Scenario 1: Texarkana — Epidemic Measles in a Divided City *adapted from: Texarkana — Epidemic Measles in a Divided City- Student Guide. Centers for Disease Control and Prevention Epidemiology program office. https://www.cdc.gov/eis/downloads/xtexark-711-903-.... Updated 2001 and 2003. Accessed March 29, 2020 Based on the information given, what do you anticipate the challenges will be for an outbreak that has occurred across state lines? What plan of action would you take in order to address the outbreak from an Interprofessional standpoint? The following are excerpts from the original case study: On Tuesday, November 3, 1970, the Center for Disease Control (CDC) in Atlanta received the weekly telegram of surveillance data from the Texas State Health Department. The telegram reported 319 cases of measles in the state during the previous week. In contrast, Texas had reported an average of 26 cases per week during the previous four weeks. In follow-up telephone calls, CDC learned from State health officials that 295 cases of measles had been diagnosed in the city of Texarkana, including 25 in children reported to have been previously immunized. An invitation to investigate the situation was extended to the CDC on November 4, 1970. An EIS officer departed for Texarkana early on November 5. Background Texarkana is a city of roughly 50,000 that straddles the Texas-Arkansas state line. Texarkana, Texas (Bowie County), had a population of 29,393 in the 1960 census; the population had been stable during the 1960s. Texarkana, Arkansas (Miller County), had a 1960 population of 21,088. Although Texarkana is divided by the state line, it is a single town economically and socially. Persons of all ages on both sides of town have frequent contact. Churches, physicians, offices, movie theatres, and stores draw people from both the Arkansas and Texas sides of town. People cross the state line to attend social functions such as football games and school dances. Many families have friends and relatives who visit back and forth on both sides of town. Private nurseries and kindergartens receive children from both sides of town. The two sides of Texarkana, however, do have separate public school systems and separate public health departments. Before this outbreak, the proportion of children vaccinated against measles on the Arkansas side was substantially higher than the proportion vaccinated on the Texas side. The Texas side had never had a community or school vaccination campaign for measles. In contrast, the Arkansas side had held mass community programs against measles for school and pre-school children in 1968 and 1969. Based on health department and physician records, investigators estimated that over 99% of children aged 1-9 years in Miller County, Arkansas had received measles vaccine prior to the outbreak. The overall vaccination level in Bowie County, Texas, was estimated to be 57%500 WORDS WITH CITATIONS!

Health History Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN. Case Scenario Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing. Objective Data Temperature: 37.1 degrees C BP 123/78 HR 93 RR 22 Pox 99% Denies pain Height: 69.5 inches; Weight 87 kg Laboratory Results WBC: 19.2 (1,000/uL) Lymphocytes 6700 (cells/uL) CT Head shows no changes since previous scan Urinalysis positive for moderate amount of leukocytes and cloudy Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L