should maintain a detailed list of staff, campers and other individuals who are not fully immunized and protected against VPDs, including against measles, as these individuals are at risk of getting sick if exposed. This list of susceptible individuals should clearly identify which disease(s) an individual is at risk of contracting. This immunization and health information should be readily available as camps will need this information to quickly identify at-risk individuals if a suspect case of a measles, or other vaccine-preventable disease, occurs during the summer camp season. Camps will be expected to review their plan and share developing lists of susceptible individuals with inspectors during pre-operational visits, and to show updated lists to health department staff who perform other visits during the season. MONITORING FOR MEASLES To prevent measles from entering and spreading in camp, it is important to screen all campers and staff at time of camp entry for any signs of illness, and for recent measles exposure. • Subpart 7-2 of the New York State Sanitary Code requires camp safety plans to include an initial health screening of all campers. Each camper should be screened for measles prior to camp entry by asking the parent or guardian if the camper has had any recent illness including fever, cough or rash in the preceding four days. If a camper has a positive screen NYSDOH recommends the camper not be permitted to enter a camp or a camp transportation vehicle without clearance from a healthcare provider. • It is recommended to screen for measles exposure by asking the parent or guardian if a camper has had any close family members or other contacts with measles or with fever and cough or rash in the preceding 21 days. NYSDOH recommends: o Unvaccinated campers, or those with only one dose of MMR, with a known measles exposure be excluded from camp and the local health department should be notified immediately. o Campers with two documented doses of MMR vaccine with a known exposure to measles do not need to be excluded from camp. They should be monitored closely while at camp for any developing signs or of measles, consistent with camp safety plan requirements for daily health surveillance of campers in Subpart 7-2 of the New York State Sanitary Code. • Local health departments may also implement further exclusions of unvaccinated campers based upon local measles outbreaks. Please speak with your local health department with any questions regarding this. RECOGNIZING MEASLES usually appear about 7 to 14 days after a person is exposed to measles but can take as long as 21 days. The first are usually: • High fever and; ---PAGE BREAK--- o Cough o Runny nose o Red watery eyes o Rash Small red spots, some of which are raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. Usually appears 2 to 4 days after the fever begins and lasts 5 to 6 days. Begins at the hairline, moves to the face and neck, down the body and then to the arms and legs. If a camper or staff member develops any of these while at camp, it is critical that the camp health director or the camp director be notified right away. Steps should be taken to immediately isolate the individual away from other campers and staff, and airborne precautions should be implemented while the local health department and parent/guardian are being notified. These precautions should include placing the individual in a private room, such as a cabin or tent with a door that closes if possible, placing a mask on the individual and restricting susceptible individuals from entering the space. This is important to help protect other campers and staff from getting sick. Additionally, if an individual in whom measles is suspected requires transfer to a medical facility, it is imperative that the responding emergency medical services team be notified of the concern for measles so proper precautions can be taken to prevent further exposures. REPORTING MEASLES AND OTHER VPDs Most VPDs are reportable by law. Measles is required by New York State Public Health Law to be reported to local health departments. The camp health director or other healthcare provider should discuss with staff the of measles, along with of other VPDs, prior to the camp season so they can assist in identifying anyone with signs of illness. The need to report the first sign of illness to the camp health director or camp director in accordance with established procedures for handling outbreaks in the approved camp safety plan, should be stressed with all staff. If measles is suspected in even one camper or camp staff member, your local health department must be notified immediately. Delays in reporting have led to large outbreaks of vaccine-preventable diseases at camps in the past. Camp operators must also report the case of illness within 24 hours to the permit-issuing official in accordance with Subpart 7-2 of the New York State Sanitary Code. ADDITIONAL INFORMATION An educational flyer titled, You Can Prevent the Spread of Measles at Summer Camp, is included with this letter. Please share the flyer with the parents or guardians of campers before campers arrive at camp this season. For more information about measles or the measles vaccine, call the New York State Measles Hotline at [PHONE REDACTED] or your local health department. More information about measles can be obtained at the NYSDOH measles website at http://www.health.ny.gov/measles/. For NYS vaccine schedules and school entrance requirements: ---PAGE BREAK--- More information can also be obtained at the CDC website at: http://www.cdc.gov/vaccines/. Communicable Disease Fact Sheets are available from the NYSDOH at: http://www.health.ny.gov/diseases/communicable/ Thank you for your partnership and efforts to keep camps free of measles and other vaccine- preventable diseases, and to provide a safe and healthy summer camp season for all campers and camp staff. Sincerely, Kristen A. Navarette, M.D., M.P.H., F.A.A.P Medical Director Center for Environmental Health New York State Department of Health