Notes from the Field: Measles Outbreak of Unknown Source - Shelby County, Tennessee, April-May 2016.

On April 15, 2016, local public health officials in Shelby County, Tennessee, were notified of a positive measles immunoglobulin M (IgM) test for a male aged 18 months (patient A). On April 18, 2016, a second positive measles IgM test was reported for a man aged 50 years (patient B). Both patients had rash onset on April 9, 2016. The Shelby County Health Department initiated an investigation, and confirmatory testing for measles virus on oropharyngeal swabs by polymerase chain reaction (PCR) at CDC was positive for both patients. On April 21, 2016, public health officials were notified of a third suspected measles case in a female aged 7 months (patient C) who had developed a rash on April 14; PCR testing was positive. Genotyping conducted at CDC identified genotype B3 measles virus in all three cases. Genotype B3 is known to be circulating globally and has previously been associated with imported cases in the United States (1).

Public health coalitions: patterns and perceptions in state immunization programs.

The central question of this research is whether state public health programs collaborate with other public and private institutions to promote public health goals. Public health administration is highly bureaucratized and dependent upon government support, but administrators can establish coalitions as adjunct to more traditional means of providing public health services. We explain how public health coalitions are beneficial to providing public health services and then assess whether administrators in state immunization programs collaborate with both the public and private sectors. The results of a 50-state survey of state immunization program officials suggest that coalitions between state immunization programs and institutions of the public and private sectors are common. Moreover, most state program officials think that the more extensive use of immunization coalitions is important for improving state immunization coverage. Our findings also indicate that some states have not yet maximized the potential involvement of the private sector to collaborate in public health efforts.

Protecting Texas children: evidence-based recommendations for improving childhood vaccination rates.

Currently, Texas ranks in the bottom quintile of states for childhood vaccinations. Approximately, one fourth of Texas children younger than age 3 years have not received the recommended full schedule of vaccinations. Such a low rate can produce serious health consequences by reducing "community immunity." We review the current literature on barriers to high immunization rates and on effective, evidence-based strategies and programs. In addition, we report the results of interviews with public health officials responsible for implementing immunization programs in Texas and in a sample of high-ranking states for their assessment of the most effective strategies. We suggest legislative and administrative changes for Texas on the basis of the literature review and interview results. These recommendations involve improving the public health network, strengthening financial and administrative incentives to providers, enhancing incentives for parents, and encouraging federal program modifications.

Childhood immunization coverage in US states: the impact of state policy interventions and programmatic support.

Although research suggests numerous interventions that can improve immunization coverage (Taskforce on Community Preventive Services, 2000), there is often a gap between policies supported by and public entities. The question for this study is whether the variation in childhood (19 to 35 months) immunization coverage rates across states is related to significant variations in state regulatory regimes that may optimize the benefits of state registries and systems that are designed to improve assessment of immunization practices. Utilizing 2002 data from the CDC and survey data collected from state immunization program officials, we find that financial support for state immunization programs, opt-out state registries, and state-mandated participation in provider quality improvement and assessment programs have positive associations with statewide coverage rates. We also suggest that more active state governmental support for interventions supported by rigorous scientific evaluation will not only improve early childhood immunization coverage, but may also support other public health objectives such as life-time full immunization and improve bioterrorism response planning.